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Today's consumers expect brands to act morally to win their hearts and wallets. Yet, existing marketing literature provides little clarity on what this behavior entails and how it differs from acting ethically. This study aims to clarify these concepts and inspire further research. Our consumer‐centric research adopted a multi‐theory and multi‐method approach, coupling Moral Foundations with Morality as Cooperation theories, 12 in‐depth interviews and three surveys with 1229 respondents from two opposite national cultures. We present a Brand Morality scale involving three meaningful dimensions: brand care, brand compliance and brand competency. Brand care is more influential in establishing a moralistic image than the other dimensions. We also learn that while consumers from different national cultures may value the same set of BM dimensions on a cognitive level, they may interpret and react differently on a behavioral‐intent level. Our unique contributions include (i) presenting a 12‐item Brand Morality scale that is theoretically meaningful and practically applicable to brands, (ii) demonstrating the co‐utility of two under‐considered theories, (iii) clarifying the nuanced distinctions of brands acting morally versus ethically, and (iv) shedding light on consumers' perceptual definitions of BM may be consistent between nations, but their behavioral interpretations may vary depending on their local cultures. [ABSTRACT FROM AUTHOR]

In the present study, we evaluate the proportion of women authorship in the field of obstetrics and gynecology research by assessing five prominent journals spanning 2001–2021, analyzing article types, study types, sub-specificities, and regions. Our outcomes demonstrate a significant increase in women’s authorship over time, highlighting progress in promoting gender equality. However, the rate of first and most senior women authors remains relatively unchanged. Notably, we determine a rise in the proportion of first authors who are women in experimental studies but not in studies that require surgical practice. This study sheds light on the challenges faced by women in scientific pursuits. Our study suggests that systemic barriers, prejudices, and inequalities likely continue to hinder gender equality in our discipline. By emphasising the continuance of this problem, we intend to encourage collective awareness and action. Together, we can transcend gender disparities and create a space where every voice, regardless of gender, can flourish. Through our study, we hope to inspire future generations and ignite change within the field of obstetrics and gynecology. By valuing and amplifying diverse perspectives, we can create a future where gender equality is the norm, enabling scientific discovery to reach new heights. [ABSTRACT FROM AUTHOR]

Background: Psychotic disorders are characterized by white matter (WM) abnormalities; however, their relationship with the various aspects of illness presentation remains unclear. Sleep disturbances are common in psychosis, and emerging evidence suggests that sleep plays a critical role in WM physiology. Therefore, it is plausible that sleep disturbances are associated with impaired WM integrity in these disorders. To test this hypothesis, we examined the association of self-reported sleep disturbances with WM transverse (T2) relaxation times in a cross-diagnostic sample of patients with psychosis. Methods: A total of 28 patients with psychosis (11 schizophrenia spectrum disorders and 17 bipolar disorder with psychotic features) were included. Metabolite (N-acetyl aspartate, choline, and creatine) and water T2 relaxation times were measured in the anterior corona radiata at 4T. Sleep was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Results: PSQI total score showed a moderate to strong positive correlation with water T2 (r = 0.64, p < 0.001). Linear regressions showed that this association was independent of the overall severity of depressive, manic, or psychotic symptoms. In our exploratory analysis, sleep disturbance was correlated with free water percentage, suggesting that increased extracellular water may be a mechanism underlying the association of disturbed sleep and prolonged water T2 relaxation. Conclusion: Our results highlight the connection between poor sleep and WM abnormalities in psychotic disorders. Future research using objective sleep measures and neuroimaging techniques suitable to probe free water is needed to further our insight into this relationship. [ABSTRACT FROM AUTHOR]

This research aims to assess the integration of different fuel cell (FC) options with battery and waste heat recovery systems through a mathematical modelling process to determine the most feasible retrofit solutions for a marine electricity generation plant. This paper distinguishes itself from existing literature by incorporating future cost projection scenarios involving variables such as carbon tax, fuel, and equipment prices. It assesses the environmental impact by including upstream emissions integrated with the Energy Efficiency Existing Ship Index (EEXI) and the Carbon Intensity Indicator (CII) calculations. Real-time data have been collected from a Kamsarmax vessel to build a hybrid marine power distribution plant model for simulating six system designs. A Multi-Criteria Decision Making (MCDM) methodology ranks the scenarios depending on environmental benefits, economic performance, and system space requirements. The findings demonstrate that the hybrid configurations, including solid oxide (SOFC) and proton exchange (PEMFC) FCs, achieve a deduction in equivalent CO2 of the plant up to 91.79% and decrease the EEXI and the average CII by 10.24% and 6.53%, respectively. Although SOFC-included configurations show slightly better economic performance and require less fuel capacity, the overall performance of PEMFC designs are ranked higher in MCDM analysis due to the higher power density. [ABSTRACT FROM AUTHOR]

Large Language Models have demonstrated expert-level accuracy on medical board examinations, suggesting potential for clinical decision support systems. However, their metacognitive abilities, crucial for medical decision-making, remain largely unexplored. To address this gap, we developed MetaMedQA, a benchmark incorporating confidence scores and metacognitive tasks into multiple-choice medical questions. We evaluated twelve models on dimensions including confidence-based accuracy, missing answer recall, and unknown recall. Despite high accuracy on multiple-choice questions, our study revealed significant metacognitive deficiencies across all tested models. Models consistently failed to recognize their knowledge limitations and provided confident answers even when correct options were absent. In this work, we show that current models exhibit a critical disconnect between perceived and actual capabilities in medical reasoning, posing significant risks in clinical settings. Our findings emphasize the need for more robust evaluation frameworks that incorporate metacognitive abilities, essential for developing reliable Large Language Model enhanced clinical decision support systems. Large Language Models demonstrate expert-level accuracy in medical exams, supporting their potential inclusion in healthcare settings. Here, authors reveal that their metacognitive abilities are underexplored, showing significant gaps in recognizing knowledge limitations, difficulties in modulating their confidence, and challenges in identifying when a problem cannot be answered due to insufficient information. [ABSTRACT FROM AUTHOR]

Background: Scarce evidence is available on the epidemiology of microbiologically proven clinical infections in patients admitted to the intensive care unit (ICU) after a great earthquake. The main aim of this study was to assess clinical infections and microbiological features in patients admitted to the ICU following the 2023 earthquake in the southeastern region of Türkiye with a focus on the timing of culture positivity during their ICU stay. The secondary objectives included determining antibiotic susceptibility patterns, identifying the types of antibiotics administered upon ICU admission, evaluating the appropriateness of antibiotic usage, assessing patient outcomes, and identifying factors that influence microbiologically confirmed clinical infections. Methods: A retrospective, multicenter, observational study was conducted on adult earthquake victims admitted to the ICU after the 2023 earthquake in southeastern Türkiye. Patients were categorized into four groups on the basis of culture positivity timing at the 72-hour breakpoint and clinical characteristics were compared among these groups. Factors influencing microbiologically proven clinical infections were also analysed. Results: A total of 107 earthquake-affected adults (58 females and 49 males, median [IQR] age: 37 [27–57] years) were analysed. Infection was present in 50.5% of the patients, predominantly with multidrug-resistant pathogens. Amputation (OR 5.30) and intermittent hemodialysis (OR 2.98) before ICU admission were independent predictors of infection. Conclusions: This study demonstrated that half of the patients admitted to the ICU with earthquake-related injuries had microbiologically proven clinical infections, highlighting the early presence of multidrug-resistant pathogens. [ABSTRACT FROM AUTHOR]

Simple Summary: Despite recent advances, glioblastoma remains incurable, with a poor prognosis. The REGOMA trial compared regorafenib with lomustine as second-line treatments for recurrent glioblastoma. Regorafenib resulted in better overall survival than lomustine, leading to its inclusion in current guidelines. Currently, bevacizumab, lomustine, and regorafenib are recommended treatment options for recurrent glioblastoma. Bevacizumab is a vascular endothelial growth factor receptor-A inhibitor and prevents angiogenesis. However, the optimal treatment for patients whose conditions progress after bevacizumab-based therapy in the third-line setting remains unclear. We assessed the efficacy and safety of regorafenib as a third-line treatment after bevacizumab and aimed to evaluate the potential benefit of continued vascular endothelial growth factor receptor inhibition. Regorafenib appears to be a good option regarding efficacy and safety for patients who progress after bevacizumab-based therapy. However, further studies are required to better define the role of regorafenib in recurrent glioblastoma. Background/Objectives: In the REGOMA trial, regorafenib demonstrated an overall survival advantage over lomustine, and it has become a recommended treatment for recurrent glioblastoma in guidelines. This study aimed to evaluate the effectiveness and safety of regorafenib as a third-line treatment for patients with recurrent glioblastoma who progressed while taking bevacizumab-based therapy. Methods: This retrospective, multicenter study in Turkey included 65 patients treated between 2021 and 2023 across 19 oncology centers. The main inclusion criteria were histologically confirmed isocitrate dehydrogenase (IDH)-wildtype glioblastoma, progression after second-line bevacizumab-based treatment, and an Eastern Cooperative Oncology Group (ECOG) performance status score of ≤2. Patients received regorafenib 160 mg once daily for the first 3 weeks of each 4-week cycle. Results: The median age of the patients was 53 years (18–67 years), with a median progression-free survival of 2.5 months (95% Confidence Interval: 2.23–2.75) and a median overall survival of 4.1 months (95% CI: 3.52–4.68). The median overall survival was improved in patients who received subsequent therapy after regorafenib treatment compared with those who did not (p = 0.022). Progression-free survival was longer in patients with ECOG 0–1 than in those with ECOG 2 (p = 0.042). The safety profile was consistent with that of the REGOMA trial, with no drug-related deaths observed. Conclusions: Regorafenib shows good efficacy and safety as a third-line treatment for recurrent glioblastoma after bevacizumab-based therapy. This study supports the use of regorafenib and emphasizes the need for further randomized studies to validate its role and optimize treatment strategies. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the pharmacokinetics of marbofloxacin after intravenous (IV) administration of a single dose of 10 mg/kg to calves of different ages. The study was carried on 1‐ (n = 6), 2‐ (n = 6), and 4‐month‐old (n = 6) Montofon calves. Plasma concentrations of marbofloxacin were measured using HPLC, and pharmacokinetic data were calculated by non‐compartmental analysis. The elimination half‐life (t1/2ʎz), volume of distribution at steady state (Vdss), total clearance (ClT), and area under the concentration‐versus time curve (AUC0–∞) values of marbofloxacin in 1‐month‐old calves were 10.62 h, 1.03 L/kg, 0.08 L/h/kg, and 127.90 h*μg/mL, respectively. While the t1/2ʎz (from 10.62 to 3.36 h) and AUC0–∞ (from 127.90 to 47.35 h*μg/mL) decreased in parallel with the age of the calves, ClT (from 0.08 to 0.21 L/h/kg) increased. The Vdss of marbofloxacin was higher in 1‐ and 2‐month‐old calves compared to 4‐month‐old calves. After IV administration of marbofloxacin at a dose of 10 mg/kg, an ƒAUC0–24/MIC90 ratio of ≥ 125 was obtained for bacteria with MIC90 values of ≤ 0.60, ≤ 0.39 and ≤ 0.27 μg/mL in 1‐, 2‐, and 4‐month‐old calves, respectively. These results show that the antibacterial effect of marbofloxacin, which has concentration‐dependent activity, decreases due to age‐related pharmacokinetic changes and that the 10 mg/kg dose should be reviewed according to the MIC90 value of the bacteria. [ABSTRACT FROM AUTHOR]

Introduction: Pulmonary exacerbations increase the requirement of aminoglycoside (AG) antibiotics in people with cystic fibrosis (pwCF). Several studies have shown that AGs have a cumulative effect on ototoxicity. We aimed to investigate the relationship between AG exposure and ototoxicity by using 3 different methods in patients with CF. Materials/Methods: The multicenter study included 121 pwCF aged between 5 and 18 years with a history of parenteral AG exposure. Standard pure-tone audiometry, extended high-frequency pure-tone audiometry (EHF-PTA), and distortion-product otoacoustic emissions (DPOAE) tests were performed. Mitochondrial mutation analysis for m1555G>A was performed in 61 patients. Results: Median age was 12.85 years and 52.1% (n = 63) were male. 18.2% (n = 22) of the patients had received parenteral AGs more than 5 courses/lifetime. Ototoxicity was detected in at least one of the tests in 56.2% (n = 68) of the patients. Only 10.7% (n = 13) of the patients had reported a symptom indicating ototoxicity. 30.3% (n = 30) of the patients had ototoxicity in the low exposure group, while it was 45.5% (n = 10) in the high exposure group according to EHF-PTA (p > 0.05). Median number of parenteral amikacin courses was significantly higher in the ototoxic group (2 [1.25–5.75] vs. 2 [1–3]; p = 0.045). No m1555A>G mutation was detected in 61 patients who screened for mitochondrial mutation analysis. Conclusion: As AG ototoxicity occurs primarily at high frequencies, EHF-PTA is important in early detecting ototoxicity. EHF-PTA and DPOAE detected ototoxicity in some patients with normal PTA results. All pwCF with a history of AG exposure should be evaluated for hearing loss since symptoms may only be noticed in the late period. [ABSTRACT FROM AUTHOR]

Background: To compare the long-term safety and efficacy of Adalimumab (ADA) and Infliximab (IFX) agents in biologic-naive patients with Ulcerative colitis (UC). Methods: The key focus was on specific outcomes such as the requirement of hospitalization due to UC, colectomy, steroid administration, and severe infections that led to the discontinuation of therapy. Results: Anti-TNF treatment was initiated in 208 of the 475 patients with ulcerative colitis. The final study population consisted of 86 biologic-naive patients with UC, including 41 treated with IFX and 45 treated with ADA. No significant differences in treatment details, baseline Mayo scores, risk factors, or demographic features were observed. The ADA group displayed a significantly increased need for steroids (44.4%) compared to the IFX group (14.6%). The UC-associated hospitalization, colectomy, and serious infections were similar between the ADA and IFX groups. Similar outcomes were observed with IFX or ADA as monotherapy or in combination with immunomodulators. The survival analysis revealed IFX had a longer time to secondary loss of response compared to ADA, however, without statistical significance (72.5% versus 46.7%, P = 0.057). Conclusion: Our results hint at the likelihood of IFX and ADA presenting similar clinical outcomes as first-time agents in UC. Nonetheless, the need for steroids with ADA should be taken into consideration. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the validity and reliability of the Turkish version of the Fear of Pain Questionnaire for Children-Short Form (FOPQC-SF) in children/adolescents with juvenile idiopathic arthritis (JIA). Methods: To evaluate validity of FOPQC-SF, 70 children/adolescents with JIA were included. Data were collected using Pediatric Quality Of Life Inventory 3.0. Module Arthritis (PedsQL), Childhood Health Assessment Questionnaire (CHAQ) and Juvenile Arthritis Disease Activity Score (JADAS).To determine the reliability of the FOPQC-SF, test-retest was performed at one-week intervals on participants who had not made any changes to their pharmacological treatment and had not received any additional treatment. Results: With factor restrictions, items of Turkish version of FOPQC-SF were found acceptable for a 2-factor structure (fear:4 items; avoidance:6 items)(RMSEA = 0.058, GFI = 0.890, X2 = 40.667 X2/df = 1.196). With no restrictions, items of Turkish version of FOPQC-SF were found to be excellent for a 3-factor structure (fear:3 items; avoidance:4 items; other:3 items) (RMSEA = 0.036, GFI = 0.909, X2 = 34.465, X2/df = 1.077).The Cronbach's alpha value of Turkish version of FOPQC-SF total was 0.865 (good). The intraclass correlation coefficient (ICC2,1) was 0.865 (very high). Fear and avoidance subscales and total score of Turkish version of FOPQC-SF had low to moderate correlation with CHAQ-disability index, CHAQ-pain, CHAQ-global evaluation, JADAS, PedsQL-child total, PedsQL-parent total (r:-0.283/-0.452)(p < 0.05). Other subscale of Turkish version of FOPQC-SF had low to moderate correlation with CHAQ-disability index, CHAQ-pain, PedsQL-parent total (r:0.286/0.318) (p < 0.05). Conclusion: The Turkish version of FOPQC-SF was found to be clinically valid and reliable in children and adolescents with JIA. [ABSTRACT FROM AUTHOR]

Although complementary feeding (CF) and maternal attitudes towards infant feeding are known to affect the nutritional status of infants during the neonatal period, studies in this field remain limited. The present study aimed to determine CF practices for infants aged 6–12 months who live in Turkey and maternal attitudes towards infant feeding. In addition, the effects of CF practices and maternal attitudes on the nutritional status of infants were examined. This study included 720 infants, of whom 289 were aged 6–8 months and 431 were aged 9–12 months. CF status was assessed using the CF index (CFI), and maternal attitudes towards infant feeding were measured using the Iowa infant feeding attitude scale (IIFAS). The weight and length measurements of infants were categorized using z‐scores. Infants with weight‐for‐age z‐score (WAZ) and weight‐for‐length z‐score (WLZ) of less than −2 standard deviation were categorized as malnourished. Mothers of malnourished infants were found to have lower CFI and IIFAS scores (p < 0.05). Consistency of fruit feeding and complementary foods in the first 3 days of CF was associated with WAZ. The mothers' level of knowledge about CF and appropriate CF practices significantly affects the nutritional status of infants. The tools used in the present study to monitor CF practices should be incorporated into public health programmes. Key messages: The mothers' level of knowledge about complementary feeding and appropriate practices significantly affects the nutritional status of infants.Mothers of malnourished infants were found to have lower complementary feeding practices.The mode of delivery was found to affect both weight‐for‐age and weight‐for‐length z‐scores of infants.Fruit feeding for the first 3 days affected weight‐for‐age z‐scores negatively. [ABSTRACT FROM AUTHOR]

This study assesses the case frequencies, underlying causes, and vision outcomes in patients with a diagnosis of corneal opacity in the United States. Retrospective cohort study. Patients in the IRIS® Registry (Intelligent Research in Sight) who received a diagnosis of corneal opacity between January 1, 2013, and November 30, 2020. The IRIS Registry contains demographic and clinical data of 79 887 324 patients who sought treatment at eye clinics during the study period. We identified patients with corneal opacity using International Classification of Diseases (ICD), Ninth and Tenth Revisions, codes of 371 (corneal scar) and H17 (corneal opacity), respectively. The analyzed data comprised demographic parameters including age, sex, race, ethnicity, and geographical location. We evaluated clinical data including laterality, cause, disease descriptors, and best-corrected visual acuity (VA) up to 1 year before the onset (± 30 days), at the time of diagnosis, and at 1 year after diagnosis (± 30 days). Case frequencies, causes, and vision outcomes in patients with a diagnosis of corneal opacity. We identified 5 220 382 patients who received a diagnosis of corneal opacity and scars using H17 (ICD, Tenth Revision) and 371.0 (ICD, Ninth Revision) codes over 7 years. The case frequency of corneal opacity during the study period was 6535 cases per 100 000 patients (6.5%). The mean age of the patients was 63.36 ± 18.14 years, and most were female (57.6%). In the cohort, 38.39% and 30.00% of patients had bilateral and unilateral corneal opacity, respectively. Most of the patients affected by corneal opacity were White (69.13%), followed by Black or African American (6.84%). Corneal dystrophies (64.66%) were the most common cause of corneal opacity in the study cohort. Visual acuity of the patients worsened significantly because of corneal opacity (0.46 ± 0.74 logarithm of the minimum angle of resolution [logMAR]) and did not improve to the baseline (0.37 ± 0.68 logMAR) after management (0.43 ± 0.77 logMAR). The multiple linear regression analysis showed worse vision outcomes in female patients (compared with male patients), and Asian, Black or African American, and American Indian or Alaska Native (compared with White) patients. Additionally, worse vision outcomes were observed in patients with opacity associated with corneal malformation, degenerative disorders, edema, injury, and ulcer compared with those with hereditary corneal dystrophy. Our study showed that corneal opacity was diagnosed in 6.5% of patients in the IRIS Registry and primarily associated with corneal dystrophies. The final vision outcomes in patients with corneal opacity were significantly worse compared with baseline. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Abstract Large Language Models have demonstrated expert-level accuracy on medical board examinations, suggesting potential for clinical decision support systems. However, their metacognitive abilities, crucial for medical decision-making, remain largely unexplored. To address this gap, we developed MetaMedQA, a benchmark incorporating confidence scores and metacognitive tasks into multiple-choice medical questions. We evaluated twelve models on dimensions including confidence-based accuracy, missing answer recall, and unknown recall. Despite high accuracy on multiple-choice questions, our study revealed significant metacognitive deficiencies across all tested models. Models consistently failed to recognize their knowledge limitations and provided confident answers even when correct options were absent. In this work, we show that current models exhibit a critical disconnect between perceived and actual capabilities in medical reasoning, posing significant risks in clinical settings. Our findings emphasize the need for more robust evaluation frameworks that incorporate metacognitive abilities, essential for developing reliable Large Language Model enhanced clinical decision support systems.

BackgroundPsychotic disorders are characterized by white matter (WM) abnormalities; however, their relationship with the various aspects of illness presentation remains unclear. Sleep disturbances are common in psychosis, and emerging evidence suggests that sleep plays a critical role in WM physiology. Therefore, it is plausible that sleep disturbances are associated with impaired WM integrity in these disorders. To test this hypothesis, we examined the association of self-reported sleep disturbances with WM transverse (T2) relaxation times in a cross-diagnostic sample of patients with psychosis.MethodsA total of 28 patients with psychosis (11 schizophrenia spectrum disorders and 17 bipolar disorder with psychotic features) were included. Metabolite (N-acetyl aspartate, choline, and creatine) and water T2 relaxation times were measured in the anterior corona radiata at 4T. Sleep was evaluated using the Pittsburgh Sleep Quality Index (PSQI).ResultsPSQI total score showed a moderate to strong positive correlation with water T2 (r = 0.64, p< 0.001). Linear regressions showed that this association was independent of the overall severity of depressive, manic, or psychotic symptoms. In our exploratory analysis, sleep disturbance was correlated with free water percentage, suggesting that increased extracellular water may be a mechanism underlying the association of disturbed sleep and prolonged water T2 relaxation.ConclusionOur results highlight the connection between poor sleep and WM abnormalities in psychotic disorders. Future research using objective sleep measures and neuroimaging techniques suitable to probe free water is needed to further our insight into this relationship.