Unhealthy diets contribute to the increasing burden of non-communicable diseases. Annually, over 11 million deaths worldwide are attributed to dietary risk factors, with the vast majority of deaths resulting from cardiometabolic diseases (CMDs) including cardiovascular disease (∼10 million) and type II diabetes . As such, defining diets and dietary patterns that mitigate CMD risk is of great public health importance. Recently, the consumption of fermented foods has emerged as an important dietary strategy for improving cardiometabolic health. Fermented foods have been present in the human diet for over 10,000 years, but knowledge on whether their consumption benefits human health, and the molecular and microbiological mechanisms underpinning their purported health benefits, is relatively nascent. This review provides an overview of the definitions of fermented foods, types and qualities of fermented foods consumed in Europe and globally, possible mechanisms between the consumption of fermented foods and cardiometabolic health, as well as the current state of the epidemiological evidence on fermented food intake and cardiometabolic health. Finally, we outline future perspectives and opportunities for improving the role of fermented foods in human diets. For millennia, fermentation has been used as an effective method of food preservation and alcohol production . Fermentvia the actions of fermentative microorganisms. Microorganisms naturally present in the raw food matrix or the surrounding environment can initiate “spontaneous” fermentations, such as during the fermentation of cocoa beans using indigenous yeasts, lactic acid bacteria (LAB), and acetic acid bacteria (AAB) (All fermented foods are procured ia (AAB) . Howeveria (AAB) . Advanceia (AAB) .While the consumption of fermented foods tends to be synonymous with consuming a “dose” of live microorganisms, this is not always the case. The presence of live microorganisms in the ready-to-consume product is dependent on several factors: the phase of the fermentation , whether the fermented food is heat-treated or if the microorganisms are intentionally removed , as well as personal food preferences  . These fIn Western societies, the resurgent interest in the consumption of fermented foods can be credited to the explosion of research into the human microbiome , 8. SeveThe diversity of microorganisms found in fermented foods produced globally, as well as their functional properties, have been the subject of several comprehensive reviews , 15. Pri5–107 colony forming units (CFU) of LAB/(mL or g), with cultured dairy products containing up to 109 CFU/(mL or g). However, considerable variation was observed based on geographical region and sampling time, in addition to the manufacturing, processing, and storage conditions (4 CFU/g), medium (104–107 CFU/g), and high (> 107 CFU/g). They found that over 50% of children and adults were consumers of foods containing high levels of live microorganisms, and that the proportions of people consuming live microorganisms and per capita intake increased significantly over time  are designated as goods with “specific geographical origin” in the EU and have distinct historical and cultural significance . SeveralIn a recent quantitative evaluation of food lists from food frequency questionnaires and 24-h recalls, it was determined that approximately 20% of the Dutch adult diet comprises fermented food items . These eLactobacillus, Lactococcus, total yeast, and Candida in the gut, which was strongly correlated with upregulated expression of fatty acid oxidation genes  in both hepatic and adipose tissues. Reduced plasma levels of the pro-inflammatory cytokine IL-6 and down-regulation of the inflammation gene MCP1 in adipose tissue was also observed. Evidence from several human trials also support a promising role for certain probiotic strains (primarily Lactobacillus) on weight maintenance, adiposity, obesity, and cholesterol levels, although further evidence is needed for their clinical relevance , which could modulate multiple metabolic signaling pathways to improve overall cardiometabolic health. Many fermented foods are produced using LAB, which generates lactic acid, short-chain fatty acids, bioactive peptides, and polyamines with potential effects on cardiovascular, immune and metabolic health , 54. Fereic acid .n = 34,409)  , total bn = 136,384, 21 countries, five continents)  showed that higher intakes of milk were associated with an increased risk of myocardial infarction  and type II diabetes  in men, but not women  study (tinents)  showed tot women . Intakesot women –65, hypeot women –70, bodyot women –76, typeot women , 77, 78,ot women  showed wot women . The strot women .Several other fermented foods whereby live microorganisms have been inactivated or removed  have also been investigated for their effects on CMD risk. Due to the abundance of literature on these foods, we focused on summarizing the results of systematic reviews and meta-analyses. In terms of coffee, previous prospective studies and meta-analyses did not show associations between coffee consumption and coronary heart disease (CHD) risk , 81. Hown = 15,630 men and n = 25,808 women), Arriola et al.  may be protective effect against CHD, while extremely high intakes have deleterious effects –86. Usina et al.  found tha et al. . Howevera et al. . OverallFor chocolate, multiple meta-analyses have found that consumption of chocolate was inversely associated with CHD, stroke, and type II diabetes; however, effective categories or levels of intake differed among the studies and need to be further clarified, and several aspects of study quality needs to be improved –92.Aside from these abovementioned fermented foods, to our knowledge, no well-designed prospective studies have examined the cardiometabolic health impacts of other fermented food products consumed in European  diets.While a plethora of studies have examined associations between the intake of certain fermented foods  and cardiometabolic health outcomes, closer examination of the methods of these studies reveals limitations and inaccuracies which could obscure the interpretations of the results. In many studies, non-fermented foods have been misclassified as fermented food products. For example, in an association study between fermented dairy intake, diet quality, and cardiometabolic profile, Mena-Sánchez et al.  defined One of the criticisms of population-based studies in nutritional epidemiology is the inability to accurately capture the foods consumed in the diet and their levels of intake, contributing to inconsistent evidence between fermented foods and health, and weakening their potential translation to clinical and public health applications , 97. ComTo circumvent the limitations of self-report dietary measurement tools, researchers have looked to food intake biomarkers (FIBs) as objective measures of dietary intake . The ideThere is a bias in the literature for investigating a narrow list of fermented foods. In a recent systematic review of FIBs of fermented foods, it was shown that the vast majority of studies were conducted for coffee, wine, cocoa, beer, and bread, while only a smattering of other types of fermented foods were represented . For somWhile self-report dietary assessment tools are often perceived to be inaccurate due to response bias and measurement error, their qualities of being non-intrusive and non-resource intensive still supports their use in large population-based studies. In addition, well-designed FFQs can produce valid and reproducible estimates to rank participants according to their levels of intake . Since mIn order for a fermented food-specific FFQ to be effective in accurately capturing the types and levels of fermented foods, researchers must first agree on what foods are considered to be “fermented.” Just recently in 2021, the International Scientific Association for Probiotics and Prebiotics (ISAPP) convened an expert panel to create a common definition for fermented foods , which iFermented food products are complex and multi-faceted. The composition of fermented foods reflects untransformed compounds from the raw food substrate, transformed raw material compounds by the fermentation process, and novel metabolites produced by fermentative microorganisms. Additionally, the presence of live microorganisms (or even inactivated microorganisms which can still be bioactive) presents a unique additional compositional layer , 52. MetFinally, food fermentation could be thought of as a versatile tool to help extend the world’s food supply. Global food and agriculture production accounts for a quarter of the world’s greenhouse gas emissions, and the global population is poised to reach 10 billion by 2050 , 110. WiAdditionally, fermented foods have an important role in promoting a circular economy, by utilizing waste products from the food industry  and generating new, value-added foods . While iFermented foods have been consumed by humans for over 10,000 years, and their renewed popularity in modern diets emphasizes the need to fully elucidate their effects on cardiometabolic health. Although some studies have suggested that the consumption of fermented foods could benefit cardiometabolic health, the evidence is still unclear. This could be partly due to the misclassification of fermented foods, and the use of subjective dietary assessment tools to estimate their intake, in large epidemiological studies. Several future research directions could help disentangle the relationships between fermented foods and cardiometabolic health: improving the dietary assessment of fermented foods (through identification of FIBs and development of a fermented food FFQ), better understanding the composition of different fermented food products, and exploring the role of fermented foods as part of healthy, sustainable diets.KL wrote the original draft of the review and prepared the figures and tables. EB-B, KB-P, GV, and EF critically reviewed the manuscript. All authors contributed to the study concept, and read and approved the final manuscript.


Trends in individual inbreeding were significantly positive in meat and mountain sheep, but trends in the individual rate of inbreeding were only slightly positive. Country sheep showed significantly negative trends in the rate of individual inbreeding. Ancestral inbreeding had increasing trends in all sheep breeds. Our results demonstrate the efficiency of genetic diversity management and should help to conserve endangered breeds and maintain high genetic diversity in breeds used for wool, meat, and milk production.Sheep breeding is a long-standing tradition throughout Germany. Due to breeding in marginal and harsh sites, sheep developed into a large number of unique breeds adapted to many different ecosystems. In this work, we study demographic measures of genetic diversity and inbreeding trends in 35 sheep breeds using the national database of herdbook breeders in Germany. This database is a valuable resource to manage and monitor diversity in breeding populations. The loss of genetic diversity was found in all breeds studied, mainly due to genetic drift rather than unequal use of founders. The analysis of pedigree data from more than 1.4 million sheep revealed an overall measure of inbreeding of F = 0.031, an individual rate of inbreeding of ΔFi), and realized effective population size across breeds were 0.031, 0.0074, and 91.4, respectively, with a significantly decreasing trend in ∆Fi in 11/35 breeds. New inbreeding, according to Kalinowski, contributed to 71.8% of individual inbreeding, but ancestral inbreeding coefficients showed an increasing trend in all breeds. In conclusion, in our study, all but one of the mountain-stone sheep breeds and the country sheep breed Wald were the most vulnerable populations, with eN < 50. The next most endangered breeds are exotic, country, and heath breeds, with average eN of 66, 83, and 89, respectively. The wool, meat, and milk breeds showed the highest genetic diversity, with average eN of 158, 120, and 111, respectively. The results of our study should help strengthen conservation program efforts for the most endangered sheep breeds and maintain a high genetic diversity in all sheep breeds.In Germany, many autochthonous sheep breeds have developed, adapted to mountain, heath, moorland, or other marginal sites, but breeds imported from other countries have also contributed to the domestic breeds, particularly improving wool and meat quality. Selective breeding and the intense use of rams may risk losing genetic diversity and increasing rates of inbreeding. On the other hand, breeds with a low number of founder animals and only regional popularity may not leave their endangered status, as the number of breeders interested in the breed is limited. The objective of the present study was to determine demographic measures of genetic diversity and recent as well as ancestral trends of inbreeding in all autochthonous German sheep breeds and sheep of all breeding directions, including wool, meat, and milk. We used pedigree data from 1,435,562 sheep of 35 different breeds and a reference population of 981,093 sheep, born from 2010 to 2020. The mean number of equivalent generations, founders, effective founders, effective ancestors, and effective founder genomes were 5.77, 1669, 123.2, 63.5, and 33.0, respectively. Genetic drift accounted for 69% of the loss of genetic diversity, while loss due to unequal founder contributions was 31%. The mean inbreeding coefficient, individual rate of inbreeding (∆F Sheep are one of the oldest domestic animal species in the world, and were bred long ago for their robustness, frugality, and adaptability to climatic conditions and a changing food supply. The most important breeding characteristics were milk, wool, and meat. Breeding has resulted in a very wide variety of breeds, especially in Europe, with varying degrees of adaptation to landscape and climatic conditions ,2. IntenHowever, due to the production system and the associated selection pressure, many of these breeding successes correlate with a decrease in the biodiversity of animal genetic resources, especially in the livestock sector, including the sheep sector ,4. The gSelective breeding is expected to reduce the fitness of animal populations through its negative effects on genetic diversity, especially in small, closed populations. The reduction in fitness caused by intensive selection for production traits is more pronounced in random mating systems due to more frequent mating between close relatives ,12. TodaThe development of sound genetic conservation strategies for livestock species requires, as a first step, the monitoring of existing genetic diversity within and between breeds. The availability of sufficient genetic variation in a given population provides the basis for sustained genetic improvement in economically important traits and facilitates adaptation to changing environmental conditions ,18. In tFor our analysis, we used the pedigree data of 1,435,562 sheep from 35 different sheep breeds. The reference population were sheep born between 2010 and 2020 and included 981,093 animals . PedigreEstimates of demographic measures of genetic diversity were obtained for the respective reference populations of each breed using the PEDIG software . Data edf), number of effective founders (ef), effective number of founder genomes (gf), effective number of ancestors (af), and the ratios ef/f, af/ef and gf/ef [f = number of founders, a = number of ancestors, kq = probability of gene origin of the individual ancestor (k), and kr = expected proportion of founder alleles that have been kept within the descendant population, marginal genetic contribution of an individual ancestor (jq).In brief, we calculated the number of equivalent complete generations (GE) to determine the degree of completeness of the pedigrees in the total dataset  as well nd fg/fe ,23 basedGD) resulting from unequal contribution of founders and genetic drift [In addition, we derived the amount of genetic diversity  due to an unequal contribution of founders was:The amount of genetic diversity , ancestral inbreeding coefficients according to Ballou [a_Bal), ancestral  and new (FNew) inbreeding coefficients according to Kalinowski et al. [inbred).We estimated individual inbreeding coefficients (F) according to Meuwissen and Luo  using PEo Ballou  i et al. , and anci et al.  using GRi et al. ,29. In tWe calculated the degree of deviation of random mating from Hardy–Weinberg proportions as the indicator of genetic substructure by comparing the average coancestry within the parental population (Φ) with the average coefficient of inbreeding according to Meuwissen and Luo  in the ri) was adjusted to GE according to Gutiérrez et al. [The individual rate of inbreeding  was derived from the mean ΔFi  and dams (NeffD):is (or id) is the relative frequency of use of the sire or dam i among all sires (or dams) in the reference population [The unbalanced use of male and female breeding animals is expressed by the effective number of sires  to 11 (=2020). Pearson correlation coefficients among the different coefficients of inbreeding were calculated using SAS. In addition, we calculated Pearson correlation coefficients for individual and ancestral inbreeding coefficients between offspring and parents, as well as between both parents, using SAS.f), effective number of founders (ef), effective number of founder genomes (gf), and effective number of ancestors (af) across all breeds were 1668.9, 123.2, 33.0, and 63.5, respectively. Median values of ef, gf, and af were 99.8, 25.6, and 53.6, respectively (ef (52.9–156.8), gf (18.0–42.1), and af (36.6–76.6). The maximum number of founders was found in German Mutton Merino with 8500 and the minimum in Black Mountain with 161. The highest number of effective number of founders was in Suffolk with 477.7 and the lowest in Alpine Steinschaf with 24.1. The most effective number of founder genomes were in Suffolk with 125.6 and the lowest in Black Mountain with 10.7. The highest number of effective number of ancestors was Suffolk with a value of 225.6 and the lowest was Black Mountain with 15.3.The number of animals in the pedigrees and the reference population as well as GE, GI, number of founders, effective number of founders, effective number of founder genomes, and effective number of ancestors for each of the 35 sheep breeds are shown in ectively . Within e/ff, a/fef, and g/fef, were less than 1, which is indicative of bottlenecks, drift, and unequal use of founders in all breeds (e/ff ranged from 0.03 (Dorper) to 0.296 (Swifter). Outside the first and third quartiles from 0.06 to 0.14 were 18/35 breeds. Ratios of a/fef ranged from 0.28 (German Mutton Merino) to 0.95 (Baraka). Within first and third quartiles (0.47–0.63) were 16/35 breeds. The ratios of g/fef had the lowest value in German Mutton Merino with 0.13 and the highest in Baraka with 0.60, and 17/35 breeds were within the quartiles (0.22–0.39).All ratios of l breeds . Ratios In addition, we calculated how many ancestors explained 30/50/70/90/95% of the genetic diversity in the different sheep breeds . The meaGD*) was 0.0066 on average across all breeds  was 0.0141 and ranged from 0.0029 (SUF) to 0.036 (WGH) among all breeds. The lower quartile was at 0.0095 and the upper quartile at 0.0176, including 17/35 breeds. The loss of genetic diversity caused by genetic drift was, across breeds, on average, higher, as opposed to losses due to unequal founder contributions. Relative loss of genetic diversity resulting from genetic drift reached 69.4% on average for all breeds, whereas unequal contributions of founders were responsible for a relative loss of 30.6% of the genetic diversity (The mean loss of genetic diversity due to genetic drift (iversity .gd) are identical to F, they are not provided. Inbred animals had higher inbreeding coefficients with an overall mean of 0.051 and a range from 0.018 (MLW) to 0.100 (IDF). The proportion of inbred animals varied from 0.113 (CHA) to 0.953 (RPL), with an average of 0.660. The comparison of the degrees of parental coancestry (Φ) and average individual coefficients of inbreeding within the respective reference population for each breed yielded a range from 0.0007 (MLW) to 0.0538 (WAD), with an overall α-value of 0.0160. With exception of the breed WAD, all breeds were within the upper and lower whisker (The different measures of inbreeding are shown in  whisker .i) were on average 0.0074, with a range from 0.0028 (MLW) to 0.0210 (GBS). Realized effective population size (eN) varied from 23.83 (GBS) to 179.16 (MLW), with an average of 91.35. We identified five breeds with eN values < 50, fifteen breeds with eN values of 50–100, and fifteen breeds with eN values > 100. The distribution of breeding directions in sheep breeds were significantly different when subdivided by eN values. All merino and milk sheep breeds and all but two of the seven meat sheep breeds reached eN values > 100. Most of the country sheep breeds (4/7) exhibited eN values of 50–100, two breeds  had eN values > 100 and one breed (WAD) had a eN value < 50. Among the mountain-stone sheep, breeds with eN values < 50  and eN values of 50–100  were equally represented. All but one of the four heath breeds (GGH with eN >100) had eN values of 50–100. The exotic breed NOL, had a eN value < 50, three exotic breeds had eN values of 50–100, and BDC had a eN value >100.Estimates of the individual rate of inbreeding  and 0.046 (WAD). The mean Fa_Kal 0.009 ranged from 0  to 0.033 (WAD). Ancestral inbreeding coefficients AHC and Fa_Bal were higher than classical inbreeding coefficient F. AHC, with an average of 0.09, ranged from 0.005 (CHA) to 0.261 (OUS). The mean Fa_Bal was 0.082, with the minimum value of 0.005 (CHA) and the maximum of 0.19 (OUS).New inbreeding, according to Kalinowski , is highi and eN and a_Bal, Fa_Kal, Fa_New, and AHC. The linear regression coefficients on birth years within breed with their p-values are provided in i, trends were significantly negative in 11/35 breeds  and slightly positive but not significant in 12/35 breeds. For eN, trends were significantly negative in 1/35 breeds (CHA) and significantly positive in 2/35 breeds . Time trends for Fa_Bal and AHC were positive in all breeds and the linear regression coefficient was significant in 30/35 breeds. Significantly positive trends were found in 17/35 breeds for Fa_Kal and significantly negative trends in 3/35 breeds, whereas for Fa_New, significantly positive trends were found in 5/35 breeds and significantly negative trends in 7/35 breeds.Trends over birth years by breed are shown for F in all and inbred animals, as well as proportion of inbred animals, in f, ef, gf, and af, the lowest losses due to drift and unequal contributions from founders, the lowest value for α, the lowest individual rate of inbreeding, and the largest eN. In contrast, mountain-stone sheep showed the lowest f, ef, gf, and af, the highest losses due to unequal contributions from founders, the highest individual rate of inbreeding, the lowest eN, and the lowest effective number of sires and dams.We assigned the breeds to their breeding directions and tested whether significant differences could be found in demographic measures of genetic diversity and inbreeding coefficients . Merino,n = 18/35) were within the first and third quartile of the boxplot, and three breeds were outliers . The maximum effective number of dams was found in German Merino, German Blackhead Mutton, and German Mutton Merino with 6870.4, 4229.4, and 3949.2 animals, respectively. The lowest effective number of dams, with 83.7, was seen in the Black Mountain  to 263.8 (SUF) and from 6.5 (LAC) to 123.1 (TEX), respectively . Within a_Bal and AHC had correlations with ΔFi close to zero.Pearson correlation coefficients across breeds among the different inbreeding coefficients and proportion of inbred animals were highly positive . The indf), effective number of founders (ef), effective number of founder genomes (gf), and effective number of ancestors (a)f per breed, inbreeding coefficients, individual rates of inbreeding, Fa_Kal, and Fa_New significantly decrease   and the e/ff, g/fef, and a/fef < 1 indicate the loss of genetic diversity since the founder generation. All breeds had ratios <1, and e/ff was, on average, the smallest ratio in all breeds, while a/fef was the largest. A similar distribution was also found in French sheep breeds [e/ff <1, was more obvious in merino (0.042) and heath sheep (0.069) than in milk (0.175), exotic (0.166), and mountain-stone (0.123) sheep breeds. In exotic and mountain-stone sheep, e/ff may be related with shorter historical pedigree records and, therefore, overestimated [e/ff estimates in previous reports were 0.09 in Roussin de la Hague, Charmoise [e/ff <0.09 in 17/35 breeds. One possible explanation for this result is that in the OviCap database, important founders could be traced back over 15 generations, in some cases even more. Relative loss of genetic diversity due to drift was much more important in all breeds, with the exception of GBS and NOL. In these breeds, losses due to unequal founder contributions were larger compared to losses due to genetic drift.In agreement with previous reports , ratios p breeds , Afsharip breeds , Nellorep breeds , Iran-Blp breeds , and Irap breeds , but notp breeds , Kermanip breeds , Iranianp breeds , and Swep breeds . The unestimated . The lowharmoise , Bharat harmoise , and Iraharmoise . In contg/fef ratios of 0.131, 0.165, and 0.166, respectively. The French breeds Roussin de la Hague (0.14), Romanov (0.15), and Charmoise (0.17) had similarly low g/fef ratios and, thus, high losses of founder genomes [a/fef below the first quartile (0.472). All breeding directions were represented among these breeds with a/fef <0.472. The merino breed MFS had the lowest a/fef ratio of 0.281, followed by the exotic breed ZWS (0.381) and the heath breed GGH (0.383). In Valachian sheep, an even lower a/fef ratio of 0.25 [The merino breed MFS, the heath breed GGH, and the milk breed OMS showed the largest drift-related losses in our study, with  genomes . Severe moise 0.1 had simied ZWS 0.1 and thee/ff, g/fef, and a/fef, as well as the individual rate of inbreeding and realized effective population size. Particularly, breeds with small population sizes have to control the number of progeny per sire in order to avoid popular sire effects with negative consequences of an increase in individual rate of inbreeding and decrease in realized effective population size. De Vries showed with a simulation study that it is essential to have a low ram-to-ewe ratio to maintain genetic diversity [i decreased and, thus, inbreeding rates could be restricted by means of targeted mating [If there is evidence of genetic bottlenecks, as was the case in our study for all breeds studied, the effective number of sires and dams should be reviewed. The numbers of effective sires and dams estimated for each breed and birth year strongly correlated with the number of founders, effective number of founders, founder genomes and ancestors, and the ratios iversity . Furtherd mating . Ghafourd mating .New of the animal with the measures of ancestral inbreeding between the dam and sire were close to zero, indicating that new inbreeding in the offspring was not associated with ancestral inbreeding in the parents.We found no evidence of line breeding or a significant increase in inbreeding in offspring of already inbred parents, as correlations of individual and ancestral inbreeding measures between parents were very close to zero for most breeds . In addiThe negative trends in effective number of sires for merinos, meat, and heath breeds were due to decreasing population size across birth years, with the exception of MLW. For this breed, decreasing population size was not responsible for the decreasing effective number of sires with birth years. For the exotic breeds, the positive trends are related with increasing population size, but for the mountain-stone and country sheep, the positive trends are equally associated with improved management of breed diversity and increasing population size. For COF, the main factor appears to be improved breed management. This was demonstrated by a model extended by a linear regression of population size per birth year within breed.eN from the individual rate of inbreeding (ΔFi) to obtain estimates independent of the number of generations recorded in the pedigree data. Both parameters varied in a wide range, similar to previous studies, and showed similar distributions , g/fef (0.667), ef (−0.531), and loss of genetic diversity due to unequal contributions of founders (0.799). New inbreeding (Fa_New) had a higher impact on ΔFi (0.755) and eN (−0.756) than the classical inbreeding coefficient , because Fa_New had a higher relative contribution to inbreeding. Inverse relationships across breeds were found between eN and a/fef (−0.590), g/fef (−0.529), ef (0.652), f (0.687), and unequal founder contributions (−0.716). In previous reports, we found strong correlations between ΔFi and e/faf (0.873), g/fef (0.747), and g/faf (0.632), and between eN and g/fef (−0.668) and g/faf (−0.549). In the across-breed comparisons of the present study, loss of genetic diversity due to unequal contribution of founders was found to be the most important factor leading to increasing individual rates of inbreeding and smaller realized effective population sizes. The greatest influence on the loss of genetic diversity due to unequal contributions from founders was the effective number of sires and dams. Data from the across-breed comparisons showed that high effective numbers of dams and high numbers of founders, and high effective numbers of sires and high effective numbers of founders were mutually dependent. Our data suggest that breeding organizations and breeders should be concerned with keeping the number of breeding dams and sires high and using dams and sires as equally as possible in breeding programs.In the present study, the parameters most strongly correlated with ΔFeN values in the critical ranges of 50–100 are considered endangered. In the present study, 15/35 breeds and 5/35 breeds were below a eN of 100 and a eN of 50, respectively. The latter five breeds would reach an estimated increase in inbreeding of 25.89% (GBS), 23.06% (SBS), 19.10% (AST), 17.11% (WAD), and 15.95% (NOL) in 50 years and, thus, be above the critical threshold of a 5% increase in inbreeding in 50 years [i were significantly decreasing in GBS, NOL, and WAD and, therefore, we may expect a lower increase in inbreeding rates for these breeds than calculated from the present breed averages. In the breed AST, a slightly negative trend for rate of inbreeding was observed, but for the breed SBS, a slightly increasing trend was observed, which may lead to a lower-than-expected increase in inbreeding in AST, but a higher-than-expected increase in inbreeding in SBS. Only 7/35  and 24/35 breeds are expected not to miss the threshold of 5% and 10% increase in inbreeding in 50 years.Breeds with 50 years . The treeN < 100 can be grouped into imported and autochthonous breeds , and new inbreeding was much more important for individual rates of inbreeding and realized effective population sizes compared to ancestral inbreeding and the classical inbreeding coefficient. Trends for individual rates of inbreeding were negative in 11 of the 35 breeds analyzed, which may demonstrate the efficiency of maintaining breed diversity. However, the large differences in population structure and breeding history in the different breeds makes it necessary to consider the trends for new and ancestral inbreeding and their impact on breed conservation. In addition, we demonstrated significant differences between the different breeding directions. Mountain-stone sheep breeds had the lowest average Ne value with <50, the lowest number of founders and founder genomes, a relatively high coancestry coefficient on average, positive trends for ancestral inbreeding , but negative trends for new inbreeding (Fa_New) and an increasing trend in population sizes and number of effective sires. On the contrary, merino breeds had an average eN > 150 and an expected increase in inbreeding <5% within 50 years, but a negative trend for population sizes and number of effective sires. Annual analyses of demographic data and their trends can be made available through the OviCap national database. This should help to critically review genetic diversity conservation efforts and focus on the most endangered breeds. Along with these analyses, breed associations and breeders can be informed on unequal use of founders and which founder lines are highly threatened and need special consideration in the breeding program. The results of the present study should strengthen the efforts for maintaining the genetic diversity of sheep breeds with a focus on the different ecosystems in Germany.The present study shows the development of demographic measures of genetic diversity and trends of inbreeding for autochthonous sheep breeds and breeds for wool, meat, and milk production in Germany. The across-breed analysis revealed losses of genetic diversity, mainly due to unequal contributions of founders in the past. This parameter had the largest impact in all 35 breeds on new inbreeding (F


IS) and inbreeding coefficient within chicken ecotypes were 0.239, 0.267 and 0.243, respectively. Analysis of the molecular variance revealed that 77% of the total genetic diversity was attributed to within-population variation and the remaining 1% and 22% were attributed to among-regions differentiation (FST) and among-individual differentiation (FIT), respectively. The highest pairwise genetic distance (0.026) was found between the local Konde ecotype and those from the Centre-North region while the lowest distance was observed between local chickens from the Sahel and the Centre-North regions (0.003). Neighbour-joining phylogenetic tree and principal component discriminant analyses confirmed the observed genetic distances between populations. The results show that local chickens in Burkina Faso have a rich genetic diversity with little differentiation between the studied populations. This study provides important information on measures of genetic diversity that could help in the design and implementation of future genetic improvement and conservation programs for local chickens in Burkina Faso.The objective of this study was to investigate the genetic diversity and population structure of local chicken ecotypes from Burkina Faso using microsatellite markers. A total of 71 individuals representing local chicken populations from the Centre-East (18), Centre-North (17), Sahel (18) and South-West (18) were used to estimate genetic diversity indices, population structure and phylogenetic relationships using 20 selected polymorphic microsatellite markers. The number of alleles, mean number of alleles, mean of observed and expected heterozygosity and polymorphic information content were 127, 6.35, 0.391, 0.521, 0.539 and 0.541, respectively. The estimated overall fixation index between loci (F), among populations (F Genetic diversity, a vital resource for the continuous genetic improvement of livestock and poultry species, has received much attention in recent years . Most loBlood samples were obtained from 71 local chickens from four regions of Burkina Faso: Centre-East (N = 18), Centre-North (N = 17), Sahel (N = 18) and South-West (N = 18). One bird was chosen from each of the participating 71 farms. Chicken blood was sampled from farms in at least five communes per region. The description of the local chicken populations has been reported previously [2 (25 mM), dNTPs (2.5 mM), QIAGEN HotStar Tag (5 U/μL), distilled water, direct and reverse non-fluorescently labelled primer pairs (Forward and Reverse) each with a concentration of 10μM and a fluochrome consisting of a FAM, VIC, NED and PET-labelled M13 sequence and genomic DNA (25 ng/μL). Amplification using the BIOMETRAABI9700 thermal cycler  was performed according to the following program: an initial denaturation at 94 °C for 15 min, followed by 35 cycles  and a final extension of 72 °C for 10 min. After amplification, plate rearrangement consisted of multiplexing, i.e., mixing of several microsatellite markers that had been amplified by simplex PCR. This required an adjustment to balance the reaction medium so that all the alleles of the different mixed microsatellite markers can be distinguished. Fragment analysis was performed on an ABI capillary sequencer the Genetic Analyzer 3500 (Applied BioSystems or ABI 3500) . Analysis of migration profiles was performed using GeneMapper 5 software (Applied BioSystems) .which is a tool developed for reading migrated microsatellite profiles on the ABI 3500  was used to determine fragment size and allele identification by comparing them to a known internal size standard.Twenty microsatellite markers were used to assess DNA polymorphism. All markers were among the 30 microsatellites recommended by the International Society of Animal Genetics (ISAG)-FAO for polymorphism assessment . PolymerIT, FST and FIS) were calculated according to the methods presented in Weir [Basic measures of inter- and intra-population genetic diversity, such as total number of alleles, number of effective allele (Ne), allelic frequencies, average number of alleles (Na), observed (Ho) and expected (He) number of alleles, polymorphism information content (PIC), Shannonindex (I),fixation index (F) and Wright’s F-statistics  to establish the phylogenetic tree and dendrogram of the local chicken ecotypes in Burkina Faso using the standard genetic distance of Nei  and the In this study, 127 alleles were detected across the 20 polymorphic markers . The 20 On the other hand, considering the four local chicken ecotypes, the highest Shannon information index, an estimator of the diversity index, ranged between 0.894 ± 0.083 and 1.054 ± 0.086 in Sahel and South-West chickens, respectively . The meaST) between the studied populations ranged between 0.003 and 0.026 (The pairwise estimates of the distances (Fnd 0.026 . The higp < 0.05). Analysis of molecular variance revealed that there was only 1% variation between local Burkina Faso chicken ecotypes and that 22% of the variation is due to differentiation of individuals in relation to the total ecotypes. The greatest variability (77%) was due to within individual variation that was represented by diversity within the population with an overall FIS value of 0.235 (p < 0.001) (IS) was 0.243 for the 20 loci and ranged from −0.136 (MCW locus 0067) to 0.774 (MCW locus 0098) (IT) ranged from −0.123 (MCW0103) to 0.787 (MCW0098 locus) with a mean of 0.267. The mean genetic distance (FST) was 0.036 for the 20 loci and ranged from 0.004 (MCW0103) to 0.120 (MCW0216).The pairwise genetic distance matrix between ecotypes showed no significant genetic distance between ecotypes from the Sahel and Centre-North regions. In contrast, the genetic distance between all other groups was significant (< 0.001) . Based ous 0098) . The oveThe evolution of K value and the unrooted consensus tree obtained using the STRUCTURE software revealed two main groups , with KoThe dendrogram , the neiThe DAPC  showed lThe mean number of alleles 6.35) found in our study is slightly lower than the estimates obtained in five agro-ecological zones of Cameroon (7.09) , using l found inThis study showed that the observed mean heterozygosity of the different chicken populations for the 20 microsatellite loci ranged from 0.078 to 0.635 while the expected and unbiased heterozygosity ranged from 0.101 to 0.727 and 0.104 to 0.750, respectively. Heterozygosity is a well-known measure of genetic diversity. The average Ho, He and uHe values between populations were0.391 (ranged from 0.364 to 0.450), 0.521 (ranged from 0.489 to 0.547) and 0.539 (ranged from 0.506 to 0.567), respectively. Genetic diversity at loci observed in local chicken ecotypes from Burkina Faso is lower than those reported in 52 populations across 22 loci (0.47) , in locaAccording to some authors ,35, lociEstimates of the genetic distance clearly indicate that the main source of genetic diversity between the studied local chicken ecotypes is between individual variation within population. Analysis of molecular variability revealed that the genetic distance between local chickens in the Centre-East (Konde ecotype), Centre-North, Sahel and South-West regions of Burkina Faso was very narrow, and it was largely due to differences within individuals.small genetic distance was reported in local chicken populations from northwestern Ethiopia (0.07 to 0.13)  and KenyOn the other hand, our estimates of genetic diversity were lower than those found for native Bangladeshi chickens (0.29 to 0.58) , and fivNei’s unbiased genetic distance matrices and dendrogram showed that local chickens from the Sahel and North-Central regions were grouped in the same branch. They formed a distinct group with the same origin that revealed their close relationships. The local Konde chickens from the Centre-East region and the South-West region were separated by a node, which means that the Konde chickens constitute a distinct chicken subpopulation with a common ancestor. This clustering results could also be explained by geographic realities, as chickens in the Sahel and Centre-Northregions trace their origin to chickens from neighbouring regions. Konde ecotype chickens and local chickens from the South-West region may have been separated from their common origin in a recent past. The large mixture of local chickens reflected in the phylogenetic tree reflects the high proportion of shared alleles that results from high gene flow between the four ecotypes. The population structure of local chickens in Burkina Faso, characterised by a high level of admixture, has also been observed in other local African chicken populations such as the case in Kenyan , CamerooThis study of local chicken ecotypes from the Centre-East (Konde chicken), Centre-North, Sahel and South-West regions of Burkina Faso based on 20 informative microsatellite loci clearly demonstrated the genetic diversity observed at the phenotypic level. The analysis of the structure of the studied ecotypes revealed three sub-populations. The Konde ecotype chicken is a distinct sub-population with likely common ancestor with chickens from the South-West region, while the local chicken ecotypes of the Centre-Northand Sahel regions form a single population. This study provides important information on the genetic background of local chicken genetic resources in Burkina Faso that could be used for conservation and in potential genetic improvement programs.


Genotype data of 222 individuals and 81,579 SNPs were retained after quality control. The average minor allele frequency (MAF) was 0.20 and the average linkage disequilibrium (LD) level (r2) was 0.67 at a distance of 0–50 Kb. The estimated relationship coefficient and effective population size (Ne) were 0.023 and 86 for the current generation. In addition, we used genotype data to estimate the genetic parameters of the population’s phenotypic traits. Among them, height at hip cross (HHC) and shin circumference (SC) were rather high heritability traits, with heritability of 0.41 and 0.54, respectively. The results reflected the current cattle population’s extent of inbreeding and history. Through the principal breeding parameters, genomic breeding would significantly improve the genetic progress of breeding.Dabieshan cattle (DBSC) are a valuable genetic resource for indigenous cattle breeds in China. It is a small to medium-sized breed with slower growth, but with good meat quality and fat deposition. Genetic markers could be used for the estimation of population genetic structure and genetic parameters. In this work, we genotyped the DBSC breeding population ( Studying the level of genetic diversity within populations can help us understand population productivity, growth, and stability, as well as interspecific interactions within communities and ecosystem-level processes . People China has plentiful ecosystems and abundant cattle resources, including 55 indigenous Chinese cattle breeds. They are reared in specific geographic regions, are widely distributed across China, and possess valuable genetic resources . HoweverThe estimation of the extent of the genome-wide linkage disequilibrium (LD) is vital for the number of markers that are needed in genome-wide association analysis (GWAS), GS, and effective population size (Ne). The availability of high-density single nucleotide polymorphism (SNP) genotyping platforms makes it possible to investigate LD better. The LD between molecular markers reflects the correlation between the genotypes of two markers or the degree of non-random association between their alleles . The difUnderstanding genetic diversity is essential for developing conservation programs in autochthonous breeds, and Ne is one of the most commonly used parameters to assess the loss of genetic diversity per generation and the increase in breeding per generation . Ne refeAn estimation of heritability in populations depends on the partitioning of observed variation into unobserved genetic and environmental factors. Genetic markers can help to estimate heritability in a novel way . Since q2), Ne, and the heritability of body measurement traits in DBSC using GGP 100 K Bovine chip. This information can help us to understand the evolutionary history of DBSC and provide reference parameters for the conservation, selection, and breeding of DBSC.The main purpose of this work is to investigate allele frequency distribution and estimate the extent of LD level  constructed a population, which were randomly selected from the breeding population of Taihu Jiuhong Agricultural Comprehensive Development Co., Ltd., Anhui (Taihu), China. The founders of the breeding population were bought from farmers living around Dabie Mountainous areas since 2014. Genomic DNA was extracted from blood samples using a TIANamp Blood DNA Kit . All the samples of 235 DBSC were genotyped with GGP Bovine 100 K . The principal component analysis (PCA) of the population was analyzed using Plink v1.09 to test the genetic background differences among individuals in the population.p < 10−6), and (4) no variation among the studied individuals were removed. Moreover, individuals with a missingness value >5% were excluded from further analysis. If a SNP pair had r2 > 0.998, only one SNP was kept for the next study pair. Initial data quality control of genotype data were utilized by Plink v1.09 [Only SNPs that were located on 29 autosome chromosomes were considered for subsequent analyses. SNPs with (1) genotype call rate <90%, (2) MAF < 1%, (3) significant deviation from Hardy–Weinberg equilibrium  and body measurement traits. Body measurement traits include wither height (WH), height at hip cross (HHC), diagonal body length (DBL), chest girth (CG), abdomen circumference (AC), waist angle width (WAW), ischial end width (IEW), and shin circumference (SC). The descriptive statistical analysis of each trait was carried out to eliminate the abnormal value (except for three times of standard deviation) before the follow-up analysis. After collecting the original data, the phenotypes were corrected for fixed effects. Fixed effects in the model included gender, farm, and birth year. The significance of fixed effects is shown in the 2 statistic can be used to estimate the extent of LD. We calculated the r2 between SNP pairs with physical distances between 0 and 1 Mb of all autosomes to estimate the extent of LD in Plink v1.9. The decays of LD were analyzed for each of 2.5 kb between SNP pairs with an interval of less than 99,999 SNPs and 1 Mb, and plotted against the distance range. The r2 is the squared correlation of the alleles at two loci [2 within each marker interval is the arithmetic mean of r2 between all the markers within the interval.The rtwo loci  and rangEstimates of Ne were implemented in the GONE software , which uIn this work, the genetic relationship matrix (GRM) between individuals represents the relationship between cattle, which is constructed by the genome array data and calculated with the following formula provided by VanRaden :(2)G=Z ZWe used a restricted maximum likelihood (REML) method to calculate heritability with an animal model and accounted for relationships between animals by using a G matrix. The animal model included random additive polygenic effects, fixed effects, and residuals for all traits. The additive polygenic effects were treated as random and assumed to be mutually independent. The GGP 100 K contains a total of 90,349 SNPs from 235 DBSC, and 81,579 SNPs from 222 DBSC with an average distance of 30.51 kb distributed over 29 chromosomes after quality control. The highest number of SNPs (5082 SNPs) was found on chromosome 1, and the lowest (1523 SNPs) was found on chromosome 25  . The lenThe distribution of MAF of all SNP markers  on autosomes of DBSC are illustrated in The PCA showed that the first two principal components (PC1 and PC2) contributed 3.39% of the marker variation. Most of the population is clustered into one group and some individuals have high dispersion as displayed in The average coefficient of kinship according to the genomic relationship of the whole population was 0.023 by calculating the GRM.2 was calculated for every 2.5 kb) is shown in 2 was 0.70 at the bin of 0–2.5 kb and reached average r2 values of 0.29 for 400–500 kb. The average r2 was 0.50, 0.66, 0.46, 0.37, and 0.29 at an inter-marker distance of 2.5 kb, 30 kb, 50 kb, 100 kb, and 500 kb, respectively. The details of markers and LD (r2) between adjacent markers across autosomes are shown in SNP pairs with an interval of 0–500 kb were selected from the results, and the decay of LD (rDemographic trajectories of up to 200th generations ago for DBSC were inferred in The coefficient of variation of each trait ranged from 6.04% to 19.83% in the population . The hig2) of each phenotypic trait are shown in The estimation of additive variance  was found. A previous study revealed that the average MAF of Chinese indigenous cattle and Simmental cattle were 0.24–0.27 and 0.29, higher than the DBSC in this study [l origin . O’Brien indicus . Howevern = 235) may have less degree of inbreeding.The GRM was calculated based on the genome relationship G matrix construction method that was proposed by Van Raden . CompareMost individuals of the population are genetically similar, shown as a dense cloud in the PCA. Although some individuals genetically diverge, they have an extent of correlation with each other, indicating that they maybe derive from the same population. A large individual variation within the population or the introduction of genetic material of other breeds may be reasons to explain the genetic variation between some individuals in the population.2 and D’ statistics can be used to estimate the extent of LD, but D’ is more sensitive to changes in the effective population size and gene frequency [2 to estimate the extent of LD. This work uses the LD decay analysis up to 500 kb for SNP pairs. The average r2 was 0.50 at a distance of 0–50 kb. The extent of LD is distinct among different cattle breeds. At an inter-marker distance of 10 kb, the average r2 value was 0.53 for DBSC, higher than Angus (0.46) and Hereford (0.49) [Both rrequency . As suchd 0.49) . Lu et ad (0.49)  found th9 . Lu etd (0.49) ,28, whicd (0.49)  or histod (0.49) , which md (0.49) . 2 of LD between markers. However, O’Brien et al. [2 values can reach 0.85 when 55 samples were used for the calculation. According to this, the results of LD evaluation in this experiment were not affected because we used a 100 k chip, which belongs to a medium density chip, and the sample size of this test (n = 235) meets the requirements. The estimate of LD is also affected by chip density and sample size. Reports of SNPs with low allele frequencies tend to underestimate rn et al.  concluden et al.  reportedLD and Ne can be used to investigate the evolutionary history and genetic contents of population. With the development of molecular biology, SNP as an essential genetic marker has been used to estimate Ne . Many LDIn this work, we used REML with an animal model to estimate the genetic parameters of BW and body measurement traits for DBSC. The animal model can maximize the use of phenotype data and gain more accuracy in estimating genetic parameters. Heritability, defined as the proportion of phenotypic variation that is attributable to genetic variation, provides important information about the genetic basis of a trait . GenotypIn this work, the estimated heritability of BW for 235 DBSC by GGP 100 K was 0.37. The estimation of heritabilities could achieve different results using different population sizes and methods of the relationship matrix for the same traits. Saatchi et al.  estimaten = 235). We found GGP 100 K markers with abundant polymorphisms  for DBSC. The population had a low extent of inbreeding. The extent of LD was great, and the decay of LD was slow at the marker distance of 0–500 kb, indicating that there might be a higher ancestral relatedness or historically smaller effective population sizes. The Ne decreased rapidly, meaning species conservation is needed. The phenotypic traits of HHC and SC could provide the references for selection for further breeding of DBSC.In this experiment, we analyzed the genetic diversity of autosomes using the GGP 100 k chip, including the extent of LD, Ne, and heritability in a DBSC population (


The 10-item Obstetric Quality-of-Recovery 10 scale is a validated patient-reported outcome questionnaire that measures the quality of recovery following delivery. This study aims to develop a Turkish version of the Obstetric Quality of Recovery 10 to evaluate its validity, reliability, and clinical feasibility.Term parturients who underwent vaginal delivery or elective caesarean delivery were asked to complete a Turkish version of Obstetric Quality-of-Recovery 10 scoring tool and EuroQol 5-dimension 3L scores  24 hours after delivery. To validate the Obstetric Quality of Recovery 10-Turkish, we assessed validity, reliability, and clinical feasibility and compared it with the EQ-5D-3L questionnaires.r = -0.611) and global health visual analogue scale score (r = 0.652) at 24 hours and discriminated well between good versus poor recovery , respectively). Scores were similar for caesarean and vaginal deliveries, 83 (76-89) and 82.5 (69-90), respectively (P = .5). Twenty-four-hour Obstetric Quality of Recovery 10-Turkish scores did not correlate with any baseline demographic and clinical data parameters. Internal consistency was good , and split-half reliability was very good (Spearman-Brown prophesy reliability estimate = 0.86). Test-retest reliability was excellent (intra-class correlation coefficient = 0.99). No floor or ceiling effects were demonstrated.One hundred parturients completed the questionnaire in 24 hours (100% response rate). Obstetric Quality of Recovery 10-Turkish correlated highly with EQ-5D-3L score (The Obstetric Quality of Recovery 10-Turkish is a valid, reliable, and clinically feasible measure of inpatient postpartum recovery following caesarean and vaginal delivery modes. Obstetric Quality of Recovery-10 is a valid and standardised patient-reported measure.Obstetric Quality of Recovery 10-Turkish was evaluated in Turkish term primipara parturients following caesarean and vaginal delivery modes, and performed well in measures of validity and reliability.Obstetric Quality of Recovery 10-Turkish can be used in Turkish-speaking women to assess postpartum recovery.1 The postnatal period can impact the long-term physical, psychosocial, and emotional health of women and their infants' physical and social development since it is a critical phase in the lives of new mothers.2 Therefore, to improve the global quality of care and optimise the quality of recovery after delivery, defining postpartum recovery by identifying specific domains and patient-reported outcome measures (PROMs) is necessary.4Globally, 140 million women experience childbirth every year in the world.6 developed the "Obstetric Quality-of-Recovery (ObsQoR-11) score," an 11-item obstetric-specific questionnaire, adopted from the QoR-40, which was used to assess recovery following elective and intrapartum caesarean delivery. The ObsQoR-11 questionnaire includes evaluations of patients' physical comfort , pain, physical independence , and emotional status (feeling in control).5 Obstetric Quality-of-Recovery-11 has since been modified to a 10-item version (ObsQoR-10) by Sultan et al8 and Shalev et al9 by combining 2 questions regarding pain into a single item based on patient feedback and validated following all modes of delivery in multiple healthcare settings.Recently, Ciechanowicz et alObstetric Quality-of-Recovery-10 has shown great potential as a PROM to provide a patient-centred, multidimensional, and standardised measure of postpartum recovery. However, ObsQoR-10 has not yet been validated in Turkish, the fifth most spoken language globally. Therefore, we intended to develop and examine the psychometric properties of a Turkish-translated version of ObsQoR-10. We hypothesised that the ObsQoR-10-Turkish would be a valid, reliable, and clinically feasible PROM for assessing postpartum recovery in a cohort of Turkish-speaking obstetric patients.https://clinicaltrials.gov/ct2/show/NCT04729192. Written informed consent was obtained from all participating patients. In this prospective and observational study, we enrolled term obstetric patients ≥ 18 years of age and able to read and understand written Turkish at the University of Health Sciences Konya City Hospital  between May and September 2021.The study protocol was approved on November 11, 2020, by the Ethics Committee of Hamidiye Scientific Researchs of University of Health Sciences Approval E-46418926-050.01.04-(20/442). The study protocol was registered at Inclusion criteria were primiparous patients who had singleton births with ≥38 weeks of gestational age delivering by spontaneous vaginal delivery with or without neuraxial anaesthesia for labour analgesia or via elective caesarean delivery . Women were excluded if they could not read Turkish, refused to participate, or underwent an operative vaginal delivery (either vacuum or forceps delivery).7 to produce a Turkish version. The translation procedure was conducted in 6 steps based on the methods recommended by the EuroQoL group.10 In the first step, 2 independent bilingual translators, 1 experienced with health terminology, translated the English version of the ObsQoR-10 questionnaire to Turkish in a forward translation process. The differences regarding consistency and adequate vocabulary between the 2 translations were blended and compared in the second step to make the first consensus version. Then, in a back-translation process, 2 bilingual native English speakers, unfamiliar with the original version of the ObsQoR-10-Turkish, retranslated the Turkish version into English. In the fourth step, the original and back-translated versions of the questionnaire were compared by a linguist to resolve any inconsistencies. In the fifth stage, cognitive debriefing interviews were conducted with face-to-face interviews involving 10 native Turkish speakers, and ObsQoR-10-Turkish was revised based on feedback regarding question clarity and interviewee understanding. This process resulted in a translated and linguistically validated version of ObsQoR-10-Turkish (Appendix 1).Permission was obtained to translate the ObsQoR-10 questionnaiream and 05:00 pm on weekdays in the postpartum ward. The elements for enhanced recovery following caesarean delivery that our institution uses are listed in Appendix 2. Participants were invited to complete the 2 PROMs, ObsQoR-10-Turkish and EQ-5D-3L ,11 24 hours following delivery. The ObsQoR-10 questionnaire consists of 10 questions that assess the patient-reported quality of recovery in obstetric patients’ postoperative period using an 11-point Likert scale  that points to a minimum score of 0 (worst possible recovery) and a maximum score of 100 (best possible recovery).7We intended to recruit a similar number of patients for caesarean and vaginal deliveries during the study period. Three investigators  assessed the participants following delivery between 08:00 13 Through the interview, participants were also requested to mark their perceived global health state using a global health visual analogue scale (VAS), expressed on a 0-100 scale with 0 and 100 being the worst and best possible health states, respectively.The EQ-5D, one of the most widely investigated and used PROMs worldwide, consists of 5 dimensions of health: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, with 3 options selected by patients .A subset of patients (n = 25) who were enrolled in the study answered the ObsQoR-10-Turkish and the overall postpartum recovery at 25 hours after delivery to evaluate test-retest reliability. Patients and researchers were unaware of the final survey results from the first round of survey administration at the 25-hour mark.General characteristics of patients, including age, American Society of Anaesthesiologists Physical Status (ASA), length of hospital stay , gestation age, body mass index (BMI), mode of the delivery , duration of each stage of labour, peripartum estimated blood loss, maternal, and foetal complications were recorded at the time of enrolment for descriptive purposes.We primarily aimed to evaluate the validity, reliability, and clinical feasibility of the ObsQoR-10-Turkish questionnaire 24 hours after delivery.Validity as a measure of accuracy was assessed by evaluating the following:Convergent validity—ObsQoR-10-Turkish scores compared to the EQ-5D-3L questionnaire and 0-100 global health VAS score within 24 h after delivery.Discriminant validity—comparison within 24-hour ObsQoR-10-Turkish scores of women who had a “good” or “poor” postpartum recovery, defined by global VAS assessment scores of ≥70 versus <70 mm at 24 hours, respectively, and scores of women delivering via vaginal versus elective caesarean delivery.Hypothesis testing—correlation within 24-hour ObsQoR-10 score to the length of hospital stay , and demographic , obstetric factors , and neonatal APGAR scores.Reliability as a measure of consistency was assessed by evaluating the following:Internal consistency of ObsQoR-10-Turkish—measured using Cronbach’s alpha and inter-item correlation tests.Split-half reliability of final ObsQoR-10-Turkish—assessed by evaluating the correlation between random split segments.Test-retest reliability of ObsQoR-10-Turkish—to be assessed in 25% (assigned randomly) of women asked to repeat the questionnaire 60 min later.Floor and ceiling effects of ObsQoR-10-Turkish—assessed by evaluating whether <15% of respondents achieve highest (100) or lowest possible scores (0).Acceptability and feasibility were assessed by evaluating:Recruitment rate of ObsQoR-10-Turkish; percentage of women agreeing to complete the study forms.Successful completion rate of ObsQoR-10-Turkish; the number of correctly completed ObsQoR-10-Turkish forms without missing data.Time taken to complete the ObsQoR-10-Turkish questionnaire; measured with a stopwatch and recorded by the investigator.8 As demonstrated previously, approximately 100 patients are needed to evaluate the psychometric properties of ObsQoR-10 and to demonstrate differences between good versus poor recovery.6 All statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS) version 22.0 . The normal distribution of the variables was examined with the "Kolmogorov-Smirnov test." Data are presented as mean [standard deviation (SD)], median [interquartile range (IQR)], and number (%). Correlations between ObsQoR-10-Turkish questionnaire items and global health VAS scores and correlations between scores and clinical parameters were determined using Spearman rank correlation coefficients (r). Internal consistency was measured with Cronbach's alpha, and split-half reliability was assessed using Spearman-Brown prophesy reliability estimate. Test-retest reliability was measured by intra-class correlation coefficient (ICC). P <.05 was accepted as statistically significant.Previous ObsQoR validation studies guided the sample size for this study.Between May 2021 and September 2021, 128 women were assessed for eligibility for participation in the study . Twenty-The demographic and clinical characteristics of the participants are presented in r = -0.611, P < .001) and global health VAS score  at 24 hours following delivery. The ObsQoR-10-Turkish and EQ-5D individual item scores are presented in Convergent validity: ObsQoR-10-Turkish correlated highly with EQ-5D-3L score (P < .001). Scores were similar for caesarean and vaginal deliveries, 83 (76-89) and 82.5 (69-90), respectively (P = .593).Discriminant validity: The scores of ObsQoR-10 differentiated patients with good and poor postoperative recovery (VAS scores ≥70 vs. <70 at 24 hours). The median IQR ObsQoR-10-Turkish scores of patients who recovered as "good" were 86 (80-90), while those who recovered as "poor" were 68 (59-75) , demographic factors ], obstetric variables , or neonatal APGAR scores .Hypothesis testing: The scores of ObsQoR-10-Turkish did not correlate with LOS . Interitem correlations were 0.416, as presented in Split-half reliability of ObsQoR-10-Turkish was assessed with Spearman-Brown coefficient and found to be good 0.864.The ObsQoR-10-Turkish was repeated and completed by 25% of participants. Test-retest reliability of ObsQoR-10-Turkish was excellent with an intra-class correlation coefficient of 0.996.Floor and ceiling effects of ObsQoR-10-Turkish were within acceptable limits, with no participants scoring the lowest or highest values, 0 and 100, respectively.The recruitment rate for the study was 78.13% among the women screened to be eligible to participate. There was a 100% successful completion rate and no missing responses.The main finding from this study is that ObsQoR-10-Turkish performs well in measures of validity, reliability, and clinical feasibility. This PROM should therefore be considered for use when evaluating the recovery of Turkish-speaking obstetric patients in the inpatient postpartum setting.r = 0.51 vs 0.61 and global health VAS r = 0.51 vs 0.65).Findings from this study add further weight to the clinical validity of ObsQoR-10 as a measure of inpatient postpartum recovery. A previous U.S. study in a single-centre setting reported an ObsQoR-10 difference in score of 11 between women delivering via caesarean (elective and intrapartum) versus vaginal delivery . Furthermore, the correlations demonstrated between ObsQoR-Turkish and EQ5D and global health VAS scores were stronger than that previously reported in the U.S. cohort 17 and a consensus statement by the Society for Obstetric Anaesthesia and Perinatology.18 While postpartum recovery research has gained popularity recently, the evidence surrounding enhanced recovery protocols remains low due to heterogeneity among protocol interventions implemented and study outcomes reported.20 Consistent use of ObsQoR as a composite measure of enhanced recovery success would facilitate the pooling of results from future studies and may ultimately help strengthen the levels of evidence surrounding the use of Enhanced Recovery After Cesarean (ERAC) protocols. Furthermore, the use of ObsQoR-10 should also be considered beyond research studies, as it has been identified as the best measure of inpatient postpartum recovery, which can therefore help determine optimal peripartum management strategies within individual institutions and has clinical utility for use as an outcome measure for protocol success in quality improvement related projects.Childbirth is the most common indication for inpatient hospitalisation globally.9 The development and validation of translated versions for use in lower and middle-income countries have thus far been lacking, so future studies are needed to evaluate ObsQoR-10 validity and performance in these settings.Obstetric Quality of Recovery-10 has now been validated for use in the UK, United States, and Israeli populations, and it can be considered a representative measure for recovery across different healthcare systems and cultures.4 A multicentre study funded by the Obstetric Anaesthesia Association within the UK recently completed recruitment of approximately 2000 women, and one aim of this study is to provide clarity regarding clinically significant values of ObsQoR-10, including scores associated with poor recovery or differences in scores corresponding to a clinically significant difference. The role of ObsQoR-10 as part of a core outcome set for use in assessing postpartum recovery still needs to be determined.The ObSQoR-10 has been recognised as the best currently available measure of inpatient postpartum recovery.21 There currently remains no robust PROM for evaluating global outpatient postpartum recovery,22 and the best PROMs for evaluating individual domains of postpartum recovery such as sleep and pain were not specifically developed for use in the postpartum population.24Outpatient postpartum recovery is a different construct from inpatient postpartum recovery, and the majority of a woman’s postpartum experience occurs following hospital discharge.25 require further study. These include measurement error, invariance, and responsiveness . Future adequately powered studies are also needed to evaluate the cross-cultural validity of ObsQoR-10. Finally, ObsQoR-10 is not designed to evaluate certain groups of women likely to experience worse recovery, such as following foetal demise, the requirement for neonatal intensive care unit (NICU) admission, maternal nerve injury, or post-dural puncture headache. Future studies should focus on recovery in these at-risk women who are more likely to experience inpatient and outpatient psychosocial morbidity.This study was a single-centre study, and therefore, the generalisability of our findings within the wider Turkish healthcare setting requires further evaluation. However, given the consistency demonstrated thus far among the different ObsQoR-10 studies, we feel that findings from this study using ObsQoR-10-Turkish are likely to be reproducible. While ObsQoR-10-Turkish performed well in validity, reliability, and clinical feasibility measures, several psychometric properties, as described by the COSMIN group,In summary, ObsQoR-10-Turkish is a valid, reliable, and clinically feasible measure of inpatient postpartum recovery following all delivery modes that should be considered for use when evaluating the quality of recovery in Turkish-speaking obstetric patients. Future studies are needed to compare the quality of recovery between different cultures and countries using translated versions of this PROM.


Emerging diseases such as the Coronavirus Disease (COVID‐19) have exposed severe weaknesses in the United States and global health. Healthcare systems have struggled and are still severely challenged and strained by this pandemic. It is clear that additional resources are needed to support healthcare providers in managing this and future pandemics. Genetic counselors can play an important supporting role in this fragile ecosystem because their comprehensive and broad training makes them uniquely qualified to meet many of the challenges that arise when healthcare workers and patients are faced with novel diseases. This paper describes the recent involvement of a telegenetic counseling company (Metis Genetics) in communicating and explaining COVID‐19 serum antibody results to patients and physicians. This experience demonstrates how genetic counselors may be called upon to play a vital supporting role in the management of infectious disease pandemics. From May 2020 to July 2020, our genetic counseling telegenetics team was asked to provide support to more than 1,580 patients who underwent serum COVID‐19 antibody testing and to educate their healthcare providers on the performance properties of this new test. The genetic counselors were able to utilize their expertise to convey test results, information on Center for Disease Control and Prevention (CDC) recommendations, COVID‐19 fact‐based evidence, to provide psychological support and reassurance to patients, and to respond to providers questions about the test. This experience suggests that the genetic counselors’ skillset that has allowed the profession to continuously evolve can also be used in the management of pandemics by communicating directly with the public, supporting other healthcare workers, and assisting individual patients and families navigate the many medical and psychological issues caused by such events. Human behavior is a major cause to an ever‐accelerating number of novel disease pandemics , as humans encroach on wild animal habitats, crisscross the world, and inhabit denser cities, such global pandemics will continue to threaten humankind  were collected at facilities in California and Texas already providing phlebotomy services. The analysis was performed at the clinical laboratory's testing facility in San Diego.The genetic counselors were able to utilize their expertise to convey positive, negative, and inconclusive antibody test panel results to patients. It is important to note that the genetic counselors were available to switch into this new role due to experiencing a similar decrease in patient volume as reported across the United States . The counselors also held weekly video conferences with the clinical laboratory's staff for administrative and scientific updates. Patients and physicians contacting the clinical laboratory with questions regarding test results were directed to our telegenetics team. Four genetic counselors and one genetic counselor aide supported these patients by providing information and counseling on the telephone. The genetic counselors educated patients on differences between diagnostic and screening tests, explained false positives and false negatives, and the differences between positive and negative predictive values. The most frequent question received by the genetic counselors was requesting further explanation into a patients’ inconclusive antibody results. Patients often expressed their frustration and confusion in their attempts of interpreting their ambiguous results. The genetic counselors were able to use their empathetic interpersonal communication skills to express how they understood the patients’ anxiety and frustrations, allowing the genetic counselors to immediately build rapport. The genetic counselors utilized their knowledge of immunology and laboratory technologies to convey the patients’ results in a simplified manner. This newly formed trust allowed the genetic counselors to then highlight the importance of adhering to the CDC’s recommendations, and explain the clinical laboratory's retesting protocols. The compassionate support demonstrated throughout these phone calls allowed the patients to make rational follow‐up decisions. Other common questions received by the genetic counselors included quarantine protocols, infection risks, and antibody development. It is important to note that much of this information regarding COVID‐19 was still being studied. Genetic counselors used fact‐based evidence during a time where much remained to be discovered about COVID‐19. From May 2020 to July 2020, the genetic counselors were able to provide support to more than 1,580 patients. This experience highlights just one of the numerous evolutionary advancements genetic counseling has taken, as the profession has continued to broaden and positively impact today's healthcare system. This experience provides insight into how genetic counselors may use their skillset to expand their professional roles in other ways.4According to the National Society of Genetic Counselors (NSGC) code of ethics, the genetic counselor's role is to ‘seek out and acquire balanced, accurate and relevant information required for a given situation’ and to ‘continue their education and training to keep abreast of relevant guidelines, regulations, position statements, and standards of genetic counseling practice’.  were created by the Accreditation Council for Genetic Counseling (ACGC) to summarize the proficiencies necessary for successful practice of entry‐level genetic counselors (Doyle et al., All authors contributed to the drafting of the manuscript. All authors contributed significantly to the editing and iterating of the manuscript. All of the authors gave final approval of this version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the integrity of this work are appropriately investigated and resolved.Nathan Hassel, MS, CGC is a consultant for Metis Genetics, LLC. Bassem Bejjani, MD is a consultant for and has options in Metis Genetics, LLC. Adel Gilbert declares that she has no conflicts of interest.No human studies were carried out by the authors for this manuscript.No non‐human animal studies were carried out by the authors for this manuscript.The data that support the findings of this study are available from the corresponding author upon reasonable request.


Tiger subspecific taxonomy is controversial because of morphological and genetic variation found between now fragmented populations, yet the extent to which phenotypic plasticity or genetic variation affects phenotypes of putative tiger subspecies has not been explicitly addressed. In order to assess the role of phenotypic plasticity in determining skull variation, we compared skull morphology among continental tigers from zoos and the wild. In turn, we examine continental tiger skulls from across their wild range, to evaluate how the different environmental conditions experienced by individuals in the wild can influence morphological variation. Fifty-seven measurements from 172 specimens were used to analyse size and shape differences among wild and captive continental tiger skulls. Captive specimens have broader skulls, and shorter rostral depths and mandible heights than wild specimens. In addition, sagittal crest size is larger in wild Amur tigers compared with those from captivity, and it is larger in wild Amur tigers compared with other wild continental tigers. The degree of phenotypic plasticity shown by the sagittal crest, skull width and rostral height suggests that the distinctive shape of Amur tiger skulls compared with that of other continental tigers is mostly a phenotypically plastic response to differences in their environments. The basis for this comparison is that the genetics of wild and captive tigers are the same, but their environments, including diets, are different, so that we can explore the phenotypic response to those environmental differences. In doing so, we can better understand the extent to which morphological variation in the natural environment is determined by an individual's environmental interactions and life history, or by long-term evolutionary processes.Morphological studies provide perspectives on genetic expression and the functional diversity of different clades and clines ,2. AlongPanthera tigris tigris) and the Sunda Island tiger (Panthera tigris sondaica) based on genetic, biogeographical and morphological data [o to +48o N. Its distribution ranges from equatorial to boreal forests with vast differences in climate and prey communities. The broad geographical range, known genetic structure, and availability of specimens from both captivity and the wild make the continental tiger well suited to a study that attempts to disentangle phenotypic plasticity from genetic expression. We do not include tigers from the Sunda Islands (Panthera tigris sondaica), to simplify our analyses by reducing potential confounding sources of variation  and remains contentious, mainly because of differences in the interpretation of data –13. Howecal data ,14,15. Scal data –18 or shcal data ,17–19 becal data ,21, yet cal data ,22–24 thody size , and lonody size ).Panthera spp., kill smaller prey with a nape bite, which severs the spinal cord, or a throat or muzzle bite, which causes the suffocation of larger prey [Phenotypic variation can result from multiple mechanisms operating at different spatial and temporal scales . Differeger prey ,30. AvaiSkull shape differences among subspecies may also result from population bottlenecks and genetic drift, which can lead to accelerated morphological and behavioural evolution , and thuUrsus arctos), meat consumption has been linked to skull parameters as indices of nutrition during stages of development [The most localized mechanism for morphological variation occurs due to the phenotypic plasticity of individuals within their respective environments. Genes do not directly encode bone shape beyond the patterning of the embryo , and bonelopment . As catselopment ,40,41.The skulls of captive big cats are wider, with greater rostral and mastoid breadths, broader zygomatic arch widths, and broader mandibles than those of wild individuals ,42,43. TAn understanding of the plasticity of skull morphology due to the very different environmental conditions and diets of captivity and the wild allows us to determine the extent to which the environmental conditions experienced by individuals, as opposed to evolutionary history, influence skull morphology in wild populations. This is important because putative subspecies across the geographical ranges of species are in part identified through morphological studies, which assume a dominant role of evolutionary history in determining differences in skull size and shape. Identifying how phenotypic plasticity influences skull shape enables better assessment of the extent to which environment affects skull morphology in wild populations. While genetic studies have superseded morphological studies as the customary determinant of phylogeny, whole-genome studies are still at an early stage and only explain a few drivers of morphology explicitly in terms of gene expression , and so This paper is based on significantly bigger datasets than previous craniometric studies that compare captive and wild specimens. It includes measurements from both wild and captive continental tigers representing all previously reported continental subspecies. Our analysis is structured around three research questions that use the profound differences between the environmental conditions of wild and captive continental tigers to understand variation between wild populations.. 1.1Using a captive–wild comparison, we identify patterns of skull variation that occur due to a plastic response of the skull to the vastly different environmental conditions of captivity compared with the wild.. 1.2The effects of recent and long-term evolutionary patterns upon the continental tiger are assessed in relation to recent phylogenetic clades .. 1.3By comparing variation between wild populations of different putative subspecies with variation caused by phenotypic plasticity (i.e. due to captivity), we ascertain whether wild variation has probably occurred from evolutionary processes or genetic drift, or from plastic changes due to environmental differences between populations.. 2. 2.1This paper examines linear cranial measurements of 172 continental tigers from museum collections across Europe, from both captivity and from wild populations. The captive specimens are individuals with known provenance with individual global studbook numbers, which had been born and died in zoos. Captive breeding programmes aim to equalize the founder contributions to the gene pool, thereby minimizing inadvertent genetic selection for particular traits. Captive tigers are likely to represent a random sample of wild populations due to a large number of founder individuals from over a century of continual influxes of animals from the wild from a broad geographical background . Subadulet al. [et al. [Seventy-four linear measurements and cranial volume were recorded for each specimen, following Barnett et al.  , which requires no missing data, we use multiple imputation by chained equations to maximize the number of specimens available for analysis . 2.2Size and shape were considered separately to differentiate influences of allometric scaling ,18. The . 2.3Sexes were analysed separately, because big cats exhibit strong sexual dimorphism ,18,46. T. 2.4t-tests were used to highlight variables that were significantly different between captive and wild specimens, and highlight variable differences between wild populations that show morphological differentiation in shape PCA plots. Owing to the large number of measurements, a Bonferroni correction was applied by dividing the standard p-value of 0.05 by the number of tested variables. The standard 0.05 value is also displayed to show variables, which may differ significantly. By highlighting measurements that differ significantly, overall patterns of variation are visualized upon diagrams of skull measurements.Standard . 3P. t. altaica (Amur tigers), which were also well represented by wild specimens. A large number of wild tigers from the Indian subcontinent was available, but there were very few captive specimens from this group. The scarcity of tiger specimens in museum collections recorded as amoyensis, corbetti, jacksoni and virgata represent a geographical scarcity from China, continental Southeast Asia and the Caspian region. The available data allow three levels of analysis: (i) an analysis of all data, (ii) an analysis of male and female continental tigers separately, which provides two independent datasets for validation, and (iii) an analysis of groupings from similar geographical origins. Given the data available, captive and wild Amur tigers from the Russian Far East were analysed separately.The dataset consists of considerably more wild specimens than captive specimens, the geographical origin of captive and wild specimens is not random, and certain putative taxonomic groups are represented in greater or lesser numbers depending on captivity status . CaptiveConsidering male and female tigers together , there iWhen male and female tigers are considered separately , the datt-tests—electronic supplementary material, table S2), are shown in figure 4. They show broadly similar patterns between captive and wild specimens for each sex. Measurements of overall skull length are not consistently affected by captivity status, which is concordant with plots showing no differentiation between captivity status by isosize. Because the variables are scaled by isometric size, large measurements of skull length exhibit low variance. Rostral depth and breadth, and palate breadth measurements are generally larger in captive specimens. Anterior facial length is larger in captive specimens, whereas posterior facial length, nasal length and head length are smaller.Measurements, which differ significantly between captive and wild specimens .There is variation in skull dimensions between the Amur tiger and all other continental tiger clades . DiffereThe same broad pattern of variation between captive and wild continental tigers is found between captive and wild Amur tigers in both males and females . AdditioWild Amur tiger skulls exhibit morphological patterns, which are concordant with more ‘wild’ characteristics compared with other continental tigers , the differentiation between captive and wild specimens is markedly more apparent than when multiple geographic groups are analysed together. When Amur tigers are analysed separately, captivity status accounts for the first PC of shape, with very little overlap between captive and wild individuals in this axis. Captive Amur tigers represent similar genetic diversity, in terms of microsatellite composition and heterozygosity, to that of their wild counterparts, and both wild and captive populations exhibit low levels of inbreeding . Therefore e.g. ,50), yet, yett-tere (e.g. ,42. The re (e.g. . The masre (e.g.  and insere (e.g. . A high re (e.g.  for a more (e.g. , which hre (e.g. –55. BeyoThere is clear separation of skull shape between Amur tigers and other continental tigers of a similar size. Previous craniometric analysis has shown the Amur tiger as the most distinct of the continental tiger populations, whilst Indian, Indochinese and South China tigers show clear morphological overlaps . It woulSus scrofa, are a ubiquitous staple of tiger diets [Owing to the known skull plasticity found by comparisons between captive and wild Amur tigers, the increased cranial volume, cranial height, sagittal crest length, mastoid breadth, and decreased rostrum size of Amur tigers, compared with other continental tigers, is probably a plastic response to the vastly different environmental conditions of the Russian Far East, compared with the rest of the continental tiger range, which have promoted greater frequency and magnitude of forces acting on the skull and mandible in killing prey and chewing. The prey composition and preferences of the Amur population could have led to skull differences, yet large deer species, similar in body size to the red deer found in the Russian Far East, are preferentially preyed upon in southern continental tiger populations, and wild pigs, er diets ,56,57. Wer diets , with aver diets . Alternaer diets  and are er diets , differeer diets ,61 and yer diets . Or this. 5The results presented here show that the skulls of male and female continental tigers differ between wild and captive environments. While overall skull size does not differ between wild and captive specimens, an overall pattern of wider skull dimensions and shorter mandible heights is found in captivity. The results highlight the importance of comparing specimens from comparable taxonomic or geographical origins, as morphological differences across the geographical range of a species can obscure patterns between captive and wild specimens. When similar geographical groupings are analysed, there is minimal overlap between captive and wild specimens within the first PCs of shape.The distinctive shape and characters of wild Amur tiger skulls that differentiate them from the skulls of continental tigers would seem to support their recognition as a distinct subspecies. However, wild and captive Amur tigers differ predominantly by skull parameters associated with forces acting on the skull and mandible during killing of prey and feeding, which closely match differences between wild Amur tigers and other continental tigers. This suggests that phenotypic plasticity is the main driver of differentiation between wild Amur tigers and other continental tigers. It is likely that the vastly different environmental conditions of their now isolated range reflect most of their morphological distinctiveness, rather than differentiation through evolutionary divergence, which has occurred only recently during the Holocene.The results here point to the value of using captive-bred animals for comparison with wild animals, in order to determine which skull characters vary due to phenotypic plasticity or genetic determination. This kind of analysis allows for a careful differentiation between characteristics that are due to phenotypic plasticity and hence of no taxonomic value, such as sagittal crest size, from those that are likely to reflect a taxon's evolutionary history. This may also help resolve disparities between genetic and morphological studies, and demonstrate the degree of adaptability of species which have very large global distributions.