This study aims to determine the effect of service quality, brand image and promotion of purchasing decisions at MCU Eka Hospital. The research design used was quantitative and descriptive. The study population included 396 service users of MCU Eka Hospital. The sample size is 76 respondents by using purposive sample method. The research data was collected by distributing questionnaires to obtain the required data. Data testing techniques include instrument test and classical assumption test. Methods of data analysis used are multiple linear regression analysis method, t test, f test, coefficient of determination test (R2) and inter-dimensional correlation analysis with the help of SPSS 23.0 for windows program. The results showed that the quality of service, brand image and promotion have a significant positive effect simultaneously to the purchase decision at MCU Eka Hospital. Partially the quality of service has a significant positive effect on purchasing decision, brand image has a significant positive effect on purchasing decision and promotion have a significant positive effect on purchasing decision. Further research is suggested to add other variables that influence purchasing decisions that have not been used in this study such as price, product and customer relationship management.

The sustainable production of ethanol from implausible bio-resources like, less or non-edible fruit samples are focused in the current investigation. Bio-ethanol is a fuel ethanol (ethyl alcohol), the same type of alcohol found in alcoholic beverages. It is most often used as a motor fuel, mainly as a bio-fuel additive for gasoline. Therefore, an attempt has been made to obtain a fuel grade ethanol using fruit samples like, Passion fruit (Passiflora edulis, L) and Cashew Apple (Anacardium occidentale, L.) by fermenting them with the help of flocculating yeast (Saccharomyces cerevisiae, L). The outcome of the experimentation facilitated to obtain 48% alcohol after finishing point of distillation processes; it can be can envisioned that, an optimized concentration of ethanol has been obtained on ensuing to standardization of the protocol. This bio-ethanol has been further subjected for physico-chemical characterization and found that, it can be one of the most promising types of bio-fuels that can be explored from the fruit resources. Hence, in the studies, the technological attributes of flocculated Yeast (Saccharomyces cereviseae) was employed to rationalize its use in alcoholic fermentation, thereby, the enhancement in the production of bio-ethanol from the selected fruit cultivars at significant level was achieved with a speed of about three to four folds greater than the yield reported in the earlier studies. Further, the ethanol samples were evaluated for Gas chromatography; the yield of ethanol, sample-4 (Passion fruit juice) gave 100% purity of ethanol as compared to standard. The bio-ethanol obtained as a result of fermentation was further subjected for the evaluation of Engine performance using single cylinder IC Engine with standard specifications.

The parotid gland lipomas are rare; they are located mainly in the superficial lobe. We report 3 cases of parotid lipomas whose diagnosis was suspected by tomodensitometry and confirmed by histology. Treatment was a superficial parotidectomy for two patients and enucleation for one patient. Parotid lipomas are located mainly in the superficial lobe. The diagnosis is based on imaging, but only histology can confirm. The treatment of superficial lipomas is based on superficial lobe parotidectomy but sometimes enucleation could be enough. In all cases, the recurrence rate is very low

Drug-induced liver injury is a potential complication of all medications because the liver has a central role in the metabolism of drugs and toxic substances. This study was designed to evaluate the hepatoprotective activity of the methanolic extract of Gymnema slyvestre leaves on acetaminophen-induced liver damage in wistar rats. The experiment was carried in three phases. In Phase I, the hepatoprotective activities of the methanolic extract of the leaves was determined by assaying for some liver function indices (AST, ALT & ALP) on acetaminopheninduced liver damage in rats. In phase II, the methanolic extract of the leaves was further fractionated with chloroform, ethylacetate and n-butanol to obtained chloroform, ethylacetate, n-butanol and residual extracts respectively; and the effect of these fractions on liver function (AST, ALT & ALP) was determined.

Osteoarthritis (OA) is the most prevalent degenerative joint disease and the most important reason of the physical disability in the elderly population. Along with the fact that OA pathogenesis is not fully known, it is highlighted in the recent studies that oxidative stress is an important factor in OA progression. OA treatment comprises attenuation of pain, maintenance of functional capacity, and development of life quality. Tai Chi Chuan, also known as Tai Chi, is a traditional Chinese martial art and exercise. In recent studies, it has been reported that Tai Chi, as an alternative therapy, can alleviate the symptoms of OA and be effective against oxidative stress.

This study draws on online focus group discussions made up of convenience sample of five businesses and face-to-face focus group discussions with fourteen participants randomly selected from university students in different faculties/departments at Delta State University, Abraka to explore the utilization of Instagram in Nigeria. Data were obtained differently through online response to questions from business operators via e-mail and direct interaction with participants through questions and answers sessions, and responses to the questions were coded by hand, and analyses using comparative method to determine majority and non- majority opinions to each question. The results yielded demographic picture of Instagram users serving as potential influence on the platform usability. Furthermore, the results indicates that Instagram is offering a new dimension in business advertisement and marketing of products to consumers, and photos and live videos as communication strategies, reflective of the semiotics principles The results noted that Instagram is creating a new life of sociability, and of selfpresentation and selfies as contemporary social behaviour with posting /selfportrait photos and live videos as identity marker and self-performance The study discussed the limitations relating to Instagram use and provide suggestions for further investigation to determine the impact of Instagram in Nigeria. The author concluded that the study has contributed to the advancement of literature in Instagram functionalities and social media research.

This complete-enumeration, before-and-after study (without controls), was conducted on third-year medical students in Maharashtra, India. Traditional didactic lectures were delivered on eight non-communicable diseases/conditions mentioned in the University syllabus for the subject of Community Medicine. The pre-test, conducted after the traditional didactic lectures, comprised eight questions pertaining to these eight topics. For case-based learning, participating students (n=61) were randomly assigned, using lottery method, to two sub-groups comprising 30 and 31 students, respectively, to enable small-group discussion. The students in each sub-group were similarly exposed to case scenarios on all eight non-communicable diseases/conditions and the same facilitators jointly guided the discussion. An identical questionnaire was used for the pre- and post-tests. The scores from students in the two sub-groups were combined for analysing results of the pre- and post-tests. The outcome studied was the difference in cognitive domain scores after attending traditional didactic lectures (by pre-test) and case-based learning (by post-test). The mean correct scores (out of 80) in the post-test (51.61 ± 7.42) were significantly higher (Z=10.088; p<0.0001) than that in the pre-test (40.61 ± 4.18). Gender difference was statistically significant for questions on obesity (Z=2.622; p=0.0088) and blindness (Z=2.017; p=0.0434) in the pre-test, but there was no significant gender difference in the post-test scores. Though case-based learning significantly increased the cognitive domain scores in all eight topics, additional educational interventions would be required for some students who obtained low scores in the post-test

Today, Kenya Government is pursuing Vision 2030. Kenya Vision 2030 is the country‟s new development blueprint covering the period 2008 to 2030. It aims to transform Kenya into a newly industrializing, “middle-income country aims to ensure gender equity in power and resource distribution and increase participation of women in all economic, social and political decision making process. Further more education may also contribute to raising the quality of the labour force and hence increased productivity within a lifespan. The purpose of the study was to carry out an in-depth analysis on performance of women with that of men in relation to equity to University learning resources. Second to examine alternative strategic plans for enhance university student performance in science, mathematics and technology programmes. The theory used in this study was Liberal feminism. It is rooted in the tradition of 16th- and 17th-century liberal philosophy, which focused on the ideals of equality and liberty. The research design used in this study is ex post facto. The study was carried out in 3 Kenyan public and 3 private universities. Chi-square statistical test was used to establish relationships and variable traits while themes were derived from narrative data. The findings of this study revealed that in lower levels of education tier boys outdo girls in SMTs in terms of performance. However, at university level, men and women perform equally well. Contrary to general misconception that transition of women is not at same the rate as men, the study has shown that the difference is insignificant. The study has also established that there is no correlation between gender and preference of SMT programmes at university level. Government should set aside lots of capital to equip the SMTs facilities at all the universities.

Silymarin, a flavonolignan contain phenolic and flavanoid component from Silybum marianum plant, is used for the strengthening against various liver conditions in both experimental models and clinical settings. Silybum marianum (milk thistle) has been used for centuries as an herbal medicine for the treatment of liver disease. Its use for various liver disorders due to drug as well as environmental factors. Silybum marianum contains silymarin, which is composed of the flavanolignans silybin, silydianin, and silychristine, with silybin being the most biologically active. Number of studies has established the cancer chemo preventive role of silymarin in both in vitro and in vivo models. Silymarin modulates imbalance between cell survival and apoptosis through intervention with the expressions of cell cycle regulators and proteins involved in apoptosis. Silymarin was found to be effective in the illness of organs like brain, prostate, lungs, heart, kidneys, pancreas and others. Silymarin act mainly by its antioxidative and free radical-scavenging properties, recently new molecular mechanisms based on the specific receptor interaction were discovered – e.g., modulation and inhibition of drug transporters, estrogenic receptors, P-glycoprotein, nuclear receptors and some others

Evaluation of strategies in Kenya may be done either quantitatively or qualitatively. This is to ascertain whether the process of implementations will succeed in attaining the objectives or not. The specific objectives of the study were to determine existing leadership style utilized by schools in implementation of strategic plans in Masaba North Sub-County.and to evaluate alternative school leadership style for implementation of strategic plans in Masaba North Sub-County. The study used descriptive research design to get the information under investigation. The target population consisted of 31 Principals of public secondary schools, 31 BOM chairpersons, and 31 PTA chairpersons. The study used simple random sampling to select 10 Principals, 10 BOM chairpersons, and 10 PTA chairpersons to be given Questionnaires. The research instruments used to collect data was questionnaires. The questionnaires were made up of close-ended questions. Data collected was analyzed quantitatively, for descriptive statistics, frequency tables and percentages were used. The findings of the study show that for effective strategic plans implementation educational stakeholders must ensure that there is good leadership from the top to the bottom to ensure there is good coordination in all aspects, also effective decision making should be inclusively so that it that does not bring disputes along the way. The Education policy makers would find this study useful in formulating educational policy that would enable the schools to improve on strategic planning process and also in addressing the critical issues that may be affecting secondary school education.

The prostate is an exocrine gland of the male reproductive system, and exists directly under the bladder, in front of the rectum with approximately the size of a walnut. Male hormones affect the growth of the prostate, and also how much prostate specific antigen the prostate produces. Medications aimed at altering male hormone levels may affect prostate specific antigen blood levels. The tumor is graded with one of the most accurate ways of determining the aggressiveness of prostate cancer by the Gleason Scale. Factors like race, family history and life style influence the risk of the occurrence of the disease. Because of the slow progression of the disease, symptoms are rarely seen. However, the choice of treatment strategy is dependent on many factors, like patient preference, and quality of life aspects. It is expected that within a near future, the focal treatment approaches like surgery, radiation therapy, hormonal, and chemotherapy would be much more developed without minimal side effects. And most importantly, proper dietary management may keep away a person from prostate cancer risk

Building on structurationist theory of sociology, Vygotskyian sociocultural theory, Chomskyian cognitive linguistics, and postmodern and poststructural logic regarding the decentered subject and indeterminacy of meaning this work explores the origins and nature of human consciousness, cognition, social action, learning, and development within Paul C. Mocombe‘s phenomenological structural sociology, phenomenological structuralism. The article attempts to synthesize Vygotskyian sociocultural theory with Chomskyian cognitive linguistics in order to offer a more complete understanding of human consciousness, action, cognition, learning, and development amidst the postmodern and post-structural attempt to decenter the subject.

Managing abdominal wall tumors with high risk of relapse usually requires large excisions. It is the case of sarcomas, desmoid fibromatosis and abdominal wall metastases. The repair of large full-thickness defects of the abdominal wall usually needs the combination of a prosthetic material as a replacement of the deep layer and a reliable flap to cover the prosthetic material. Depending on the local condition of the surgical site and the size of the defect, the use of a free flap might become necessary. The authors report the case of a 55 year-old patient who underwent surgery for a relapsing sarcoma of the anterior abdominal wall. A two-stage reconstruction of the abdominal wall defect was performed using a free transfer of a myocutaneous Latissimus Dorsi flap. The first stage of reconstruction took place before the excision was performed. The free flap was then folded in the fashion of an “apple turnover” waiting for the second stage to take place, so the excision of the tumor and the final covering could be performed at the same surgical time. Microsurgical transfers imply potential peroperative and postoperative risks, especially the risk of vascular thrombosis. The authors discuss the two-stage surgical transfer of the myocutaneous Latissimus Dorsi free flap, its technique, its advantages and its disadvantages

This article highlights and explores the hermeneutical phenomenology found in Haitian/Vilokan Idealism. The work posits that Haitian ontology, Vodou/Vilokan, gave rise to its epistemology, Haitian/Vilokan Idealism, which subsequently gave rise to the Vodou Ethic and the spirit of communism and the lakou system as its form of social and system integration, respectively. Within Haitian/Vilokan Idealism, the work concludes, is a hermeneutical phenomenology that parallels Martin Heidegger’s hermeneutical phenomenology.

Major challenge in ophthalmic drug delivery system is to locate the drug in precorneal site for some time as the applied dose has been washed out quickly in the lachrymal drainage. As well as it has been always a challenge in the drug delivery to formulate poorly soluble compound as conventional ophthalmic delivery like eye drops. Hence the purpose of the present study is to formulate ophthalmic in-situ nanoemulgels which are generally liquids at room temperature but exhibit sol‐to‐gel phase transition on the ocular surface due to change in specific physicochemical parameter like ionic strength, pH or temperature. The formulation was so designed to prolong the precorneal resident time thereby getting sustained delivery of drug and to improve bioavailability of poorly soluble model drug of curcumin by distributing it in nano globules of dispersed system. Different parameters of fabricated nanoemulgel like gelling capacity, gelation temperature, droplet size analysis, stability study, and refractive index, viscosity, Scanning Electron Microscopy (SEM) and drug release profile are evaluated. The physico-chemical evaluation reveals good rheological properties with instantaneous gelling capacity. Fourier Transform Infrared analysis (FTIR) study showed absence of incompatibility between the drug and polymer. The globular size found in nanometer range (below 200nm) and uniformity in size distribution (ploydispersity index 0.215-0.53) is studied by Malvern Zetasizer. Accelerated stability analysis ascertained the stability of formulation after storing at 40°C ± 2°C/75% RH ± 5% RH for 3 months. The drug release study of the formulations revealed sustained release of drug for the study period of 5 hours ranging from 31.87±2.12 to 61.77%±1.27. The developed thermosensitive nanoemulgel formulation is an effective ophthalmic delivery for getting sustained action of poorly soluble compound like curcumin