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In the framework of this study, the phenomenon of transfer is probed pragma-linguistically and socio-linguistically concerning marriage situations among Iraqi EFL learners. The study also strives to look at the refusal strategies most commonly employed by Iraqi female English as a foreign Language (EFL) learners compared to their counterparts, American native speakers of English. The study involved 70 female participants who answered a Discourse Completion Task (DCT), which contained ten marriage proposals to be refused. Each situation entailed refusal of a person from a higher, an equal, and lower status. The researchers adapted Beebe, Takahashi, and Uliss Weltz's (1990) taxonomy of refusal for analyzing the data comprehensively. The study's findings indicated that Iraqi female EFL learners followed similar patterns of refusing marriage situations to American speakers. The most prevalent strategies used by the two groups were "reasons/ excuses and explanations," followed by "statements of regrets," and then "non-performative statements" with slight variation in frequency. However, the Iraqi learners' native language and culture affected how they formulated their refusal; hence they manifested pragma-linguistic and socio-pragmatic transfer in particular areas. The areas of pragma-linguistic transfer included the literal translation of words, expressions, and structures into their refusal in English. As for the socio-pragmatic areas, the transfer occurred in certain Arabic culture features like elaboration, exaggeration, repetition, endearing terms, and many others in expressing the target language, English.

AimsTo determine the extent of shared decision-making (SDM), during selection of oral anticoagulant (OAC) and rhythm control treatments, in patients with newly diagnosed atrial fibrillation (AF).Methods and resultsWe evaluated survey data from 1006 patients with new-onset AF enrolled at 56 US sites participating in the SATELLITE substudy of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT II). Patients completed surveys at enrolment and at 6-month follow-up. Patients were asked about who made their AF treatment decisions. Shared decision-making was classified as one that the patient felt was an autonomous decision or a shared decision with their healthcare provider (HCP). Approximately half of patients reported that their OAC treatment decisions were made entirely by their HCP. Compared with those reporting no SDM, patients reporting SDM for OAC were more often female (47.2% vs. 38.4%), while patients reporting SDM for rhythm control were more often male (62.2% vs. 57.6%). The most important factors cited by patients during decision-making for OAC were reducing stroke and bleeding risk, and their HCP's recommendations. After adjustment, patients with self-reported understanding of OAC, and rhythm control options, had higher odds of having participated in SDM [odds ratio (OR) 2.54, confidence interval (CI): 1.75-3.68 and OR 2.36, CI: 1.50-3.71, both P ≤ 0.001, respectively].ConclusionShared decision-making is not widely implemented in contemporary AF practice. Patient understanding about available therapeutic options is associated with a more than a two-fold higher likelihood of SDM, and may be a potential target for future interventions.

• Pulmonic valve endocarditis (PVE) is a rare complication of infective endocarditis. • It is occasionally associated with significant pulmonic insufficiency (PI). • PVE usually has a benign course, but it can sometimes be complicated. • Doppler and echocardiographic parameters are commonly required to grade the severity of PI. • The decision to manage complicated PVE conservatively versus surgically is challenging.

BackgroundThe necessity for rapid evaluation and treatment of acute ischemic stroke with intravenous tPA (tissue-type plasminogen activator) may increase the risk of administrating tPA to patients presenting with noncerebrovascular conditions that closely resemble stroke (stroke mimics). However, there are limited data on thrombolysis safety in stroke mimics.Methods and resultsUsing data from the Get With The Guidelines-Stroke Registry, we identified 72 582 patients with suspected ischemic stroke treated with tPA from 485 US hospitals between January 2010 and December 2017. We documented the use of tPA in stroke mimics, defined as patients who present with stroke-like symptoms, but after workup are determined not to have suffered from a stroke or transient ischemic attack, and compared characteristics and outcomes in stroke mimics versus those with ischemic stroke. Overall, 3.5% of tPA treatments were given to stroke mimics. Among them, 38.2% had a final nonstroke diagnoses of migraine, functional disorder, seizure, and electrolyte or metabolic imbalance. Compared with tPA-treated true ischemic strokes, tPA-treated mimics were younger (median 54 versus 71 years), had a less severe National Institute of Health Stroke Scale (median 6 versus 8), and a lower prevalence of cardiovascular risk factors, except for a higher prevalence of prior stroke/transient ischemic attack (31.3% versus 26.1%, all P

Blunt cardiac injury (BCI), also referred to in the literature as a cardiac contusion, is a known cause of myocardial injury. It is often challenging to diagnose this condition in the absence of clear diagnostic criteria. Furthermore, its clinical presentation is highly variable depending on the severity, type, and duration of the trauma, as well as the timing from the initial insult. The clinical manifestation of BCI ranges from none to fatal arrhythmias to cardiac wall rupture seen on post-mortem examination. Cardiac biomarkers and electrocardiograms (EKG) are usually helpful in identifying cardiac trauma but are not necessarily abnormal in all cases. Falls by slipping on ice are common in the winter, but rarely do people present with a myocardial injury with these mechanical events. We describe the case of a cardiac contusion with an unusual presentation and an unusual cause, whereby both the initial EKG and troponin level were normal, and the patient presented with an atrioventricular (AV) block two weeks after "slipping on ice".

Indigenous communities worldwide continue to disproportionately bear the burden during pandemics due to ongoing health inequities and systemic exclusion from pandemic decision-making processes. As the global community prepares for the next pandemic, it is critical to prioritise Indigenous leadership and governance within public health responses. This commentary highlights successful models of Indigenous-led pandemic responses during COVID-19 in Canada and Australia. It introduces the EPIC (Equity, Partnerships, Intelligences, and Change) framework, that emphasises equity, leadership and local and cultural intelligence as critical components to improve pandemic preparedness and response for Indigenous communities. This international collaboration calls on governments and health authorities to uphold Indigenous sovereignty, self-determination, and leadership in pandemic planning and response efforts. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the association between cytomegalovirus (CMV) and abortion in 150 women using diagnostic methods (ELISA and Real-time PCR targeting the Ul55 gene). The research reveals a CMV prevalence of 13.53%, with significant correlations between CMV infection and sexually transmitted diseases, multiple sexual partners, recurrent miscarriages and headache/fever. Sensitivity and specificity for IgG in detecting CMV infection were 100% and 6.12%, while for IgM, they were 78.26% and 100%, respectively. The optimal cut-points for IgG and IgM were identified at 145.65 mg/dL and 4.5 mg/dL, demonstrating sensitivities of 65% and 96%, specificities of 25% and 95% and AUCs of 0.45 and 0.95, respectively. Real Time PCR, the gold standard for pathogen detection, outperforms ELISA as a screening test for CMV infections, especially in detecting IgG. This study underscores the significance of molecular methods, recommending their stronger and faster application for effective cytomegalovirus detection. [ABSTRACT FROM AUTHOR]

An emerging body of literature examines multiple connections between water insecurity and mental health, with particular focus on women’s vulnerabilities. Women can display greatly elevated emotional distress with increased household water insecurity, because it’s them who are primarily responsible for managing household water and uniquely interact with wider water environments. Here we test an extension of this proposition, identifying how notions of dignity and other gendered norms related to managing menstruation might complicate and amplify this vulnerability. Our analysis is based on systematic coding for themes in detailed semi-structured interviews conducted with twenty reproductive-age women living in two water insecure communities in New Delhi, India in 2021. The following themes, emerging from our analysis, unfold the pathways through which women’s dignity and mental health is implicated by inadequate water: ideals of womanhood and cleanliness; personal dignity during menstruation; hierarchy of needs and menstruation management amidst water scarcity; loss of dignity and the humiliation; expressed stress, frustration and anger. These pathways are amplified by women’s expected roles as household water managers. This creates a confluence of gendered negative emotions – frustration and anger – which in turn helps to explain the connection of living with water insecurity to women’s relatively worse mental health.

Purpose: To compare effectiveness of Peribulbar and topical anesthesia in phacoemulsification in terms of severity of pain. Study Design: Quasi experimental study. Place and Duration of Study: This cross-sectional study was conducted at Eye Department, Liaquat National Hospital, Karachi, from August 2017 to January 2020. Methods: This study included 1154 patients of 40-75 years of age who underwent phacoemulsification. Complete ocular examination was performed. Patients were allocated into two groups by convenient sampling. Cataract surgery was performed under Peribulbar anesthesia in 577 patients and other 577 patients were operated using topical anesthesia. Pain was assessed by Visual Analogue Scale Score. Frequency and percentage and mean ± standard deviation was computed for qualitative and quantitative variables respectively using SPSS version 21. Chi square test was used for stratification of gender, duration of symptom and age, p≤0.05 was considered significant. Results: Average age of the patients was 57.43±6.70 years. There were 576(49.9%) males and 578(50.1%) females. There were 34 (5.9%) patients in Peribulbar group and 382 (66.2%) patients in topical group who had no pain (p=0.0005). Frequency of mild, moderate and sever pain was less in patients given topical anesthesia. The rate of pain was significantly higher in older and female patients with shorter duration of symptoms (p 0.0005). Conclusion: Phacoemulsification can be accomplished efficiently and effectively using topical anesthesia. Compared to retro bulbar and Peribulbar anesthesia, it offers several advantages and a high degree of pain satisfaction for the patient. [ABSTRACT FROM AUTHOR]

We assessed the association between troponin levels and all-cause mortality in individuals with chest pain who presented to the Charleston Area Medical Center Emergency Department (CAMC). We identified adult patients with chest pain as defined in the International Classification of Diseases 10 (R07) family group from the CAMC data warehouse between June 6, 2020, and June 6, 2021. These cases required a visit to the emergency room. We created 3 different cohorts to assess the endpoints of all-cause mortality at 30 days and 6 months. Patients were divided into the following 3 categories: negative troponin level, defined as high sensitivity troponin I (HSTNI) assay ≤15 pg/mL for women and ≤20 pg/mL for men; weakly positive, 21–88 pg/mL for men and 16–88 pg/mL for women; and strongly positive, >88 pg/mL for men and women. A propensity score matching analysis was also conducted using the negative group as a control; the weakly and strongly positive groups were compared to the control across differing cardiology covariates. This study introduces novel cutoffs for high-sensitivity troponin I (Beckman Coulter assay, Beckman Coulter, Inc., Chaska Campus, 1000 Lake Hazeltine Drive, Chaska, Minnesota 55318). [ABSTRACT FROM AUTHOR]