The Moon and Sixpence is told in a series of glimpses into the mind and soul of the central character Charles Strickland, a middle-aged English stockbroker, who abandons his wife and children abruptly to pursue his desire to become an artist. In this novel, Strickland tried to search for his identity that he had lost in the past years. He deconstructed his former identity and constructed his new identity. Strickland searched for this identity through several steps: First, to get rid of the bondage of family. Second, don’t care what others think about him. Third, to accept a support. Finally, died but fulfilling his construction of identity.

This study investigated the effectiveness of discussion method of teaching in curriculum delivery in secondary schools in Ogbia Local Education Authority (LEA) of Bayelsa State, Nigeria. Nigeria has thirty six States in which Bayelsa State is one of it and Bayelsa State has eight Local Education Authorities which Ogbia is one of it. Ten secondary schools were randomly selected from the thirty schools in Ogbia LEA and eighteen teachers from each of the ten selected secondary schools were randomly selected for the study. The study was guided by three research questions. The instrument for the study was questionnaire developed by the researchers. Split half reliability was used to determine the reliability of the instrument, r = 0.87 was realized which is within the acceptable reliability benchmark. The instrument was administered to respondents and was retrieved and analyzed using percentage. The findings revealed that discussion method of delivering curriculum had positive impact on student because it encourages listening, talking and critical thinking among students which leads to better performance. It also encourages cooperation and teamwork among students and teachers. From the study, it was also discovered that discussion method of curriculum delivery helps students to deal with stereotype, gender bias and social disability. The best subjects suitable for discussion method are art/social science related subjects as well as science subject like health education. Teachers have adequate preparation but lack adequate instructional materials for effective curriculum implementation using discussion method of teaching. Based on the findings of this research, the researchers made some recommendation which includes curriculum planners and textbook writers should provide topical issues/discussion topics before, during and after every reading task to make lessons more participatory, meaningful, purposeful, exciting, enjoyable and pleasurable. Teachers should be encouraged to attend seminars, workshops and conferences in methodology to update their skills in discussion.

Chylous leakeage is a well know complication reported in 1% to 3% of patients undergoing cervical neck dissection, mediastinal lymph node dissection, or gastric resection for cancer as well in breast cancer patients undergoing axillary lymph node dissection; most of these cases occurs on the left side. This complication seems to be mainly related to abnormalities of the thoracic duct anatomy or the subclavian duct leading to injury of an aberrant lymphatic channel trunk during level I-II ALND. Two case reports in breast cancer patients with left sided chylous leakage following level I-II ALND are reported; their diagnostic and therapeutic management is discussed with a literature review in order to update the diagnostic and therapeutic perspectives in this peculiar clinical setting.

This is an analysis, commentary, and critique of the “Planet of the Apes” saga, with major focus on the 2011 film, “Rise of the Planet of the Apes”. The author examines the film from the perspective of an extended and continuing, overarching theme characterizing earlier films of the same: “Planet of the Apes” (1963), and “Planet of the Apes” (2001). The issue of freedom and anthropocentric values defining things human are examined in the face of what emerges as a merger or transformation of this “humanity” to, and with apes, and thus, the creation of what the author describes as “Apeity” in the film. The author examines what can be viewed as a bi-directional “violation” of both Humanity and “Apeity” and describes this “violation” in terms of its meaning to the concept of Humanity using various characters from these films and explores the “apish” and “human” values and behaviors inherent in concepts of culture – social psychological and sociological. The author evokes themes of anthropocentrism and anthropomorphism in exploration of values, freedom, identity, and conflicts as depicted in the ape saga. The author briefly examines the continuation of the social humanism and conflicts in the 2014 film “The Dawn of the Planet of the Apes” into the third presentation, “War of the Planet of the Apes” (2017). These ideas are presented in relation to ideals of femininity and masculinity, individualism and collectivism relative to definition of Humanity. Finally, the author reconciles this treatment of the film with concurrent practices regarding human values and treatment of non-human creatures and the ideas of human fate and future.

With the implementation of the new curriculum reform and the wide application of teaching technologies in China, the teaching model of the non-English major students’ English as foreign language teaching has also undergone great changes. Constructivism emphasizes student-centered, autonomous and cooperative learning, which offers a solid theoretical foundation for the autonomous learning in the non-English major students’ teaching process. Therefore, based on the constructivism theory, the article attempts to explore strategies to cultivate the autonomous learning ability of non-English major students. With the application of teaching strategy of cooperative learning, situational teaching and task-driven teaching, the students can more actively participate in the classroom activities and their learning enthusiasm can be stimulated.

Nurses are present at both the beginning and the end of life, and play a key role in caring for dying patients. It clearly indicates that role of nurses can never be ignored when we are talking of end of life care or palliative care. Palliative care is defined by literature as care that improves the quality of living in individuals who are facing life threatening problems and illness to prevent and treat them through early identification of pain and other physical and psychosocial problems. The main purpose of this study was, to assess palliative care knowledge and attitude among nurses of Mayo Hospital Lahore. A cross sectional descriptive survey was performed to assess the knowledge and attitude level. A simple random sample of n=150 was used. A structured questionnaire with demographic data, knowledge and attitude of palliative care was applied. The data was analyzed on SPSS version 21. 36% of the study participants had poor knowledge, 49.33% of the study participants had average knowledge and very less number of participants that is only 14.7% of the study participants had good knowledge of palliative care. Findings reveals that 33.33% of the study participants had negative attitude towards care of end of life among terminally ill patients, while 66.7% had positive attitude towards end of life care. Knowledge was poor among majority of the participants but attitude was found positive among them

Abstract: The study aims to compare between serum non-HDL Cholesterol, CRP and Uric Acid Levels in Metabolic Syndrome. Fifty subjects of metabolic syndrome (MetS) (30 women, 20 men) who confirmed by the ATP III diagnosis criteria and have no any medical treatment were included in the study. Twenty healthy subjects constituted as the control group (13 women, 7 men). Blood samples were obtained after overnight fasting by using standard sampling procedure and measured fasting blood sugar, lipid profile, serum uric acid and CRP levels. Non–HDL-C was calculated by a formula (Non HDL-C = TC - HDL-C), C-reactive protein was measured using a commercially available ELISA Kit (Ray Biotech, Inc.) Uric acid level was determined using enzymatic (urease) method. Blood sugar and lipid profile were measured by using standard colorimetric commercial kit. Mean, Standard deviation and unpaired t- test (p value) were applied. A p value < 0.05 was considered as statistically significant. Anthropometric variables (blood pressure, BMI and WC) highly significantly (p<0.0001) increased except age (p=0.37 NS) in MetS (n=50) patients than control (n=30) groups. Lipid profile including TC, TG, LDL-C and VLDL-C showed statistically significantly raised (p<0.0001) whereas HDL-C observed decreased (p<0.0001) in same manners. In case N-HDL-C, CRP and serum uric acid levels were found statistical significantly elevated (p<0.0001) in MetS on comparison with control group. Non-HDL-C may be an independent risk factor for cardiovascular events in MetS. Monitoring HDL-C concentrations may reduce the cardiovascular risk. Therefore, non-HDL-C and CRP might be useful markers for predicting cardiovascular events in both high-risk and healthy individuals. Serum Uric Acid levels were significantly higher with MetS samples. Uric acid and non HDL cholesterol can be considered as a component of MetS.

Population growth, aging, and sedentary lifestyles, particularly in developing countries, will create a crisis for population health that requires a multisystem response with musculoskeletal health services as a critical component. The prevalence and impact of musculoskeletal conditions increase with aging. Aim of this study assesses lifestyle elderly women Suffering from knee osteoarthritis pain. A descriptive research design used in this study. Was conducted at out patient orthopedic and rheumatology clinics at Nasr City Hospital and the Nile Hospital, affiliated to the National Health Insurance Organization Cairo Egypt. A purposive sample of 120 elderly women with OA. Tools the investigator will use four tools for collection of the data, namely an interview questionnaire, Lawton scale for the Activities of Daily Life Arthropometne measurement, Measure Body mass index, and a pain. Revealed 85% of study subjects from urban areas, suffered from OA since many years, and 68% Unsatisfactory knowledge and Adequate practices 71.7% and 80% was obese, and 73% suffered from Moderate pain. The results of the study show the lifestyle practices older women are higher than women's knowledge and higher in cases of moderate obesity and moderate pain in most elderly women. Health education about lifestyle modification, practice exercise should be provided to all female with OA attended to orthopedic and rheumatology clinic.

The margin is one of the components of the cast restoration most susceptible to failure, both biologically and mechanically. Obtaining a good marginal seal is one of the most important factor in determining the long term success of cast restorations. The purpose of the study was to comparative evaluate the casting accuracy by axial coverage of the die spacer 1.00 mm short from the finish line and complete axial coverage of the die spacer. Irrespective of the method of the die spacer application, all the castings showed deficiency in the marginal fit. Efforts were made to select and utilize standard method. The enhancement of marginal fit with incomplete axial die spacer coverage by providing an area of close adaptation near the marginal area, thereby improving the marginal seal and thus reducing the dissolution of cementing media is of great clinical significance. Increased casting accuracy with die spacer application short by 1.00 mm from finish line could be due to the reason that unpainted area will ensure an area of close adaptation at the margin. From this study, it is clear that the die spacer application short by 1.00 mm from finish line gives better marginal adaptation to castings when compared to full length die spacer application

Percy Bysshe Shelley was one of the important English romantic lyric poets. He remains a central role in English Romanticism. The theme in his work includes religious fervor, nature, Ancient Greek aesthetics, and emotional response to beauty. These are components of Romanticism. His major works are considered as challenging beliefs of revolutionary philosophy, and his odes and shorter lyrics are widely known for their stylistic mastery.

Pericardial effusion is an extremely rare expression of hyperthyroidism. We report a case of a patient with Graves’ disease who developed a sanguineous pericardial effusion. Our patient had been hospitalized for retrosternal chest pain and dyspnea. She underwent pericardiocentesis resulting in 700 ml of blood. The pericardial fluid’s cytology and culture were negative. Besides, thyroid hormone markers were progressively normalized using antithyroid drugs .Thus the pericardial effusion resolved without recurrence.

Supervisory practice has evolved since its origins in colonial times, and its effectiveness as a means of improving instruction depends on the ability of educational leaders to remain responsive to the needs of teachers and students. An educational leader’s resolve to remain adaptable also depends on an appreciation of the changing and evolving nature of supervision, especially in the new millennium. An educational leader who understands the history of supervision and how current demands are influenced by that history will be better able to confront the technological, social, political, and moral issues of the day. Educational leaders also will have to develop the requisite knowledge, skills, and dispositions that are the foundation for effective supervisory practice. This chapter explicates how supervision has evolved to its current state, how you might respond to ever-increasing supervisory needs and demands, and how your beliefs and attitudes affect how you react to daily challenges.

Abstract: Infertility is more of a social problem rather than a medical problem. The term “subfertility” used to describe any form of reduced fertility that results in a prolonged duration of unwanted lack of conception. The difficulty to conceive or subfertility constitutes a major social and psychological burden amongst couples especially in lower-middle country like Bangladeshi women. Accurate and precise diagnosis is mandatory prior to management of case. Although there are many diagnostic tests available, the clinical presentation of each patient can usually be linked to specific and efficient testing strategies. Ultrasonography is an accurate and reliable test for evaluation of subfertilty. Ultrasonographic imaging is easy to use, safe, and readily available noninvasive means to evaluate fertility potential. The purpose of the study is to evaluate and correlate the clinical findings with ultrasonography finding of the subfertile female patient. A hospital based cross sectional study conducted Department of obstetrics & Gynecology (Infertility unit), Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka. Sample was selected from the population by Purposive sampling. All subjects were subfertility in reproductive age group. Total 50 patients were enrolled for study after fulfilling inclusion and exclusion criteria Detail demographic data were collected from the patients and recorded in structured case report form. All collected questionnaire checked very carefully to identify the error in the data. Data processing work consist of registration schedules, editing computerization, preparation of dummy table, analyzing and matching of data. Maximum numbers of patients (62.0%) were between 20-30 years age group with mean age was 26.47 ± 11.57 years. Detailed history taking, examination suggested that, etiology for subfertility were (14%) for tubal factors and (26%) ovarian factors. Clinical and pathological factors for subfertilty were verified by pelvic ultrasonography in all the cases. In case of female infertility, uterine factors account for 32% of the cases. Among the uterine causes, fibroids or myomas in the uterus found (16%) cases, endometrial thickening (10%), endometrial polyp and endometriosis (6%) cases. Ovarian factors like polycystic ovary syndrome (PCOS) found (18%) cases. In 24% of women, USG tests were normal and there is no easily identifiable cause for infertility. Subfertility is not an uncommon problem in our country, major social, personal and economical burden. When pregnancy is considered such an important event in life, and considered a “socially unacceptable condition”, it can lead to a search for treatment appropriately and accurately. Aetiology of infertility are numerous and presentation also variable, sometimes confusion occurs regarding the actual diagnosis and thus delay the prompt management which may result in poorer clinical outcome. Therefore proper clinical evaluation with sonographic and other pathological findings correlation, interpretation helps to proper diagnosis, treatment and prevention as well.

Middle level managers play a very vital role in employee talent development in institutions of higher learning since they man a large population of employees at this level. Talent development seems to be the key theme driving the educational institutions. The study sought to investigate the influence of leadership styles of middle level managers on employee talent development at Rongo University. Descriptive research design was used for the study because it allowed for the statistical analysis of data to describe the trends about responses to questions and to test research questions. The study targeted 10 senior management level staff, 8 Deans, 30 middle level managers of departments and sections, 80 middle level employees, 100 low level management employees. Simple random sampling was used on middle and low level employees from different sections and departments.10 senior management level staff, 8 Deans, 30 middle level managers of departments was sampled using purposive sampling method. Reliability was ensured through test-retest which yielded 0.78 Cronbach‟s alpha. To ensure content validity, the questionnaire is to be given to the experts and researchers of Rongo University who examined the items critically and pass on their comments to the researcher. Statistical techniques of averages and percentages with the aid of Computer Statistical Software for Social Sciences to yield descriptive results. The findings revealed that 63% of the respondents observed that stakeholders were involved in talent development in Rongo University while 37 % indicated that stakeholders were not involved. The study concluded that leadership styles of middle level managers influence employee talent development in Rongo University since effective leadership style is seen as a potent source of management development and sustained competitive advantage. The study recommended that the middle level managers in Rongo University should be trained on talent management and leadership style to apply in management of employees talents. The study adhered to ethical considerations.

Abstract: Obstetrics patients may require intensive care at any time unpredictably. The most common causes of morbidity and mortality in these patients are anaemia, hemorrhage, hypertension, pre eclampsia, eclampsia, septicemia and their complications. The aim of this study was to evaluate the incidence, occurrence, indications, course of ICU stay, interventions required and the outcome of those obstetric patients admitted in the ICU. It was a hospital based, retrospective study conducted in a tertiary care medical college in Haryana, in North India over a period of 2 years – from January 2015 to January 2017. Out of a total deliveries of 7150, 165 patients required ICU admission and care (2.30 %). Most admissions were in the post partum period – 95(57.57 %), followed by antepartum period – 70 (42.43 %). Most common indications for ICU admission were obstetric hemorrhage – 50 (%), eclampsia -17(%), pre eclampsia- 8 (%), septicemic shock – 23 (%), HELLP syndrome – 16 (%), DIC- 10 (%), cerebral malaria-10 (%), dengue-7 (%), hepatic encephalopathy-5(%). The most common interventions warranted were artificial ventilation-139 (84.24 %), transfusion of blood & blood products-140 (84.84 %), surgical exploratory laparotomy – 35 (21.21 %) and there were 15 maternal deaths (9.09 %).