What effect does the inclusion of the provision of a referendum have on the likelihood of a lasting peace after a settlement in conflicts over territory?

Today, the field of conflict resolution is increasingly becoming influential due to the increase of conflicts that we are facing. While there are set standards of rules and procedures for dealing with conflicts that happen between states, this cannot be said when it comes to civil wars. What is sought when it comes to conflicts is either starting a peace process or restoring a failed one. What usually results from a peace process is a negotiated settlement that lays out several provisions to appease both sides to achieve a durable peace. Provisions in a peace agreement are a very important factor in a negotiated settlement especially in conflicts regarding self-determination/ secession conflicts. Negotiated settlements in conflicts over territory increasingly contain provisions for referendums. The idea of a referendum on such cases is not a new phenomenon

Echocardiographic pearl a rare complication of infective endocarditis one of the rarest complication of infective endocarditis being diagnosed by echocardiography

Our patient is a 41 years old male, born and living in Cairo, working as a constructor worker and has 3 children the older of which is 13 years old. He was admitted to the internal medicine department by fever and shortness of breath for about 1 week associated with weakness of his right upper limb for 12h before his presentation which made him sought medical advice. He was not known to be hypertensive nor diabetic.He was a heavy Cigarette and Shesha smoker for about 17 years .He denied history of any substance abuse. He has no family history of any cardiac disease O/E: The patient appeared pale, toxic, orthopenic, a little confused however he was oriented to time, place and persons.There was mild weakness of his right upper limb with intact sensation. BP: 100/70 bilaterally, HR: 110, regular, of average volume, peripherally felt, Temp: 38.8°C, RR: 20/min. Bilateral fine basal rales on deep inspiration, Normal abdominal examination.Cardiac examination: The cardiac impulse was hyperdynamic at the 5th intercostal space just outside the mid-clavicular line with no palpable thrill. Auscultation revealed S3 gallop apically with grade III–IV pan systolic murmur radiating to the anterior axillary line.InvestigationsHgb: 11.2,WBC’s: 13,000, Platelet count: 270,000. Total billirubin: 1.1, BUN: 17, Creat: 1.4, Na: 135, K: 3.9, SGOT: 45, SGPT: 37.DiscussionLeft atrial dissection (LAD) is a rare complication and the literature reveals only a small number of cases. LAD is by Gallego et al. as a gap from the mitral or tricuspid annular area to interatrial septum or left atrial wall, creating a new chamber with or without communications into the true left or right atrium. The most common etiology of LAD is mitral valve surgery.Debridement of much calcified valves annulus, improper suturing of the annulus to the prosthetic cuff, excessive traction on sutures in the posterior annulus, and the hemodynamic influence of the paraprosthetic leak extended the dissection into the left atrial wall, developing a false cavity. Also left atrial thrombectomy can be associated with injury to the left atrial endocardium as a mechanism of primary tear.A rare case of left atrial dissection as a consequence of infectious endocarditis was reported. They present a patient with infectious endocarditis with involvement of mitral and aortic valves; in whom the trans-esophageal echocardiography was able to visualize the left atrial dissection.The LA has a venous component that receives the PVs, a fingerlike atrial appendage, and shares the septum with the right atrium. The major part of the atrium, including the septal component, is relatively smooth-walled whereas the appendage is rough with pectinate muscles. The smoothest parts are the superior and posterior walls that make up the pulmonary venous component, and the vestibule. Seemingly uniform, the walls are composed of one to three or more overlapping layers of differently aligned myocardial fibers, with marked regional variations in thickness. Why the posterior wall of the left atrium:A sagittal section through the left atrium of a cadaver shows the proximity of the esophagus to the posterior wall of the left atrium The wall is particularly thin at the level of the superior pulmonary veins. Clinical presentation may be the appearance of a new systolic murmur, associated with or without symptoms of heart failure and low-output manifestations, hours to days after the operation but there were patients in whom clinical onset occurs years after surgery. Rarely, LAD can be an incidental finding on TEE in an asymptomatic patient.LA dissection typically appears as a hypoechoic space from the mitral/tricuspid origin extending along the interatrial septum or LA wall. M-mode is excellent at distinguishing subtle movement of the intima or the endocardium in relation to the cardiac cycle. Similar to what is seen in aortic dissections, the false cavity is compressed during systole as the LA is being filled.Other entities that should be considered when an LA mass is visualized are:Thrombi most common left atrial myxoma, cysts, coronary aneurysms. Pericardial blood impinging on the LA wall may mimic these findings.Color flow Doppler can be used to examine the endocardium for a tear and point of communication with the chamber. Pulsed wave Doppler can also be used to identify flow across a tear. TEE is the diagnostic modality of choice for LAD.No definitive criteria exist to help guide management of LAD. Prompt surgical repair is usually required because of coexistent significant mitral regurgitation, intra-cardiac shunt, mycotic aneurysm, pseudo aneurysm or fistulous communication. However, in the absence of these findings, surgery may not always be necessary and occasionally successful repair has been performed years after diagnosis

REVIVING THE ANCIENT EGYPTIAN FESTIVALS AS AN AUTHENTIC TOURISM PRODUCT

إحياء المهرجانات المصرية القديمة كمنتج سياحي أصيل [Ar] تعد المهرجانات من المكونات الأساسية لصناعة السياحة نظرا لأهميتها في الترويج للمقصد السياحي وتعزيز صورته، وأصبحت الأصالة من العناصر الرئيسية التي تؤثر بشكل مباشر على التصنيف العالمي للمنطقة المزارة. و بالرغم من تزايد اعداد الباحتين والدراسين لمفهوم الأصالة في السياحة إلا أن تجربة المهرجانات القديمة لم يتم التطرق إليها. استنادا على تلك الفجوة البحثية، تهدف الدراسة إلى إلقاء الضوء علي الأصالة المتحققة من المهرجانات المصرية القديمة عن طريق دراسة نوعية لتحديد كيفية توظيف تلك الأحداث كوسيلة لترويج السياحة في مصر. وجدير بالذكر أن المهرجانات كانت معروفة في مصر منذ العصور القديمة بل ويمكن القول أن كل معبد كان لديه قائمة من الاحتفالات. ورغم ذلك يلاحظ أن أجندة المناسبات الحالية تكاد تخلو من هذه الأحداث، لذا تسعي هذه الدراسة إلى التعرف على العوامل التي تعوق تطور سياحة الأحداث الخاصة من خلال اللقاءات مع عدد من المسؤولين في قطاع السياحة. وطبقا لتصريحاتهم، فإنه بالرغم من إقامة كثير من المناسبات الا أن عدد قليل منها يحقق الهدف المطلوب سواء فيما يتعلق بالتسويق أوالتخطيط الاستراتيجي أوالتمويل وإنه ربما يرجع ذلك إلى إلا افتقاد الإدارة المهنية، فضلا عن أن التقويم الملائم لمابعد الحدث سواء للعوائد الاقتصادية أو الحضور غالبا لايتم. كما سعت الدراسة إلى تحديد مفهوم الأصالة لدى السائحين من خلال دراسة مسحية على عينة من زائرى مهرجان تعامد الشمس بأبوسمبل. وأشارت النتائج إلى أن العينة عبرت عن التجارب الفريدة من نوعها بطرق عديدة، لكن الغالبية اتفقت على أن هذا المهرجان تحديدا كان فريدا. لذا يجب على منظمي الأحداث في مصر الاستفادة من تراثهم العريق وأحياء المناسبات المصرية القديمة لتطوير وتنويع المنتج السياحي. [En] Festivals are one of the essential components of the tourism industry due to their importance in promoting destinations and enhancing the region\u27s image. Authenticity has become one of the main elements that directly affect the classification of the visited country at the global level. Despite the growing number of researchers looking at the concept of authenticity in tourism, the experience of ancient festivals has not yet been investigated.Based on the previously mentioned research gap, the current study aims to shed light on the perceived authenticity of Egyptian ancient festivals via a qualitative study, Ancient festivals could be a conduit to promote tourism in Egypt. Although festivals have been known in Egypt since ancient times, and it can be said that every temple had a list of celebrations, the modern Egyptian calendar is almost devoid of these types of events. This study investigates the factors that hinder the development of special events tourism through interviews with a number of officials in the tourism sector. The study also seeks the perceived authenticity of the Egyptian ancient festivals via a qualitative study about the visitors to the Sun Festival. According to the declarations of tourism officials, despite a large number of festivals very few events were engaged in goal setting, marketing, strategic planning, and structured fund-raising ventures- this may be due to the lack of managerial experience. Moreover, proper evaluations of attendance and economic consequences were frequently unavailable. The results of the study indicated that attendees felt differently about their experiences in many ways, but the majority agreed that the event was authentic. Event Planners in Egypt should take advantage of their ancient historical roots and use them to develop and diversify touristic product offerings

Imaging Software Programs for Reliable Mathematical Measurements in Orthodontics

Aim: To evaluate the reliability of linear and angular measurements taken using different software programs in orthodontics. Materials and Methods: A sample of four software programs from different manufacturers, namely MicroDicom viewer, Photoshop® CS3, AutoCAD®, and Image-Pro®, were used for measuring the geometric features of four types of miniscrews from different manufacturers. Each miniscrew type presented a group: Group I, Tomas® (Dentaurum, Ispringen, Germany); Group II, HUBIT® (HUBIT, Gyeonggi-do, Korea); Group III, AbsoAnchor® (Dentos, Daegu, Korea); and Group IV, Creative (Creative, Zhejiang, China). Measurements of apical face angle, thread angle, lead angle, flank, pitch depth, and width were taken on 45 × magnification scanning electron microscope images of the shafts of the miniscrews. One assessor measured the seven geometric features for the four types of miniscrews using the four software programs twice in two sessions separated by a three week interval. Results: Pairwise comparisons, for each of the four miniscrew groups, showed that the only common result observed was the significant difference (p < 0.001) between measurements of flank taken by the four software programs. When measurements of the four types of miniscrews were pooled into one group, a high degree of intra-rater reliability (ICC range from 0.9 to 1.0) for all the seven geometric features was found with all the four software programs. The paired t-test showed insignificant difference (at p ≤ 0.05) between the first and second measurements, except for a few measurements including pitch width measured by Image-Pro® (p = 0.012), MicroDicom (p = 0.023), and Photoshop® (p = 0.001). Conclusions: Results did not give absolute superiority to one software program over the others and suggested an assessor effect. Assessor estimates could have been affected, among other factors, by the design of the miniscrews and the technical features of the software programs

Efficacy of Bioactive Glass Nanofibers Tested for Oral Mucosal Regeneration in Rabbits with Induced Diabetes

The healing of oral lesions that are associated with diabetes mellitus is a matter of great concern. Bioactive glass is a highly recommended bioceramic scaffold for bone and soft tissue regeneration. In this study, we aimed to assess the efficacy of a novel formula of bioactive glass nanofibers in enhancing oral mucosal wound regeneration in diabetes mellitus. Bioactive glass nanofibres (BGnf) of composition (1-2) mol% of B2O3, (68-69) mol% of SiO2, and (29-30) mol% of CaO were synthesized via the low-temperature sol-gel technique followed by mixing with polymer solution, then electrospinning of the glass sol to produce nanofibers, which were then subjected to heat treatment. X-Ray Diffraction analysis of the prepared nanofibers confirmed its amorphous nature. Microstructure of BGnf simulated that of the fibrin clot with cross-linked nanofibers having a varying range of diameter (500-900 nm). The in-vitro degradation profile of BGnf confirmed its high dissolution rate, which proved the glass bioactivity. Following fibers preparation and characterization, 12 healthy New Zealand male rabbits were successfully subjected to type I diabetic induction using a single dose of intravenous injection of alloxan monohydrate. Two weeks after diabetes confirmation, the rabbits were randomly divided into two groups (control and experimental groups). Bilateral elliptical oral mucosal defects of 10 x 3.5 mm were created in the maxillary mucobuccal fold of both groups. The defects of the experimental group were grafted with BGnf, while the other group of defects considered as a control group. Clinical, histological, and immune-histochemical assessment of both groups of wounds were performed after one, two and three weeks' time interval. The results of the clinical evaluation of BGnf treated defects showed complete wound closure with the absence of inflammation signs starting from one week postoperative. Control defects, on the other hand, showed an open wound with suppurative exudate. On histological and immunohistochemical level, the BGnf treated defects revealed increasing in cell activity and vascularization with the absence of inflammation signs starting from one week time interval, while the control defects showed signs of suppurative inflammation at one week time interval with diminished vascularization. The results advocated the suitability of BGnf as bioscaffold to be used in a wet environment as the oral cavity that is full of microorganisms and also for an immune-compromised condition as diabetes mellitus

A critical stylistic analysis of the ideological positioning in Rudyard Kipling’s poem, “If"

This paper deals with the ideological positioning of the English poet, Rudyard Kipling in a selected poem, entitled “If”, as regards to the theme of the heroic attributes of ―Wisdom, Strength, and Courtesy. The researcher adopts a branch of stylistics, called Critical Stylistics, as proposed by Jeffries (2010) in order to uncover the ideologies of the poet regarding the topic concerned and how linguistic choices are used to display his ideas. The model is comprised of ten tools of analysis which, upon being applied to the selected poem, have shown how the poet exploits language resources in order to pass his ideology and influence his readers. In this paper, the ten tools are presented as applied to the whole poem. The objective of the study is to examine how Kipling’s poem astonishingly excels in giving advice and how it is easier to give advice than being guided by it. The model of stylistics used in this analysis also includes in it these tools that have predominantly been applied to small-scale qualitative analyses. Findings from the analysis reveal the ways in which sets of beliefs and advice may be structured in the language of wisdom and compassion, and, more specifically, the ways in which Kipling’s ideological attitudes and assumptions are embedded in the structure of his poems. Moreover, how this poem articulates the significance of burying the gap between the generations. The old should instruct and the young in turn should listen and learn from the experiences of the old. Such ideological assumptions about listening to the previous generation experiences and have the liberty to abide by or reject their ways of thinking

Defining Professionalism for Mental Health Services : A Rapid Systematic Review

Background: Efforts have been made to define professionalism across the professions, yet little attention has been paid to the concept in mental health services, where patients’ needs differ to that in other healthcare specialties. Aims: To derive a definition of professionalism for mental health services using the existing literature. Method: A rapid, systematic review was conducted to identify empirical and non-empirical records that described professionalism in a mental health service context from 2006 to 2017. Studies were synthesised narratively using thematic analysis. Results: Seventy records were included in the review. Professionalism was described on two levels; at a societal level, a dynamic social contract between professions and society, and; at an individual level, having intrapersonal, interpersonal, and working professionalism. Utilising emerging themes, an operationalised definition of professionalism, suitable for a mental health service context was derived. Conclusions: Within mental health services, emphasis is placed on the interpersonal aspects of practice such as communication skills, maintaining boundaries and humanity. Themes relating to the vulnerability of patients and the challenge of supporting autonomy and choice whilst maintaining safety and acting in a client’s best interest are also evident. ‘Practical wisdom’ and a flexible approach to working are needed to manage these challenging situations

Carbon footprint estimation for tillage operations

As a larger use of agricultural machinery, the measurement of carbon emission is highly important. Quantification of the carbon footprint is important for the identification of more sustainable and environmentally friendly practices. Information about input energy (fuel energy) used by some tillage techniques was collected and converted into carbon. In order to use low emission tillage operations, the equivalent carbon emission factors of each tillage technique were determined. The carbon equivalents for using traditional tillage system were the highest comparing with other tillage systems (158.63 kg CE ha-1 and 55.63 kg CO2e ha-1), while No-till system which give (5.8 kg CE ha-1 and 5.45 kg CO2e ha-1). Improved conservation technology and management equipment can all help minimize the carbon footprints of farm machinery.

Knowledge and practice of protective personal equipment (PPE) among health care providers in Saudi Arabia during the early stages of COVID-19 Pandemic in 2020

Introduction. Health care providers are at high risk of becoming infected when taking care of patients who have COVID-19, especially while attending aerosol generating procedures. Protective personal equipment must be used in the correct manner to prevent transmission of the disease. Published protocols on protective personal equipment (PPE) donning and doffing have been issued by disease control agencies. Methods. A questionnaire-based cross-sectional study was designed. An online anonymous questionnaire, which was validated and tested for reliability, focused on PPE related knowledge, donning and doffing practices of healthcare providers across the eastern region of Saudi Arabia. Results. A total of 312 healthcare providers across the eastern region of Saudi Arabia participated in the study, 208 physicians (66.7%) and 104 non-physicians (33.3%). Results indicate poor practice regarding PPE donning (13.8% reported the correct sequence) and PPE doffing (3.5% reported the correct sequence) among participants. In addition, practice and confidence scores regarding other issues with PPE were analyzed. Based on questionnaire responses, being male (T=2.825; p=0.008), being a non-physician (T=-2.120; p=0.014) and being an allied medical professional (F=5.379; p=0.003) were significantly associated with higher confidence levels. Also, being a consultant was significantly associated with higher practice scores (F=4.774; p=0.008). Conclusion. The study demonstrates deficiencies among healthcare providers in following the recommended practices for correctly using PPE during the pandemic. Poor practice in PPE donning and doffing necessitates additional educational and training programs focused on infection control practices

Circulating Hematopoietic Stem Cell and Some Physiological Parameters in Different Training Programs

Abstract: Exercise is one of the most powerful non pharmacological strategies, which is able to affect nearly all cells and organs in the body. Changes in the behavior of adult stem cells have been shown to occur in response to exercise training. The aim of this study is to reveal the role of aerobic and anaerobic training programs on CD 34+ stem cells and some physiological parameters .20 healthy male athletes aged (18-24 yrs) were recruited for this study. Healthy low active males and BMI matched participants (n=10) aged (20-22 yrs) were recruited as controls .Aerobic and anaerobic training programs for 12 weeks were used. Vo 2max , pulse rate estimation using strand Rhyming protocol. RBCs,WBCs,Hb and hematocrit were estimated using coulter counter, Lactate by accusport,CD 34+ stem cells by flow cytometer. Results revealed: VO 2 max was increased in case of aerobic training program compared to anaerobic one .Lactate concentration was decreased in case of aerobic training programs compared to anaerobic one. RBCs,Wbcs,Hb and hematocrit were increased in anaerobic than aerobic training programs CD 34+ stem cells were increased in case of anaerobic training program than aerobic one and control. It is concluded that training programs provoke better adaptatio