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IntroductionThe increasing demands for pulse crops and the lack of water resources in most parts of Iran, especially in dry areas, need to employ new strategies to increase water productivity of pulse crops. One of the new methods in managing water and soil resources is the use of zeolite as a storage tank, which prevents wastage and increases the efficiency of irrigation water particularly in light soils. The purpose of this research was to determine the effect of different amounts of zeolite and irrigation interval on growth and yield indices in Pak cultivar of white beans (Phaseolus vulgaris L.). Materials and MethodsThis research was conducted in order to investigate the effect of different amounts of zeolite and irrigation interval on the growth and grain yield in Pak cultivar of white bean (Phaseolus vulgaris L.), in a split plot design based on randomized complete block design with three replications in a farm located in the bojnord city - north Khorasan in the agronomic year 2023-2024. The study factors included 7, 10 and 13 days irrigation interval in the main plot and three levels of zeolite in the soil (0 (no use), 5 and 10 t.ha-1) in the sub plots. Data were analyzed using SAS 9.4 statistical package and figures were drawn by Excel program. Mean comparison were arranged by least significant differences in the 95% probability. Results and DiscussionThe results revealed that the white bean plants attained their shortest height across all three irrigation levels when zeolite was not applied in the plots. Conversely, when a zeolite level of 10 t.ha-1 was introduced, there was an observed increase of 18.15% in the number of nodes per plant compared to scenarios where no zeolite was utilized. The highest level of zeolite consumption caused an increase of 13.88% in the seed weight compared to the level of no zeolite consumption. The highest seed yield of 4651.5 kg.ha-1was recorded in the 7 day irrigation interval and zeolite consumption of 10 t.ha-1. The lowest amount of electrolyte leakage related to irrigation interval of 10 and 7 days and consumption of 10 t.ha-1 of zeolite was 14.8 and 12.34%, respectively. The consumption of 10 t.ha-1 of zeolite caused a 21% increase in protein compared to the non-use of zeolite in white beans, and with the increase of the irrigation frequency from 7 to 10 days, although the amount of seed protein decreased, it did not have a significant difference with the level of irrigation once every 7 days. And when the irrigation cycle reached once every 13 days, the amount of seed protein decreased significantly by 6.8% compared to the irrigation cycle once every 7 days. It was also found that the addition of 10 tons of zeolite per hectare to the soil caused a 41.5% decrease in the amount of proline in white bean leaves compared to the absence of zeolite. In this research, it was found t.hat the level of 10 t.ha-1 the highest biological yield of 13475 kg.ha-1 recorded and it increased by 29.2% compared to the no zeolite consumption. By reducing the irrigation interval to 10 and 7 days, with the increase of zeolite consumption, the harvest index increased, and in the meantime, the highest index related to the irrigation cycle of 7 days and zeolite consumption of 10 tons was 35.5%. ConclusionsBased on the obtained results, it can be concluded that water stress resulted in a reduction in the growth characteristics and overall performance of white bean plants. The lowest values ​​of parameters calculated in this research were observed at the level of no zeolite consumption and irrigation cycle of 13 days, and their highest values ​​were observed at the level of zeolite of 10 t.ha-1 and irrigation cycle of 7 days, which shows that Zeolite, help more water absorption and water return when the plant needs water, and increase the growth of different plant tissues and production of more products. Overall, it can be inferred that applying zeolite at a rate of 10 t.ha-1, particularly in conjunction with a 7-day irrigation cycle, can optimize the yield and growth characteristics of white beans, specifically the Pak cultivar. However, we recommend further investigation into higher levels of zeolite application across various soil textures to enhance our understanding and refine cultivation practices.

Abstract The coronavirus disease 2019 (COVID‐19) pandemic has caused widespread devastation, with millions of confirmed cases and deaths worldwide. Although there were efforts made to develop treatments and vaccines for COVID‐19, the coexistence of sarcopenia, a muscle disorder, has been largely overlooked. It is while new variants of this disease (eg, BA.2.86) are challenging the current protocols. Sarcopenia is associated with increased mortality and disability, and shares common mechanisms with COVID‐19, such as inflammation, hormonal changes, and malnutrition. This can worsen the effects of both conditions. Furthermore, survived patients with COVID‐19 who have elevated risk, as well as aging, which increases the process of sarcopenia. Therefore, addressing sarcopenia in patients with COVID‐19 and surviving individuals can be crucial for improving outcomes and preventing long‐term disability. During hospital stays, assessing sarcopenia through indicators like muscle wasting and malnutrition is important. Nutritional interventions, such as malnutrition screening and enteral feeding, play a critical role in preventing sarcopenia in hospitals. Mental health and physical activity evaluations and interventions are also necessary. Even after recovering from COVID‐19, there is a risk of developing sarcopenia, requiring continued monitoring. Nutrition and physical activity considerations are vital for prevention and management, necessitating tailored training programs and diet therapy. Mental health should not be overlooked, with regular screening, and community‐based interventions. Infrastructure should support physical activity, and mental health services must become more accessible. Community engagement through support groups and peer networks can foster resilience and social connection. Efforts are needed to promote healthy diets and ensure access to nutritious foods.

BackgroundChronic diseases remain a significant contributor to both mortality and disability in our modern world. Physical inactivity and an unhealthy diet are recognized as significant behavioral risk factors for chronic diseases, which can be influenced by the built environment and socio-economic status (SES). This study aims to investigate the relationship between the built environment, SES, and lifestyle factors with chronic diseases.MethodsThe current study was conducted in Mashhad’s Persian cohort, which included employees from Mashhad University of Medical Sciences (MUMS). In the study, 5,357 participants from the cohort were included. To assess the state of the built environment in Mashhad, a Geographic Information System (GIS) map was created for the city and participants in the Persian Mashhad study. Food intake and physical exercise were used to assess lifestyle. A food frequency questionnaire (FFQ) was used to assess food intake. To assess food intake, the diet quality index was computed. To assess the link between variables, the structural model was created in accordance with the study’s objectives, and partial least square structural equation modeling (PLS-SEM) was utilized.ResultsThe chronic diseases were positively associated with male sex (p

Abstract Objectives This study aims to identify a new barrier to the use of the Mini‐Nutrition Assessment Short‐Form (MNA‐SF), which is a malnutrition assessment tool for the risk assessment of sarcopenia in a nourished population. Methods The MNA‐SF was completed, and individuals with a score of > 11 were considered nourished in this cross‐sectional feasibility study of a registry. Sarcopenia was assessed in 766 healthy, nourished adults (33.4% men, 64.9 ± 7.1 years) based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Results The MNA‐SF scores for non‐sarcopenia, pre‐, confirmed, and severe sarcopenia were 13.59 ± 0.69, 13.73 ± 0.60, 12.64 ± 0.74, and 12.5 ± 0.71, respectively. The higher MNA‐SF score association with pre‐sarcopenia [odds ratio (OR): 1.41, 95% confidence interval (CI): 1.06–1.86, P = 0.02], confirmed sarcopenia (OR = 0.25, 95% CI: 0.13–0.49, P

Abstract Background The benefits and harms of vitamin D supplementation in the treatment of COVID-19 have not yet been fully documented. In this study, we aimed to evaluate the effects of high-dose vitamin D supplementation on liver function tests in COVID-19. Method This double-blinded randomized clinical trial was conducted on 140 hospitalized patients aged > 30 years. Patients were randomly allocated to receive either intervention group (n = 70 receiving 50,000 IU of vitamin D capsules orally as a single dose and then 10,000 IU syrup daily from the second day of admission for 30 days) and the control group (n = 70 receiving 1000 IU vitamin D syrup orally per day). Liver function tests (LFT), including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and Lactate Dehydrogenase (LDH) were evaluated at baseline and at the end of the intervention. Decision tree analysis was performed to identify the predictors for change in liver enzymes. Results Among COVID-19 patients, a significant decrease was observed in serum level of ALP between intervention and placebo groups (p = 0.04). In addition, decision tree analysis revealed that GGT, temperature, serum magnesium level at baseline and gender were the most important predictors of ALT changes in COVID-19 patients. Conclusion High-dose vitamin D supplementation improved ALP markers among COVID-19 patients. More randomized controlled trials with longer follow-up times will be required.

Abstract Introduction Cervical cancer is one of lethal cancers in women. As a global concern, identifying important factors of cancer is a useful strategy for prevention. Due to the role of diet/nutrition factors for cancer, the purpose of our study was to determine the impact of 150 nutrition/vitamin factors and 50 non-nutritional factor in cervical cancer and phase. Methods Population samples of 2088 healthy subjects and patients with cervical cancer were investigated. 200 factors such as vitamin E, B1, B6, fruits, HPV, and age were gathered. Deep learning, Decision tree, and correlation matrix were used for modeling and identifying important factors. SPSS 26, R4.0.3, and Rapid miner were utilized for implementation. Results Our findings indicated that zinc, Iron, Niacin, Potassium, Phosphorous, and Cooper have a beneficial impact in reducing the risk of cervical cancer and progression of phase in Iranian women, as well as Salt, snacks and milk Were identified as high-risk food factors (P value 0.6). Also, alcohol, and sex patient with two groups, HPV positive have an impact on cervical cancer incidence. Phosphorus and selenium in the Micronutrients category (R2 = 0.85, AUC = 0.993) and polyunsaturated fatty acid and salt in the Macronutrients category and other categories of nutrients were identified as the most effective factors in cervical cancer using deep learning (R2 = 0.93, AUC = 0.999). Conclusions A diet and rich nutrition can be helpful for the prevention of cervix cancer and may reduce the risk of disease. Additional research is necessary for different countries.

Abstract Background Different dietary protein sources are supposed to have various effects on metabolic responses and arterial stiffness in the postprandial period. This study aims to assess the postprandial effects of dietary protein sources, including animal-based protein (AP) and plant-based protein (PP), as part of a high-protein breakfast on appetite response, energy metabolism, and arterial stiffness in overweight and obese men. Methods This acute randomized crossover clinical trial will be conducted at the Persian study research center at Imam Reza Hospital, affiliated with the Mashhad University of Medical Sciences, located in the northeast of Iran. Forty-six healthy overweight, and obese men aged 18–60 years will be enrolled based on the eligibility criteria. The subjects will complete two interventions (high-protein AP and PP meals) with 1 week washout period. The primary outcome will be the acute effect of the two test meals on appetite response, energy metabolism parameters, including resting metabolism rate (RMR), diet-induced thermogenesis (DIT), and substrate oxidation (SO), and arterial stiffness indices, including pulse wave velocity (PWV) and pulse wave analysis (PWA). The secondary outcomes include changes in lipemia, glycemia, and insulinemia. Discussion The findings of this study will provide novel insight regarding the acute effects of different protein sources on energy metabolism, appetite, and arterial stiffness as a significant cardiovascular disease (CVD) risk factor. It will help dieticians develop effective and efficient meal plans to improve weight reduction and maintenance in overweight/obese individuals. Trial registration Iranian Registry of Clinical Trials; code: IRCT20211230053570N1; registered on February 10, 2022

Linking words, an essential tool in creating a coherent relationship between units and paragraphs in written texts, was one of several aspects of the English language that was challenging for many foreign language learners in the writing process. The current study investigated the impacts of flipped blended instruction on Iranian EFL learners’ use of English-linking words in writing. To this end, 40 EFL learners from one institute were selected for this study. To collect the data, an Oxford Placement Test (OPT) was used to ensure the homogeneity of the participants. They were randomly divided into the flipped blended (n=20) and conventional ( n=20) groups. Then, a pre-test was given to both groups of learners to examine their ability in using linking words. Moreover, the flipped blended group received instruction in an online context, while the conventional group received instruction in a traditional learning context. After the treatment, a post-test was given to both the flipped blended and conventional groups. The results of the independent sample t-test demonstrated that there was a statistically significant difference between flipped blended and Conventional groups in terms of choosing linking words. It was observed that the flipped blended method had a significant effect on improving EFL learners' linking words knowledge. The study discusses the implications of the finding for EFL learners and teachers.

This study investigates how sensitizing graduate L2 students about source-text use might affect their citation practices. Two summary writing tasks involving two similar published articles, one irrelevant and one pertinent to source-text use, were assigned individually to 16 graduate English language teaching students from Iran. After completing the tasks, the students participated in retrospective interviews about their source-text use. Recursive thematic data analysis indicated that while they were inclined towards more direct source-text use in the first summary, they opted for more indirect and academic source-text use that involved their contribution and interpretation in the sensitizing task. The paper discusses the significance of sensitizing students to source-text use.

Abstract Background Enteral feeding intolerance, energy-protein malnutrition, and muscle wasting are common conditions in the critical care setting. The primary aim of this study was to investigate the effect of synbiotic supplementation on enteral feed volume, energy and protein homeostasis, and muscle mass maintenance in critically ill adult patients. Methods A consecutive of 42 patients admitted to the Edalatian Medical ICU, requiring enteral nutrition (EN), were prospectively randomized to receive the synbiotic capsule (containing a combination of Lactobacillus, Bifidobacterium, Streptococcus, and fructooligosaccharides) or placebo (21 patients in each group) for a maximum of 14 days. Enteral intolerance and energy homeostasis were evaluated on a daily basis. Nitrogen balance and 24-h urine creatinine excretion were recorded on days 1 and 14. Mid-arm circumference was recorded every 3 days. Results Mean EN volume, energy, and protein intake per day were 962.5 ± 533.82 ml, 770 ± 427.05 kcal, and 38.5 ± 21.35 g (fourth day) vs. 590 ± 321.1 ml, 472 ± 256.81 kcal, and 23.6 ± 12.84 g (first day) in the synbiotic group (p

Abstract Background Time‐restricted feeding (TRF) is a kind of intermittent fasting defined as eating and drinking only during a certain number of hours in a day. It has been suggested that intermittent fasting may improve cardiovascular risk factors. This study evaluated the association of TRF and arterial stiffness, using pulse wave velocity (PWV), pulse wave analysis, and arterial age in metabolic syndrome participants. Methods A cohort study was carried out among metabolic syndrome adults who were followed over the Ramadan fasting period (used as a model of TRF since food was only allowed for about 8 h/day). The subjects were divided into Ramadan fasting and Ramadan nonfasting groups. The aortic PWV and central aortic pressure waveform were measured. Central systolic pressure, central pulse pressure, and indices of arterial compliance, such as augmentation pressure and augmentation index (AIx), were determined from waveform analysis. Results Ninety‐five adults (31.57% female, age: 45.46 ± 9.10 years) with metabolic syndrome (based on the International Diabetes Federation definition) participated in this study. Ramadan fasting and Ramadan nonfasting groups were including 80 and 15 individuals respectively. A significant reduction was seen in PWV (0.29 m/s), central systolic pressure (4.03 mmHg), central pulse pressure (2.43 mmHg), central augmentation pressure (1.88 mmHg), and central AIx (2.47) in the Ramadan fasting group (p = 0.014, p

Research on second language acquisition generally suggests that input needs to be noticed before turning into the intake. Therefore, the current paper explored the comparative effects of textual enhancement on Iranian EFL learners’ vocabulary noticing. Thirty students from an intact class of general English course participated in this study. During the semester, an extended paragraph from which 18 target words were perceptually enhanced using boldfacing and Emoji stickers or were left untouched was distributed to the participants using the smartphone Telegram application. After 45 minutes, they received a set of post-reading vocabulary questions through Telegram and were asked to type the answers and send them back to the examiner. The results of Repeated Measures ANOVA indicated that both textual enhancement techniques had a significantly positive effect on their vocabulary noticing. The paper discusses the findings and implications for both EFL teachers and language learning materials developers.

This study investigates three illegal maneuvers at signalized intersections: pedestrians jaywalking at signalized crosswalks (JSC), vehicles stopping near the intersections (SNI), and vehicles occupying the through lane instead of the left-turn lane to make a left turn (OTL). Traffic microsimulation models of four intersections were developed using Aimsun, and data were collected by a drone over a 3-hour period. The car-following model (Gibbs model) implemented in Aimsun was calibrated for each of the intersections and validated at the 95% confidence level. The validated Aimsun models were used to perform 13 experiments designed to investigate the interaction effects of decreasing two or more illegal maneuvers on travel time and fuel consumption. These 13 experiments were identified using the design of experiments D-optimality criterion. To investigate the main and interaction effects of decreasing two or more illegal maneuvers on travel time and fuel consumption, the response surface methodology (RSM) was used. Using RSM, the statistical model that was found to best fit the simulation results was a quadratic form. The results showed that the dependent variables “travel time ratio” and “fuel consumption ratio” are affected not only by a decrease in violations ratio but also by the volume of traffic as the exogenous variable. It was found that decreasing two of the violations, namely, JSC and SNI, improves travel time and fuel consumption but decreasing OTL has the opposite effect, resulting from the inadequate design of left-turning lane length/capacity and/or inadequate signal timing to accommodate left-turning volume.

Abstract Admission in English-medium universities or institutions of higher education depends on the results obtained by candidates in large-scale proficiency tests including Test of English as a Foreign Language (TOEFL) internet-based test (iBT). The structure and administration procedure of the TOEFL iBT speaking test leaves no room for carrying out reciprocal interactions and, consequently, examining applicants’ questioning ability. This study highlights the significance of non-native students’ skills to ask oral English questions in academic contexts as experienced by non-native graduates from English-medium universities and in the view of Iranian TOEFL iBT instructors. Further, the washback of the absence of the skill in the TOEFL iBT test was investigated in speaking preparation classes. Twelve non-native graduates and nineteen Iranian TOEFL iBT instructors participated in the study. They were all interviewed about the significance of oral questioning. The instructors’ views were also sought about the consequences of the disregard of questioning in the test. To triangulate the data, two classes of the instructors were also observed. Classroom observations and interviews were analyzed through content analysis. The results indicated that the participants generally assumed questioning as indispensable in academic interactions. Despite their acknowledgment of its significance, as both the interviews and observations unveiled, the instructors, however, tended not to work on their students’ questioning because of the absence of the skill in the test, the students’ reluctance, limited preparation time, and dependence of their professional reputation on the test results rather than target situation performance. The study further discusses the implications of the findings for the test construct representation and preparation courses.

Introduction: Ramadan fasting (RF) is a model of calorie restriction similar to intermittent fasting, which is extensively practiced by a large population of Muslims. Limited and controversial studies have investigated the physiological changes induced by 30 days of RF. The present study aimed to evaluate the effects of Ramadan fasting on the resting metabolic rate and body composition of overweight and obese individuals. Methods: This study was conducted on 21 men and women aged 18-40 years. The subjects avoided eating and drinking for one month during the holy month of Ramadan (at least 20 days) and received a routine diet without an intervention between Iftar and dawn (Sahur). Before and after the study, the energy of the basal metabolic rate was measured via indirect calorimetry, and body composition was measured by bioimpedance (InBody s10). In addition, the physical activity of each participant was evaluated using a pedometer during one week. During the study, each participant received a 24-hour recall once a week. Results: Compared to the pre-study period and after four weeks of RF, body weight (77.91±11.83 vs. 77.01 ±11.75 kg; P

Research on the use of hedging strategies as one of the key issues of rhetorical organization of academic texts has gained growing attention during the past few decades. The present study aimed to explore the frequency and form of hedging expressions in the abstracts of Iranian writers’ English research articles where findings and claims were more explicitly projected. To this end, a random sample of 200 abstracts (50 each) was drawn equally from the four subfields of chemistry and mathematics, and philosophy and English randomly selected from the two academic fields of Soft Sciences and Hard Sciences respectively as suggested in Biglan’s (1973) typology of academic disciplines. The tally and analysis of the tokens of the hedge expressions indicated that the abstracts from the soft sciences differed from those from the hard sciences in terms of both frequency and form. The results revealed that the writers from the soft sciences tended to employ more hedge expressions than hard sciences writers. More specifically, whereas soft sciences writers utilized more modals, verbs, nouns, adjectives, and adverbs, their counterparts opted for more conditional expressions. Moreover, epistemic and cognition verbs were found to be the most frequently used hedging expressions in both sciences. This study discusses the research and pedagogical implications of the findings in the context of Iranian academia.

Abstract Purpose The objective of this systematic review was to evaluate the effect of pre-, pro-, and synbiotics on feeding tolerance of enterally fed critically ill adult patients. Methods MEDLINE, Science Direct, Web of Knowledge, and the Cochrane Central Register of Controlled Trials were searched up to November 2019. English language randomized controlled trials reporting the effect of pre, pro or synbiotics on the feeding tolerance of enterally fed critically ill adult patients were included. Results Overall, 15 papers were selected for review. Among six studies reporting the energy intake, only two studies showed significantly higher energy intake in the prebiotic-receiving groups. Among four RCTs reporting frequency or time to achieve the target calorie, only one found a significant effect of probiotics to reduce the time to achieve a target dose of calorie. About the prevalence or duration of diarrhea, 7 out of 12 RCTs reported a beneficial effect. All but one study found no beneficial effects for gut microbiota manipulation on clinical endpoints including length of stay (LOS) in hospital and intensive care unit (ICU). Conclusion It should be noticed that the heterogeneity in study designs, product format, and ICU patient populations makes it difficult to draw any general conclusion. Overall, it seems that pre, pro, or synbiotics have no significant beneficial effect on feeding tolerance and clinical endpoints in critically ill adults, but they may reduce the prevalence or duration of diarrhea.

Introduction: Indirect calorimetry (IC) is the optimal tool for the assessment of the resting energy expenditure, as well as the reference standard for energy expenditure measurement. During the outbreak of coronavirus, performing respiratory tests such as IC has become challenging. The current guidance was designed to prevent the virus spread at calorimetry centers. Methods: This protocol was devised in accordance with the latest recommendations of the World Health Organization (WHO) and Centers for Disease Control (CDC), as well as the related articles. Conclusion: Due to the specific features of COVID-19, unnecessary ICs should be avoided in the hotspots of the disease. If these tests must be performed, adherence to the validated infection control recommendations is critical.

Abstract Background Prior studies have shown that meal composition may affect the metabolic responses and arterial stiffness indices, and these responses may be different in lean and obese adults. The primary objective of this study is to determine the feasibility of conducting a trial to compare the effect of three test meals in lean and obese men. Due to the lack of a comprehensive study that concurrently compares metabolic responses and vascular stiffness indices after receiving three different meals in lean and obese men, this pilot study will be conducted with a three-phase parallel design, aiming to investigate the effects of meal composition on the metabolic parameters and arterial stiffness indices of lean and obese adults. Methods This pilot, a parallel clinical trial will be performed on 24 male adults aged 18–35 years since January 2021 and will continue until March 2021 who are disease-free and selected based on the inclusion and exclusion criteria at Mashhad University of Medical Sciences, Iran. The subjects will complete three interventions at a 1-week interval, including high carbohydrate (70% carbohydrates, 10% protein, 20% fat), high protein (30% protein, 50% carbohydrates, 20% fat), and high-fat meal (50% fat, 40% carbohydrates, 10% protein). Postprandial effects will be assessed within 360 min after each meal, including the energy expenditure component (resting energy expenditure, thermic effects of feeding, respiratory quotient, and substrate oxidation) and arterial stiffness indices (augmentation index and pulse wave velocity). In addition, blood sampling will be performed to measure glucose, insulin, free fatty acids, and lipid profile. Discussion The differences in the postprandial responses can affect the metabolic and vascular parameters due to different meal compositions, thereby providing beneficial data for the establishment of new strategies in terms of nutritional education and metabolic/vascular improvement. Also, the results from this pilot study will inform intervention refinement and efficacy testing of the intervention in a larger randomized controlled trial. Trial registration Iranian Registry of Clinical Trials; code: IRCT20190818044552N1 ; registered on August 26, 2019

Introduction: Acute inflammation in critically ill patients could affect the metabolism, including nutritional needs and nutrient uptake. Diet also affects the body through various mechanisms, such as the reduction of inflammatory processes, antioxidant capacity, and alteration of lipid profiles and the microbial balance of the intestine. The dietary inflammatory index is a predictive index of inflammatory dietary potential. The present study aimed to hypothesize whether designing a new low dietary inflammatory index formula with high antioxidants could reduce the inflammatory factors in critically ill patients. Methods: This single-center, prospective, randomized, single-blind, controlled study was conducted on patients with severe trauma, who were randomly assigned to the standard formula (n=10) and intervention formula (n=10) upon admission to the intensive care unit. Result: The primary outcomes of the study were the clinical status, metabolic factors, and inflammatory biomarkers. Conclusion: Since no studies have been focused on the formulation of antioxidant micronutrients in terms of dietary inflammation indices, this research aimed to investigate the effects of this formulation with a low inflammatory profile on the metabolic and inflammatory markers of patients with multiple traumas.

Abstract Background The rising burden of premature mortality for Non-Communicable Diseases (NCDs) in developing countries necessitates the institutionalization of a comprehensive surveillance framework to track trends and provide evidence to design, implement, and evaluate preventive strategies. This study aims to conduct an organization-based prospective cohort study on the NCDs and NCD-related secondary outcomes in adult personnel of the Mashhad University of Medical Sciences (MUMS) as main target population. Methods This study was designed to recruit 12,000 adults aged between 30 and 70 years for 15 years. Baseline assessment includes a wide range of established NCD risk factors obtaining by face-to-face interview or examination. The questionnaires consist of demographic and socioeconomic characteristics, lifestyle pattern, fuel consumption and pesticide exposures, occupational history and hazards, personal and familial medical history, medication profile, oral hygiene, reproduction history, dietary intake, and psychological conditions. Examinations include body size and composition test, abdominopelvic and thyroid ultrasonography, orthopedic evaluation, pulse wave velocity test, electrocardiography, blood pressure measurement, smell-taste evaluation, spirometry, mammography, and preferred tea temperature assessment. Routine biochemical, cell count, and fecal occult blood tests are also performed, and the biological samples (i.e., blood, urine, hair, and nail) are stored in preserving temperature. Annual telephone interviews and repeated examinations at 5-year intervals are planned to update information on health status and its determinants. Results A total of 5287 individuals (mean age of 43.9 ± 7.6 and 45.9% male) were included in the study thus far. About 18.5% were nurses and midwives and 44.2% had at least bachelor’s degree. Fatty liver (15.4%), thyroid disorders (11.2%), hypertension (8.8%), and diabetes (4.9%) were the most prevalent NCDs. A large proportion of the population had some degree of anxiety (64.2%). Low physical activity (13 ± 22.4 min per day), high calorie intake (3079 ± 1252), and poor pulse-wave velocity (7.2 ± 1.6 m/s) highlight the need for strategies to improve lifestyle behaviors. Conclusion The PERSIAN Organizational Cohort study in Mashhad University of Medical Sciences is the first organizational cohort study in a metropolitan city of Iran aiming to provide a large data repository on the prevalence and risk factors of the NCDs in a developing country for future national and international research cooperation.

Abstract Background Traumatic brain injury (TBI) is the most common trauma worldwide and is a leading cause of injury-related death and disability. Inflammation is initiated as a result of the TBI, which is in association with severity of illness and mortality in brain trauma patients, especially in subdural hemorrhage and epidural hemorrhage cases. A high percentage of adults admitted to the intensive care unit with TBI are diagnosed with vitamin D deficiency; this deficiency may induce impaired immune responses and increase the risk of infections. Vitamin D intervention has been shown to modulate pro- and anti-inflammatory cytokines in non-critically ill patients, but to date, there is no substantial data on the effectiveness of vitamin D for the improvement of immune function in traumatic brain injury patients. Methods/design A randomized clinical trial (RCT) will be performed on 74 Iranian adults 18–65 years old with brain trauma and will be treated daily with vitamin D supplements (100,000 IU oral drop) or a similar placebo (1000 IU) for 5 days. Discussion If this randomized clinical trial demonstrates reductions in inflammatory cytokines, it would provide evidence for a multicenter clinical trial to evaluate the efficacy of vitamin D supplementation in neurocritically ill patients. Since vitamin D supplements are inexpensive and safe, this clinical trial could have the potential to improve clinical outcomes in traumatic brain injury patients through reduction of inflammation and infection-associated morbidity and mortality rates. Trial registration Iranian Registry of Clinical Trials, IRCT20180619040151N3 . Registered on 10 August 2019.

Abstract Background Overweight and obesity are major health concerns worldwide, with adverse health consequences during the life span. This study measured socioeconomic inequality in overweight and obesity among Iranian adults. Methods Data were extracted from 129,257 Iranian adults (aged 35 years and older) participated in the Prospective Epidemiologic Research Studies in IrAN (PERSIAN) in 14 provinces of Iran in 2014. Socioeconomic-related inequality in overweight and obesity was estimated using the Concentration Index (Cn). The Cn further decomposed to find factors explaining the variability within the Socioeconomic related inequality in overweight and obesity. Results Of the total number of participants, 1.98, 26.82, 40.76 and 30.43% had underweight, normal weight, overweight and obesity respectively. The age-and sex standardized prevalence of obesity was higher in females than males (39.85% vs 18.79%). People with high socioeconomic status (SES) had a 39 and 15% higher chance of being overweight and obese than low SES people, respectively. The positive value of Cn suggested a higher concentration of overweight (0.081, 95% confidence interval [CI]; 0.074–0.087) and obesity (0.027, 95% CI; 0.021–0.034) among groups with high SES. There was a wide variation in socioeconomic-related inequality in overweight and obesity rate across 14 provinces. The decomposition results suggested that SES factor itself explained 66.77 and 89.07% of the observed socioeconomic inequalities in overweight and obesity among Iranian adults respectively. Following SES, province of residence, physical activity, using hookah and smoking were the major contributors to the concentration of overweight and obesity among the rich. Conclusions Overall, we found that overweight and obesity is concentrated among high SES people in the study population. . Accordingly, it seems that intersectional actions should be taken to control and prevent overweight and obesity among higher socioeconomic groups.

Abstract Background An extreme and persistent dysbiosis occurs among critically ill patients, regardless of the heterogeneity of disease. Dysbiosis in critically ill patients may make them prone to hospital-acquired infections, sepsis, multi-organ failure (MOF), energy homeostasis disturbance, muscle wasting, and cachexia. Modulation of gut microbiota through synbiotics can be considered as a potential treatment for muscle wasting and macronutrient homeostasis disturbances. Methods This is a prospective, single-center, double-blind, parallel randomized controlled trial with the aim to evaluate the effects of synbiotic supplementation on energy and macronutrient homeostasis and muscle wasting in critically ill patients. A total of 40 hemodynamically stable, adult, critically ill patients who receive enteral nutrition via a nasogasteric tube (NGT) in the 24–48 h after admission to critical care will be included in this study. Eligible patients will be randomly assigned to receive Lactocare (ZistTakhmir) capsules 500 mg every 12 h or a placebo capsule, which contains only the sterile maize starch and is similar to synbiotic capsules for 14 days. The synbiotic and placebo capsules will be given through the nasogastric tube, separately from gavage, after feeding. Discussion Gut microbiota modulation through synbiotics is proposed to improve clinical prognosis and reduce infectious complications, ventilator dependency, and length of ICU stay by improving energy and macronutrient homeostasis and reducing muscle protein catabolism. Trial registration Iranian Registry of Clinical Trials, IRCT20190227042857N1. Registered on 17 March 2019.

Introduction. Gastric bypass surgery is a gold standard therapy for severe obesity. This study aimed to evaluate anthropometric predictors for short-term excess weight loss (EWL) after Roux-en-Y gastric bypass surgery (RYGB) in a sample of severely obese patients. Materials and Methods. This cohort study was conducted on severely obese candidates for RYGB bariatric surgery in Mashhad, Iran. Indirect calorimetry, anthropometric measurements, and body composition data were collected before, one, and six months after RYGB. Results. Fifty-four participants (43, 79.6% women and 11, 20.4% men) with a mean age of 39.63 ± 9.66 years participated in this study. The mean total weight and BMI loss within six months were 32.89 ± 20.22 kg and 12.37 ± 7.34 kg/m2, respectively. The mean reduction in adipose tissue and fat-free mass was 24.49 kg and 7.46 kg, respectively. The mean resting metabolism rate (RMR) reduction at one and six months after RYGB was 260.49 kcal and 396.07 kcal, respectively. There was a significant difference in mean RMR between the baseline and one and six months after RYGB (p0.05). Baseline skeletal muscle mass (SMM), excess BMI loss (EBMIL) at first month after surgery, and baseline neck circumference (NC) could predict EWL six months after surgery. Conclusion. Reduced RMR shortly after RYGB may be due to FFM reduction. Some anthropometric and their acute changes after RYGB may predict the short-term EWL in RYGB patients.

In instructional contexts, instructor credibility or ethos is deemed to play a paramount role in teacher–student interaction and relationships. Much effort has been devoted to instructor credibility conceptualization, measurement, and its association with other instructional variables of interest in dominantly quantitative inquiries. However, little research has been undertaken in second-language education in which communication is both a means and an end. This qualitative research set out to explore the perception of the students of instructor credibility in the context of higher English education and how gender, nativeness, and subject matter might impact their perceptions. It also aimed to study how instructor credibility could, in turn, influence the engagement and success of the students. Thirteen senior students of English as a foreign language from a university in Iran participated in this study. They were given a scenario about their prospective professors for two courses of “Research Methodology” and “Essay Writing.” The professors included four native English- and Persian-speaking male and female PhD holders. The participants were, then, interviewed about their perceptions of instructor credibility, their choices of instructors, and how they would affect their engagement. The data were recorded, transcribed, and recursively analyzed using an inductive thematic analysis. While instructor credibility is commonly characterized as a three-dimensional construct, involving competence, character, and caring, the data analysis generated a new component of performance concerned with the effectiveness of classroom knowledge presentation and activity organization. Caring also emerged as a constituent of a more inclusive component of rapport. Interestingly, albeit they viewed native English professors as generally more competent due to their nativeness, they perceived non-native professors as more credible for both courses, mainly because of their rapport building and familiarity with the needs and challenges of the students. Most of the participants also viewed male professors as more competent and communicative for both courses. The participants also tended to argue that perceived instructor credibility would encourage them to put in more effort in their academic undertakings and to engage in class activities. This would ultimately enhance their academic achievements and success. The paper discusses the findings and implications for second-language instructor credibility conceptualization and practice.

The purpose of this triangulated mixed-method study was twofold. Firstly, to examine whether the use of wikis as a collaborative tool affected EFL learners’ writing fluency. Secondly, to explore their attitudes toward using wikis. To this end, 72 EFL learners from a language institute in Gachsaran, Iran were selected through convenience sampling and randomly assigned into two groups of conventional and wiki-based writing classes. Whereas the traditional group submitted their writing assignments to the teacher for feedback in class, the wiki group uploaded their writing assignments in the teacher-created wiki site where the learners themselves edited and corrected their writings and sometimes discussed writing topics further. To explore the participants’ attitudes on the use of wiki-based writing, we administered a post-task attitude questionnaire entailing 18 five-point Likert scale items and four open-ended questions. Observational notes were also taken into account for data triangulation. The statistical results indicated that the participants in the wiki group significantly outperformed the traditional group in terms of writing fluency. The results of the qualitative phase of the study involving thematic analysis of the answers to the four open-ended questions as well as the field notes supported the quantitative findings in that the learners generally held positive attitudes toward using wikis. The implications of the results are also discussed in the paper.

Educational psychology has recently reflected a policy shift from focusing on “what goes wrong” in schools, including psychological, physical, and educational disabilities, to recognizing and promoting strengths and positive aspects of students and their environments. Within this scope, some lines of research have examined the extent to which setting personal high standards influences such positive outcomes as educational achievement and high level of motivation. The present study was motivated by the concern that Iranian English language teachers' setting high standards, i.e. perfectionism, may predict English language learners’ motivation and language achievement. Through cluster random sampling, a total of 30 English language teachers with more than one year of experience and 300 elementary English language learners were selected from English Language Institutes in Fars province, Iran. Frost Multidimensional Perfectionism scale and Motivations Underlying English Language Learning questionnaire were used to measure teachers' perfectionism and learners’ language learning motivation, respectively. The learners' final scores in the English courses were collected as a measure of their language learning achievement. The result of simple regression analysis revealed that the teachers' perfectionism did not predict English language learners’ motivation and language achievement. In other words, Iranian English language teachers' perfectionism did not account for any variance in these two variables of interest. Keywords: Perfectionism, Motivation, Language Learning Achievement

The central component of the complement system, C3, is associated with obesity, metabolic syndrome and cardiovascular disease however the underlying reasons are unknown. In the present study we evaluated gene expression of C3, the cleavage product C3a/C3adesArg and its cognate receptor C3aR in subcutaneous and omental adipose tissue in women.Women (n = 140, 21-69 years, BMI 19.5-79 kg/m2) were evaluated for anthropometric and blood parameters, and adipose tissue gene expression.Subjects were separated into groups (n = 34-36) according to obesity: normal/overweight (≤30 kg/m2), obese I (≤45 kg/m2), obese II (≤51 kg/m2), and obese III (≤80 kg/m2). Overall, while omental expression remained unchanged, subcutaneous C3 and C3aR gene expression decreased with increasing adiposity (2-way ANOVA, p

Adipose tissue receptors C5aR and C5L2 and their heterodimerization/functionality and interaction with ligands C5a and acylation stimulating protein (ASP) have been evaluated in cell and rodent studies. Their contribution to obesity factors in humans remains unclear. We hypothesized that C5a receptors, classically required for host defense, are also associated with adiposity. Anthropometry and fasting blood parameters were measured in 136 women divided by body mass index (BMI): normal/overweight (≤30 kg/m2; n = 34), obese I (≤45 kg/m2; n = 33), obese II (≤51 kg/m2; n = 33), and obese III (≤80 kg/m2; n = 36). Subcutaneous and omental adipose tissue C5aR and C5L2 expression were analysed. C5L2 expression was comparable between subcutaneous and omental across all BMI groups. Plasma ASP and ASP/omental C5L2 expression increased with BMI (P < 0.001 and P < 0.01, resp.). While plasma C5a was unchanged, C5aR expression decreased with increasing BMI in subcutaneous and omental tissues (P < 0.01 and P < 0.05, resp.), with subcutaneous omental depots. Omental C5L2/C5aR ratio increased with BMI (P < 0.01) with correlations between C5L2/C5aR and waist circumference, HDL-C, and adiponectin. Tissue and BMI differences in receptors and ligands, particularly in omental, suggest relationship to metabolic disturbances and highlight adipose-immune interactions.

Objective. Obesity is associated with metabolic dysfunction with sex differences and chronic, low-grade inflammation. We proposed that hepatic expression of immune complement C3 related receptors (C3aR, C5aR, and C5L2) would be associated with pre- or postmenopausal status and metabolic profile in severely obese women. We hypothesized that C5L2/C5aR ratio, potentially influencing the ASP/C5L2 metabolic versus C5a/C5aR immune response, would predict metabolic profiles after weight loss surgery. Materials and Methods. Fasting plasma (hormone, lipid, and enzyme analysis) and liver biopsies (RT-PCR gene expression) were obtained from 91 women during surgery. Results. Hepatic C5L2 mRNA expression was elevated in pre- versus postmenopausal women (P