THE EFFECTIVENESS OF USING COMMUNICATIVE LANGUAGE TEACHING APPROACH (CLT) IN DEVELOPING STUDENTS’ SPEAKING SKILLS FROM TEACHERS’ PERCEPTIONS

The current study mainly aims at investigating the effectiveness of using Communicative Language Teaching (CLT) approach in developing students’ speaking skills at Sudanese secondary school levels from English language teachers’ perceptions. Also, the study seeks to find out the problems that hinder the teachers’ from implementing the CLT approach. To meet these aims and objectives the researcher employed a quantitative approach using a descriptive design. The researcher used the survey to collect data from the participants of the study. The random sampling technique was applied to select the sample out of all English language teachers at Omdurman Locality. Therefore, (100) female and male teachers have participated in this study. The information gained from the surveys was analyzed using the software Statistical Package for Social Sciences (SPSS). The study revealed the following findings: First of all, the majority of participants strongly agree that there is a positive relationship between teachers’ attitudes and effective usage of the communicative approach. The mains statements that gathered the highest level of response are: I think using CLT in my classroom helps my whole teaching process and using CLT in my class helps me share ideas and opinions with my learners. This means that most of the study participants assured that the use of CLT in the classrooms helped them to share the knowledge and facilitated their teaching process. Secondly, the majority of participants agree that there are effective factors that hinder teachers from using communicative approach to develop students speaking skills. The main statements which gathered their highest level of response are the following: Lack of authentic materials hinder the use of CLA in my and classroom size makes using CLT in my classroom more difficult. This clearly shows that the most effective factors that hinder teachers from implementing CLT in their classes are lacking of authentic material and classroom size. Finally, the majority of participants strongly agree that the communicative approach to develop students speaking skills – in general, and the main statements which gathered their highest level of response: Using CLA enhances students speaking skills, and I think using CLT motivates my student to speak accurately inside and outside the classroom. This result indicates that their participants of the study confirmed that using CLT in classroom enhanced their students speaking skill and motivated them to speak fluently.  Article visualizations

Evaluation of Apoptotic Effect of Betanin Nanoparticles against Squamous Cell Carcinoma Cell Line Compared to Doxorubicin

Objective : to evaluate the anticancer effect of nano sized betanine particles (betanine NP) on squamous cell carcinoma cell line compared to doxorubicin (DOX) by measuring apoptosis through caspase 3. Methods: Three groups of the human tongue squamous cell carcinoma cell line (SCC 25) were created, and two of them were treated with DOX and betanine NP. The third group served as a negative control and was not given any treatment. To evaluate the concentration of caspase 3 using the ElISA technology, different quantities of betanin NP and DOX were administered to SCC25 at 48- and 72-hour intervals.Results: Caspase 3 levels in the current investigation were 501.69.93, 543.86.71 pg/ml for DOX and 336.913.1, 405.53.5, and respectively for betanine NP in 48h and 72h intervals. Additionally, morphological analysis was performed to demonstrate the cells\u27 apoptotic alterations. There was a highly statistically significant difference between samples of various materials, as revealed by the ANOVA test for Comparison between groups using the ELISA technique for caspase 3 detection at 48h and 72h (p0.001). These findings suggest that DOX has a stronger apoptotic effect on SCC25 cells than betanin NP.. Conclusion: Our findings explained that DOX and betanine NP can induce cancer cell death against SCC 25 cell lines by increasing the concentration of caspase 3. DOX has higher apoptotic effect on SCC25 cells than betanin NP according to ELISA technique

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Bahraini cohort of the A 1 chieve study

Background: The A 1 chieve, is a multicentric (28 countries), 24-weeks, non-interventional study to evaluate the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726) in routine clinical care across four continents. Materials and Methods: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from Manama, kingdom of Bahrain. Results: A total of 115 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Study patients had started on or were switched to biphasic insulin aspart (n = 67), insulin detemir (n = 16), insulin aspart (n = 4), basal insulin plus insulin aspart (n = 21) and other insulin combinations (n = 7). At baseline, glycaemic control was poor for both insulin naïve (mean HbA1c: 10.2%) and insulin users (mean HbA1c: 9.8%) groups. After 24 weeks of treatment, both the groups showed improvement in HbA1c (insulin naïve: −1.1%, insulin users: −1.3%). SADRs including major hypoglycaemic events did not occur in the study patients. Conclusion: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia

Interobserver agreement for the Vesical Imaging-Reporting and Data System (VI-RADS) in differentiating non-muscle-invasive and muscle-invasive urinary bladder tumors

Abstract Background Bladder cancer is the most common tumor of the genitourinary tract. Transitional cell carcinoma is divided into two categories: non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). In spite of the high recurrence rate, NMIBC has good prognosis, while MIBC has poor prognosis due to local organ invasion and metastases. Mp-MRI shows better tumor detection and staging. The aim of this study is to validate VI-RADS in detecting MIBC and assessing interobserver agreement and impact of reader's experience. Results At cutoff value of VI-RADS score ≥ 3, the VI-RADS showed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 96.8%,83.3%, 93.8%, 90.9%, and 93%, respectively, for reader 1, 93.5%, 91.7%, 84.6%, and 93% for reader 2, and 96.8%,83.3%, 93.8%, 90.9%, and 93% for reader 3. The interobserver agreement between individual readers was excellent among the three readers. Conclusions Vesical imaging-reporting and data system (VI-RADS) is a good method showing satisfactory sensitivity, specificity, and diagnostic value for detecting detrusor muscle invasion

Vaginal length and sexual function after vertical versus horizontal closure of the vaginal cuff after abdominal hysterectomy: a randomised clinical trial

This randomised clinical trial aimed to evaluate the vaginal length and female sexual function after vertical and horizontal closure of the vaginal cuff after abdominal hysterectomy. The patients were allocated into two groups, vertical closure and horizontal closure groups. The vaginal length was determined using transperineal ultrasound, once preoperative and again 3 months after the operation. Female sexual function was determined using an Arabic validated female sexual function index questionnaire. Both techniques resulted in a significant shortening of the vaginal length (p-value .001). There was a significant improvement in sexual function in the vertical closure group rather than the horizontal closure one. We concluded that there was no significant difference in the vaginal length after vertical or horizontal closure of the vaginal cuff. However, female sexual function improved significantly in the vertical closure group. Trial registration number: PACTR201909573801168.IMPACT STATEMENT What is already known on this subject? Conflicting results exist regarding the effect of different techniques of vaginal length closure on vaginal length and sexual function after hysterectomy. What do the results of this study add? There was no significant difference in the vaginal length after vertical or horizontal closure of the vaginal cuff. However, female sexual function improved significantly in the vertical closure group. This study is considered to be the first one to evaluate the correlation between the vaginal length and the female sexual function. What are the implications of these findings for clinical practice and/or further research? The correlation between vaginal length and female sexual function needs to be evaluated in a multicenter study, recruiting larger number of sexually active women