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Mike P Holzer,1 Rudy MMA Nuijts,2 Soraya MR Jonker,2 Erik LJG Mertens,3 Asim Bozkurt Sener,4 Jorge AO Cazal,5 Antoni Salvador Playa,5 Ramon Ruiz Mesa,6 Bettina C Thomas1 1Universitäts-Augenklinik Heidelberg, Heidelberg, Germany; 2Academisch Ziekenhuis Maastricht, Maastricht, the Netherlands; 3Medipolis, Antwerp, Belgium; 4Acibadem Maslak Hospital, Istanbul, Turkey; 5Hospital Universitari Mútua Terrassa, Barcelona, Spain; 6Oftalvist CIO Jerez, Cádiz, SpainCorrespondence: Mike P HolzerAugenzentrum Prof. Dr. Holzer & Prof. Dr. Rabsilber, Bahnhofstrasse 18, Weinheim, 69469, GermanyTel + 49 0 6201 87 87 24Email info@augenzentrum-holzer.dePurpose: To evaluate the safety and efficacy of a new multi-segmented refractive multifocal intraocular lens (IOL) after phacoemulsification and refractive lens exchange (RLE).Patients and Methods: In this prospective, multicenter clinical trial, 63 presbyopic subjects who had cataract or where RLE candidates were bilaterally implanted with the Precizon Presbyopia IOL (Ophtec BV, Groningen, the Netherlands) after phacoemulsification. The study was conducted at 6 clinical centers in Germany, the Netherlands, Belgium, Turkey and Spain. Subjects were evaluated at baseline and at 1 day, 1 week, 1 and 3 months postoperatively for monocular and binocular uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected (UIVA) and distance-corrected intermediate visual acuity (DCIVA), uncorrected (UNVA), corrected (CNVA) and distance-corrected near visual acuity (DCNVA), contrast sensitivity and quality of vision.Results: Three months postoperatively, binocular UDVA and CDVA of ≥ 20/40 was achieved in 98.4% (60/61) and 100%, respectively. Binocular UIVA and DCIVA of ≥ 20/40 was achieved in 96.7% (59/61) and 93.4% (57/61) respectively. Binocular UNVA, CNVA and DCNVA of ≥ 20/40 was achieved in 93.4% (57/61), 98.4% (60/61) and 95% (57/60) subjects, respectively. Complete spectacle independence was achieved in 80% (49/61) patients; 93% of patients reported that they were quite or very satisfied with the outcomes of the procedure.Conclusion: Precizon Presbyopia IOL implantation is a safe and effective method to provide good visual acuity at all distances in presbyopic and cataract patients.Keywords: presbyopia-correcting IOL, refractive lens exchange, cataract surgery, multifocal IOL

This study aims to compare the psychological resilience of children who receive Montessori education with those who do not receive Montessori education(the group attends a school where education is provided according to the Preschool Education Programme of the Ministry of National Education). The study used the Relational Scanning Model Comparison Types to compare the psychological resilience of children who received Montessori education with those who did not. The research involved 99 children aged 3-6 years who received regular preschool and Montessori education during the 2021-2022 academic year. It is reported that no developmental or neurological defects were observed in any of the participants. The study group comprised 50 children aged 3-6 years from a private kindergarten affiliated with National Education in Nilüfer district and 49 children aged 3-6 years from a private Montessori kindergarten in Nilüfer district. According to the study, children who received Montessori education demonstrated comparatively higher levels of psychological resilience than those who did not receive Montessori education. It has been observed that there exists a weak but meaningful correlation between the psychological resilience of children and their social relationships/social performance, particularly in those who have received Montessori education for an extended duration. As a result, it can be inferred that Montessori education positively impacts children's psychological resilience.

Classroom rules are a fundamental aspect of classroom management and ensuring compliance with established rules is crucial. Previous research has shown that students often pay little attention to the development of classroom rules. This quantitative study aims to investigate the expectations that students have concerning classroom rules. To this end, a 4-point Likert scale questionnaire consisting of 30 items was administered to 356 secondary school students. The Bayesian Search method and expert opinion were used to obtain a Bayesian Network model. The findings of the study indicate that students expect rules to be determined at the beginning of the academic year, wish to be involved in the determination process, and prefer minimal changes to the rules. They also expect a limited number of rules and reinforcement from teachers for displaying desirable behavior. Additionally, the study found that students are more likely to adhere to classroom rules in a clean and uncrowded environment, and prefer that their parents are not informed about these rules. The results also suggest that increased adherence to classroom rules leads to increased class inclusion, while decreased adherence results in decreased class inclusion. Furthermore, the study found that adoption of classroom rules leads to increased in-class cohesion, while non-adoption results in decreased cohesion. These findings contribute to the existing body of knowledge concerning student expectations of classroom rules.

To fully understand human memory, it is necessary to understand its lifespan development. However, memory assessments often rely on significantly different methodologies for different age groups, and their results are typically not directly comparable. In this paper, we present a quantitative assessment of memory function spanning an age range of five to 85 years that is based on a model-based memory assessment. This approach yields a uniform metric that is directly interpretable and can be compared across different tasks and materials that are appropriate for different age groups. The results show a robust U-shape function, with long-term memory function at age 5 being comparable to that of cognitively impaired elderly individuals. These results and the method utilized could provide a new foundation for future studies on memory development across life stages.

Abstract Erroneous and delayed triage in an increasingly crowded emergency department (ED). ChatGPT is an artificial intelligence model developed by OpenAI® and is being trained for use in natural language processing tasks. Our study aims to determine the accuracy of patient triage using ChatGPT according to the emergency severity index (ESI) for triage in EDs. In our cross-sectional study, 18 years and over patients who consecutively presented to our ED within 24 h were included. Age, gender, admission method, chief complaint, state of consciousness, and comorbidities were recorded on the case form, and the vital signs were detected at the triage desk. A five-member expert committee (EC) was formed from the fourth-year resident physicians. The investigators converted real-time patient information into a standardized case format. The urgency status of the patients was evaluated simultaneously by EC and ChatGPT according to ESI criteria. The median value of the EC decision was accepted as the gold standard. There was a statistically significant moderate agreement between EC and ChatGPT assessments regarding urgency status (Cohen’s Kappa = 0.659; P

Pulmonary arterial hypertension (PAH) is a progressive disorder caused by the narrowing of small blood vessels in the lungs, which, in the absence of therapies, leads to right heart failure and premature death. No cure for this devastating disorder is known. Current management therapies aim to improve symptoms, and hence, there is a need to identify novel therapeutic interventions. The major objectives of this review are to critically evaluate current treatment strategies and highlight the challenges and prospects of established drugs and natural products for the resolution of PAH.

This study aims to reveal how model eliciting principles are used in the process of designing, applying, and evaluating teacher candidates' model-eliciting activities. This study was conducted in three stages in a multi-tiered teaching experiment. Firstly, 15 teacher candidates designed activities for Grade 7 students after they were trained on mathematical modeling. In the second stage, these activities were performed with Grade 7 students and video recorded. In the third stage, teacher candidates watched the videos and evaluated how model-eliciting principles were executed during instruction and revise their activities. To collect data, we used focus group interviews with teacher candidates, field notes, and reports. The findings revealed the two principles of reality and model construction to be at the fore during the design stage. The teacher candidates who watched the application videos found some problems in the principles of 'reality' 'self-assessment' and 'model generalization'. Teacher candidates following the applications, for the new design, offered recommendations for 'reality' and 'model construction' principles although the other principles were somewhat neglected. They did express that by making the proper arrangements to the learning environment, students would be able to acquire the other principles over time.

Background: The use of intraoperative diuretics, such as furosemide or mannitol, during kidney transplantation has been suggested to reduce the rate of delayed graft function (DGF). The evidence base for this is sparse, however, and there is substantial variation in practice. We sought to evaluate whether the use of intraoperative diuretics during kidney transplantation translated into a reduction in DGF. Methods: We conducted a cohort study evaluating the use of furosemide or mannitol given intraoperatively before kidney reperfusion compared with control (no diuretic). Adult patients receiving a kidney transplant for end-stage renal disease were allocated to receive furosemide, mannitol, or no diuretic. The primary outcome was DGF; secondary outcomes were graft function at 30 days and perioperative changes in potassium levels. Descriptive and comparative statistics were used where appropriate. Results: A total of 162 patients who received a kidney transplant from a deceased donor (either donation after neurologic determination of death or donation after circulatory death) were included over a 2 -year period, with no significant between-group differences. There was no significant difference in DGF rates between the furosemide, mannitol, and control groups. When the furosemide and mannitol groups were pooled (any diuretic use) and compared with the control group, however, there was a significant improvement in the odds that patients would be free of DGF (odds ratio 2.10, 95% confidence interval 1.06-4.16, 26% v. 44%, p = 0.03). There were no significant differences noted in any secondary outcomes. Conclusion: This study suggests the use of an intraoperative diuretic (furosemide or mannitol) may result in a reduction in DGF in patients undergoing kidney transplantation. Further study in the form of a randomized controlled trial is warranted. Contexte: Il a t sugg r que le recours aux diur tiques perop ratoires, comme le furos mide ou le mannitol, durant la transplantation r nale pourrait r duire le taux de retard la reprise de fonction du greffon. Cependant, il existe peu de donn es probantes appuyant cette hypoth se, et une grande variabilit dans la pratique. Nous avons voulu valuer si le recours aux diur tiques perop ratoires durant la transplantation r nale entra nait une diminution des retards de reprise de fonction. M thodes: Nous avons men une tude de cohorte valuant l'administration per-op ratoire de furos mide ou de mannitol avant la reperfusion du rein, comparativement un groupe t moin (aucun diur tique). Des patients adultes atteints d'une insuffisance r nale chronique terminale recevant une transplantation r nale ont t r partis en 3 groupes: furos mide, mannitol, ou aucun diur tique. Le r sultat principal tait le retard la reprise de fonction du greffon; les r sultats secondaires taient la fonction du greffon 30 jours et la variation p riop ratoire du taux de potassium. Des statistiques descriptives et comparatives ont t utilis es, le cas ch ant. R sultats: Au total, 162 patients ayant re u une greffe du rein d'un donneur d c d (don apr s un diagnostic de d c s neurologique ou de d c s cardiocirculatoire) ont t inclus dans l' tude sur une p riode de 2 ans, sans diff rences significatives entre les groupes. Aucune diff rence significative de taux de retard la reprise de fonction n'a t observ e entre les groupes furos mide, mannitol, et aucun diur tique. Consid r s ensemble, les groupes furos mide et mannitol (tous diur tiques confondus) pr sentaient toutefois une am lioration significative du taux de retard comparativement au groupe t moin (rapport de cotes 2,10, intervalle de confiance 95% 1,06-4,16, 26% c. 44%, p = 0,03). On n'a not aucune diff rence statistiquement significative entre les 2 groupes pour ce qui est des param tres secondaires. Conclusion: Cette tude semble indiquer que le recours aux diur tiques perop ratoires (furos mide ou mannitol) pourrait entra ner une r duction du taux de retard la reprise de fonction du greffon chez les personnes ayant subi une transplantation r nale. L'ex cution d'un essai clinique randomis est de mise., Kidney transplantation has provided decades of successful treatment for end-stage renal disease. Delayed graft function (DGF) is a condition defined in the modern era as a requirement for dialysis within [...]

Abstract Electric vehicles are promoted as ‘clean’ technologies and offer promising reductions in transportation emissions. Nevertheless, their environmental benefits critically depend on the local electricity grid mix and the type of emission being considered. Here, we conduct a comparative life cycle assessment of the four dominant light-duty vehicle categories at both the global scale and in three representative countries: Norway, the US, and China. By analyzing different environmental indicators, particularly global warming potential and respiratory effects, and quantifying related parametric uncertainties, we reveal that the advantages of electric vehicles vary across these regions and across environmental impact types. While electric vehicles offer considerable decarbonization potential as the grid mix becomes cleaner, they might not mitigate other environmental impacts, such as increased respiratory effects on rural, low-income communities. Our results support stakeholders in identifying environmentally friendly vehicle and policy options while considering multiple factors, and emphasize the importance of tailored approaches over one-size-fits-all solutions in sustainable transportation.

Abstract Tamoxifen has been the mainstay therapy to treat early, locally advanced, and metastatic estrogen receptor-positive (ER + ) breast cancer, constituting around 75% of all cases. However, the emergence of resistance is common, necessitating the identification of novel therapeutic targets. Here, we demonstrated that long-noncoding RNA LINC00152 confers tamoxifen resistance by blocking tamoxifen-induced ferroptosis, an iron-mediated cell death. Mechanistically, inhibiting LINC00152 reduces the mRNA stability of phosphodiesterase 4D (PDE4D), leading to activation of the cAMP/PKA/CREB axis and increased expression of the TRPC1 Ca2+ channel. This causes cytosolic Ca2+ overload and generation of reactive oxygen species (ROS) that is, on the one hand, accompanied by downregulation of FTH1, a member of the iron sequestration unit, thus increasing intracellular Fe2+ levels; and on the other hand, inhibition of the peroxidase activity upon reduced GPX4 and xCT levels, in part by cAMP/CREB. These ultimately restore tamoxifen-dependent lipid peroxidation and ferroptotic cell death which are reversed upon chelating Ca2+ or overexpressing GPX4 or xCT. Overexpressing PDE4D reverses LINC00152 inhibition-mediated tamoxifen sensitization by de-activating the cAMP/Ca2+/ferroptosis axis. Importantly, high LINC00152 expression is significantly correlated with high PDE4D/low ferroptosis and worse survival in multiple cohorts of tamoxifen- or tamoxifen-containing endocrine therapy-treated ER+ breast cancer patients. Overall, we identified LINC00152 inhibition as a novel mechanism of tamoxifen sensitization via restoring tamoxifen-dependent ferroptosis upon destabilizing PDE4D, increasing cAMP and Ca2+ levels, thus leading to ROS generation and lipid peroxidation. Our findings reveal LINC00152 and its effectors as actionable therapeutic targets to improve clinical outcome in refractory ER+ breast cancer.

The concept of twice-exceptional is used to define individuals who are gifted or talented in one or more domains while having disability, disorder or difficulty in certain areas. This situation has made the definition and acceptance of the concept difficult since giftedness and disability are mentioned together. In order to clarify current understanding of the concept, a conceptual analysis of the term "twice-exceptional" was conducted in this study using Rodgers' evolutionary concept analysis method. Firstly, the epistemological and ontological structure of the concept was discussed. It was seen that the concept was used in different terms in literature such as "twice exceptional", "dual exceptionality", "gifted with learning difficulties", "gifted handicapped". Instead of looking for an alternative term for the concept, existing studies were reviewed and the characteristics of the concept were tried to be revealed. Although the concept has been used for almost four decades, its implications date back to gifted studies addressing learning difficulties a century ago. It was later associated with Asperger's Syndrome, Attention Deficit and Hyperactivity Disorder, Autism Spectrum Disorder and other deficits. It was concluded that definition and characteristics of relevant concepts of twice exceptionality such as giftedness and disability have changed over time, which has also affected the evolution of twice exceptionality. Therefore, a clear definition or sharp boundary of the concept cannot be claimed, but its importance has been revealed by the field studies which also contributes to the further development of the concept.

The aim of this article is to examine the curriculum alignment of the current program in line with the opinions of Turkish teachers based on the flexibility of the 2019 Turkish Language Curriculum. The study group for the research consists of a total of 153 teachers, including 40 Turkish teachers who participated in the semi-structured interview in Igdir in the 2020-2021 academic year and 113 Turkish teachers who gave their opinions about the achievements in order to measure the accessibility levels of the achievements. When the participant comments are examined, it is seen that their statements emphasize the content of the program in terms of intensity and time. It should be noted that teachers express more curriculum fidelity than curriculum alignment. However, it can be said that the concept of curriculum alignment is considered here as a central program implementation algorithm. It can be said that teachers mostly emphasize inner harmony with the alignment of goals. In addition, stating that the achievements are realized within the framework of texts and activities shows that teachers only adhere to the texts and activities in the text book. It was concluded that the students had difficulties in the application because of problems related to the program, and this might be related to local factors.

The universal experience of parents with a child with disabilities are added responsibilities and needs in supporting the child's development. This study assessed the nature and extent of needs identified by parents of children with disabilities in Turkey using a Turkish translation of the Family Needs Survey (Bailey, Blasco & Simeonsson, 1992). The survey of 35 items and two open-ended questions was translated to reflect Turkish culture and linguistic equivalency. The psychometric properties of the Family Needs Survey were examined by administering it to 377 mothers and 297 fathers of children with disabilities, served in special education schools or rehabilitation centres. Factor analysis of data for mothers and fathers yielded a six-factor model explaining 56% and 61% of the variance, respectively. Alpha values for the factors of the survey ranged from 0.63 to 0.90 for the mother data set, and 0.80 to 0.91 for the father data set. Analyses of endorsed needs in the Family Needs Survey revealed an overall similar profile for both parents, with greater needs expressed for the factors of obtaining information, family and social support and community services than for factors pertaining to financial topics, explaining to others and child care. Mothers and fathers identified 35 additional needs reflecting themes of personal and societal concern related to parenting a child with disabilities in Turkey.

Abstract Immunoglobulin‐G4 (IgG4)‐related disease is essentially a fibro‐inflammatory disease that can affect any organ simultaneously or at different times. The disease usually presents with organ growth that mimics a tumour and can affect the lacrimal glands, major salivary glands, pancreas, bile ducts, retroperitoneal area, lungs, kidneys, aorta, meninges and thyroid gland. The immunopathogenesis behind this new disease has not yet been elucidated. Histopathological distinguishing features of the disease include dense lymphoplasmocytic infiltrates dominated by IgG4 positive plasma cells, storiform fibrosis and obliterative phlebitis. The likelihood of developing with immunoglobulin G4 (IgG4‐RD) is a recently identified rare systemic fibroinflammatory disease with an estimated incidence of less than 1 in 100,000 people worldwide. We present our case, which was diagnosed with IGG4‐related vasculitis by lung fine needle aspiration biopsy, which is very rare in the literature.

ABSTRACT This study explores the dynamics of immune gene expression, ruminal metabolome, and gut microbiota in cows due to the duration of high-grain feeding, shedding light on host response and microbial dynamics in parallel. Cows consumed forage for a week, then gradually transitioned to a high-grain diet, which they consumed for 4 weeks. Immune response was evaluated in ruminal papillae by expression of genes related to the nuclear factor-kappaB (NFkB) pathway and correlated with the microbiota. Rumen metabolome was evaluated with high-performance liquid chromatography coupled with mass spectrometry and anion-exchange chromatography. Rumen and fecal microbiota were evaluated with 16S rRNA gene amplicon sequencing. In the rumen, expression of inflammation-associated genes increased with the duration on high grain, indicating activation of pro-inflammatory cascades; microbial diversity decreased with a high-grain diet but stabilized after week 3 on high grain. Changes in microbial relative abundance and metabolite enrichment were observed throughout the 4 weeks on high grain, with increments in propionogenic taxa (i.e., Succinivibrionaceae). Metabolite enrichment analysis showed that at the start of high-grain feeding, simple carbohydrates were enriched; then, these were substituted by their fermentation products. There were correlations between certain ruminal bacterial taxa (i.e., Ruminococcaceae UCG-005) and expression of genes of the NFkB pathway, suggesting the influence of these taxa on host immune response. In feces, microbial diversity and several Ruminococcaceae members initially declined but recovered by weeks 3 and 4. Overall, despite the stabilization of microbial diversity, changes in microbial relative abundance and proinflammatory genes were observed throughout high-grain feeding, suggesting that cows need more than 4 weeks to fully adjust once consuming a high-grain diet.IMPORTANCEDespite the stepwise diet transition typically assumed to serve for animal adaptation, expression of signaling receptors, mediators, and downstream targets of nuclear factor-kappaB pathway were found throughout the 4 weeks on high grain, which correlated with changes in the rumen microbial profile. In addition, although microbial diversity recovered in the feces and stabilized in the rumen in week 3 on high grain, we observed changes in microbial relative abundance throughout the 4 weeks on high grain, suggesting that cows need more than 4 weeks to adjust once consuming this diet. Findings are particularly important to consider when planning experiments involving dietary changes.

Abstract Conducting metal interconnections are essential to link electronic components or multiple circuits for electronic device fabrication. Scalable, rapid, and sustainable methods for printing adherent metal interconnections on dielectric materials are lacking, which stifles the development of new electronic consumer devices. Here a breakthrough single‐step and rapid process to deposit highly conducting metal tracks is introduced, using an atmospheric pressure plasma jet. The deposition process used a rudimentary aqueous solution of metal salts as ink, that was introduced as a mist into a helium plasma gas. The metal salt was reduced and deposited with spatiotemporal control using a plasma jet generated at radio frequency with 15 W power at room temperature and pressure. The conductive metal layers were highly adhesive on glass, ceramics, polymeric materials, even biological surfaces such as plant leaves and animal skin, depostedwith little damage to the substrate. The conductivity of deposited tracks on glass shows 50.8 ± 8.6% and 5.2 ± 1.6% of bulk silver and copper metal conductivity respectively.

ABSTRACT Objective This study aimed to assess vitamin D deficiency in a cohort of healthy young adults using the novel inflammatory parameters neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), monocyte-to-high-density lipoprotein (HDL) cholesterol ratio (MHR), and uric acid-to-HDL cholesterol ratio (UHR). Subjects and methods The study included 1,190 participants, with demographic and laboratory data retrieved retrospectively from our institution’s database. The inclusion criteria were ages 22-35 years; absence of acute, subacute, or chronic diseases; no regular medication use; and laboratory values within specified reference ranges. The exclusion criteria were pregnancy, diagnosis of malignancy, and laboratory measurements indicating infection. Participants were categorized into four groups based on vitamin D levels for comparative analysis of study parameters. Correlation analyses were conducted between these parameters and 25-hydroxyvitamin D levels, followed by receiver-operating characteristic analyses to determine the parameters’ sensitivity and specificity in detecting vitamin D deficiency. Additionally, regression analyses were performed to identify potential risk factors for vitamin D deficiency. Results Subjects in Groups A1 and A2 exhibited higher MHR and UHR than those in Groups A3 and A4 (p < 0.001). Both MHR and UHR correlated negatively with vitamin D levels (r = -0.377 and r = -0.363, respectively; p < 0.001). The area under the curve for MHR was 0.766 (95% confidence interval [CI] 0.739-0.794), with a 79% sensitivity and 61% specificity for identification of vitamin D deficiency. Increased MHR and UHR were independent risk factors for vitamin D deficiency (β = 0.219, odds ratio 1.244 95% CI 1.178-1.315, and β = 2.202, odds ratio 1.224, 95% CI 1.150-1.303). Conclusions Both MHR and UHR can be useful in predicting vitamin D deficiency in healthy young adults and may serve as valuable screening tools.