The Prevalence of Clubfoot in the Neonates who were Referred to the Emergency Department of Mofid Children Hospital

ObjectiveClub-foot is one of the most prevalent congenital anomalies of the lowerextremities. Since there is no epidemiologic study on the prevalence of thisdisease in Iran, we decided to assess it in a sample population in Tehran.Materials and MethodsWe assessed all neonates who were referred to the emergency department ofmofid children hospital between October 2007 and November 2008, due to apaediatric emergency problem. None of the patients had chief complaints oflower extremity deformity.ResultsDuring this time period (13 months), we could examine 682 neonates. Noneof the parents of these neonates had complaints regarding anomaly of lowerextremities of their neonates at the time of the emergency referral. Of them, 371(54%) were female and 311 (46%) were male. The age of the mother at the timeof pregnancy was 35 yr in 86 (13%) neonates. There was a previous historyof clubfoot in the siblings of one of the neonates who was under orthopaedictreatment.Among all these neonates, we found two cases of clubfoot (0.3%), with bilateralinvolvement. In one of these cases, the older sibling also had clubfoot.ConclusionThe incidence of clubfoot has been reported between 0.39 and 6 cases in 1000live birth in the literature. In the present study, we found a prevalence of 0.3 forclubfoot in every 1000 neonates.Keywords: Clubfoot; prevalence; congenital; talipesequinovarus.  

Global leadership in a university setting

What is global leadership? How can we develop global leadership for a university? This study was conducted using the qualitative approach through in-depth interviews of eight selected top leaders in a selected university. Based on the in-depth interviews, the findings discussed are as follows; Global leadership is related to diversity. Global leaders need to be developed with additional competencies to lead a university and to be able to compete worldwide. Global leadership has to operate in diverse situations. This means that a global leader has to understand different cultures, different ideas and different beliefs. So a global leader has to understand leading in diversity, which requires a different set of competencies. These include attitudes, skills and knowledge. This study is significant because it fills a gap in current knowledge regarding the experience that leaders perceived to be important in understanding and developing global leadership

Identification and prioritization of efficiency-influencing factors in banking using MADM technique (Case study: Tejarat Bank)

The present study is an attempt to identify and prioritize efficiency-influencing factors in banking system based on Analytic Hierarchy Process (AHP) and (topsis), performed by considering comments and remarks of Tejarat bank experts in Tehran. For this purpose, first the most important efficiency-influencing factors were identified by studying the related literature, background of the study, and interviews with some of Tejarat bank’s managers and authorities. Then, by performing a field study, it was attempted to ask Tejarat bank experts for their opinions in Tehran as the statistical population of the study. After analyzing data and testing measures using T- student test, it was finally found that all recognized variables and factors influence banking efficiency. Results obtained from Analytic Hierarchy Process (AHP)-based statistical studies and analyses indicated that among the main criteria, the criteria of hardware, software, and working systems are the most important, followed by manpower; financial tools and attitudes have the lowest priority. Also, regarding sub-criteria, the sub-criteria of customers-specific convenient facilities, targeted marketing and advertisement of products and services had the highest rank

Identification and prioritization of efficiency-influencing factors in banking using MADM technique (Case study: Tejarat Bank)

The present study is an attempt to identify and prioritize efficiency-influencing factors in banking system based on Analytic Hierarchy Process (AHP) and (topsis), performed by considering comments and remarks of Tejarat bank experts in Tehran. For this purpose, first the most important efficiency-influencing factors were identified by studying the related literature, background of the study, and interviews with some of Tejarat bank’s managers and authorities. Then, by performing a field study, it was attempted to ask Tejarat bank experts for their opinions in Tehran as the statistical population of the study. After analyzing data and testing measures using T- student test, it was finally found that all recognized variables and factors influence banking efficiency. Results obtained from Analytic Hierarchy Process (AHP)-based statistical studies and analyses indicated that among the main criteria, the criteria of hardware, software, and working systems are the most important, followed by manpower; financial tools and attitudes have the lowest priority. Also, regarding sub-criteria, the sub-criteria of customers-specific convenient facilities, targeted marketing and advertisement of products and services had the highest rank

Identification and prioritization of efficiency-influencing factors in banking using MADM technique (Case study: Tejarat Bank)

The present study is an attempt to identify and prioritize efficiency-influencing factors in banking system based on Analytic Hierarchy Process (AHP) and (topsis), performed by considering comments and remarks of Tejarat bank experts in Tehran. For this purpose, first the most important efficiency-influencing factors were identified by studying the related literature, background of the study, and interviews with some of Tejarat bank’s managers and authorities. Then, by performing a field study, it was attempted to ask Tejarat bank experts for their opinions in Tehran as the statistical population of the study. After analyzing data and testing measures using T- student test, it was finally found that all recognized variables and factors influence banking efficiency. Results obtained from Analytic Hierarchy Process (AHP)-based statistical studies and analyses indicated that among the main criteria, the criteria of hardware, software, and working systems are the most important, followed by manpower; financial tools and attitudes have the lowest priority. Also, regarding sub-criteria, the sub-criteria of customers-specific convenient facilities, targeted marketing and advertisement of products and services had the highest rank

Genetic evaluation of dystocia and its relationship with productive and reproductive traits in Holstein cows

Background: dystocia is one of the most economically significant secondary traits in dairy cows and has adverse effects on the subsequent survival, health, and performance of mothers and offspring. Objective: the aim of this study was to estimate direct and maternal genetic parameters for calving ease (CE) and its relationship with productive and reproductive traits in Iranian Holstein cows. Methods: data from 1991 through 2011 were collected from the Animal Breeding Center of Iran, and contained 132,831 records of CE, 183,203 records of productive traits including 305-d adjusted milk yield (MY305), 305-d adjusted fat yield (FY305) and 305-d adjusted protein yield (PY305), and 129,199 records of reproductive traits including days open (DO), days to first service (DFS) and calving interval (CI). Univariate and bivariate linear animal models were used for the analysis of traits in two different models on which direct genetic effect (model 1) and direct + maternal genetic effects (model 2) using AI-REML algorithm were included. Results: estimated heritabilities for CE in model 1 were 0.02 in univariate and 0.02-0.03 in bivariate analyses. Direct and maternal heritabilities in model 2 were 0.02 and 0.002 for univariate, and 0.03 and 0.0004-0.006 in bivariate analyses, respectively. Genetic correlations between direct effects of CE with MY305, FY305, and PY305 were -0.99, 0.02 and -0.07 in model 1, and -0.2, -0.02 and -0.13 in model 2, respectively. Conclusion: this study suggested that a selection index that includes both direct and maternal effects should be included in CE breeding programs. , rendimiento productivo, aca lechera.   Resumo Palavras chave: correlação genética, desempenho produtivo, dificuldade de parto, parâmetros genéticos, vaca de leiteria

Serum Insulin-Like Growth Factor-1 in Parkinson's Disease; Study of Cerebrospinal Fluid Biomarkers and White Matter Microstructure

Background: Growing evidence shows that impaired signaling of Insulin-like Growth Factor-1 (IGF-1) is associated with neurodegenerative disorders, such as Parkinson's disease (PD). However, there is still controversy regarding its proinflammatory or neuroprotective function. In an attempt to elucidate the contribution of IGF-1 in PD, we aimed to discover the relation between serum IGF-1 levels in drug-naïve early PD patients and cerebrospinal fluid (CSF) biomarkers as well as microstructural changes in brain white matter.Methods: The association between quartiles of serum IGF-1 levels and CSF biomarkers (α-synuclein, dopamine, amyloid-β1−42, total tau, and phosphorylated tau) was investigated using adjusted regression models in 404 drug-naïve early PD patients with only mild motor manifestations and 188 age- and sex-matched healthy controls (HC) enrolled in the Parkinson's Progression Markers Initiative (PPMI). By using region of interest analysis and connectometry approach, we tracked the white matter microstructural integrity and diffusivity patterns in a subgroup of study participants with available diffusion MRI data to investigate the association between subcomponents of neural pathways with serum IGF-1 levels.Results: PD patients had higher levels of IGF-1 compared to HC, although not statistically significant (mean difference: 3.60, P = 0.44). However, after adjustment for possible confounders and correction for False Discovery Rate (FDR), IGF-1 was negatively correlated with CSF α-synuclein, total and phosphorylated tau levels only in PD subjects. The imaging analysis proved a significant negative correlation (FDR corrected P-value = 0.013) between continuous levels of serum IGF-1 in patients with PD and the connectivity, but not integrity, in following fibers while controlling for age, sex, body mass index, depressive symptoms, education years, cognitive status and disease duration: middle cerebellar peduncle, cingulum, genu and splenium of the corpus callosum. No significant association was found between brain white matter microstructral measures or CSF markers of healthy controls and levels of IGF-1.Conclusion: Altered connectivity in specific white matter structures, mainly involved in cognitive and motor deterioration, in association with higher serum IGF-1 levels might propose IGF-1 as a potential associate of worse outcome in response to higher burden of α-synucleinopathy and tauopathy in PD

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions