The awareness of cultural beliefs and customs seems not to have attracted adequate attention during the phase of teaching and learning in ESP courses. The requirements of effective and appropriate interaction and communication with other cultures (Wiseman, Hammer, & Nishida, 1989) bring this matter to ESP teachers and learners. That studying merely from the course book and completing the given tasks discourages students from exploring the world, which expects a more efficient way to include language acquisition and cultural awareness. This paper explores the correlation of cultural awareness and blended learning in which educator in charge of a tourism class can raise students’ cultural communicative competence together with their understanding of global culture. Some of the key issues of this pedagogical methodology also can be discussed regarding language learning, cultural awareness and self-studying in an ESP course.   Keywords-Cultural awareness, blended learning, ESP, cultural communicative competence, language acquisition, Vietnam

Introduction The present study aims to identify normal high-resolution anorectal manometry (HRAM) values and related factors in healthy Vietnamese adults. Methods The present cross-sectional study was conducted at the Viet Duc hospital, Hanoi, Vietnam, during April and May 2019. Healthy volunteers were recruited to participate in the study. Anorectal measurement values from the digestive tract, including pressure, were recorded. Results A total of 76 healthy volunteers were recruited. The mean functional anal canal length was 4.2 ± 0.5 cm, while the mean anal high-pressure zone length was 3.4 ± 0.5 cm. The mean defecation index was 1.4 ± 0.8, with values ranging from 0.3 to 5.0. The mean threshold volume to elicit the rectoanal inhibitory reflex (RAIR) was 18.1 mL. The mean rectal sensation values were 32.4 mL, 81.6 mL, and 159 mL for first sensation, desire to defecate, and urge to defecate, respectively. Dyssynergic patterns occurred in ∼ 50% of the study participants and included mainly types I (27.6%) and III (14.6%). There were significant differences between male and female patients in terms of maximum anal squeeze pressure, maximum anal cough pressure, maximum anal strain pressure, maximum rectal cough pressure, and maximum rectal strain pressure (all p < 0.01). Conclusions The present study establishes normal HRAM values in healthy Vietnamese adults, particularly regarding normal values of anorectal pressure and rectal sensation. Further studies that include larger sample sizes should be conducted to further confirm the constants and their relationships.

Background This study aims to identify normal HRAM values and related factors in healthy Vietnamese adults. Methods This cross-sectional study was conducted at Viet Duc hospital, Hanoi, Vietnam, during April and May, 2019. Healthy volunteers were recruited to participate in the study. Anorectal measurement values including pressure and an electromyographical signal from the digestive tract were recorded. Differences between groups were analyzed using paired t-tests, and linear regression models was used to compare anorectal values between men and women. Results A total of the 76 healthy volunteers was recruited. The mean functional anal canal length was 4.2 ± 0.5 cm while the mean anal high-pressure zone (HPZ) length was 3.4 ± 0.5 cm. The mean defecation index was 1.4 ± 0.8, with values ranging from 0.3 to 5.0. The mean threshold volume to elicit RAIR was 18.1 mL. Mean rectal sensation values were 32.4 mL, 81.6 mL, and 159 mL at the first sensation, the desire to defecate, and the urge to defecate, respectively. Dyssynergic patterns occurred in approximately 50% of study participants and included mainly types I (27.6%) and III (14.6%). There were significant differences between males and females in maximum anal squeeze pressure, maximum anal cough pressure, maximum anal strain pressure, maximum rectal cough pressure, and maximum rectal strain pressure (all p < 0.01). Conclusions This study establishes normal HRAM values in healthy Vietnamese adults, particularly with regards to normal values of anorectal pressure and rectal sensation. Further studies that include larger sample sizes should be conducted in order to further confirm the constants and their relationships.