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This article presents the design and development of a novel terahertz (THz) sensor with a graphene-infused metamaterial for precise detection of different refractive indices. The sensor operates in a single-band frequency, with a metamaterial unit cell size set at 1.401 times the effective wavelength ( $\lambda _{\mathbf {eff}}$ ), and it exhibits a resonant frequency of 4.48 THz. The proposed sensor achieves a remarkable peak absorption of 99%. The sensor is composed of a series of layers, such as graphene, polyimide, copper, and Teflon, to finely tune the absorption response. The sensitivity metrics of the sensor were derived from its absorption response to various refractive index profiles. The sensor’s sensitivity is studied with random dielectric substances and specific chemical analytes. The complete characterization of the sensor has been obtained for performance parameters, such as absorptivity versus analyte thickness, refractive indices, and chemical potentials. The outcome of this research affirms the suitability of the developed refractive index-based metamaterial sensor for a broad spectrum of THz sensing applications, highlighting its potential for enhancing THz imaging techniques.

IntroductionThe current study aimed to investigate the psychological impact of the Turkey 2023 earthquakes on children with autism spectrum disorder (ASD) and their parents residing in Hatay, Sanlıurfa, and Ankara provinces, encompassing the periods both before and after the Turkey 2023 earthquakes.MethodThis cross-sectional, multicenter study included 103 children and adolescents with ASD aged between 6 and 18. Participants were evaluated based on their residence in Ankara, Hatay, and Sanlıurfa, three cities affected differently by the earthquake. Parent-report questionnaires were utilized to assess the children’s autism symptoms and behavioural problems. The Childhood Autism Rating Scale was used to determine autism severity. The psychiatric problems of mothers were also assessed with self-report scales.ResultsSignificantly increased levels of core autism symptoms, irritability, and hyperactivity were found in Hatay and Sanlıurfa participants after the earthquakes compared to before, while no differences were detected in children from the Ankara group. Scale score increases in the Hatay group, which had to take a more extended break from special education, were higher than in the Sanlıurfa group. Participants with late-diagnosed ASD exhibited a more significant increase in their scale scores after the earthquake. Depression, stress and hopelessness scores were the highest, and the life satisfaction levels were the lowest in mothers of the Hatay and Sanlıurfa groups. More pronounced increases were observed in aberrant behaviours among children of mothers with low educational levels following the earthquake.DiscussionOur findings demonstrate that the exacerbation of core ASD symptoms and behavioural deterioration after the earthquakes are associated with disruptions in specialized education services, exposure to earthquake-related trauma, and the educational level of mothers.

Background:Providing supportive care to patients with cancer and improving their comfort levels can promote their adjustment to the disease, compliance with treatment and improve their quality of life.Aim:The aim of this cross-sectional, descriptive study was to identify the effects of the supportive care needs of cancer patients on their comfort levels.Methods:The study was performed in the oncology department of a university hospital. A total of 153 cancer patients undergoing chemotherapy constituted the sample. The data collection procedure included the Supportive Care Needs Survey (SCNS) and the General Comfort Questionnaire (GCQ).Results:The SCNS scores of the patients were low (Mean±SD: 75.13±27.93). The socio-cultural dimension of the GCQ was the most adversely influenced area of comfort. There was a negative relationship between needs and comfort levels (rs=-0.69, p<0.01). Lower scores of comfort were associated with higher scores of SCNS (ß=-0.487; ß=-0.316; ß=-0.958, respectively).Conclusions:Cancer patients undergoing chemotherapy were supported in meeting their physical and psychological needs and performing their activities of daily living and care during their hospital stay. Patients with higher support needs had lower comfort levels.

Background: Each year, millions face natural disasters, encountering mass fatalities and severe medical issues such as crush injuries and crush syndrome. Crush syndrome, marked by acute kidney injury (AKI) and hyperkalemia, correlates with mortality. This study focuses on presenting epidemiological data on kidney disease resulting from the February 6, 2023 earthquakes centered in Kahramanmaras. Methods: This retrospective analysis included patients diagnosed with crush syndrome after the 2023 Kahramanmaras earthquakes, treated in regional hospitals or referred elsewhere in Turkey. Patient data were documented using the web-based system developed by the Turkish Nephrology Association Renal Disaster Working Group. Results: Of the 1024 analyzed patients from 46 centers, 515 (50.3%) were women. The mean age was 41 ± 16 years, with a median duration of 12 h under rubble, and the median presentation time to the first health facility was 4 h after extrication from the rubble. Upon admission, 79.8% received intravenous fluid therapy, all potassium-free. Initial serum creatinine, K+, and creatinine kinase levels averaged 2.59 ± 2 mg/dl, 5.1 ± 1 mmol/L 38,305 ± 54,303 U/L, respectively. Intensive care unit (ICU) admissions were 53.6%, with mean hospital and ICU stays of 20 and 11 days, respectively. Compartment syndrome occurred in 40.8% of patients, with 75.8% undergoing fasciotomy. Acute kidney injury developed in 67.9% of patients, with 70.3% undergoing hemodialysis, totaling 3016 sessions on 488 patients. The overall in-hospital mortality rate was 9.8%. Conclusion: Earthquakes have a significant impact on kidney health. Although our study indicates some progress compared to previous earthquake responses, there remains a crucial need for drills emphasizing post-earthquake initial response, fluid-electrolyte balance management, and emergency dialysis protocols. Graphical abstract:

Objective: Endogenous cortisol excess is known to affect body fat distribution. Ectopic fat is the accumulation of triglycerides in non-adipose tissue regions that normally contain little fat. The aim of study was to investigate the amount of ectopic fat in aortic perivascular and renal sinus fat of patients with endogenous cortisol excess and its relationship with their comorbitidies and laboratory findings. Design: A total of 119 patients, including 16 patients with pituitary Cushing’s disease (CD), 21 patients with adrenal Cushing’s syndrome (CS), 34 patients with mild autonomous cortisol secretion (MACS), and 48 patients with nonfunctioning adrenal adenomas were enrolled in this retrospective study. Aortic perivascular fat and renal sinus fat were evaluated with magnetic resonance imaging. Results: It was determined that the amount of aortic perivascular fat was increased in patients with CD (P= 0.01). The linear regression analysis showed that the amount of perivascular fat was associated with triglyceride levels and cortisol levels after the 1 mg dexamethasone suppression test as well as with gender (P&lt; 0.01). Renal sinus fat measurements were similar in the groups (P> 0.05). After adjusting for age, sex, and BMI, perivascular fat was found to be higher in pituitary the CD than in the MACS and the nonfunctioning adenoma groups, and renal sinus fat was seen to be higher in pituitary the CD than in the MACS groups (P&lt; 0.05). Patients with diabetes mellitus had an increased amount of renal sinus fat (P= 0.008). Conclusion: The amount of perivascular and renal sinus fat may increase in patients with CD. Further studies are needed to elucidate ectopic fat distribution in patients with endogenous cortisol excess.

Purpose: Studies on intestinal microbiota in acromegaly are scant. This study aimed to characterize the gut microbiome in patients with acromegaly. Method: Stool samples were collected from 11 patients newly diagnosed with acromegaly and 12 healthy controls matched for body mass index (BMI) and age after three days on a standard diet. Clinical and gut microbial composition assessments were performed for the two participant groups using 16S rRNA gene amplicon sequencing. Results: There was no difference in the alpha diversity of the microbiota between the samples from patients with acromegaly and those from the healthy controls. Based on beta diversity measurements, differences in microbial community structures were found to be significant only when compared using the Jaccard similarity index. The corresponding Firmicutes/Bacteroidotaratio tended to be higher in individuals with acromegaly than in healthy controls. The mean relative abundance of Actinobacteriotawas 2.3 times higher in the acromegaly patient group than in the control group. Eggerthellaceae, Christensenellaceae, and Bacteroidaceaewere among the significantly abundant bacterial families in the samples from the acromegaly patient group, while Butyricicoccaceaeand Tannerellaceaewere decreased. At the level of the genus, the most discriminative features were the abundance of Prevotella 7, Bacteroides, Senegalimassilia, Enterohabdus, the Family XIII AD3011 group, Howardella, and Hungatellain the samples from the acromegaly patient group. In contrast, the Butyrivibrioand the Eubacterium eligens groupwere the most discriminative genera for the healthy controls and were significantly less abundant in patients with acromegaly. While there were no significantly differentiated taxa between the diabetic and non-diabetic subgroups, Prevotella_7was significantly enriched in the osteoarthritis (OA) subgroup. No significant association was found between individual genera and growth hormone (GH) levels and insulin-like growth factor-1 (IGF-1) levels as well as the upper limit of normal (ULN). Conclusion: Although alpha and beta diversity were mainly similar between the two groups, significant differences were observed between the acromegaly group and the control group at the family and genus levels. These results suggest that the differences between the microbial communities in patients with acromegaly and those in healthy individuals consist primarily of compositional differences independent of abundance. Prospective studies are needed to further explore the clinical implications of gut microbiome dysbiosis in patients with acromegaly.

Purpose: Our aim was to develop a prediction model based on a simple score with clinical, laboratory, and imaging findings for the subtype diagnosis of primary aldosteronism (PA). The contribution of adrenal volumetric assessment to PA subtyping was also investigated. Methods: Thirty-five patients with adequate cannulation in adrenal venous sampling (AVS) were included. Laboratory data, the saline infusion test (SIT), and the AVS results of patients with PA were retrospectively evaluated. Volumetric assessment was performed using magnetic resonance imaging (MRI) and the ratio of adrenal volumes was calculated after adjusting for gender- and side-specific mean reference values of both adrenal glands. Results: The AVS was consistent with unilateral PA in 49% and bilateral in 51% of the patients. Hypertension as a reason for work-up, the highest aldosterone/lowest potassium value higher than 12, the percentage of plasma aldosterone concentration (PAC) reduction after SIT by equal or less than 43.5%, the use of oral potassium replacement, unilateral disease at pre-AVS imaging, and a ratio of adjusted adrenal volumes equal to or below 1.7 were indicative of unilateral disease in univariate logistic regression analysis concerning the distinction of PA subtyping (p&lt; 0.05). Multivariate logistic regression analysis also revealed that adrenal volumetric assessment has an impact on PA subtyping (p&lt; 0.05). In the prediction model, when each of the six parameters that were significant in the univariate logistic regression analysis was assigned one point, &lt; 4 predicted bilateral PA, whereas ≥ 4 predicted unilateral PA (AUC:0.92, p&lt; 0.001). Conclusion: This prediction model before AVS may serve as a convenient and practical approach, while an adjusted adrenal volumetric assessment can make a positive contribution to PA subtyping.

To determine the feasibility of a pivotal randomised clinical trial of intravenous (IV) iron and erythropoietin in adult survivors of critical illness with anaemia requiring treatment in the intensive care unit.

Pituitary, meningioma, and glioma tumors are the primary widespread brain tumors. Treatment algorithms for these tumors may differ from each other. For this reason, the detection and typing of brain tumors are necessary to determine the appropriate treatment quickly. Since imaging findings vary, even experts often have difficulties in classifying brain tumors. In this study, a convolutional neural network-based hybrid model is developed to classify glioma, meningioma, pituitary tumors, and normal brain magnetic resonance images. In the proposed hybrid model, features are obtained using pre-trained Efficientnetb0 and Shufflenet architectures. Also, the images in the existing dataset are improved, such as colored and used as the second database. With the proposed two pre-trained models, the features of individual images from two datasets are extracted. Later, these features are concatenated, and the best of these features are selected using the mRMR feature reduction method and classified using the Support Vector Machine (SVM) classifier. The proposed method achieved better results than the previously trained Efficientnetb0 and Shufflenet architectures. The accuracy value of the proposed hybrid model is 95.4%.

Swarms of unmanned aerial vehicles (UAVs) are being explored as viable options for a variety of missions. However, extremely dynamic and rapidly changing environmental conditions such as wind prevent UAVs from maintaining a minimum safe distance and cause them to lose Connectivity. Furthermore, the UAVs near the swarm's edge will be more sensitive to connectivity failure. This study presents a thorough examination of the impact of wind on the connectivity of a large-scale swarm. The correlation between the number of UAVs needed to sustain swarm connectivity and characteristics like UAV speed, mass, wind speed, and drag force is also explored. From the results, the number of UAVs that do not maintain the minimum safe distance are seen to increase with increasing absolute value difference between the UAV and wind speed. Moreover, the number of critical UAVs is seen to decrease as the speed of UAVs increases relative to the mean wind speed for the same percentage of change in distance relative to the expected distance to be covered with the flight speed. Extending on these findings, a novel algorithm for updating UAV locations in a swarm in a constantly changing environment is also provided in order to maintain intra-UAV connectivity between individual UAV's. In this regard, a thorough examination of the impact of flying and maneuvering tactics selection is offered. As a result of comprehensive study, the proposed approach for updating UAV locations in uncertain conditions obtained a reduction in average outage probability of around 35%, 10%, and 40% using three distinct approaches, respectively, in contrast to earlier efforts. In addition, as compared to previous techniques, the proposed algorithm produced a smoother flight path with less jitters.

To study if a pituitary or ovarian defect contributes to subfertility of the female Nsmfknockout (KO) mouse, an animal model of the hypogonadotropic hypogonadism gene NSMF.

Polyurethane is a versatile polymer with a high degree of toughness and ductility used in a wide variety of applications. In this study, two-part thermoset polyurethane was used as a matrix material to prepare hybrid and non-hybrid composites. Hybrid laminates were prepared by combining either glass fiber or basalt fibers with steel fibers. The mechanical properties of prepared composite specimens were characterized and scanning electron microscope (SEM) observation was performed around the fracture region of the tested specimens. The results revealed a significant increment in tensile strength, and flexural strength in BS1-PU (8 layers of basalt-1 layer of steel) hybrid laminate by 357.74 % and 64.59 %, respectively, compared to steel fibers reinforced polyurethane composites. Furthermore, GS4-PU hybrid composite (5 layers of glass-4 layers of steel) achieved an improvement in tensile strain by 12.07 %, flexural strain by 25.32 %, and absorbed energy by 18.21 %, compared to glass fibers reinforced polyurethane composite. Moreover, the SEM observations revealed that the replacement of some basalt and glass layers with steel layers leads to a positive hybridization effect of the overall produced hybrid composites.

In this randomized phase 2 trial, blockade of cytotoxic T-lymphocyte protein 4 (CTLA-4) with continuation of programmed death protein 1 (PD-1) blockade in patients with metastatic melanoma who had received front-line anti-PD-1 or therapy against programmed cell death 1 ligand 1 and whose tumors progressed was tested in comparison with CTLA-4 blockade alone. Ninety-two eligible patients were randomly assigned in a 3:1 ratio to receive the combination of ipilimumab and nivolumab, or ipilimumab alone. The primary endpoint was progression-free survival. Secondary endpoints included the difference in CD8 T cell infiltrate among responding and nonresponding tumors, objective response rate, overall survival and toxicity. The combination of nivolumab and ipilimumab resulted in a statistically significant improvement in progression-free survival over ipilimumab (hazard ratio = 0.63, 90% confidence interval (CI) = 0.41–0.97, one-sided P= 0.04). Objective response rates were 28% (90% CI = 19–38%) and 9% (90% CI = 2–25%), respectively (one-sided P= 0.05). Grade 3 or higher treatment-related adverse events occurred in 57% and 35% of patients, respectively, which is consistent with the known toxicity profile of these regimens. The change in intratumoral CD8 T cell density observed in the present analysis did not reach statistical significance to support the formal hypothesis tested as a secondary endpoint. In conclusion, primary resistance to PD-1 blockade therapy can be reversed in some patients with the combination of CTLA-4 and PD-1 blockade. Clinicaltrials.gov identifier: NCT03033576.

This work presents the study of suspended Y-cut Lithium Niobate shear bulk acoustic resonators for wide band filter applications in the frequency range of 3.5-4.5GHz. The resonators consist of a Lithium Niobate film with Aluminum top interdigitated electrodes (IDE) and floating bottom metal plate. Through vertical electric field excitation, shear bulk acoustic waves are generated in each unit cell of the device functioning as a quasi-independent resonator. Measured devices at 3.7GHz having large relative resonance-antiresonance bandwidth of 16.7% (750MHz), with $2\mathrm {\Omega }$ impedance at resonance are presented. Suppression of higher order lateral harmonics through etching of trenches in the Lithium Niobate and geometric optimization is discussed. [2022-0205]

AbstractAn earthquake measuring 7.7 magnitude on the Richter scale occurred at 04:17amon February 6, 2023 in the Pazarcık district of Kahramanmaraş province Turkey. In the hours following the 7.7 magnitude event in Kahramanmaraş, a second 7.6 magnitude earthquake struck the region and a third 6.4 magnitude earthquake struck Gaziantep, causing extensive damage and death. A total of ten provinces directly experienced the earthquake, including Kahramanmaraş, Hatay, Gaziantep, Osmaniye, Malatya, Adana, Diyarbakır, Şanlıurfa, Adıyaman, and Kilis. The official figures indicate 31,643 people were killed, 80,278 were injured, and 6,444 buildings were destroyed within seven days of the earthquakes (as of 12:00pm/noon on Monday, February 13th). The area affected by the earthquake has been officially declared to be 500km in diameter. This report primarily relies on observations made by pioneer Emergency Physicians (EPs) who went to the disaster areas shortly after the first earthquake (in the early stages of the disaster). According to their observations: (1) Due to winter conditions, there were transportation problems and a shortage of personnel reaching disaster areas on the first day after the disaster; (2) On the second day of the disaster, health equipment was in short supply; (3) As of the third day, health workers were unprepared in terms of knowledge and experience for the disaster; and (4) The subsequent deployment of health personnel to the disaster area was uncoordinated and unplanned on the following days, which resulted in the health personnel working there not being able to meet even their basic needs (such as food, heating, and shelter). During the first week, coordination was most frequently reported as the most significant problem.

Chemogenetic Operation of iNTRacellular prOton Levels (pH-Control) is a novel substrate-based enzymatic method that enables precise spatiotemporal control of ultralocal acidification in cultured cell lines and primary neurons. The genetically encoded biosensor SypHer3s showed that pH-Control effectively acidifies cytosolic, mitochondrial, and nuclear pH exclusively in the presence of β-chloro-d-alanine in living cells in a concentration-dependent manner. The pH-Control approach is promising for investigating the ultralocal pH imbalance associated with many diseases.

During the current COVID pandemic, waste generation has been more evident with increased use of single use masks, gowns and other personal protective equipment. We aimed to understand the scale of waste generation, recycling rates and participation in Australian and New Zealand (ANZ) ICUs.

ObjectiveThis study examined the relationship between sensory processing (SP) differences and behavioral problems in children with autism spectrum disorder (ASD). We also investigated whether audiological test results could objectively detect auditory processing differences.MethodForty-six children with ASD, ages 3–9 years, were enrolled in the study. Problematic behaviors and sensory processing of children were assessed using scales. The otolaryngologist performed a detailed head and neck examination and a formal audiological examination was performed by an audiologist.ResultsStereotypy, hyperactivity, and irritability were related to sensation seeking. Stereotypy was also associated with visual processing. Touch processing differences was related to irritability and inappropriate speech. Lethargy was associated with auditory processing. There were no differences in SP and behavior problems in the children whose audiological profiles could be measured between those who passed or failed the test.ConclusionThere was an association between SP differences and behavioral problems in children with ASD, supporting previous studies. Audiological test results did not reveal the SP differences documented in the parent forms.

Background:This study aimed to analyze postoperative upper pole fullness, upper/lower pole ratios, bottoming-out deformity, and complication rates for patients who underwent planned bilateral reduction mammoplasty for gigantomastia using the superomedial dermoglandular pedicle technique and Wise-pattern skin excision. Methods:A total of 105 consecutive patients were evaluated postoperatively within a year in full lateral position, and the upper pole was between the lines drawn horizontally from the nipple meridian, where the breast became evident on the chest wall. Flat and slightly convex upper pole slopes were considered well-rounded; the concave ones were evaluated as exhibiting decreased fullness. The lower pole was the height between the horizontal line passing through the level of the inframammary fold and nipple meridian. Bottoming-out deformity was evaluated according to the 45/55% ratio developed by Mallucci and Branford, where the bottom pole was above 55%, at which it was held to be leaning toward bottoming-out deformity. Results:The upper and lower pole ratios were 44.79% ± 2.80% and 55.21% ± 2.80%, respectively. In 4 cases, a lower pole distance of >55% was leaning toward bottoming-out deformity. A minimum of 12 months was required after surgery to detect upper pole fullness and any possible bottoming-out deformity. The upper pole fullness was achieved in 94% of cases that underwent superomedial dermoglandular pedicle Wise-pattern breast reduction. Conclusion:The use of the superomedial dermoglandular pedicle technique with the Wise-pattern in breast reduction operations helps in ensuring upper pole fullness, resulting in less bottoming-out deformity and requiring less revision.

Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation.