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Axillary dissection for low-volume nodal involvement after neoadjuvant therapy in breast cancer: Multicentre AXSANA cohort study
No full textBackground Completion axillary lymph node dissection (cALND) is often recommended for patients with isolated tumour cells (ITCs) or micrometastases in the sentinel lymph node (SLN) or target lymph node (TLN) to assess the definite nodal tumour burden after neoadjuvant chemotherapy (NACT). The aim of this study was to investigate the upgrade of N stage by cALND in patients with low-volume metastases in the SLN/TLN after NACT from the prospective, international, multicentre AXSANA cohort study. Methods NACT-treated patients that converted from a positive to a negative clinical lymph node status and underwent cALND based on low-volume SLN/TLN involvement were included. The association between the final N stage, the pathological tumour response in the breast, and the clinical impact of cALND on post-NACT treatment decisions was determined. Results Among 5329 patients recruited between June 2020 and March 2024, 2194 were scheduled for SLN biopsy (SLNB), targeted axillary dissection (TAD), or TLN biopsy (TLNB). Among 16 patients with ypN0i+(SLN/TLN), one patient was upgraded to ypN1a by cALND, while five of the 71 patients with ypN1mi(SLN/TLN) were upstaged to ypN2 and one of the 71 patients with ypN1mi(SLN/TLN) was upstaged to ypN3. None of these patients had a pCR in the breast and thus nodal upstaging had no impact on post-NACT treatment decisions. Conclusion Despite substantial additional nodal involvement in low-volume SLN/TLN disease, cALND does not provide clinically meaningful information for post-NACT systemic treatment modifications and should not be encouraged for diagnostic purposes alone. © 2025 Elsevier B.V., All rights reserved
Mainstreaming gender equality in local governments: Edirne Municipality example
No full textBu çalışma, Edirne Belediyesi örneğinde yerel yönetimlerde toplumsal cinsiyet eşitliğinin ana akımlaştırılmasını incelemektedir. Araştırmada, Edirne Belediyesi'nin faaliyet raporları ve stratejik planları, toplumsal cinsiyet eşitliği perspektifinden tematik analiz yöntemiyle değerlendirilmiştir. Çalışma, toplumsal cinsiyet eşitliği politikalarının kurumsal yapıya entegrasyonu ve eşitlik odaklı yerel hizmetlerin geliştirilmesine yönelik bir çerçeve sunmayı amaçlamaktadır. Araştırma sonuçları, Edirne Belediyesi'nin toplumsal cinsiyet eşitliği konusunda uygulamalarını geliştirme potansiyelini ortaya koyarken, bu konuda karşılaşılan zorluklara da dikkat çekmektedir. Ayrıca, yerel yönetimlerin toplumsal cinsiyet eşitliğini sağlama süreçlerinde politika önerileri sunulmuştur.This study examines the mainstreaming of gender eq
Investigation of the effect of digitalisation process of patient files archive on cost and work motivation of employees
No full textBackground One of the most important topics in the process of digital transformation in healthcare services are 'electronic patient records' and 'digital archive' applications.Objectives The study was to create the infrastructure of the digitalisation process of the patient files archive, to compare cost benefit analysis and time study of paper-based archive and digital archive systems, to analyse the change in work motivation of archive employees with the transition process to digital archive.Methods The study carried out in 3 stages. At scanning of patient files stage, hospital archive employees started to scan the files. The 2nd stage of the study was cost calculation and time study. The third stage of the study was evaluation of work motivation of employees. The effect of paper-based archive and digital archive on work motivation was evaluated with a qualitative study.Results As of the study closing date, 222,461 patient files were digitalised. As a result of the cost-benefit analysis, the benefit of the fixtures we bought for the archive was 2.37 times more in the calculation of creating a new additional archive instead. It has been determined that at the end of the digitalisation process, the motivation of patient file archive employees increased, work-related anxiety and their physical problems such as hand hurt decreased, and they felt valued.Conclusion In this study, it has been proven that digital archives provide advantages in terms of financial benefit, time study and employee motivation.Trakya University Scientific Research Studys Unit [27.01.2020]The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by Trakya University Scientific Research Studys Unit on 27.01.2020 with the study number 2020/18 as a high cost infrastructure study
The effect of the intensive care unit nurse manpower on care behaviours and stress level on the nurses
No full textBACKGROUND: Nurses working in the intensive care units (ICU) regarding the work-index-nursing work environment, the effect level ICU environment has on the nurses' care behaviors and stress levels of the nurses should be determined.OBJECTIVE: The study aimed to investigate the effect of the nurse manpower on care behaviours and stress level of the nurses working in the ICU.METHODS: This was a cross-sectional and correlational study. The sample of the study consisted of 123 nurses working in the ICUs. The data were collected using the survey form, Distress Thermometer (DT), The Practice Work Environment Scale of the Nursing Work Index (PES-NWI), and Caring Behaviors Scale-24 (CBS-24).RESULTS: The mean age of nurses in the ICU was 30.2 +/- 5.6 and the mean of working time in the intensive care unit of nurses in the ICU was 3.7 +/- 3.1 years. The mean of the DT was 4.8 +/- 3.4, and the mean score of PES-NWI was 2.6 +/- 1.0 and the mean score of CBS-24 was 4.7 +/- 1.1 in nurses in the ICU. The regression model which was studied to investigate the relationship between caring behaviors and stress and nurse manpower of nurses working in intensive care unit was significant.CONCLUSION: Care behaviors and stress levels of nurses working in intensive care units are negatively affected by insufficient nurse manpower
Hemodiyaliz Hastalarının Konfor Düzeyleri ve Hemşirelik Bakımından Memnuniyetlerinin Değerlendirilmesi
No full textAim: To evaluate the comfort levels and satisfaction with nursing care of patients receiving hemodialysis treatment. Materials and Methods: A descriptive and cross-sectional study was conducted with 109 patients receiving hemodialysis in units of a university and a state hospital. Patients who had been receiving hemodialysis treatment for at least six months, had no communication difficulties, and voluntarily agreed to participate were included in the study. Data were collected using the “Hemodialysis Comfort Scale” and the “Newcastle Satisfaction with Nursing Care Scale”. Results: The mean age of the patients was 61.54±12.67 years. Among the participants, 62.4% were male, 72.5% were married, 85.3% had children, and 89.9% lived in nuclear families. Half of the participants (50.5%) were primary school graduates, 56.9% were retired, and 66.1% had a moderate income level. Participants’ disease duration was 6.80±7.54 years. The mean total score of the Hemodialysis Comfort Scale was 3.30±0.86, and the mean total score of the Newcastle Satisfaction with Nursing Care Scale was 82.40±16.37. Conclusion: This study found that the comfort levels of hemodialysis patients were moderate, while their satisfaction with nursing care was at high level. Nurses should periodically evaluate patients’ comfort and care satisfaction during hemodialysis. © 2025 Elsevier B.V., All rights reserved
Multi-Objective Optimal Energy Management Strategy for Grid-Interactive Hydrogen Refueling Stations in Rural Areas
No full textThe transportation sector is a significant contributor to global carbon emissions, thus necessitating a transition toward renewable energy sources (RESs) and electric vehicles (EVs). Among EV technologies, fuel-cell EVs (FCEVs) offer distinct advantages in terms of refueling time and operational efficiency, thus rendering them a promising solution for sustainable transportation. Nevertheless, the integration of FCEVs in rural areas poses challenges due to the limited availability of refueling infrastructure and constraints in energy access. In order to address these challenges, this study proposes a multi-objective energy management model for a hydrogen refueling station (HRS) integrated with RESs, a battery storage system, an electrolyzer (EL), a fuel cell (FC), and a hydrogen tank, serving diverse FCEVs in rural areas. The model, formulated using mixed-integer linear programming (MILP), optimizes station operations to maximize both cost and load factor performance. Additionally, bi-directional trading with the power grid and hydrogen network enhances energy flexibility and grid stability, enabling a more resilient and self-sufficient energy system. To the best of the authors' knowledge, this study is the first in the literature to present a multi-objective optimal management approach for grid-interactive, renewable-supported HRSs serving hydrogen-powered vehicles in rural areas. The simulation results demonstrate that RES integration improves economic feasibility by reducing costs and increasing financial gains, while maximizing the load factor enhances efficiency, cost-driven strategies that may impact stability. The impact of the EL on cost is more significant, while RES capacity has a relatively smaller effect on cost. However, its influence on the load factor is substantial. The optimization of RES-supported hydrogen production has been demonstrated to reduce external dependency, thereby enabling surplus trading and increasing financial gains to the tune of USD 587.83. Furthermore, the system enhances sustainability by eliminating gasoline consumption and significantly reducing carbon emissions, thus supporting the transition to a cleaner and more efficient transportation ecosystem
Examining state-trait anxiety levels in youth soccer players across various variables
No full textGiriş ve Amaç: Futbol dünya çapında en popüler ve yaygın sporlardan biridir. Yetenekli bir futbolcunun gelişmesi ve başarılı bir kariyer yolunda ilerlemesi genellikle iyi bir altyapı eğitimiyle başlar. Futbol altyapısı genç sporculara temel becerileri kazandırmayı ve onları profesyonel futbola hazırlamayı amaçlamaktadır. Futbolcuların fiziksel ve teknik gelişiminin yanı sıra psikolojik durumları da oldukça önemlidir. Bu çalışmada futbol altyapı yaş gruplarında durumluk - sürekli kaygı seviyelerinin çeşitli değişkenlere göre düzeyleri incelenmiştir. Gereç ve Yöntemler: Araştırmaya katılan futbolculara araştırmanın amacı ve önemi anlatılmıştır. Sonrasında Demografik Bilgi Formu ve Çocuklar İçin Durumluk ve Sürekli Kaygı Envanteri doldurtulmuştur. Tanımlayıcı değerler, yüzde, maksimum, minimum, ortalama ve standart sapma olarak sunulmuştur. Verilerin Shapiro -Wilk normallik dağılım testi gerçekleştirilmiş ve normal dağılım göstermediği bulunmuştur (p<0,05). Bu sebeple parametrik olmayan analizler gerçekleştirilmiştir. Sporcuların yaş, spor yaşı, mevki, bulundukları şehir, ailelerin gelir durumları ve kardeş sayısı ile anketlerden aldıkları puanların fark analizleri Kruskall-Wallis testi ile analiz edilmiştir. Gruplar arasındaki ikili farklılıklar ise Dunn's posthoc testi ile gösterilmiştir. Ailede sporcu geçmişi durumu farklılıkları için Mann-Whitney U testi kullanılmıştır. Verilerin analizi JASP (versiyon 0.19.1, Hollanda) yazılımı ile gerçekleştirilmiştir. İstatistiki anlamlılık düzeyi p<0,05 olarak kabul edilmiştir. Bulgular: Araştırmaya katılan futbolcuların durumluk-sürekli kaygı seviyeleri spor yaşı, yaş ve mevkilerine göre incelenmesi yapılmıştır. Spor yaşı grubu olarak incelendiğinde durumluk ve sürekli kaygı puan ortalamasının değişmediği gözlemlenmiştir. Yaş grubu olarak incelendiğinde 11 yaş grubunun en düşük değerde olduğu, yaş büyüdükçe kaygı puanın düşük oranda yükseldiği gözlemlenmiştir. Mevki olarak incelendiğinde orta saha grubunun en yüksek değerde olduğu gözlemlenmiştir. Sonuç: Araştırmaya katılan futbolcuların spor yaşı, yaş ve mevkilere göre durumluk-sürekli kaygı seviyeleri test edilmiş, her değişkene göre kaygı seviyelerinin değiştiği tespit edilmiştir. Anahtar kelimeler: Futbol, altyapı, kaygı, stres, yaş.Background and Aim: Football is one of the most pop
Evaluation of the effect of printing orientations onwater sorption, solubility, and color stability of a 3D-printedpermanent crown material
No full textAmaç: Bu çalışmanın amacı, 3B yazıcı teknolojisi ile üretilmiş daimi kuron materyalinde farklı baskı açıları (0°, 45°, 90°) kullanılarak hazırlanan örneklerin sıvı emilimi, çözünürlük ve renk stabilitesi özelliklerinin değerlendirilmesidir. Materyal ve Metot: Bu çalışmada, SLA teknolojisine sahip 3B yazıcı (Formlabs, Sommerville, MA, USA) kullanılarak Formlabs Permanent CB Resin materyalinden toplam 150 adet disk formunda numune üretilmiştir (n=50/grup). Numuneler, üç farklı baskı açısında (0°, 45°, 90°) basılmış ve 10×10×1 mm boyutlarında olacak şekilde hazırlanmıştır. Sıvı emilimi ve çözünürlük testleri, ISO 4049 standardı referans alınarak gerçekleştirilmiştir. Her bir numune, desikatörde son kuruluk seviyesine ulaşana dek bekletilmiş ve bu durumda elde edilen kütle değerleri m? olarak kaydedilmiştir. Tüm tartımlar, 0.1 mg hassasiyetindeki analitik terazi (AUW-220D, Shimadzu, Japonya) ile yapılmıştır. Ardışık iki gün boyunca yapılan tartımlarda 0.1 mg'dan az fark gözlenen numuneler, nihai kuru kabul edilmiştir. Kuruyan numuneler distile suya daldırılarak 37 °C sıcaklıkta 7 gün boyunca etüvde bekletilmiştir. Süre sonunda numuneler yüzeysel olarak kurulanarak yeniden tartılmış ve bu değerler m? olarak kaydedilmiştir. Daha sonra tekrar desikatöre alınarak ikinci kuruma süreçleri tamamlanmış, son kütleleri m? olarak ölçülmüştür. Sıvı emilimi (Wsp) ve çözünürlük (Wsl) değerleri hesaplanmış ve sonuçlar µg/mm³ cinsinden değerlendirilmiştir. Renk stabilitesini değerlendirmek amacıyla, numuneler beş farklı solüsyona (distile su, kola, kırmızı şarap, portakal suyu, kahve) daldırılmış ve 1., 3., 6. ve 12. günlerde spektrofotometre (Vita EasyShade V) ile renk ölçümleri gerçekleştirilmiştir. Renk değişimi CIEDE2000 (?E00) formülü ile hesaplanmış, istatistiksel analizler IBM SPSS V23 ve Jamovi 2.3.28 programları kullanılarak yapılmıştır. Bulgular: Elde edilen veriler, baskı açısının hem sıvı emilimi hem de çözünürlük üzerinde istatistiksel olarak anlamlı bir etkiye sahip olduğunu göstermiştir (p<0.05). En yüksek sıvı emilimi ve çözünürlük değerleri 0° baskı açısında, en düşük değerler ise 90° açısında gözlemlenmiştir. Renk değişimi açısından en yüksek ?E değerleri kırmızı şarap ve portakal suyu solüsyonlarında, özellikle 90° baskı açısında tespit edilmiştir. Distile su grubunda ise tüm açılarda en düşük ?E değerleri kaydedilmiştir. Sonuç: Üç boyutlu yazıcı ile üretilen daimi kuron materyalinde baskı açısının sıvı emilimi, çözünürlük ve renk stabilitesi üzerinde doğrudan etkili olduğu belirlenmiştir. Klinik uygulamalarda hem estetik hem de dayanıklılık açısından daha uygun restorasyonlar elde edebilmek için uygun baskı açısı seçimi büyük önem taşımaktadır. Anahtar Kelimeler: 3D yazıcı, daimi kuron, baskı açısı, sıvı emilimi, çözünürlük, renk stabilitesi,Background and aim: Th
Predicting homozygous M694V genotype in paediatric FMF: multicentre analysis and scoring system proposal
No full textObjectives: This study aimed to evaluate the predictability of the homozygous M694V genotype in paediatric FMF patients and to develop a clinical scoring system to enhance disease management strategies. Methods: This nationwide, multicentre, cross-sectional study included 3981 paediatric FMF patients with biallelic pathogenic variants in exon 10 of the Mediterranean fever gene. Patients were divided into two groups: group 1 (homozygous M694V) and group 2 (other variants). Data were collected from 37 paediatric rheumatology and/or nephrology clinics across T & uuml;rkiye, covering patients followed between 2014 and 2023. Results: Group 1 had significantly earlier symptom onset (<= 3 years: 49.8% vs 43.9%, P < 0.001) and diagnosis (median age: 5 years vs 5.8 years, P < 0.001) compared with group 2. A higher prevalence of family history of FMF was observed in group 1 (P < 0.001). Clinical manifestations, including arthritis (27.5%), erysipelas-like erythema (ELE) (20.3%) and protracted febrile myalgia syndrome (PFMS) (3.6%), were significantly more frequent in group 1 (P < 0.001 for all). Colchicine resistance was also higher in group 1 (18.1% vs 5.1%, P < 0.001). Logistic regression analysis showed that <= 3 years of age at symptom onset, family history, arthritis, myalgia, PFMS, ELE and splenomegaly were independent predictors of the homozygous M694V genotype. A clinical scoring system was proposed based on these findings. Conclusion: This study provides valuable insights into the clinical predictors of the homozygous M694V genotype in paediatric FMF. The proposed scoring system will support clinicians in prognosis assessment and treatment planning, contributing to improved patient outcomes
Chemometric investigation of river system contamination: Source identification and risk assessment using positive matrix factorization and Monte Carlo simulation
No full textThis study investigates the water quality of the Abdal River System in T & uuml;rkiye, an important water supply for the metropolitan area, using chemometric applications, including Positive Matrix Factorization (PMF) for source apportionment and Monte Carlo Simulation (MCS) for health risk assessment. Surface water samples were analyzed for 14 potentially toxic elements (PTEs), including nutrients and other elements. Their concentrations, in ascending order, were: Cd (0.13) G Cr (1.34) G Pb (1.50) G Mn (1.89) G Hg (1.98) G Cu (2.96) G Ni (5.32) G As (7.17) G Fe (31.16) G Zn (151.48) G Al (320.86) GK (3631) G Mg (15607) G Na (18870) G Ca (72842) mu g/L. The water quality was evaluated utilizing indices including Heavy Metal Pollution Index (HPI), Water Quality Index (WQI), and Contamination Degree (CD), with results indicating generally good water quality and minimal pollution levels. PMF analysis identified three primary sources of contamination: natural/geogenic processes, agricultural runoff, and urban activities including domestic runoff. Health risk assessments highlighted arsenic as the most significant contributor to non-carcinogenic and carcinogenic risks. For children, the hazard index (HI) for arsenic was 7.35E-01 (ingestion: 7.26E-01; dermal: 9.00E-03), remaining below the safety threshold of 1, indicating no significant non-carcinogenic risk. Similarly, the carcinogenic risk (CR) for arsenic was 2.92E-04, within the acceptable range (1E-06 to 1E-04). The Monte Carlo Simulation quantified variability and uncertainty in health risks, highlighting arsenic as the main contributor, with 16.15 % of scenarios for children exceeded the acceptable non-carcinogenic risk threshold. This study is the first to integrate PMF with MCS for a comprehensive evaluation of pollution sources and health risks in the Abdal River System, offering a novel approach to environmental management in semi-urban watersheds. The findings confirm the water quality is safe under current conditions but highlight the need for ongoing monitoring and targeted mitigation to ensure sustainable management of the Abdal River System.Giresun University Scientific Research Office [FEN-BAP-A-290224-14]We acknowledge the Giresun University Scientific Research Office for their support (Grant No. FEN-BAP-A-290224-14)