The major purpose of economic instruments is to control pollution by harnessing the power of market incentives. Against this background, this paper examined and assessed the use of economic instruments for environmental sustainability in the Nigerian oil and gas sector. The political economy method was adopted to illuminate the issues surrounding the use of economic instruments in Nigeria. The study found that the use of economic instruments has not been effective in the Nigerian oil and gas sector. This was due mainly to inadequacies of economic instruments in use. The study thus recommended a combination of command – and – control tools and market based instruments to combat environmental problems in the oil and gas sector. Also, the government should muster sufficient will and determination to enforce the content of the Gas Flaring (Prevention of Waste Pollution) Regulation 2018.

Introduction: The term “hysterectomy” though means removal of uterus, in practice it has a much wider classification depending upon the indication. At times, it is done without removal of cervix (Supracervical hysterectomy) or with removal of adnexa (Hysterectomy with salpingooopherectomy). It can also be a part of staging laparotomy or radical hysterectomy. Hysterectomy can be performed abdominally, vaginally or through abdominal ports with the help of laparoscope. Materials and Methods: This is a Prospective and Comparative Study conducted in the Department of Obstetrics and Gynaecology, Shadan Institute of Medical Sciences, Teaching Hospital & Research Centre over a period of 1 year. Total 100 patients undergoing hysterectomy for benign uterine pathology meeting the inclusion and exclusion criterion will be included in the study. 50-Laparoscopic assisted vaginal hysterectomy and 50-Total abdominal hysterectomy. Results: 95% of women of TAH group needed spinal anaesthesia and only 5% needed general anaesthesia. On the other hand, all the women of LAVH group needed general anaesthesia. Duration of surgery was little more in patients who underwent LAVH when compared to patients who underwent TAH. The average duration of surgery in TAH group is 50 minutes and it is 75 minutes in LAVH group. Only 2 patients in LAVH group needed conversion into laparotomy because of adhesions and uncontrollable haemorrhage. Fever and wound infection was more with TAH group 11.6% compared to LAVH group 5% and 3.3%. UTI was also comparatively more with TAH group., which was the reason for longer hospital stay in TAH group. RTI was observed in 3 patients of LAVH group. Conclusion: LAVH is associated with less blood loss and decreased intra operative complications when compared to TAH. Length of hospital stay is significantly less for LAVH when compared to TAH. Post-operative pain, complications and blood transfusions are more with TAH group, because of which patient had longer hospital stay and took longer time for recovery and return to work.

Background: Psychological stress adversely affects immune function, potentially influencing cancer progression and patient outcomes globally. Objective: This study aims to evaluate the impact of stress on the immune system of cancer patients in Al-Ahsa, Saudi Arabia, and its correlation with disease progression and treatment response. Methods: A cross-sectional study was conducted in Al-Ahsa during 2019, enrolling 1,000 cancer patients. Stress levels were assessed using the Perceived Stress Scale (PSS). Immune parameters, including cortisol levels, natural killer (NK) cell activity, and cytokine profiles (e.g., IL-6, TNF-α), were measured through blood samples. Statistical analysis was performed using SPSS version 26.0, employing descriptive statistics, Pearson correlation, and multivariate regression to examine relationships between stress and immune markers. Additionally, Receiver Operating Characteristic (ROC) curve analysis was utilized to determine the predictive accuracy of stress on immune dysfunction and clinical outcomes. Results: High stress levels were reported by 68% of patients. Elevated cortisol was observed in 72% of highly stressed patients compared to 28% in low-stress groups (p < 0.001). NK cell activity was significantly reduced in stressed patients, with a mean decrease of 35% (p < 0.001). IL-6 and TNF-α levels were elevated in 65% and 60% of patients experiencing high stress, respectively (p < 0.001). Multivariate analysis revealed that stress independently predicted reduced NK activity (β = -0.45, p < 0.001) and increased pro-inflammatory cytokines (β = 0.50, p < 0.001). Additionally, stress was associated with a 20% higher rate of disease progression (OR = 1.20, 95% CI: 1.05-1.37) and a 15% poorer treatment response (OR = 0.85, 95% CI: 0.78-0.93). ROC analysis demonstrated that the PSS score had an area under the curve (AUC) of 0.82 (95% CI: 0.78-0.86) for predicting immune dysfunction. The combined effect of high stress and immune dysregulation contributed to a 25% increase in overall mortality risk (p < 0.05). Furthermore, subgroup analysis indicated that females exhibited a higher prevalence of stress-induced immune alterations compared to males (75% vs. 62%, p = 0.004). Conclusions: Stress significantly impairs immune function in cancer patients in Al-Ahsa, Saudi Arabia, correlating with increased disease progression and diminished treatment efficacy. These findings underscore the necessity for integrating stress management interventions in oncology care to enhance patient outcomes.

Objective: To study profile of accidental poisoning in 1yr –12 yr children admitted at Paediatric ward in Calcutta national medical college & hospital, (CNMCH) Kolkata from April 2018–March 2019 and their outcome. Method: All children admitted at CNMCH children ward from 1 to 12 year with accidental poisoning excluding all bites-including snake bite, scorpion sting etc. The age group, nature, type of poison, symptom complex & response to therapy were studied. Result: 201 children of 9 month to 12 year with accidental exposure to poisoning admitted in a tertiary care centre. Common age group affected in the study is below 3 yrs (75%).Boy child commonly affected & common poisoning was kerosene oil (52.2%) followed by turpentine oil (14.9%). Among medication, poisoning (4.97%) not only due accidental ingestion but due to overdosing. Other Rare causes of poisoning was Phenyl, Rat killer, Mosquito repellent/oil, bed bug killer etc. Mortality of the patient was 0.49 % .30% cases (>14 days) suffering was prolonged. PICU management was needed in 1.99% cases. Conclusion: Most common cause of accidental poisoning was kerosene ingestion in rural children. Male children of toddler age group was involved commonly.

Background: Pterygium is a triangular fibrovascular subepithelial in growth of degenerative bulbar conjunctival tissue over the limbus on to the cornea. Pterygium typically develops in patients who have been living in hot climates and may represent a response to chronic dryness and ultraviolet exposure. Methods: This prospective study included 70 patients with primary pterygium, randomly divided into two groups: Group A treated with conjunctival autograft and Group B with intraoperative mitomycin C. Standard preoperative evaluation, surgery under local anesthesia, and postoperative follow-up up to 6 months were performed to assess visual outcomes, complications, and recurrence. Results: A total of 70 patients with primary pterygium were divided into two groups: Group A (conjunctival autograft) and Group B (mitomycin C). Most patients in Group A were aged 31–40 years (40%), while Group B had more in the 51–60 range (28.6%) (p=0.018). Males predominated in both groups. Visual acuity improved in both, with 6/6 vision in 37.1% of Group A and 28.6% of Group B at 6 months. Complications were fewer in Group A (11.5%) than in Group B (54.3%), making conjunctival autograft the safer and more effective method. Conclusion: The study of 70 eyes with primary pterygium showed that conjunctival autograft had fewer complications and a lower recurrence rate (2.9%) compared to intraoperative mitomycin C (14.3%), proving it to be a safer and more effective method for managing primary pterygium.

As pharmaceutical industries now a days concerns with the safety and continuously enhance the quality of the drug products. The development of pharmaceutical industries is based on the innovation of the product as well as the manufacturing process by keeping quality in the mind. In earlier times, the development of pharmaceutical products shows the failure in the quality and hence alters the therapeutic effect of the product. Quality by test (QbT) was the only way to maintain the quality of the drug product before the FDA launches the current Good Manufacturing Practices (cGMP), which was an approach without understanding the processes. So FDA decided to applied the several Design of Experiments (DoE) in the pharmaceutical fields. QbD (Quality by design) was one of the design experiment approved by the FDA to maintain the quality of the drug products before reaching to the market. In pharmaceutical industry, QbD brings cost-efficiency and simplicity of manufacturing process into reality. QbD is a systematic risk-based, proactive approach to pharmaceutical development that begins with predefined objectives and emphasizes product and process understanding and process control based on sound science and quality risk management. The main aim of this review is to discuss the concept of pharmaceutical Quality by Design and describe how it can be helpful to ensure pharmaceutical quality & drug development.

Background: Central line-associated bloodstream infections (CLABSIs) are significant healthcare challenges, associated with increased morbidity, mortality, and healthcare costs (Magill et al., 2014). Nursing care plays a crucial role in preventing these infections. Objective: This study investigates the impact of nursing interventions on central line care and CLABSI rates in patients admitted to Imam Abdulrahman Bin Faisal Hospital, Dammam, Saudi Arabia. Method: A prospective observational study was conducted from June 2018 to June 2019 with a sample size of 100 patients with central lines. Nursing interventions included daily line assessments, sterile dressing changes, and strict adherence to hand hygiene protocols. Data on CLABSI incidence were collected and analyzed to determine the association between nursing care quality and infection rates. Result: Among 100 patients, 15 developed CLABSIs, yielding a 15% infection rate. Patients with consistent nursing interventions had a 7% infection rate (3 out of 45), compared to 28% (12 out of 55) among those with inconsistent care, reflecting a 75% reduction with effective nursing practices (p < 0.05). Standardized dressing changes lowered infection rates by 40%, from 20% to 12%. Adherence to hand hygiene further reduced infections by 33%, from 15% to 10%. Units with nurse-patient ratios below 1:5 saw a 5% infection rate, significantly lower than the 18% in units with higher ratios, showing a 72% reduction. Conclusions: Effective nursing interventions significantly reduce CLABSI rates, underscoring the need for stringent infection control protocols and adequate nurse staffing. Enhanced nursing training and policy standardization are recommended to further minimize CLABSIs.

This study is entitled the meaning of "small step gives a change" version of ADES corporate social responsibility advertisement in television media. The purpose of this study is to uncover the meaning contained in an advertisement. This research is expected to give scientific contributions for all parties that have an interest in communication practitioners. In addition, this research also hopefully gives contributions of thoughts relating to the application and advertisement creation that have the right meaning and message through the audio visual language of CSR advertisements in television media, so that the Advertising messages can touch the rational and emotional aspects of the audience. The method used in this research was a semiotic analysis method of Charles Sanders Pierce. The object of study in this study was the ADES mineral water advertisement of "Small Step Gives a Change" version in television media which has seventeen seconds time duration. Based on research that has been obtained on the results of research and discussion on the meaning of the messages contained in the ADES mineral water advertisement of "Small Step Gives a Change" version on television media, it can be concluded that through the finding of signs in Ades advertisement, it was implied a message about the environment care. Ades wanted to show that the mineral water had a high quality and gave solutions to the public in protecting the body. Broadly speaking, the advertisements' meaning show the commitment of Coca-Cola Amatil Indonesia towards sustainable packaging. The sustainable means that through the environmentally and friendly ADES packaging, it can have a positive impact on the environment sustainiblity.

Every year, over 250,000 patients have cardiac surgery and the incidence of cardiac arrest. When treated quickly, 17% to 79% of patients who experience cardiac arrest after cardiac surgery survive to discharge. Many of health care providers found this was disorganised and they would have performed better if they had well defined roles. Objectives: The aim of the study is to assess the level of knowledge among novice nurses regarding cardiac advance life support surgery (CALS) in cardiac surgery intensive care unit (CICU) and Cardio pulmonary department (D1 department) of Aga khan university hospital. Material and Methods: The descriptive cross-sectional study done. The 15 nurses were selected as sample to assess knowledge. Results: Novice nurses were not aware about (CALS). Moreover we developed module for nurses for future education and awareness about CALS the later study will help to assess the efficacy of CALS module. Conclusion: The study helps to make module of CALS for nurses taking care of patient underwent open heart surgery.

Facial nerve schwannoma is an uncommon benign tumor, which is rarely encountered in the parotid gland, and mimicking the tumors of this gland. It’s a neurogenic lesion that arises from Schwann cells of peripheral nerve sheath. Most of cases, it is localized in the intratemporal segment of the facial nerve, only 9% that occur in the extratemporal segment. Intraparotid facial nerve schwannoma was firstly described by Ibarz in 1927. Even if the tumor arises from the nerve itself, the function of the facial nerve is generally unaffected. If there is facial paralysis, it is interfered with malignant parotid tumors. Because of the heterogeneity of imaging features, it is difficult to diagnosis and differentiate preoperatively the intraparotid facial nerve schwannoma from other parotid tumors, so the definitive diagnosis is made by histological examination of resected tumor. The management of intraparotid facial nerve schwannoma is a very contested issue within the literature. Because the benignity and low evolutionary potential of the tumor, some authors advocating a conservative attitude with clinical surveillance for patients without facial nerve dysfunction or for tumor localized in the parotid gland. However, if a severe or a sudden facial nerve dysfunction, or extension into the mastoid was founded, the surgical resection of the tumor is indicated without delay. We report a case of a 24-year-old young female, complaining of a slow-growing and painless mass in the left parotid area, associated with grade V facial paralysis on left side since 10 years. No lymphadenopathy was founded in the neck. The computed tomography scan was revealed a heterogeneous tumor, involving in superficial and deep lobes of the left parotid gland, and extending into the parapharyngeal space. On surgical exploration, the dissection of facial nerve and isolation of the mass was impossible. Because the patient had a facial paralysis preoperatively, we had to sacrifice the facial nerve to remove

Background: Gestational Diabetes Mellitus is considered to be a significant problem among pregnant women in Egypt. Aim: To evaluate the effect of educational protocol to improve pregnant women practices about gestational diabetes mellitus. Design: A quasi-experimental design was used. Setting: The outpatient diabetic clinic at Zagazig university hospital. Sample: A purposive sample of eighty pregnant diabetic women. Tools: Two tools were used in the study, Tool (1): Contained two parts; (1) demographic characteristics, (2) History about reproductive profile during pregnancy, Tool (2): Included two parts, assessment of knowledge of pregnant women about DM, and assessment of practice of pregnant women about DM. Results: The mean age of the pregnant women were 32.04 ± 9.36 years, also it was revealed that the total knowledge scores improved from 31.35% to 58.20%, with a highly significant difference (p=0.0044) for the participants, additionally, the overall increase in adequate practices improved from 56 to 78.5% after the implementation of the protocol sessions, with a significant difference (p=0.0106). Conclusion: The implementation of educational protocol for pregnant women was effective and enhanced their practices, and knowledge regarding the gestational diabetes mellitus. Recommendation: The study recommended that further studies for pregnant women with gestational diabetes mellitus should be applied in all health care centers.

Inclusive education may be understood in the way that allows students with special needs to be placed to receive instruction in the mainstream classes and to be taught by mainstream teachers. Novice teachers or teachers with differential levels of teaching experience, belonging to urban-rural background may have a differential attitude towards inclusive education set up. Keeping this in mind, the present study was conducted to study the attitudinal dispositions of elementary school teachers towards inclusive education with reference to gender, teaching experience and locality. Descriptive research design was followed for carrying out the study. The data was collected from the 120 elementary school teachers of Choudwar block and Cuttack city of Odisha. The sample was selected through stratified random sampling technique. A self-developed five-point attitude scale was used for collection of data. The findings of the study revealed that, gender, teaching experience and locality were the factors for developing differential attitudes among the teachers as there were significant differences in the mean attitude scores of elementary school teachers towards various aspects of inclusive education with reference to gender, teaching experience and locality.

Background: Peak expiratory flow rate (PEFR) reflects the strength and condition of respiratory muscles and the degree of airflow limitation in large airways. PEFR is recorded in Mini Wrights Peak Flow Meter and it is commonly used for screening the individuals who are asthmatics. PEFR shows hour to hour variation that follows a specific pattern in asthmatics and healthy individuals. Circardian oscillations in the sympathetic activity may have impact on the airway smooth muscles. Materials and Methods: Peak expiratory flow rate was recorded in 60 young healthy females in the age group of 18-25years in Sri Ramachandra Institue of Higher Education and Reasearch. Mini Wright’s peak flow meter was used to measure the peak expiratory flow rate. PEFR was recorded at 6-7am, 9-10am, 1-2pm, 5-6pm, 10-11pm in a single day. Results: Our results showed PEFR values were low in the morning, followed by progressive rise peaking in the afternoon and evening and a small fall at night time. Highest PEFR is seen around afternoon. Conclusion: Comparing the PEFR readings there ia diurnal variation there is a diurnal variation in healthy young females showing a overall dip in the morning PEFR at 6 A.M, peaking in the evening PEFR at 6P.M, eventually decrease in night PEFR at 10P.M. But there is no significant in the afternoon (2P.M) and night (10.P.M).

The proliferation of slum residential areas in cities in Sub Saharan Africa adversely affects the inhabitants through overcrowding and congestion, sub-standard housing development, disease prevalence, inadequate socio-economic infrastructures such as potable water supply, hygiene and sanitation facilities, wastes disposal schemes and drainage channels, the prevalence of crime and violence and environmental hazards such as floods and landslides. In Cameroon, slums continue to appear in cities and towns because of poor urban governance which fails to ensure effective and comprehensive city management strategy in order to prevent new slum neighbourhoods from emerging in the urban landscape and make existing ones more livable and sustainable. This study makes an appraisal of slum upgrading in Cameroonian cities and proffers a twin-track planning solution that will ensure an effective and comprehensive city management for urban sustainability. To do this, on-the-spot appraisals, field surveys and participatory appraisals were undertaken with individual slum households, quarter heads, municipal authorities, CIGs and NGOs working with slum dwellers and government ministries in charge with urban development for a period of twelve months. Analysis was done using descriptive techniques. Findings showed that the Participatory Slum Upgrading Programmes (PSUP) launched in 2008 and implemented by UN-Habitat which aims to improve the living conditions of slum dwellers is the current slum upgrading approach used in Cameroon. But an appraisal of the problems plaguing this approach shows that much still need to be done to assure adequate and decent affordable housing. Tenure security, financial difficulties, displacement/forced evictions, coordination of actors, follow-ups, determination of slum sites and their full coverage, the non-respect of building/construction norms during resettlement, trivial help from international donors, lack of technical expertise, government neglect and

The role of this study was to explain the relationship between religious cultures and student retention in Chartered Christian Universities in Kenya. The study was based on Students’ Integration Theory by Tinto [1] and Cultural Model of Educational Management by Bush [2]. Descriptive survey research design was adopted. The targeted population was 604 year four students, 12 Academic Deans, 5 chaplains, 5 Finance Managers, and 5 Deans of students in Chartered Christian Universities. Census method was used to sample the respondents. Questionnaires which were piloted and tested for reliability using test-retest method and validated by experts were used together with interviews to collect data. Qualitative data was later analysed and presented. Quantitative data was analysed using descriptive statistics. SPSS version 22 was employed for data analysis. Pearson Product Moment Correlations Co-efficient and regression analysis were computed to establish relationships between the two variables. Embedded Design for mixed methods was used to integrate and present the findings. It was established that religious cultures were related to student retention (r=0.437; p=0.000) and thus, the null hypothesis was rejected, and the alternate hypotheses adopted. The study recommends that chartered Christian universities in Kenya should take advantage of their religious cultures and find policies that strengthen the existing cultures as tahey develop new ones. It also recommends that the Ministry of Education should develop policies that could facilitate student retention and review the existing policies on students’ retention in institutions of higher learning in Kenya and beyond. Moreover, further research should be carried out.