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This study examines the effects of quality of service, product awareness, and perceptions among customers of Islamic financial institutions (IFIs) on customer loyalty through technology integration using customer satisfaction as a mediator. A well-structured, comprehensive questionnaire was developed and data were collected from 203 respondents who were customers of six IFIs in Pakistan and had at least 2 years of experience in dealing confiorm this is correct with these IFIs. A total of 171 accurate responses were received from the respondents. Ten hypotheses were developed and statistically verified using regression and correlation analytical techniques. The results reveal that the quality of customer services and awareness of IFIs had a direct and positive relationship with customer loyalty, which in turn was mediated by customer satisfaction. Perceptions about IFIs had a direct positive relation with customer satisfaction. However, the relation of perceptions and quality of service with customer loyalty and satisfaction in financial institutions through technology integration was found to be insignificant, even in the presence of customer satisfaction as a mediator.

PurposeTo detect any choroidal thickness (CT) change in patients after alpha-lytic drugs withdrawal that could help in the cataract surgery timing decision.MethodsTwenty-five eyes of 25 patients (mean age: 76 ± 7 years) under alpha-lytic therapy, and 25 eyes of 25 control subjects (CS) (mean age: 75 ± 7 years) without alpha-lytic therapy, both scheduled for cataract surgery in the fellow eye, were included in this observational, prospective, non-randomized study. All patients underwent EDI-OCT during the first preoperative visit and approximately 1 month (range 28–31 days) after alpha-lytic withdrawal. In the CS group, the OCT during preoperative visit and approximately 1 month after (range 28–31 days) the first examination was performed. Data normality with Kolmogorov-Smirnov test was checked and statistical evaluation with the Wilcoxon-signed rank test was performed.ResultsThe mean subfoveal CT was 224 ± 79.7 μm during therapy and 217 ± 70.4 μm after withdrawal; 1.5 mm nasally from the fovea CT was 198 ± 83.8 μm and 194 ± 82.8 μm, respectively; and 1.5 mm temporally from the fovea CT was 217 ± 55.9 μm and 205 ± 54.4 μm, respectively. A statistically significant reduction (p < 0.05) in all the 3 measured CT points was found. In the CS no significant changes were detected (p > 0.05).ConclusionNo severe floppy iris syndrome was detected at the time of surgery. In these patients, CT decrease could be an important sign for cataract surgery timing decision.

Purpose To aid preoperative risk assessment by identifying anatomic parameters corresponding with a higher risk of intraoperative floppy iris syndrome (IFIS) during cataract surgery. Methods Prospective cohort study of 55 patients with α 1 -adrenergic receptor antagonist (α 1 -ARA) treatment and 55 controls undergoing cataract surgery. Anterior segment optical coherence tomography (AS-OCT), video pupilometer, and biometry measurements were performed preoperatively and analyzed regarding anatomic parameters that corresponded with a higher rate of IFIS. Those statistically significant parameters were evaluated with logistic regression analysis and receiver operating characteristic (ROC) curve. Results Pupil diameter was significantly smaller in patients who developed IFIS compared to those who did not develop IFIS (AS-OCT 3.29 ± 0.85 vs. 3.63 ± 0.68, p  = 0.03; Pupilometer 3.56 ± 0,87 vs. 3.95 ± 0.67, p  = 0.02). Biometric evaluation revealed shallower anterior chambers in the IFIS group (ACD 3.12 ± 0.40 vs. 3.32 ± 0.42, p  = 0.02). Cutoff values for 50% IFIS probability ( p  = 0.5) were PD = 3.18 mm for pupil diameter and ACD = 2.93 mm for anterior chamber depth. ROC curves of combined parameters were calculated for α 1 -ARA medication with pupil diameter and anterior chamber depth, which yielded an AUC of 0.75 for all IFIS grades. Conclusion The combination of biometric parameters with history of α 1 -ARA medication can improve assessment of risk stratification for IFIS incidence during cataract surgery.

Purpose –It is this study’s objective to examine the correlations between internal Shariah auditors’ independence, qualifications and performance in Islamic financial institutions (IFIs), conceptually. Design/methodology/approach – This paper is theoretical in its approach; whereby it also undertakes an extensive literature review. From a general agency theory, an Islamic agency theory is articulated and applied to ascertain the attributes of internal Shariah auditor performance revolving around the concept of independence and qualifications. Findings – Performance of internal Shariahauditing, as a mechanism of assuring Shariahcompliance by IFIs varies directly with the degree of independence and qualifications enjoyed by internal Shariah auditors themselves. The study finds that in evaluating the freedom and qualifications of FIs’internalShariah auditors, Islamic agency theory can potentially serve as the theoretical foundation in developing a multi-dimensional conceptual framework. Research Limitations/implications – Evidence is drawn strictly from secondary sources. Practical implications –To ensure that internal Shariahauditor is effectively performing, IFIs ought to improve the degree of independence and qualifications of their auditors. Originality/value –The studies on the performance of internal and external Shariahauditorsin conventional financial institutions have been extensively researched. However, research on the performance of IFIs’ internal Shariah audit is yet to be conducted extensively.

Although current research indicates that the active mode of displacement commuting influences the health of schoolchildren, what is known about the relationship between self-reported physical fitness and its relationship with activecommuting to school(ACS)is known less so. In addition, trends highlight the need to conduct country-specific analyses to understand each context better. The aims of this study were a) to analyze self-reported physical fitness and the ACS, and b) to determine the association between self-reported physical fitness andthe ACSthrough an extensive survey in southern Chile. A cross-sectional analytic design was conducted. The sample consisted of 733 schoolchildren (aged 10 to 16, 46.1% girls) from Chilean public schools. The International Fitness Scale (IFIS) was used to determine the self-reported physical fitness. The ACS was assessed using separate questions about commuting to and from school. The main results showed that the boys presented better self-reported physical fitness than the girls, except in the self-perception of flexibility (p= 0.041). In addition, an association was observed between the ACSand the self-reported flexibility (OR:1.53, p=0.022; OR:1.47, p= 0.036), an association that was maintained when adjusting for sex and age (OR:1.55, p=0.020; OR:1.50, p= 0.030), and self-reported speed and agility was associated only with active commuting from school (OR:1.60, p=0.005), also after adjusted model (OR:1.81, p=0.024). In conclusion,this study provides evidence regarding the relationship between self-reported physical fitness and active ways of ACS. Strategiesthat favor ACS should be soughtto promote health in schoolchildren. Aunque las investigaciones actuales indican que el modo activo de desplazamiento influye en la salud de los escolares, lo que se sabe sobre la relación entre la condición física autoinformada y su relación con la forma de desplazarse activamente hacia y desde la escuela (ACS, por sus siglas en inglés) se sabe menos. Los objetivos de este estudio fueron a) analizar la aptitud física autoinformada y la ACS, y b) determinar la asociación entre la aptitud física autoinformada con ACSa través de una encuesta realizada en el sur de Chile. Se realizó un diseño analítico transversal. La muestra estuvo compuesta por 733 escolares (de 10 a 16 años, 46,1% niñas) de colegios públicos chilenos. Se utilizó la International Fitness Scale (IFIS) para determinar la aptitud física autoinformada. Se evaluaron los modos de desplazamiento de los estudiantes a la escuela mediante preguntas separadas sobre ACS. Los principales resultados mostraron que los niños presentaron una mejor aptitud física autoinformada que las niñas, excepto en la autopercepción de flexibilidad (p= 0,041). Además, se observó asociación entre el tipo de ACS y la flexibilidad autoinformada (OR:1,53, p=0,022; OR:1,47, p= 0,036), asociación que se mantuvo al ajustar por sexo y la edad (OR:1,55, p=0,020; OR:1,50, p= 0,030), la velocidad y la agilidad autoinformada se asociaron sólo con el desplazamiento activo desde la escuela (OR:1,60, p=0,005), también después del modelo ajustado (OR:1,81, p=0,024). En conclusión, este estudio proporciona evidencia sobre la relación entre la aptitud física autoinformada y las formas de ACS. Para promover la salud en los escolares se deben buscar estrategias que favorezcan los ACS.

Background: Physical activity and physical fitness play an important role in adolescence. Both are considered to be indicators of the current and future health status of young adults. The main objective of this article was to report the normative values of the Physical Activity Questionnaire for Adolescents (PAQ-A) and the International Fitness Scale (IFIS) instruments in Peruvian school adolescents. Methods: A sample of 1229 participants (622 girls and 607 boys) aged between 12 and 17 years was used. The type of study was descriptive-comparative. All measures used were obtained by means of self-administered instruments. The PAQ-A was used to assess the level of physical activity and the IFIS to assess the self-perceived physical fitness level of the adolescents. Results: It was observed that the PAQ-A questionnaire results obtained from the total sample was 2.34; significantly higher for boys (2.41) compared with girls (2.27). For the IFIS, the total score was 3.07, with boys obtaining 3.13 and girls 2.97. Conclusions: It was concluded that there was a direct relationship between the level of PA and self-perceived PF in Peruvian adolescents. Furthermore, adolescent boys were more physically active than girls and they had a better self-perceived PF with the exception of flexibility. Finally, there was a higher weight category involved at the lower level of PA.

Advancements in allogeneic haematopoietic stem cell transplant (alloHSCT) procedures have improved patient outcomes over the last two decades, though invasive fungal infections (IFIs) remain a significant risk. The incidence of IFIs in alloHSCT recipients is estimated at 6%, with a mortality rate of 13%, and Aspergillus species are the most common pathogens involved. Posaconazole is effective in preventing IFIs post-transplant and is standard care during neutropenia or when managing graft-versus-host disease (GvHD) with high-dose steroids. However, azole prophylaxis may cause resistant Aspergillus species like A. calidoustus, which are difficult to treat. We report a case from our institution where a patient developed a dual infection with Aspergillus calidoustus and Talaromyces columbinus after alloHSCT and posaconazole prophylaxis. While A. calidoustus is known to cause IFIs in HSCT recipients, T. columbinus represents a previously unreported occurrence in medical literature. This case underscores the importance of a multifaceted diagnostic strategy, integrating BAL diagnosis, mycological cultures, direct microscopy, fungal speciation, susceptibility testing, and biomarkers. These comprehensive approaches are indispensable for accurate pathogen identification and effective management of IFIs with appropriate antifungal agents.

The aim of the present study was to analyze the effect of a physical activity (PA) program on the fitness perceptions (FP) of nine-to-11-year-old schoolchildren. This quasi-experimental study involved 24 children divided into experimental (EG) and control groups (CG). Perceptions of fitness (FP), cardiorespiratory fitness (CRFP) and muscular strength (MSP) were assessed using the International Physical Fitness Scale (IFIS). Mann-Whitney and Wilcoxon U tests were used with significance set at p < .05. Significant differences were found between groups in FP (.000 p < .05), CRFP (.002 p < .05) and MSP (0.02 p < .05), with better perceptions existing in the EG. The estimated effect size was large, indicating real differences between the two groups (FP [CG] = 0.15; FP [EG] = 1.71; CRFP [CG] = 0.15; CRFP [EG] = 2.50; MSP [CG] = 1.14; MSP [EG] = 3 .34). The main findings revealed that the examined PA program had a significantly positive effect on FP both overall and in relation to its cardiorespiratory (CRF) and muscular strength (MS) components. A large effect size was also produced with regards to differences between experimental and control groups. The strategy examined here could be applied in schools and may also influence psychological, academic and social outcomes.

Almost fifteen years since its initial description, intraoperative floppy iris syndrome (IFIS) during phacoemulsification surgery remains a challenge for cataract surgeons in all its key aspects that include the stratification of the preoperative risk, preoperative prophylaxis treatment, surgery design and intraoperative management. Since its original association with tamsulosin intake, IFIS has been positively correlated with a plethora of risk factors which include: gender, age, hypertension, other a1-adrenergic receptor antagonists, finasteride, angiotensin II receptor inhibitors, benzodiazepines, antipsychotics, hypertension drugs and decreased dilated pupil diameter. The assessment and stratification of the preoperative risk is pivotal in screening patients prone to develop IFIS. For these patients, it is essential that preoperative prophylaxis, employment of necessary measures and surgical technique modifications are considered. A multidisciplinary approach of IFIS is a mandate, thus ophthalmologists, urologists and sometimes other specialties should cooperate to \"educate\" each other about the risks of their respective fields. They both must be aware of the joint statement on IFIS by the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery which suggests either the initiation of tamsulosin after phacoemulsification or the use of a non-selective a1-ARA for benign prostatic hyperplasia treatment. In conclusion, awareness of the risk factors associated with IFIS and their detailed preoperative documentation is crucial in addressing IFIS. The lack of such an awareness can turn a routine, uneventful surgery into one with significant visual morbidity.

Small pupil is a well-known risk factor for causing cataract surgery complications such as vitreous loss, anterior capsular tear, increased inflammation, and an irregular pupil shape. Because all currently available pharmacological approaches of dilating the pupil before or during cataract surgery cannot guarantee the result, the surgeon sometimes resorts to the use of mechanical pupil-expanding devices. However, these devices can increase the overall surgical cost and operative time. Very frequently, a combination of the two is needed; thus, we present the Y-shaped chopper designed by the authors, which serves the purpose of managing the intra-operative miosis and allows simultaneous nuclear emulsification.