Service quality towards customer loyalty in Malaysia's domestic low cost airline service

Delivering high quality service to the passengers is imperative so that airline companies can survive and strengthen their competitiveness. Even though there have been extensive research on service quality and customer loyalty in the past, little study has been conducted in this specific area. Hence, this paper aims to propose a conceptual framework on service quality and its relationship towards customer loyalty among Malaysia’s domestic low cost airline services passengers. Reliability, tangibles, responsiveness, assurance and empathy are considered as critical dimensions of service quality that possibly provide empirical evidence in relation to customer loyalty. Subsequently, the consequences of the customer loyalty are further elaborated in this paper too. It is expected that the findings of this study can assist the organization to deliver high service quality to the customers and enhancing customers’ satisfaction in fulfilling their needs and wants. More importantly, improving service quality in such an organization may result in long-term increase in customer’s loyalty; this in turn leads to cost savings and improved profitability and market share

Anti mullerian hormone: Ovarian response indicator in young patients receiving long GnRH agonist protocol for ovarian stimulation

Objective: Anti Mullerian hormone (AMH) is gaining place as ovarian marker, chiefly in infertility assistance. We explored its correlation with oocytes retrieval after long GnRH agonist protocol for stimulation, in younger and older infertile population.Methods: This retrospective analysis compiled data of 166 females, receiving ICSI treatment from June 2014 to March 2015. Serum FSH, LH, Estadiol, AMH and antral follicle count were assessed. Outcomes were measured as good (5 to 19 oocytes) and bad responders.Results: Higher discriminatory power of AMH (AUROC; 0.771; p \u3c 0.05) was seen in comparison to FSH (0.692; p \u3c 0.05) and AFC (0.690; p \u3c 0.01). AMH reported strongest association with oocyte retrieved (odds ratio of 15.06). Subgroup analysis reported 68.6 % risk of bad response with AMH levels of less than 1.37ng/ml. This association was observed more significant in young infertile patients \u3c35 year of age (r=0.245; p=0.012) versus older population \u3e35 year (r=0.169; p\u3e0.05).Conclusion: Our study reaffirms that serum AMH correlates well with oocytes retrieved, particularly in females younger than 35 years. We suggest incorporation of AMH in baseline assessment of infertile females, who are falsely advised to postpone interventions based on their age and normal FSH levels

Optimization of biodiesel production from waste cooking oil using a green catalyst prepared from glass waste and animal bones.

Biodiesel as a fuel has been shown to positively impact the environment; replacing or reducing the dependence on fossil fuels while providing a viable alternative. The use of waste oils, such as non-edible or used oils, can reduce competition with food, loss of resources, and the resulting higher prices. In this study, biodiesel was obtained by a transesterification reaction using used cooking oil from fast-food restaurants as the feedstock and catalysts from waste glass and animal bones as the silica and calcium oxide sources, respectively. Utilizing waste or non-edible oils for the production of biodiesel can lessen the competition with food sources while achieving environmental and ethical biofuel standards. Additionally, employing readily available waste oils and catalysts prepared from waste material is an economical and low-cost process compared to the use of conventional expensive feedstock and catalyst. The catalyst characterization for the prepared CaO–SiO2 catalyst was performed using X-ray diffraction (XRD), scanning electron microscopy (SEM), and Fourier transform infrared spectroscopy (FT-IR). The reaction was optimized using the response surface methodology (RSM) with central composite design (CCD) by varying three parameters: methanol-to-oil ratio, catalyst weight fraction (wt%), and reaction time. The highest biodiesel yield obtained using Design Expert software was 92.3419% at the optimum conditions of a 14.83:1 methanol-to-oil molar ratio, 3.11 wt% catalyst, and 143 min reaction time. This proved that waste cooking oil with CaO–SiO2 catalyst could be used in the transesterification process to produce a high yield of biodiesel, which was shown in the results obtained from the experimental runs

Histopathological Assessment of Microvascular Invasion in Hepatocellular Carcinoma Resection Specimens and its Correlation with Tumor Size and Grade

OBJECTIVES To determine the histopathological assessment of microvascular invasion in Hepatocellular Carcinoma Resection Specimens and its correlation with tumour size and grade. METHODOLOGY This retrospective cross-sectional study included the biopsy-proven Hepatocellular (HCC) case with microvascular invasion (MVI) noted in the resected specimens evaluated by two independent consultants Histopathologists. The exclusion criteria were; all patients below 18 years, unfixed autolyzed samples, and incomplete requisition-filled forms. Numerical data, i.e., patient age and tumour size, are presented as mean with standard deviation. Categorical variables, i.e., tumour size, grade, and presence or absence of MVI, were submitted as numbers with percentages. Continuous variables, i.e., tumour size and differentiation grade, were assessed using the Chi-square test. A p-value of ≤ 0.05 was considered significant. RESULTSMost patients, 34.4%, fall into the age group of 47-70. Most patients were males, 63.6%, and microvascular invasion was noted in 49.09% of cases. Most cases were of moderate to poorly differentiated tumours, 80.0%. MVI was statistically significant with the grade of the tumour. CONCLUSION Microvascular invasion is an important prognostic marker noted in a surgical resection specimen. Although the exact definition and risk stratification is unclear, survival studies have proven that MVI is associated with poor outcomes

Sequence Analysis of Prion Protein Gene in Bhagnari Cattle Breed from the Hottest Region of Sibi, Balochistan, Pakistan

Prion diseases are a type of neurodegenerative disorder caused by the transmission of specific pathogens containing prion proteins. Due to the unique structural characteristics of Prion proteins (PrP), which differ from other types of proteins, the extended incubation period observed in the transmission of specific Prions can be attributed to these differences, at least in part. Prions are found in several other mammals and animals. Prions are unique among false protein folding abnormalities because these are infections and contain various strains of contagious agents associated with a unique in vivo phenotype. They can be acquired either by inheritance or sporadically. There are two types: classical and typical BSP. The objective of this study was to observe the Bhagnari cattle breed of Balochistan, Pakistan, and compare the PrP gene sequence of the Bhagnari with other reported sequences from Pakistan and other parts of the world. This research collected 40 Bhagnari cattle blood samples from Tali, Bhag Nari, and Sibi district areas. DNA extraction of each sample was performed by inorganic method, and then DNA amplification and sequencing of PRNP Gene was performed. The results of this research work showed different polymorphic variations (SNPs) in 16 samples. In this study, while mutations causing prion diseases in cattle were detected in Italian and German breeds, none were identified in the PRNP gene of the cattle population investigated, despite its association with neurological disorders

Factors Predicting the Recurrence of Spontaneous Bacterial Peritonitis in Patients with Cirrhosis

Objective: To evaluate the frequency of recurrence of spontaneous bacterial peritonitis (SBP) in patients with end stage liver disease and the factors responsible for it. Study Design: Descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from November 2008 till November 2009. Methodology: Patients with cirrhosis who were admitted at AKUH with diagnosis of SBP during the study period were included. Any episode of SBP after resolution of the first index case of SBP within one year was considered as recurrence. Results: Out of 238 cirrhotic patients, 157 (66%) had single, while 81 (34%) had recurrent episodes of SBP. History of using proton pump inhibitors (PPI) and diuretics was found in 113 (47.5%) and 139 (58.4%) patients respectively. Only 58 (24.4%) patients were on prophylactic antibiotic therapy. Univariate analysis revealed that the female gender (52%), and presence of porto-systemic encephalopathy (PSE, 31%) were statistically significant (p=0.03) among those who had recurrent SBP. On multivariate analysis bilirubin level of \u3e 1.0 mg (OR=7.03; 95%CI=1.55-32), protective factor of hepatitis B (OR 0.31; 95%CI=0.13-0.70) and presence of urinary tract infection (UTI) (OR=2.24; 95%CI=0.99-5.09) were significant in patients with recurrent SBP. Conclusion: Recurrent SBP was noticed in 34% patients. Serum bilirubin level of \u3e 1.0 mg, protective factor of HBV and presence of UTI were significant factors present in patients with recurrent SBP

Etiology, clinical characteristics, and outcome of infective endocarditis: 10-year experience from a tertiary care center in Pakistan

This study was conducted to assess the clinical characteristics, causative agents, complications, and outcomes of infective endocarditis (IE) among patients presenting to our tertiary care center over the last decade. This retrospective cohort study included all adult patients admitted to the Aga Khan University Hospital with the diagnosis of IE over a ten-year period from 2010 to 2020. Outcomes variables included complications during hospitalization, surgical intervention, mortality, and length of stay. We identified a total of 305 cases out of which 176 (58%) were males and 129 (42%) were females. The mean age of the patients was 46.9±18.8 years. 95 (31%) had prosthetic valves in place. Staphylococcus aureus was isolated in 54 (39%) patients followed by coagulase-negative Staphylococcus in 23 (17%). Echocardiography revealed vegetations and abscesses in 236 (77%) and 4 (1%) patients, respectively. The most common valvular complication was mitral valve regurgitation found in 26 (9%) patients, followed by tricuspid valve regurgitation in 13 (4%) patients and aortic valve regurgitation in 11 (3%) patients. Furthermore, 81 (27%) patients suffered from heart failure and 66 (22%) from a stroke during hospitalization. The mean hospital length of stay was 10.4 ± 10.6 days. 64 (21%) patients required surgical repair and the overall mortality rate was 25%. Prosthetic valve endocarditis (OR = 3.74, 95% CI = 2.15-6.50,

Epidemiology of Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus infections in Lebanon

Background. Methicillin-resistant Staphylococcus aureus (MRSA) is a prevalent pathogen associated with significant morbidity and mortality. In Lebanon, MRSA rates have recently started to rise. We aimed to determine risk factors for acquiring MRSA and Methicillin-sensitive Staphylococcus aureus (MSSA) infections and identify independent risk factors for in-hospital mortality among patients with S. aureus infection. Methods. We used a case-case-control study design that included patients with infections and compared them to uninfected controls. Two multivariable regression models were constructed to determine variables associated with acquiring MRSA and MSSA infections. We explored independent predictors of mortality in the overall population compared with the MRSA subgroup. Results. 356 patients with S. aureus infections were identified and compared to 208 uninfected controls. A recent history of surgery and underlying diabetes were independent risk factors for acquiring both infections. Having a urinary catheter for more than 6 days and steroid therapy were unique risk factors for MRSA infection (aOR 28.1, 95% CI 3.5-223.6 and 3.7, 95% CI 1.6-8.7, respectively). Risk factors exclusively associated with MRSA infection included ICU admission, acute renal failure, and malignancy. Conclusions. Risk factors associated with MRSA infection are distinct from those associated with MSSA infection. This can be used to risk stratify patients and will aid in choosing empirical antibiotic therapy

Managing Urology Consultations During COVID-19 Pandemic: Application of a Structured Care Pathway

OBJECTIVE: To describe and evaluate a risk-stratified triage pathway for inpatient urology consultations during the SARS-CoV-2 (COVID-19) pandemic. This pathway seeks to outline a urology patient care strategy that reduces the transmission risk to both healthcare providers and patients, reduces the healthcare burden, and maintains appropriate patient care. MATERIALS AND METHODS: Consultations to the urology service during a 3-week period (March 16 to April 2, 2020) were triaged and managed via one of 3 pathways: Standard, Telemedicine, or High-Risk. Standard consults were in-person consults with non COVID-19 patients, High-Risk consults were in-person consults with COVID-19 positive/suspected patients, and Telemedicine consults were telephonic consults for low-acuity urologic issues in either group of patients. Patient demographics, consultation parameters and consultation outcomes were compared to consultations from the month of March 2019. Categorical variables were compared using Chi-square test and continuous variables using Mann-Whitney U test. A P value \u3c.05 was considered significant. RESULTS: Between March 16 and April 2, 2020, 53 inpatient consultations were performed. By following our triage pathway, a total of 19/53 consultations (35.8%) were performed via Telemedicine with no in-person exposure, 10/53 consultations (18.9%) were High-Risk, in which we strictly controlled the urology team member in-person contact, and the remainder, 24/53 consultations (45.2%), were performed as Standard in-person encounters. COVID-19 associated consultations represented 18/53 (34.0%) of all consultations during this period, and of these, 8/18 (44.4%) were managed successfully via Telemedicine alone. No team member developed COVID-19 infection. CONCLUSION: During the COVID-19 pandemic, most urology consultations can be managed in a patient and physician safety-conscious manner, by implementing a novel triage pathway

The Impact of Psychosocial Factors of Physical Health Outcomes: A Review of the Biopsychosocial Model in Family Medicine

Discontent with the biological model of illness—which is still the predominant healthcare model—led to the development of the biopsychosocial model, which was described in Engel's seminal Science paper forty years ago. It is the foundation of the International Classification of Functioning (WHO ICF) developed by the World Health Organization Clinical outcomes for functional disorders and chronic diseases treated in family medicine may be improved by the biopsychosocial approach. Since clinical performance metrics and standards are biomedically focused, family medicine doctors have no financial incentive to implement the biopsychosocial paradigm in their practices. Implementing the biopsychosocial approach in family medicine may be hampered by workload and incompetence