Lower extremity amputation is performed to remove ischemic, infected, necrotic tissue or locally unresectable tumor, and at times, is a life-saving procedure. Peripheral artery disease, alone or in combination with diabetes mellitus, contributes more than half of all amputations; trauma is the second leading cause. Lower extremity amputations are common debilitating complications in patients with diabetes mellitus. Our aim was to analyse the various causes for lower extremity amputations, assess the complications and amputation rates in patients with diabetes mellitus and to identify risk groups for lower extremity amputations that can be focussed for preventive treatment at Vydehi Institute of Medical Sciences and research centre, Bangalore. This retrospective audit was conducted jointly in the Dept of General Surgery & Dept of Medicine, VIMS&RC, a super speciality teaching hospital in south India, between Jan 2011 and Dec 2014. Case files of patients who underwent lower extremity amputations were retrieved from the institution medical records section and data analysed for demography, clinical presentation of diabetics, other causes for amputation such as vascular disorders, kidney disorders, malignancy and diabetic ulcer/ infections of the foot, and post-operative morbidity and mortality. 137 patients were amputated, of which 120(87.59%) males and 17(12.40%) females (table-1, fig-1). 82(59.85%) patients were diabetic and 55(40.14%) non diabetic patients which included twenty three peripheral vascular disease (16.78%), osteosarcoma 16(11.67%), crush injuries 9(6.56%) and elephantiasis 3(2.18%) (fig-3). Of the 82 diabetics males were 65(79.26%) and females 17(20.73%) (Table-2). Foot infections and chronic renal disease preceded amputation in patients with diabetes. Diabetic women were older than the men when amputated, diabetic men underwent multiple amputations both minor and major, had severe foot infections compared to the women. 90 % of all diabetes-related amputations were preceded by foot ulcers leading to ischaemic gangrene. Various interventions the patient underwent ranged from wound debridement to revision amputation ( table-3,fig-4)The number of diabetics attending the diabetic foot clinic increased over the years showing the impact of awareness programmers and counselling about the disease (fig-2).The complications of diabetic foot infections ranged from cellulitis to gangrene (table-4,fig-5) There was 50% reduction in the rate of amputations performed above the ankle in patients with diabetes during the year 2014( table-6)) as most of them were referred to the multidisciplinary foot team in our diabetic clinic prior to the decision of amputation. There was no mortality in the study. The gradual decrease in rate of major amputations is due to an active implementation of the consensus guidelines of foot care in the diabetic clinic and awareness of the patients to get themselves examined and treated for foot problems early. Diabetic foot complications and diabetic nephropathy when identified early in diabetics can prevent major lower extremity amputations.

Orthodontic camouflage treatment is an acceptable option for mild to moderate skeletal discrepancies for correcting the malocclusion as well as the skeletal problem. Surgical treatment is the preferred and most stable treatment for adult patients with severe skeletal Class III malocclusion. Patients with borderline dentoalveolar compensation who are not willing to accept the costs, risks, and potential complications of surgery can sometimes be treated successfully with camouflage orthodontics. It is not clear which mechanics are most appropriate or which patients are most likely to benefit from an orthodontic approach to severe skeletal Class III malocclusion. In this article a case report of a camouflage treatment in a skeletal class III malocclusion patient with prognathic mandible with average growth pattern and partially erupted palatally placed upper right canine and retained deciduous right upper canine. The aim of this article is to show that Orthodontic camouflage is an acceptable option for mild skeletal discrepancies that offers esthetic results in the soft tissues as well as correction of malocclusion.

This paper proposed a framework to establish the relationship between the implementation of TQM success factors and the organizational performance measures, using the role organizational culture plays as a moderating variable in the oil and gas industrial sector in Libya. The study which is the first step in providing a base for the empirical study of the moderating effect of culture in the Libya oil and gas industry has put forward some key success factors for TQM implementation with special consideration of the operational culture in the oil distribution sector in the Libya oil and gas industry. Thus, the study focused on those critical factors that can easily and positively affect the organizational performance. Having proved by previous TQM researchers how organizational culture and practices significantly influence the overall organizational goal and performance, if adopted and implemented with sincerity, this study will help Libya’s Oil and Gas Sector to improve its competitiveness among firms, quality of products and services, and a standard customer expectation.

The study empirically examined the determinants of share price in the Nigerian Stock Market from 1980 to 2000. Data from fifteen quoted companies were used. The study adopted ordinary least square method i.e multiple regression to analyse and interpret the data that were mainly sourced from the Nigerian Stock Exchange. The model used expressed the share price as a function of some identified determinant established by theories and literature. These determinants are earning per share, dividend per share, money supply, oil price, the gross domestic product, consumer price index and interest rate. After the analysis it appears that all these variables are true determinants of the share price in Nigerian Stock market going by the significance of the model at both 5% and 10% levels of significance and the robustness of the R square which stood at about 0.93. This simply shows that these identified determinants have been able to explain about 93% variation in the share price of the companies. However based on the revelations concerning the relationship of the share price and each of this variables it appears the that earning per share, dividend per share, money supply, oil price and consumer price index all exhibited positive relationship with the share price while interest rate and GDP exhibited negative relationship.

This paper discussed on small and medium scale industries pathway to Nigeria economic development. It also point out the problems facing the entrepreneurship development of Nigeria economy. It also examines the importance of entrepreneurship in Nigeria. The methodology adopted was systematic review method. It also found that entrepreneurship can enhance economic development in Nigeria primarily by generating employment opportunity. The study also revealed that initiatives by government failed because of over bearing bureaucracies, corruption, inadequate and inefficient infrastructure facilities, financial backup and maladministration. The paper also recommended that government and banks should recognize the important entrepreneurship to her economic development growth by providing the enabling environment for small and medium scale industry to develop. Specifically, government should provide infrastructural facilities (electricity, road network, and communication). It is also recommended that government should reactivate all the institutions established to promote small and medium scale industries in Nigeria.

PBL goes with the trend of the times which is conducive to cultivate students' comprehensive qualities and autonomous learning ability, moreover, to stimulate their creativity, exploration and critical thinking so as to provide the society with interdisciplinary talents. This paper aims to probe into the validity of PBL method in College English reading teaching through the review of PBL theory, the contrast between traditional class and PBL class, and the PBL class design of College English reading so as to lay the foundation for further in-depth teaching and research in the future.

The present study aimed at the In Vitro Evaluation of Xanthine Oxidase Inhibitory Activity of Apium graveolens dulce and Bryophyllum pinnatum kurz. The activity was performed usingethanolic extract of leaves and stalk of Apium graveolens dulce and fresh juice of leaves of Bryophyllum pinnatum kurz at various concentrations (100µg, 200µg, 300µg, 400µg, 500µg, 600µg, 700 µg, 800µg). In this study Allopurinol was used as a standard drug. The results were noted in terms of highest percentage inhibition of Xanthine oxidase. The combination of ethanolic extract of leaves and stalk of Apium graveolens dulce and fresh juiceof leaves of Bryophyllum pinnatum kurz shows significant effect at highest concentration such as 800µg in combination group

The study empirically investigate the nexus between agricultural financing and economic growth in Nigeria from 1983 to 2015. Augmented Dickey-Fuller (ADF) test and the Phillip-Perron tests were used to establish which variable is stationary at different levels. Almost all the variables (Real Gross Domestic Product (RGDP) Agricultural credit guarantee scheme fund (ACGSF) Commercial Bank Loan and Advance on Agriculture (CBLAA) are stationary at first different form, that is they are integrated of order I (1) except interest rate (INTR) which is stationary at level, that is, it is integrated of order I (0), hence Bounds co-integration test was adopted since it allows combination of fractionally integrated variables i.e. combines variables of different orders of integration. The results reveal existence of long-run relationship between proxy of economic growth and the proxies of agricultural financing. Meanwhile, Auto Redistributed Lag (ARDL) results show both short and long run effect of agricultural financing schemes on the growth of Nigerian economy. In addition, various diagnostic tests (such as Jarque-Bera (JB) test, Breusch-Pagan Serial Correlation (LM) test, Ramsey test, and ARCH test) were conducted to fulfill some of both Ordinary Least Square and normality assumptions. Notably, the loan disbursement mechanism adopted by agricultural credit institutions have fail to drive the Nigerian economy towards real growth despite the long run nexus among the key variables, coupled with corruption, and policy summersaults in the sector. Therefore, there is need for proper channelization of loans across board with sustainable fiscal measures that can translate to actual growth.

Cytological examination of cavity effusions is extremely important as it highlight the cause, presence of metastatic cells, typing of unknown cases, prognosis and staging of cancer. To study and evaluate trends in cytological evaluation of cavity effusions for various pathological conditions in a tertiary health care centre. 2) To correlate their frequency in relation to diagnosis. Our Study was cross-sectional study performed in Department of Pathology, Sri Aurobindo Medical College and Post Graduate Institute from 1st January 2013 to 31st December 2014. Serous cavity effusions included in the study were pleural and peritoneal in origin. All other fluids (pericardial and synovial fluid) were excluded from the study. The history and relevant parameters were noted and correlated clinically. Cytospin and Conventional smear methods were performed on pleural and peritoneal fluids. Both air dried and wet fixed smears in methyl alcohol were used and stained with Papanicolaou (PAP) and May-Grunwald-Giemsa (MGG) stain. Out of 885 cases, 400 (45.19%) were pleural fluid, 485(54.8%) were peritoneal fluid .806 (91%) were of benign effusion and 79 (8.92%) were of malignant effusion. Total transudate cases in our study were 611 (69%) and exudates were 274 (30.9%). Male to female ratio was 1.5:1 with youngest patient 20 years old and eldest was 85years old. In younger age group benign effusions are common and malignant in older age group. Morphology and staining with May-Grunwald-Giemsa (MGG) and Papanicolaou (PAP) helped in better interpretation. Preliminary fluid analysis for cytology in resource limited settings, still remains the most convenient and cost effective method in arriving at the diagnosis, thereby reducing the need for invasive investigations and their related complications. Presence and absence of malignant cells at times can be the only clue to the presence of malignancy thereby affecting the prognosis and treatment outcome of the patient

Xanthogranulomatous gastritis is an extremely rare condition and only few cases have been reported in literature. It is an inflammatory tumor like lesion usually misdiagnosed preoperatively as an advanced gastric cancer. We report one such rare case in a 68 year old female who came with complaint of epigastric pain and vomiting for 15 days. Endoscopy revealed solitary elevated nodule in the gastric lesser curvature. Clinical diagnosis was suspicious of gastric carcinoma. Histopathologically foamy histiocytes with dense chronic inflammatory infiltrate were seen in gastric wall suggestive of xanthogranulomatous gastritis

In this paper, a framework for exploring the relationship between the moderating effects of organizational culture on TQM implementation and organizational performances was proposed and investigated using Alrahila Oil Services Company, Libya, as a case company. The study, which provides a whole new approach to the investigation of the relationship of variables, used qualitative and quantitative survey methods and the PLS program for its evaluation. The study showed a great potential for ensuring the survival and growth of Alrahila Oil Services Company, Libya, as well as other oil serving companies in Libya. The results of the study provided a substantial knowledge and scientific addition to this field as it established the moderating effects of organizational culture on the different TQM critical elements, as well as on the overall company’s performances. Training/educational development and continuous improvement (Hypothesis 3 and 5) as TQM parameters showed insignificant and negative influences on the relationship between different TQM critical elements and the overall company’s performance.

This study aimed to evaluate the effect of an educational program on nursing performance regarding advanced cardiopulmonary resuscitation. A QuasiExperimental Study. The study conducted at the emergency department at Ain Shams University hospital and children hospital affiliated to Ain Shams University hospitals. A convenience sample included all available nurses (100) , at the previously mentioned settings over a 6 months’ period. Pre-designed sheet; it was concerned with their knowledge regarding advanced cardiopulmonary resuscitation.

This study intends to examine the relationship and impact between servant leadership and organizational commitment in the context of bank employees. Moreover, it intends to discover the differences between bank employees who are working in the local and foreign banks in the Northern Region of Malaysia. Questionnaires had been distributed among bankers in local and foreign banks in the states of the Northern States of Malaysia, namely Penang, Perak, and Kedah. Almost 300 questionnaires were distributed. This paper adapted servant leadership instrument from Van Dierendonck and Nuijten. Furthermore, the organizational commitment had been adopted from Meyer and Allen. The study provide a better understanding of the right leadership in fostering employees commitment, improve the leader-follower relationship and allow more leaders to realize the benefits of using servant leadership in increasing their relationship with their subordinates, influencing the subordinates’ positive job behavior as well as increasing their subordinates’ satisfaction and commitment with their job, department, and organization. Furthermore, this study urges the human resource department to conduct proper leadership training to their employees to promote new ideas toward servant leadership to improve the leadership skills among bank employees that may lead to rising up their organizational commitment.

As a remarkable Victorian novelist, Charlotte Bronte wrote four impressive novels including Jane Eyre and The Professor. Jane Eyre proves to be a typical Victorian book, fascinating and enduring, whereas The Professor, the first complete novel that Charlotte Bronte wrote has always been considered as minor and illconceived. Despite the totally different judgments of the two novels, there exists many similarities between Jane Eyre and The Professor. This paper aims at helping readers have a better understanding of The Professor by comparing with Jane Eyre from two aspects: genre and theme, and try to find out the similarities of Jane Eyre and The Professor, thus we can have a further understanding of Charlotte Bronte.

The increasing number of opioid users among chronic pain patients, and opioid abusers among the general population, makes perioperative pain management challenging for health care professionals. Anesthesiologists, surgeons, and nurses should be familiar with some pharmacological phenomena which are typical of opioid users and abusers, such as tolerance, physical dependence, hyperalgesia, and addiction. Further clonidine also reduces intraoperative requirement of opioid analgesics as compared to normal saline group. Total amount of rescue analgesia needed in 24 hour was also significantly less in clonidine group as compared to placebo group. Intraoperatively more fentanyl required in placebo group as compared to clonidine group (p<0.05).