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The focal point of this writing is to spotlight the brutal gender discrimination, suppression and servitude endured by Maya Angelou, an acclaimed American writer and distinguished poet, a plucky rape survivor, splintered the prejudiced stereotypes, metamorphosing the whole world. This writing further dissects how Maya Angelou swallowed the pellet of subjugation and gender marginalization through her poetry. The kaleidoscopic view of Angelou’s poetry unfolds the keynotes of class distinction, toxic masculinity, bondage and notably racism. The particular goal of this writing is the interpretation of Angelou’s poetry in context of chauvinist discrimination that tormented the Black women and how Angelou’s writings appeased dolour community. The writing engaged both primary and secondary data sources. The primary source includes Maya Angelou’s metrical compositions and publications. The secondary source encompasses Angelou’s memoirs, the web and other featured treatise. Ultimately, the writing finalizes with an objective ameliorating an unprivileged women’s life globally by dint of Angelou’s influential poetry.

Contains fulltext : 290851.pdf (Publisher’s version ) (Open Access) BACKGROUND AND OBJECTIVES: Our objective was to develop an extension of the widely used GIN-McMaster Guideline Development Checklist and Tool for the integration of quality assurance and improvement (QAI) schemes with guideline development. METHODS: We used a mixed-methods approach incorporating evidence from a systematic review, an expert workshop and a survey of experts to iteratively create an extension of the checklist for QAI through three rounds of feedback. As a part of this process, we also refined criteria of a good guideline-based quality indicator. RESULTS: We developed a 40-item checklist extension addressing steps for the integration of QAI into guideline development across the existing 18 topics and created one new topic specific to QAI. The steps span from 'organization, budget, planning and training', to updating of QAI and guideline implementation. CONCLUSION: The tool supports integration of QAI schemes with guideline development initiatives and it will be used in the forthcoming integrated European Commission Initiative on Colorectal Cancer. Future work should evaluate this extension and QAI items requiring additional support for guideline developers and links to QAI schemes. 01 februari 2023

Systematic reviews are necessary to synthesize available evidence and inform clinical practice and health policy decisions. There has been an explosion of evidence available in many fields; this makes it challenging to keep evidence syntheses up to date and useful. Comparative effectiveness systematic reviews are informative; however, producing these often-large reviews bring intense time and resource demands. This commentary describes the implementation of a systematic review using a collaborative model of evidence synthesis. We are implementing the collaborative review model to update a large Cochrane review investigating the efficacy and comparative effectiveness of the design, delivery, and type of exercise treatment for people with chronic low-back pain. Three key benefits of the collaborative review model for evidence synthesis are (1) team coordination and collaboration, (2) quality control measures, and (3) advanced comparative and other analyses. This new collaborative review model is developed and implemented to produce and share high-quality, comparative evidence more efficiently while building capacity and community within a research field.

Objective: To emphasize the importance of antenatal diagnosis of the morbidly adherent placenta, employ management options accordingly and their impact on the patient’s outcome. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Okara Pakistan, Jan 2018 to Aug 2020. Methodology: One hundred and twenty-four patients were enrolled in the study. Diagnosed morbidly adherent placenta was made through trans-abdominal ultrasound, and a Doppler study in selected cases of posterior placenta previa magnetic resonance imaging (MRI) was performed. The surgical approach was either a high transverse placenta sparing or a classical incision on the uterus. After delivery of baby, conservative management included resection of part of uterus with adherent placenta followed by reconstruction of the lower uterine segment, segmental resection of myometrial tissue and hemostatic sutures, and over sewing of placental bed. The requirement of blood transfusion, intensive care unit stay, post-operative recovery, and day of discharge, along with all demographic and surgical details, was noted. Results: In 87(70%) patients, high transverse or placental sparing incision was made to assess the baby. Over sewing of the placental bed was done in 37(29.8%) patients, and myometrial segment resection was done in 57(46%) patients. An obstetrical hysterectomy was carried out in 30 patients. Blood transfusion of > 4 units RCCs was required in 92(74%) patients. 16% the patients required intensive care management. Conclusion: Antenatal diagnosis of morbidly adherent placenta through useful imaging modality allowed for a planned surgical approach and minimized......

Suprasegmental phonemes are the linguistic phenomenon which has phonemic value in a language. These features do not have a specific form as segments but have semantic relativity. As the numbers of suprasegmental features are not specified in Pashto Linguistics, but in most of the sources, stress, accent, intonation, syllable, pitch, and juncture are known as suprasegmental features. Rhythm is a type of intonation which has a specific value in the language. While changing intonation causes semantic changes. The accent is a phenomenon that takes place upon the segments, syllables and words and changes its meanings. In Pashto prose and verse, stress has its exact importance, which causes changes in the meaning of the sentence. Juncture is another suprasegmental phenomenon that causes changes in the context while reading it continuously or breaking it up into parts. The syllable is another suprasegmental feature which may be consisted of a single vowel or a vowel and consonant or consonants.

Children are the future of the world, but their health and future are facing great uncertainty because of the coronavirus disease 2019 (COVID-19) pandemic. In order to improve the management of children with COVID-19, an international, multidisciplinary panel of experts developed a rapid advice guideline at the beginning of the outbreak of COVID-19 in 2020. After publishing the first version of the rapid advice guideline, the panel has updated the guideline by including additional stakeholders in the panel and a comprehensive search of the latest evidence. All recommendations were supported by systematic reviews and graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Expert judgment was used to develop good practice statements supplementary to the graded evidence-based recommendations. The updated guideline comprises nine recommendations and one good practice statement. It focuses on the key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin (IVIG) for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health.This updated evidence-based guideline intends to provide clinicians, pediatricians, patients and other stakeholders with evidence-based recommendations for the prevention and management of COVID-19 in children and adolescents. Larger studies with longer follow-up to determine the effectiveness and safety of systemic glucocorticoids, IVIG, noninvasive ventilation, and the vaccines for COVID-19 in children and adolescents are encouraged.• Several clinical practice guidelines for children with COVID-19 have been developed, but only few of them have been recently updated. • We developed an evidence-based guideline at the beginning of the COVID-19 outbreak and have now updated it based on the results of a comprehensive search of the latest evidence.• The updated guideline provides key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health.

The current study was conducted to assess the water quality of Valley Duhok as a water source for drinking livestock and poultry in the region. Seventy-two water samples were collected from six sites in the valley to conduct physicochemical and biological tests, and the sub-index model (WQI) was applied to assess water quality.The results of the water quality index indicated that the water of Duhok Dam Lake (site N1) was of good quality for drinking livestock and poultry, while the rest of the sites on the valley were in the category of water very poor for drinking animals, with WQI values ranging from (204-286).This deterioration in water quality is a result of the relative increase in the three parameters of most of the studied properties, especially dissolved oxygen, organic load, and phosphate ions, to reach the values for the quality rating (Qi) and Sub-Index (Sbi)to(500and56.8),(1026and117)and(958and87.1)consecutively.

Objectives: To describe divergence between actionable statements issued by coronavirus disease 2019 (COVID-19) guideline developers cataloged on the “COVID-19 Recommendations and Gateway to Contextualization” platform. Study Design and Setting: We defined divergence as at least two comparable actionable statements with different explicit judgments of strength, direction, or subgroup consideration of the population or intervention. We applied a content analysis to compare guideline development methods for a sample of diverging statements and to evaluate factors associated with divergence. Results: Of the 138 guidelines evaluated, 85 (62%) contained at least one statement that diverged from another guideline. We identified 223 diverging statements in these 85 guidelines. We grouped statements into 66 clusters. Each cluster addressed the same population, intervention, and comparator group or just similar interventions. Clinical practice statements were more likely to diverge in an explicit judgment of strength or direction compared to public health statements. Statements were more likely to diverge in strength than direction. The date of publication, used evidence, interpretation of evidence, and contextualization considerations were associated with divergence. Conclusion: More than half of the assessed guidelines issued at least one diverging statement. This study helps in understanding the types of differences between guidelines issuing comparable statements and factors associated with their divergence. © 2022

In this work, Cobalt (0-10) % doped MgO nanoparticles are prepared for magnetic and optical studies. X-ray diffraction studies show the particle size increases from 3.10 nm to 9.50 nm with increasing Cobalt concentration in MgO samples. The secondary phases are observed beyond 5% Cobalt in the host MgO which indicates the solubility limit of dopant in this material. SEM analysis further reconfirms the purity and spherical morphology of nanoparticles in all samples. Its result also reveals that the smallest particles have the largest oxygen vacancy concentration as compared to other samples. The dopant and size-induced effects are observed for electronic absorption spectra and bandgap of the samples. UV-visible absorption spectra show a quantum confinement effect as the optical band gap decreases with the increase of the particle size. The optical band gap of the nanoparticles ranges from 4.68 eV to 3.15 eV which is very less in comparison with the bulk MgO band gap up to 7.2eV. Vibrating sample magnetometer studies at room temperature clearly show the ferromagnetic behavior for pure MgO nanoparticles in contrast with the paramagnetic behavior for other samples. It is suggested that the presence of the ferromagnetic behavior in pure MgO nanoparticles are due to the presence of oxygen vacancies.

Effects of Cu addition (0-5)% in ZnO are studied for structural and optical properties. The structural, photoluminescence properties and vibrational modes are strongly influenced with the Cu incorporation. Detailed investigations of the structural features of Cu doped ZnO nanostructures are reported. Our results show the systematic decrease in crystallite size (50.40 - 37.56 nm), lattice strain (1.82 - 1.49 micro), lattice stress (216.33 - 177.64 MPa) and energy density (196.78 - 132.69 KJ/m3) in the limit of small dopant concentration (0 < Cu ? 0.02). Decreasing trends are attributed to the smaller ionic size of Cu in comparison of Zn. Beyond Cu= 0.02 an increasing trend was noticed in crystallite size (41.67 - 70.67 nm), lattice strain (1.90 – 3.11 micro), lattice stress (226.32 – 369.35 MPa) and energy density (215.40 – 573.67KJ/m3. This increase in structural parameters is attributed to segregation of secondary phases for Cu content increase beyond 0.02. Two prominent regions in PL spectra were observed and the deconvoulution of these regions show a strong correlation with the structural changes observed within the limit of high and low dopant concentration. The FTIR spectra show shift of Zn-O vibrational mode toward higher frequency with increasing Cu concentration.