Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in critical care settings and affects between 9%-27% of mechanically ventilated patients for more than 48 or 72 hours. One of the strategies that reduce the VAP incidence is subglottic secretion drainage (SSD) through a lumen attached to a specialised endotracheal tube. This integrative review aims to investigate the efficacy of intermittent and continuous SSD in reducing VAP among critically ill ventilated patients. A systematic electronic search was conducted via CINAHL, PUBMED, MEDLINE and COCHRANE using the key terms. A manual search was also conducted through the references of retrieved studies, Scopus, and Google Scholar. Sixteen relevant primary articles were identified; twelve studies were conducted on general ICU populations examining intermittent subglottic drainage (ISD) and continuous aspiration of subglottic secretions (CASS) while four other studies were undertaken in cardiothoracic ICUs investigating CASS. No studies were found concerning the efficacy of ISD in this setting. Current evidence has revealed that ISD and CASS appear to be effective in general ICU settings while CASS did show significant reduction among the cardiothoracic ICU population. It was found that ISD appears to be safer in terms of tracheal damage despite the concerns of secretion pooling. This integrative review concluded that ISD and CASS appears to be effective methods in reducing VAP incidence among general ICU populations. Further research is needed to investigate both methods among cardiothoracic patients. A large randomised controlled trial is also required to compare the two settings and to determine the optimal frequency and suction pressure that could minimise complications.

Implementation of standardised oral hygiene protocols could potentially minimise the occurrence of ventilator-associated pneumonia (VAP) among critically ill patients. However, inclusion of the topical application of oral chlorhexidine as an effective oral antiseptic in such protocols and VAP guidelines remains controversial and questionable, due to inconstancy in the current evidential findings. The aim is to investigate the efficacy of oral chlorhexidine in reducing the incidence of VAP among mechanically ventilated patients in different critical care settings. A comprehensive electronic and manual literature search was conducted utilising different databases, including Cinahl, Medline, PubMed, Google Scholar and Scopus, and using related keywords to identify the relevant primary research sources published in English since 2005. Data were extracted and summarised in tables and then were critically appraised using validated tools. When the relevant studies were analysed, they were grouped based on two main themes and varied subthemes. One of these is the patient population, including those admitted to mixed or general ICU and those who had undergone cardiac surgery. The second theme is the chlorhexidine type, in which solution and gel were investigated at varied concentration using different frequencies. Topical application of chlorhexidine may have the potential benefit of reducing VAP incidence; however, no recommendation can be made regarding the best type or optimal concentration that can be used. Thus, a large-scale randomised control trial to investigate further the effectiveness of its routine use among mixed ICU patients and to demonstrate the optimal form, as well as concentration and frequency, is required

Abstract: Customers are important constituents in the hotel industry. In business environment where competition is fierce and customer preferences shifting, organizations come under pressure to pay attention to customers to achieve competitive performance. The purpose of the study was to investigate the effect of customer focus on hotel performance in Kenya. The study concentrated on high standard or four and five star hotels in Nairobi and employed a quantitative research design to determine the effect. A sample of 146 respondents comprising of senior managers including Chief Executive Officers, Line Managers (ICT, HR, Marketing, Food and Beverage and Room) out 234 target population in 39 hotels were aimed at but only 105 questionnaires were returned. Data was collected, classified and tabulated according to research objective. Afterwards, descriptive statistics using central tendency, measure of variability and standard deviation was utilized. Inferential statistics was used to find out level of association between independent and dependent variables. The study concludes that customer focus has positive effect on the performance of star rated hotels. Consequently, hotel needs to strategically align its processes to customer needs and develop a culture that attracts and retains them. The study recommends that hotel targets customer satisfaction as a matter of priority through developing an innovative system that connects it with customers, awards credit or points for use of facility and provide updates and feedback. It also recommends that hotel invests in developing capacities of staff for them to have competence to manage customers effectively.

Diabetes mellitus is among the major global public health problems and its prevalence is currently increasing at an alarming rate. According to the International Diabetes Federation, about 366 million people are living with diabetes and this figure is projected to increase to 552 million by the year 2030. The study investigated the effect of oral administration of aqueous extract of coconut oil on blood glucose, total protein, kidney function indices, liver function indices, and lipid profile levels in alloxan-induced diabetic rats. The aqueous extract was administered orally at a dose of 400mg/kg body weight to both normal and alloxan-induced diabetic rats. Twenty adult male rats were divided into four groups of five rats each, two groups were made diabetic and the other two groups were non diabetic. One of the diabetic groups was treated with the extract and the other serves as control. The alloxan was administered intraperitoneal at a dose of 120mg/kg per body weight. The administration of the extract lasted for 21 days. Effect of the extract on blood glucose, total protein, albumin, bilirubin, urea, creatinine, total cholesterol, triglyceride, and high density lipoprotein concentrations were analyzed. The toxic effect of the extract was determined using biochemical enzyme markers. Treatment with the extract showed significantly (p<0.05) reduction in elevated blood levels of glucose, cholesterol, and proteins and other biochemical parameters associated with alloxan-induced diabetic rats. The extract possesses no toxic effect as indicated by the lowering of ALP and ALT levels and may be used for the management of diabetes mellitus

Open and Flexible Learning is an excellent method of reaching all types of learners. It is truly a medium that helps to democratize education to all. Today, we are currently experiencing a time of constant evolution in the field of education in which students require more resources and tools to obtain the information and construction of knowledge. One such resource is the use of open and distance learning environment, where the lecturer assigns additional activities for the understanding of the concepts seen before. But there are times when the student does not understand the content because of the form it represents, making it necessary to have more options to facilitate the understanding of content through different ways that may be more attractive to the students, achieving more active participation in the subject and an affinity that leads to a better learning experience. This is the goal of the study, which proposes a model called “Learning Buffet Model” for designing Open and Flexible Learning content adaptable to the student´s learning style. This learning buffet model can be used as a fundamental model and applied in any area or discipline of education as it forces the consideration of four components (leaning style, content, pedagogy and technology) in the design of the lesson plan and subsequently enrich the learning environment with more specific learning objects the subjects taught.

Pulsatile Drug Delivery System are the system where in there is a rapid and transient release of an active molecule within a short time period produced immediately after a predetermined off release period. In this present study efforts are made to formulate and evaluate chronotherapeutical drug delivery system of Losartan and Hydrochlorothiazide in the form of bi layered tablets for the treatment of hypertension by using various synthetic polymers. The compatibility study between drug and polymer was done by FTIR. Blend analysis of Losartan and Hydrochlorothiazide layers were studied. Based on the results these were formulated into bi layered tablets. Various evaluation tests of the tablets like weight variation, disintegration test and friability test etc were carried out. In vitro drug releases of the formulated tablets were carried out. Results of these studies indicated that the formulated bi layered tablets achieved a burst release after 3h-4 h lag time and hence can be used as the pulsatile drug delivery for hypertension. From this present work it can be concluded that pulsatile release of drug in the form of bi layered tablet can be achieved for newer chronotherapeutical drug delivery system

This study investigates the domestic dwellings built in Brisbane by twenty first-generation migrants, natives of the Veneto region in Italy, who migrated to Australia in the post WWII period and built their houses in the 1980s and 1990s in Brisbane. The purpose of this research study is to explore whether notions of culture were present in the homes migrants constructed in Brisbane, both in the material realm (interpreted as internal and external organization of space and the composition of the façade) and in the symbolic realm (the meanings attached to these houses by Italian migrants). The project is of qualitative nature and as primary sources of data uses semi-structured interviews, associated when circumstances made this possible, to photo-elicitation interviews, and focus group discussion. The semi-structured interviews were conducted both in Australia with twenty first-generation Italian migrants, and in Italy with another ten informants who are indigenous to the Veneto region and who built their homes there. These primary data are supplemented by (4) secondary data in the form of photographs and drawings. The findings reveal that home is both a physical structure and a set of meanings where these two components are tied together rather than being separate and distinct. It shows that there were two models the Veneto migrants chose for the erection of their houses in Brisbane and these correspond to: (1) the rural houses built in the 1970s and 1980s by their family and friends in the Veneto region and (2) the villas designed for noble families by the architect Andrea Palladio in the 15th century in the homeland of the respondents.

Salacia lehmbachii is being used in traditional medicine for the treatment of gastric ulcer, this claim has not been scientifically substantiated or refuted. This work was therefore, designed to validate the antiulcer potential of the aqueous root bark extract of S. lehmbachii on stress induced and ethanol induced gastric lesions in rats. Phytochemical analysis and acute toxicity studies were also carried out. The extract (200 and 400 mg/kg) exhibited significant and dose dependent antiulcer effect in both models. The ulcer protection effect of the root extract is comparable to ranitidine. The root bark extract was found to be non toxic up to 5000 mg/kg dose level in rats. Phytochemical analysis identified flavonoids, tannins, saponis, alkaloids, terpenoides and flavonoids. The study provides strong evidence of antiulcer activity of S. lehmbachii aqueous root bark extract against gastric acid ulceration in rats

This study aimed to determine the level of transformational leadership practices by school principals in the national secondary schools in the state of Pulau Pinang, Malaysia. The four dimensions of transformational leadership studied were vision identification, modeling, goal acceptance and individual support. The study also looks at the level of organizational health as well as the relationship with the practice of transformational leadership by the national secondary school principals’. The respondents consisted of 226 teachers employed in 16 national secondary schools in the state of Pulau Pinang, Malaysia. The data obtained was analyzed using SPSS version 20.0. Descriptive analysis and inferential analysis were used to analyze the influence of the relationship. The study found that school culture functions as a moderator in the relationship between the transformational leadership style of school principals’ and the organizational health of the secondary school teachers’ in the state of Pulau Pinang, Malaysia. In addition, school culture as a moderator in the relationship between transformational leadership and organizational health is a new discovery in the field of leadership. This is because the organizational health of secondary schools has never been investigated by local researchers. Most previous studies have highlighted transformational leadership and school culture has a direct influence on school improvement.

The main aim of this study was to determine the influence of consumers‟ awareness and attitude toward interest under Islamic law and Shari‟ah. The study used a target population of peoples of Zanzibar which was a majority Muslim by 99 percent. A descriptive design was adopted in this study for data collection. The descriptive design allows the description of the state of affairs as it exists and draws respondents‟ opinions and views on the influence of the consumer awareness toward prohibited of interest in Islam. The study found out that 68.9 percent of the respondents were aware the interest is one of the dangerous weapons to exploit and extort the poor and needy. We recommended that in order achieve certain economic and social goals, central banks have intervened in the determination of the rate of interest and establish of an interest free banking system because the most important portion of the wealth of a country is captured by a few rich peoples through interest.

Langerhans histiocytosis is a rare multi-systemic disease defined by the accumulation of Langerhans cells in the various organs of the human body, it predominates in children. Different localizations are described, Including the hematological localization characterized by the presence of histiocytes cell in the bone marrow. The aim of this work is to show the interest of the medullogram in the diagnosis of histiocytosis. We report 3 cases of Multifocal langerhanstic histiocytosis diagnosed in the hematology department in the Hassan II University Hospital in Fez. The diagnosis of Langerhans' histiocytosis was retained on clinical, cytological and anatomopathological criteria.

This study aims to analyze the influence of Competence and Organizational Culture on Job Satisfaction. The design of this research is quantitative by using survey method. The population of this research is all the Regional Device Work Unit (SKPD) in Bekasi City Government, Head of Department, Head of Agency and Head of Division who occupy essay II and III in Bekasi City Government which amounted to 208 people consist of 36 echelon II and 172 people Echelon III officials. The sample size of this study using Slovin formula with α size used is 5%, thus the sample size is 137 people. This research uses multiple linear regression analysis technique. SPSS 20.00 analysis tool. The result of this research is that Competence and Organizational Culture have positive and significant influence to Job Satisfaction. There are still other factors influencing the Performance of the Organization apart from the two Competence and Organizational Culture variables.

Lumps in the breast are common especially in women of reproductive age, majority of these lumps which mimic or are suspected to be breast cancers clinically and radiologically are later found to be benign breast diseases histologically. This study therefore aims to determine the prevalence of benign breast diseases in this environment and describe the spectrum of histopathologic pattern of Benign Breast Diseases that is seen in Port Harcourt. A review of benign surgical breast specimen from the university of Port Harcourt teaching hospital was done. A total of 2002 breast specimens were diagnosed as benign between January 2007 and December 2011. 397 paraffin blocks were suitable for this study. No lesions from male patients or congenital lesions were observed in this study. 117 of these lesions (29.5%) were non proliferative breast lesions, 275 (69.3%) were proliferative breast lesions without atypia, and 5 (1.2%) were proliferative breast lesions with atypia. The commonest non proliferative lesion was fibrocystic change while the commonest proliferative lesion was fibroadenoma. The proliferative lesion with atypia was atypical ductal hyperplasia.

Although multifaceted problems are causing the frustrating scenario of the country’s tourism sector, Jordan has the potentials to develop its tourism sector and earn huge foreign currency and generate employment opportunities like the neighbouring countries, such as The Holy Lands, Egypt and Turkey who attract substantial number of tourists every year and thus generates huge amount of foreign currencies. The paper looks at different preferences of the tourist and examines the tour intention in selecting different tour destination. The study utilizes both exploratory and empirical research approach. The study collects data through interview with a structured self-administered questionnaire from 165 tourists, in utilizing convenient sampling technique. A multiple regression model was estimated to examine the effects of different factors on the tourists tour intention where nine factors related to different aspects of tourism such as service quality, natural beauty, known destination, convenient lodging, adventure, security, effective and efficient transportation, safe and quality food and shopping facility were used as indigenous variables where tour intention was used as exogenous variable of the model. The regression result shows that Service quality, Natural Beauty, Security and Shopping Facility are statistically significant indicating 24.6% of the variation in explaining the intention to select a tour destination in Jordan. The study outlines some policy implications.

Abnormal uterine bleeding (AUB) is one of the commonest presenting symptoms in gynaecology out-patient department. The term dysfunctional uterine bleeding is used to describe abnormal uterine bleeding for which no specific cause has been found. Evaluation of histopathological pattern of endometrium is essential for appropriate management of patient with abnormal uterine bleeding. Endometrial biopsy could be effectively used as the first diagnostic step in DUB. This study was done to evaluate histopathology of endometrium for identifying the endometrial causes of DUB. This is a prospective study, undertaken in the department of pathology. This study consisted of 150 cases of hysterectomy specimens and endometrial scrapings received in the department of Pathology, Bhaskar Medical College and Satya Diagnostic Centre, Hyderabad, Telangana State. Total duration of study was 2 years i.e from June 2014 to November 2016. 150 endometrial lesions diagnosed on histopathology were selected for the final analyses. The most common age group presenting with DUB was 40–49 years (49.3%). The commonest pattern in these patients was proliferative endometrium (29.3%),followed by secretory endometrium (14%) and simple cystic hyperplasia (9.3%). Other patterns identified were endometrial polyp, complex hyperplasia without atypia, endometrial carcinoma, pill endometrium ,complex hyperplasia with atypia , endometritis , atrophic endometrium and adenomatous hyperplasia. Endometrial causes of DUB and age pattern was statistically significant with P value <0.05. Histopathological examination of endometrium should be done generously in women presenting with abnormal uterine bleeding especially after the age of 40 years to rule out malignancy. It is useful for diagnosis, to assess therapeutic response and to know the pathological incidence of organic lesions in cases of dysfunctional uterine bleeding prior to surgery.