Gastrointestinal stromal tumor (GIST) is a rare sarcoma, typically starts in the cells that line the gastrointestinal tract’s (GIT) wall. While certain GISTs may develop slowly over time, others might spread drastically. However, it will indicate recurrence for certain people. Patients with locally resectable gastro intestinal stromal tumours continue to be treated primarily with radical surgery, which, in more than 50% of instances, results in a long-term remission of this disease. The first targeted medication for the GISTs treatment was the tyrosine kinase inhibitor imatinib, and is now the preferred option for treating advanced gastro intestinal stromal tumours. This case highlights recurrence of GIST for two times even after laparotomy which provides an information, that the hazards associated with this type of tumour must be reduced by receiving appropriate therapy because it can recur.

The aims of this research are to analyze the weaknesses that exist in evidentiary regulations in civil courts and how to reconstruct evidentiary constraints in civil justice based on the value of justice. This research uses a constructivist paradigm, with a social legal research approach that uses primary data. Methods of data collection using interviews, observation, and field systems. The results of this research show that in evidentiary regulations in civil courts in Indonesia, judges are bound by valid evidence, which means that judges are only allowed to make decisions (impose decisions) based on evidence determined by law only, and From a formal juridical point of view, electronic document law has not been strictly regulated in the Civil Procedure Code so that it has not had the value of justice, namely the normalization of Articles 163 and 164 HIR and Articles 283 and 284 RBg., has not provided justice values in the evidentiary system. Current weaknesses in evidentiary regulations in civil court include weaknesses in the context of legal substance, legal structure, and legal culture, therefore it is necessary to reconstruct the provisions in Article 164 HIR or 284 RBg with the need for arrangements regarding electronic evidence, which has been validated and the strength is the same as documentary evidence. Then in Article 163 HIR/Article 283 RBg there needs to be an arrangement so that Electronic Information and Electronic Documents submitted by litigants must come from an Electronic System that meets the requirements based on Legislation In contrast, where the implication is to provide a new idea related to evidentiary regulations in civil courts based on the value of justice.

The study is premised upon the enormity and relevance of African myths and legends as congenial substance for the continuity of African culture and writing tradition. Existing literary engagements have focused on the usage of myths and legends in African literature, their consistent usage in fictional writings is aesthetically commendable, however, the modern days African writers appear to be delusive in this literary endeavor. This is the lacuna this paper seeks to fill by advocating for the reinventing and entrenching of mythical and legendary characters in contemporary and future African writings. The paper investigates the extent of import, inculcation and exploration of myths and legends in some extant African writings, it pontificates their literary aestheticism, cultural beautification and prognostic values in African society. Significantly, the paper elucidates the pedagogical didactics that are intrinsically inherent in the myths and legends in spite of the seemingly archaic existence attributed to them. African writers that have creatively used mythical and legendary sources are highly commended and appreciated and passionate appeals have been made through this paper to the contemporary and future African writers to effectuate the representation and entrenchment of the continental cultural myths and legends in subsequent creative writing for the purpose of cultural integration and propagation, rejuvenation of cultural material and dispersal of moral values.

This study examined the use of e-learning technologies as predictors of students’ academic performance in public secondary schools in Kangundo subcounty, Machakos county, Kenya The study was guided by three objectives, three research questions and hypotheses. The population of the study comprised of 31 academic staff, 1560 students of 31 secondary schools in Kangundo subcounty, Machakos county, Kenya. The sample size for this study was 266 respondents, representing 10-30% of the entire population. The sampling technique was a proportionate stratified random sampling. The instruments were questionnaire and teacher made test, used for the study to generate date. The instruments were validated and it reliability were tested using Kuder Richardson method, which yielded coefficients of 0.84 and 0.82 for The Use of E-learning Technologies Scale (TUETS) and Teacher Made Test Scale (TMTS) respectively. The research questions were answered while the hypotheses were tested with Chisquare associated with simple regression at 0.05 level of significance. The findings revealed that the use of computer Simulated models helped learners participate fully and more in class than conventional methods thus enhancing performance of students in Kangundo subcounty, Machakos county, Kenya, while smartphone as e-learning technologies predicts students’ academic performance in public secondary schools in Rivers State to a high extent. Based on the findings, it was recommended among others that the government who are the owners of public secondary schools should ensure that all schools have functional laptop computer laboratories, accessible to both teachers and students with trained personnel to help them acquire relevant ICT skills that will aid teaching and learning process for improve both the participation and hence the academic performance of students. Also, parents should explore all positive means to provide smartphones, constant strong Wi-Fi connection, browsing data, constant power supply for students with strict monitoring by the school PTA to guide, orientate and control students on how they can use the smartphones available to them to their own advantage, as all of these will enhance effective academic learning activities with minimal distraction.

Our judicial structure owes to the colonial administration for its evolution & is still bearing the remnants of the system it inherited from its predecessor. Our judiciary is still following the adversarial trial system. Though the British legal system has developed to a standard for others we are still on the same footing where they left us. We could not overcome the obstacles associated with the civil justice system. The main problems facing our judiciary are the cost, delay & complexity. Several steps have been taken to solve the problems but deserved success cannot be achieved. The main problem lies probably in the identification of the real problems & providing pragmatic solutions. In this research I have tried to identify the real problems by interviewing different legal persons & litigants, by analyzing the opinions of different scholars & taking into account the attitude of the society towards the civil litigation social aspects & applying my own reason & experience. I have evaluated the reforms made in some foreign legal systems to compare with our system specially the Woolf’s reform in England. Lastly, I have provided some reform & amendment proposals based on the findings.

Worldwide e-learning has emerged as a leading channel of learning but its implementation in Kenya has not been successful. Studies have noted infrastructural challenges in implementation of e-learning, an aspect the present study sought to address. The study determined infrastructural factors that influence implementation of e-learning in TVET institutions in Uasin Gishu County. The study established the extent to which the following factors affect the effective implementation: the availability of good bandwidth; quick response time in uploading and retrieving content; fast processors; high performance features on the servers; accessibility of learning management system and the availability of electronic learning equipment. The study was guided by Roger’s theory of Diffusion of innovation and adopted an explanatory research design with a target population of 94 electrical and electronic engineering trainers and 6 HoDs of electrical and electronic engineering departments from public TVET institutions from Uasin Gishu County. Data was collected by use of questionnaire, observation and interview schedule. The piloting of the tools was done in Kitale National Polytechnic to test for reliability and validity. Quantitative data was analyzed by use of both inferential and descriptive statistics using SPSS version 25 while qualitative data using themes and sub-themes. The inferential statistics used included: simple and multiple regression, Pearson’s correlation and Analysis of Variance (ANOVA) while descriptive statistics included mean, standard deviation and frequencies. From the findings, the coefficient of determination (R square) of .449 indicated that the model explained only 44.9% of the variation or change in implementation of e-learning. The study findings indicate that infrastructure (t =2.589, P<.05), significantly influence the implementation of e-learning in TVET institutions in Uasin Gishu County and it is therefore important for TVET institutions to consider strengthening the infrastructure requirements for e-learning.

Leakages in pipeline is an important problem that can occur at any stage of the pipeline lifespan due to ageing, improper installation, or human related factors like bunkering or vandalization. Several invasive and non-invasive techniques are being used which have proven to be successful. However, this study focuses on leakage in an area of the pipeline network that is most often overlooked. This area is within the first 100 meters of the pipeline network to the excitation pump and is often prone to leakages due to high pressure. This study shows that even at no leak conditions pressure profile of a short pipeline in a closed loop configuration can vary by as much 59.93 percent. The study also examined the impact of single leak, double leaks, and triple leaks on the pipeline network with pressure loss compared to the no leak condition ranging from about 10 percent to as high as 60 percent.

The Lefort II fracture (pyramidal fracture) or high transfacial is a solution of bone continuity of the middle stage of the face whose fracture line concerns the glabella, the ethmoid massif, the two maxillary sinuses and the pterygoids causing more or less important the mobility of the middle stage of the face. Objectives: of this study were to study the frequency of Lefort II fractures at Nianankoro FOMBA Hospital in Segou; to study the target population of Lefort II fractures at the Nianankoro FOMBA hospital in Segou; evaluate the treatment option for this pathology; to study the fate of treated patients. This was a prospective study, carried out in the stomatology and maxillofacial surgery department of Nianankoro FOMBA Hospital in Ségou over a period of 3 years, i.e. 36 months from October 1, 2016 to October 1, 2019. It covered all cases of Lefort II fractures admitted to this department for their care. During our study we recorded 225 cases of maxillofacial trauma including 17 cases of Lefort II fractures or 7.55% of all traumatic injuries admitted to the service. Lefort II fractures are a social and public health problem affecting mainly young male subjects in the 20 to 29 age group most often following accidents on public roads. Their diagnosis is made by clinical examination associated with paraclinical examination (computed tomography) which makes it possible to locate the fracture foci.

Breastfeeding is one of the important and natural mode of feeding a child and it should be encouraged in every society irrespective of your occupational status. Every woman owes a duty to breastfed their child to ensure a healthy living. This study is to ascertain the Pattern of Breastfeeding Adopted by Working Class Nursing Mothers in South-South Nigeria. This was a cross-sectional study involving 320 working class nursing mothers who were within the age of 18 to 47 years. A well-structured questionnaire was administered to participants. Each participant had one questionnaire to fill appropriately and independently after instructions were given to them by the Research Assistants. The study lasted for a period of 6 months. The research findings revealed that 20(6.30%) were within 18-22 years, 40(12.50%) were within 23-27years, 50(15.60%) were within 28-32 years, 120(37.60%) were within 33-37 years, 60(18.80%) were within 38-42 years while 30(9.40%) were within 43-47 years. The study also revealed the educational status of the participants which shows that 50(15.60%) had primary level of education, 80(25.00%) had secondary level of education, while 190(59.40%) had tertiary level of education respectively. The occupational distribution of the respondents shows that 80(25.00%) were farmers, 100(31.30%) were business women, and 140(43.80%) were civil servants. 300(93.80%) of the participants were nursing mothers whereas 20(6.30%) were not nursing mothers. 300(93.8%) of the participants agreed that they are aware of exclusive breastfeeding and 20(6.3%) said no awareness. The findings also revealed that 250(78.10%) of the participants do not breastfed their child / children while 70(21.90%) agreed that they do. 20(6.30%) of the respondents agreed that they carried out exclusive breastfeeding and 300(93.80%) did not. 280(87.50%) of the participants who are working class women said they preferred non-breastfeeding methods of child’s nutrition.

High drop-out rates in sports programmes, both health and therapeutic sports, are not exceptional. Long-term retention of active athletes is a problem. This is equally true for fitness training in fitness clubs, where about half of the active individuals drop out prematurely. The aim of this study is to create a comprehensive inventory of the dropout problem and the prevention of it in fitness sports. From the results obtained, recommendations for action can be derived to increase customer satisfaction in fitness facilities and thus reduce the dropout rate in the long term. Methodologically, a review of the relevant literature was conducted in this study. When analysing various research results, it was found that dropping out of a sports programme always depends on several factors. Characteristics of dropping out of sports activity can be personal as well as situational and structural. While it is often possible to identify individual reasons that ultimately tip the balance in favour of quitting, this is usually influenced by a complex set of factors. The reason that fitness club membership fees are too expensive is found at the top of the list in all known studies, followed by the statement that the time spent on sport is too much. Relocation, job and family reasons, other hobbies and, last but not least, health reasons are then usually found in the further course of the lists of dropout reasons. All these reasons seem plausible, but they may also be feigned. They are often difficult to verify by those responsible in the fitness clubs and usually have to be accepted as such. They are rather unsuitable for use in successful dropout prevention. At most, stated health reasons can play a role for preventive measures, but not if serious diseases are involved. Essential demands on the management of a fitness club are therefore the creation of a good social atmosphere during training, time-efficient training programs, fun during the training, fulfilment of training goals and intensive support mechanisms. Only sensible innovations, market-oriented behaviour and flexibility can lead to future success in the fast-moving fitness market.

Triage is the first process of assessment and prioritization of all patients who present to emergency departments (EDs) into categories according to their condition and level of urgency. In this study, a systematic review of the literature on the effectiveness of triage systems was conducted in Saudi Arabia. Following PRISMA guidelines, six large databases were searched for relevant articles published between 2003 and 2023. Three authors reviewed the titles, abstracts, and full texts. The databases were searched using the following keywords: triage systems, CTAS, emergency department overcrowding, non-urgent or inappropriate visits to the ED, ED overutilization, and triage and ED overcrowding in the Middle East. A total of 1,051 articles were identified, of which 245 met our inclusion criteria. From the findings of these studies, in relation to the factors that reduce triage efficacy in the Middle East and specifically in Saudi Arabia, it can be argued that there is a need for more studies and solutions to address these issues. Patients are in need of health education, and alternative solutions must be considered to address the high percentage of non-urgent visits to the ED. Emergency department triage is the first screening step that sorts patients in emergency situations by categorizing their urgency levels to prioritize patients for evaluation and treatment. Because the ED is an integral hospital department and a complicated, fast-paced environment, ED healthcare services have evolved to be delivered through effective triage systems to reduce waiting times and overcrowding.

Endoscopic ultrasound (EUS) is is a technique used for the exploration of the digestive system, enabling the diagnosis and classification of gastric tumors. The aim of our study was to describe the contribution of EUS and fine needle aspiration in the diagnosis and determination of the histological type of gastric tumors. Our study consists of a retrospective descriptive study involving 36 patients. The mean age was 54 ± 14.4 years, with a female-to-male sex ratio of 2. EUS revealed an ulcerated and polypoid appearance with prominent folds in half of the cases. Fine needle aspiration biopsy was performed in 80.5% of cases. The histopathological findings were predominantly gastrointestinal stromal tumors and adenocarcinomas.

Background: Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a relatively new therapeutic modality in the arsenal of endoscopists for attaining satisfactory biliary drainage when traditional ERC fails. The aim of our study is to describe the first Moroccan experience with EUS-BD in patients with malignant biliary obstruction after a failed or inaccessible ERCP. Methods: This is a retrospective study conducted at Ibn Sina Hospital, from Mars 2018 to July 2022, which include 27 patients with an inoperable or metastatic malignant biliary obstruction who underwent endoscopic ultrasonography-guided biliary drainage (EUS-BD) in case of endoscopic retrograde cholangiopancreatography (ERCP) failure. Results: From a total of 288 patients with malignant biliary obstruction,27 underwent EUS-BD (9,3%), 15 EUS-guided hepaticogastrostomy (55,5%) and 12 EUS-guided choledocoduodenostomy (44,4%) were performed. The mean age was 62.5 years (age range: 23-74 years), a male predominance of 59% was noted, cholestatic jaundice was present in 100% of patients and associated with pruritus in 92.59% of cases. The mean level of Total Bilirubin was 190 mg/l. The causes of biliary obstruction were: an inoperable pancreatic head mass in 13 patients(48,1%), a cholangiocarcinoma in 7 patients (25.9%), an ampullary mass in 4 patients(14,8%), a gallbladder cancer with hepatic and duodenal invasion in one patient (3,7%), a gastric antropyloric adenocarcinoma with pancreatic head invasion in one patient (3,7%) and Duodenal adenocarcinoma in one patient (3,7%).The leading causes of failed ERCP were secondary to tumor infiltration of the duodenal wall and critical duodenal stenosis in 11 cases (40,7%), in 9 cases due to a difficult cannulation (33.3%) and in 7 cases due to a failure to pass the stricture by ERCP (25.9%). In EUS-HG The technical and the clinical success rates were 86.6% (13/15) and 84.6% (11/13), respectively, the complication rate was 13.3% (2/15) including one case of stent migration complicated with bile leak and one case of cholangitis. In EUS-CD The technical and the clinical success rates were 91.6% (11/12) and 81.8% (9/11)), respectively, the complication rate was 16.6% (2/12) including two cases of cholangitis. The technical and the clinical success rates in all EUS-BD were 85.1% (24/27) and 83.3% (20/24), respectively. The complication rate was 14.8% (4/27). Conclusion: EUS-BD appears to be an effective and safe therapeutic option for biliary decompression in cases where ERCP fails.

‘Church Going’ by Philip Larkin, the romantic recluse is not a religious poem, as it may appear from the title, but a poem about Going to Church. The poem expresses a view that faith and belief in religion must die but that the spirit of tradition represented by the English Church can’t come to an end. Larkin’s agnosticism becomes more understandable if we look at this poem in the National and the International context of the post-world-war years. The poem refers both to the erosion of the Church as an Institution and to the perpetuation of some kind of ritual observance. The poet’s tone is pessimistic and somewhat sceptic about the bleak future of the Church. But he is quite confident of the lasting mystic spiritual significance of the Church, “Serious house on serious earth” for its devotees. Larkin’s dilemma is not whether to believe in God but what to put in God’s place. The loss of religious faith and the fear of death are counteracted by an unshakable faith in individual human potential. So, the poem is both reverent and irreverent that indicate poet’s dual split personality, skepticism, agnosticism.

Two texts are presented here. The first is by Gerhard Lehmann who talks about the philosophical and political activity of Alfred Baeumler. The second is the first English version of ‘Nietzsche and National Socialism’ by Alfred Bæumler, Philosopher, Full Professor at the University of Berlin, Director of the Institute of Political Pedagogy.