ronak ahmadi

Adjusting the exact warfarin dose has always been challenging since it has a narrow therapeutic window. Numerous factors, including poor drug compliance, drug-drug interactions, and malabsorption syndromes, affect the warfarin plasma concentration, leading to oversensitivity or resistance to warfarin. Patients who need more than 15 mg/d of warfarin for maintained anticoagulant effects are considered warfarin resistant.
We describe a 62-year-old man referred to our center with bruising on his feet in June 2021. The patient had a history of valve replacement (mechanical prosthetic valves in 2013), hypothyroidism, and atrial fibrillation. He presented with warfarin resistance (first noticed in 2013) and did not reach the desired warfarin therapeutic effect despite receiving 60 mg of warfarin daily.
Upon admission, the patient was on warfarin (100 mg/d) with an international normalized ratio (INR) of 1.5. He underwent laboratory and molecular genetic tests, which showed no mutation in the CYP2C9 and VKORC1, the genes associated with warfarin resistance.
A stepwise diagnosis is required to identify the underlying cause. Assessing the patient’s compliance, drug history, dietary habits, malabsorption diseases, and genetics may be necessary. We evaluated these possible reasons for resistance and found no correlation. The patient’s warfarin intake was monitored closely to reach the INR therapeutic target of 3-3.5. He decided to leave the hospital with personal consent. He was discharged with a cardiologist referral and 24 warfarin tablets daily (120 mg/d) with an INR of 1.8. The patient was followed up 6 months and 2 years after discharge and was on the same daily dose of warfarin as at discharge, with no complications.

The future of human life depends on a better understanding of the factors that lead to satisfaction. Social capital is one of the factors that can grow through the exchange of knowledge and experience and communication with others and be effective in promoting the satisfaction of local communities. Effective and efficient implementation of rangeland rehabilitation programs using a participatory approach also raises issues and problems for policy makers and managers that require a general approach to solving them. This study emphasizes the mediating role of social learning in the interaction of participation and trust in rangeland farmers' satisfaction with the implementation of rangeland management projects in Mazandaran summer rangelands and ends with the modeling process.

The study method is a survey and the statistical population studied includes rangers of 11 customary systems with 136 people in the summer rangelands of Mazandaran province in which rangeland management projects have been implemented in 1397. The sample size was determined using Cochran's formula of 100 people. Data were collected by stratified random sampling method using a Likert scale (structured) questionnaire. Data analysis was performed using SPSS22 and Smart PLS3 software. The apparent and content validity of the research tool was confirmed using the collective opinions of experts related to the research topic. Also, the values obtained from Cronbach's alpha, combined reliability and mean variance extracted for different sections of the questionnaire were acceptable. In order to test the conceptual model of the research, structural equation modeling of reflective model type (for arrows from structures to items) based on the partial least squares method has been used. The values observed on the path between the structures (hidden variables) with each other are called the path coefficient and show the correlation coefficient of the two structures or the standardized regression beta. This method is a very powerful and general technique of multivariate regression or general linear model expansion, and external and internal models examine the relationship between overt and covert variables.

The results of path analysis with Smart PLS3 software showed that all three indicators (trust, participation and social learning) have a positive and significant effect on the satisfaction of rangers with the implementation of rangeland plans and are able to 85% of the dependent variable changes ( Explain the satisfaction of ranchers). The trust variable has a direct effect of 0.303 and the participation variable has a direct effect of 0.598 on satisfaction. But because of the mediating role of social learning, they have more effects on satisfaction; Thus, the indirect effect of trust on satisfaction due to the mediating role of social learning (0.608 * 0.561) is equal to 0.341 and more than the direct and unmediated effect of social learning, ie 0.303. In general, the effects of trust (0.644), ie directly in addition to the indirect effect, are stronger than the effect of trust on satisfaction alone (0.303). Also, the indirect effect (through the mediating role of social learning) of participation on satisfaction (0.608 * 0.329) is equal to 0.000, which is less than its direct effect (0.598), but in general, the effects of participation on Satisfaction (0.798) which is obtained by combining direct and indirect effects of social learning on satisfaction is greater than the effect of participation alone (0.598) on satisfaction, so it can be concluded that social learning plays a role. There has been an improvement in increasing the total effects of independent variables on the dependent variable.

In this study, social learning through the sharing of information and relationships between rangelanders prepares the necessary ground for knowledge transfer and by increasing the indicators of social capital among rangeland ranchers in Mazandaran summer rangelands in which in 1397 Were implemented; Improving manpower productivity and increasing ranchers' satisfaction. Indicators of social capital express different conditions and characteristics governing the actions and performance of rangelanders in the implementation of rangeland projects that have many effects on their satisfaction. Therefore, it can be said that the richer the relationship of ranchers in the implementation of projects, the higher their satisfaction with the performance and implementation of projects.

Effective and efficient implementation of rangeland improvement and rehabilitation programs using a participatory approach will raise issues and problems for policy makers and managers requiring a general approach to solve them. This type of management is often related to the pattern of social relations between ranchers in the structure of different management systems governing on rangelands. The purpose of this study is to analyze the social network of ranchers in terms of participation related to the implementation of rangeland activities and compare it in the management systems of private exploitation, collective and council in the Delarstaq rangelands of Amol. In this research, using a network analysis questionnaire and a direct interview, the link was examined between participation in the implementation of rangeland management plan. According to the research findings, the rates of density, reciprocity and transitivity indices in private exploitation management system are higher than collective and in common management system are higher than the council. However, the average geodetic distance index and network centrality indices in group management systems (collective and council) were higher than the private exploitation management system, which indicates less participation, cohesion and integration of the ranchers in group management systems. Therefore, considering the discovery of social gaps in the participatory network of group management systems, modifying the structural pattern of social relations in these systems before the implementation of the desired programs is one of the basic and necessary measurment for successful participatory management in these areas.

Heart failure (HF) is one of the most prevalent and debilitating diseases of the current era, which is the leading cause of high mortality rates in human. This study aims to investigate the simultaneous effect of crataegus supplementation and a 4-week cardiac rehabilitation program on ejection fraction (EF), blood pressure (BP), heart rate (HR), and functional capacity in patients with heart failure. 30 patients with heart failure (EF between 10 to 30%) with an average age of 50 to 75 voluntarily participated in the present study and randomly divided into three equal groups (n = 10), crataegus+exercise (cr+e), crataegus (cr), and control (c) groups. The cr+e and cr groups received the crataegus extract for one month. cr+e group did rehabilitation exercises for one month. The c group had their usual lifestyle and treatment without any regular exercise or supplement. Before and after the project, all subjects were tested for vital signs, (electrocardiogram) ECG, echocardiography, and a 6-minute walking test (6MWT). The findings showed a significant increase in EF in the cr+e group after 4 weeks (p <0.00). Results of 6MWT increased after 4 weeks in cr+e and cr groups (p <0.05) and BP and HR was improved in both groups. Results indicate that 4 weeks of exercise program along with crataegus supplement will lead to the reduction of heart risk factors in patients with heart failure by increasing the contractile strength of the heart, lowering blood pressure and improving functional capacity.

The aim of this study was to identify factors influencing participation of landholders in the the rehabilitation and restoration of Choqakadoo rangeland in the city Sarpolzahab province of Kermanshah The aim of the research, applied research methodology, causal correlation. In addition to data processing descriptive statistics and correlation, multiple regression and path analysis method of inferential statistics were used. The results showed that the correlation coefficient attend public hearings, cordial relations with its neighbors, dominating the promoters on technical topics, providing extension services in the field of rehabilitation and restoration of rangeland, over responsibility for part of the program into landholders, membership in local organizations, familiar of landholders with and participate in training courses and promotional programs most of solidarity with the participation of landholders in the rangeland rehabilitation and restoration. Enter regression methods on variables including background indicate that their level of education, the most direct and positive effects (0/281) and the most positive effect and total (0/357) on the participation of landholders, also number of livestock, number of dependents and income are next in priorities. Among the variables including background age and years of exploitation has a negative effect (-0/482 , -0/468) on landholders' participation in the rangeland rehabilitation and restoration. So pay particular attention to these factors can be placed on the agenda of managers and planners and more participation of landholders in areas of rehabilitation and restoration of rangelands, provide in every area.

The aim of this study was to investigate the factors affecting the beneficiaries' economic recession in the BolbanAbad Rangelands. The statistical population of this study was 400 beneficiaries in the BolbanAbad Rangelands. The sample size of this study was determined to be 196 rangeland beneficiaries by using Krejcie and Morgan table. A random sampling method was used to select the samples. The tool used to collect data and information was a questionnaire. The validity of the questionnaire was confirmed by rangeland experts and its reliability was confirmed by Cronbach's alpha coefficient. Data were analyzed by SPSS software version 22. The results of Spearman correlation test showed that economic factors had the highest correlation with the beneficiaries' economic recession. In addition, the results of factor analysis showed that among the economic factors, the lack of job diversification with a coefficient of 0.912; among the management factors, the limitation of credit transfer to low-income beneficiaries to reduce the income dependency with a coefficient of 0.885; among the environmental factors, the traditional livestock vulnerability due to drought and forage deficiency with a coefficient of 0.893; and among the social factors, the distrust between the beneficiaries in collaborative activities with a coefficient of 0.910 had the most impact on the beneficiaries' economic recession. Also, the results of the path analysis showed that the most direct and total effects were related to economic factors and the most indirect effect was related to management factors.

In this study, the relationship between different levels of trust including basic trust, interpersonal trust, institutional trust, and generalized trust with the participation of rangeland beneficiaries in rangeland rehabilitation and reclamation projects was investigated. The survey instrument was a questionnaire. The statistical population included all rangeland beneficiaries (78 people) in Choghakadoo, Sarpolzohab. The sample size was determined to be 67 people using Cochran's formula. Stratified random sampling was used to select the samples and SPSS20 software was used to analyze the data. The results of this study showed that there was a positive and significant correlation between different levels of trust with the participation rate of rangeland beneficiaries in rangeland improvement and reclamation and the correlation between the generalized trust and the participation of rangeland beneficiaries was stronger. Furthermore, in this study, 34 indices of different levels of trust were reduced to 12 factors by the factor analysis method, totally explaining 36/71% of variation in dependent variable (participation in rangeland improvement and reclamation. Generalized trust could be named as the first and most influential factor in this method. Therefore, considering the effect of different levels of trust in the participation of rangeland beneficiaries, it can be stated that the increased generalized trust, which is one of the dimensions of outgroup social capital, will result in increased efficiency of the participation of rangeland beneficiaries in range improvement and reclamation as compared with other levels of trust.

The presence of pericardial effusion (PE) in the setting of infective endocarditis (IE) may be a sign of more severe IE. In this study, we aimed to determine the prevalence and prognostic significance of PE in patients with native valve IE.
The Iranian Registry of Infective Endocarditis (IRIE) is a single-center observational hospital-based study of patients with IE. Between 2002 and 2015, all patients with a diagnosis of IE who had been enrolled in the IRIE were evaluated.
A total of 445 patients (68.3% male) were enrolled in this registry, and 221 (49.7%) patients had PE. PE was more prevalent in the patients with native valve IE and those with right-heart involvement (65% in right-heart IE vs 50% in left-heart IE; P=0.002). The rate of in-hospital mortality was 20% and 19.2% in the patients with and without PE, respectively, and the presence of PE was not a predictor of in-hospital death in our multivariate analyses. Additionally, there was no relationship between the rates of IE-related complications and the severity of PE. However, the prevalence of PE was higher in the patients with right-sided IE as well as in those with aortic root abscess and systemic emboli at presentation.
The prevalence of PE in the setting of IE was relatively high in the present study. Most cases of PE had mild effusion, and there was no relationship between the severity of PE and IE- related complications as well as in-hospital mortality.

Today, rehabilitation of rangelands in terms of range management plans is an important step towards sustainable development. It seems that managing any rehabilitation program in rangelands will not be successful without participating the stakeholders. This study aimed to investigate the factors influencing participation of stakeholders in range management plans and evaluate the performance of biological operations in terms of range management plans in summer rangeland of Sjadrud watershed basin. For this reason, research had done in two parts; qualitative research (questionnaire) and quantitative (field operation) in 6 saman with or without range management plan. The questionnaire was conducted 117 stockholders, 34 indicators using factor analysis. Quantitative part evaluated for investigating the effectiveness of biological treatments in estimating and comparing forage production and canopy cover in the sites. In order to ensure the integrity of the variables and their suitability for factor analysis, KMO and Bartlet tests were used. Results showed that after carrying out biological operations production had increased in total sites. But the difference was not significant. KMO coefficient were 0.781 and Bartlet coefficient were 81.23 with 99 percentage meaningful level. results showed that economic, social, environmental and executive factors determined 81.68 percentage of stakeholder's participation in biological treatments.

The correct and efficient management of rangeland ecosystems requires sufficient knowledge of the grazing intensity and its effect on the characteristics of different plant species in the rangeland this study was designed to compare three types of managing excluding grazing, moderate grazing and heavy grazing in Choghakadou winter rangeland. Systematic-random sampling was performed in each grazing site. In each grazing site randomly deployed three transects 100 meters along each transect, 10 plots of one square meter at a distance of 10 meters were placed. Features included: production, canopy cover, vegetative forms (grasses, forbs and shrubs), life forms (Chamaephytes and Hemicryptophytes¡ Therophytes and Cryptophytes), palatability (Class I (palatable), class II (good) and class III (non palatable)), indicators of richness (Margalef and Menhinic) and diversity (Shannon-Wiener and Simpson), respectively. Data analysis was performed in SPSS20. Comparing the features of species composition and diversity index and richness between sites with different grazing intensities was done by Duncan test. The results of the diversity and richness indices are computed showed that the numerical value of the index on intensive grazing enclosure highest on the lowest values. Duncan statistically significant difference between the three sites in terms of the diversity of the statistical level of one percent difference proved. Site excluding grazing characteristics is include Hemicryptophytes, Cryptophytes, plants Class I, perennial grasses and forbs. It also features moderate grazing site were including abundance of Class II plants and heavy grazing site features of also were include annual grasses, therophytes, shrubs and plants class III. In general, grazing reduces the richness and diversity of vegetation, so the negative effect on ecosystem stability, require attention of range managers.

Efforts to identify and address the factors underlying the lack of participation of ranchers in rehabilitation and restoration of rangelands constitute an essential step towards sustainable development. Many areas of natural resources such as rangelands have been affected by mining operations which has consequently various economics, social, ecological and environmental influences on the local residents. Therefore, the present study aimed to assess the effects of mining projects in this regard in Sanandaj. Analysis of the data was performed through multiple regression (stepwise method) by spss20. The results indicated that the lack of participation among the majority of the ranchers (59.2 %) was at average and above average. On the other hand, there was a significant positive correlation (p