The role of customary international water law in settling water disputes by mediation: An examination of the Indus river and Renaissance dam disputes

Managing internationally shared rivers commonly lead to disputes among the states sharing the watercourse. In general, these disputes mostly relate to water allocation, equitable and reasonable utilization, and potential for harm. Scholars argue that all of the rules of Customary international water law contradict each other and are vague. According to their points of view, this law is not efficient in resolving these disputes. This paper tries to prove the efficiency of these rules in settling these disputes because they identify the different criteria used to manage internationally shared watercourses. This paper contends that these rules whether substantive or procedural are compatible and can settle any water dispute on an equitable basis. However, the intervention of a third party as a neutral mediator especially international organization is important for narrowing the gap between disputants. To support this argument, this paper will examine the role of mediation in settling the Indus River dispute, and the Renaissance Dam dispute based on the rules of Customary international water law . This paper concludes that the rules of international customary law are coherent and effective in settling water disputes. The problem lies in its implementation, which is related to several factors. These include fact-finding, conflict of interest, and politicization of the dispute. It is for this reason that the intervention of a neutral third party, such as an international organization to act as mediator, is important in settling water disputes

Assessment of the prevalence of obstructive sleep apnea in patients with stable uncontrolled asthma, impact of continuous positive airway pressure treatment

AbstractThere are increasing data about the association between bronchial asthma and obstructive sleep apnea (OSA) is an important contributor to asthma control and can aggravate asthma exacerbation, continuous positive airway pressure (CPAP) which is the main line of treatment in OSA can improve asthma outcomes.Aim of the present studyTo assess the prevalence of OSA in patients with stable uncontrolled asthma and to study the effect of CPAP treatment on the asthma condition.Subjects and methodsSixty subjects with uncontrolled bronchial asthma were included in the study, mean age was 46±13years, there were female predominance (75%), all patients were not smokers, pregnancy and patients in acute exacerbation were excluded, after detailed history taking and physical examination pulmonary function tests and asthma control test were applied to all patients to assess the asthma control, then polysomnography was done to all patients and those proved to have OSA were offered CPAP treatment and followed up for 6weeks then assessed again for asthma control test, pulmonary function tests and day – time sleepiness.ResultsFifteen patients out of the 60 patients included in the study proved to have OSA, Apnea Hypopnea Index (AHI) was 23.5±10.9/h of sleep, CPAP treatment improved significantly the AHI (from 23.5±10.9 to 2.3±2.1/h of sleep, p<0.01), but there was no significant improvement in asthma control test or in the pulmonary functions (ACT was 13.97±3.52 before CPAP and became 14.1±3.97, p>0.05 after CPAP, FEV1% pred. was 60.1±6.9 before CPAP and became 61.2±6.2, p>0.05 after CPAP.ConclusionObstructive sleep apnea should be screened for in all patients with uncontrolled bronchial asthma, CPAP treatment may improve asthma quality of life but not improving the pulmonary function tests. Larger studies are needed to fully address the impact of CPAP on asthma condition in patient with both asthma and OSA

Risk factors for atypical mycobacterial disease in patients with smear positive pulmonary TB

AbstractNon Tuberculous Mycobacteria (NTM) can cause severe infection in selected groups of patients and is very difficult to be differentiated from TB infection clinically or radiologically leading to miss diagnosis and wrong treatment in these cases, the Aim of the present study is to study risk factors associated with NTM disease in patients with Acid Fast Bacilli (AFB) smear positive, Subjects and methods: 1402 patients with AFB smear positive were included in the study, only 47 patients from the study group proved to have NTM disease (diagnosis was done according to ATS/IDSA criteria). Results: the mean age of the NTM patients was 61.8±23.2years, NTM was more common in older age groups and more common in white race patients, on using logistic regression analysis NTM disease was more commonly associated with old TB infection (42.6%) and with bed ridden patients on tracheostomy (31.9%). The most common organisms isolated were the MAC complex (55.3%) followed by M. Kansasii (34.04%). Conclusion: NTM disease should be put into consideration in patients with AFB smear positive and suffering from old TB infection or in bed ridden patients who are on tracheostomy, also if smear is positive for AFB and PCR is negative NTM should be suspected

Morphological and morphometric study of the cartilaginous framework of the dorsum and tip of the nose among Egyptian populations: a cadaveric study

  Background: Success or failure of rhinoplasty depends mainly on the awareness of the surgeon with the construction of the nasal cartilaginous framework and the knowledge of the morphology and different dimensions of these cartilages. The current study aimed at evaluation of the morphology of the nasal cartilages and to address their different measurements as well as observation of anatomical variations of these cartilages and elucidation of their implications in rhinoplasty. Materials and methods: Thirty adult human cadaveric noses, males and females aged 20–70 years were used in the current study. The specimens were dissected; cartilages were exposed and examined morphologically for shape, parts and attachments. Different nasal cartilage measurements were done. Results: The examination of nasal cartilage revealed that the mean length of upper lateral cartilage was variable. The mean width and thickness were 12.8 ± 1.29 mm and 1.34 ± 0.14 mm, respectively. The mean length, width and thickness of alar cartilage were assessed. Angle of divergence was observed to be 23–44°. Statistically, there were no significant differences between genders. Conclusions: Data obtained from this study confirmed the anatomical varia­tions of the nasal cartilages among the Egyptians and confirmed the differences with several ethnic groups. This has important surgical implications giving the attention required during different techniques in rhinoplasty in order to maintain dorsal aesthetic lines of the nose and proper respiratory function

The sphenopalatine foramen in man: anatomical, radiological and endoscopic study

Background: Epistaxis is a frequent problem otorhinolaryngologists faces of in their practice. The variations of the sphenopalatine foramen (SPF) and consequ­ently the artery may be one of the major sources of such bleeding. The present work aimed to localise the site of SPF and also to illustrate its different shapes, number and any other variation. Materials and methods: In the current study, 20 adult skulls of both sexes with total 40 half skulls were used in addition to 20 heads of adult living subjects of both sexes aged between 30 and 60 years examined with multislice helical com­puted tomography with 3-dimensional reconstruction of SPF. Then, examination of another ten dried skulls with endoscope was performed. Results: The number of the SPF is varied being single in nearly 80% and multiple in 20% of examined cases. The shape of the foramen also is varied; regular in 67.5% and irregular in 32.5% of all cases. The site of the foramen on the lateral nasal wall is placed in the superior meatus in most of examined skulls (62.5%) while in the rest (37.5%) they are found in the superior meatus and extending to the middle one. Conclusions: There are variation of the number, shape and site of the SPF, and consequently of the branches of the sphenopalatine artery, and this may explain the surgical failure in management of severe epistaxis. The data obtained from the current work support the predication of more than one sphenopalatine ar­teries and gives ample knowledge on the endoscopic study of the lateral nasal wall and consequently the surgical treatment of severe epistaxis. (Folia Morphol 2018; 77, 2: 345–355

How Does the Entrepreneurs’ Financial, Human, Social and Psychological Capitals Impact Entrepreneur’S Success?

The literature has widely covered the factors that determine the success of entrepreneurial ventures from financial and organizational perspectives. This study intends to tackle how the Financial Capital, the Human Capital, the Social Capital, and the Psychological Capital of the Entrepreneur affect Entrepreneurial Success. Despite that the Financial, Human, and Social Capitals are extensively examined in the literature as they relate to entrepreneurial success, this paper will add the psychological capital of the entrepreneur and examine its effect on entrepreneurial success in Egypt.This study aimed to investigate the effect of Financial Capital, Human Capital, Social Capital, and Psychological Capital on Entrepreneurial Success using a cross-sectional survey. Respondents were the owners and founders of small and medium enterprises (SMEs) in Cairo, Egypt. The results revealed that Social Capital and Psychological capital had a statistical significance as well as a positive strong relationship with Entrepreneurial success, while the Financial Capital and the Human Capital had statistical insignificance as well as a positive weak to a very weak relationship with Entrepreneurial success respectively.The study findings suggested that entrepreneurial success is strongly connected to the intangible resources of the entrepreneur, which are Social Capital and Psychological Capital, and that the Psychological Capital had the highest impact on Entrepreneurial success. However, the impact of the Financial Capital and Human Capital on Entrepreneurial Success was statistically insignificant

Compliance and knowledge about glaucoma in patients at tertiary glaucoma units

To document the rate of self-reported compliance and glaucoma-related knowledge in Swiss patients and to identify risk factors for their poor compliance. This was an observational study, including a total of 200 consecutive patients already under glaucoma medication in two Swiss tertiary glaucoma clinics (Geneva and Bern). Personal characteristics, presence of systemic disease, compliance with glaucoma medication, attitude to the ophthalmologist, and glaucoma-related attitudes were ascertained by means of a predetermined questionnaire with 40 questions. Patients were subsequently assessed for the ability to correctly instil placebo eye drops. Non-compliance with glaucoma medication was defined as omitting more than two doses a week as reported by the patient. Logistic regression was used to evaluate how patient characteristics and knowledge about the disease were related to compliance. Overall, 81% (n=162) of patients reported to be compliant. Forgetfulness was the most frequently cited reason for non-compliance with dosing regimen (63%). Although 90.5% (n=181) of patients believed glaucoma medication to be efficient, only 28% (n=56) could correctly define glaucoma. Factors positively associated with compliance were ‘knowledge of glaucoma' [adjusted odds ratio (OR) 4.77 (95% CI 1.36-16.70)] and ‘getting help for administration of drops' [OR 2.95 (1.25-6.94)]. These findings indicate that despite the comparatively high compliance rate among glaucoma patients, knowledge of glaucoma remains poor in long-term glaucoma sufferers. Improving knowledge about the disease is important since it is positively associated with compliance in our stud

Factors Affecting the Behavioral Intention to Use Standalone Electronic Personal Health Record Applications by Adults in Egypt

Standalone electronic personal health record can be a useful tool that enables individuals to store, arrange and share their health information easily and they can build a history of their health timeline which is crucial for raising healthcare quality and better self-management, the adoption rate of these applications has been identified in several countries to be low and slowly progressing.Although there are some applications of standalone ePHR available in the market for usage free of charge but it’s almost not adopted at all, this study will investigate some of the factors that might affect the adoption of ePHR technology by adults in Egypt and provide business professionals a better picture for what can motivate or hinder the adoption process to achieve better adoption rates and eliminate the barriers.In order to ensure a comprehensive contextual analysis, researchers analyzed the research in hand with the perspective of the proposed contextual framework, the Nine Elements Framework/Model (Elsafty, 2018) that analyzes social studies research in general, and business/management reseaerches as well.Using the nine elements framework, the authors used it to discover the underlying factors that are causing the problems faced by the research in hand, and resulted in the coming contextual analysis defining the research scope and focus, which in the case of this paper is on Perceived usefulness and perceived ease of use were adapted from TAM that was initially developed by Fred Davis (1989) and they proved to have a high predictive power of behavioral intention in CHI context, The extensions of TAM including UTAUT & UTAUT2 seems to be irrelevant to this research context since UTAUT is more oriented towards the organizational context (Venkatesh et al., 2012) and UTAUT2 added factors, Price value seems to be irrelevant in this research context as we are already studying platforms that are provided free of charge, Hedonic motivation maybe irrelevant to this context as healthcare related service is mostly associated with seriousness and urgency, also testing unimplemented platforms that are not yet adopted makes from the habit unrealistic experience that may be inaccurate to measure.Since other several researches recommended extending these factors with other additional factors to make it more relevant to the healthcare consumer context (Kim & Park, 2012), these factors may include health-related factors, technology-related factors and personal-related factors. Findings in this research revealed that adoption rate in Egypt is still very low and high demand for this service which makes this research is significant as it’s trying to find out the reasons behind this gap, perceived usefulness, perceived ease of use, (privacy and security), eHealth literacy, personalization and awareness had a significant impact on behavioral intention to use standalone ePHR applications. Personalization was found to have the strongest effect on behavioral intention followed by perceived usefulness. Health status was found to have an insignificant effect on behavioral intention which indicates the interest of people with different health statuses in standalone ePHR

Preoperative Evaluation and Management of Patients with Liver Disease

Patients with liver disease who undergo surgery have an increased risk of morbidity and mortality. Impairment of the liver functions increases the risks of surgery and anesthesia.The risk depends on the severity of liver disease, nature of the surgery and comorbid conditions. Patients with compensated cirrhosis and normal synthetic function have a low risk. Elective surgery should be postponed in patients with abnormal liver tests. All patients should have thorough preoperative evaluation, and their conditions are to be optimized before elective surgery. Thorough history and physical examination usually provide important informatation. Elective surgery can be rescheduled or cancelled once the severity of underlying liver disease is assessed. When surgery is mandatory, meticulous perioperative management is required, including hemodynamic stability, broad-spectrum antibiotics, correction of coagulopathy, improvement of nutritional status, avoidance of nephrotoxins and sedatives that could precipitate hepatic encephalopathy, and intensive care unit admission if needed