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Affect plays a significant role in language teaching and learning and in use of languages, and this includes the phenomenon of linguistic shame. Although shame is considered personal by many, its origins are social; linguistic shame is inextricably connected to language use as a social practice. In this paper, we focus on English language teacher education in settings outside the Anglosphere where English is taught and learned as an additional language, in which pre-service English teachers are generally also learners of English. Awareness and understanding of linguistic shame within language teacher education in such settings has implications for participation in the learning of pre-service teachers. Drawing on data from pre-service English teacher education in the non-Anglophone setting of Sri Lanka, we discuss the understanding of linguistic shame and shaming as a social practice, awareness of and responses to it in teacher education classrooms, and the implications.

In this study, it is expected to highlight some common illusions that can interfere with classroom teaching of physics at secondary school. Cases cited here surfaced as useful by-products while some experimental teaching sessions were being conducted with grades 10 and 11 students in three government schools in a suburb of Western province in Sri Lanka. The main purpose of that exercise was to test the efficacy of visual-perceptual approach to teaching on some physics lessons, namely, kinematics, Newton's laws of motion and equilibrium of forces, turning effect of forces etc. It has become necessary to keep an open dialog with students and to get their active participation in the teaching / learning process in order to prepare a suitable visual-perpetual assessment tool to measure their performance at the end of the teaching exercise. This teaching sessions spans for about 15 hours after school and spread over three months (each period being 40 minutes duration). These classes were held with the help of the respective science teachers of the school. The problematic cases for the students that will be discussed in detail later were successfully tackled by employing appropriate lesson specific visualization objects in conjunction with existing traditional methods of teaching. Sometimes more than one visualization mode (external representations) had to be used to facilitate better understanding of the same principle. End result seemed satisfactory in terms of marks scored for the visual-perceptual assessment tool and, student and teacher interviews.

Aims: The outcome of acute kidney injury (AKI) depends on causes, patient factors and care received. We studied the causes, complications and 90‐day outcomes of patients with AKI at a tertiary referral centre in Sri Lanka. Methods: Patients aged 18 years or older with AKI referred to nephrology services were analysed retrospectively. AKI severity was assessed using the KDIGO classification. Information was gathered from hospital and clinic records. Results: Of the 464 patients studied, 262 (56.5%) were males. The mean age of the study sample was 57.04 (SD 16.85) years. The majority (212–45.69%) were discharged with normal renal functions, 173 (37.28%) were discharged with impaired functions, and 79 (17.03%) died during hospital stay. There were 377 patients at 3 months follow‐up; 331 (87.8%) had normalised renal function, 40 (10.6%) had not recovered fully and 6 (1.6%) had succumbed. Progression of AKI to chronic kidney disease or death was significantly high in patients aged > 60 years (p = 0.017). More severe AKI was associated with type 2 diabetes (p = 0.0042), hypertension (p < 0.0001) and multiple comorbidities (p = 0.0014). Persons with no comorbidities had less severe AKI (p = 0.0004). Even in the early stages of AKI, there was significantly high mortality (11% in AKI stages 1 and 2) which doubled in stage 3 (22%). Mortality was low in patients with prerenal causes of AKI (OR: 0.59, 95% CI: 0.35–0.99 and p = 0.047). Conclusions: AKI in elderly and comorbid patients has high morbidity and mortality. Identification of individuals who are at high risk of developing AKI is important for its prevention, early diagnosis and proper treatment. Limitations in infrastructure, manpower, local research, reporting and recording of AKI are key challenges in providing optimal care for AKI in Sri Lanka. [ABSTRACT FROM AUTHOR]

The existence of an indigenous community within a country is a source of pride and warrants significant attention. Sri Lanka is no exception, and, as a country with the fossil remains of anatomically modern Homo sapiens, it is hypothesized that Sri Lankan Indigenous people might harbor ancient genetic signatures. This study aims to establish baseline data of certain craniofacial anthropometric measurements in the Coastal Indigenous people and classify their head, face, and nose types. This study involved 126 (70 Male and 56 Female) unrelated individuals from six villages, representing the Coastal Indigenous population. Sixteen craniofacial measurements were obtained, providing calculations of three craniofacial indices: the Cephalic index, Facial index, and Nasal index. It was apparent that all craniofacial measurements, except nose protrusion of males, had significantly higher dimensions than those of the female participants. In addition to baseline quantitative raw data, the calculated indices are as follows: The mean cephalic, facial, and nasal indices of females were 78.50± 4.84, 88.37±13.06, and 93.93±12.23, respectively, whereas those of males were 78.85±5.76, 91.74±13.70, and 94.58±14.06, respectively. This is the first craniofacial study on Coastal Indigenous people in Sri Lanka. The most common head shape observed among both genders was mesocephalic. Males predominantly exhibited a hyperleptoprosopic facial type, while females mostly showed a leptoprosopic facial type. The most dominant nasal type recorded for both genders was the platyrrhine nasal phenotype. Interestingly, such platyrrhine nose is rarely present in other world populations, except in African populations. [ABSTRACT FROM AUTHOR]

Background: Assessment of QoL has become an essential component in the holistic care of patients with acne. The Cardiff Acne Disability Index (CADI) is used globally to assess quality of life (QoL) in patients with acne. This study was done to validate CADI in Tamil, as 90 million of the global population are native speakers and Tamil is an official language of several countries. Methods: CADI was translated and validated into Tamil according to published guidelines. The Tamil versions of both CADI and Dermatology Life Quality Index (DLQI), was administered to 150 Sri Lankan young adults with acne. The clinical severity was assessed using the Global Acne Grading System (GAGS). Discriminant validity was tested by comparing the results of CADI with those of GAGS and DLQI, using reliability, validity, Cronbach's alpha, and Spearman's correlation coefficient measurements. Construct validity was assessed by factor analysis. Results: 70% were female, and the mean age was 25.1 (SD, 5.2). The majority (91.3%) had acne of mild to moderate severity when measured by GAGS. CADI-Tamil showed high internal consistency and reliability (Cronbach's alpha coefficient = 0.83). The CADI total score showed a strong correlation (0.86) with that of DLQI. The correlation between CADI and GAGS was low, whereas CADI had a high and significant correlations with the DLQI. The construct validity explained 61% of the variability. Conclusions: The CADI-Tamil is a reliable and valid tool for assessing the QoL of Tamil speaking patients with acne. This tool will help clinicians understand the patient's perspective on acne. [ABSTRACT FROM AUTHOR]

Background There is limited knowledge about the stigma associated with cutaneous leishmaniasis (CL) in Sri Lanka. To ensure that leishmaniasis researchers focus on CL-associated stigma, we provide an evidence-based framework that can be used in future research. Methods We conducted a systematic review on CL-associated stigma using international evidence and carried out a multimethod qualitative study in the Anuradhapura district in Sri Lanka. Based on that, we identified manifestations of stigma, drivers and facilitators that we synthesised to develop a conceptual framework on CL-associated stigma. Results Our framework consists of drivers, facilitators and self-stigma experienced by people with CL. Stigma drivers included fear, misbeliefs and misconceptions about CL; the belief that wounds are disfiguring; the treatment burden and implied blame. Facilitators that reduced stigma included knowledge of the curability of CL and awareness that CL is not contagious. The nature of social interactions in rural communities enhanced stigma formation. We identified various enacted, felt and internalised stigma experiences of people with CL. Conclusions We developed a conceptual framework of the stigma associated with CL that can be used to develop targeted interventions to increase CL awareness, address stigma and improve the quality of life for CL patients. [ABSTRACT FROM AUTHOR]

Introduction: Hyperinflation is a common procedure to clear secretion, increase lung compliance and enhance oxygenation in mechanically ventilated patients. Hyperinflation can be provided as manual hyperinflation (MHI) or ventilator hyperinflation (VHI), where outcomes depend upon the methods of application. Hence it is crucial to assess the application of techniques employed in Sri Lanka due to observed variations from recommended practices. Objective: This study is aimed to evaluate the application and parameters used for MHI and VHI by physiotherapists in intensive care units (ICUs) in Sri Lanka. Methodology: An online survey was conducted among physiotherapists who are working in ICUs in Sri Lanka using WhatsApp groups and other social media platforms. Results: A total of 96 physiotherapists responded. The survey comprised of three sections to obtain information about socio-demographic data, MHI practices and VHI practices. Most of the respondents (47%) worked in general hospitals and 74% of participants had a bachelor's degree in physiotherapy; 31.3% had 3–6 years of experience; 93.8% used hyperinflation, and 78.9% used MHI. MHI was performed routinely and as needed to treat low oxygen levels, abnormal breath sounds, and per physician orders while avoiding contraindications. Self-inflation bags are frequently used for MHI (40.6%). Only a few participants (26%) used a manometer or tracked PIP. In addition to the supine position, some participants (37.5%) used the side-lying position. Most physiotherapists followed the recommended MHI technique: slow squeeze (57.3%), inspiratory pause (45.8%), and quick release (70.8%). VHI was practised by 19.8%, with medical approval and it was frequently performed by medical staff compared to physiotherapists. Treatment time, number of breaths, and patient positioning varied, and parameters were not well-defined. Conclusion: The study found that MHI was not applied with the recommended PIP, and VHI parameters were not identified. The study indicates a need to educate physiotherapists about current VHI and MHI practice guidelines. [ABSTRACT FROM AUTHOR]

Background: A significant number of patients require non-tunneled haemodialysis catheters (NTHCs) in the event of an urgent need for immediate haemodialysis in developing countries. Catheter-related bloodstream infections (CRBSIs) are a major concern in haemodialysis, but there is a lack of local epidemiological data. This study aimed to determine the incidence of CRBSI, causative agents and associated risk factors in a tertiary care hospital in Sri Lanka. Methods: A prospective study was conducted at the dialysis unit of Colombo South Teaching Hospital, Sri Lanka from December 2019 to August 2020. Adult patients who had haemodialysis for the first time with NTHCs were included. Results: Of 149 dialysis patients (104—jugular vein and 45—femoral vein, mean age 58 ± 13.7 years, mean duration of catheterization 7.9 ± 3.4 days), the incidence of CRBSI was 13.58 per 1000 catheter days. Serum albumin levels, capillary blood sugar levels at admission, haemoglobin levels and duration of catheterization were significantly associated with CRBSI. Prescence of diabetes and patients with ESRD who started routine haemodialysis had a significantly higher risk of CRBSI. Gram-positive bacteria were the most common microorganisms associated with CRBSI (87.5%). Conclusions: Our results show high rates of infection with temporary vascular catheters in Sri Lanka, mainly due to Gram-positive bacteria. Diabetes mellitus, duration of catheterisation, low serum albumin, haemoglobin level and CBS on admission were identified as significant risk factors for CRBSI. Management strategies tailored to specific centers should be established in the nation to optimise catheter care and to monitor local microbiology for appropriate empirical antimicrobial treatment. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to describe the prevalence and characteristics of ADRs and to identify the factors associated with ADRs among hospitalized patients. Methodology: A descriptive cross-sectional study was conducted over a 6 month period at Teaching Hospital Karapitiya (THK), Sri Lanka. A total of 2000 patients, who were admitted consecutively for any type of treatment during the study period were enrolled. The factors associated with ADRs were evaluated using logistic regression models, using ADR occurrence as the outcome. Results: A total of 123 ADRs were found from the sample. The prevalence of ADRs among hospitalized patients was 6.2%. (95% CI 5.1-7.2). ADRs were reported in 62 males (50.4%). The median (IQR) age of ADR occurrence was 52 (35-67) years. The most prevalent type of ADR was Type A (n = 62, 50.4%) and out of the total ADRs, 74 were moderately severe reactions (60.2%). Antibiotics (n = 29, 23.5%) were the most common causative agent for ADRs, followed by anticoagulants (n = 10, 8.1%). The multivariate logistic regression model showed that the number of prescribed drugs (P =.011), ADR history (P = 0 0.01) and diabetes mellitus (P =.003) were significantly associated with the occurrence of ADRs. Age (P =.21), gender (P =.31), ethnicity (P =.14), and other concomitant illnesses (Hypertension P =.66, Ischemic Heart Disease P =.25, etc.) did not associated with the occurrence of ADRs. Conclusion: According to this study the prevalence of ADRs was significant among inward patients in the Teaching Hospital, Karapitiya. The number of prescribed drugs, ADR history and diabetes mellitus were significantly correlated with the occurrence of ADRs. The results of the study can be used to guide healthcare professionals to revise the medication list frequently and monitor the patients who are at risk for developing ADRs. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the evidence of the prevalence of psychological distress and poor sleep among medical students and its associations during an economic crisis. Design: This was a cross-sectional study using an online questionnaire. It included the Depression Anxiety Stress Scales and Pittsburgh Sleep Quality Index (PSQI). Setting and participants: This study included medical undergraduates from a large metropolitan university in Sri Lanka. Primary and secondary outcome measures: We assessed the prevalence of psychological distress, sleep quality, and factors associated with psychological distress. To evaluate the associations, we used logistic regression. Results: The majority (69.2%) had some form of distress (depression, anxiety or stress), while 23% had distress in all three. Anxiety was the most prevalent (50.7%). Poor sleep quality was reported in 41%. The highest contribution to global PSQI was from sleep latency, duration, and daytime dysfunction subscales. In bivariate analysis, sleep quality was directly related to depression (t245.65 = -6.75, p<0.001)., anxiety (t313.45 = -6.45, p <0.001), and stress (t94.22 = -5.14, p <0.001). In multinomial logistic regression models, sleep quality was independently associated with depression, anxiety and stress. In addition, frequent contact with friends was inversely associated with depression and anxiety. Also, social media use was inversely linked to depression, anxiety and stress. Clinical-year students had lower depression and anxiety than non-clinical students. Engaging in mindfulness activities was inversely associated with depression. However, models explained only a moderate amount of variance (Nagelkerke R-squared values were 0.21, 0.18, and 0.13 for depression, anxiety and stress, respectively). Conclusions: Poor sleep quality and psychological distress are high among the undergraduates. The findings emphasize the importance of addressing sleep quality and psychological wellbeing in medical undergraduates. Further research with larger and more diverse samples is needed for a more comprehensive understanding of the factors associated with psychological distress among undergraduates. [ABSTRACT FROM AUTHOR]

Pyruvate carboxylase, a mitochondrial enzyme, catalyses the conversion of glycolytic end-product pyruvate to tricarboxylic acid cycle intermediate, oxaloacetate. Rare pyruvate carboxylase deficiency manifests in three clinical and biochemical phenotypes: neonatal onset type A, infantile onset type B and a benign C type. The objective of this case series is to expand the knowledge of overlapping clinical and biochemical phenotypes of pyruvate carboxylase deficiency. We report three Sri Lankan neonates including two siblings, of two unrelated families with pyruvate carboxylase deficiency. All three developed respiratory distress within the first few hours of birth. Two siblings displayed typical biochemical findings reported in type B. The other proband with normal citrulline, lysine, moderate lactate, paraventricular cystic lesions, bony deformities, and a novel missense, homozygous variant c.2746G>C [p.(Asp916His)] in the PC gene, biochemically favoured type A. Our findings indicate the necessity of prompt laboratory investigations in a tachypneic neonate with coexisting metabolic acidosis, as early recognition is essential for patient management and family counselling. Further case studies are required to identify overlapping symptoms and biochemical findings in different types of pyruvate carboxylase deficiency phenotypes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) are highly prevalent among people who work in sedentary jobs. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) is a valid tool to assess WMSDs, but is not available in the local language of Sri Lanka (Sinhala). OBJECTIVE: To cross-culturally adapt the original CMDQ from English to Sinhala and evaluate its psychometric properties. METHODS: The linguistic and cultural adaptation of the CMDQ to the Sinhala (Si-CMDQ) language followed international guidelines. The adapted pre-version was tested for comprehensibility among 32 subjects from different educational and occupational backgrounds. The Content Validity Index (CVI) was computed with ratings from five experts. The questionnaire was validated further by 111 security guards employed at the university. The tool was validated with reference to the Numeric Rating Scale. Test-retest reliability was assessed at two time points one week apart and internal consistency was tested. RESULTS: The Si-CMDQ showed adequate cross-cultural, content and construct validity, internal consistency, and test-retest reliability. The Kappa coefficient showed excellent agreement between NRS and Si-CMDQ frequency scale. Spearman's correlation coefficients showed a moderate to a strong significant positive correlation between NRS and the severity scale of Si-CMDQ. The Kappa values for test-retest reliability were moderate to excellent for the three scales of CMDQ. The internal consistency was high. CONCLUSION: The Si-CMDQ fulfilled the psychometric requirement for questionnaires. This tool will be beneficial to assess WMSDs among sedentary workers in different occupations in Sri Lanka. [ABSTRACT FROM AUTHOR]

Background: Liver transplant is the cure for children with liver failure. Sri Lanka is a lower‐middle‐income country with a predominant free, state health system. Pediatric liver transplant program in Sri Lanka is still in the budding state where the initial experience of the program is yet to be documented. Methods: A retrospective review was performed including the clinical characteristics of all pediatric liver transplant recipients of Colombo North Centre for Liver Diseases since the inception of the program from June 2020 to May 2023. Results: There were 14 PLT performed in 3 years. The median recipient age and weight were 8 years (6 months–15 years) and 23.3 kg (6.4–49.2), respectively. The majority were boys (64%). All were from low‐income backgrounds. Indications for LT were acute liver failure (5/14), decompensated chronic liver disease (5/14), and acute on chronic liver failure (4/14). Underlying liver diseases were Wilson disease (6/14), autoimmune liver disease (3/14), biliary atresia (2/14) and progressive familial intrahepatic cholestasis type 3 (1/14), and unknown etiology (2/14). The majority were living donor liver transplants (86%). Of the living donors, 42% (5/12) were Buddhist priests. There were three immediate deaths and two late deaths. The 3‐month survival was 78%, and overall survival was 64%. Living donor transplants carried a higher success rate (92%) compared to diseased donor transplants (0%; 2/2). Conclusions: Initial experience of pediatric liver transplant program of Sri Lanka is promising despite being established in a free healthcare system amidst the crisis circumstances. Initial experience of pediatric liver transplant program of Sri Lanka is promising despite being established in a free healthcare system amidst the crisis circumstances. There were 14 PLT performed in 3 years. [ABSTRACT FROM AUTHOR]

Background: Duke Activity Status Index (DASI) is a widely used tool to assess functional capacity among patients, but there is no Sinhala version validated for patients in Sri Lanka. This study aimed to cross-culturally adapt and test the validity and reliability of the Sinhala version of DASI (DASI-S). Methods: The translation and cross-cultural adaptation of the DASI questionnaire were conducted following the standard guidelines. It was pre-tested on ten pre-operative patients and further modified. The construct validity and reliability of DASI-S were evaluated by administering the modified final DASI-S, which comprised 12 items, along with the physical functioning sub-scale of the 36-item short-form health survey (SF-36), consisting of 10 items to eighty-one patients who were awaiting non-cardiac surgeries at university surgical wards, National Hospital of Sri Lanka (NHSL), and Colombo North Teaching Hospital (CNTH), Sri Lanka. Reliability was assessed through Cronbach alpha, while the validity was evaluated using factor analysis and Spearman's correlation. The ethical approval was obtained from the Ethics Review Committee, Faculty of Medicine, University of Colombo, Sri Lanka. Results: The mean age of the participants was 46.2 (± 16.6) years and the majority were females (54.3%). The mean height, weight, and body mass index of the sample were 160.5 (± 9.6) cm, 60.3 (± 11.9) kg, and 23.4 (± 4.5) kgm−2 respectively. The Cronbach's alpha coefficient for the internal consistency of DASI-S was 0.861. The concurrent validity of DASI-S was substantiated by positively correlating (p < 0.01, rs = 0.466) with the physical sub-scale of SF-36. There was a significant difference (p < 0.01) in the total score of DASI-S between the two age groups. Conclusions: Sinhala version of the DASI appears to be a valid, reliable and easy-to-administer tool to assess functional capacity among patients who are awaiting non-cardiac surgeries. [ABSTRACT FROM AUTHOR]

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In recent years, the emergence of drug resistance and sensitivity in leading diseases has heightened global interest in natural nutraceuticals as primary health supplements. However, comprehensive scientific scrutiny is essential before marketing these as supplements. In this study, we assessed the nutritional composition, antioxidant activities, and trace metal accumulation in eleven selected Sri Lankan coastal seaweed species. Gracilaria corticata had the highest (p < 0.05) ash and crude fiber content among the species. Protein content ranged from 4.87% to 23.67% (DW), with Ulva rigida displaying the highest (p < 0.05). Crude fat content ranged from 0.09% to 4.13% (DW), with Cladophora herpestica having the highest (p < 0.05) crude fat content. Sargassam cinereum, Turbinaria ornata and Sargassum crassifolium had the highest (p < 0.05) TPC content (51.32 ± 0.61–28.90 ± 2.68 mg/GAE g) and the highest (p < 0.05) radical scavenging antioxidant activity compared to other seaweeds. The study findings indicate that most of the studied metals in seaweeds exceeded the WHO-recommended levels. Aluminum was the highest (p < 0.05) accumulated metal in seaweeds compared to other metals. Toxic heavy metals, such as arsenic, cadmium and chromium, levels in all of the studied seaweeds surpassed the WHO limits. While seaweeds displayed acceptable nutritional and antioxidant properties, heavy metal presence poses a potential health risk to consumers. Products using seaweeds with accumulated heavy metals may have lower nutritional quality. Thus, this study underscores the need for comprehensive scientific investigation before developing high-quality natural food products or supplements from seaweeds. [ABSTRACT FROM AUTHOR]

The Federation of Asian and Oceanian Biochemists and Molecular Biologists (FAOBMB) and the College of Biochemists of Sri Lanka (CBSL) organized a virtual education symposium in 2021 funded by the International Union of Biochemistry and Molecular Biology (IUBMB). The parallel session named "Students' Perception" was attended by 188 participants from 11 countries. The main objectives of this session were to aggregate participants' viewpoints on aspects of virtual education, including innovative strategies to enhance motivation and engagement of students, improving teacher–student and student–student interactions, managing stress, and virtual learning platforms. Data were collected via rapporteurs from multiple segments of the session including a mini‐introductory talk, poll, role play, and discussions about outstanding student experiences, types of virtual platforms, innovative methods of teaching, student motivation and stress management. The importance of student perception and issues like technological difficulties and the reluctance of students to engage were discussed. In addition to well‐established strategies such as using polls, chat box features, and discussions in breakout rooms, participants also proposed exciting learning methods to engage students such as quizzes, competitions and challenges, engagement of multiple sensory modalities, story‐based learning, and so forth. This report provides anecdotal evidence on pedagogies described in textbooks and also introduces new ideas based on this existing foundation. Future research should aim to harmonize virtual education with traditional classroom methods and explore innovative virtual tools like avatar‐based universities, virtual labs, and user‐friendly online assessment platforms. The results apply to all disciplines, and not exclusively to biochemistry and molecular biology (BMB). [ABSTRACT FROM AUTHOR]

Background: Carbohydrate is the primary source of energy in the human diet and plays an important role in a healthy diet. In this study, 15 different carbohydrate sources (white raw rice, red raw rice, white basmati rice, red basmati rice, wheat, atta flour, soy, black gram, corn, finger millet, water lily seeds, kithul, chickpea, oats, and palmyra sprouts) in Sri Lanka were investigated for their physicochemical and functional properties. Results: The shape of the extracted starch granules varied according to the source, and the amylose content ranged from 17.22% to 36.12%. Kithul and black gram showed the highest water swelling capacity and water absorption index, respectively. Flour of white raw rice and finger millet showed significantly higher (p < 0.05) freeze–thaw stability than other sources. Flour of Soy, black gram, and chickpea showed significantly higher (p < 0.05) dietary fiber content and potassium content than other samples. Water lily seeds showed remarkable in vitro prebiotic activity from the studied carbohydrate sources. Conclusion: The study indicates the potential utilization of raw white rice, palmyra, and finger millet starch in the food processing industry as alternatives to conventional starch sources. Furthermore, the flour from water lily seeds, white basmati rice, soy, and black gram has the potential for use in functional food preparation, offering a wide range of health benefits. [ABSTRACT FROM AUTHOR]

Background: The use of inappropriately long needles for subcutaneous insulin injection increases the risk of inadvertent intramuscular injection. Aims: To estimate the inadvertent intramuscular injection risk at potential subcutaneous insulin injection sites and to identify the determinants of this risk in adults. Methods: A descriptive cross-sectional study was conducted on adult patients between the ages of 18 and 70 years who were admitted to the National Hospital of Sri Lanka. Skin-to-muscle distance and dermal thickness of potential insulin injection sites were measured using ultrasonography to estimate the intramuscular injection risk. Results: A total of 185 patients were included in the study. The estimated risk of inadvertent intramuscular injections with insulin needles of any length was considerably higher at the mid-arm and mid-thigh compared to the abdomen. The risk of inadvertent intramuscular injection was approximately 60% with 13-mm needles without a skin fold at the arm and thigh. The abovementioned risk was approximately halved when the needle length was 8 mm. We developed formulae to predict the skin-to-muscle distance with or without a raised skin fold based on assigned sex at birth and anthropometric parameters. Conclusions: There is a high inadvertent intramuscular injection risk with currently used needles (8 and 13 mm) with U-100 syringes in our population even with a raised skin fold. To minimize this risk, 13-mm needles should be avoided when injecting insulin subcutaneously especially to the limbs. Sex and anthropometric parameters can be used to predict the distance from skin to muscle surface; hence, the selection of needle length could be personalized based on the derived formulae. [ABSTRACT FROM AUTHOR]

Falls can be identified as one of the main issues in elderly population which can lead to serious consequences. Elderly population can be subdivided as community dwelling older adults and institutionalized older adults. The components of health-related physical fitness factors play an important role in the perspective of healthy ageing. The objective of the study was to determine the prevalence of falls and to compare health-related physical fitness factors between different fall categories among institutionalized older adults. This descriptive cross-sectional study comprised of one hundred and seventy-two elders above 60 years of age, living in registered elder's homes in Kandy District. The prevalence of falls was determined by the number of falls reported by the subjects. They were further categorized as non-fallers, fallers, and frequent fallers depending on the number of falls. Body Mass Index (BMI) for body composition, 2-minute walk test for cardiovascular endurance, 30 second sit to stand test for muscle strength and endurance, hand grip strength for upper body strength, chair sit and reach test for lower body flexibility and back scratch test for upper body flexibility were the measures used to assess health-related physical fitness factors. The prevalence of falls is presented as percentage and the health-related factors were compared between the three faller categories using one-way ANOVA and pairwise comparison was performed using Scheffe test. The prevalence of falls was 47.1%. There was a significant difference in BMI, cardiovascular endurance, and lower body flexibility between the three categories of fallers. Higher BMI, lower cardiovascular endurance and lower flexibility in the lower body were associated with increased prevalence of falls (p<0.05). There was no significant difference in body fat percentage, hand grip strength, lower body muscle strength and endurance and upper body flexibility (p>0.05). The findings suggest that, BMI, cardiovascular endurance, and lower body flexibility must be addressed and managed, while designing intervention programs for falls prevention among institutionalized older adults. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to describe the knowledge, attitudes and practices of Adverse Drug Reactions (ADR) reporting among healthcare professionals at Teaching Hospital Karapitiya (THK), a tertiary care hospital in Sri Lanka. Methodology: A descriptive cross-sectional study was conducted at THK. The healthcare professionals working in THK who were available during the study period were invited to the study. A self-administered pre-tested questionnaire was administered to the participants. Respondents were evaluated for their knowledge, attitudes and practices related to ADR reporting. The data were analyzed using SPSS statistical software. Results: Of the total 444 respondents, 31% were doctors and 69% were nurses. The majority of respondents, 90% (n = 400) were aware of the term ADR, while 64.8% (n = 288) could correctly define it. Among the respondents, 30.8% (n = 137) knew about the types of ADR and only 15.5% (n = 70) were able to mention a drug that is banned due to ADR correctly. Among the respondents, only 38.7% (n = 172) were aware of a formal process of reporting ADR and, only 35.3% (n = 157) stated that they had seen the ADR reporting form. Further, only 33.7% (n = 150) respondents have recognized ADR during their clinical practice and only a small proportion 18.2% (n = 81) have ever reported an ADR during their practice. Regarding attitudes toward ADR reporting, overall 84.1 (n = 373) had positive attitudes toward ADR reporting, while 13.54% (n = 60) of them stayed neutral and 2.25% (n = 10) had negative attitudes toward ADR reporting. Conclusions: Although the majority were aware of ADR, the knowledge and practices regarding spontaneous reporting of ADR are inadequate. However, most respondents have shown a positive attitude toward ADR reporting. A sincere and sustained effort should be made by concerned bodies to enhance the healthcare professionals' knowledge, attitudes, and practices regarding ADR reporting. [ABSTRACT FROM AUTHOR]

Background: The phenotype of Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) patients is determined by the type of DMD gene variation, its location, effect on reading frame, and its size. The primary objective of this investigation was to determine the frequency and distribution of DMD gene variants (deletions/duplications) in Sri Lanka through the utilization of a combined approach involving multiplex polymerase chain reaction (mPCR) followed by Multiplex Ligation Dependent Probe Amplification (MLPA) and compare to the international literature. The current consensus is that MLPA is a labor efficient yet expensive technique for identifying deletions and duplications in the DMD gene. Methodology: Genetic analysis was performed in a cohort of 236 clinically suspected pediatric and adult myopathy patients in Sri Lanka, using mPCR and MLPA. A comparative analysis was conducted between our findings and literature data. Results: In the entire patient cohort (n = 236), mPCR solely was able to identify deletions in the DMD gene in 131/236 patients (DMD-120, BMD-11). In the same cohort, MLPA confirmed deletions in 149/236 patients [DMD-138, BMD -11]. These findings suggest that mPCR has a detection rate of 95% (131/138) among all patients who received a diagnosis. The distal and proximal deletion hotspots for DMD were exons 45–55 and 6–15. Exon 45–60 identified as a novel in-frame variation hotspot. Exon 45–59 was a hotspot for BMD deletions. Comparisons with the international literature show significant variations observed in deletion and duplication frequencies in DMD gene across different populations. Conclusion: DMD gene deletions and duplications are concentrated in exons 45–55 and 2–20 respectively, which match global variation hotspots. Disparities in deletion and duplication frequencies were observed when comparing our data to other Asian and Western populations. Identified a 95% deletion detection rate for mPCR, making it a viable initial molecular diagnostic approach for low-resource countries where MLPA could be used to evaluate negative mPCR cases and cases with ambiguous mutation borders. Our findings may have important implications in the early identification of DMD with limited resources in Sri Lanka and to develop tailored molecular diagnostic algorithms that are regional and population specific and easily implemented in resource limited settings. [ABSTRACT FROM AUTHOR]

Nutrition and diet are key modifiable risk factors for the rising burden of non-communicable diseases like cardio-vascular diseases and diabetes in low- and middle- income countries (LMICs). The nutritional transition in dietary behaviours in LMICs has most likely contributed to this problem. Although traditionally assumed to be environmental, dietary choices are also genetically influenced. Twin study designs can be used to investigate the relative influence of genes and environment on nutrition intake, eating behaviours and associated psychological health. The overall aim of this project is to: provide proof-of-concept for the feasibility of using dietary (biomarker) data within the Children-of-Twin design in nutrition studies, develop laboratory skills and statistical genetic skills and establish a Sri Lankan-specific food composition database. Currently, a pilot study is being conducted with 304 individuals (38 Monozygotic twin pairs, 38 Dizygotic twin pairs and their male or female adult offspring). Questionnaire data on nutritional intake, eating behaviours, psychological well-being, physical health, and bio-specimens are being collected. A Sri Lankan-specific food composition database was developed, training sessions on macro and micro element analysis in biological samples and statistical genetics skills development were conducted and Community Engagement and Involvement programs were carried out in two districts of Sri Lanka. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Adequate sleep protects the mental and physical health of individuals while boosting brain and body functions. Significant lifestyle changes due to COVID 19 can affect the sleep quality and level of stress among nurses. The aim of the study was to evaluate the association between sleep quality and perceived stress among nurses during this COVID 19 outbreak. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among 292 registered nurses in Sri Lanka through an anonymous online survey. Data were collected using self-administered, structured questionnaire that included Pittsburg Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS). SPSS 25 software (version 25) was used for data analysis. RESULTS: The majority (79.8%) were between 26-35 years and females (93.5%). Among all participants, the average hours of sleep per night was 5.50 (±1.07). The results of the PSQI scale revealed that 78.4 % of nurses had poor sleep quality (PSQI > 5points), while 67.1% of nurses had moderate level of perceived stress according to the PSS scale. Pearson's coefficient correlation demonstrated that, as nurses' sleep quality decreased, stress level of the nurses increased moderately (r=0.53). CONCLUSIONS: The majority of nurses had poor sleep quality and moderate stress. Furthermore, it showed that there is a moderate positive correlation (r=0.53) between the PSQI global score and the perceived stress scale score. [ABSTRACT FROM AUTHOR]

This study examined plastic waste management in Sri Lanka, concentrating on the contributing factors to plastic waste generation and collection. Data were gathered through a questionnaire survey from registered plastic recycling and management centres. The analysis revealed a positive correlation between tourist arrivals and plastic waste generation, indicating increased plastic waste production due to tourism spanning from 2014 to 2022. However, plastic waste collection negatively correlated with precipitation levels, suggesting heavy rainfall hampers collection efforts. This study found HDPE, PVC, LDPE, and PP to be the most collected and recycled plastic types, whereas PS and PET recycling were less prevalent. The results demonstrate the need for enhanced recycling infrastructure and highlight the necessity for government participation in plastic waste management initiatives. This study recommends increasing waste collection and recycling during the tourist season. In addition to enhancing public and private awareness, there should be additional investment in recycling facilities. The findings offer crucial insights into plastic waste management in Sri Lanka, emphasizing the importance of collaborative efforts and comprehensive strategies to tackle plastic pollution. [ABSTRACT FROM AUTHOR]

Simple Summary: The incidence of oral cancer is increasing with little improvement in survival. This is due to late diagnosis with most cases diagnosed at a stage beyond a cure. In Sri Lanka, oral cancer is the most common cancer in males, carrying a high mortality rate. Identifying markers that can help in early detection is important for improving patient outcome. Here, we present findings from a study in Sri Lanka that assessed salivary interleukins in oral cancer and precancer patients compared to disease-free controls. Our results clearly show that the salivary protein levels of these interleukins progressively increase from disease-free participants through different grades of dysplasia with the highest levels reported in cancer patients. This has significant clinical potential, as assessment of salivary levels of these interleukins can be developed into non-invasive risk assessment tools for detecting disease progression in dysplasia, and as screening tests for early detection of oral cancer. The incidence of oral squamous cell carcinoma (OSCC), and its precursor, oral epithelial dysplasia (OED), is on the rise, especially in South Asia. OSCC is the leading cancer in males in Sri Lanka, with >80% diagnosed at advanced clinical stages. Early detection is paramount to improve patient outcome, and saliva testing is a promising non-invasive tool. The aim of this study was to assess salivary interleukins (lL1β, IL6, and IL8) in OSCC, OED and disease-free controls in a Sri Lankan study cohort. A case-control study with OSCC (n = 37), OED (n = 30) patients and disease-free controls (n = 30) was conducted. Salivary lL1β, IL6, and IL8 were quantified using enzyme-linked immuno-sorbent assay. Comparisons between different diagnostic groups and potential correlations to risk factors were assessed. Salivary levels for the three tested interleukins increased from disease-free controls through OED, and were highest in OSCC samples. Furthermore, the levels of IL1β, IL6, and IL8 increased progressively with OED grade. The discrimination between patients (OSCC and OED) and controls, as assessed by AUC of receiver operating characteristic curves, was 0.9 for IL8 (p = 0.0001) and 0.8 for IL6 (p = 0.0001), while IL1β differentiated OSCC from controls (AUC 0.7, p = 0.006). No significant associations were found between salivary interleukin levels and smoking, alcohol, and betel quid risk factors. Our findings suggest that salivary IL1β, IL6, and IL8 are associated with disease severity of OED, and are potential biomarkers for predicting disease progression in OED, and the screening of OSCC. [ABSTRACT FROM AUTHOR]

Introduction: Availability of essential medicines that meet the expected quality standards, in appropriate dosage forms at affordable prices is a fundamental prerequisite to fulfill healthcare needs of given a population. This study assessed available products, prices and affordability of essential medicines (EM) in community pharmacies in Sri Lanka with comparison of registration status from the National Medicines Regulatory Authority(NMRA). Methods: A cross-sectional island-wide survey of 80 pharmacies was conducted according to World Health Organization and Health Action International Manual (WHO/HAI). Hundred medicines were selected from the global core list(n = 14), regional core list(n = 16) and the Sri Lanka Essential Medicine List (SL-EML) (n = 70) based on healthcare needs. Number of registered products in 2015 and 2021 were compared. Findings: Average availability was 85.4%(± 12.31) and availability was lowest in the Northern province (69.38 ± 21.18%)(p = 0.008). Availability between the state owned, franchise and privately owned pharmacies was not significantly different (p > 0.05). 89.4% medicines were affordable except for amiodarone, hydroxychloroquine, sitagliptin, soluble insulin, isophane insulin, losartan, levodopa carbidopa combination, clonazepam and ceftriaxone. The median price ratio (MPR) of 33.7% of medicines was less than 1 and MPR of 37.1% originator brands (OB) was over 3. Median number of generic brands in the market was 8(range 2–44), 9% of medicines had 20 or more products in the market and 72.7% medicines had more products available than the number registered in 2015. The average number of registered products were similar in 2015 (8.27) and 2021(7.59) (p = 0.15). Conclusion: The overall availability of EMs in Sri Lanka was high in all categories of community pharmacies. Medicines were largely affordable and reasonably priced in 2015, although OBs were generally more expensive. Majority of medicines had more products in the market than the number of registered products. [ABSTRACT FROM AUTHOR]

Background: Leptospirosis is a tropical disease associated with life threatening complications. Identifying clinical and investigation-based parameters that predict mortality and morbidity is vital to provide optimal supportive care Methods: We conducted an observational study in an endemic setting, in the southern Sri Lanka. Consecutive patients having complicated leptospirosis were recruited over 18 months. Clinical, investigational and treatment data were collected and the predictors of mortality were analysed. Results: Out of 88 patients having complicated leptospirosis, 89% were male. Mean age was 47yrs (±16.0). Among the total major complications 94.3% had acute kidney injury, 38.6% pulmonary haemorrhages, 12.5% fulminant hepatic failure, 60.2% hemodynamic instability and 33% myocarditis. An acute significant reduction of haemoglobin (Hb) was observed in 79.4% of patients with pulmonary haemorrhage. The mean of the highest haemoglobin reduction in patients with pulmonary haemorrhage was 3.1g/dL. The presence of pulmonary haemorrhage (PH) and hemodynamic instability within first 48 hours of admission significantly predicted mortality (p<0.05) in severe leptospirosis. Additionally, within first 48 hours of admission, elevated SGOT (AST), presence of atrial fibrillation, presence of significant haemoglobin reduction, higher number of inotropes used, prolonged shock, invasive ventilation and admission to ICU significantly predicted mortality. Out of major complications during the first week after admission, pulmonary haemorrhage and fulminant hepatic failure (FHF) combination had significant adjusted odds of mortality (OR = 6.5 and 4.8, p<0.05). Six patients with severe respiratory failure due to PH underwent ECMO and four survived. The overall mortality in complicated leptospirosis was 17%. In PH and FHF, the mortality rate was higher reaching 35.4% and 54.5%, respectively. Conclusions: Within first 48 hours of admission, major complications such as pulmonary haemorrhage and haemodynamic instability and other parameters such as atrial fibrillation, acute haemoglobin reduction, elevated SGOT level could be used as early parameters predictive of mortality in severe leptospirosis. PH and FHF during the first week of admission in leptospirosis are associated with high morbidity and mortality requiring prolonged ICU care and hospitalisation. Above parameters could be used as parameters indicating severity for triaging and intensifying treatment. Using ECMO is a plausible treatment option in patients with severe pulmonary haemorrhage. Author summary: Leptospirosis is a tropical infectious disease predominantly affecting the lower socioeconomic groups in Sri Lanka. It is associated with significant morbidity and mortality, especially in an endemic setting. Hence, it is vital to identify clinical and biochemical parameters that can predict mortality for triaging and for escalation of care. We observed that pulmonary haemorrhage, myocarditis, hemodynamic instability and hepatic dysfunction are frequent complications of leptospirosis in southern Sri Lanka. Additionally, we identified that mortality was associated with the presence of two major complications of leptospirosis: pulmonary haemorrhage and haemodynamic instability. Therefore, early detection of these two complications along with other parameters that predict mortality such as elevated SGOT levels on admission, acute haemoglobin reduction, atrial fibrillation, prolonged shock and need for invasive ventilation would assist to recognise critically ill patients. Within the first week of admission, PH and development of FHF predicted mortality. One-third our population had acute kidney injury in isolation and they had lesser mortality. Other major complications were almost always detected in combination and were associated with a higher mortality. Pulmonary haemorrhage was detected in one-third of patients and the majority warranted intensive care. Other than usual treatment modalities, ECMO (Extracorporeal Membrane Oxygenation) was used in six patients with critical respiratory failure due to pulmonary haemorrhage, where four survived. Out of the total group of complicated leptospirosis, more than one-third required intensive care treatment and 17% succumbed. Additionally, we mapped the case rates of complicated leptospirosis in Galle district, and observed that severe cases are detected in specific localities. These features are helpful in early detection of severe disease and proactive management for those who are having predictors of mortality. [ABSTRACT FROM AUTHOR]

Mushrooms have been consumed as delicacies since ancient times; however, little knowledge is available on the nutritional and bioactive properties of commercially grown mushroom species in Sri Lanka; button (Agaricus bisporus), oyster (Pleurotus ostreatus), Makandura white (Calocybe sp.), and Reishi (Ganoderma lucidum). Samples from four mushroom species were analysed for proximate composition, mineral and fatty acid content, and antioxidant, antidiabetic, and microstructural properties. Carbohydrate, protein, fat, ash, and dietary fibre content in mushroom species ranged from 64.83–79.97%, 10.53–23.29%, 0.57–4.37%, 2.80–11.00%, and 33.04 to 75.33%, respectively. The highest (P ≤ 0.05) protein and ash content were observed in A. bisporus, and G. lucidum had the highest (P ≤ 0.05) fat and dietary fibre content. When considering the micronutrients, G. lucidum comprised higher (P ≤ 0.05) Ca, Mg, Mn, and Cu, while A. bisporus had higher (P ≤ 0.05) Fe and Zn contents than other species. Essential omega-6 fatty acid, linoleic (18:2n-6) content was in the range of 37- 81% in studied mushroom samples. Results obtained from FTIR (Fourier transform infrared spectroscopy) in conjunction with ATR (Attenuated total reflectance) revealed the presence of functional groups associated with fat (̴1740 cm−1), protein (̴1560 cm−1), polysaccharides (1500–750 cm−1) and moisture (̴3300 cm−1) in mushroom samples. According to the results, P. ostreatus showed the highest (P ≤ 0.05) polysaccharide content, while G. lucidum showed the lowest (P ≤ 0.05). The highest (P ≤ 0.05) total phenolic content (TPC) (3.95 ± 0.05 mg GAE/g DW) and total flavonoid content (TFC) (2.17 ± 0.06 mg CE/g DW) were observed in P. ostreatus. Antioxidant activity measured by DPPH, ABTS, and FRAP methods was higher (P ≤ 0.05) in P. ostreatus and A. bisporus compared to the other two species. Among all the studied mushroom species, G. lucidum showed the highest (P ≤ 0.05) α-amylase (IC50 = 77.51 ± 6.80 µg/mL) and α-glucosidase (IC50 = 0.4113 ± 0.08 µg/mL) inhibition activities. This study reveals the potential of using A. bisporus, G. lucidum, and P. ostreatus for nutritional, functional, and therapeutic uses. [ABSTRACT FROM AUTHOR]

Background: Skeletal dysplasias are a diverse group of rare disorders in the chondro-osseous tissue that can have a significant impact on patient's functionality. The worldwide prevalence of skeletal dysplasias at birth is approximately 1:5000 births. To date, disease burden and trends of skeletal dysplasias in the Sri Lankan population have not been described in any epidemiological study. Our aim was to evaluate the burden and the current trends in hospital admissions for skeletal dysplasias in the Sri Lankan population. A retrospective evaluation of hospital admissions for skeletal dysplasia during 2017–2020 was performed using population-based data from the eIMMR database which covers government hospitals in the entire country. The trends in hospital admissions for skeletal dysplasias by calendar year, age, and types of skeletal dysplasia were described using appropriate summary statistics. Results: Respective crude admission rates of skeletal dysplasias in the years 2017, 2018, 2019 and 2020 were 5.2, 8.1, 8.0, and 6.5 per million population. A female predominance (1.4:1) was noted during the studied period. Of all reported cases the majority (n = 268; 44.2%) were children less than 4 years. Each year, 0–4 years age group represented 40–47% of the total hospital admissions. More than half of the cases were reported from Colombo (28.1%) and Kandy (25.4%) districts combined. 60% of cases were diagnosed as osteogenesis imperfecta (OI). Rising trends were observed in the hospital admissions for osteogenesis imperfecta, achondroplasia and osteopetrosis, while other skeletal dysplasia types collectively showed a relatively stable trend. Conclusion: This preliminary study revealed a female predominance of skeletal dysplasias and a relatively high admission rate of osteogenesis imperfecta in the Sri Lankan population. A distinct trend was not visible in the studied years probably due to the impact on hospital services due to COVID- Pandemic. Future research on the healthcare burden on families affected by skeletal dysplasia is required to better understand the overall cost of care and identify therapies that reduce admission rates. This study highlights the value of analysing population-based data on rare diseases to improve healthcare in low-resource countries. [ABSTRACT FROM AUTHOR]

Research on language learning strategies (LLS) has pointed to a significant association at a general level between learners' gender and their choice of LLS. To explore this generality further, we conducted a study on gender and strategy use with Sri Lankan learners (N = 886) of English as a second language (ESL) in five different learning contexts: speaking in class, listening in class, listening and speaking outside class, reading in class and writing in class. We found that when preferences for individual strategies were considered rather than for strategies in some broadly categorised group such as cognitive, metacognitive or affective strategies, some preferences did not associate with gender; nevertheless, some strategies were clearly preferred by males while others were clearly preferred by females. Perhaps most importantly for teacher development, we found that there were distinct preferences for males and females depending on the learning contexts in which specific strategies were reportedly being utilised. (Contains 1 note and 3 tables.)

The current study evaluates the efficacy of an intensive four-day contact intervention (a peace workshop) organized in Sri Lanka and represents an initial step toward understanding the long-term impact of such interventions on attitudes and behaviors in the context of protracted ethnic conflict. Compared with two control groups, the participant group showed greater empathy toward members of the "other" ethnicity, even one year after participation in the peace workshops. Consistent with the attitudinal data on empathy, participants donated more money to help poor children of the "other" ethnicity than did nonparticipants. Implications are discussed. (Contains 3 tables.)

This paper describes the distribution, abundance and seasonal variation in blue whales (BWs) on the south coast of Sri Lanka, off Mirissa, where they are faced with anthropogenic threats. Data collection encompassed opportunistic sightings by whale-watching (WW) operations. This study revealed that large aggregations of BWs consistently overlapped with busy shipping lanes located between Dondra Head and Galle within important foraging and breeding regions on the south coast. Throughout 2015 (except June and July), 729 BWs were sighted over 177 sighting days. The sighting frequency was higher during the northeast monsoon and the first intermonsoon and lower throughout the second intermonsoon (n = 9) and latter part of the southwest monsoon. The highest frequencies of BW encounters per day occurred in April (n = 15) and December (n = 20), while the mean annual group size per sighting was 3.07 ± 0.24. From the January-to-April season, 13 mother–calf combinations and 1 pregnant cow were sighted off the southern coastline of Mirissa, suggesting the calving season peaks between the months of March and April in Sri Lanka. As this important habitat overlapped with the busiest shipping lanes, fishing and commercial whale-watching activities, the authorities have to take action toward the conservation of this ecosystem and whales as well as their safe navigation. [ABSTRACT FROM AUTHOR]

Research aims: This study explores the factors affecting and the internal mechanisms employed by companies to manage their integrated reporting practices. Design/Methodology/Approach: The qualitative study is conducted through semi-structured interviews with 15 officers responsible for the integrated reporting practices of public listed companies in Sri Lanka. Research findings: The study found that relative advantage, compatibility, complexity, trialability, and observability affect the adoption of integrated reporting practices. Under the internal mechanism, it was found that sustainability reporting helped the adoption, and companies used their own ways to collect and manage information. Despite the companies' duration of practice, the constellations of structures, cultures, and reporting practices with which integrated reporting is managed change within the companies. Furthermore, the study showed the success stories of integrated reporting. Theoretical contribution/Originality: The study is the first South Asian and emergent market study to identify the enablers of integrated reporting by employing the diffusion of innovation theory as the theoretical foundation and internal mechanism. Practitioner/Policy implication: This study provides insight into the dynamic processes that operate within the framework of the organisational change that has taken place from this perspective and demonstrates how integrated reporting can be incorporated into the organisational change process. The experience of these organisations allows others that intend to embrace integrated reporting to choose the optimal way to implement it and use integrated reporting. Research limitations/Implications: Although much effort was taken to ensure that the study comprised successful IR businesses that displayed best practices in IR, this research study was confined to a small number of 15 public listed companies who participated. [ABSTRACT FROM AUTHOR]

The thermal stress of oceans causes coral bleaching, which induces loss of life in coral reefs and makes them exposed to other threats which directly and indirectly affect millions of other species that inhabit the reef. However, studies focusing on how those thermal stresses affect Sri Lankan fringing reef ecosystems are scarce. Hence, the patterns of long-term and short-term fluctuations of sea surface temperature (SST) over the shallow reefs around the country were studied by separating them into different zones as the eastern coast (Passikudha, Kayankerni, Adukkuparu, Parrot Rock, and Pigeon Island), the southern coast (Beruwala Barbarian, Hikkaduwa, Unawatuna, Ahangama, Mirissa, Madiha, Polhena, and Devundara), and northern-northwestern coasts (Valiththoondal, Palk Bay, Mannar, Kalpitiya, Thalwila, and Uswatakeiyawa). The 1 km Multiscale Ultrahigh Resolution (MUR) Level 4 SST dataset was used to analyze seasonal and interannual SST variability from 2005 to 2021. The data were correlated with the Indian Ocean Dipole (IOD), Ekman velocity, and wind stress curl. The annual, seasonal, and monthly variability of SST on different coasts is significantly different. Higher increasing trends of SST from 0.0324 to 0.0411 ℃/year are observed on different coasts, and most of the time higher positive anomalies are recorded after 2014. The First Inter Monsoon (IM-1) and the month of April are more critical since they reach the maximum SST, and the minimum is in the North West Monsoon (NWM) and January. Significant positive relationships are recorded between the Indian Ocean Dipole (IOD) index and the monthly average SST on different coasts, which was robust on the southern coast. Therefore, tropical coral reefs in Sri Lanka are severely threatened due elevation of SST by global warming and climate variability. [ABSTRACT FROM AUTHOR]

Background: Knowledge of early clinical manifestations, people's perceptions and behaviours is crucial in preventing and controlling neglected tropical diseases (NTDs). Cutaneous leishmaniasis is an NTD that causes skin lesions and affects millions worldwide. Delayed healthcare-seeking behaviour leading to prolonged treatment periods and complications is rife among people with cutaneous leishmaniasis. This study examined the patient-reported early clinical manifestations of cutaneous leishmaniasis, local interpretations and associated health behaviours within the socio-cultural context of rural Sri Lanka. Methodology/principal findings: We conducted a qualitative study among people with cutaneous leishmaniasis in three rural communities in the Anuradhapura district, Sri Lanka. Participants' experiences were explored through a study-bespoke participant experience reflection journal and in-depth interviews. We analysed the data using a narrative-thematic approach. The study included 30 people with cutaneous leishmaniasis (12 females and 18 males) aged between 18 and 75 years. We identified four major themes during the analysis: 1) patient-reported early clinical manifestations of cutaneous leishmaniasis, 2) local interpretations of the early skin lesion(s), 3) associated actions and behaviours, and 4) the time gap between the initial notice of symptoms and seeking healthcare for cutaneous leishmaniasis. Early clinical manifestations differed among the participants, while the majority misinterpreted them as a mosquito/ant bite, pimple, wart, eczema, macule, or worm infestation. Participants undertook different context-specific self-management actions to cure cutaneous leishmaniasis. We identified an average time gap between the notice of symptoms and the first visit to the healthcare facility ranging from three to twelve months. Conclusions/significance: Diverse early clinical manifestations, local interpretations, and associated behaviours of people with cutaneous leishmaniasis have led to a substantial delay in healthcare-seeking. The study sheds light on the importance of understanding the manifestations of NTDs within the social context. Our findings will inform designing context-specific health interventions to improve awareness and healthcare-seeking in cutaneous leishmaniasis in rural settings. Author summary: Sri Lanka records a high annual incidence rate of leishmaniasis. Early diagnosis and prompt treatment for cutaneous leishmaniasis are crucial to reduce complications and infection transmission and to facilitate a speedy recovery. Delayed healthcare-seeking in cutaneous leishmaniasis hinders effective disease management leading to a significant burden for the affected people and the healthcare systems. Therefore, this study explored how people with cutaneous leishmaniasis describe and interpret early symptoms of the disease and behave in a certain way leading to a substantial time gap between the notice of symptoms and seeking healthcare. Our study findings are important for three primary purposes; 1) for designing awareness-raising and public health campaigns related to cutaneous leishmaniasis for the general public, 2) for healthcare professionals to conduct an early and accurate clinical diagnosis of cutaneous leishmaniasis and initiate prompt treatment following laboratory confirmation, leading to much-improved disease management and 3) for policymakers to revisit and tailor the national and regional level guidelines and programmes related to leishmaniasis toward successful prevention, early diagnosis, effective treatment and control of the disease. [ABSTRACT FROM AUTHOR]

Purpose: Live rocks are very important and highly demanded in the global aquarium industry and can be cultured easily without sophisticated techniques or knowledge. Marine Live rock culture may become a conceivable alternative industry among the resource utilizing coastal communities in Sri Lanka. However, it has not been scientifically studied yet. Research Method: Nine types of cement rocks were made by changing three types of shapes and three types of substrates and those were placed in different study locations on the Southern and Eastern coast of Sri Lanka covering all four types of monsoon patterns prevail in the country. Findings: Live species attachments, their attachment rates, and consumer preferences differed with the shape, substrate, monsoon pattern, study location, and growth period in the sea and most of those differences were statistically significant. Consumer preference was mainly dependent on the nature of biota attachments on top of the different rock types. Therefore, their preferences were also changing with the types of rock, monsoon pattern, and location. Originality/Value: Findings can be effectively utilized for establishing live rock culture as an alternative industry, especially in ecosystems where resources are depleted or degraded. [ABSTRACT FROM AUTHOR]

People's quality of life (QOL) has been disrupted globally in the wake of the pandemic in recent times. This was mainly due to global economic crises fuelled by the coronavirus (COVID– 19) and other related factors. Sri Lanka, too, was facing major social and economic constraints in the period 2021–2022. Thus, all communities islandwide have been economically disturbed. Among others, people with Visual Impairment and Blindness (VIB) have been pushed to severely disadvantageous positions, financially and otherwise. A sample from three geographical locations in Sri Lanka; and eleven individuals representing diverse cadres in Sri Lankan society were purposively selected for the study based on the existence of the majority of the visually impaired community using a mixed approach. Descriptive statistics were utilised to analyse the identified socio-economic characteristics. Ordered probit regression was employed to determine the mediating effect of socio-economic status on income levels. Word Cloud illustrates the factors affecting the QOL. Most severely impaired individuals are more likely to earn a lower rate of income. This situation has degraded their lives and poor QOL. Participants' responses elucidate that facilities, resources, education, opportunities, income, employment, and government activities would enhance their QOL. The study adds value to society by recognising VIB people, helping them gain financial independence and strengthening them without marginalising the impaired community. The proposed policies in this study would be valuable for these social groups to address their wealth concerns. [ABSTRACT FROM AUTHOR]

Background/Aims: The prevalence of perinatal mental health issues is significantly higher among South Asian women in the UK. However, little attention has been given to examine the views and opinions of sub-groups of South Asians in the UK. Although the prevalence of perinatal mental health issues is much higher in Sri Lanka, so far, no studies have focused on Sri Lankan women in the UK. This study's aim was to examine the views and opinions of Sri Lankan women living in the UK about perinatal mental health. Methods: A convergent mixed-method online survey was administered in English and Sinhalese. A total of 34 Sri Lankan women living in the UK, from their baby's conception to 24 months postpartum, were recruited. Qualitative responses were interpreted using thematic analysis, supported by quantitative data. Results: The participants reported that they maintained good perinatal mental health with the support of their partner and family. Midwives were most involved in inquiring about and providing information on perinatal mental health. Social stigma was a dominant barrier to accessing support. Conclusions: Midwives need to ensure that perinatal mental health is discussed sensitively with Sri Lankan women. Future quantitative research needs to examine if existing tools are culturally sensitive and qualitative research should include women's partners and families to explore how best to care for this population. [ABSTRACT FROM AUTHOR]

Underutilized wild edible species or neglected crop species are still used at low levels within the local communities, but show a high potential to contribute to the food supply with more health benefits. This study was conducted to assess the nutritional properties of two underutilized wild edible species, namely, Acrostichum aureum and Talinum triangulare available in Sri Lanka. Plant extracts were analyzed for their ascorbic acid content, total phenolic content, antioxidant activities, and mineral contents (Ca, Cu, Zn, and Fe). Bioaccessibility of minerals was also tested through an in vitro digestion model. Ca is the most abundant micronutrient (45.61-102.91 mg/100 g) in both tested species, while the in vitro bioaccessibility assay shows a higher fraction of Ca (47.46%) in A. aureum and Cu (64.68%) in T. triangulare. The highest concentrations of ascorbic acid and total phenolic content were found in T. triangulare (AAC: 165 mg/100 g; TPC: GAE,34.8 mg/100 g). Studied species were found to have significant antioxidant activities as evaluated by two different methods, such as DPPH and ABTS radical scavenging activity. In relation to the tested data, T. triangulare has shown the greatest antioxidant activity in both methods. Hence, consumption of identified underutilized plant species may serve as good sources of antioxidants and minerals in their natural form. [ABSTRACT FROM AUTHOR]

Due to the significant quantities of waste generated by the Sri Lankan rice industry, circular bioeconomy methodologies were applied to examine value-adding entrepreneurial activities for rice industry by-products (RIB). The study was conceived after scouring the existing literature on agricultural waste management and interviewing experts in the field and the rice industry. In the first phase, the suitability of valorizing alternatives for RIB was considered via a multi-criteria decision-making method. Valorization options, such as biochar production, energy purposes, composting, and other activities, were evaluated using an analytical hierarchy process (AHP) based on four criteria, namely environmental, social, technical, and economic issues. The results indicated that the highest priority should be given to environmental, social, and economic considerations, with local priority vectors of 0.5887, 0.2552, and 0.0955, respectively. It was found that biochar production is the optimal valorization strategy for managing RIB in Sri Lanka. From these findings, the development of a sustainable business model for making biochar out of RIB was done based on commercial motivations and value addition in biochar manufacturing processes. The Business Model Canvas elements played a vital role in categorizing and interpreting the case study data. Though the RIB seems undervalued at present, it was found that as a direct result of environmental concerns, several stakeholders have developed RIB valorization with an emphasis on bioenergy generation and biochar production. Adequate subsidies (technology and knowledge), standard regulations, more collective actions for creating economies of scale, and marketing strategies (consumer awareness) are all necessary for the successful implementation of sustainable circular business models. [ABSTRACT FROM AUTHOR]

River basins are logical units interacting with geological formations and anthropological footprints while providing many rewards to humans and the associated ecosystems. Yan Oya is the primary surface water source in the North Central Province of Sri Lanka. The timely study focused on analyzing the present status of surface water quality in the Yan Oya river basin to evaluate the impacts of anthropological activities. Forty surface water samples were collected in wet and dry seasons in 2019. Principal component analysis (PCA) was employed to evaluate the similarities and dissimilarities of the water quality between three different zones of the Yan Oya river basin. At the same time, GIS was applied to show the spatial distribution of water quality parameters. According to the Sri Lankan Standards for drinking water, pH, DO, NO3−, NO2−, NH4+, TP, fluoride, Na+, K+, and trace metal concentrations remained within permissible limits. Electric conductivity (EC), total dissolved solids (TDS), chemical oxygen demand (COD), turbidity, total hardness (TH), fecal coliform, and total coliform were exceeded the allowable threshold levels. PCA analysis revealed that the significance of geomorphological catchment factors and land use features on broad-scale water quality patterns and the study identified that spatial variations in cations (Na+, K+, Ca2+, Mg2+), TH, EC, and TDS. High FC contamination was the most important factor variable for COD and turbidity in the Yan Oya river. The results yielded spatiotemporal patterns of contamination divided along anthropogenic footprints, serving as a benchmark for future studies, particularly basins that have reservoirs constructed to facilitate better human consumption of water. [ABSTRACT FROM AUTHOR]

Introduction/objectives: Psoriasis is a chronic inflammatory dermatosis with significant physical and psychological impact leading to negative influence on the quality of life among patients with psoriasis. Other than the disease characteristics many external factors could operate in South Asian context. Lack of a reliable disease-specific instrument prevents objective estimation and monitoring of disability in patients with psoriasis and hence we aim to validate assess the psychometric properties of the Sinhala version of PDI. Methods: A cross-sectional study conducted at dermatology clinic at a tertiary care National Hospital in Sri Lanka. Patients with psoriasis and on therapy at least 4 weeks prior to enrollment, aged more than 18 years, were included while those with already diagnosed psoriatic arthritis and/or nail psoriasis alone without any skin involvement and generalized pustular psoriasis de novo were excluded. All patients were examined by dermatologist to obtain disease characteristics. The reliability was assessed by internal consistency using Cronbach's α and item-total correlation. Convergent validity was measured with the known groups. Results: Of 199 patients studied, the PDI Sinhala version showed Cronbach's α of 0.86 (all 15 items) and ranged from 0.57 to 0.77 for subscales. PDI score and Dermatology Life Quality Index (DLQI) showed good correlation of coefficient 0.76 (p < 0.01). Positive associations were noted with extent and severity of psoriasis when using sample medians (p < 0.05). The dimensionality of the PDI was determined using exploratory factor analysis and four factors were structured. Conclusion: The PDI Sinhala version is proved to be valid and reliable tool to assess the burden of psoriasis among Sinhala conversant patients in Sri Lanka [ABSTRACT FROM AUTHOR]

The distal great saphenous vein is a popular site for venous access by means of percutaneous cannulation or venous cutdown in a hemodynamically unstable patient. The aim of this study was to precisely define the surface anatomy and dimensions of the distal part of the great saphenous vein to facilitate the aforementioned procedures. Cross-sectional anatomy of the distal saphenous vein was studied in 24 cadaveric ankles sectioned at a horizontal plane across the most prominent points of the medial and lateral malleoli. The curvilinear distance from the most prominent point of the medial malleolus to the center of the saphenous vein, its widest collapsed diameter and skin depth were obtained. The great saphenous vein was located at a mean distance of 24.4 ± 7.9 mm anterior to the medial malleolus. The mean widest collapsed diameter was 3.8 ± 1.5 mm. The mean distance from the skin surface to the vein was 4.1 ± 1.2 mm. These measurements could be used to locate the saphenous vein accurately, particularly in hemodynamically unstable patients with visually indiscernible veins. [ABSTRACT FROM AUTHOR]

Air quality in urban areas is deteriorating over time with the increased pollutant distribution levels mainly caused due to anthropogenic activities. In addition, these pollutant distribution levels may relate to changing meteorological conditions. However, the relationships were not researched in-depth in the context of Sri Lanka, a country with a significant impact on climate change. The main objective of this study was to provide a broader perspective on the seasonal variation of tiny particles in air (PM2.5 and PM10), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), and sulfur dioxide (SO2) in two urban cities (Colombo and Kandy) in Sri Lanka over 3 years period (2018–2021) and the possible relationships between air pollution and meteorological variables. Results show that all the aforementioned pollutants except O3 consistently depict two peaks during the day, one in the morning (∼07:00–09:00 local time) and the other in the evening (∼18:00–20:00 local time). These peaks coincided with the traffic jams observed in both cities. The results further revealed that the concentration of all pollutants has significant seasonal variations. Compared to two monsoon seasons, the highest daily average PM2.5 (31.2 μg/m3), PM10 (49.5 μg/m3), NO2 (18.9 ppb), CO (717.5 ppb), O3 (18.5 ppb), and SO2 (9.4 ppb) concentrations in Colombo are recorded during northeast monsoon (NEM) seasons while contrast pattern is observed in Kandy. In addition, it was found that wind speed with its direction is the most influencing factor for the pollutant concentration except for SO2 and O3 in two cities, and this is irrespective of the season. This study's findings contribute to understanding the seasonality of ambient air quality and the relationship between meteorological factors and air pollutants. These findings ultimately lead to designing and implementing season-specific control strategies to achieve air pollution reduction at a regional scale. [ABSTRACT FROM AUTHOR]

Students consider the selection of their college major as one of the critical decisions in their life. Literature suggests that influencing factors can differ based on the academic discipline, student status (freshmen, declared, etc.), and geography. We select two countries, the United States and Sri Lanka, with contrasting education systems and study the factors which may have influenced students to become mathematics majors. We consider the effect of ten influencing factors, which form three clusters, namely, "Career-Related", "Math-Related", and "Other". The study first reveals that the factors and clusters significantly affect student decisions in the two countries. One of the critical conclusions of the study is how the "Math-Related" cluster influences students' decisions significantly more than the other two clusters. We also look at the difference in the impact of specific influencing factors on the two populations and find that factors related to the nature of mathematics influence US students more than Sri Lankan students. The study's conclusions should benefit teachers and recruiters when guiding future math majors. [ABSTRACT FROM AUTHOR]

Blue whales Balaenoptera musculus are the most abundant and widely distributed cetacean species in Sri Lankan waters. A vessel-based opportunistic line transect survey focusing on marine mammals was conducted in Sri Lankan waters between 24 June to 12 July 2018, while an ecosystem survey was performed by the R/V Dr. Fridtjof Nansen. The entire transect length was 2090 km within an area of 3895 km2. Overall, 72% (n = 57) of blue whale observations were group assemblages ranging between 1 and 5 individuals out of a total of 79 sightings. The largest aggregations of blue whales were recorded at the intersection of the submarine canyon off the coastline of Mirissa and busy shipping lanes between Dondra Head and Galle, where previous ship strikes were recorded. Overall, the average observed group size was 2.64 (CV, 12.34%; 95% CI, 2.07–3.38), the average group density was 0.0029 km−2 (CV, 35.96%; 95% CI, 0.00145–0.00610), and the total blue whale abundance within the survey area was 513 individuals (CV, 38.02%; 95% CI, 243–1083). These survey results fill vital knowledge gaps regarding the abundance and distribution of blue whales in Sri Lanka, which is essential for the establishment of management and conservation strategies. [ABSTRACT FROM AUTHOR]

Nipa (Nypa fruticans Wurmb.) is an important mangrove palm species, but it is understudied due to lack of information on genetic patterns within its distribution range. In this study, we identified 18 informative microsatellite markers to assess genetic variations among local populations in the Indo-West Pacific (IWP). Results showed population stratification based on high genetic differentiation (FST = 0.22131) with the Mantel test indicating significance to isolation-by-distance. We found a pronounced differentiation between the west populations in Sri Lanka and east populations in Southeast Asia. The east populations around the South China Sea were more genetically similar than those along the Malacca Strait and Java Sea. These genetic clines were shaped by ocean circulations and seasonal monsoon reversals as plausible factors. The Malacca Strait was confirmed as both a genetic and a geographic barrier rather than a corridor according to the Monmonier plot. Simulations of directional migration indicated a statistically strong contemporary genetic connectivity from west to east where Sri Lankan immigrants were detected as far as central Philippines via long-distance dispersal. This is the first report on the recent migration patterns of nipa using microsatellites. Assignment of first-generation (F0) immigrants suggested Mainland Southeast Asia as a melting pot due to the admixture associated with excess of homozygosity. The western populations were recent expansions that emerged in rapid succession based on a phylogram as supported by footprints of genetic drift based on bottleneck tests. [ABSTRACT FROM AUTHOR]