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Tourism industry is one of sectors that have potential to develop and grow in the next few years in Sri Lanka. According to Tourism Development Strategy of Sri Lanka, tourism industry is expected to be the largest foreign exchange earner by 2024. The principal focus of this study was to explore major factors that affect women’s participation and non-participation in the hospitality industry in Ella DS division Sri Lanka. The study used a deductive approach, and primary data were collected through a self-administered structured questionnaire. Samples were 60 women, consisting of thirty women involved in the hospitality industry and thirty women of the non-hospitality industry, randomly selected. Results were analyzed using descriptive statistics and inferential statistics. The results found that the differences in language skills and problem-solving had the most significant effect on women’s participation in hospitality industry. Besides, childcare responsibility and lack of experience were affected women’s involvement in this industry. The results also showed that most of the non-hospitality workers have language barriers (33.3%), lack of knowledge about tourism industry (23.3%), and lack of opportunities to engage in tourism work (13.3%). Based on the results, 53.3% of 30 non-hospitality workers had an idea to be involved in tourism and hospitality industry in the future, while the remaining 46.6% had no idea to be involved.

This paper attempts to measure the level of success of the dry zone home gardening (HG) program introduced by the government of Sri Lanka among the women. The women used the organic amendments for their HG activities. This study assessed the success of the program and the constraints faced in engaging in home gardening using organic amendments, and solutions to overcome were identified. Using an interviewer administrated structured questionnaire and purposive sampling technique, data were collected from 80 beneficiaries in Thirappane DS division. The results revealed that the beneficiaries were mainly married, unemployed, with no primary education and in more than 50 years’ age category. There was significant relationship between two socio-economic factors, farming factors, reasons to engage in home gardening with organic amendments, and outcomes of the program. Majority of women perceived that all the purposes of the program were successfully achieved. But 91.25 % of women have no idea on farming with organic amendments at large scale. Most influencing reason was the resulting low productivity with organic amendments. To address these solutions, the government should intervene to build the large scale farming with organic amendments in Anuradhapura district.

This research examined the impact of customer’ perceived value on CRM in Business to Business (B2B) agrochemical agribusinesses in Sri Lanka. Customer perceived value was measured by economical value, emotional value and social value based on standard 36 attributes. A total of 110 respondents including distributors and direct dealers engaged in agrochemical marketing covering all island were interviewed. Results were obtained by both descriptive and inferential statistics. Two mediating variables; customer satisfaction and customer loyalty were used to find the impact of customer perceived value on relationship marketing attributes. Findings revealed that dealers perceived slightly higher economical values than emotional values and comparatively low social values. Weaker but positive correlations were found between dealer’s perceived emotional, economic and social values with their satisfaction and customer loyalty. Customer satisfaction and customer loyalty had mediating effects to the relationship of customer perceived value with CRM attributes hence with relationship marketing. The findings provide utilizable model for the agro chemical manufacturing companies to enhance dealer’s perceived value that contribute to higher dealer satisfaction, loyalty hence re-purchase behaviour and long term customer retention.

Abstract Background Chronic airway inflammation and hypersensitivity to bacterial infection may contribute to lung cancer pathogenesis. Previous studies have demonstrated that nontypeable Haemophilus influenzae (NTHi) is the most common colonizing bacteria in the lower airways of patients with COPD. The objective of this study was to determine the presence of NTHi and immunoglobulin concentrations in patients with lung cancer, COPD and controls. Methods Serum and bronchial wash samples were collected from patients undergoing diagnostic bronchoscopy. Total IgE, IgG and specific NTHi IgG were measured by enzyme linked immunosorbent assay. Bronchial wash samples were examined for the presence of NTHi via PCR. Results Out of the 60 patients: 20 had confirmed Lung Cancer, 27 had COPD only and 13 were used as Controls. NTHi was detected in the lower airways of all three groups (Lung Cancer 20%; COPD 22% and Controls 15%). Total IgE was highest in Lung Cancer subjects followed by COPD and control subjects (mean ± SD: 870 ± 944, 381 ± 442, 159 ± 115). Likewise total IgG was higher in Lung cancer (Mean ± SD: 6.99 ± 1.8) patients compared to COPD (Mean ± SD: 5.43 ± 2). Conclusions The lack of difference in NTHi and specific antibodies between the three groups makes it less likely that NTHi has an important pathogenetic role in subjects with Lung Cancer. However the detection of higher IgE antibody in Lung Cancer subjects identifies a possible mechanism for carcinogenesis in these subjects and warrants further study.

Multiple endocrine neoplasia (MEN) type 1 syndrome is an autosomal dominant disorder caused by germline mutations in MEN1 gene, characterized by tumours in endocrine and nonendocrine organs. Giant prolactinoma is defined as tumours larger than 40mm with very high prolactin secretion. We report two unrelated Sri Lankan patients (8-year-old boy and a 20-year-old female) who presented with giant prolactinomas with mass effects of the tumours. The female patient showed complete response to medical therapy, while the boy developed recurrent resistant prolactinoma needing surgery and radiotherapy. During follow-up, both developed pancreatic neuroendocrine tumours. Genetic analysis revealed that one was heterozygous for a nonsense mutation and other for missense mutation in MEN1 gene. Screening confirmed familial MEN-1 syndrome in their families. High clinical suspicion upon unusual clinical presentation prompted genetic evaluation in these patients and detection of MEN1 gene mutation. Pituitary adenomas in children with MEN-1 syndrome are larger tumours with higher rates of treatment resistance. This report emphasizes importance of screening young patients with giant prolactinoma for MEN-1 syndrome and arranging long-term follow-up for them expecting variable treatment outcomes. Sri Lanka requires further studies to describe the genotypic-phenotypic variability of MEN-1 syndrome in this population.

Background: Currently there is a paucity of information about biomarkers that can predict hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients presenting to the emergency department (ED). There is limited data on the consistency of ED management of AECOPD with local COPD guidelines. The aim of this study was to identify biomarkers associated with hospitalization in AECOPD patients and to determine if the ED management was concordant with local COPD guidelines. Materials and Methods: We performed a retrospective audit of consecutive AECOPD patients presenting to the Gold Coast Hospital ED over a 6-month period. Results: During the study period, 122 AECOPD patients (51% male, mean age (SE) 71 (±11) years) presented to the ED. Ninety-eight (80%) patients were hospitalized. Univariate analysis identified certain factors associated with hospitalization: Older age, former smokers, home oxygen therapy, weekday presentation, SpO 2 < 92%, and raised inflammatory markers (white cell count (WCC) and C-reactive protein (CRP)). After adjustment for multiple variable, increased age was significantly associated with hospitalization (odds ratio (OR) 1.09; 95% confidence interval (CI): 1.00-1.18; P = 0.05). Radiology assessment and pharmacological management was in accordance with COPD guidelines. However, spirometry was performed in 17% of patients and 28% of patients with hypercapneic respiratory failure received noninvasive ventilation (NIV). Conclusion: We identified several factors on univariate analysis that were associated with hospitalization. Further research is required to determine the utility of these biomarkers in clinical practice. Also, while overall adherence to local COPD guidelines was good, there is scope for improvement in performing spirometry and provision of NIV to eligible patients.

Context: Hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) may be managed by either respiratory specialists (RS) or general medicine physicians (GMP). While previous studies have audited the hospital AECOPD management of RS, only a small number of studies have evaluated the management of GMP. Aims: The aims of this study were to firstly examine the differences in AECOPD management of GMP and RS and secondly compare their care to national COPD guidelines. Methods: A retrospective review was undertaken of consecutive AECOPD patients admitted to two hospitals (one hospital where all AECOPD patients were managed by RS and another where all AECOPD patients were managed by GMP) over a 3-month period. Electronic medical records, medical case notes, pathology and radiology data for the admission were reviewed. Results: There were 201 COPD exacerbations in 169 patients (49.7% male, mean age 72.3). GMP managed 84 (41.7%) exacerbations. In comparison to RS, GMP performed fewer spirometry tests, blood gas analysis and less frequently treated patients with guideline-recommended medications. Referral to pulmonary rehabilitation was poor for both groups of clinicians. Median length of stay was shorter in GMP patients versus RS patients (3 days vs. 5 days, P = 0.001). There were no differences in the 12-month re-admission (41.7% vs. 38.5%, P = 0.664) and mortality rates (10.7% vs. 6%, P = 0.292) between both groups of patients. Conclusion: Our study found differences in the hospital AECOPD management of GMP and RS, but these did not translate into different clinical outcomes between their patients. We also found suboptimal adherence to national COPD guidelines, suggesting that there is scope for improvement in the AECOPD management of both groups of clinicians.

Sri Lanka’s energy policy presumes that the country will be meeting 20% of its energy requirements by non-conventional renewable energy resources by 2020. This study attempts to assess diesel vehicle owners’ willingness to pay (WTP) for Jatropha biodiesel and the factors affecting their decisions. The Contingent valuation method (CVM) was used to elicit the WTP for the non-marketed biodiesel, which leads to a hypothetical allocation. For diesel vehicle users, a single bid approach was used at Rs.121/= per litre (€ 0.83). The study was carried out in Kandy region among diesel vehicle users. The factors affecting WTP were estimated using probit regression and WTP was estimated using nonparametric estimation techniques. The mean WTP for biodiesel by the diesel vehicle users was Rs.109 per litre (€ 0.74) for lower bound levels. The median WTP was Rs.124/= per litre (€ 0.85). Elderly respondents with higher education are less likely to pay for biodiesel in both samples. Married respondents with higher income are more likely to pay higher prices for biodiesel.

Aims and Method: The aim of this project was to set out recommendations for the section 17 leave form to reflect guidance provided in the Mental Health Act 1983: Code of Practice, following local Care Quality Commission feedback. We reviewed guidance in the Code and publicly available leave forms to identify items to include in the leave form. Then, we determined which publicly available leave forms included each item and reviewed whether the item should be included in the leave form and whether any reformulation was needed., Results: Using the method described, we identified a list of items that should be included in the leave form. When comparing the leave forms of different trusts, there was considerable variation with respect to which items were included in each form., Clinical Implications: We provide some recommendations for future practice regarding section 17 leave forms to facilitate consistency with the Code and between different trusts.

Background: Parathyroid carcinoma is an uncommon cause of PTH-dependent hypercalcemia. Only a handful of cases have been reported of parathyroid carcinoma during pregnancy., Case Presentation: Twenty-four - Year - old female presented with proximal myopathy was found to have hypercalcemia. Her serum corrected total calcium was - 15 mg/dl (8.5 - 10.3), serum phosphate - 2.3 mg/dl (2.5 - 4.5), intact PTH - 118 pg/ml (20 - 80), Vitamin D - 15 ng/ml and Urine Ca/Cr ratio - 2.1 (0.1 - 0.2). Her CECT-neck revealed a well-defined mass lesion posterior to the right lobe of the thyroid - 2.6 cm × 2.5 cm × 2.9 cm in size. She was started on vitamin D supplementation, and she underwent right lower focal parathyroidectomy. Her PTH levels normalized following surgery. Her histology revealed an atypical parathyroid adenoma. She was treated with calcium and vitamin D. Her follow up was uneventful. One year following initial surgery the patient became pregnant and at 16 weeks of POA, the patient presented with a rapidly enhancing neck mass for one week duration. Her biochemical investigations were suggestive of a recurrence of primary hyperparathyroidism. Her ultrasound scan of the neck revealed a well-defined discreate hypoechoic nodule, superior to the thyroid isthmus which was confirmed by a non-contrast MRI scan of the neck. She underwent an uncomplicated second trimester parathyroid tumour excision with normalization of post op PTH. Her histology revealed a parathyroid carcinoma with vascular and capsular invasion. Her genetic studies revealed a novel frameshift mutation of the CDC73 gene. She was treated with calcium and vitamin D supplementation and closely followed up with ionized calcium and PTH levels which were normal throughout the pregnancy. She had an uncomplicated caesarean section at a POA of 37 weeks. Currently she is twelve weeks post-partum, in remission of disease., Conclusion: This case shows the importance of stringent follow up of atypical parathyroid adenoma patients, the benefit of second trimester surgery in management of hypercalcemia due to parathyroid carcinoma during pregnancy and the importance of identifying the novel CDC73 gene mutation., (© 2022. The Author(s).)

Met is an oncogene aberrantly activated in multiple cancers. Therefore, to better understand Met biology and its role in disease we applied the Ma mmalian M embrane T wo- H ybrid (MaMTH) to generate a targeted interactome map of its interactions with human SH2/PTB-domain-containing proteins. We identified thirty interaction partners, including sixteen that were previously unreported. Non-small cell lung cancer (NSCLC)-focused functional characterization of a Met-interacting protein, BLNK, revealed that BLNK is a positive regulator of Met signaling, and modulates localization, including ligand-dependent trafficking of Met in NSCLC cell lines. Furthermore, the interaction between Met and GRB2 is increased in the presence of BLNK, and the constitutive interaction between BLNK and GRB2 is increased in the presence of active Met. Tumor phenotypical assays uncovered roles for BLNK in anchorage-independent growth and chemotaxis of NSCLC cell lines. Cumulatively, this study provides a Met-interactome and delineates a role for BLNK in regulating Met biology in NSCLC context., Competing Interests: Authors declare no competing financial interests., (© 2022 The Authors.)