Impact of Digital Marketing, Such As Social Media Marketing, Mobile Marketing and E-Mail Marketing, On Customer Buying

Digital marketing is the promotion of a product or buying and selling behavior through electronics and the Internet. From this perspective, this study was conducted to find out the role and impact of each of the three types of digital marketing (social media marketing, email marketing, mobile marketing). The significance of our research is that it enables people to have a clear understanding about digital marketing and how the use of technology and digital marketing changes their buying attitudes. The research was conducted through a survey through the publication of Google forms on several residents of the Kurdistan Region aged 18 to over 50 years and residents of Halabja and Sulaimani and the surrounding areas of Halabja and Sulaimani and surrounding areas. About 250 respondents were recruited which were obtained through an adaptive questionnaire. Conclusion We found that all three types of digital marketing influence customers’ purchases separately, but both types of digital marketing (social media marketing, email marketing) play a role in encouraging people to buy digitally. This will cause the Kurdish people to trust the digital market and gradually replace the traditional market. In conclusion, this study shows that digital marketing has been able to influence customer’s buying behavior and encourage them to do more in this way

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Enzymatic synthesis of phenolic lipids from krill oil in solvent-free media and their microencapsulation

The optimization of the synthesis of phenolic lipids (PLs), obtained by the enzymatic transesterification of krill oil (KO) with selected phenolic acids (PAs) in solvent-free media (SFM), as well as their separation, characterization and encapsulation were investigated. Using high-performance liquid chromatography (HPLC), the evaporative light-scattering detector (ELSD) was shown to be a more appropriate tool of detection of PLs. The structural analyses of the synthesized PLs by HPLC/mass spectrometry (MS) suggested the formation of two phenolic monoacylglycerols. Using two immobilized commercial enzymes, Novozym 435 and Lipozyme TL IM, the enzymatic synthesis of PLs from KO with two phenolic acids (PAs), including 3,4-dihydroxyphenylacetic acid (DHPA) and dihydrocaffeic acid (DHCA), was investigated. The use of Novozym 435 and DHPA resulted in the highest bioconversion yield (BY). The central composite rotatable design (CCRD) was used to evaluate the effects of PA concentration (PAC) and lipase concentration (LC) as well as the agitation speed (AS) on the BY of PLs. For the models with PAC, fixed at 10 and 20 mM, the results revealed that LC had a significant quadratic effect (P <0.05) on the BY, whereas a significant linear effect was only obtained with PAC, fixed at 20 mM. The AS had a significant quadratic effect (P <0.05) on the BY, only for the model, with a PAC fixed at 10 mM. At fixed PAC of 20 mM, the response surface model predicted a BY of 75%, using a LC of 62 mg/mL and an AS of 154 rpm. The antioxidant capacity (AOC) and the oxidative stability of PLs, obtained by the enzymatic transesterification of PAs with the selected edible oils (EOs), including flaxseed (FSO), fish liver (FO) and krill (KO) oils, were determined. The statistical analyses of Tukey's test at P <0.05 revealed that the difference in AOC between that of the esterified oils of flaxseed (EFSO) and krill (EKO) and that of EOs was significant (P <0.05). The experimental findings showed that all esterified oils containing PLs had higher oxidative stability when they were subjected to light, oxygen and agitation at 50ºC as compared to that of the EOs; nevertheless, only the esterified fish oil (EFO) showed a significant difference in its peroxide value (PV), when it was placed in the dark at 25ºC. The development of a process to yield gelatin (GE)-gum arabic (GA) multinuclear microcapsules of KO, via complex coacervation, was investigated. A three-level-by-three factor Box-Behnken design (BBD) was used to evaluate the effects of the ratio of the core material to the wall (RCW), with x1 of 1.25:1 to 1.75:1, the stirring speed (SP) with x2 of 2 to 4, over a scale of 10 and the pH with x3 of 3.8 to 4.2, on the encapsulation efficiency (EE). The experimental findings indicated that x3 had the most significant linear and quadratic effects on the EE of KO and a bilinear one with x1; however, x2 did not have any effect. The optimal predicted conditions for a 92% of EE were 1.75:1 for RCW, 3.8 for pH and 3 for SP. The microcapsules, formed by complex coacervation and without any cross-linking agent, were multinucleated, circular in shape and had sufficient stability to maintain their structure. The microencapsulation of the esterified krill oil (EKO), obtained by complex coacervation, was carried out. The experimental findings showed that the presence of DHPA and PLs, in the EKO, affected the stability of GE-EKO emulsion. The ultrasonic liquid processor was found to be a more appropriate device for the emulsification of the EKO into GE, as compared to the high-shear homogenizer. In addition, the capsules prepared with a GE at pH 8.0 showed higher storage stability, with significantly (P <0.05) lower primary oxidative products, as compared to those prepared with a GE at pH 6.5. The microencapsulation of the EKO was effective in delaying the development of primary and secondary oxidation products during a period of 25 days of storage at room temperature.L'optimisation de la synthèse de lipides phénoliques (PLs), obtenus par la transésterification enzymatique de l'huile de krill (KO) avec des acides phénoliques sélectionnés en milieu réactionnel sans solvant (SFM) ainsi que de leur séparation, caractérisation et encapsulation ont été étudiées. En utilisant la chromatographie en phase liquide (HPLC), le détecteur évaporatif à diffusion de lumière (ELSD) a été sélectionné pour les analyses des composants de KO et ses PLs estérifiés. Les analyses structurales des PLs synthétisés par HPLC/spectrométrie de masse (HPLC/MS) ont suggéré la formation de deux lipides phénoliques monoacylglycéroles. En utilisant deux enzymes commerciales immobilisées, Novozym 435 et Lipozyme TL IM et deux acides phénoliques (PA) modèles y compris l'acide 3,4-dihydroxyphénylacétique (DHPA) et l'acide dihydrocaffeique, la synthèse enzymatique des PLs à partir de KO, a été investiguée. Le meilleur rendement de bioconversion (BY) a été obtenu avec la Novozym 435 et le DHPA. Le plan composite central à caractère rotatif (CCRD) a été utilisé pour évaluer les effets de la concentration de l'acide phénolique (PAC) et de celle de la lipase (LC) ainsi que de la vitesse d'agitation (AS) sur le BY des PLs. Pour les modèles avec PAC, fixée à 10 et 20 mM, les résultats ont montré que la LC a un effet quadratique significatif (P <0,05) sur le BY, alors qu'un effet linéaire a été seulement obtenu avec PAC fixée à 20 mM. L'AS avait un effet quadratique significatif (P <0,05) sur le BY, seulement pour le modèle, avec une PAC fixée à 10 mM. Á PAC fixée à 20 mM, la surface de réponse du modèle a prédit un BY de 75%, en utilisant la LC de 62 mg/mL et la AS de 154 rpm. La capacité antioxydante (AOC) et la stabilité oxydative des PLs dans les huiles de lin (FSO), de poisson (FO) et de krill, ont été déterminées. Les analyses statistiques du test Tukey à P <0,05 ont révélé que la différence en AOC entre celle des huiles estérifiées de lin (EFSO) et de krill (EKO) et celle des blancs a été significative (P <0,05). Les résultats ont montré que tous les huiles estérifiées avec PLs avaient une stabilité oxydative plus élevée quant ils étaient exposés à la lumière et en présence de l'oxygène mais aussi soumis à l'agitation et à 50ºC comparée à celle des EOs. Le développement d'un processus pour produire des microcapsules multinucléaires, en utilisant l'association de gélatine (GE)-gomme arabique (GA) par la coacervation complexe a été investigué. Le plan Box-Behnken (BBD) à trois-niveaux-par-trois facteurs a été utilisé pour évaluer les effets du ratio huile/polymères (RCW) avec x1 de 1,25:1 à 1,75:1, la vitesse de la turbine (SP) avec x2 de 2 à 4, sur une échelle de 10 et un pH avec x3 de 3,8 à 4,2, sur l'efficience d'encapsulation (EE). Les résultats expérimentaux ont indiqué que x3 avait les effets linéaires et quadriques les plus significatifs sur la EE de KO et un effet bilinéaire avec x1; Par contre, x2 n'avait aucun effet. Les conditions optimales prédites pour une EE de 92% étaient 1,75:1 pour RCW, 3,8 pour pH et 3 pour SP. Les microcapsules, formées par la coacervation complexe et sans aucun agent d'articulation, étaient multinucléées, circulaires et assez stables pour maintenir leurs structures. La microencapsulation de l'huile de krill estérifiée par la coacervation complexe a été effectuée. Les résultats ont montré que la présence du DHPA et des PLs, dans l'EKO, avait un effet sur la stabilité de l'émulsion de GE-EKO. L'ultrason utilisé pour traitement liquide a été plus approprié pour l'émulsification de l'EKO dans GE, par rapport à l'homogénéisateur à haut débit. Les capsules préparées avec un GE à pH 8,0 ont montré une stabilité d'entreposage plus élevée avec une PV significativement (P <0,05) moins élevée que celles pour les capsules préparées avec un GE à pH 6,5. La microencapsulation de EKO a été effective pour retarder le développement de produits d'oxydation primaires et secondaires