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Objectives: To compete in the global environment, the simultaneous use of four lean, agile, resilient, and green paradigms that each one has its advantages for supply chain management, can lead to competitive advantage for organizations. However, due to the shared and conflicting aspects of these paradigms, the simultaneous integration of their actions (indicators) in the supply chain processes will create considerable management challenges in this area. Although this issue has received attention in some studies, there are still research gaps that can be traced. Therefore, the aim of this study is to analyze the causal relationships between a set of indicators as a basis for appropriate planning and their phased implementation.Methods: The present study is descriptive-survey and also practical in terms of purpose. The research community are experts and managers of the Iran-Yazd alloy steel industry in relevant research fields in the years 2021-2020, and among them, experts were selected by purposive judgmental sampling for this research.The data collection tool consists of two self-made questionnaires. The first questionnaire was used to confirm the indicators and the second questionnaire (hierarchical DEMATEL method questionnaire) was used to determine the causal relationships between the indicators. The content validity approach was also used to examine the validity of the data collection tool. To complete the hierarchical DEMATEL questionnaire, experts were asked to complete comparison tables for each category and also the indicators of each category based on the intensity of the effect of each factor, in pairs and based on a 5-point Likert scale. For data analysis, the hierarchical DEMATEL technique was used, which is an extended method of classic DEMATEL, that by considering the hierarchical structure among factors, it reduces the number of pairwise comparisons in problems with a large number of factors. In this technique, comparison tables are integrated and a super matrix of direct impact is obtained, which forms the basis of analyzes.Results: At first, the lean, agile, resilient and green indicators were identified through a background review and were categorized based on the categories in previous researches. Then, the causal relationships between this indicators were investigated using the hierarchical DEMATEL method. The results show that the "knowledge and technology" dimension indicators were the most influential indicators and the "Comptency" dimension indicators were the most under influence indicators. Based on the research results, the "technology inclusion in strategy" indicator is the most important and influential indicator and "customer satisfaction" is the most under influence indicator. In terms of importance, after technology inclusion in strategy indicator, supplier management and collaboration with them indicator is ranked second. Also in terms of impact, the green information technology indicator has ranked second, which, in addition to emphasizing the importance of attention to information technology, also demonstrates the importance of considering environmental considerations. Customer satisfaction is the most influential indicator in the set of LARG supply chain indicators and be affected from many other indicators. It is also ranked seventh in terms of importance. After that, the presentation of new products and product quality, in terms of be affected from the others have subsequent ranksConclusions: Determining causal relationships between the indicators of the LARG supply chain helps managers allocate their limited financial, temporal, and human resources to implement high-priority indicators, taking into account the shares and conflicts present in the principles and performance of these four paradigms, and have proper planning to implement other indicators. Moreover, utilizing the new technique of DEMATEL hierarchy can lead to more familiarity among researchers with this method for analyzing causal relationships among factors in issues with multiple factors.Keywords: Supply Chain Management Paradigms, LARG Supply Chains, Competitive Advantage Gaining, Hierarchical DEMATEL Method (H- DEMATEL), Determining Causal Relationships, Steel Industry

ObjectiveAwns increase photosynthesis, reduce bird damage, and play a distinct role in grains spreading of wild species. However, there are some challenges to its effect on grain yield under irrigated conditions. The objective of this research was evaluation the effect of awns on important agronomic traits including grains number per spike, 1000-grain weight and earliness. For this purpose, near-isogenic line in Roshan’s background was developed to assess the effect of this trait on yield and yield components. Materials and methodsIn the present study, in a 10-year wheat breeding program (from 2010 to 2020), awny head characteristic was transferred from Mahdavi to Roshan using backcrossing. In the second generation of the fifth backcross (BC5F2), awny and awnless progenies (isogenic lines with the genetic background of Roshan) were selected. Isogenic lines and their parents (Roshan and Mahdavi) were evaluated in a randomized complete block design with five replications in the 2021-2022 cropping season under irrigated conditions. ResultsIn the present research, the awny head character was successfully transferred from Mahdavi to the Roshan cultivar. The awny Roshan was cultivated under farm conditions (300 plants m-2). The results of mean comparisons showed that, out of the 16 evaluated agronomical traits, only three traits including grains number per spike, spikelet number per spike, and plant height were affected by awns. Awny head characteristic increased grain yield by 820 kg/ha in comparison with Roshan, but it was not significant. Awny Roshan produced 26% more grains number per spike than Roshan. The significant increase of spikelet number per spike in awny line also confirmed the increasing of grains number per spike. In comparison with Roshan, awnd isogenic line had 12 cm higher plant height, where 6 cm was due to awn length. ConclusionsAwns not only did not hurt the wheat yield under irrigated conditions of Kerman but also potentially can increase grain yield by increasing the number of grains per plant. Due to the reduction of bird damage, the promising line produced in the present research can be an appropriate alternative for the Roshan cultivar.

Background and Aim: Pain and restlessness are common problems in the intensive care unit. Sensory stimulation is one of the non-pharmacological methods of pain control. Dyang sensory stimulation includes visual, auditory, olfactory, tactile, and motor-sensory stimulation. In this study we investigated the effects of Dyang sensory stimulation on the level of consciousness, pain, and restlessness in the unconscious patients. Materials and Methods: This clinical trial included 60 patients under mechanical ventilation. The patients were divided into two groups. The intervention group received Dyang sensory stimulation. Sensory stimulation was performed for one hour in the evening and at night for six consecutive days. Fifteen minutes after sensory stimulation, the level of consciousness, pain, and restlessness were measured using GlasgowComa Scale , BPS (Behavioral Pain Scale), and Rass (Richmond Agitation Sedation Scale), respectively. Results: The mean values for level of consciousness of the patients in the two groups before the intervention were below 7. The mean values for pain intensity (p=0.684) and restlessness (p=0.739) did not show any significant differences between the two groups before the intervention. After sensory stimulation on the second day, the level of consciousness of the patients in the intervention group increased compared to that in the control group (p=0.016). However, there were no significant differences between the two groups in terms of pain intensity and restlessness on all days of the study (p>0.05). Conclusion: Dyang sensory stimulation can increase the level of consciousness. Therefore, this multidimensional stimulation method can be used in the patients under mechanical ventilatation.

Background:Cardiac rehabilitation program (CRP) is a useful method of modifying cardiovascular risk factors, improving life expectancy and quality of life in patients with ischemic heart disease (IHD). The present study was conducted to evaluate the effects of cardiac rehabilitation on the pulmonary artery systolic pressure (PASP) and left ventricular end-diastolic pressure (LVEDP). Methods: This Quasi-experimental study with pretest-posttest design was conducted on 80 patients with IHD who had participated in CRP after undergoing coronary artery bypass graft (CABG) surgery. Echocardiography was performed before the beginning of CRP (the 1st session) and at the end of the rehabilitation sessions, and ventricular function indices (ejection fraction), PASP (using the tricuspid regurgitation velocity), and LVEDP (using Nagueh formula: 1.24×E/e´+1.9) were measured. Results: Ejection fraction (EF) was changed from 49.3 ± 7.8 before rehabilitation to 50.7 ± 7.4 after rehabilitation, which was a statistically significant difference (P=0.003). The pulmonary artery systolic pressure altered from 30.3 ± 8.4 before rehabilitation to 27.3 ± 6.6 after rehabilitation. The left ventricular end-diastolic pressure (LVEDP) changed from 10.5 ± 3.7 before rehabilitation to 9.1 ± 2.9 after rehabilitation, which was a statistically significant difference (P= 0.000). Conclusion: According to the results, LVEDP and PASP in patients with IHD who underwent CABGs decreased after cardiac rehabilitation.

Abstract Background Patients with multiple sclerosis (MS) especially those with younger age experience an alteration in physiological and emotional lifestyle that can affect intimacy and sexuality. The aim of this study was to determine demographic and disease related determinants of intimacy and sexuality in young women with MS. Methods This was a cross sectional study carried out in Tehran, Iran. A convenience sample of young women aged ≤35 years old with MS attending to outpatient clinics in a teaching hospital affiliated to Tehran University of Medical Sciences was entered into the study. The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) was used to evaluate how the disease influences sexual function and satisfaction in these patients. Multivariable analysis using hierarchical method was performed to identify variables that are associated with intimacy and sexuality. Results In total 117 young women with confirmed diagnosis of MS were included in the study. Participants mean was 25.7 (SD = 8.07) years. A multivariable hierarchical regression analysis was performed using demographic variables entered in step one, relevant neurological variables in step two, and psychological variables in step three. Furthermore, we loaded antidepressant use in the last step. Overall, the seven variables accounted for 39% of total variance observed for the MSISQ score (P

Manipulation is an illegitimate mind control that can be performed via the triangular model of social, cognitive, and discursive strategies which leads to social inequality. This study aims to investigate the discursive strategies employed in Persian printed advertisements to manipulate audiences based on triangular model of van Dijk (2006). Since manipulation is a crucial notion of Critical Discourse Analysis (CDA), the researchers have to utilize CDA principles of Fairclough (2013) too. To do this, an analysis was performed on the corpus of 160 Persian printed advertisements collected during one year, from 2016 to 2017. Half of the data were collected from real context of use in three different cities of Iran (Kermanshah, Ahwaz, and Mashhad), and another half were downloaded from different websites. Then, the corpus of data was analyzed employing triangular model of manipulation and CDA in order to determine the strategies used in those advertisements to manipulate audiences. The results revealed that the advertising discourse in Iran is completely manipulative which uses discursive, cognitive and social strategies to manipulate consumers. Furthermore, the results added more strategies such as (a) Religious messages, (b) Challenging hints, (c) Giving discount or rewards, and (d) Deadline, to the findings of previous studies.

Background and purpose: Sexual dysfunction (SD) is an important subject and unfortunately an overlooked symptom of multiple sclerosis (MS) especially in women. The aim of this study was to investigate the impact of affected functional systems on primary sexual dysfunction. Materials and methods: A cross-sectional study was carried out in Tehran, Iran in which a sample of female patients with MS was recruited consecutively from an outpatient clinic. Sexual function was evaluated by the Multiple Sclerosis Intimacy and Sexuality Questionnaire. A neurologist evaluated the clinical characteristics including disease progress, duration, and affected functional systems. The neurological impairment was assessed by the Kurtzke Expanded Disability Status Scale (EDSS). Results: There were 226 women in whom brainstem and/or cerebellum (OR for suffering from Brainstem and/or cerebellum=2.54, 95% CI=1.40-4.60, P=0.002), pyramidal dysfunction (OR for suffering from pyramidal dysfunction = 3.14, 95% CI= 1.363-7.26, P=0.002), and sensory dysfunction (OR for suffering from sensory dysfunction = 3.13, 95% CI= 1.56-6.25, P

Background & objectives: Streptococcus pneumoniae is one of the major causes of vaccine - preventable diseases worldwide. Current pneumococcal vaccines consist of serotype specific capsular polysaccharide antigen and do not offer full clinical protection against pneumococcal diseases. Due to such limitations, a new generation of protein-based pneumococcal vaccines is being developed. The objective of this study was to determine the distribution of gens encoding five protein antigens including pneumococcal histidine triad D and E (phtD, phtE), rlr- regulated gene A (rrgA), Autolysin (lytA) and Pneumococcal surface protein C (pcpC) among pneumococcal isolates collected from nasopharyngeal specimens in healthy children. Methods: A total of 43 pneumococcal isolates were collected from nasopharyngeal specimens of healthy children attending the kindergartens in Ardabil province. The strains were identified using optochin susceptibility and bile solubility testes and further confirmed by amplification of capsular polysaccharide A gene (cpsA). PCR was used for screening the presence of pcpC, phtD, phtE, rrgA and lytA genes. Results: 81.4 % of isolates were found to contain at least one of the tested genes. lytA, pcpC, phtE, phtD and rrgA were detected in 70, 60, 39.5, 35 and 25.5 percent of isolates, respectively. The results showed that the genes were not distributed consistently among the isolates and for obtaining a full coverage pneumococcal vaccine, multiple choices of these antigens should be included.

Objective (s): The objective of this study was to translate and to test the reliability and validity of the Persian version of Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19). Methods: Using a standard "forward-backwardchr('39') translation procedure, the English language version of the questionnaire was translated into Persian (Iranian language). Then a sample of 226 women with multiple sclerosis aged 18-65 years completed the questionnaire. To test reliability the internal consistency was assessed by Cronbachchr('39')s alpha coefficient. Validity was evaluated using face validity, content validity, convergent validity and discriminant validity. Results: The mean age of respondents was 35.7 (SD=8.07) years. Reliability analysis provided evidence for high internal consistency for the total MSISQ-19 (0.90) and for the primary (0.85), secondary (0.90) and tertiary (0.78) subscales. The MSISQ-19 had convergent validity with measure of the Female Sexual Function Index (FSFI). The results from Known group’s comparison (discriminant validity) indicated that older women with MS were significantly scored higher than younger women and the questionnaire was able to discrimiate these groups as expected. Conclusions: In general, the findings suggest that MSISQ-19 is a reliable and valid measure of sexual dysfunction in women with MS.

Objective (s): Sexual dysfunction (SD) in patients with multiple sclerosis (MS) is common, but often overlooked. The purpose of this study was to determine prevalence of sexual dysfunction and its predisposing factors in women with multiple sclerosis. Method: This was a cross sectional study. Participants were recruited from two MS clinics in Tehran.Sexual function and disability status were quantified by the Female Sexual Function Index-FSFI and Expanded Disability Status Scale(EDSS) respectively.Clinical characteristics and the extent of physical disability were examined by a neurologist .Data were analyzed by univariate and multivariate logistic regression.Results: In all 226 MS patients were studied.The mean age of participants was 35.77 years (SD = 8.07). Sexual dysfunction were diagnosed in 125(55/3%) of participants. The most common sexual problem in women was arousal dysfunction (44/2%) and the lowest frequency of the dysfunction was sexual pain (12/8%).Results obtained from multiple logistic regression analysis showed that MS patients with sexual dysfunction had lower educational status (Odds ratio=1.95 CI 95%= 1.957-0.998), insufficiency low (Odds ratio=3.94 CI 95%= 1.614-90619), more than 3 children (Odds ratio=4.659 CI 95%= 1.517-14.314) and Secondary Progressive MS-(SPMS) (Odds ratio=3.034 CI 95%= 1.447-6.362). Conclusion: Awareness of sexual problems and related factors for the management and treatment of women with MS is necessary .It is suggested that sexual rehabilitation programs compiled as part of the comprehensive care of patients with MS.

Objective(s): Withdrawal contraception accompanied with high unwanted and morbidity .the aim of this study to gain of the knowledge, perceptions and experiences of using contraceptive methods withdrawal users to design effective effective intervention for them.Methods: In the first stage qualitative methods used to elicit questionnaire with 50 women .In the second stage cross-sectional study was performed 300 women attending to the health care centers in west Tehran were selected randomly. In the both of them women were not intended to become pregnant and use withdrawal contraception .data analyzed by using descriptive statistical tests.Results: They had used modern contraceptive methods before withdrawal in 70.7 percent .The mean withdrawal usage was 60.5 4.9 and modern contraceptive was 2.3 2.9 years. The most common source of information on modern contraceptive was health care providers and informal sources. The women are familiar with emergency contraception in 34 percent. Unwanted pregnancy related to withdrawal contraception was 33/7 percent. The most common beliefs related to oral pills nervousness (79.3%) obesity (26.7%) infertility (79.3%), IUD infection (34%) pregnancy (22.7%), spontaneous movement (21%) condom, pregnancy (73.7%) and three monthly injection, pregnancy (33.3%).Conclusion: It was important that planners will be design family planning packages should contain programs to correct the wrong beliefs. Side effects of modern contraception should be as soon as possible recognizing. They counselors must be guided them .Positive attitude related to withdrawal contraception suggests that family planning programs disseminated essential information among this groups.

The present study aims to investigate the effective variables of knowledge management in food exports in Iran. A new model was designed in this research on the basis of achieved statistical data from production associations and export firms. Structural equation modeling (SEM) was applied to assess the impact of effective variables of knowledge management in food exports. Suggested model of the research is comprised of eight dimensions which are as follows: specialized relations, coordinated knowledge, knowledge tools, organizational knowledge, knowledge process, knowledge chain, knowledge hardware, and knowledge feasibility. Target population of the study was consisting of 57 production associations which export food from Iran. The sales staffs and business departments formed the target population, and 317 questionnaires were validly obtained to test the research model. Exploratory factor analysis and Amos software were utilized for modeling. This study indicates that knowledge management is positively effective in the process of food exports in Iran, and all effective factors of knowledge management significantly affect the efficiency and performance of exporting. Eight-dimensional model which is suggested in this research introduces a practical strategy of evaluating the effective factors of knowledge management in food exports. [ABSTRACT FROM AUTHOR]