The aim of the company to register its shares in the stock exchange is to get additional funds from investors so that the business continues to grow. The company's financial performance is a factor that is highly considered by investors, but what if the information is not quality based on the audit results from the auditor? This study aims to determine investor reactions to financial performance information and audit quality. The uniqueness of this research is the 2x2 method between financial performance and quality audit so that this study can produce information about how 1) investor reaction to high financial performance with high audit quality, 2) investor reaction to high financial performance but low audit quality, 3) investor reaction to low financial performance with high audit quality, 4) investor reaction to low financial performance with low audit quality. The results showed that investors only react to high financial performance but low audit quality with negative react, it shows that investors are concerned about audit procedures in assessing the company's financial performance. High company performance but has a low audit quality makes investors pay more attention to the company because the good value is actually considered to be detrimental to investors because of its doubtful quality.

Background: Critical thinking is a key element in the field of education. Where many studies have been published regarding the importance of critical thinking while practicing or studying nursing in hospital settings or academic environment, this project indicates the development of critical thinking in nursing students at all levels of their nursing program. Objective: The purpose of the study is to enhance critical thinking in the nursing students to improve clinical practice and judgment. Methodology: A sample of 20 nursing students participated. A questionnaire tool regarding Knowledge, Attitude and Practice of nursing student to enhance critical thinking was used for pre and post-test evaluation. In implementation phase, participants presented with different critical thinking skill development presentations which were based on clinical scenarios. Results: The result analyzed was 18 out 20 participants strongly agreed that critical thinking development workshop enhanced the skill in patient care. The critical thinking assessment too was further assessed over the time period for their consistency and sustainability on utilizing the critical thinking strategy. Conclusion: The enhancement in critical thinking in nursing students is a necessary development in one’s ability ultimately improving patient care outcomes and quality indicators.

This study aims to determine the effect of corporate governance mechanisms on fraud in financial reporting. The sampling technique used was purposive sampling. This research was conducted at non-financial companies with a research time period (2015-2017). The estimated model used is logistic regression analysis. The purpose of this study is to determine whether corporate governance mechanisms influence fraud in financial reporting. This research involves 2 (two) variables consisting of 1 (one) dependent variable, 2 (two) independent variables. The dependent variable in this study is fraud in financial reporting. The independent variables in this study are the audit committee and leverage. The results of the research conducted in the regression analysis are 11.5% of the corporate governance mechanism variables against fraud in financial reporting. This means that corporate governance mechanisms simultaneously influence fraud in financial reporting.

Aim of the study was to find out the role of biochemical markers in diagnosis of alcoholic liver disease and non-alcoholic liver disease and compared these values with healthy subjects of Rajasthan. Total 300 subjects were selected in which 200 were selected as patients group (alcoholic liver disease (ALD) and non-alcoholic liver disease (NALD) group) and 100 were normal healthy subjects. Total 100 alcoholic liver disease patients in which 91 patients were male and 09 patients were female. In non- alcoholic liver disease group 55 males and 45 females are enrolled. Patients were distributed age wise. Serum cholinesterase and serum 5-nucleotidase were estimated by commercially available kit on spectrophotometer. Serum cholinesterase level is 2822.99± 716.51 in ALD patients. In NALD patients, serum cholinesterase level was 4299.95±1014.76 and in control group mean serum cholinesterase level was 6303.99±977.59. P-value was statically highly significant. (P≤ 0.0001), as well as serum 5-nucleotidase level was 25.89± 5.77 and 17.70± 4.43 in ALD and NALD respectively. In control group mean level of serum 5-nucleotidase was 9.851± 3.24. (P≤ 0.0001). We conclude that serum cholinesterase level was decreased in both disease group, whereas serum 5-nucleotidase level is increased in both disease groups. Both parameters are liver specific and specific test for alcohol induced or alcoholic liver disease as well as in non-alcoholic liver disease. Both parameters can be used as a marker of liver disease. it was concluded that serum cholinesterase and 5' -nucleotidase are better diagnostic marker then the conventional liver function test that are raised in other liver disease also.

This study aims to test the effect of Current ratio empirically, Return on Assets, Debt Ratio, Dividend Payout Ratio, and Price Book Value on Financial Distress. Causal correlation research methods. The sample selection in this study uses the Purposive Sampling method, so the criteria selected six mining sector companies. The data analysis method used in this study is the panel data regression method and found that the more appropriate model to use is the fixed effect. Based on the calculation results of the random effect model, the results of this study stated Current ratio, Return on Assets affect financial distress while Debt Ratio, Dividend Payout Ratio, Price Book Value do not affect financial distress.

Nursing profession is full of hazards. Health care worker faced all kind of hazards including biological, non-biological hazards, physical environmental, electrical, chemical hazards. A health care professional are at risk of these hazards. Among physical hazards back pain is more common. WHO provide a modal in 2010 for healthy work place. There are four avenues of this modal are: The physical work environment 2. The psychosocial work environment 3. Personal health resources in the workplace 4. Enterprise community involvement. There are many reasons for these hazards like Poor work organization, lack of awareness and competency of dealing with the equipment, heavy work load, lack of proper rest, poor diet, strict manager. Sufficient literature review is given for these hazards and their managements. In this study we discuss what are common hazards that are faced by health care worker and how they control.

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: 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.

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: 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.

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: 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.

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.