Search results for: cooperative institution

Authors: Roman Graf, Sergiu Gordea, Heather M. Ryan

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This paper presents an approach for easy creation and classification of institutional risk profiles supporting endangerment analysis of file formats. The main contribution of this work is the employment of data mining techniques to support set up of the most important risk factors. Subsequently, risk profiles employ risk factors classifier and associated configurations to support digital preservation experts with a semi-automatic estimation of endangerment group for file format risk profiles. Our goal is to make use of an expert knowledge base, accuired through a digital preservation survey in order to detect preservation risks for a particular institution. Another contribution is support for visualisation of risk factors for a requried dimension for analysis. Using the naive Bayes method, the decision support system recommends to an expert the matching risk profile group for the previously selected institutional risk profile. The proposed methods improve the visibility of risk factor values and the quality of a digital preservation process. The presented approach is designed to facilitate decision making for the preservation of digital content in libraries and archives using domain expert knowledge and values of file format risk profiles. To facilitate decision-making, the aggregated information about the risk factors is presented as a multidimensional vector. The goal is to visualise particular dimensions of this vector for analysis by an expert and to define its profile group. The sample risk profile calculation and the visualisation of some risk factor dimensions is presented in the evaluation section.

Keywords: linked open data, information integration, digital libraries, data mining

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Authors: Ali Abu Ali, Mohammad Salhab

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Introduction: In the Middle East and North Africa (MENA) microfinance struggles to find momentum. The Lebanese economy has been struggling through the years due to domestic and external, political and social instability. Although as of 2014 there are around 23 MFIs that are mainly subsidized by the USAID, operating in the country, the Lebanese microfinance market is mostly dominated by three microfinance institutions: Al Majmoua, Vitas, and Al Quard Al Hassan Association. Methodology: A quantitative approach using a standardized questionnaire would analyse the perception of the average Lebanese towards microfinance. A questionnaire was designed and validated. Results: Almost half of the respondents earn a monthly income ranged between $100 and $600. Almost 52% of the respondents were university graduates, around 25% finished secondary and high school, and 12% hold a masters or MBA degree. Topic understanding towards microfinance differs across Lebanese areas. The highest percentage of respondents who claim that microfinance offers financial services to low income people are the residents of Beirut (35.1%), Bekaa (30.8%), and South of Lebanon (24.7%). Higher levels of topic understanding were associated with lower levels of age range. Al Quard el Hassan foundation was regarded as the most known micro financial institution operating in Lebanon. In general, Lebanese people tend to believe that microfinance can play an important role in reducing unemployment rates and poverty levels in Lebanon. When people were asked what would motivate you to get a loan from MFIs, most of the respondent (57.4%) across all the Lebanese region claimed that it was the need for money to satisfy a need such as paying back a loan, to fix something at home, or for self-consideration like buying a car. Conclusion: Our findings showed that in general Lebanese tend to have a positive perception towards microfinance. However, most Lebanese perceive microfinance as the process of just providing loans without specifying for whom it is intended. We advise that government introduces laws to regulate the microfinance market.

Keywords: microfinance, economics, finance, business, analysis, theory

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Authors: Bibire Abdulkareem Hussein

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Job satisfaction and motivation are considered as major tools in sustaining institutional development, they are also the machinery used to achieve an institutional goals and objectives. However, it has been observed that some institutions failed in motivating and stimulating their workers; in contrast, workers may be motivated but not satisfied with the job and failed to perform efficiently and effectively. It is hoped that the study of this nature would be of significance value to all stakeholders in education specifically, lecturers in higher institutions in Nigeria. Also it significances will enhance lecturers’ effectiveness and performance in discharging their duties. It is against this backdrop that, this study investigated whether job satisfaction and motivation predict lecturers’ effectiveness in Nigeria Police Academy, Wudil, KanoState. The correlational research method was adopted for the study while purposive sampling technique was used to choose the institution and the sampled lectures (70). Simple random sampling technique was used to select one hundred cadets across the academy. Two instruments were used to elicit information from both lecturers and cadets. These were job satisfaction and motivation; and lecturers’ effectiveness Questionnaires. The instruments were subjected to pilot testing and found to have reliability coefficient of 0.69 and 0.71 respectively. The results of the study revealed that there was a significance relationship among job satisfaction, motivation and lecturers effectiveness in Nigeria Police Academy, Job satisfaction had a Beta weight (β) of .125, t = 3.253, p<0.05, Job motivation had a Beta weight (β) of .185, t = 3.849, p<0.05. There was a significance relationship between job satisfaction and lecturers’ effectiveness in Nigeria Police Academy the cal r is 0.21 while the crt r is 0.19. at p<0.05 and; there was a significance relationship between job motivation and lecturers effectiveness in Nigeria Police Academy the cal r is 0.20 while the crt r is 0.19 at p<0.05This study therefore concluded that there was a significance relationship among job satisfaction, motivation and lecturers effectiveness in Nigeria Police Academy s,In view of the findings of this study, the paper recommends that lecturers should be more pro-active and more effective in their primary assignment (teaching) in order to make meaningful impacts and inputs in the life of cadets and boost the standard of the academy. In the same vein, it is recommended that management should intensify efforts to improve lecturers’ welfares by providing more motivational techniques to enhance more productivity.

Keywords: academy, lecturers effectiveness, motivation, satisfaction

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Authors: Andre Bechuke

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The quality of every learning programme in Higher Education (HE) is dependent on the planning, design, and development of the curriculum decisions. These curriculum development decisions are highly influenced by the knowledge of the end-user, who are not always just the students. When curriculum experts plan, design and develop learning programmes, they always have the end-users in mind throughout the process. Without proper knowledge of the end-user(s), the design and development of a learning programme might be flawed. Curriculum experts often struggle to determine who the real end-user is. As such, it is even more challenging to establish what needs to be known about the end user that should inform the plan, design, and development of a learning programme. This research sought suggest approaches to guide curriculum experts to identify the end-user(s), taking into consideration the pressure and influence other agencies and structures or stakeholders (industry, students, government, universities context, lecturers, international communities, professional regulatory bodies) have on the design of a learning programme and the graduates of the programmes. Considering the influence of these stakeholders, which is also very important, the task of deciding who the real end-user of the learning programme becomes very challenging. This study makes use of criteria 1 and 18 of the Council on Higher Education criteria for programme accreditation to guide the process of identifying the end-users when developing a learning programme. Criterion 1 suggests that designers must ensure that the programme is consonant with the institution’s mission, forms part of institutional planning and resource allocation, meets national requirements and the needs of students and other stakeholders, and is intellectually credible. According to criterion 18, in designing a learning programme, steps must be taken to enhance the employability of students and alleviate shortages of expertise in relevant fields. In conclusion, there is hardly ever one group of end-users to be considered for developing a learning programme, and the notion that students are the end-users is not true, especially when the graduates are unable to use the qualification for employment.

Keywords: council on higher education, curriculum design and development, higher education, learning programme

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Authors: Thair Mahmood Altaiee

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Because of the increasing population and the growing water requirements from the transboundary water resources within riparian countries in addition to un-proper management of these transboundary water resources, it is likely that a conflicts on the water will be occurred. So it is mandatory to search solutions to mitigate the action and probabilities of these undesired conflicts. One of the solutions for these crises may be sharing the riparian countries in the management of their transboundary water resources and share benefit. Effective cooperation on a transboundary river is any action by the riparian countries that lead to improve management of the river to their mutual acceptance. In principle, friendship dams constructed by riparian countries may play an important role in preventing conflicts like the Turkish-Syrian friendship dam on Asi river (Orontes), Iranian-Tukmenistan dam on Hariroud river, Bulgarian-Turkish dam on Tundzha river, Brazil-Paraguay dam on Parana river, and Aras dam between Iran and Azerbaijan. The objective of this study is to focus the light on the hydrological aspects of cooperation in constructing dams on the transboundary rivers, which may consider an option to prevent conflicts on water between the riparian countries. The various kinds of benefits and external impacts associated with cooperation in dams construction on the transboundary rivers with a real examples will be presented and analyzed. The hydrological benefit sharing from cooperation in dams construction, which type of benefit sharing mechanisms are applicable to dams, and how they vary were discussed. The study considered the cooperative applicability to dams on shared rivers according to selected case study of friendship dams in the world to illustrate the relevance of the cooperation concepts and the feasibility of such propose cooperation between Turkey and Iraq within the Tigris river. It is found that the opportunities of getting benefit from cooperation depend mainly on the hydrological boundary and location of the dam in relation to them. The desire to cooperate on dams construction on transboundary rivers exists if the location of a dam upstream will increase aggregate net benefits. The case studies show that various benefit sharing mechanisms due to cooperation in constructing friendship dams on the riparian countries border are possible for example when the downstream state (Iraq) convinces the upstream state (Turkey) to share building a dam on Tigris river across the Iraqi –Turkish border covering the cost and sharing the net benefit derived from this dam. These initial findings may provide guidance for riparian states engaged in and donors facilitating negotiation on dam projects on transboundary rivers.

Keywords: friendship dams, transboundary rivers, water cooperation, benefit sharing

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Authors: Kumiko Inagaki

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In recent, years, Japanese universities have begun to face a dilemma: more than half of all high school graduates go on to attend an institution of higher learning, overwhelming Japanese universities accustomed to small student bodies. These universities have been forced to embrace qualitative changes to accommodate the increased number and diversity of students who enter their establishments, students who differ in their motivations for learning, their levels of eagerness to learn, and their perspectives on the future. One of these changes is an increase in awareness among Japanese educators of the importance of active learning, which deepens students’ understanding of course material through a range of activities, including writing, speaking, thinking, and presenting, in addition to conventional “passive learning” methods such as listening to a one-way lecture. 　The purpose of this study is to examine the effectiveness of the teaching method adapted to improve active learning. A teaching method designed to promote active learning was implemented in a social science course at one of the most popular universities in Japan. A questionnaire using a five-point response format was given to students in 2,305 courses throughout the university to evaluate the effectiveness of the method based on the following measures: ① the ratio of students who were motivated to attend the classes, ② the rate at which students learned new information, and ③ the teaching method adopted in the classes. The results of this study show that the percentage of students who attended the active learning course eagerly, and the rate of new knowledge acquired through the course, both exceeded the average for the university, the department, and the subject area of social science. In addition, there are strong correlations between teaching method and student motivation and between teaching method and knowledge acquisition rate. These results indicate that the active learning teaching method was effectively implemented and that it may improve student eagerness to attend class and motivation to learn.

Keywords: active learning, Japanese university, teaching method, university education

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Authors: Emilio Galdeano-Gómez, Ángeles Godoy-Durán, Juan C. Pérez-Mesa, Laura Piedra-Muñoz

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Eco-efficiency is receiving ever-increasing interest as an indicator of sustainability, as it links environmental and economic performances in productive activities. In agriculture, these indicators and their determinants prove relevant due to the close relationships in this activity between the use of natural resources, which is generally limited, and the provision of basic goods to society. In this context, various analyses have focused on eco-efficiency by considering individual family farms as the basic production unit. However, not only must the measure of efficiency be taken into account, but also the existence of a series of factors which constitute socio-economic, political-institutional, and environmental determinants. Said factors have been studied to a lesser extent in the literature. The present work analyzes eco-efficiency at a micro level, focusing on small-scale family farms as the main decision-making units in horticulture in southeast Spain, a sector which represents about 30% of the fresh vegetables produced in the country and about 20% of those consumed in Europe. The objectives of this study are a) to obtain a series of eco-efficiency indicators by estimating several pressure ratios and economic value added in farming, b) to analyze the influence of specific social, economic and environmental variables on the aforementioned eco-efficiency indicators. The present work applies the method of Data Envelopment Analysis (DEA), which calculates different combinations of environmental pressures (water usage, phytosanitary contamination, waste management, etc.) and aggregate economic value. In a second stage, an analysis is conducted on the influence of the socio-economic and environmental characteristics of family farms on the eco-efficiency indicators, as endogeneous variables, through the use of truncated regression and bootstrapping techniques, following Simar-Wilson methodology. The results reveal considerable inefficiency in aspects such as waste management, while there is relatively little inefficiency in water usage and nitrogen balance. On the other hand, characteristics, such as product specialization, the adoption of quality certifications and belonging to a cooperative do have a positive impact on eco-efficiency. These results are deemed to be of interest to agri-food systems structured on small-scale producers, and they may prove useful to policy-makers as regards managing public environmental programs in agriculture.

Keywords: data envelopment analysis, eco-efficiency, family farms, horticulture, socioeconomic features

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Authors: Nashaat A. Deiab, Aida Radwan, Mohamed S. Yahiya, Mohamed Elnagdy, Rasha Moustafa

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This study is to evaluate the dosimetric performance of our institution's 3D treatment planning system for wedged and off-axis 6MV photon beams, guided by the recommended QA tests documented in the AAPM TG53; NCS report 15 test packages, IAEA TRS 430 and ESTRO booklet no.7. The study was performed for Elekta Precise linear accelerator designed for clinical range of 4, 6 and 15 MV photon beams with asymmetric jaws and fully integrated multileaf collimator that enables high conformance to target with sharp field edges. Ten tests were applied on solid water equivalent phantom along with 2D array dose detection system. The calculated doses using 3D treatment planning system PrecisePLAN were compared with measured doses to make sure that the dose calculations are accurate for simple situations such as square and elongated fields, different SSD, beam modifiers e.g. wedges, blocks, MLC-shaped fields and asymmetric collimator settings. The QA results showed dosimetric accuracy of the TPS within the specified tolerance limits. Except for large elongated wedged field, the central axis and outside central axis have errors of 0.2% and 0.5%, respectively, and off- planned and off-axis elongated fields the region outside the central axis of the beam errors are 0.2% and 1.1%, respectively. The dosimetric investigated results yielded differences within the accepted tolerance level as recommended. Differences between dose values predicted by the TPS and measured values at the same point are the result from limitations of the dose calculation, uncertainties in the measurement procedure, or fluctuations in the output of the accelerator.

Keywords: quality assurance, dose calculation, wedged fields, off-axis fields, 3D treatment planning system, photon beam

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Authors: Jorge Iván Bañol-Betancur, Lina María Martínez-Sánchez, María de los Ángeles Rodríguez-Gázquez, Estefanía Bahamonde-Olaya, Ana María Gutiérrez-Tamayo, Laura Isabel Jaramillo-Jaramillo, Camilo Ruiz-Mejía, Natalia Morales-Quintero

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Acute chest pain is a distressing sensation between the diaphragm and the base of the neck and it represents a diagnostic challenge for any physician in the emergency department. Objective: To establish the main clinical and epidemiological characteristics of patients who present with chest pain to the emergency department in a private clinic from the city of Medellin, during 2014-2015. Methods: Cross-sectional retrospective observational study. Population and sample were patients who consulted for chest pain in the emergency department who met the eligibility criteria. The information was analyzed in SPSS program vr.21; qualitative variables were described through relative frequencies, and the quantitative through mean and standard deviation ‬or medians according to their distribution in the study population. Results: A total of 231 patients were evaluated, the mean age was 49.5 ± 19.9 years, 56.7% were females. The most frequent pathological antecedents were hypertension 35.5%, diabetes 10,8%, dyslipidemia 10.4% and coronary disease 5.2%. Regarding pain features, in 40.3% of the patients the pain began abruptly, in 38.2% it had a precordial location, for 20% of the cases physical activity acted as a trigger, and 60.6% was oppressive. Costochondritis was the most common cause of chest pain among patients with an established etiologic diagnosis, representing the 18.2%. Conclusions: Although the clinical features of pain reported coincide with the clinical presentation of an acute coronary syndrome, the most common cause of chest pain in study population was costochondritis instead, indicating that it is a differential diagnostic in the approach of patients with pain acute chest.

Keywords: acute coronary syndrome, chest pain, epidemiology, osteochondritis

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Authors: Naim Izet Kajtazi

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Context: Although rare, glomus tumor (i.e., nonchromaffin chemodectomas and paragan¬gliomas) is the most common middle ear tumor, with female predominance. Pre-operative embolization is often required to devascularize the hypervascular tumor for better surgical outcomes. Process: A 35-year-old female presented with episodes of frequent dizziness, ear fullness, and right ear tinnitus for 12 months. Head imaging revealed a right glomus tympanicum tumor. She underwent pre-operative endovascular embolization of the glomus tympanicum tumor with surgical, cyanoacrylate-based glue. Immediately after the procedure, she developed drowsiness and severe pain in the right temporal region. Further investigations revealed a right cerebellar stroke in the posterior inferior cerebellar artery territory. She was treated with intravenous heparin, followed by one year of oral anticoagulation. With rehabilitation, she significantly recovered from her post embolization stroke. However, the tumor was resected at another institution. Ten years later, follow-up imaging indicated a gradual increase in the size of the glomus jugulare tumor, compressing the nearby critical vascular structures. She subsequently received radiation therapy to treat the residual tumor. Outcome: Currently, she has no neurological deficit, but her mild dizziness, right ear tinnitus, and hearing impairment persist. Relevance: This case highlights the complex nature of these tumors, which often bring challenges to the patients as well as treatment teams. The multi-disciplinary team approach is necessary to tailor the management plan for individual tumors. Although embolization is a safe procedure, careful attention and thoughtful anatomic knowledge regarding dangerous anastomosis are essential to avoid devastating complications. Complications occur due to encountered vessel anomalies and new anastomoses formed during the gluing and changes in hemodynamics.

Keywords: stroke, embolization, MRI brain, cerebral angiogram

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Authors: Ilyasu G., Ogoina D., Otu AA, Muhammed FD, Ebenso B., Otokpa D., Rotifa S., Tuduo-Wisdom O., Habib AG

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Background: The 2014 Ebola Virus Disease (EVD) outbreak was characterized by fear, misconceptions and irrational behaviors. We conducted a knowledge attitude and practice survey of EVD in Nigeria to inform the institution of effective control measures. Methods: Between July 30th and September 30th 2014, a cross-sectional study on knowledge, attitude and practice (KAP) of Ebola Virus Disease (EVD) was undertaken among adults of the general population and healthcare workers (HCW) in three states of Nigeria, including Kano, Cross River and Bayelsa states. Demographic information and data on KAP were obtained using a self-administered standardized questionnaire. The percentage KAP scores were categorized as good and poor. Independent predictors of good knowledge of EVD were ascertained using a binary logistic regression model. Results: Out of 1035 study participants with a median age of 32 years, 648 (62.6%) were males, 846 (81.7%) had tertiary education and 441 (42.6%) were HCW. There were 218, 239 and 578 respondents from Bayelsa, Cross Rivers, and Kano states, respectively. The overall median percentage KAP scores and interquartile ranges (IQR) were 79.46% (15.07%), 95.0% (33.33%), and 49.95% (37.50%), respectively. Out of the 1035 respondents, 470 (45.4%), 544(52.56%), and 252 (24.35%) had good KAP of EVD defined using 80%, 90%, and 70% score cut-offs, respectively. Independent predictors of good knowledge of EVD were a HCW (Odds Ratio-OR-2.89, 95% Confidence interval-CI of 1.41-5.90), reporting ‘moderate to high fear of EVD’ (OR-2.15, 95% CI-1.47-3.13) and ‘willingness to modify habit’ (OR-1.68, 95% CI-1.23-2.30). Conclusion: Our results reveal suboptimal EVD-related knowledge, attitude and practice among adults in Nigeria. To effectively control future outbreaks of EVD in Nigeria, there is a need to institute public sensitization programs that improve understanding of EVD and address EVD-related myths and misconceptions, especially among the general population.

Keywords: Ebola, health care worker, knowledge, attitude

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Authors: Jayakant Singh, Enu Anand

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Background: Child marriage is widely prevalent in India. It is a form of gross human right violation that succumbs a child bride to be subservient to her husband within a marital relation. We investigated the relationship between age at marriage of women and her level of empowerment with physical violence experienced 12 months preceding the survey among young women aged 20-24 in two culturally distinct states- Bihar and Tamil Nadu of India. Methods: We used the information collected from 10514 young married women (20-24 years) at all India level, 373 in Bihar and 523 in Tamil Nadu from the third round of National Family Health Survey. Empowerment index was calculated using different parameters such as mobility, economic independence and decision making power of women using Principal Component Analysis method. Bivariate analysis was performed primarily using chi square for the test of significance. Logistic regression was carried out to assess the effect of age at marriage and empowerment on physical violence. Results: Lower level of women empowerment was significantly associated with physical violence in Tamil Nadu (OR=2.38, p<0.01) whereas child marriage (marriage before age 15) was associated with physical violence in Bihar (OR=3.27, p<0.001). The mean difference in age at marriage between those who experienced physical violence and those who did not experience varied by 7 months in Bihar and 10 months in Tamil Nadu. Conclusion: Culture specific intervention may be a key to reduction of violence against women as the results showed association of different factors contributing to physical violence in Bihar and Tamil Nadu. Marrying at an appropriate age perhaps is protective of abuse because it equips a woman to assert her rights effectively. It calls for an urgent consideration to curb both violence and child marriage with stricter involvement of family, civil society and the government. In the meanwhile physical violence may be recognized as a public health problem and integrate appropriate treatment to the victims within the health care institution.

Keywords: child marriage, empowerment, India, physical violence

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Authors: Lemi Tolu

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Background: Postpartum family planning (PPFP) focuses on the prevention of unintended and closely spaced pregnancies through the first 12 months following childbirth. Objective: This study assesses the barriers to uptake of long-term and permanent family planning methods among immediate post-partum mothers at Saint Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia. Methodology: An institution-based cross-sectional study was conducted from January 1 to June 30, 2017. The six months of study were used as strata, and systematic sampling used to select participants in each month. Post-partum mothers were interviewed using pretested structured questionnaires. Data entry and analysis were done using SPSS version 17. Bivariate and multivariable logistic regressions were fitted to identify determinants of post-partum family planning uptake. An OR with 95% CIs was calculated, and p values set at 005 were used to determine the statistical significance of associations. Results: Four hundred and twenty-two post-partum women were interviewed. Two hundred sixty-eight (63%) women received counselling on family planning, and 241 (66.8 %) got information about contraception. One hundred and fifty-two (45%) of the women accepted long-term and permanent contraception on their immediate postpartum period before discharge. Contraceptive counselling (OR = 2.13, 95% CI 1.004-3.331), getting information from the health facility (OR = 15.15, 95% CI 1.848-19.242), and partner support (OR = 1.367, 95% CI 1.175-2.771) were significantly associated with long-term and permanent contraception uptake. Conclusion: Postpartum counselling on family planning and provision of contraception information improve immediate postpartum FP acceptance, and, hence postpartum programs need to strengthen such services.

Keywords: contraception, immediate postpartum, long-term family planning, post-partum family planning

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Authors: Methembe Mdlalose

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This paper synthesizes the findings of a study that utilized a purposive sampling methodology laced within a grounded theory analytical framework with LED managers, mayors, and traditional leaders representing six municipalities of uThukela District of KwaZulu-Natal, South Africa. The paper critiques the two institution’s micro-relations within local governance and their overall impact on the general development discourse of rural areas. The study is located in the province of KwaZulu-Natal, a part of South Africa that experiences extremely low levels of development in rural areas and suffers from high rates of inequality, poverty, and unemployment. The paper unpacks the role of two significant stakeholders in the local sphere. Considered as the two dominant stakeholders at the local level, questions of compatibility between traditional leaders and municipal councillors often surge, as the two institutions (who represent two autonomous entities) that operate within the same operational boarders. The discussion around community development lies very deeply on accountability, which assures citizens that fruitless spending is curbed and good governance is maintained. If development is to be assured, it is vital to monitor accountability within government spheres and its departments. It is further essential to monitor the relations within local government. The findings of this research confirmed how relationships between traditional leaders and councillors can and have contributed to economic development or its stagnation thereof in rural areas. In addition, the findings revealed that there is an extensive need for the two stakeholders to work collectively, as this is a vital move in planning for development. Furthermore, the better accountability of local government and a better understanding of how clear policy and its implementation is may be a valuable asset in the discourse of community economic development in rural areas.

Keywords: economic development, traditional leadership, democratically elected councillors, local governance

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Authors: Jan Gayl Barcelon, N. Gorgonio

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Renal tubular acidosis, a medical condition that involves the accumulation of acid in the body due to failure of the kidneys to maintain normal urine and blood pH, is rarely encountered in pregnancy. The effect of renal tubular acidosis in pregnancy is not fully established. It may worsen during pregnancy and cause maternal and fetal morbidity. A 30-year-old primigravida was diagnosed with renal tubular acidosis at age 7, but due to uncontrolled disease progression, she developed rickets at age 10. She was first seen in our institution at eight weeks gestation and maintained on bicarbonate and potassium supplementation. At 26 weeks gestation, she was diagnosed with polyhydramnios, causing on and off irregular uterine contractions. At 30 weeks gestation, despite oral Nifedipine, premature labor was uncontrolled; hence she was admitted for tocolysis. With elevated creatinine (123 umol/L) and a normal blood urea nitrogen level (6.70 mmol/L), she was referred to Nephrology Service, which cleared the patient prior to MgSO₄ drip. Dosing of 4g MgSO₄ over 20 minutes followed by a maintenance of 2g/hour x 24 hours for neuroprotection and tocolysis was ordered. Two hours after MgSO₄ drip initiation, hematuria developed with adequate urine output. The infusion was immediately stopped. The serum magnesium level was high normal at 6.7 mEq/L. After 4 hours of renal clearance, the repeat serum magnesium level was normal (2.7 mEq/L) and with clear urine output. The patient was then given Nifedipine 30mg/tab, 3x a day which controlled the uterine contractions. At 37 weeks gestation, the patient delivered via primary low transverse Cesarean Section to a live female with a birthweight of 2470gm, appropriate for gestational age. The use of MgSO₄ for the control of premature labor in patients with chronic renal disease secondary to renal tubular can cause hematuria.

Keywords: hematuria, magnesium sulfate, premature labor, renal tubular acidosis

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Authors: Marlon P. Perez

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The study intended to determine the level of occupational stress that was experienced by faculty members of private and public business schools in Batangas City with the end in view of proposing organizational development interventions in managing occupational stressors. Stressors such as factors intrinsic to the job, role in the organization, relationships at work, career development and organizational structure and climate were used as determinants of occupational stress level. Descriptive method of research was used as its research design. There were only 64 full-time faculty members coming from private and public business schools in Batangas City – University of Batangas, Lyceum of the Philippines University-Batangas, Golden Gate Colleges, Batangas State University and Colegio ng Lungsod ng Batangas. Survey questionnaire was used as data gathering instrument. It was found out that all occupational stressors were assessed stressful when grouped according to its classification of tertiary schools while response of subject respondents differs on their assessment of occupational stressors. Age variable has become significantly related to respondents’ assessments on factors intrinsic to the job and career development; however, it was not significantly related to role in the organization, relationships at work and organizational structure and climate. On the other hand, gender, marital status, highest educational attainment, employment status, length of service, area of specialization and classification of tertiary school were revealed to be not significantly related to all occupational stressors. Various organizational development interventions have been proposed to manage the occupational stressors that are experienced by business faculty members in the institution.

Keywords: occupational stress, business school, organizational development, intervention, stressors, faculty members, assessment, manage

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Authors: Norbert Tribl

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European contemporary scientific public opinion considers the concept of constitutional identity as a highlighted issue. Some scholars interpret the matter as the manifestation of a conflict of Europe. Nevertheless, constitutional identity is a bridge between the Member States and the EU rather than a river that will wash away the achievements of the integration. In accordance with the opinion of the author, the main problem of constitutional identity in Europe is the undetermined nature: the exact concept of constitutional identity has not been defined until now. However, this should be the first step to understand and use identity as a legal institution. Having regard to this undetermined nature, the legal-theoretical examination of constitutional identity is the main purpose of this study. The concept of constitutional identity appears in the Anglo-Saxon legal systems by a different approach than in the supranational system of European Integration. While the interpretation of legal institutions in conformity with the constitution is understood under it, the European concept is applied when possible conflicts arise between the legal system of the European supranational space and certain provisions of the national constitutions of the member states. The European concept of constitutional identity intends to offer input in determining the nature of the relationship between the constitutional provisions of the member states and the legal acts of the EU integration. In the EU system of multilevel constitutionalism, a long-standing central debate on integration surrounds the conflict between EU legal acts and the constitutional provisions of the member states. In spite of the fact that the Court of Justice of the European Union stated in Costa v. E.N.E.L. that the member states cannot refer to the provisions of their respective national constitutions against the integration. Based on the experience of more than 50 years since the above decision, and also in light of the Treaty of Lisbon, we now can clearly see that EU law has itself identified an obligation for the EU to protect the fundamental constitutional features of the Member States under Article 4 (2) of Treaty on European Union, by respecting the national identities of member states. In other words, the European concept intends to offer input for the determination of the nature of the relationship between the constitutional provisions of the member states and the legal acts of the EU integration.

Keywords: constitutional identity, EU law, European Integration, supranationalism

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Authors: Saadia Izzeldin Malik

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Lack of ethics is the crisis of the 21-century. Today’s global world is filled with economic, political, environmental, media/communication, and social crises that all generated by the eroding fabric of ethics and moral values that guide human’s decisions in all aspects of live. Our global world is guided by liberal western democratic principles and liberal capitalist economic principles that define and reinforce each other. In economic terms, capitalism has turned world economic systems into one market place of ideas and products controlled by big multinational corporations that not only determine the conditions and terms of commodity production and commodity exchange between countries, but also transform the political economy of media systems around the globe. The citizen (read the consumer) today is the target of persuasion by all types of media at a time when her/his interests should be, ethically and in principle, the basic significant factor in the selection of media content. It is very important in this juncture of clashing media values –professional and commercial- and wide spread ethical lapses of media organizations and media professionals to think of a perspective to theorize these conflicting values within a broader framework of media ethics. Thus, the aim of this paper is to, epistemologically, bring to the center a perspective on media ethics as a basis for reconciliation of clashing values of the media. The paper focuses on conflicting ethical values in current media debate; namely ownership of media vs. press freedom, individual right for privacy vs. public right to know, and global western consumerism values vs. media values. The paper concludes that a framework to reconcile conflicting values of media ethics should focus on the “individual” journalist and his/her moral development as well as focus on maintaining ethical principles of the media as an institution with a primary social responsibility for the “public” it serves.

Keywords: ethics, media, journalism, social responsibility, conflicting values, global

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Authors: Nataliya Apanovich, Mark Wright

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Uganda is among the poorest but fastest growing populations in the world. Its annual population growth of 3% puts additional stress through land fragmentation, agricultural intensification, and deforestation on already highly weathered tropical (Ferralsol) soils. All of these factors lead to decreased agricultural yields and consequently diminished food security. The central region of Uganda, Buganda Kingdom, is especially vulnerable in terms of food security as its high population density coupled with mismanagement of natural resources led to gradual loss of its soil and even changes in microclimate. These changes are negatively affecting livelihoods of smallholder farmers who comprise 80% of all population in Uganda. This research focuses on biochar for soil remediation in Masaka District, Uganda. If produced on a small scale from locally sourced materials, biochar can increase the quality of soil in a cost and time effective manner. To assess biochar potential, 151 smallholder farmers were interviewed on the types of crops grown, agricultural residues produced and their use, as well as on attitudes towards biochar use and its production on a small scale. The interviews were conducted in 7 sub-counties, 32 parishes, and 92 villages. The total farmland covered by the study was 606.2 kilometers. Additional information on the state of agricultural development and environmental degradation in the district was solicited from four local government officials via informal interviews. This project has been conducted in collaboration with the international agricultural research institution, Makerere University in Kampala, Uganda. The results of this research can have implications on the way farmers perceive the value of their agricultural residues and what they decide to do with them. The underlying objective is to help smallholders in degraded soils increase their agricultural yields through the use of biochar without diverting the already established uses of agricultural residues to a new soil management practice.

Keywords: agricultural residues, biochar, central Uganda, food security, soil erosion, soil remediation

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Authors: Giovanna Carugno

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The concept of invention is rarely scrutinized by legal scholars since it is a slippery one, full of nuances and difficult to be defined. When does an idea become relevant for the patent law? When is it simply possible to talk of what an invention is? It is the first question to be answered to obtain a patent, but it is sometimes neglected by treaties or reduced to very simple and automatically re-cited definitions. Maybe, also because it is more a transnational and cultural concept than a mere institution of law. Tautology is used to avoid the challenge (in the United States patent regulation, the inventor is the one who contributed to have a patentable invention); in other case, a clear definition is surprisingly not even provided (see, e.g., the European Patent Convention). In Europe, the issue is still more complicated because there are several different solutions elaborate inorganically be national systems of courts varying one to the other only with the aim of solving different IP cases. Also a neighbor domain, like copyright law, is not assisting us in the research, since an author in this field is entitles to be the 'inventor' or the 'author' and to protect as far as he produces something new. Novelty is not enough in patent law. A simple distinction between mere improvement that can be achieved by a man skilled in the art (a sort of reasonable man, in other sectors) or a change that is not obvious rising to the dignity of protection seems not going too far. It is not still defining this concept; it is rigid and not fruitful. So, setting aside for the moment the issue related to the definition of the invention/inventor, our proposal is to scrutinize the possible self-sufficiency of a system in which the inventor or the improver should be awarded of royalties or similar compensation according to the economic improvement he was able to bring. The law, in this case, is in the penumbras of misleading concepts, divided between facts that are obscure and technical, and not involving necessarily legal issues. The aim of this paper is to find out a single definition (or, at least, the minimum elements common in the different legal systems) of what is (legally) an invention and what can be the hints to practically identify an authentic invention. In conclusion, it will propose an alternative system in which the invention is not considered anymore and the only thing that matters are the revenues generated by technological improvement, caused by the worker's activity.

Keywords: comparative law, intellectual property, invention, patents

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Authors: Londeka Ntuli, Frasia Oosthuizen

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Background: Tenefovir disiproxil fumarate (TDF) is a nephrotoxic drug and has been proven to contribute to renal insufficiency necessitating intensive monitoring and management of adverse effects arising from prolonged exposure to the drug. TDF is one of the preferred first-line drugs used in combination therapy in most regions. There are estimated 300 000 patients being initiated on the Efavirenz/TDF/Emtricitabine first-line regimen annually in South Africa. It is against this background that this study aims to investigate the effects of TDF on renal sufficiency of HIV positive patients. Methodology: A retrospective quantitative study was conducted, analysing clinical charts of HIV positive patient’s older than 18 years of age and on a TDF-containing regimen for more than 1 year. Data were obtained from the analysis of patient files and was transcribed into Microsoft® Excel® spreadsheet. Extracted data were coded, categorised and analysed using STATA®. Results: A total of 275 patient files were included in this study. Renal function started decreasing after 3 months of treatment (with 93.5% patients having a normal EGFR), and kept on decreasing as time progressed with only 39.6% normal renal function at year 4. Additional risk factors for renal insufficiency included age below 25, female gender, and additional medication. Conclusion: It is clear from this study that the use of TDF necessitates intensive monitoring and management of adverse effects arising from prolonged exposure to the drug. The findings from this study generated pertinent information on the safety profile of the drug TDF in a resource-limited setting of a public health institution. The appropriate management is of tremendous importance in the South African context where the majority of HIV positive individuals are on the TDF containing regimen; thus it is beneficial to ascertain the possible level of toxicities these patients may be experiencing.

Keywords: renal insufficiency, tenefovir, HIV, risk factors

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Authors: Uzma Imtiaz

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Ecological feminism adheres to the basic philosophy that patriarchy is the wellspring of natural and gender domination. It explores the relationship between women and nature in a patriarchal society. Eco-feminism argues that women and nature have an intrinsic association and exploitation of women is the exploitation of nature itself. It further views the world as a holistic institution that offers equal opportunities for men and women. Eco-feminism rejects male domination in a patriarchal society where men and women do not get equal rights to survival. Furthermore, it investigates modern capitalist practices that exert unjust male dominance over nature and women. Cultural eco-feminist theorists argue that industrialization and modern science are male-centered and exhibit male chauvinistic views in attempts to control females’ ability to reproduce. This research intends to analyze an eco-feminist novel by Laila Halaby from the eco-feminism theoretical framework of Maria Mies and Vandana Shiva. The feminist dystopian novel throws light on the double-faced processes of capitalism and housewifization that destroy the autonomy of women over their bodies and life. Moreover, this study aims to highlight the unjust capitalistic processes and policies that turn other countries and women into colonies to exploit them by white men in the name of progress and civilization. The novel brings the patriarchal ways of dominance over women into question. This research paper concludes that women and men should get equal opportunities to survive in society, and women should have given rights over their bodies to decide their future. The research is qualitative in nature, so the method of close reading is selected to analyze the hypodermic effect of patriarchy in society. This study is valuable in highlighting the exploitative ways of men to subjugate women and nature and helps to give awareness to women against gender exploitation in society.

Keywords: housewifization, exploitation, capitalist patriarchy, female victimization

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Authors: Petronella Lunda, Catharina Susanna Minnie, Welma Lubbe

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Background This review aimed to provide healthcare professionals with a scientific summary of the best available research evidence on factors influencing respectful perinatal care. The review question was ‘What were the perceptions of midwives and doctors on factors that influence respectful perinatal care?’ Methods A detailed search was done on electronic databases: EBSCOhost: Medline, OAlster, Scopus, SciELO, Science Direct, PubMed, Psych INFO, and SocINDEX. The databases were searched for available literature using a predetermined search strategy. Reference lists of included studies were analysed to identify studies missing from databases. The phenomenon of interest was factors influencing maternity care practices according to midwives and doctors. Pre-determined inclusion and exclusion criteria were used during the selection of potential studies. In total, 13 studies were included in the data analysis and synthesis. Three themes were identified and a total of nine sub-themes. Results Studies conducted in various settings were included in the study. Multiple factors influencing respectful perinatal care were identified. During data synthesis, three themes emerged: healthcare institution, healthcare professionals, and women-related factors. Alongside the themes were sub-themes human resources, medical supplies, norms and practices, physical infrastructure, healthcare professional competencies and attributes, women’s knowledge, and preferences. The three factors influence the provision of respectful perinatal care; addressing them might improve the provision of the care. Conclusion Addressing factors that influence respectful perinatal care is vital towards the prevention of compromised patient care during the perinatal period as these factors have the potential to accelerate or hinder provision of respectful care.

Keywords: doctors, maternity care, midwives, obstetrician, perceptions, perinatal care, respectful care

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Authors: Edwin Onwuka, Segun Omidiora, Eugenia Abiodun-Eniaiyekan

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The Nigerian military is often the subject of active critical inquiries having played significant roles in Nigeria’s national development. However, the soldier is one of the most vilified characters in Nigeria’s imaginative literature, be it in poetry, drama or prose fiction. In the main, the characterization of soldiers is predictable because of their entrenched stereotype as oppressors, tyrants, bullies, rapists, despots, killers or at best law-breakers subject to no authority outside the military institution. In most novels, the soldier’s personality is associated with force and violence; still, few have defied the norm to portray soldiers that go against the grain of notoriety. Such novels have characterized the Nigerian soldier positively as a civil, thinking and human personality in relating to civil society. To a great extent, two major impetuses that influence literary representation of characters and institutions in African literature are ideology and commitment, and one necessarily impacts on the other in shaping the artistic vision of the writer. Using two war novels therefore as templates, this paper argues that the ideology that drives the Nigerian writer’s socio-cultural commitment to national development shapes their portrayal of the Nigerian soldier in imaginative literature. A major objective of this study, therefore, is to show through close textual analysis that the writers’ ideologies influence their perception and characterization of the Nigerian soldier in Isidore Okpewho’s The Last Duty and Festus Iyayi’s Heroes, two representative novels of both persuasions described above. New Historicism is the critical framework applied in this study and its conclusion is that the Nigerian writer’s characterization of the soldier is influenced by his ideological perception of the military in the policy against the backdrop of their past socio-political activities.

Keywords: commitment, ideology, national development, new historicism, Nigerian soldier

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Authors: Akash Soogumbur

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Tourniquets are commonly used in orthopaedic surgery to provide hemostasis during procedures on the upper and lower limbs. However, there is a risk of complications associated with tourniquet use, such as nerve damage, skin necrosis, and compartment syndrome. The British Orthopaedic Association (BOAST) guidelines recommend the use of tourniquets at a pressure of 300 mmHg or less for a maximum of 2 hours. Research Aim: The aim of this study was to evaluate the effectiveness of a tourniquet checklist in improving compliance with the BOAST guidelines. Methodology: This was a retrospective study of all orthopaedic procedures performed at a single institution over a 12-month period. The study population included patients who had a tourniquet applied during surgery. Data were collected from the patients' medical records, including the duration of tourniquet use, the pressure used, and the method of exsanguination. Findings: The results showed that the use of the tourniquet checklist significantly improved compliance with the BOAST guidelines. Prior to the introduction of the checklist, compliance with the guidelines was 83% for the duration of tourniquet use and 73% for pressure used. After the introduction of the checklist, compliance increased to 100% for both duration of tourniquet use and pressure used. Theoretical Importance: The findings of this study suggest that the use of a tourniquet checklist can be an effective way to improve compliance with the BOAST guidelines. This is important because it can help to reduce the risk of complications associated with tourniquet use. Data Collection: Data were collected from the patients' medical records. The data included the following information: Patient demographics, procedure performed, duration of tourniquet use, pressure used, method of exsanguination. Analysis Procedures: The data were analyzed using descriptive statistics. The compliance with the BOAST guidelines was calculated as the percentage of patients who met the guidelines for the duration of tourniquet use and pressure used. Question Addressed: The question addressed by this study was whether the use of a tourniquet checklist could improve compliance with the BOAST guidelines. Conclusion: The results of this study suggest that the use of a tourniquet checklist can be an effective way to improve compliance with the BOAST guidelines. This is important because it can help to reduce the risk of complications associated with tourniquet use.

Keywords: tourniquet, pressure, duration, complications, surgery

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Authors: B. Gechbaia, K. Goletiani, G. Gabedava, N. Mikeltadze

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At this stage, Georgia is a country which is actively involved in the European integration process, for which the primary priority is effective integration in the European education system. The modern Georgian higher education system is the process of establishing a new sociocultural reality, whose main priorities are determined by the Quality System as a continuous cycle of planning, implementation, checking and acting. Obviously, in this situation, the issue of management of education institutions comes out in the foreground, since the proper planning and implementation of personnel management processes is one of the main determinants of the company's performance. At the same time, one of the most important factors is the psychological comfort of the personnel, ensuring their protection and efficiency of stress management policy. The purpose of this research is to determine how intensely the relationship is between the psychological comfort of the personnel and the efficiency of the quality system in the institution as the quality assurance mechanisms of educational institutions affect the stability of personnel, prevention and management of the stressful situation. The research was carried out within the framework of the Internal Grant Project «The Role of Organizational Culture in the Process of Settlement of Management of Stress and Conflict, Georgian Reality and European Experience » of the Batumi Navigation Teaching University, based on the analysis of the survey results of target groups. The small-scale research conducted by us has revealed that the introduction of quality assurance system and its active implementation increased the quality of management of Georgian educational institutions, increased the level of universal engagement in internal and external processes and as a result, it has improved the quality of education as well as social and psychological comfort indicators of the society.

Keywords: quality assurance, effective management, stability of personnel, psychological comfort, stress management

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Authors: Aneri Mehta, Krunal Mehta

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Financial administration is part of government which deals with collection, preservation and distribution of public funds, with the coordination of public revenue and expenditure, with the management of credit operation on behalf of the state and with the general control of the financial affairs of public households. The researcher has taken the prime body of the local self government viz. Municipal Corporation. However, the number of municipal corporations in India has rapidly increased in recent years. Countries 27% of the total population are living in urban area & in recent it increasing very fast. People are moving very fast from rural area to urban area. Their demand, awareness is increasing day by day. The Municipal Corporations render many services for the development of the urban area. Thus, researcher has taken a step to know the accounting practices of the municipal corporations of Gujarat state (AMC & BMC ). The research will try to show you the status of finance of municipal corporations. Article 243(w) of the constitution of India envisaged that the state government maybe, by law , endow the municipalities with such powers and authorities as may be necessary to enable them to function as institution of self government and such law may contain provision for devolution of powers and responsibilities upon municipalities subjects to such condition as may be specified there in with respect to (i) the peroration of plans for economic development and social justice and (ii) the performance of the function and the implementation of schemes as may be entrusted to them including those in relation to the matters listed in the twelfth schedule. The three tier structure of the Indian Government i.e. Union, State & Local Self Government is the scenario of the Indian constitution. Local Self Government performs or renders many services under the direct control of state government. They (local bodies) possess autonomy within its limited sphere, raise revenue through local taxation and spend its income on local services.

Keywords: financial administration, urban local bodies, local self government, constitution

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Authors: Chernet Mulugeta, Girma Seyoum, Yeshineh Demrew, Kehabtimer Shiferaw

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Background: Obstetric fistula (OF) is a serious medical condition that includes an abnormal opening between the vagina and bladder (vesico-vaginal fistula) or the vagina and rectum (recto-vaginal fistula). It is usually caused by prolonged obstructed labour. Despite its serious health and psychosocial consequences, there is a paucity of evidence regarding the time it takes to heal from OF. Objective: The aim of this study was to assess the time to cure from obstetric fistula and its predictors among women admitted to Addis Ababa Hamlin Fistula Hospital, Addis Ababa, Ethiopia. Methodology: An institution-based retrospective cohort study was conducted from January 2015 to December 2020 among a randomly selected 434 women with OF in Addis Ababa Hamlin Fistula Hospital. Data was collected using a structured checklist adapted from a similar study. The open data kit (ODK) collected data was exported and analyzed by using STATA (14.2). Kaplan Meir was used to compare the recovery time from OF. To identify the predictors of OF, a Cox regression model was fitted, and an adjusted hazard ratio with a 95% confidence interval was used to estimate the strength of the associations. Results: The average time to recover from obstetric fistula was 3.95 (95% CI: 3.0-4.6) weeks. About ¾ of the women [72.8% (95% CI - 0.65-1.2)] were physically cured of obstetric fistula. Having secondary education and above [AHR=3.52; 95% CI (1.98, 6.25)] compared to no formal education, having a live birth [AHR=1.64; 95% CI (1.22, 2.21)], having an intact bladder [AHR=2.47; 95% CI (1.1, 5.54)] compared to totally destructed, and having a grade 1 fistula [AHR=1.98; 95% CI (1.19, 3.31)] compared to grade 3 were the significant predictors of shorter time to cure from an obstetric fistula. Conclusion and recommendation: Overall, the proportion of women with OF who were not being cured was unacceptably high. The time it takes for them to recover from the fistula was also extended. It connotes us to work on the identified predictors to improve the time to recovery from OF.

Keywords: time to recovery, obstetric fistula, predictors, Ethiopia

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Authors: Paiboon Chuwatthanakij

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Each of the countries around the world has different ways of management and many of them depend on people to administrate their country. Thailand, for example, empowers the sovereignty of Thai people under constitution; however, our Thai voting system is not able to flow fast enough under the current Political management system. The sovereignty of Thai people is addressing this problem through representatives during current elections, in order to set a new policy for the countries ideology to change in the House and the Cabinet. This is particularly important in a democracy to be developed under our current political institution. The Organic Act on Political Parties 2007 is the establishment we have today that is causing confrontations within the establishment. There are many political parties that will soon be abolished. Many political parties have already been subsidized. This research study is to analyze the legal problems with the political party establishment under the Organic Act on Political Parties 2007. This will focus on the freedom of each political establishment compared to an effective political operation. Textbooks and academic papers will be referenced from studies home and abroad. The study revealed that Organic Act on Political Parties 2007 has strict provisions on the political structure over the number of members and the number of branches involved within political parties system. Such operations shall be completed within one year; but under the existing laws the small parties are not able to participate with the bigger parties. The cities are capable of fulfilling small political party requirements but fail to become coalesced because the current laws won't allow them to be united as one. It is important to allow all independent political parties to join our current political structure. Board members can’t help the smaller parties to become a large organization under the existing Thai laws. Creating a new establishment that functions efficiently throughout all branches would be one solution to these legal problems between all political parties. With this new operation, individual political parties can participate with the bigger parties during elections. Until current political institutions change their system to accommodate public opinion, these current Thai laws will continue to be a problem with all political parties in Thailand.

Keywords: coalesced, political party, sovereignty, elections

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Authors: Christine Ysabelle G. Roman, Pauline Torres

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Background: Hypertrophic cardiomyopathy is a disease of marked heterogeneity. It is a genetically determined heart disease characterized by significant myocardium hypertrophy that results in diastolic dysfunction, left ventricular outflow tract obstruction, and an increased risk of arrhythmias. The primary treatment in patients with such conditions is negative inotropic drugs, such as beta-blockers, calcium channel antagonists, and disopyramide. However, for those who remain symptomatic and need septal reduction therapy, surgical septal myectomy or alcohol septal ablation are options. Case Summary: A 19 – year old female presented in the authors’ institution with easy fatigability. The consult was done a year prior, and 2D echocardiography was requested which showed concentric left ventricular hypertrophy, asymmetrically hypertrophied interventricular septum (IVS) with the largest diameter of 3.3cm & subaortic dynamic obstruction with a maximum gradient of 47 mmHg. A repeat echo a year later showed asymmetric septal hypertrophy (IVS measuring at 3cm) with the systolic anterior motion of anterior mitral valve leaflet and left ventricular outflow tract obstruction (peak gradient of 50mmHg). The patient then underwent alcohol septal ablation and was discharged stable after four days of admission. Conclusion: Hypertrophic obstructive cardiomyopathy, a cardiovascular genetic disease, results in various patterns of left ventricular hypertrophy and abnormality of mitral valve apparatus. The patient is managed medically initially. However, despite optimal drug therapy and significant left ventricular outflow tract obstruction, significant heart failure symptoms or syncope require invasive treatment.

Keywords: hypertrophic obstructive cardiomyopathy, left ventricular outflow tract obstruction, alcohol septal ablation, alcohol

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