Official Recommendations Research Articles

Parsley production using organic sources of phosphorus

Parsley is a condiment produced mainly by small producers, often in the organic system. Organic fertilizers make nutrients slowly available to plants when compared to inorganic fertilizers, an important quality for phosphorus (P), which is a nutrient that tends to fixate and adsorption. Thus, the objective of this work was to evaluate the production of parsley with the use of organic sources of phosphorus in different proportions. Fourteen treatments were evaluated, resulting from the factorial 6 x 2 + 2: six proportions of two phosphate fertilizers (thermophosphate Yoorin® (TY) and bone meal (BM)), two doses (recommended (180 kg.ha-1 of P2O5, and double this) + two controls (without phosphate fertilizer; and with inorganic triple superphosphate fertilizer (recommended dose)). The proportions were: 100% P with TY; 80% P with TY + 20% with BM; 60% P with TY + 40% with BM; 40% P with TY + 60% with BM; 20% P with TY + 80% with BM; 100% P with BM. Shoot height, number of leaves, fresh and dry weight of leaves in two harvests and the total of these two harvests were evaluated. No significant differences were obtained in the two harvests. The lack of effect to phosphate fertilization may be related to the high initial P content in the soil (123 mg.dm-3), which shows that in this case, fertilization with this nutrient is not necessary to produce parsley, despite the official recommendation to fertilize with phosphorus in a soil with a high P content.

BOOSTING SMALL BUSINESS AND ENTERPRISE CREATION AND DEVELOPMENT IN UZBEKISTAN

This paper aims to investigate strategies for enhancing the creation and development of Small and Medium Enterprises (SMEs) in Uzbekistan. SMEs play a vital role in fostering economic growth, generating employment opportunities, and promoting innovation. Despite their potential contributions, SMEs in Uzbekistan face numerous challenges that hinder their establishment and growth. This study seeks to identify these challengesand propose effective measures to overcome them, thereby fostering a conducive environment for SME development. Through a comprehensive analysis of the current state of SMEs in Uzbekistan and an exploration of successful strategies employed in other countries, this paper provides valuable insights and recommendations for policymakers, government officials, entrepreneurs, and other stakeholders interested in promoting SME growth and entrepreneurship in Uzbekistan.

Antibiothérapie des infections respiratoires basses de l’enfant

Lower respiratory tract infections (LRTI) encompass a wide range of clinical syndromes, prominently including bronchiolitis, bronchitis and pneumonia. LRTIs are the second leading cause of antibiotic prescriptions. The vast majority of these infections are due to (or triggered by) viruses and are self-limited diseases. Pneumonia in children is responsible for significant morbidity and mortality worldwide. For clinicians, one of the main difficulties consists in diagnosing pneumonia in febrile children with (or without) cough. The diagnosis is given on the basis of anamnesis, clinical examination and (if necessary) complementary examinations, with chest X-ray or thoracic ultrasound; biological markers are particularly important. Over recent years, since the implementation of PCV13, the bacterial epidemiology of pneumonia and empyema has evolved; involvement in these diseases of pneumococcus has been reduced, and resistance to penicillin has lessened – and remained extremely low. In 2021, according to the National Pneumococcal Reference Center, only 6% of the strains isolated from blood cultures in children are resistant to amoxicillin. The therapeutic choices proposed in this article are in full compliance with the previously published official French recommendations.

Earthquake recommendations in Europe: Types and diversity

Disaster literature agrees that knowledge alone is insufficient to promote the adoption of preparedness by populations. Nevertheless, this is a prerequisite for initiating behaviour. Governments and Civil Protection authorities are among the multiple sources of information on preparedness and appropriate disaster behaviours. If these sources are trusted, members of the public will accept the information they transmit. However, few studies have addressed the content of risk communication messages from European authorities. We analysed and discussed the frequency and diversity of household earthquake preparedness and response measures recommended by European Civil Protection authorities in countries exposed to seismic risk, using 84 official website documents and texts from 25 countries. Authorities highly recommended behaviours to apply during an earthquake, focusing on physical protection and conforming to the literature. However, official recommendations weakly recommended planning measures, a well-established preparedness component in the literature. Furthermore, authorities failed to reinforce skill acquisition, insurance acquisition, structural mitigation, and other mitigation measures. Nevertheless, non-structural mitigation was highly advised and was more frequent than stockpiling recommendations. The results also pointed to concerns about the behaviour of residents during and after an earthquake, misinformation, and to the diversity of measures in each country, disagreeing with previous research. Local differences and factors related to the process of selecting recommendations may explain the results. This study contributes to the literature on earthquake recommendations, risk communication, household preparedness and response, and practical applications of preparedness and response literature.

An Analysis of the Correct Frequency of the Service Inspections of German Passenger Cars—A Case Study on Kazakhstan and Poland

This article presents a case study on estimating the real service inspection intervals for German-brand passenger cars in Kazakhstan and Poland. This study aimed to identify disparities between the official recommendations of manufacturers for car maintenance and the real data collected in these two countries. The following passenger cars were examined: Audi A6, Q5, and Q8; Porsche Cayenne and Cayenne coupe; and Volkswagen Passat, Polo, Teramont, Tiguan, Touareg, Arteon, Golf, T-Cross, Tiguan all space, Touran, T-Roc, and Up. To assess the difference between real and recommended values, the manufacturer criteria of a recommended mileage of 15,000 and 30,000 km or a time frame of 365 and 730 days to the first service inspection were applied. The data analysis showed that in Kazakhstan, 31.4% of cars did not meet the warranty conditions, while in Poland, it was 21.0%. The dominant criterion that was not met was the time criterion. The assessment of these factors emphasizes the importance of customizing vehicle maintenance schedules to the specific conditions and driving behaviors prevalent in each country. The practical contribution of the article lies in uncovering the discrepancies between official manufacturer recommendations for car maintenance and the actual data collected in Kazakhstan and Poland. By identifying specific models, Volkswagen Touareg and Tiguan in Kazakhstan and Volkswagen Up in Poland, for which the maintenance intervals deviated significantly from those recommended, this study offers valuable insights for optimizing service schedules and improving the efficiency of maintenance practices in these countries. From a scientific perspective, this article contributes by providing empirical evidence of real-world maintenance behaviors for German-brand passenger cars.

Role of virtual reality in advancing forensic medical examination in cases of occupational safety violations: a review

This article discusses the prospects for introducing innovative technologies in the form of virtual and augmented reality when conducting forensic examinations of certain categories of criminal cases, such as violations of labor protection rules. Problematic aspects are revealed when conducting inspections of crime scenes in hard-to-reach areas with possible risks to people.
 Based on a generalization of scientific works and practical experience of foreign countries, the application of innovations in scientific and technological progress in forensic examinations were analyzed.
 The authors proposed an algorithm for conducting forensic examination in the field of labor protection using virtual reality technology, as well as its further application in legal proceedings. The proposed algorithm can serve as basis for the development of more effective and safe methods for conducting forensic examinations in virtual reality.
 The development of detailed 3D injury models that simulate real-life accident scenarios will enable more accurate and objective injury assessments. Moreover, compared to traditional forensics, the use of virtual reality technology ensures high accuracy of measurements and coverage of the entire object under investigation, significantly reduces operating time, and stores all received information in its original state, which is an excellent opportunity to recreate the scene of an incident in real time.
 The introduction of virtual reality into forensic examination in cases of violation of labor protection rules will contribute to efficiency, objectivity, completeness, and ensuring the reliability of not only the conclusions of forensic examinations but also legal proceedings in general. Additionally, this direction of technology development represents significant benefits for the judicial system, contributing to the reduction of time and fair trials in the field of labor protection and in other categories of criminal cases.

Transfusion of blood components in pediatric age groups: an evidence-based clinical practice guideline adapted for the use in Egypt using ‘Adapted ADAPTE’

Pediatric transfusion is a complex area of medicine covering a wide age range, from neonates to young adults. Compared to adult practice, there is a relative lack of high-quality research to inform evidence-based guidelines. We aimed to adapt the pre-existing high-quality practice guidelines for the transfusion of blood components in different pediatric age groups to be available for national use by general practitioners, pediatricians, and other health care professionals. The guideline panel included 17 key leaders from different Egyptian institutions. The panel used the Adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to the target context of use. The guideline covered all important aspects of the indications, dosing, and administration of packed red cells, platelets, and fresh frozen plasma. It also included transfusion in special situations, e.g., chronic hemolytic anemia and aplastic anemia, management of massive blood loss, malignancies, surgery, recommendations for safe transfusion practices, and recommendations for modifications of cellular blood components. The final version of the adapted clinical practice guideline (CPG) has been made after a thorough review by an external review panel and was guided by their official recommendations and modifications. A set of implementation tools included algorithms, tables, and flow charts to aid decision-making in practice. This adapted guideline serves as a tool for safe transfusion practices in different pediatric age groups.

XBB.1.5 monovalent mRNA vaccine booster elicits robust neutralizing antibodies against XBB subvariants and JN.1

COVID-19 vaccines have recently been updated to specifically encode or contain the spike protein of the SARS-CoV-2 XBB.1.5 subvariant, but their immunogenicity in humans has yet to be fully evaluated and reported, particularly against emergent viruses that are rapidly expanding. We now report that administration of an updated monovalent mRNA vaccine booster (XBB.1.5 MV) to previously uninfected individuals boosted serum virus-neutralizing antibodies significantly against not only XBB.1.5 (27.0-fold increase) and EG.5.1 (27.6-fold increase) but also key emerging viruses such as HV.1, HK.3, JD.1.1, and JN.1 (13.3- to 27.4-fold increase). Individuals previously infected by an Omicron subvariant had the highest overall serum neutralizing titers (ID50 1,504-22,978) against all viral variants tested. While immunological imprinting was still evident with the updated vaccines, it was not nearly as severe as observed with the previously authorized bivalent BA.5 vaccine. Our findings strongly support the official recommendation to widely apply the updated COVID-19 vaccines.

Practices of French General Practitioners Regarding Vaccination of Boys Against Human Papillomavirus (HPV), One Year After the Application of Its Official Recommendation

In 2019, French health authorities extended the recommendation for human papillomavirus (HPV) vaccination to include boys aged 11 to 19 years. We describe HPV vaccination practices among French general practitioners (GPs) since this recommendation wasapplied. We also identified factors associated with the propensity to propose HPV vaccination to boys. Cross-sectional study, between May and August 2022, among French GPs using a questionnaire asking about the GPs, their practices, and opinions regarding HPV vaccination, including whether they systematically proposed HPV vaccination to eligible boys or not. We investigated factors associated with systematic proposal of HPV vaccination, using univariate and multivariate logistic regression. In total, 360 GPs participated (76.6% females; mean age 34.7 ± 7.8 years; 22.9% had additional training in gynecology or pediatrics); 5.5% reported that they systematically offered HPV vaccination to boys prior to the recommendation, whereas 61.2% do so systematically since the recommendation. Factors associated with systematic proposal to boys (post recommendation) were female GP sex (78.6% versus 66.2%; OR = 2.0 [95% confidence interval (CI) 1.2–3.3]; p = 0.007) and systematic proposal prior to the recommendation (8.5% versus 0.7%; OR = 13.3 [1.7–101.7]; p = 0.01). Protection against HPV-induced cancer was cited as an argument to vaccinate girls (98.3% versus 89.2%; p < 0.0001); while reducing the risk of transmission was more commonly an argument to vaccinate boys (78.1% versus 51.8%; p < 0.0001). This study underlines the positive impact of the official recommendation for HPV vaccination of boys on the attitude of GPs, with an increase in the systematic proposal of HPV vaccination to boys.

Confounders in Predictive Medical Models: The Role of Religion

Aim: The aim of this study was to assess the acceptance among natural science specialists of the current official regulatory recommendations to avoid utilizing artificial intelligence (AI) and machine learning (ML) models that could exacerbate social disparities. Materials and Methods: An anonymous online survey was conducted using the Telegram platform, where participants were asked a single question: "Do you consider the inclusion of religious status in AI and ML models justified from the perspective of medical ethics and science?" Respondents were provided with only two response options: "Yes" or "No." This survey was specifically targeted at international groups, focusing primarily on English and Russian-speaking clinicians and scientific researchers. Results: 134 unique individuals participated in the survey. The results revealed that two-thirds of the respondents (87 individuals) agreed that including Religion status as predictor in the ML and AI models is inappropriate. Conclusion: Two-thirds of healthcare practitioners and scientific researchers participating in this survey agree that categorizing individuals within healthcare settings based on their religion is inappropriate. Constructing healthcare predictive models based on confounders like religion is unlikely to aid in identifying or treating any pathology or disease. However, the high conflict potential of this predictor may deepen societal disparities.

Risk of Cardiovascular Events After Influenza: A Population-Based Self-Controlled Case Series Study, Spain, 2011-2018.

This study explores the relationship between influenza infection, both clinically diagnosed in primary care and laboratory confirmed in hospital, and atherothrombotic events (acute myocardial infarction and ischemic stroke) in Spain. A population-based self-controlled case series design was used with individual-level data from electronic registries (n = 2 230 015). The risk of atherothrombotic events in subjects ≥50 years old increased more than 2-fold during the 14 days after the mildest influenza cases in patients with fewer risk factors and more than 4-fold after severe cases in the most vulnerable patients, remaining in them more than 2-fold for 2 months. The transient increase of the association, its gradient after influenza infection, and the demonstration by 4 different sensitivity analyses provide further evidence supporting causality. This work reinforces the official recommendations for influenza prevention in at-risk groups and should also increase the awareness of even milder influenza infection and its possible complications in the general population.

Chirurgie bariatrique et médicaments : revue de la littérature et analyse des effets indésirables dans la banque nationale de pharmacovigilance

Bariatric surgery is the only treatment for severe obesity (BMI>35kg/m2) currently recognized as effective both in achieving tangible and lasting weight loss, and in improving obesity-related comorbidities such as type 2 diabetes, hypertension, and cardiovascular complications. Bariatric surgery, like any other surgery of the digestive tract, can have an impact on nutrient absorption, as well as on drug absorption. The literature on drug management in bariatric surgery patients concerned mainly of case reports and retrospective studies involving a small number of patients. No official guidelines are available. We conducted a literature search on the consequences of bariatric surgery in terms of drug bioavailability and/or effect. The Medline® (PubMed) database was searched using the following keywords: "bariatric surgery", "bioavailability", "gastric bypass", and "obesity". We completed this review with an analysis of reports of adverse drug reactions (ADRs) in post-bariatric surgery patients for obesity registered in the National pharmacovigilance database (PVDB). We selected all cases with the mention of "bariatric surgery and/or gastrectomy" as "medical history". After reading the cases, we excluded those in which the patient had undergone surgery for an indication other than obesity, where the route of administration was other than oral, and cases in which ADRs resulted from voluntary overdose, attempted suicide, allergy, switch to Levothyrox® new formulation, meningioma under progestative drugs, inefficacy related to generic substitution and medication error. The literature search identified mainly "case report" about the impact of bariatric surgery on so-called "narrow therapeutic window" drugs. We identified 66 informative cases out of a total of 565 cases selected (11%) in the PVDB. Nevertheless, the information does not allow a clear relationship between the occurrence of the ADR and the influence of bariatric surgery. There is a lack of official information and/or recommendations on medication use in subjects who have undergone bariatric surgery. Apart from under-reporting, ADRs reports remain largely uninformative. Health professional and patients would be awareness for improving, quantitatively and qualitatively the reporting of ADRs in this population.

P492 All intestinal ultrasound scores for ulcerative colitis (and IBUS-SAS) strongly correlate with endoscopic activity: a prospective study

Abstract Background Intestinal ultrasound (IUS) is gaining increasing acceptance as a reliable tool for tight monitoring of ulcerative colitis (UC). Although several IUS scores have been proposed, none has been formally implemented into official recommendations of international scientific societies. This study aims to compare the available IUS score for UC, in terms of correlation with endoscopic activity. Methods Patients with UC ≥ 18 years old undergoing partial or full colonoscopy between April and October 2023 were prospectively included. Endoscopic evaluation of at least the sigmoid colon was mandatory for inclusion, and patients with proctitis (Montreal E1) were excluded. Endoscopic activity was scored with both the Mayo Endoscopic Subscore (MES) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and defined by MES ≥ 1 and UCEIS ≥ 2. IUS was performed within 4 weeks of endoscopy. The Milan Ultrasound Criteria (MUC, Allocca et al.), the UC-IUS score (Bots et al.), the US Score from Parente et al., and the score from Hata et al. were included in the analysis. Applicability of the US Score from Civitelli et al, an IUS score developed for paediatric patients, and the IBUS-SAS, an IUS score validated for Crohn’s disease, was also evaluated. The Spearman’s rank coefficient (rho = ρ) was used to perform correlations, while receiver operating characteristic (ROC) curves were compared with the Hanley &amp; McNeil method. Results Fifty-nine patients were included, of which 59.3% and 50.8% showed any endoscopic activity using the MES and the UCEIS, respectively. Detailed information about the population is reported in Table. All the evaluated IUS scores showed a significant positive correlation with endoscopic activity (p &amp;lt; 0.001), with the UC-IUS score and the US Score from Civitelli et al. outperforming the others both with MES (ρ = 0.745, ρ = 0.762) and UCEIS (ρ = 0.751, ρ = 0.769). The same scores showed the highest Areas Under the Curve (AUC) for detecting a MES ≥ 2 (UC-IUS: 0.841, 95%CI 0.722-0.923, p &amp;lt; 0.001; Civitelli et al.: 0.842, 95%CI 0.724-0.924, p &amp;lt; 0.001) [Figure]. The optimal cut-offs for detecting a MES ≥ 2 with both the MUC and the Civitelli score were similar to that proposed by the Authors (&amp;gt; 5.04 vs &amp;gt; 6.20 and &amp;gt; 2 vs &amp;gt; 1, respectively). Conclusion All the included IUS scores showed good correlation with endoscopic activity. The UC-IUS and the US Score from Civitelli et al. performed better than the others in detecting a MES ≥ 2 and might be suggested to monitor disease activity of UC and intervene early during disease relapse.

Health Policy for Prostate Cancer Early Detection in the European Union and the Impact of Opportunistic Screening: PRAISE-U Consortium.

With the new policy recommendation in 2022 to explore the possibilities of screening for prostate cancer by the European Commission, the landscape for prostate cancer early detection is evolving. In line with this recommendation, the PRAISE-U project aims to evaluate the early detection and diagnosis of prostate cancer through customised and risk-based screening programmes, with the goal to align protocols across European Union member states. This systematic review is part of the PRAISE-U project, with the goal to review the policy, medical guideline recommendations, and the current level of opportunistic screening presented in the scientific literature on prostate cancer early detection from 2016 to 2023 in European Union member states. An extensive literature search was performed on 1 June 2023 in a large number of databases, including Embase.com, Medline (Ovid), Web of Science Core Collection, Google Scholar, and Policy Commons. We identified 318 articles (qualitative, quantitative, and reviews), of which 41 were included in the full-text screening. Seventeen articles were ultimately identified as eligible for inclusion. The included articles revealed significant variations towards PSA-based early detection policies for prostate cancer in nine European countries. Despite official recommendations, opportunistic screening was prevalent across all nine countries regardless of recommendations for or against PSA-based early detection. This systematic review suggests that the current early detection policies are not fit for purpose. High levels of opportunistic screening and overdiagnosis persist, prompting policy recommendations for standardised guidelines, informed decision making, and increased awareness to improve efficiency and effectiveness in early detection.

Recomendaciones SER sobre el tratamiento del síndrome de Behçet refractario

ObjectiveTo develop multidisciplinary recommendations based on available evidence and expert consensus for the therapeutic management of patients with refractory Behçet's syndrome (difficult to treat, severe resistant, severe relapse) to conventional treatment. MethodsA group of experts identified clinical research questions relevant to the objective of the document. These questions were reformulated in PICO format –patient, intervention, comparison and outcome–. Systematic reviews of the evidence were conducted; the quality of the evidence was evaluated following the methodology of the international working group Grading of Recommendations, Assessment, Development, and Evaluation. After that, the multidisciplinary panel formulated the specific recommendations. ResultsFour PICO questions were selected regarding the efficacy and safety of systemic pharmacological treatments in patients with Behçet's syndrome with clinical manifestations refractory to conventional therapy related to mucocutaneous and/or articular, vascular, neurological parenchymal and gastrointestinal phenotypes. A total of 7 recommendations were made, structured by question, based on the identified evidence and expert consensus. ConclusionsThe treatment of most severe clinical manifestations of Behçet's syndrome lacks solid scientific evidence and, besides, there are no specific recommendation documents for patients with refractory disease. With the aim of providing a response to this need, here we present the first official recommendations of the Spanish Society of Rheumatology for the management of these patients. They are devised as a tool for assistance in clinical decision making, therapeutic homogenisation and to reduce variability in the care of these patients.

What Happens If You Do Not Get Enough Sleep?

Good sleep is essential for a healthy lifestyle. The official recommendations for the length of a night’s sleep range from 7 to 9 h for adults and 10–13 h for children, depending on age. Based on this recommendation, many children and adolescents around the world do not get the recommended amount of sleep. In this article, we will review the reasons why young people are not getting enough sleep, discuss the effects of lack of sleep on brain function and emotions, and emphasize the benefits of adequate sleep for improving mood and optimizing performance in school. We will also examine how delaying the start of the school day could help increase overall sleep hours and reduce the negative consequences of sleep deprivation.

Plant Products for Musculoskeletal, Respiratory, Circulatory, and Genitourinary Disorders in Eastern and South-Eastern Serbia – Folk Uses Comparison with Official Recommendations

Plant Products for Musculoskeletal, Respiratory, Circulatory, and Genitourinary Disorders in Eastern and South-Eastern Serbia – Folk Uses Comparison with Official Recommendations

The impact of official recommendations during the COVID-19 pandemic on the clinical activity and business turnover of manual therapists in Sweden-The CAMP cohort study.

This study examined manual therapy business owners' perception of official recommendations during the COVID-19 pandemic and the impact on their clinics' economic performance, including clinic activity hours and business turnover. In a longitudinal study design, data were collected in November 2021 (baseline), and after three months, six months, and 12 months. Participants were manual therapists who were business owners. A growth curve model was used to analyze differences in clinical activity trajectories. Multinomial logistic regression analysis was used to assess the relationship between perceived disruptions in business and turnover. Qualitative text analysis was used to examine participants' responses to open-ended questions concerning economic measures taken to sustain their business during the pandemic. This study of 443 manual therapy business owners found that clinics were initially active with minimal variation, but activity changed following COVID-19 recommendations. Business owners perceived that the disruptions had no significant impact on turnover during the initial stages of the official recommendations. Economic support and the previous decrease in turnover increased the likelihood of experiencing a decreased turnover at 12 months. Business owners implemented cost-cutting measures and diversified income sources to navigate COVID-19 challenges and sustain their businesses. The official recommendations in Sweden had an impact on manual therapists' businesses as the COVID-19 pandemic lingered. Some business owners were concerned at the early stages about lower turnover but showed financial resilience by cutting costs and finding new revenue sources to overcome COVID-19 challenges.

Evaluation of endogenous residual insulin secretion by C-peptide measurement

C-peptide measurement allows an estimation of the residual endogenous insulin secretion in diabetic patients. Nowadays plasmatic testing is convenient and unexpensive, but we lack standardized tests. Therefore, there are no official recommendation regarding its use. As an indication, in some circumstances, C-peptide measurement could be used to specify the type of diabetes, help guide the treatment strategy and potentially assess the risk for complications. Its use is still limited and not recommended on a routine base for all patients living with diabetes, but in the future, tests standardization and establishment of reference ranges could give more insight on the clinical relevance of C-peptide measurement.

Outcomes-based education in Indonesian higher education: Reporting on the understanding, challenges, and support available to teachers

Outcome-Based Education (OBE) is a widely recognised approach to curriculum reform in higher education. This study investigates the level of understanding of OBE among tertiary teachers of English in Indonesia and explores the challenges that hinder, and the factor that support for the implementation of OBE in their classrooms. A total of 632 English teachers from 31 provinces in Indonesia participated in an online survey that comprised closed- and open-ended questions. The study employed descriptive statistics using SPSS 28 and thematic analysis using NVivo 12 to analyse the data. The findings reveal that most teachers feel confident in their understanding of OBE, but their understanding is not comprehensive. Teachers who implement OBE face significant challenges primarily due to self-related factors, including traditional views of a teacher-centred approach to teaching, heavy workloads, lack of awareness about OBE, and limited commitment and willingness to implement OBE. They also encounter difficulties in developing appropriate learning outcomes, teaching strategies, learning materials, and assessment tools. The strong commitment of university leaders is considered the most crucial factor for the success of OBE implementation. This article concludes with implications and recommendations for university leaders, government officials, curriculum developers and future researchers.