Search results for: incidental findings

Authors: Norhan H. Mahdally, Bathini Thissera Riham A. ElShiekh, Noha M. Elhosseiny, Mona T. Kashef, Ali M. El Halawany, Mostafa E. Rateb, Ahmed S. Attia

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Multidrug-resistant (MDR) pathogens pose a global threat to healthcare settings. The exhaustion of the current antibiotic arsenal and the scarcity of new antimicrobials in the pipeline aggravate this threat and necessitate a prompt and effective response. This study focused on two major pathogens that can cause serious infections: carbapenem-resistant Acinetobacter baumannii (CRAB) and methicillin-resistant Staphylococcus aureus (MRSA). Multiple soil isolates were collected from several locations throughout Egypt and screened for their conventional and non-conventional antimicrobial activities against MDR pathogens. One isolate exhibited potent antimicrobial activity and was subjected to multiple rounds of fractionation. After fermentation and bio-guided fractionation, we identified pure microbial secondary metabolites with two scaffolds that exhibited promising effects against CRAB and MRSA. Scaling up and chemical synthesis of derivatives of the identified metabolite resulted in obtaining a more potent derivative, which we designated as 2HP. Cytotoxicity studies indicated that 2HP is well-tolerated by human cells. Ongoing work is focusing on formulating the new compound into a nano-formulation to enhance its delivery. Also, to have a better idea about how this compound works, a proteomic approach is currently underway. Our findings suggest that 2HP is a potential new broad-spectrum antimicrobial agent. Further studies are needed to confirm these findings and to develop 2HP into a safe and effective treatment for MDR infections.

Keywords: broad-spectrum antimicrobials, carbapenem-resistant acinetobacter baumannii, drug discovery, methicillin-resistant staphylococcus aureus, multidrug-resistant, natural products

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Authors: Shikuku Emmanuel Tsikhungu

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Theatre and religion have enjoyed a symbiotic relationship from time immemorial, each transforming in different epochs and into different forms of practice but gaining from each other’s growth. Despite the fact that religion has more or less looked at the theatre and its dramatic rituals with distaste, the two human engagements have had dynamic and reciprocal relationships. In Kenya, there is an emerging innovation and transformation of theatre for religion in which churches and sects are consciously developing a youth wing that is vibrant in theatre practice. The imagination that youth and children derive pleasure and vibrancy in theatre has led to a lively competition among churches that is now creating a new form of theatre in Kenya. This has given rise to a practice in which art engages the religious not at the spiritual level but at the social-cultural level. Thus theatre is finding itself in sanctums that it had been banished; not for its own sake but as a tool for keeping the youth nearer the church if not the church This article analyses findings of a study carried out in December of 2017 among theatre festivals for the Catholic Church held in Kitui School, KituiCounty, and the Methodist Church of Kenya festival held in Ntemwene Church, Nkubu, Meru County, Kenya. One of the findings of interest was that while they were not theatres of religion nor religious theatres since they did not fuse the religious rituals with the dramatic rituals, the festivals never the less qualify as theatres for religion for they link the former to the latter. Secondly, while they claimed to be youth or children theatre festivals, they lacked youth-centredness nor child-centredness associated with such. Thirdly and most importantly the style of dramatic execution ranged from bibliodramatic to secular drama with Christian messages. Fourthly, by this stroke of acceptance in formerly forbidden sanctums, theatre is re-inventing itself back to its ‘old’ nature and function. It may be argued conclusively that this sprouting movement of theatre for religion may be comparable to the Jesuit Theatre fronted by Ignatius Loyola but clothed in modern African theatre practice.

Keywords: theatre, religion, theatre for religion, social constructs, socio-cultural

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Authors: Kenny Chi Man Chui

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Background: In Chinese culture, the traditional equivalent term for English dementia is chi dai zheng, which, whether translated as ‘insanity’ or ‘idiocy’ carries a sharply negative connotation. In fact, even though the traditional name for dementia has evolved, from chi dai zheng to shi zhi zheng, nao tui hua zheng or ren zhi zhang ai zheng, educating the population about more respectful terms for the condition and promoting a positive understanding about people with dementia in society have proven to be time-intensive endeavors. By extension, the use of such terms promotes the perception that people with dementia undergo a ‘total loss of self’ or experience a ‘living death’ or ‘social death’. Both in Asia and elsewhere, the appropriate nomenclature for dementia remains controversial, and different medical and healthcare professionals in Hong Kong have taken various stances on how to refer to the condition there. Indeed, how this negative perception affects the interaction between people with dementia and the surrounding others? Methodology: Qualitative research with the concept of postmodernism, interpretivism, and Foucauldian theory was adopted as frameworks in applying participatory observations, in-depth interviews, and other qualitative methods. First, ten people with dementia—one man and nine women—living in two residential care homes in Hong Kong were interviewed, as were ten members of the care staff, all of whom were women. Next, to coach the staff in understanding the feelings and self-perceptions of people with dementia, two reflective training sessions were provided. Afterward, to assess the impact of the training sessions on the staff, two focus groups were held. Findings: The findings revealed that residents with dementia did not perceive themselves as being ‘demented’ and were confused by not getting responses from the others. From the understanding of care staff, they perceived the residents as being ‘demented’, desolate troublemakers. They described people with dementia as ‘naughty children’ who should be controlled and be punished while treated them as ‘psychiatric patients’ who could be ignored and be mute. “Psychosocial restraint” happened regarding the discrepancy of perception between people with dementia and the care staff. People with dementia did not think that their confusion of memory was related to dementia or, frankly speaking, they did not know what dementia was. When others treated them as ‘demented patients, the residents with mild to moderate dementia fiercely rejected that designation and reported a host of negative feelings, hence the fluctuations of mood and emotion noted by the care staff. Conclusion: As the findings revealed, the people with dementia were also discontent with the care arrangements in the care homes, felt abandoned by others and worried about bothering others. Their shifting emotional states and moods were treated as the Behavioral and Psychological symptoms of Dementia (BPSD), which nothing can do reported by the care staff in the residential care homes. People with dementia become social withdrawal or isolated in daily living, which should be alert and be changed by the social work professionals about the occurrence of “psychosocial restraint” in dementia care.

Keywords: psychosocial restraint, qualitative research, social work with dementitude, voice of people with dementia

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Authors: Mehmet Sinan Erguven

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Modern art is relatively new but a popular area in Turkish art society. Modern art museums are mainly located in big cities like Istanbul and Ankara where cultural life is more dynamic. Odunpazarı Modern Museum (OMM) will open its doors on September 2019 and be the only modern art museum located in a small town in Turkey. OMM executives declare the mission of the museum as; art must go beyond the metropolises of the world, give a new lease of life to cities that make a difference with their cultural texture, and reach a greater audience through that expansion. So OMM will not only serve as a museum but a landmark for regenerating the city brand of Eskişehir like the Guggenheim in Bilbao. OMM is located in the Odunpazarı area, the heart of Eskişehir. Named after the historical timber market it once hosted, Odunpazarı is a nominated site for the UNESCO Intangible Cultural Heritage List, and is Eskişehir’s first area of settlement. This study focuses on the complex nature of opening a modern art museum in a small town. The management and marketing dynamics of OMM are discussed in the study. Content analysis technique is used on local and national news to display the perception differences before and after the opening of OMM. In depth interviews with the executives of the museum are conducted in order to enlighten the insights of opening a modern art museum in a small town. Early findings of the content analysis point out that, the comments on the national press are mostly positive. On the other hand, different views occur on the local press. The location OMM is constructed and grandness of the museum building are criticized by some of the local newspapers. OMM’s potential as a tourist attraction is agreed by most of the media. OMM executives stated the most challenging task as reaching the different target audiences on international, national and local levels. These early findings will be improved and compared shortly before and after the opening of the museum.

Keywords: management, marketing, Odunpazarı modern museum, small town

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Authors: Shaista Meghani, Rozina Karmaliani, Khairulnissa Ajani, Shireen Shahzad, Nadeem Ullah Khan

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Background: The concept of Family Presence During Resuscitation (FPDR) is gradually gaining recognition in western countries, however, it is rarely considered in South Asian countries including Pakistan. Over time, patients’ and families’ rights have gained recognition and healthcare has progressed to become more patient-family centered. Objectives: The objective of this study was to evaluate the impact of an educational program on the Knowledge, Attitude, and Practices (KAP) of healthcare professionals (HCPs) towards FPDR in Emergency Department (ED), at a tertiary care setting, in Karachi, Pakistan. Methods: This was a Pre-test and Post-test study design. A convenient universal sampling was done, and all ED nurses and physicians with more than one year of experience were eligible. The intervention included one-hour training sessions for physicians (three sessions) and nurses (eight sessions), The KAP of nurses and physicians were assessed immediately after (post-test I), and two weeks(post-test II) after the intervention using a pretested questionnaire. Results: The findings of the study revealed that the mean scores of knowledge and attitude of HCPs at both time points were statistically significant (p-value=<0.001), however, an insignificant difference was found on practice of FPDR (p-value=>0.05). Conclusion: The study findings recommend that the educational program on FPDR for HCPs needs to be offered on an ongoing basis. Moreover, training modules need to be developed for the staff, and formal guidelines need to be proposed for FPDR, through a multidisciplinary team approach.

Keywords: family presence, cardiopulmonary resuscitation, attitude, education, practices, health care professionals

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Authors: Manal Ahmed, Amal Shehata, Shereen Deeb

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The study's purpose was to determine the effect of the perioperative protocol of care on clinical outcomes among patients undergoing coronary artery bypass graft. Subjects: A sample of 100 adult patients who were planned for coronary artery bypass graft, were selected and divided alternatively and randomly into two equal groups (50 study -50 control).The study was carried out at National heart Institute in Cairo and open heart surgical intensive care unit in Shebin El-Kom Teaching Hospital. Instruments: Four instruments were used for data collection: Interviewing questionnaire, dyspnea analogue scale, Biophysiological measurement instrument, and Compliance assessment sheet. Results: There were statistically significant differences between both groups regarding most respiratory system assessment findings at discharge. More than two-thirds of the study group of the current study had a continuous and regular commitment to diet regimen, which ranked first followed by the compliance of daily living activities then quitting smoking. Conclusions: The perioperative protocol of care has a significant improving effect on respiratory findings, dyspnea degree, duration of mechanical ventilation, length of hospital stay, compliance to diet, therapeutic regimen, daily living activities, and quit smoking among study group undergoing CABG. Recommendations: Perioperative protocol of care should be carried out for CABG patients at open-heart surgical units as well as an illustrative colored booklet about CAD, CABG and perioperative care should be available and distributed to all CABG patients.

Keywords: perioperative, effect, clinical outcomes, coronary artery, bypass graft, protocol of care

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Authors: A. Yakub AbdurRaheem

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Urban violence in the form of ethnic and religious conflicts have been on the increase in many African cities in the recent years of which most of them are the result of intense and bitter competition for political power, the control of limited economic, social and environmental resources. In Nigeria, the emergence of the Boko Haram insurgency in most parts of the northeastern parts have ignited violence, bloodshed, refugee exodus and internal migration. Not only do the persistent attacks of the sect create widespread insecurity and fear, but it has also stifled normal processes of trade and investments most especially real property investment which is acclaimed to accelerate the economic cycle, thus the need to evolve strategies for an improved property market in such areas. This paper, therefore, examines the impact of this social crisis on effective and efficient utilization of real properties as a resource towards the development of the economy, using a descriptive analysis approach where particular emphasis was based on trends in residential housing values; volume of estimated property transactions and real estate investment decisions by affected individuals. Findings indicate that social crisis in the affected areas have been a clog on the wheels of property development and investment as properties worth hundreds of millions have been destroyed thereby having great impact on property values. Based on these findings, recommendations were made to include the need to strategically continue investing in property during such times, the need for Nigerian government to establish an active conflict monitoring and management unit for the prompt response, encourage community and neighborhood policing to ameliorate security challenges in Nigeria.

Keywords: social crisis, economy, resources, property market

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Authors: Ye Jiang

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To examine how the relationships among multiple institutional logics vary over time and the factors that may impact this process, we conducted a 15-year in-depth longitudinal case study of a Higher Education Institution to examine its exploration in college student management. By employing constructive grounded theory, we developed a four-stage process model comprising separation, formalization, selective bridging, and embeddedness that showed how two contradictory logics become complementary, and finally become a new hybridized logic. We argue that selective bridging is an important step in changing inter-logic relations. We also found that ambidextrous leadership and situational sensemaking are two key factors that drive this process. Our contribution to the literature is threefold. First, we enhance the literature on the changing relationships among multiple institutional logics and our findings advance the understanding of relationships between multiple logics through a dynamic view. While most studies have tended to assume that the relationship among logics is static and persistently in a contentious state, we contend that the relationships among multiple institutional logics can change over time. Competitive logics can become complementary, and a new hybridized logic can emerge therefrom. The four-stage logic hybridization process model offers insights on the logic hybridization process, which is underexplored in the literature. Second, our research reveals that selective bridging is important in making conflicting logics compatible, and thus constitutes a key step in creating new hybridized logic dynamics. Our findings suggest that the relations between multiple logics are manageable and can thus be manipulated for organizational innovation. Finally, the factors influencing the variations in inter-logic relations enrich the understanding of the antecedents of these dynamics.

Keywords: institutional theory, institutional logics, ambidextrous leadership, situational sensemaking

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Authors: Khizar Z. Choudhrya, Richard Coles, Salman Qureshi, Robert Ashford, Salim Khan, Rabia R. Mir

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Abstract: The majority of existing landscape research has been derived by conducting heuristic evaluations, without having empirical insight of real participant visual response. In this research, a modern multimodal measurement approach (using narratives and eye tracking) was applied to investigate visual behaviour in perceiving naturalistic and urban environments. This research is unique in exploring gaze behaviour on environmental images possessing different levels of saliency. Eye behaviour is predominantly attracted by salient locations. The concept of methodology of this research on naturalistic and urban environments is drawn from the approaches in market research. Borrowing methodologies from market research that examine visual responses and qualities provided a critical and hitherto unexplored approach. This research has been conducted by using mixed methodological quantitative and qualitative approaches. On the whole, the results of this research corroborated existing landscape research findings, but they also identified potential refinements. The research contributes both methodologically and empirically to human-environment interaction (HEI). This study focused on initial impressions of environmental images with the help of eye tracking. Taking under consideration the importance of the image, this study explored the factors that influence initial fixations in relation to expectations and preferences. In terms of key findings of this research it is noticed that each participant has his own unique navigation style while surfing through different elements of landscape images. This individual navigation style is given the name of ‘visual signature’. This study adds the necessary clarity that would complete the picture and bring an insight for future landscape researchers.

Keywords: human-environment interaction (HEI), multimodal measurement, narratives, eye tracking

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Authors: Mohammad Javad Seddighi, Avar Almukhtar

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The occurrence of natural disasters, such as floods and earthquakes, can cause significant damage to heritage sites and surrounding areas. In Iran, the city of Bam was devastated by an earthquake in 2003, which had a major impact on the rivers and watercourses around the city. This study aims to investigate the environmental design techniques and sustainable hazard mitigation strategies that can be employed to preserve heritage sites in the face of natural disasters, using the Bam experience as a case study. The research employs a mixed-methods approach, combining both qualitative and quantitative data collection and analysis methods. The study begins with a comprehensive literature review of recent publications on environmental design techniques and sustainable hazard mitigation strategies in heritage conservation. This is followed by a field study of the rivers and watercourses around Bam, including the Adoori River (Talangoo) and other watercourses, to assess the current conditions and identify potential hazards. The data collected from the field study is analysed using statistical methods and GIS mapping techniques. The findings of this study reveal the importance of sustainable hazard mitigation strategies and environmental design techniques in preserving heritage sites during natural disasters. The study suggests that these techniques can be used to prevent the outbreak of another natural disaster in Bam and the surrounding areas. Specifically, the study recommends the establishment of a comprehensive early warning system, the creation of flood-resistant landscapes, and the use of eco-friendly building materials in the reconstruction of heritage sites. These findings contribute to the current knowledge of sustainable hazard mitigation and environmental design in heritage conservation.

Keywords: natural disasters, heritage conservation, sustainable hazard mitigation, environmental design, landscape architecture, flood management, disaster resilience

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Authors: Lindy Van Vliet, Saloni Phadke, Anthea Nelson, Ann Gallant

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Holistic and patient-centred palliative care and support require an integrated system of care that includes health and social service providers working together to ensure that patients and families have access to the care they need. The objective of this study is to further explore and understand the benefits and challenges of mobilizing multidisciplinary care teams for health care professionals and social service providers. Drawing on an interpretivist, exploratory, qualitative design, our multidisciplinary research team (medicine, nursing and social work) conducted interviews with 15 health care and social service providers in the Ottawa region. Interview data was audio-recorded, transcribed, and analyzed using a reflexive thematic analysis approach. The data deepens our understandings of the facilitators and barriers posed by multidisciplinary care teams. Three main findings emerged: First, the data highlighted the benefits of multidisciplinary care teams for both patient outcomes and quality of life and provider mental health; second, the data showed that the lack of a system-wide integrated communication system reduces the quality of patient care and increases provider stress while working in multidisciplinary care teams; finally, the data demonstrated the existence of implicit hierarchies between disciplines, this coupled with different disciplinary perspectives of palliative care provision can lead to friction and challenges within care teams. These findings will have important implications for the future of palliative care as they will help to facilitate and build stronger person-centred/relationship-centred palliative care practices by naming the challenges faced by multidisciplinary palliative care teams and providing examples of best practices.

Keywords: public health palliative care, palliative care nursing, care networks, integrated health care, palliative care approach, public health, multidisciplinary work, care teams

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Authors: Essang Anwana Onuntuei, Chinyere Blessing Azunwoke

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The study focused on probing the effectiveness of online consumer privacy and protection laws, electronic transaction laws, privacy and data protection laws, and cybercrime legislation amid frequent cyber-attacks and malware types worldwide. An empirical analysis was engaged to uncover ties and causations between the stringency and implementation of these legal structures and the prevalence of cyber threats. A deliberate sample of seventy-eight countries (thirteen countries each from six continents) was chosen as sample size to study the challenges linked with trending regulations and possible panoramas for improving cybersecurity through refined legal approaches. Findings establish if the frequency of cyber-attacks and malware types vary significantly. Also, the result proved that various cybercrime laws differ statistically, and electronic transactions law does not statistically impact the frequency of cyber-attacks. The result also statistically revealed that the online Consumer Privacy and Protection law does not influence the total number of cyber-attacks. In addition, the results implied that Privacy and Data Protection laws do not statistically impact the total number of cyber-attacks worldwide. The calculated value also proved that cybercrime law does not statistically impact the total number of cyber-attacks. Finally, the computed value concludes that combined multiple cyber laws do not significantly impact the total number of cyber-attacks worldwide. Suggestions were produced based on findings from the study, contributing to the ongoing debate on the validity of legal approaches in battling cybercrime and shielding consumers in the digital age.

Keywords: cybercrime legislation, cyber attacks, consumer privacy and protection law, detection, electronic transaction law, prevention, privacy and data protection law, prohibition, prosecution

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Authors: Bernice Badal

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This article addresses a persistent challenge related to teacher agency in knowledge acquisition in professional development (PD) workshops in contexts of educational change, given that scholarship identifies a need for more teacher involvement and amplification of teacher's voices. Theoretical concepts are drawn from Bandura’s Social cognitive theory, incorporating the triadic causation model of agency to examine the reciprocal nature of the context, teacher characteristics, and systemic influences that shape how knowledge is transmitted and acquired in PD workshops. This qualitative study, using a mix of classroom observations and interviews, explored the political, contextual, and personal characteristics of teacher agency in PD through an analysis of data extracted from a PhD study. The narratives of six teachers from three township schools are examined to show how PD efforts in South Africa have failed to take account of the holistic development of teacher agency in knowledge dissemination and how this shapes teacher self-efficacy beliefs about being able to masterfully apply the tenets of the reform. Agency, teacher voice, and contextual considerations were used as markers of the quality of the training provided to understand how knowledge is acquired and meaning is made. The findings suggest that systemic influences of institutionally imposed PD offer partial understandings of the reform, which is offered in traditional formats that do not consider teacher empowerment in knowledge production and the development of teacher agency. Common in all the participants’ responses is the need for more information and training on the prescribed approach for teaching English as a second language; however, this paper holds the view that more information may not solve teachers’ dilemmas. Accordingly, it recommends a restructuring of the programme with facilitators being more cognisant of teacher agency for the development of transformative teachers. The findings of the study contribute to the field of teacher knowledge, teacher training, and professional development in the context of educational reforms.

Keywords: teacher professional development, teacher voice, teacher agency, educational reforms, teacher knowledge

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Authors: Inam Ridha, Christine L. Kuryla, Madhuranga Thilakasiri Madugoda Ralalage Don, Norman J. Kleiman, Yunro Chung, Jin Park, Vel Murugan, Joshua LaBaer

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To date, more than 275 million people worldwide have been diagnosed with COVID-19 and the rapid spread of the omicron variant suggests many millions more will soon become infected. Many infections are asymptomatic, while others result in mild to moderate illness. Unfortunately, some infected individuals exhibit more serious symptoms including respiratory distress, thrombosis, cardiovascular disease, multi-organ failure, cognitive difficulties, and, in roughly 2% of cases, death. Studies indicate other coronaviruses can alter the host cell's epigenetic profile and lead to alterations in the immune response. To better understand the mechanism(s) by which SARS-CoV-2 infection causes serious illness, DNA methylation profiles in peripheral blood mononuclear cells (PBMCs) from 90 hospitalized severely ill COVID-19 patients were compared to profiles from uninfected control subjects. Exploratory epigenome-wide DNA methylation analyses were performed using multiplexed methylated DNA immunoprecipitation (MeDIP) followed by pathway enrichment analysis. The findings demonstrated significant DNA methylation changes in infected individuals as compared to uninfected controls. Pathway analysis indicated that apoptosis, cell cycle control, Toll-like receptors (TLR), cytokine interactions, and T cell differentiation were among the most affected metabolic processes. In addition, changes in specific gene methylation were compared to SARS-CoV-2 induced changes in RNA expression using published RNA-seq data from 3 patients with severe COVID-19. These findings demonstrate significant correlations between differentially methylated and differentially expressed genes in a number of critical pathways.

Keywords: COVID19, epigenetics, DNA mathylation, viral infection

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Authors: Saeed Ullah Jan, Waheed Ullah Kha

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Purpose of the study: This study aims to assess faculty members' information literacy skills in public sector medical colleges in Khyber Pakhtunkhwa. Design/Methodology/approach: The descriptive research design was used to conduct and accomplish the study's objectives. The research population consisted of faculty members at public sector medical colleges in Khyber Pakhtunkhwa southern region. Professors, Associate Professors, Assistant Professors, Lecturers, and demonstrators comprise the faculty. The adapted questionnaires were modified and used as data collection instruments. Key findings: The majority of the public sector medical college faculty recognizes the various sources of information, and they use both printed and online materials to identify needed information. The majority of faculty at these medical colleges consults monographs/textbooks regularly, preceded by online journals/medical databases. A good number of medical faculty members opted to use the HEC digital library to locate and access their contents. Delimitations of the study: This study is delimited to three public sector medical colleges operate in southern districts: Khyber Medical University Institute of Medical Sciences (KIMS) in Kohat, the Gomal Medical College (GMC) in Dera Ismail Khan, and the Bannu Medical College (BMC) in Bannu. Practical implication(s): The findings of the study will motivate the policymakers and authorities of these three medical colleges in the southern region of Khyber Pakhtunkhwa to enhance the information literacy skills of medical faculty. This practice will result in an effective medical education in the province. Contribution to the knowledge: No significant work has been done on the Faculty's Information literacy skills at public sector medical colleges in Khyber Pakhtunkhwa. This study will add valuable literature to the literary world.

Keywords: information literacy skills-Khyber Pakhtunkhwa, information literacy skills-medical faculty-Khyber Pakhtunkhwa, medical sciences, information literacy, information-literacy-Pakistan

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Authors: Jim Shih-Chiao Chin , Tsai Lin Hsu, Shui Lien Chen

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This article extends the relation between company’s employee and customers in market. According to the previous researches, most researchers analyzed and focused on customers’ brand perception. In the recently, some scholars star to explore the brand management from company viewpoint. The aim of this study is to explore whether consumers perception would be affected by the firm brand. This research would like to examine the relationship between individual consumers and corporate brands in the business-to-consumers sector. First, the study develops a framework that the connection with consumer and company. Second, this article uses three dimensions, brand knowledge, brand commitment, and brand equity to measure employees’ loyalty of brand and applies brand relationship quality to gauge the level of brand’s importance in consumer’s mind. This paper uses SPSS 20.0 and AMOS 20.0 to test consumers’ minds toward the brand equity which the company provides. There are totally 862 valid questionnaires returned, and 431 participants are consumers; the other 431 participants are employees. Those questionnaires are one-by-one to consumer and employee so those are 431 pairs questionnaires. Based on 431 pairs of consumers and company’s employees, analyzed results show that brand knowledge and brand commitment play important roles influencing brand equity. The results also demonstrate the extra-role brand equity positively impact on the brand relationship quality of consumers. In addition, the findings reveal that the company can improve brand relationship quality of consumers by enhancing extra-role brand equity. There is a sufficient evidence denote that brand relationship quality not only shows about the brand of customers’ thought but also implies company how to build the brand to impress on consumers. These findings provide the degree of the brand in consumers’ cognition. The brand-owner employee can reference the conclusion to creative new strategic to the next time or can be one of the company’s competitive advantages. Those results and conclusions are contributed to management practice and future.

Keywords: brand knowledge, brand commitment, brand equity, brand relationship quality

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Authors: Akhentoolove Corbin, Leta De Jonge, Charmaine De Jonge

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Introduction: Various writers have promoted the adoption of the 4th R in the education curricula (relationships, respect, reasoning, religion, computing, science, art, conflict management, music) and the 5th R (responsibility). They argue that the traditional 3 Rs are not adequate for the modern environment and the requirements for students to become functional citizens in society. In particular, the developing countries of the anglophone Caribbean (most of which are tiny islands) are susceptible to the dangers and complexities of climate change and global economic volatility. These proposed additions to the 3Rs do have some justification, but this research considers Resilience as even more important and relevant in a world that is faced with the negative prospects of climate change, poverty, discrimination, and economic volatility. It is argued that the foundation for resilient citizens, workers, and workplaces, must be built in the elementary and secondary/middle schools and then through the tertiary level, to achieve an outcome of more resilient students. Government, business, and society require widespread resilience to be capable of ‘bouncing back’ and be more adaptable, transformational, and sustainable. Methodology: The paper utilises a mixed-methods approach incorporating a questionnaire and interviews to determine participants’ opinions on the importance and relevance of resilience in the schools’ curricula and to government, business, and society. The target groups are as follows: educators at all levels, education administrators, members of the business sector, public sector, and 3rd sector. The research specifically targets the anglophone Caribbean developing countries (Barbados, Guyana, Jamaica, Trinidad, St. Lucia, and St Vincent, and the Grenadines). The research utilises SPSS for data analysis. Major Findings: The preliminary findings suggest that the majority of participants support the adoption of resilience as a 4th R in the curricula of the elementary, secondary/middle schools, and tertiary level in the anglophone Caribbean. The final results will allow the researchers to reveal more specific details on any variations among the islands in the sample andto engage in an in-depth discussion of the relevance and importance of resilience as the 4th R. Conclusion: Results seem to suggest that the education system should adopt the 4th R of resilience so that educators working in collaboration with the family and community/village can develop young citizens who are more resilient and capable of manifesting the behaviours and attitudes associated with ‘bouncing back,’ adaptability, transformation, and sustainability. These findings may be useful for education decision-makers and governments in these Caribbean islands, who have the authority and responsibility for the development of education policy, laws, and regulations.

Keywords: education, resilient students, adaptable, transformational, resilient citizens, workplaces, government

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Authors: Syed Toqueer, Omer Younus

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Terrorism, today, has emerged as a global menace with Pakistan being the most adversely affected state. Therefore, the motive behind this study is to empirically establish the linkage of terrorism with socio-economic (uneven income distribution, poverty and unemployment) and political nexuses so that a policy recommendation can be put forth to better approach this issue in Pakistan. For this purpose, the study employs two competing models, namely, the distributed lag model and OLS, so that findings of the model may be consolidated comprehensively, over the reference period of 1984-2012. The findings of both models are indicative of the fact that uneven income distribution of Pakistan is rather a contributing factor towards terrorism when measured through GDP per capita. This supports the hypothesis that immiserizing modernization theory is applicable for the state of Pakistan where the underprivileged are marginalized. Results also suggest that other socio-economic variables (poverty, unemployment and consumer confidence) can condense the brutality of terrorism once these conditions are catered to and improved. The rational of opportunity cost is at the base of this argument. Poor conditions of employment and poverty reduces the opportunity cost for individuals to be recruited by terrorist organizations as economic returns are considerably low and thus increasing the supply of volunteers and subsequently increasing the intensity of terrorism. The argument of political freedom as a means of lowering terrorism stands true. The more the people are politically repressed the more alternative and illegal means they will find to make their voice heard. Also, the argument that politically transitioning economy faces more terrorism is found applicable for Pakistan. Finally, the study contributes to an ongoing debate on which of the two set of factors are more significant with relation to terrorism by suggesting that socio-economic factors are found to be the primary causes of terrorism for Pakistan.

Keywords: terrorism, socioeconomic conditions, political freedom, distributed lag model, ordinary least square

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Authors: Debdatta Mukherjee, Abhiman Das, Amit Garg

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In recent years, there is a growing interest about corporate social responsibility of firms in both academic literature and business world. Since business forms a part of society incorporating socio-environment concerns into its value chain, activities are vital for ensuring mutual sustainability and prosperity. But, until now most of the works have been either descriptive or normative rather than positivist in tone. Even the few ones with a positivist approach have mostly studied the link between corporate financial performance and corporate social performance. However, these studies have been severely criticized by many eminent authors on grounds that they lack a theoretical basis for their findings. They have also argued that apart from corporate financial performance, there must be certain other crucial influences that are likely to determine corporate social performance of firms. In fact, several studies have indicated that firms operating in distinct national institutions show significant variations in the corporate social responsibility practices that they undertake. This clearly suggests that the institutional context of a country in which the firms operate is a key determinant of corporate social performance of firms. Therefore, this paper uses an institutional framework to understand why corporate social performance of firms vary across countries. It examines the impact of country level institutions on corporate social performance using a sample of 3240 global publicly-held firms across 33 countries covering the period 2010-2015. The country level institutions include public institutions, private institutions, markets and capacity to innovate. Econometric Analysis has been mainly used to assess this impact. A three way panel data analysis using fixed effects has been used to test and validate appropriate hypotheses. Most of the empirical findings confirm our hypotheses and the economic significance indicates the specific impact of each variable and their importance relative to others. The results suggest that institutional determinants like ethical behavior of private institutions, goods market, labor market and innovation capacity of a country are significantly related to the corporate social performance of firms. Based on our findings, few implications for policy makers from across the world have also been suggested. The institutions in a country should promote competition. The government should use policy levers for upgrading home demands, like setting challenging yet flexible safety, quality and environment standards, and framing policies governing buyer information, providing innovative recourses to low quality goods and services and promoting early adoption of new and technologically advanced products. Moreover, the institution building in a country should be such that they facilitate and improve the capacity of firms to innovate. Therefore, the proposed study argues that country level institutions impact corporate social performance of firms, empirically validates the same, suggest policy implications and attempts to contribute to an extended understanding of corporate social responsibility and corporate social performance in a multinational context.

Keywords: corporate social performance, corporate social responsibility, institutions, markets

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Authors: Karim Ahmed

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The purpose of this study was to investigate how factoring the impact of natural disasters beyond flooding would affect managed retreat policy eligibility in the United States. For the study design, a correlation analysis method compared weighted measures of flooding and other natural disasters (e.g., wildfires, tornadoes, heatwaves, etc.) to CBSA Populated areas, the prevalence of cropland, and relative poverty on a county level. The study found that the vast majority of CBSAs eligible for managed retreat programs under a policy inclusive of non-flooding events would have already been covered by flood-only managed retreat policies. However, it is noteworthy that a majority of those counties that are not covered by a flood-only managed retreat policy have high rates of poverty and are either heavily populated and/or agriculturally active. The correlation is particularly strong between counties that are subject to multiple natural hazards and those that have both high rates of relative poverty and cropland prevalence. There is currently no managed retreat policy for agricultural land in the United States despite the environmental implications and food supply chain vulnerabilities related to at-risk cropland. The findings of this study suggest both that such a policy should be created and, when it is, that special attention should be paid to non-flood natural disasters affecting agricultural areas. These findings also reveal that, while current flood-based policies in the United States serve many areas that do need access to managed retreat funding and implementation, other vulnerable areas are overlooked by this approach. These areas are often deeply impoverished and are therefore particularly vulnerable to natural disaster; if and when those disasters do occur, these areas are often less financially prepared to recover or retreat from the disaster’s advance and, due to the limitations of the current policies discussed above, are less able to take the precautionary measures necessary to mitigate their risk.

Keywords: flood, hazard, land use, managed retreat, wildfire

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Authors: Masita Mokeira, Kimani Rita, Obonyo Brian, Kwenda Kennedy, Mugambi Purity, Kirui Joan, Chomba Eric, Orwa Daniel, Waiganjo Peter

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Rugby is a highly intense and physical game requiring speed and strength. The need for physical fitness therefore cannot be over-emphasized. Sports are no longer about lifting weights so as to build muscle. Most professional teams are investing much more in the sport in terms of time, equipment and other resources. To play competitively, Kenyan players may therefore need to complement their ‘home-grown’ and sometimes ad-hoc training and nutrition regimes with carefully measured strength and conditioning, diet, nutrition, and supplementation. Nokia Research Center and University of Nairobi conducted an exploratory study on needs and behaviours surrounding sports in Africa. Rugby being one sport that is gaining ground in Kenya was selected as the main focus. The end goal of the research was to identify areas where mobile technology could be used to address gaps, challenges and/or unmet needs. Themes such as information gap, social culture, growth, and development, revenue flow, and technology adoption among others emerged about the sport. From the growth and development theme, it was clear that as rugby continues to grow in the country, teams, coaches, and players are employing interesting techniques both in training and playing. Though some of these techniques are indeed scientific, those employing them are sometimes not fully aware of their scientific basis. A further case study on sports science in rugby in Kenya focusing on physical fitness and nutrition revealed interesting findings. This paper discusses findings on emerging adoption of techniques in managing physiological and nutritional needs of rugby players across different levels of rugby in Kenya namely high school, club and national levels.

Keywords: rugby, nutrition, physiological needs, sports science

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Authors: Tatenda Manomano, Moreblessing Memory Ndonga

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In South Africa and the world over, despite an array of commendable policies to protect the rights of children, the situation on the ground indicates that HIV/AIDS continues to pose increasing challenges on the children’s’ right to education due to the death of their parents. This study sought to validate the home experiences of children that negatively impact on their right to education in South Africa with a case of HIV/AIDS orphans and vulnerable children (OVCs) in Amatole District. The study utilized a qualitative research method in collecting the feelings, views and attitudes of these children to establish the children’s home experiences. An interview guide with semi-structured questions was used to steer the one-on-one in-depth interviews with children from Parkside Primary School, Langa-Liphumile High School and one anonymous school in East London, Eastern Cape Province. 5 learners were purposively selected from each school and subjected to a one-on-one interview with the researcher. The researcher purposively selected one teacher per school, 2 members each from 3 community based organizations (CBOs) who were also subjected to a one-on-one in-depth interview. The findings indicated these negative experiences of the OVCs in their homes such as; attendance to a school was poor; academic performance was low; enrollment in schools was very low and abuse of these children was high. These researchers recommend for psychosocial support for these children to be placed in the schools; integration of HIV/AIDS programmes to target especially the OVCs; social workers should ensure that they regularly do home visits to these OVCs to establish whether the home circumstances these children are still conducive for them. It is hoped that the findings from this paper will be an asset that other researchers, policy makers, the government and NGOs/CBOs will take into consideration for the benefit of OVCs.

Keywords: orphaned and vulnerable children (OVCs), HIV, AIDS, home experiences

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Authors: Abdelrhman Elagez, Rolla Monib

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This empirical study investigates the observed risks associated with adopting Artificial Intelligence (AI) technologies in the construction industry and proposes potential mitigation strategies. While AI has transformed several industries, the construction industry is slowly adopting advanced technologies like AI, introducing new risks that lack critical analysis in the current literature. A comprehensive literature review identified a research gap, highlighting the lack of critical analysis of risks and the need for a framework to measure and mitigate the risks of AI implementation in the construction industry. Consequently, an online survey was conducted with 24 project managers and construction professionals, possessing experience ranging from 1 to 30 years (with an average of 6.38 years), to gather industry perspectives and concerns relating to AI integration. The survey results yielded several significant findings. Firstly, respondents exhibited a moderate level of familiarity (66.67%) with AI technologies, while the industry's readiness for AI deployment and current usage rates remained low at 2.72 out of 5. Secondly, the top-ranked barriers to AI adoption were identified as lack of awareness, insufficient knowledge and skills, data quality concerns, high implementation costs, absence of prior case studies, and the uncertainty of outcomes. Thirdly, the most significant risks associated with AI use in construction were perceived to be a lack of human control (decision-making), accountability, algorithm bias, data security/privacy, and lack of legislation and regulations. Additionally, the participants acknowledged the value of factors such as education, training, organizational support, and communication in facilitating AI integration within the industry. These findings emphasize the necessity for tailored risk assessment frameworks, guidelines, and governance principles to address the identified risks and promote the responsible adoption of AI technologies in the construction sector.

Keywords: risk management, construction, artificial intelligence, technology

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Authors: Hager Elsheikh

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Context: Pancreatitis is a condition characterized by inflammation in the pancreas, which can lead to serious complications if untreated. Both acute and chronic pancreatitis are associated with immune reactions and fibrosis, which further damage the pancreas. The type 2 immune response, primarily driven by alternative activated macrophages (AAMs), plays a significant role in the development of fibrosis. The IL-4/STAT6 pathway is a crucial signaling pathway for the activation of M2 macrophages. Pancreatic fibrosis is induced by dysregulated inflammatory responses and can result in the autodigestion and necrosis of pancreatic acinar cells. Research Aim: The aim of this study is to investigate the impact of STAT6, a crucial molecule in the IL-4/STAT6 pathway, on the severity and development of fibrosis during acute and chronic pancreatitis. The research also aims to understand the influence of the JAK/STAT6 signaling pathway on the balance between fibrosis and regeneration in the presence of different macrophage populations. Methodology: The research utilizes murine models of acute and chronic pancreatitis induced by cerulean injection. Animal models will be employed to study the effect of STAT6 knockout on disease severity and fibrosis. Isolation of acinar cells and cell culture techniques will be used to assess the impact of different macrophage populations on wound healing and regeneration. Various techniques such as PCR, histology, immunofluorescence, and transcriptomics will be employed to analyze the tissues and cells. Findings: The research aims to provide insights into the mechanisms underlying tissue fibrosis and wound healing during acute and chronic pancreatitis. By investigating the influence of the JAK/STAT6 signaling pathway and different macrophage populations, the study aims to understand their impact on tissue fibrosis, disease severity, and pancreatic regeneration. Theoretical Importance: This research contributes to our understanding of the role of specific signaling pathways, macrophage polarization, and the type 2 immune response in pancreatitis. It provides insights into the molecular mechanisms underlying tissue fibrosis and the potential for targeted therapies. Data Collection and Analysis Procedures: Data will be collected through the use of murine models, isolation and culture of acinar cells, and various experimental techniques such as PCR, histology, immunofluorescence, and transcriptomics. Data will be analyzed using appropriate statistical methods and techniques, and the findings will be interpreted in the context of the research objectives. Conclusion: By investigating the mechanisms of tissue fibrosis and wound healing during acute and chronic pancreatitis, this research aims to enhance our understanding of the disease progression and potential therapeutic targets. The findings have theoretical importance in expanding our knowledge of pancreatic fibrosis and the role of macrophage polarization in the context of the type 2 immune response.

Keywords: immunity in chronic diseases, pancreatitis, macrophages, immune response

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Authors: Mandayachepa C. Nyando, Lauren Suchman, Innocencia Mtalimanja, Address Malata, Tamanda Jumbe, Martha Kamanga, Peter Waiswa

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Background: Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a new innovation in contraceptive methods that allow users to inject themselves with a hormonal contraceptive in their own homes. Self-injection (SI) of DMPA-SC has the potential to improve the accessibility of family planning to women who want it and who are capable of injecting themselves. Malawi started implementing this new innovation in 2018. SI was incorporated into the DMPA-SC delivery strategy from its outset. Methodology: This study involved two districts in Malawi where DMPA-SC SI was rolled out: Mulanje and Ntchisi. We used a qualitative cross-sectional study design where 60 in-depth interviews were conducted with women of reproductive age group stratified as 15-45 age band. These included women who were SI users, non-users, and any woman who was on any contraceptive methods. The women participants were tape-recorded, and data were transcribed and then analysed using Dedoose software, where themes were categorised into mother and child themes. Results: Women perceived DMPA SC SI as uniquely private, convenient, and less painful when self-injected. In terms of privacy, women in Mulanje and Ntchisi especially appreciated that self-injecting allowed them to use covertly from partners. Some men do not allow their spouses to use modern contraceptive methods; hence women prefer to use them covertly. “… but I first reach out to men because the strongest power is answered by men (MJ015).” In addition, women reported that SI offers privacy from family/community and less contact with healthcare providers. These aspects of privacy were especially valued in areas where there is a high degree of mistrust around family planning and among those who feel judged or antagonized purchasing contraception, such as young unmarried women. Women also valued the convenience SI provided in terms of their ability to save time by injecting themselves at home rather than visiting a healthcare provider and having more reliable access to contraception, particularly in the face of stockouts. SI allows for stocking up on doses to accommodate shifting work schedules in case of future stockouts or hard times, such as the period of COVID-19, where there was a limitation in the movement of the people. Conclusion: Our findings suggest that SI may meet the needs of many women in Malawi as long as the barriers are eliminated. The barriers women mentioned include fear of self-inject and proper storage of the DMPA SC SI, and these barriers can be eliminated by proper training. The findings also set the scene for policy revision and direction at a national level and integrate the approach with national family planning strategies in Malawi. Findings provide insights that may guide future implementation strategies, strengthen non-clinic family planning access programs and stimulate continued research.

Keywords: family planning, Malawi, Sayana press, self-injection

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Authors: Gary Young, David Zepeda, Gilbert Nyaga

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This study investigated whether vertical integration of hospitals and physicians is associated with better care for patients with cardiac conditions. A dramatic change in the U.S. hospital industry is the integration of hospital and physicians through hospital acquisition of physician practices. Yet, there is little evidence regarding whether this form of vertical integration leads to better operational performance of hospitals. The study was conducted as an observational investigation based on a pooled, cross-sectional database. The study sample comprised over hospitals in the State of California. The time frame for the study was 2010 to 2012. The key performance measure was hospitals’ degree of compliance with performance criteria set out by the federal government for managing patients with cardiac conditions. These criteria relate to the types of clinical tests and medications that hospitals should follow for cardiac patients but hospital compliance requires the cooperation of a hospital’s physicians. Data for this measure was obtained from a federal website that presents performance scores for U.S. hospitals. The key independent variable was the percentage of cardiologists that a hospital employs (versus cardiologists who are affiliated but not employed by the hospital). Data for this measure was obtained from the State of California which requires hospitals to report financial and operation data each year including numbers of employed physicians. Other characteristics of hospitals (e.g., information technology for cardiac care, volume of cardiac patients) were also evaluated as possible complements or substitutes for physician employment by hospitals. Additional sources of data included the American Hospital Association and the U.S. Census. Empirical models were estimated with generalized estimating equations (GEE). Findings suggest that physician employment is positively associated with better hospital performance for cardiac care. However, findings also suggest that information technology is a substitute for physician employment.

Keywords: physician employment, hospitals, verical integration, cardiac care

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Authors: Ali Al Shamli, Talal AlMamari

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Background: The relationship between motivation and satisfaction is posited to be mediated by reward. In this study, the motivation construct was measured by a motivation scale. The scale when factor analysed generated five factors. These factors were referred as; 1) leisure motivation, 2) egoistic motivation, 3) external motivation, 4) purposive, and 5) material motivation. The reward construct was measured by using a five-item scale whereas the satisfaction construct was measured by using a 13-item scale. The scale when factor analysed produced three factors which are referred as; 1) satisfaction A, 2) satisfaction B, and 3) satisfaction C. Objective: The main purpose of the present paper was to find out the relation of motivation and reward with volunteer satisfaction at national sports organizations (NPSOs) in Oman. Methods: This current study adopts a cross-sectional design as the data collection is done only once whereas the mode of administration was postal questionnaire where each questionnaire was posted, completed, and returned using the self-addressed envelope after its completion. The population of the study consisted of (160) boards and directors members of NPSOs (Non-Profit Sports Organization Services) in Oman from all 43 sports club. Results: The findings provided new empirical evidence that supported the argument of the relationship between motivation and satisfaction is indeed, mediated by reward. However, this study differs in that the relationship was tested based on the first-order constructs which were derived from the underlying dimensions of both motivation and satisfaction constructs. It was established that the relationships between motivation B and motivation C with satisfaction A are mediated by reward. Conclusion: In light of study findings, there is a direct relationship between developmental motivation and experiential satisfaction, a direct relationship between social motivation and relational satisfaction, as well as personal motivation and relational satisfaction, is mediated by reward. Therefore, Omani volunteers are less reliant on the reward as evidenced by the direct relationship between motivation A and satisfaction and between motivation C and satisfaction A. More tests in different settings will provide more understanding on volunteer motivation.

Keywords: non-profit sports organization, sport and reward, volunteers in sport, satisfaction in sport

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Authors: Wang Yunhong

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The present paper is preoccupied with the different styles of three translators in their translating a Chinese classical novel Shuihu Zhuan. Based on a parallel corpus, it adopts a target-oriented approach to look into whether and what stylistic differences and shifts the three translations have revealed. The findings show that the three translators demonstrate different styles concerning their word choices and sentence preferences, which implies that identification of recurrent textual patterns may be a basic step for investigating the style of a translator.

Keywords: corpus, lexical choices, sentence characteristics, style

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Authors: B. Self, V. Fleming, C. Maxwell

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The fourth clause of the UK 1967 Abortion Act allows individuals (including health care practitioners) to conscientiously object to participating in an abortion. Individuals are able to object if they consider that participating is incompatible with their religious, moral, philosophical, ethical, or personal beliefs. Currently, there is no research on service users’ opinions and understandings of conscientious objection or the impact of conscientious objection from the UK service users’ perspective. This perspective is imperative in understanding the real-world consequences and impact of conscientious objection and essential when creating policy and guidelines. This qualitative research took a liberal feminist approach. It provided a platform for service users to share their experiences of abortion and conscientious objection, as well as their opinions and understandings of conscientious objection. The method employed was semi-structured interviews. Findings indicated that conscientious objection could work in practice. However, it is currently failing some individuals, as health care practitioners are not always referring and informing service users. Participants didn’t experience burdens such as long waiting times and were still able to access legal abortion. However, participants did experience negative emotional effects, as they were often left feeling scared, angry, and hopeless when they were not referred. Moreover, participants’ opinions on conscientious objection in the UK varied greatly. The majority supported the most common approach within the literature and in practice, whereby health care practitioners are able to object so long as they refer and inform the service user. However, the opinion that health care practitioners should not be allowed to object or should be able to object without referring and informing was also present. Without this research, the impact that conscientious objection is having on service users in the UK and service users’ opinions on conscientious objection wouldn’t be known. These findings will be used to inform national policy and guidelines, making access to abortion fairer and safer for all.

Keywords: conscientious objection, abortion, medical ethics, reproductive justice

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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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