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Background: ISARIC mortality score is a risk stratification tool that helps predict the in-hospital mortality of COVID-19 patients. However, this tool was developed and validated in a British population, and thus, the external validation of this tool in local populations is important. Objectives: External validation of the ISARIC mortality score in COVID-19 patients from a large Saudi Arabian intensive care unit (ICU). Methods: This is a retrospective study that included all adult patients with COVID-19 admitted to the ICU of King Saud Medical City, Riyadh, Saudi Arabia, from March 2020 to June 2021. Patients who were pregnant or had pulmonary tuberculosis/human immunodeficiency virus were excluded along with patients with missing variables. Data were collected to calculate the ISARIC mortality score and then fitting receiver operator characteristic curve against patients' outcome. Results: A total of 1493 critically ill COVID-19 patients were included. The mortality was 38%, the area under the curve of the score was 0.81 (95% confidence interval [CI]: 0.79–0.83, P < 0.001) and the cutoff value correctly classified 72.7% of the cohort. The cutoff value of >9 had sensitivity of 70.5% (95% CI: 66.6–74.3); specificity, 73.97% (95% CI: 71–76.8); positive predictive value, 62.4% (95% CI: 59.5–65.2) and negative predictive value, 80.2% (95% CI: 78.2–82.4). Conclusion: The ISARIC score was found to have excellent predictive ability for mortality in critically ill COVID-19 patients in our Saudi Arabian cohort. A cutoff score of >9 was the optimal criterion.

Background: The large-scale earthquake which had struck off Lombok, an island in West Nusa Tenggara, made the survivors faced poor conditions, difficulties, and lack of supplies. Besides physical losses, the survivors also experienced various psychological health disorders that significantly affected their psychological condition as well as life. Purpose: This study was aimed at exploring and gaining deeper meaning from the lived experiences of the Lombok earthquake survivors. Methods: This study used a qualitative method with a descriptive phenomenological approach to elucidate the phenomena from experiences. The participants were ten (10) survivors of the Lombok earthquake, who were determined by purposive sampling. Data were collected through in-depth interviews and analyzed using Colaizzi's method. Results: The results showed six emerging themes, including (1) problems solving skills when disaster strikes, (2) surviving from the limitations and difficulties, (3) feeling accustomed to earthquake, (4) family is a key source of strength to continue life, (5) getting closer to God by doing religious prayers and actions to have peace of mind, and (6) learning from the disasters to become a better human being. Conclusion: The lived experience of the Lombok earthquake survivors was a long journey where they survived and adapted the difficult situations, as later, they could turn the under-pressure conditions to chances for their personal development. The findings of this study provide insights for nurses to greatly contribute to solving post-disaster psychological issues by strengthening the survivors’ religious aspects, trauma healing, play therapy, and peer-support group.

Recent studies report that during the U.S. trade war, the overall burden of tariffs has entirely passed on to U.S. firms and consumers in terms of higher import prices, but the pass-through is incomplete in the case of steel products. Using 10-digit import data from U.S. Customs for 2018–2019, contrary to the recent literature, we find that import tariff pass-through is complete for steel products. We also find significant and large supply chain adjustments following the imposition of tariffs. However, despite the supply chain adjustments, the overall imports of steel products, which moved in tandem with domestic steel consumption over the last ten years, exhibited a declining trend. The overall steel imports declined from 34.5 in 2017 to 26.3 million metric tons in 2019. During the same period, domestic production increased from 81.6 to 87.9 million metric tons, almost equal to the peak production the U.S. achieved in 2012 and 2014. [ABSTRACT FROM AUTHOR]

Moyamoya disease is a sporadic cerebrovascular malady categorized by progressive stenosis of the internal carotid arteries and successive development of friable collateral vessels in the brain. The primary root of Moyamoya disease remains undefined, with a genetic predisposition playing an essential role. Familial cases show autosomal dominant inheritance patterns, Chained to particular genetic mutations. Genetic factors cooperating with environmental factors add to disease development. The moyamoya disease mostly occurs in East Asian countries like Korea and Japan. It has global impact. Its occurrence percentage shows demographic variations, with a greater prevalence among females and diverse agerelated occurrence in childhood and adulthood. These patterns show genetic and environmental factors' interconnected linkage. Clinical Manifestations show transient, ischemic strokes, ischemic attacks and intracranial hemorrhages. Clinical signs vary between children and adults, with the later more susceptible to strokes. Cognitive impairment and motor discrepancies also arise due to compromised cerebral perfusion. Diagnosis depends on clinical assessment, neuroimaging, and angiography. Imaging techniques like Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans identify cerebral ischemic or hemorrhagic events. Cerebral angiography confirms the diagnosis by revealing a characteristic collateral vessel formation resembling a "puff of smoke." Treatment management includes revascularization procedures, such as direct or indirect bypass surgeries, to improve cerebral blood flow. Medical therapies, including antiplatelet agents, aim to reduce thrombotic risks. Continuing follow-up is crucial to calculate treatment-efficacy and disease progression. [ABSTRACT FROM AUTHOR]

The present literary study posits the argument that contemporary women's poetry depicts androgyny as a subversive tool against patriarchal order and gender-specific behaviors. The selected poetry of American and British women writers is explored for the representation of androgynous role and the ways it problematizes and challenges patriarchal stereotypical norms of gender identity and gender determined attitudes and performances. To substantiate the claim in relation to this particular motif in contemporary women's poetry, the theoretical concepts of flexible performativity, inter-gender egalitarianism and enhanced artistic capability from within the broader theory of Androgyny are applied to substantiate the claim in the analysis of the poetic works. A close reading of the selected poetry is done to show that androgyny is employed as a subversive tool in the selected body of creative writing. [ABSTRACT FROM AUTHOR]

Background. New sonographic quality criteria to optimize optic nerve sheath diameter (ONSD) measurements were suggested. The latter were correlated to elevated intracranial pressure (ICP) in traumatic brain injury (TBI). Aim. We investigated whether ONSD measurements were correlated to simultaneous ICP measurements in severe TBI. Methods. Forty patients with severe TBI (Marshall Scale ≥II and GCS ≤8) participated in the study. All patients had an intraparenchymal ICP catheter inserted, while ONSD was measured bilaterally, upon admission and over the next 48 hours, based on the new sonographic criteria. A total of 400 ONSD measurements were performed, while mean ONSD values of both eyes were used in the analysis. Results. ONSD measurements were strongly correlated to ICP values (r=0.74, p

The World Conference on Education for All (1990) stated that learning begins at birth. The Dakar Framework for Action (2000) included the expansion and improvement of early childhood care and education as the first of six global goals. A number of countries have launched a variety of efforts to meet their global commitment to the development of care and education services for their young children. Pakistan is one of the signatories of the Education for All movement. However, Pakistan has not nationally agreed to implement a systematic scheme of early childhood education. Thus, Pakistan is considered "far behind" in its progress towards meeting the goal of early childhood education. One strategy in some countries has been to use mothers in the education of the young. However, this policy option is problematic in Pakistan, since educating mothers to become literate and more knowledgeable about contemporary childrearing will require far more extensive efforts and resources than in other countries. This article is an effort to uncover the basic issues around early childhood education in Pakistan and to provide practicable, research-based suggestions regarding early childhood education.

This research study is theoretically based on postcolonial ecocriticism: a critical paradigm for the rigorous scrutiny of the impacts of European colonialism and American neocolonialism on the ecology of postcolonial states. The theoretical concepts under the rubrics of which the selected literary text "How to Get Filthy Rich in Rising Asia" (2013) has been scrutinized are taken from the works of Graham Huggan and Helen Tiffin, and Feldman and Hsu, the pioneering and key theoreticians of postcolonial ecocriticism. Feldman and Hsu postulate that the global unequal distribution of environmental burdens is vitally linked to the racial inequality, geographically uneven development, and global stratification of the North and South, while Huggan and Tiffin argue that Euro-American politico-economic manipulation and extortion of postcolonial economies make them subscribe to a capitalist growth model that is both demonstrably asymmetrical, and carries a potentially devastating environmental cost. The literary text "How to Get Filthy Rich in Rising Asia" (2013) by Mohsin Hamid, a Pakistani English novelist, is a highly merited fictional work with the narrative being woven around the rise of a lower-class protagonist to riches and power. The novel has been previously academically explored from postmodern, feminist, linguistic, and a broadly approbatory ecocritical perspective; however, it significantly portrays negative images of postcolonial ecology as well. This study, by exploring the thematic connections between neoliberal capitalism and environmental dilapidation, fills a research gap in available academic works on the novel. [ABSTRACT FROM AUTHOR]