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Tourism is one of the most dynamic economic activities, which plays an essential role in sustainable development. Consequently, the significance of this industry in economic and cultural development has prompted the majority of regional. Despite the significant potential of many cities, such as Shiraz, tourism industries have remained underdeveloped. This study delves into the role of tourism service quality, specifically exploring the impact of knowledge management on service quality mediated by dynamic capabilities. Since the concept of knowledge management is used to accept and embrace intangible capital and sharing knowledge in organizations, this research aims to investigate the effect of knowledge management among tourism units’ employees on the quality of tourism services through the utilization of dynamic capabilities. The statistical population of the research included the employees of Travel Agencies in Shiraz, 119 of whom were selected as a statistical sample using Cochran's formula. A conceptual model, in the form of four hypotheses, examines the relationship exists between dynamic capability and knowledge management, the relationship between dynamic capability and the quality of tourism services, the relationship between knowledge management and the quality of tourism services, and consequently, the significant relationship between knowledge management and the quality of tourism services are all taken into account with dynamic capability plays a mediating role. The findings of this research using structural equation modelling, indicate the presence of a significant relation between knowledge management and dynamic capability and the absence of a relationship between dynamic capability and the quality of tourism services. 1. Introduction In recent decades, organizations and companies have increasingly focused on knowledge, leading to concepts such as knowledge-based work, knowledge management, and knowledge organizations. This trend highlights the growing importance of knowledge in creating significant power from minimal resources (De Bem Machado et al., 2022). The rapidly changing world necessitates organizations to adopt new concepts like knowledge management to survive. Knowledge management assists organizations in finding, selecting, organizing, and disseminating important information. Research indicates that traditional organizations primarily focus on managing physical resources and base their competitive advantages on that focus (Fauzi, 2022). However, the knowledge era has rendered many traditional approaches ineffective, while new orientations rely on intangible resources such as knowledge. Many organizations implement knowledge management programs without understanding the key influencing factors, often leading to failure (Liu et al., 2022). Conversely, organizations that have pioneered knowledge management regard it as a powerful tool for gaining market advantage and improving performance. Consequently, many businesses are exploring how knowledge management can help them achieve a more integrated and coordinated approach. Since the tourism industry is one of the most prosperous branches of economic growth and business globally, especially in developing countries, knowledge management can be considered a helpful tool for this service industry. The specific sensitivities of this industry have led managers to focus on this crucial aspect over the past decade (Martins et al., 2019). Considering the high potential of tourism in many cities, examining the factors influencing the quality of tourism agencies has become essential. The research reveals numerous factors affecting service quality, such as innovation in service delivery, responsiveness, reliability, and customer relationship management. One factor that has received less attention is employee knowledge management. Thus, this study focuses on the impact of employee knowledge management in tourism units on the quality of tourism services offered by travel agencies. Specifically, it seeks to answer whether employee knowledge management in tourism units affects the quality of tourism services in travel agencies, with the role of dynamic capabilities in mediating. The travel agencies in Shiraz, a prominent destination for national and international tourists, are considered as a case study. This research aims to identify critical components to provide strategies for successfully implementing knowledge management in travel agencies. The main objective is to elucidate the relation between dynamic capabilities and knowledge management with the quality of tourism services in travel agencies. Other objectives of this research include: Defining the relation between dynamic capabilities and knowledge management in travel agencies. Defining the relation between the quality of tourism services and dynamic capabilities in travel agencies. Defining the relation between the quality of tourism services and knowledge management in travel agencies. Defining the relation between the quality of tourism services and knowledge management in travel agencies dynamic capabilities play a role in mediating. 2. Literature Review In this section, to present the originality and novelty of the current study, the literature review in the field of tourism is summarized as follows. Rezai et al. (2023) analysed tourism development in Shiraz with a resilience approach using the Meta-SWOT model, assessing internal and external tourism resources and providing strategies to achieve tourism development with resilience. Shirmohammadi and Shirzadi (2022), examined the effect of tourist satisfaction on brand loyalty to a destination, with tourist satisfaction in the post-COVID-19 world (East Asian tourists) as a mediating variable. The study included twelve hypotheses, all except two were confirmed using structural equation modeling. Kiu (2006) examined previous research and conceptual framework for a research agenda in knowledge management in tourism. Rouhan (2008), in an article entitled "Advancement of the Sustainability Debate: A Knowledge Management Approach to Sustainable Tourism Planning," investigated the transfer of academic knowledge on sustainability to the public tourism sector's performance, indicating that knowledge has not been effectively disseminated at the destination level. Shaw and Williams (2009), examined current research on knowledge management and transfer in tourism organizations, exploring fundamental mechanisms and channels of knowledge transfer and concepts such as co-management, communities of practice, learning regions, and labor mobility. Sigala and Chalkiti (2014), in a research paper entitled "Examining the Use of Web 2.0 for Knowledge Management in the Greek Tourism Industry: A Utilization-Importance Analysis," examined the role of information technology in supporting knowledge management processes. Their demonstration showed how the use of Web 2.0 in different ways reflects different levels of knowledge management practices that are supported by technology. They also collected empirical data from tourism professionals to analyze the type and level of use of Web 2.0 utilization for knowledge management in the Greek tourism industry. By integrating these studies, this research aims to fill the gap in understanding the impact of employee knowledge management on tourism service quality, particularly dynamic capabilities play a crucial role in mediating. 3. Methodology This research aims to identify the relationship between knowledge management and the quality of tourism services in travel agencies, with dynamic capabilities as a mediating factor. The study is applied in nature and is descriptive in terms of data collection. The statistical population of the current research is the employees of travel agencies in Shiraz City; due to the comprehensive tourist attractions and the number of travel agencies, the statistical population is infinite; therefore, to determine the exact sample size, Cochran's formula is considered, which is the calculation of the error value of 0.09 equal to one hundred nineteen people, and this number was selected from among the employees of travel agencies in Shiraz city based on random sampling method. Data were collected using a questionnaire with three sections: knowledge management (independent variable) with fourteen questions, dynamic capabilities (mediating variable) with eight questions, and service quality (dependent variable) with eight questions, measured on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). One hundred twenty-five questionnaires were distributed, with one hundred nineteen valid ones used for statistical analysis. Content validity was ensured through expert opinions, while reliability was assessed using Cronbach's alpha, indicating internal consistency. Variables were defined through interviews with tourism experts, whose feedback was incorporated. Structural equation modeling (SEM) was used for final analysis and hypothesis testing. Finally, to check the proper model and to check the proper model and assess the significance of inter-variable relationships, the path analysis method was used. It should be mentioned that Path analysis is a statistical methodology that relies on multivariate regression analysis that is used to measure relationships in a model. 4. Results The tourism literature includes only a few studies on knowledge management, indicating limited professional knowledge management in tourism companies. This study focuses on tourism service quality, examining the impact of employee knowledge management in tourism units on service quality, the mediating variable being dynamic capabilities. In this research, knowledge management is the independent variable, service quality is the dependent variable, and dynamic capabilities are the mediating variable. The findings, with 95% confidence, are as follows: The first hypothesis examines the relation between dynamic capabilities and knowledge management in travel agencies. The standardized factor loading was 0.543, and the t-statistic was 8.035, a value that exceeds the critical value of 1.96. Thus, hypothesis one is confirmed, indicating a significant relationship. The second hypothesis examines the relationship between dynamic capabilities and tourism service quality. The standardized factor loading was 0.181, and the t-statistic was 1.270, which is lower than the critical value of 1.96. Thus, hypothesis two is rejected. The third hypothesis examines the relationship between knowledge management and tourism service quality in Shiraz. The standardized factor loading was 0.302, and the t-statistic was 1.866, which is lower than the critical value of 1.96. Thus, hypothesis three is rejected. Finally, examining the significant relation between the quality of tourism services and knowledge management in travel agencies involves the mediating role of dynamic capability was regarded as the last hypothesis, based on the results, the standard factor loading for the random variables of knowledge management and quality of tourism services adjusted with the dynamic ability variable was calculated as -0.039. The value of ''t'' statistic was also 0.488, which is under the critical value of 1.96. Therefore, it can be said that hypothesis four is rejected. 5. Conclusion Today, the tourism industry is one of the most promising fields; and, referred to as the development corridor, has become one of the main economic sectors. In today's knowledge-based economy, more emphasis is placed on managing organizational intangible knowledge assets. This is also true for the tourism industry, which can be considered a knowledge-based field. However, the tourism literature includes only a few studies on knowledge management. This concept can be regarded from different aspects, as the current research emphasizes the quality aspect of tourism services and aims to investigate the impact of knowledge management of employees of tourism units on the quality of tourism services of travel agencies. dynamic capabilities play a mediating roleBased on the results that were mentioned in the previous section, the following suggestions are made to develop the tourism industry to its maximum potential: · Given the confirmed relationship between knowledge management and dynamic capabilities, according to the first hypothesis, organizations should create an environment conducive to knowledge management. This involves fostering a favourable work environment for creating, managing, transferring, and reflecting knowledge to employees, enabling continuous enhancement of their capabilities. Due to the lack of a relationship between dynamic capabilities and tourism service quality, organizations should focus on internal matters. To improve service quality, all aspects of tourism enterprises, such as employee knowledge, human resources, and equipment, should be continuously expanded and updated. Based on the result of the third hypothesis, it is suggested that, in order to increase the quality of tourism services, various innovative means should be considered. These means include implementing personal branding of the target agency, introducing and showcasing tourist attractions and facilities of the province, improving the provision of tourism services by considering attractive advertising programs, and upgrading and extending lodging facilities. According to the last hypothesis, since the relation between service quality and knowledge management with dynamic capabilities as a mediator was not confirmed, tourism enterprises should aim to become a source of competitive advantage indirectly. Based on the results, this hypothesis is also rejected. Accordingly, it is recommended that tourism agencies become more competitive.

Background and Objective: Familial hypercholesterolemia (FH) is one of the most common inherited familial diseases that cause lipid accumulation in tendons and arteries by increasing the level of low density plasma lipoprotein (LDL). The main cause of FH is a mutation in the low-density lipoprotein receptor (LDLR) gene. This study was performed to evaluate common mutations in LDLR gene in FH patients. Methods: This descriptive study was performed on 100 patients with suspected familial hypercholesterolemia referred to Sepehr laboratory according to the Simon Broom international standard in Karaj city, Iran during 2015. After complate the questionnaire form and drawing the family tree, it was found that 17 of them had a history of disease in at least one of the first degree relatives. The presence of changes was investigated using PCR-SSCP method, and after identifying the suspected cases direct DNA sequencing was performed. Results: Among of 17 patients with a history of FH disease, 13 patients had a heterozygote mutation in the LDLR gene. Mutations included: c.97C>T, c.445G>T, c.651-653 (DEL3), c.652-654 (DEL3), c.682G>T, c.925-931 (DEL7), c.936-940 (DEL5), c.986G>T, c.2054C>T, c.2177C>T and c.313+1G>A. Four patients did not have mutations in their LDLR gene. In two patients the common polymorphism c.1959T>C was identified. Conclusion: The LDLR gene was involved in the development of FH in the study population. However, another gene or locus may be involved in the outbreak of this disease in the studied population.

Water dynamic in wetted volume of soil around emitter is one of the primary information for designing the irrigation systems and management of water and chemical substances. In fact, for particular kind of soil, knowing the evolution and gradual change of the shape of the wetted volume is necessary for estimation of the distance of emitters from each other and irrigation duration. Most of the numerical and analytical models used for prediction of wetting pattern need determining the pounding area from high cost experimental tests. These models predict unreliable results if the discharge of emitter is more than infiltration of soil. In this paper, a new model for coupling surface (Navier-Stokes, VOF) and subsurface flow equations (Richards) is presented. The method can use for simulation of both two phase air-water surface flow along with wetting pattern inside the soil in surface drip irrigation. In this model, Richards equation is discretized with finite volume method and coupled with two phases Navier-Stokes equations based on the new coupling algorithm. To demonstrate the accuracy of the model the results of new method for two different soil texture and discharge are compared with experimental data and numerical results of HYDRUS software. Furthermore, statistical indexes such as mean error and root mean square error and model efficiency are evaluated for the model. The results indicated that the presented model has the high ability in simulation of wetted pattern, and its accuracy is more than HYDRUS software.

Purpose: Toxoplasma gondii is a widespread protozoan parasite that infects a broad range of warm blooded animals as well as humans. The present study was investigated to evaluate the effects of allium cepa on renal failur in male rats which experimentally infected by Toxoplasma gondii, RH strain. Methods: Wistar male rat (n=40) were allocated into four groups, group one that received tachyzoites of T. gondii (ip) (n=10), group two that received tachyzoites of T. gondii (ip), plus fresh onion juice by gavages method (n=10), group three received just fresh onion juice by gavages method (n=10) and control group (n=10) that received nothing. Animals were kept in standard condition. In 30 day after inducing Toxoplasma infection, 5cc blood was collected for serum protein and TAC levels. Kidney tissues of Rat in whole groups were removed and prepared for apopetosis analysis. Results: Serum protein and kidneys weights were significantly decreased in groups that were infected with T. gondii, in comparison to control and onions groups. Kidneys Apopetosis in toxoplasma group significantly increased in comparison to control group (P

Prevalence of non-communicable diseases (NCDs) is high in rural Bangladesh. Given the complex multi-directional relationships between NCDs, COVID-19 infections and control measures, exploring pandemic impacts in this context is important. We conducted two cross-sectional surveys of adults ≥30-years in rural Faridpur district, Bangladesh, in February to March 2020 (survey 1, pre-COVID-19), and January to March 2021 (survey 2, post-lockdown). A new random sample of participants was taken at each survey. Anthropometric measures included: blood pressure, weight, height, hip and waist circumference and fasting and 2-hour post-glucose load blood glucose. An interviewer-administered questionnaire included: socio-demographics; lifestyle and behavioural risk factors; care seeking; self-rated health, depression and anxiety assessments. Differences in NCDs, diet and exercise were compared between surveys using chi2 tests, logistic and linear regression; sub-group analyses by gender, age and socio-economic tertiles were conducted. We recruited 950 (72.0%) participants in survey 1 and 1392 (87.9%) in survey 2. The percentage of the population with hypertension increased significantly from 34.5% (95% CI: 30.7, 38.5) to 41.5% (95% CI: 38.2, 45.0; p-value = 0.011); the increase was more pronounced in men. Across all measures of self-reported health and mental health, there was a significant improvement between survey 1 and 2. For self-rated health, we observed a 10-point increase (71.3 vs 81.2, p-value = 0.005). Depression reduced from 15.3% (95% CI: 8.4, 26.1) to 6.0% (95% CI: 2.7, 12.6; p-value = 0.044) and generalised anxiety from 17.9% (95% CI: 11.3, 27.3) to 4.0% (95% CI: 2.0, 7.6; p-value<0.001). No changes in fasting blood glucose, diabetes status, BMI or abdominal obesity were observed. Our findings suggest both positive and negative health outcomes following COVID-19 lockdown in a rural Bangladeshi setting, with a concerning increase in hypertension. These findings need to be further contextualised, with prospective assessments of indirect effects on physical and mental health and care-seeking., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 King et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Diarrheal disease is one of the most common causes of hospital admission globally. The barriers that influence guideline-adherent care at resource limited hospitals are poorly defined, especially during diarrheal disease outbreaks. The objective of this study was to characterize challenges faced in diarrheal disease management in resource-limited hospitals and identify opportunities to improve care., Methods: The study was conducted during a diarrheal disease outbreak period at ten public district hospitals distributed across Bangladesh. A rapid ethnographic approach included observations and informal interviews with clinicians, staff nurses and patients. In the first phase, observations identified common and unique challenges in diarrheal management at the ten sites. In the second phase, four hospitals were purposively selected for additional ethnographic study. Systematic observations over 420 total hours were collected from patient-clinician interactions (n = 76) and informal interviews (n = 138). Applied thematic analysis identified factors that influenced hospitalbased diarrhea management., Results: Normalization of guideline deviation was observed at all ten sites, including prescription of non-indicated antibiotics and intravenous (IV) fluids. Conflict between 'what should be done' and 'what can be done' was the most common challenge identified. Clinical assessments and patient treatment plans were established at admission in a median of 2 minutes (n = 76), often without a physical examination (57%; n=43/76). Factors that prevented adherence to clinical guidelines included human resource constraints, conflicts of interests, overcrowding, and inadequate hygiene and sanitation in the emergency department and wards., Conclusion: This study identified challenges in hospital-based management of diarrheal disease and opportunities to improve care in seemingly change-resilient hospital settings. The results reveal important areas for intervention and policy engagement that may have additive benefit for both hospitals and their patients. These interventions include targeting barriers to clean-water, sanitation and hygiene that prevent clinicians from adopting guidelines out of concern for hospital acquired infections., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Acute diarrhoeal disease management often requires rehydration alone without antibiotics. However, non-indicated antibiotics are frequently ordered and this is an important driver of antimicrobial resistance. The mHealth Diarrhoea Management (mHDM) trial aimed to establish whether electronic decision support improves rehydration and antibiotic guideline adherence in resource-limited settings., Methods: A cluster randomised controlled trial was done at ten district hospitals in Bangladesh. Inclusion criteria were patients aged 2 months or older with uncomplicated acute diarrhoea. Admission orders were observed without intervention in the pre-intervention period, followed by randomisation to electronic (rehydration calculator) or paper formatted WHO guidelines for the intervention period. The primary outcome was rate of intravenous fluid ordered as a binary variable. Generalised linear mixed-effect models, accounting for hospital clustering, served as the analytical framework; the analysis was intention to treat. The trial is registered with ClinicalTrials.gov (NCT03154229) and is completed., Findings: From March 11 to Sept 10, 2018, 4975 patients (75·6%) of 6577 screened patients were enrolled. The intervention effect for the primary outcome showed no significant differences in rates of intravenous fluids ordered as a function of decision-support type. Intravenous fluid orders decreased by 0·9 percentage points for paper electronic decision support and 4·2 percentage points for electronic decision support, with a 4·2-point difference between decision-support types in the intervention period (paper 98·7% [95% CI 91·8-99·8] vs electronic 94·5% [72·2-99·1]; p interaction =0·31). Adverse events such as complications and mortality events were uncommon and could not be statistically estimated., Interpretation: Although intravenous fluid orders did not change, electronic decision support was associated with increases in the volume of intravenous fluid ordered and decreases in antibiotics ordered, which are consistent with WHO guidelines., Funding: US National Institutes of Health., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0. license. Published by Elsevier Ltd.. All rights reserved.)