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Objective This study aimed to describe cases of cesarean scar pregnancies that were successfully treated with suction curettage under ultrasound guidance and their outcome. Methods This retrospective, descriptive case-series study was performed on 17 patients diagnosed with cesarean scar ectopic pregnancy in Sulaimani Maternity Teaching Hospital from May 2022 to April 2023. The patients’ sociodemographic and clinical data were collected. The patients were treated with suction curettage alone or in combination with local injection of methotrexate under ultrasound guidance. Results Patients with a viable fetus (n = 4) received local intrinsic methotrexate injection into the gestational sac and suction curettage, while those in whom the fetus had died (n = 13) underwent only suction curettage. Five patients required intrauterine balloon insertion to stop bleeding without further treatment, and only three required a blood transfusion owing to severe bleeding. Conclusions Cesarean scar ectopic pregnancy is a dangerous and complex disorder with an increasing occurrence in recent years. Accurate early diagnosis and effective management are essential to reduce maternal mortality and mortality of this type of pregnancy.

Background: CCHFV is well recognized as a major public health threat and its prevalence and epidemiological distribution in Pakistan and specifically in KP province is not well documented. Methods: We used a gold-standard PCR-based diagnostic assay for confirmation of CCHFV among suspected patients. A total of 150 patients were enrolled from June 2022 to September 2022 and their blood samples were collected for PCR confirmation. Results: The overall positivity rate for CCHFV was 26.67 %, with the virus mostly prevalent in the middle-aged group (21–40 years). In the July of 2022, a significant spike in the prevalence of CCHFV was observed in provincial capital Peshawar with the highest burden (31.57 %). Conclusion: Our findings indicate the necessity of strengthening CCHFV monitoring programs and intensifying efforts to identify hotspot regions for effective surveillance and control of CCHFV. The months before the Eid-ul-Adha are crucial in the context of CCHFV control.

This experiment was conducted in the poultry field of Kusar_Irbil Company, to study the effectof using the local mint leaf powder compared with vitamin C to decrease thermal stress and itseffect on the production performance of the broiler from 23/7/2021 to 2/9/2021. The chicksweight rate (35+3). Chicks were distributed randomly to seven treatments, 4 replicates for eachThe mint leaves powder and vitamin C were added to the diet from the 2 to 6 weeks of age. Thetreatments were: T1 control without any addition, T2,T3 and T4 addition of 1g, 2g and 3g mintleafs powder /kg feed,T5 mint leaves 1g/kg with vitamin C 25mg/kg feed T6 added mint leaves2g/kg mint leaves with vitamin25 mg/kg feed, added 2 mg/kg feed. T7 mint leaves at a rate of 3g/kg with vitamin25 c mg/kg feed.results showed a there are a significant difference (p

BACKGROUND: Sickle cell disease (SCD) is the second-most common hemoglobin disorder in Duhok governorate. Health-related quality of life (HRQoL) instrument provides physicians with the patient's perspectives of their disease and thus more patient-oriented care. MATERIALS AND METHODS: In this case–control study, a total of 70 adults (≥18 years old) registered as SCD at the center for blood diseases in Duhok as well as 70 age- and sex-matched healthy controls were enrolled. Enrolled patients had their records and treatment reviewed, were clinically assessed, and appropriately investigated. All patients and controls had their HRQoL scored using the SF36 questionnaire, which consists of eight domains, namely physical function, role limitation physical, role limitation emotional, vitality, emotional well-being, social function, bodily pain, and general health perception. RESULTS: The mean standard deviation age of the SCD patients enrolled was 26.2 (8.9) years and included 32 males and 38 females. The patients had significantly lower HRQoL scores in all eight domains when compared to their matched controls. The most affected domain was general health. Within the patients' group, it was noted that HRQoL scores were negatively correlated with age in several domains, most significantly with general health (P = 0.011). On the other hand, there was no significant difference in HRQoL in relevance to gender, marital status, education, or employment. The most significant negative correlations of HRQoL scores were documented with the annual number of pain episodes and hospital admissions observed with all eight domains. CONCLUSIONS: The current study documented that in adults with SCD, HRQoL in all domains was significantly worse than in healthy controls and that it gets worse with age. The most significant contributors to the worse HRQoL are pain episodes and hospital admissions. The study underscores the importance of HRQoL assessments to enable attending physicians provide more patient-centered management.

…for me you are a bright, wise, and compassionate woman and an exemplary academic, providing an embracing environment for her colleagues. I was most fortunate to be introduced to you first in 2018 for the preparations of the Learn X Design 2019 Ankara conference. That initial shy communication conducted via emails, turned into regular online meetings when I joined the DRS EdSIG convening group in late 2019, and then into intense engagements as we started working collectively for the Learn X Design 2021 Jinan conference. Many were involved with their hard work and valuable contribution, but your involvement in particular, has been a motivation for me in the process. We spent many productive hours in online meetings, organizing the event, and building the background to realise it. I love the tapestry that you have behind you on screen in the background, and I love that it is you who have made it. I love you telling us that you will go skiing after the meeting. I can actually imagine you in your suit, grasping your gear, and starting to ski immediately as you step out of the cabin. That is how skilled and talented I find you. Many times, I have felt a reciprocal understanding between the two of us, which has always been reassuring and encouraging. I have learned a lot from you. Thank you for being a friend!

This study explores the feasibility of using AI technology, specifically ChatGPT-3, to provide reliable, meaningful, and personalized feedback. Specifically, the study explores the benefits and limitations of using AI-based feedback in language learning; the pedagogical frameworks that underpin the effective use of AI-based feedback; the reliability of ChatGPT-3's feedback; and the potential implications of AI integration in language instruction. A review of existing literature identifies key themes and findings related to AI-based teaching practices. The study found that social cognitive theory (SCT) supports the potential use of AI chatbots in the learning process as AI can provide students with instant guidance and support that fosters personalized, independent learning experiences. Similarly, Krashen's second language acquisition theory (SLA) was found to support the hypothesis that AI use can enhance student learning by creating meaningful interaction in the target language wherein learners engage in genuine communication rather than focusing solely on linguistic form. To determine the reliability of AI-generated feedback, an analysis was performed on student writing. First, two rubrics were created by ChatGPT-3; AI then graded the papers, and the results were compared with human graded results using the same rubrics. The study concludes that e-Learning arning certainly has great potential; besides providing timely, personalized learning support, AI feedback can increase student motivation and foster learning independence. Not surprisingly, though, several caveats exist. It was found that ChatGPT-3 is prone to error and hallucination in providing student feedback, especially when presented with longer texts. To avoid this, rubrics must be carefully constructed, and teacher oversight is still very much required. This study will help educators transition to the new era of AI-assisted e-Learning by helping them make informed decisions about how to provide useful AI feedback that is underpinned by sound pedagogical principles.

Gender disparity in science and mathematics performance is being researched internationally. In a complex education system, like Pakistan, studying the difference in isolation may not generate holistic understanding. Therefore, this paper investigates changes in trends of performance in Science and Mathematics for both genders across public and private schools. Data were gathered from a nationwide sample of elementary grades students (n=15,391) using SATs/MATS. Independent t-test and two-way-ANOVA were employed to analyse data. Results revealed that girls outperformed boys in Science (p<0.01) while no gender differences in performance were observed in Mathematics. Gender and school systems demonstrated significant interaction effect only in mathematics, unveiling that girls perform better in public schools while this difference diminished in the private school system. The results show implications for employing gender-fair policies and practices in science and mathematics education.

Summary: Background: Autonomic dysfunction has been implicated in the pathophysiology of the Sudden Infant Death Syndrome (SIDS). Butyrylcholinesterase (BChE) is an enzyme of the cholinergic system, a major branch of the autonomic system, and may provide a measure of autonomic (dys)function. This study was undertaken to evaluate BChE activity in infants and young children who had died from Sudden Infant Death or Sudden Unexpected Death. Methods: In this case-control study we measured BChE activity and total protein in the eluate of 5μL spots punched from the dried blood spots taken at birth as part of the newborn screening program. Results for each of 67 sudden unexpected deaths classified by the coroner (aged 1 week-104 weeks) = Cases, were compared to 10 date of birth - and gender-matched surviving controls (Controls), with five cases reclassified to meet criteria for SIDS, including the criterion of age 3 weeks to 1 year. Findings: Conditional logistic regression showed that in groups where cases were reported as “SIDS death” there was strong evidence that lower BChE specific activity (BChEsa) was associated with death (OR=0·73 per U/mg, 95% CI 0·60-0·89, P=0·0014), whereas in groups with a “Non-SIDS death” as the case there was no evidence of a linear association between BChEsa and death (OR=1·001 per U/mg, 95% CI 0·89-1·13, P=0·99). Interpretation: BChEsa, measured in dried blood spots taken 2-3 days after birth, was lower in babies who subsequently died of SIDS compared to surviving controls and other Non-SIDS deaths. We conclude that a previously unidentified cholinergic deficit, identifiable by abnormal -BChEsa, is present at birth in SIDS babies and represents a measurable, specific vulnerability prior to their death. Funding: All funding provided by a crowd funding campaign https://www.mycause.com.au/p/184401/damiens-legacy

Background: In low- and middle-income countries (LMIC), 45% of deaths could be addressed by implementation of an emergency medical services (EMS) system. Prehospital care is a critical component of EMS worldwide, and basic, affordable training has been shown to improve EMS systems. However, patient outcome impact is unclear. In this study we aimed to assess the current state of prehospital care in Kigali, Rwanda, through a needs assessment, focused training intervention, and analysis of current practices and patient outcomes.Methods: We identified 30 clinicians through the prehospital medical command office and included them in the study. A prospective, nonrandomized, interrupted time-series approach was used. Data collected through closed- and open-ended questionnaires included age, sex, training, and knowledge assessment. We used the data to create a tailored, 18-hour training after which immediate and 11-month post-tests were administered. Linked prehospital and hospital care datasets allowed for evaluation of patient outcomes and prehospital process indicators that included training skill application, airway intervention, intravenous fluid administration, and glucose administration.Results: Of 30 clinicians, 18 (60%) were female, 19 were nurses, and 11 were nurse anaesthetists. Median age was 36, and median years providing care was 10 (IQR 7–11). Twenty-four (80%) participants completed immediate and post-test assessments. Mean knowledge across 12 core skills significantly improved from a pre-test mean of 59.7% (95% confidence interval [CI] 42.2–77.20) to a post-test mean of 87.8% (95% CI 74.7–100). At 11 months post-training, the score improvement maintained, with a mean score of 77.6%(95% CI 59.2–96.8). For patient outcomes, the total sample size was 572 patients; 324 of these patients were transported to the ED during the pre-training period (56.4%), while 248 were transported post-training. Prehospital oxygen administration for patients with a saturation level of

To learn the meaning of a new word, or to recognize the meaning of a known one, both children and adults benefit from surrounding words, or the sentential context. Most of the evidence from children is based on their accuracy and efficiency when listening to speech in their familiar native accent: they successfully use the words they know to identify other words' referents. Here, we assess how accurately and efficiently 4-year-old children use sentential context to identify referents of known and novel nouns in unfamiliar-accented speech, as compared to familiar-accented speech. In a looking-while-listening task, children showed considerable success in processing unfamiliar-accented speech. Children robustly mapped known nouns produced in an unfamiliar accent to their target referents rather than novel competitors, and they used informative surrounding verbs (e.g., "You can eat the dax") to identify the referents of both known and novel nouns--although there was a processing cost for unfamiliar-accented speech in some cases. This demonstrates that 4-year-olds successfully and rapidly process unfamiliar-accented speech by recruiting the same strategies available to them in familiar-accented speech, revealing impressive flexibility in word recognition and word learning across diverse linguistic environments.

With the adoption of sustainability continuing to gain momentum, there has never been a better time for business schools to understand the extent to which they are preparing students to contribute to sustainable organizations and society. The current research seeks to help schools advance this aim by examining the extent to which sustainability is being integrated within business school curricula. We accomplish this through a systematic analysis of 529 websites from undergraduate marketing programs accredited by the Association to Advance Collegiate Schools of Business (AACSB). To further our understanding of how sustainability can be integrated into curricula, we draw upon prior research and the United Nations' Blueprint for Sustainable Development Goal (SDG) Integration to propose a new sustainability curriculum framework. This research fills a gap in the literature by offering a comprehensive look at the state of sustainability in marketing education and offers direction for programs seeking to meet market demands, advance SDG goals, and fulfill current AACSB standards.

ObjectiveDiabetic foot ulcers (DFUs) present a significant global health challenge, resulting in high morbidity and economic costs. Current available treatments often fail to achieve satisfactory healing rates, highlighting the need for novel therapies. This study evaluated the safety and efficacy of a novel autologous whole blood clot (AWBC)-a blood-based, biodegradable provisional matrix-in conjunction with standard of care (SoC) when compared to SoC alone in the treatment of hard-to-heal DFUs.MethodA multicentre, prospective, blinded assessor, randomised controlled trial was conducted at 16 sites across the US, South Africa and Turkey. A cohort of patients with hard-to-heal DFUs was enrolled and randomised to either the AWBC group or the control group. The primary endpoint was complete wound closure at 12 weeks, while secondary endpoints included time to heal and percentage area reduction (PAR) at four and eight weeks. Data were analysed using both intention-to-treat (ITT) and per-protocol (PP) populations.ResultsThe cohort included 119 patients. AWBC treatment resulted in a significantly higher healing rate compared to the control in both ITT (41% versus 15%, respectively; p=0.002) and PP populations (51% versus 18%, respectively; p=0.0075). AWBC treatment also resulted in a shorter mean time to heal and higher durability of wound closure. Safety analysis showed a similar incidence of adverse events (AEs) between groups, with no device-related AEs.ConclusionThe AWBC system, by modulating the wound microenvironment and providing a functional extracellular matrix, offered a promising new approach to treating hard-to-heal DFUs, demonstrating superior healing outcomes compared to SoC alone in this study.

INTRODUCTION: Oral pre-exposure prophylaxis (PrEP) for HIV-1 infection is over 99% effective in protecting against HIV acquisition when used consistently and appropriately. However, PrEP uptake and persistent use remains suboptimal, with a substantial gap in utilization among key populations who could most benefit from PrEP. In Latin America specifically, there is poor understanding of barriers to PrEP uptake and persistence among transgender (trans) women. METHODS: In April-May 2018, we conducted qualitative interviews lasting 25-45 min as part of an end-of-project evaluation of TransPrEP, a pilot RCT that examined the impact of a social network-based peer support intervention on PrEP adherence among trans women in Lima, Peru. Participants in the qualitative evaluation, all adult trans women, included individuals who either (1) screened eligible to participate in the TransPrEP pilot, but opted not to enroll (n = 8), (2) enrolled, but later withdrew (n = 6), (3) were still actively enrolled at the time of interview and/or successfully completed the study (n = 16), or (4) were study staff (n = 4). Interviews were audio recorded and transcribed verbatim. Codebook development followed an immersion/crystallization approach, and coding was completed using Dedoose. RESULTS: Evaluation participants had a mean age of 28.2 years (range 19-47). When describing experiences taking PrEP, participant narratives highlighted side effects that spanned three domains: physical side effects, such as prolonged symptoms of gastrointestinal distress or somnolence; economic challenges, including lost income due to inability to work; and social concerns, including interpersonal conflicts due to HIV-related stigma. Participants described PrEP use within a broader context of social and economic marginalization, with a focus on daily survival, and how PrEP side effects negatively contributed to these stressors. Persistence was, in some cases, supported through the interventions educational workshops. CONCLUSION: This research highlights the ways that physical, economic, and social side effects of PrEP can impact acceptability and persistence among trans women in Peru, amplifying and layering onto existing stressors including economic precarity. Understanding the unique experiences of trans women taking PrEP is crucial to informing tailored interventions to improve uptake and persistence.

BACKGROUND AND OBJECTIVES: Epilepsies are associated with differences in cortical thickness (TH) and surface area (SA). However, the mechanisms underlying these relationships remain elusive. We investigated the extent to which these phenotypes share genetic influences. METHODS: We analyzed genome-wide association study data on common epilepsies (n = 69,995) and TH and SA (n = 32,877) using Gaussian mixture modeling MiXeR and conjunctional false discovery rate (conjFDR) analysis to quantify their shared genetic architecture and identify overlapping loci. We biologically interrogated the loci using a variety of resources and validated in independent samples. RESULTS: The epilepsies (2.4 k-2.9 k variants) were more polygenic than both SA (1.8 k variants) and TH (1.3 k variants). Despite absent genome-wide genetic correlations, there was a substantial genetic overlap between SA and genetic generalized epilepsy (GGE) (1.1 k), all epilepsies (1.1 k), and juvenile myoclonic epilepsy (JME) (0.7 k), as well as between TH and GGE (0.8 k), all epilepsies (0.7 k), and JME (0.8 k), estimated with MiXeR. Furthermore, conjFDR analysis identified 15 GGE loci jointly associated with SA and 15 with TH, 3 loci shared between SA and childhood absence epilepsy, and 6 loci overlapping between SA and JME. 23 loci were novel for epilepsies and 11 for cortical morphology. We observed a high degree of sign concordance in the independent samples. DISCUSSION: Our findings show extensive genetic overlap between generalized epilepsies and cortical morphology, indicating a complex genetic relationship with mixed-effect directions. The results suggest that shared genetic influences may contribute to cortical abnormalities in epilepsies.

This protocol serves as a guiding source for a Campbell registered systematic review aiming to assess the effectiveness of Public-Private Partnerships (PPPs) in education in Low- and Middle-Income Countries (LMICs). The primary question for this review is: What is known about the impact of PPPs on improving access (i.e., enrolment, attendance, drop-out, and completion) and quality (i.e., students' learning outcomes and teachers' teaching practices) of primary and secondary schooling in LMICs? Using a predefined search query, we will retrieve studies from various databases including Scopus, Campbell Library, EBSCO Education Research Complete, NBER, Dissertation and Theses Global (ProQuest), along with other sources of grey literature. Covidence will be used for screening and extraction. A bias assessment tool will be used for the included studies. A standardised mean difference (SMD) effect size of Hedges' g will be calculated for the outcome variables using RevMan.