Backpackers Expectation and Satisfaction towards Budget Hotel: a Case Study in Penang

Penang has been the popular cultural heritage tourism attractions in Malaysia. Penang has great potential to develop and offers its cultural and heritage products and experiences to local and foreign visitors. Georgetown is one of the most visited sites in Penang.  Georgetown is awarded the UNESCO listing for its unique architecture and cultural townscape. The variety of cultures on display within the heritage area, such as Muslim, Chinese, Indian and European, is unique to Georgetown. The city is also known as Malaysia's food capital, home to multicultural distinct cuisines, cheap and delicious open-air hawker centers. Apart from that, Georgetown also offers unique and affordable budget hotels to enrich backpacker’s experiences. The main objective of this study is to evaluate the facilities and services provided by budget hotels in Georgetown. The evaluation was based on backpackers’ opinions on the importance and performance rating of the listed attributes. This study adopted the simple random sample method of data collection. About 30 questionnaires were distributed to the backpackers during weekdays and weekends. The socio-demographic data were evaluated using Frequency Analysis. The data showed the different socio-demographic, socio-economic, and trip characteristics of the backpackers. The demographic and trip characteristics data provided the information of visitor’s motivation and activity during their visit to Penang. The Importance-Performance Analysis (IP Analysis) was used to evaluate the overall budget hotels’ facility and service attributes, and the final result has been translated into Importance-Performance action grid. The action grid showed all the 23 attributes of general and specific facilities, and services provided were plotted on the High Importance and Performance quadrant.  Attributes plotted on the action grid showed that all of the attributes were evaluated high on importance and performance suggested that the cultural village management should maintain the status of performance in all attributes area. The Ratio Analysis indicated the ranking of priority which needed special attention from the management of the budget hotels. From the analysis, availability of mini bar, hotel safe box availability, and hotel F&B are value for money were ranked at the highest priority and needed special intention from the management of the budget hotels. Overall, the result of the study was, all of the attributes were evaluated as High Importance and High Performance. The management of the budget hotels in Georgetown has to keep up the good work and maintain the attributes.  Hopefully, the findings of this study will be useful for the management of budget hotels to manage and maintain the facilities and services provided to enhance the quality of backpackers’ experiences.

The Effect Of Store Atmosphere, And Sales Promotiontoward Impulse Buying With Positive Emotions As Intervening Variables And Money Attitudes As Moderatingvariables (Study on Moro Grosir & Retail Purwokerto).

Moro Grosir & Retail adalah salah satu department store di Purwokerto. Pesaing dari Moro Grosir & Ritel di Purwokerto relatif besar, misalnya: RITA, SRI RATU, INTAN, dan SE (SUPER EKONOMI). Variasi ini banyak department store di Purwokerto membuat persaingan sangat ketat di antara bisnis (penjualan ritel). Untuk meningkatkan layanan & kepuasan pelanggan, Moro membuat beberapa renovasi. Moro Grosir & Retail, menambahkan lantai untuk membuat ruang bagi pelanggan untuk mengeksplorasi toko. Lebih juga menciptakan suasana toko dengan konsep yang berbeda, seperti menambahkan lebih banyak toko di lantai 1 tujuan untuk membuat kesan yang baik dari pelanggan. Mereka juga mencoba untuk perubahan tata letak toko dengan memindahkan posisi toko di setiap lantai menjadi lebih tersegmentasi, misalnya membuat lantai atas sebagai food court. Untuk menarik pelanggan Moro juga memberikan besar promosi / diskon seperti seperti memberikan diskon 50-75% untuk banyak produk dan banyak lagi. Jadi pertanyaan yang mungkin muncul adalah; "Apakah itu akan mempengaruhi perilaku pembelian impuls?”. Berdasarkan permasalahan di atas, penelitian ini akan menganalisis store atmosphere, dan sales promotion pada impulse buying dengan positive emotions sebagai variabel mediasi dan money attitudes sebagai variable moderasi. Metodelogi penelitian yang digunakan untuk studi ini bersifat kuantitatif secara eksklusif menggunakan pendekatan penelitian survei. Teknik convenience sampling berasal dari teknik non probability sampling yang digunakan untuk pemilihan sampel. Sample penelitian ini berjumlah 155, berasal dari konsumen di Purwokerto yang sudah pernah mengunjungi Moro Ritel & Grosir minimal dua kali. Perangkat lunak statistik SPSS, AMOS digunakan untuk menganalisis data. Penelitian ini memiliki implikasi bagi manajer; karena mereka dapat merumuskan strategi pemasaran berdasarkan temuan penelitian. Karena keterbatasan peneliti, studi ini tidak bisa mencakup keseluruhan wilayah Purwokerto

A Management of forgotten double J Ureteric stent in a young male: A Case Report

Urologic devices called Double-J stents (DJSs) are frequently used to treat urinary tract blockage. Advancement in endourology in last few decades has led to an increase in use of ureteric stents and so its related complications. Herein, we report a case of a 17 years old male patient of poor socioeconomic background from a remote village of Afghanistan, presented to our out-patient department with abdominal pain at the right flank. He had history of double J stent placement during right open pyelolithotomy 6 year before. However, no further details were available

Efficacy of Tamsulosin Alone and Combination with Tolterodine in Managing Intramural Ureteric Stone

Objective: To compare the efficacy of Tamsulosin alone and combination with  in  managing intramural ureteric stone in order to obviate the need for surgical treatment and related complications Methodology: A total of 104 patients with distal ureteral stones were included in the study (90 men and 14 women) age ranging from 19 to 59 years. Those with stones less than 10 mm and allowing urinary flow were included in the study. Asymptomatic or incidentally found Intramural Ureteric Stone, Ureteric stone along with kidney stone, Presence of urinary sepsis, Chronic kidney disease stage 4 or stage 5, Pregnancy, Patients currently taking an α-blocker/Antimuscrinic agents, Gross hydronephrosis, Diabetes were excluded from the study. After randomization, divided 2 groups and patients were given respective drugs. Group 1 patients received Tamsulosin 0.4 mg/day, group 2 patients received Tamsulosin 0.4 mg/day plus  2 mg (twice a day). Results: The mean days of stone expulsion was 20.05± 6.11 and 10.41±4.63 days in group 1 and 2, respectively which was significantly shorter in group 2 (p-value, <0.001). Overall in 43 (82.6%) patients in group 2 and 34 (65.3%) cases in group 2, stone was expulsed before 28 days. The expulsion of intramural ureteric stones were more observed in patients treated with combination therapy (group 2) than tamulosin alone therapy. The mean duration of expulsion of stones was also found significantly shorter the combination therapy group. Conclusion: In the present study, the expulsion of intramural ureteric stones were more observed in patients treated with combination therapy (group 2) than tamulosin alone therapy. It is concluded that Tamsulosin combined with  has a better effect in terms of intramural ureteric stone expulsion

A New Subblock Segmentation Scheme in Partial Transmit Sequence for Reducing PAPR Value in OFDM Systems

Partial transmit sequence (PTS) is considered an efficient algorithm to alleviate the high peak-to-average power ratio (PAPR) in orthogonal frequency division multiplexing (OFDM) systems. The PTS technique is depended on the partitioning the input data sequence into the several subblocks, and then weighting these subblocks with a group of the phase factors. There are three common types of partitioning schemes: interleaving scheme (IL-PTS), adjacent scheme (Ad-PTS), and pseudo-random scheme (PR-PTS). The three conventional partitioning schemes have various performances of the PAPR value and the computational complexity pattern which are considered the main problems of the OFDM system. In this paper, the three ordinary partition schemes are analyzed and discussed depending on the capability of reducing the PAPR value and the computational complexity. Furthermore, new partitioning scheme is introduced in order to improve the PAPR reduction performance. The simulation results indicated that the PR-PTS scheme could achieve the superiority in PAPR mitigation compared with the rest of the schemes at the expense of increasing the computational complexity. Furthermore, the new segmentation scheme improved the PAPR reduction performance better than that the Ad-PTS and IL-PTS schemes

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021

Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. Methods We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. Findings In 2021, the global prevalence of anaemia across all ages was 24·3% (95% uncertainty interval [UI] 23·9–24·7), corresponding to 1·92 billion (1·89–1·95) prevalent cases, compared with a prevalence of 28·2% (27·8–28·5) and 1·50 billion (1·48–1·52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52·0 million (35·1–75·1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422·4 [95% UI 286·1–612·9]), haemoglobinopathies and haemolytic anaemias (89·0 [58·2–123·7]), and other neglected tropical diseases (36·3 [24·4–52·8]), collectively accounting for 84·7% (84·1–85·2) of anaemia YLDs. Interpretation Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Funding Bill & Melinda Gates Foundation

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere

The Effect of Mineral Ions Present in Tap Water on Photodegradation of Organic Pollutants: Future Perspectives

Photodegradation is the chemical conversion of large, toxic, and complex molecules into non-toxic, simpler, and lower molecular weight species due to light exposure. Heterogeneous photocatalysis has sufficient potential to degrade toxic organic pollutants present in wastewater. As industries discharge their effluents containing organic pollutants into natural water bodies, which penetrate into the subsurface through connected pores it is necessary to study this process in natural or tap water. Tap water (TW) is mainly obtained from underground wells having inorganic salts in a minute quantity with a conductivity of 500 μS/cm. TW contains inorganic anions, which affect the photocatalytic activity and photocatalysis process. The aim of this review is to evaluate the effect of TW on the photo-degradation of organic pollutants such as dyes, pharmaceutical products, pesticides, etc., with the support of the literature. The TW had a diverse effect on the photodegradation of organic pollutants; either it may enhance or decrease the rate of pollutants’ photodegradation