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This study uses an analytical approach to investigate the emerging disconnect between firm size and financial performance, as observed recently from a set of long-term data collected from U.S. public firms. By holding all organizational aspects of a firm constant, it confirms the validity of the old saying that the larger a firm is, the better chance it can secure advantages against rivals and the higher returns it can fetch. However, if the assumption about organizational aspects is removed, the present study shows that if a firm employs its assets to increase production output through hiring additional employees, then the consequently increased organizational inefficiency, as caused by interactions of the employees, will soon erase the expected increase in the output. Additionally, it is also shown, among other results, that when a firm hires additional human labor to meet the increasing market demand, the expected profit will decline after first reaching its maximum level. These results crystalize what has been speculated and what have been empirically observed. In the conclusion section, it is recommended that increasing a firm’s size, in terms of the number of employees, is not a realistic, efficient solution to meeting the challenge of increasing market demand. Instead, any genuine solution must satisfy the condition that it does not increase the organization’s inefficiency of the firm, such as increasing the magnitude of automation and/or digitization.

Fable artifabulas, which are transhistorical in nature, have many ethnocultural refractions in the literature of different peoples of the world. In this article, with methodological support on the works of I.G. Herder, G.D. Gachev, as well as contemporary Caucasian scholars, the author explores the specifics of the Kabardian fable, taken in the dialectical unity of its stable, archetypal constants and nationally determined contexts. By the example of the fables of K. Atazhukin, A. Dymov, B. Zhanimov, B. Kagermazov, P. Tambiev, B. Tkhamokov, M. Khakuasheva, P. Shekikhachev, T. Sheretlokov, A. Shomakhov, H. Elberdov the law of correlation between moral values declared by poets and the postulates of the Kabardian ethical code “Adyghe Khabze” is shown. Within the framework of historical poetics, the author demonstrates three-stage evolutionary process associated with the transition of fabulists from the practice of borrowing classical subjects to national adaptation, and then to the creation of original texts. Much attention is paid to the decoding of symbolic images.

Abstract Odronextamab is a fully‐human IgG4‐based CD20xCD3 bispecific antibody that binds to CD3 on T cells and CD20 on B cells, triggering T‐cell‐mediated cytotoxicity independent of T‐cell‐receptor recognition. Adequate safety, tolerability, and encouraging durable complete responses have been observed in an ongoing first‐in‐human (FIH) study of odronextamab in patients with relapsed/refractory (R/R) B‐cell non‐Hodgkin lymphoma (B‐NHL; NCT02290951). We retrospectively evaluated the pharmacokinetic, pharmacodynamic, and antitumor characteristics of odronextamab in a series of in vitro/in vivo preclinical experiments, to assess their translational value to inform dose escalation for the FIH study. Half‐maximal effective concentration values from in vitro cytokine release assays (range: 0.05–0.08 mg/L) provided a reasonable estimate of odronextamab concentrations in patients associated with cytokine release at a 0.5 mg dose (maximum serum concentration: 0.081 mg/L) on week 1/day 1, which could therefore be used to determine the week 1 clinical dose. Odronextamab concentrations resulting in 100% inhibition of tumor growth in a Raji xenograft tumor mouse model (1–10 mg/L) were useful to predict efficacious concentrations in patients and inform dose‐escalation strategy. Although predicted human pharmacokinetic parameters derived from monkey data overestimated projected odronextamab exposure, they provided a conservative estimate for FIH starting doses. With step‐up dosing, the highest‐tested weekly odronextamab dose in patients (320 mg) exceeded the 1 mg/kg single dose in monkeys without step‐up dosing. In conclusion, combination of odronextamab in vitro cytokine data, efficacious concentration data from mouse tumor models, and pharmacokinetic evaluations in monkeys has translational value to inform odronextamab FIH study design in patients with R/R B‐NHL.

Abstract T-cell-redirecting bispecific antibodies have emerged as a new class of therapeutic agents designed to simultaneously bind to T cells via CD3 and to tumor cells via tumor-cell-specific antigens (TSA), inducing T-cell-mediated killing of tumor cells. The promising preclinical and clinical efficacy of TSAxCD3 antibodies is often accompanied by toxicities such as cytokine release syndrome due to T-cell activation. How the efficacy and toxicity profile of the TSAxCD3 bispecific antibodies depends on the binding affinity to CD3 remains unclear. Here, we evaluate bispecific antibodies that were engineered to have a range of CD3 affinities, while retaining the same binding affinity for the selected tumor antigen. These agents were tested for their ability to kill tumor cells in vitro, and their biodistribution, serum half-life, and anti-tumor activity in vivo. Remarkably, by altering the binding affinity for CD3 alone, we can generate bispecific antibodies that maintain potent killing of TSA + tumor cells but display differential patterns of cytokine release, pharmacokinetics, and biodistribution. Therefore, tuning CD3 affinity is a promising method to improve the therapeutic index of T-cell-engaging bispecific antibodies.

Objective: It is aimed to evaluate the protective effect of bilberry on I/R injury in rat ovary. Materials and methods: A total 48 female Wistar–Albino rats were utilized to form five groups: Group 1 (control group) (n = 8), neither drug was given and nor procedure was performed. Group 2 (bilberry control group) (n = 10), single dose 200 mg/kg bilberry was administered by gavage and no procedure was performed. Group 3 (I/R group) (n = 10), no drug was given, 1-h ischemia and 2-h reperfusion was performed. Group 4 (bilberry before I/R group) (n = 10), single dose 200 mg/kg bilberry was administered by gavage before ischemia. Then 1-h ischemia and 2-h reperfusion was performed. Group 5 (bilberry after I/R group) (n = 10), first 1-h ischemia was performed. Single dose 200 mg/kg bilberry was administered by gavage and then 2-h reperfusion was performed. Right ovaries were surgically extirpated in all groups. In ovarian tissue samples, malondialdehyde (MDA) levels and enzymatic activities of superoxide dismutase (SOD), catalase (CAT) were studied. In ovarian tissue samples, DNA damage and apoptosis were assessed by using TUNEL method. Histopathologic examination was performed by light microscopic findings. Results: When group 3 was compared with another groups, MDA levels were significantly higher, enzymatic activities of SOD and CAT were found to be as significantly lower in ovarian tissue and blood (p

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The purpose of this study was to explore validity of the paper pull test (PPT) to assess hallux flexion strength and function in persons with hallux valgus (HV). The following hypotheses were tested: 1) The PPT is valid for inferring 1st MTP flexion strength and heel rise (HR) performance (e.g. heel height). 2) A specified threshold of force during the PPT can be identified that discriminates patients with HV. 3) Muscle activity (abductor hallucis [AH], flexor hallucis brevis [FHB]), in patients with HV will be distinct from controls across three tasks: 1) PPT, 2) lowering phase of a HR, and 3) rising phase of a HR. Methods: Participants (24 controls, 22 with HV) performed: 1st MTP flexion, PPT, and heel rise. A force transducer in a jig assessed 1st MTP flexion. The same transducer recorded force during the PPT. Electromyography (EMG) was used to record FHB/AH muscle activity during 1st MTP flexion, PPT, and heel rising. 3D movement analysis was used to measure heel height and divide the HR into an up (HR-Up) and down (HR-Dwn) phase. One practice and 3 maximum 1st MTP flexion efforts were recorded. Manchester Scale of hallux deformity was used; 63.6% were classified as C or D. Validity was assessed with Pearson correlation’s between force during the PPT and 1st MTP flexion and PPT and HR height. Assessment of a threshold value for discriminating participants with HV from controls was determined using receiver operator curve (ROC) analysis. A two-way ANOVA for muscle groups and tasks were used to assess muscle activation. Results: The correlation between PPT force and maximum 1st MTP force was high (r=0.87, p

Vertebral body haemangioma (VBH) is a common incidental finding on imaging, occurring in at least 10% of the population. Typical VBH are comprised of endothelial lined vessels and sinuses between vertical longitudinal bony trabeculae. Occasionally these lesions will demonstrate extraosseous extension resulting in cord or nerve root compression and require active management. Accurate, timely diagnosis is critical particularly given the increased risk of haemorrhage compared with other lesions that occur in this location. These lesions can be rapidly progressive or complicated by a pathological fracture and if diagnosis and treatment is delayed permanent paralysis may result. Both magnetic resonance imaging (MRI) and computed tomography (CT) have independent roles to play in diagnosis, assessment of local complications and preoperative planning to reduce morbidity and mortality. Extraosseous VBH are more likely to have atypical features on MRI, and in some cases CT will be crucial for diagnosis. An accurate preoperative diagnosis will allow for preoparative angiography in selected cases to both aid surgical planning and for preoperative angioembolisation. Keywords: Extra osseous haemangioma, Vertebral body, Magnetic resonance imaging, Cord compression, Myelomalacia, Endothelial cells

Abstract Background The Auckland Stillbirth study demonstrated a two-fold increased risk of late stillbirth for women who did not go to sleep on their left side. Two further studies have confirmed an increased risk of late stillbirth with supine sleep position. As sleep position is modifiable, we surveyed self-reported late pregnancy sleep position, knowledge about sleep position, and views about changing going-to-sleep position. Methods Participants in this 2014 survey were pregnant women (n = 377) in their third trimester from South Auckland, New Zealand, a multi-ethnic and predominantly low socio-economic population. An ethnically-representative sample was obtained using random sampling. Multivariable logistic regression was performed to identify factors independently associated with non-left sided going-to-sleep position in late pregnancy. Results Respondents were 28 to 42 weeks’ gestation. Reported going-to-sleep position in the last week was left side (30%), right side (22%), supine (3%), either side (39%) and other (6%). Two thirds (68%) reported they had received advice about sleep position. Non-left sleepers were asked if they would be able to change to their left side if it was better for their baby; 87% reported they would have little or no difficulty changing. Women who reported a non-left going-to-sleep position were more likely to be of Maori (aOR 2.64 95% CI 1.23–5.66) or Pacific (aOR 2.91 95% CI 1.46–5.78) ethnicity; had a lower body mass index (BMI) (aOR 0.93 95% CI 0.89–0.96); and were less likely to sleep on the left-hand side of the bed (aOR 3.29 95% CI 2.03–5.32). Conclusions Maternal going-to-sleep position in the last week was side-lying in 91% of participants. The majority had received advice to sleep on their side or avoid supine sleep position. Sleeping on the left-hand side of the bed was associated with going-to-sleep on the left side. Most non-left sleepers reported their sleeping position could be modified to the left side suggesting a public health intervention about sleep position is likely to be feasible in other multi-ethnic communities.

Background: Sexual partner concurrency has been implicated in the genesis of generalized HIV epidemic in South Africa. Most South Africans, however, disapprove of concurrency in surveys. These surveys test individuals’ explicit attitudes which are susceptible to a number of important biases such as the social desirability bias. Assessment of implicit cognitions have been found to be better predictors of behaviour in socially sensitive domains. We hypothesized that South Africans may have implicit attitudes more tolerant of concurrency than lower concurrency prevalence populations. Methods: To test this hypothesis, we developed a concurrency-implicit association test (C-IAT) and compared the C-IATs of samples of South African and Belgian university students. Results: We found a large and statistically significant difference in the C-IAT between the South Africans (D600-score = -0.009, indicating absence of preference for concurrency or monogamy) and Belgians (D600-score = 0.783, indicating a strong preference for monogamy; t-test = 13.3; P < 0.0001). The effect size measure, Cohen’s d, was found to be 0.88, which is considered a large effect size in this field. Conclusions: Our results are compatible with the thesis that differences in implicit attitudes to concurrency play a role in the genesis of generalised HIV epidemics.

High rates of sexual partner concurrency have been shown to facilitate the spread of various sexually transmitted infections. Assessments of explicit attitudes to concurrency have however found little difference between populations. Implicit attitudes to concurrency may vary between populations and play a role in generating differences in the prevalence of concurrency. We developed a concurrency implicit associations test (C-IAT) to assess if implicit attitudes towards concurrency may vary between individuals and populations and what the correlates of these variations are. A sample of 869 Belgian students (mean age 23, SD 5.1) completed an online version of the C-IAT together with a questionnaire concerning sexual behavior and explicit attitudes to concurrency. The study participants C-IATs demonstrated a strong preference for monogamy (-0.78, SD = 0.41). 93.2% of participants had a pro-monogamy C-IAT. There was no difference in this implicit preference for monogamy between heterosexual men and women. Men who have sex with men and women who have sex with women were more likely to exhibit implicit but not explicit preferences for concurrency compared to heterosexual men and women. Correlates of the C-IAT varied between men and women.

Background: AIDS mortality played an important role in the decline in syphilis prevalence in the USA, but its effect on the dramatic reduction in syphilis prevalence in Southern and Eastern Africa has not been explored. In this ecological study, we investigated the extent to which the relationship between syphilis and HIV prevalence at a population level varied between the early and late periods of the HIV epidemic. Methods: We performed linear regression analysis to measure the association between the national prevalence of syphilis and the peak-HIV prevalence in the early and late phases of the HIV epidemic in 11 countries of Southern and Eastern Africa. Results: Our analysis showed a strong positive association between peak-HIV prevalence and syphilis prevalence early in the HIV epidemic (R2 = 0.59; p = 0.006). Although only of borderline statistical significance, this linear relationship between HIV prevalence and syphilis prevalence switched to a negative direction late in the HIV epidemic (R2 = 0.32; p = 0.07). Conclusions: AIDS mortality may have played an important role in the decline in syphilis in this region. Consequently, with AIDS deaths declining in Sub-Saharan Africa, vigilant surveillance of syphilis prevalence will be necessary to detect a potential re-emergence, as has occurred in high-income countries, and to render a timely public health response.

Book review of Gregory Rabassa’s Latin American literature: a translator’s visible legacy by María Costanza Guzmán. Affiliated with Dr. Steven White with St. Lawrence University.

BACKGROUND:How can we explain the uneven decline of syphilis around the world following the introduction of penicillin? In this paper we use antenatal syphilis prevalence (ASP) to investigate how syphilis prevalence varied worldwide in the past century, and what risk factors correlate with this variance. METHODS:1) A systematic review using PubMed and Google Scholar was conducted to identify countries with published data relating to ASP estimates from before 1952 until the present. Eleven countries were identified (Canada, Denmark, Finland, India, Japan, Norway, Singapore, South Africa, United States of America (USA), United Kingdom (UK) and Zimbabwe). The ASP epidemic curve for each population was depicted graphically. In South Africa and the USA, results are reported separately for the black and white populations. 2) National antenatal syphilis prevalence estimates for 1990 to 1999 and 2008 were taken from an Institute for Health Metrics and Evaluation database on the prevalence of syphilis in low risk populations compiled for the Global Burden of Diseases study and from a recent review paper respectively. National ASPs were depicted graphically and regional median ASPs were calculated for both time periods. 3) Linear regression was used to test for an association between ASP in 1990-1999 and 2008 and four risk factors (efficacy of syphilis screening/treatment, health expenditure, GDP per capita and circumcision prevalence). WHO world regions were included as potential explanatory variables. RESULTS:In most populations, ASP dropped to under 1% before 1960. In Zimbabwe and black South Africans, ASP was high in the pre-penicillin period, dropped in the post-penicillin period, but then plateaued at around 6% until the end of the 20th century when ASP dropped to just above 1%. In black Americans, ASP declined in the post penicillin period, but plateaued at 3-5% thereafter. ASP was statistically significantly higher in sub-Saharan Africa in 1990-1999 and 2008 than in the other world regions (P < 0.001). On multivariate analysis in both time periods, ASP was only associated with residence in sub-Saharan Africa. CONCLUSIONS:Further research is necessary to elucidate the reasons for the higher prevalence of syphilis in sub-Saharan Africa.

Background. This paper investigates two issues: do ethnic/racial groups with high HIV prevalences also have higher prevalences of other STIs? and is HIV prevalence by ethnic group correlated with the prevalence of circumcision, concurrency, or having more than one partner in the preceding year? Methods. We used Spearman’s correlation to estimate the association between the prevalence of HIV per ethnic/racial group and HSV-2, syphilis, symptoms of an STI, having more than one partner in the past year, concurrency, and circumcision in Kenya, South Africa, the United Kingdom, and the United States. Results. We found that in each country HSV-2, syphilis, and symptomatic STIs were positively correlated with HIV prevalence (HSV-2: Kenya rho = 0.50, P = 0.207; South Africa rho-1, P = 0.000; USA rho-1, P = 0.000, Syphilis: Kenya rho = 0.33, P = 0.420; South Africa rho-1, P = 0.000; USA rho-1, P = 0.000, and STI symptoms: Kenya rho = 0.92, P = 0.001; South Africa rho-1, P = 0.000; UK rho = 0.87, P = 0.058; USA rho-1, P = 0.000). The prevalence of circumcision was only negatively associated with HIV prevalence in Kenya. Both having more than one partner in the previous year and concurrency were positively associated with HIV prevalence in all countries (concurrency: Kenya rho = 0.79, P = 0.036; South Africa rho-1, P = 0.000; UK 0.87, P = 0.058; USA rho-1, P = 0.000 and multiple partners: Kenya rho = 0.82, P = 0.023; South Africa rho-1, P = 0.000; UK rho = 0.87, P = 0.058; USA rho-1, P = 0.000). Not all associations were statistically significant. Conclusion. Further attention needs to be directed to what determines higher rates of partner change and concurrency in communities with high STI prevalence.

Purpose: Health care reform in the United States has introduced terms such as “the patient-centered medical home” and “integrated care” that are often unclear and unfamiliar to patients. This study explored patient experiences with the functional domains of integrated care.Theory and methods: Patients first wrote their definitions of integrated care and then participated in focus group discussions about their experiences with the health care system. Transcripts were analyzed for thematic content.Results: Forty-four patients participated in one of seven focus groups in San Francisco, CA in English and Spanish. Many patients were not clear about the meaning of the term integrated care. However, patients described experiences largely reflected in an existing conceptual model of integrated care and the importance of coordination within and across teams and with community resources, continuity and sharing of information, and patient engagement. Patients with high medical needs described the ubiquitous challenges they faced in experiencing coordinated care.Conclusions: Patients may not understand the term integrated care but are relatively clear on what the concept of integrated care entails and support its successful implementation. Patients and their families are at the center of integrated care, and health systems need to support and empower them to successfully navigate the medical neighborhood.

Geschwind syndrome has been described in patients with temporal lobe epilepsy and is characterized by sexual behavioural disorders, hyperreligiosity, hypergraphia, and viscosity. Presented here is a case of a 53-year-old man with clinical findings consistent with Geschwind syndrome in the setting of a known diagnosis of schizoaffective disorder, with no identifiable comorbid illness of temporal lobe epilepsy or frontotemporal dementia. Brain MRI showed bilateral temporal lobe atrophy greater than would be expected for age and more prominent on the left side than the right. It is likely that these structural abnormalities may be related to this patient’s clinical presentation of Geschwind syndrome. To our knowledge, this is the first reporting of a case of Geschwind syndrome in the setting of schizoaffective disorder. These symptoms of Geschwind syndrome were present irrespective of mental state status. The report highlights the importance in correct identification of underlying cause and differentiation between Geschwind syndrome and schizoaffective disorder in order to avoid mistreatment and consequent iatrogenic adverse events.

Abstract Henoch-Schonlein Vasculitis (HSV) is systemic small vessel vasculitis involving the skin, kidney, joints, and gastrointestinal tract. The proportion of patients reported to have renal involvement varies between 20% and 80%. Rapidly progressive glomerulonephritis (RPGN)is rare syndrome in children, characterized by clinical features of glomerulonephritis (GN) and rapid loss of renal function. We present a severe kidney involvement in a 14 year old boy with HSV in who is carring MEFV mutation. A 14 year old boy had developed sudden onset of palpable purpuric rash on his extensor surfaces of lower extremities. He had elevated an erythrocyte sedimentation rate (ESR) (45 mm/h), C-reactive protein (3.74 mg/dl), serum urea 66 mg/dl, serum creatinine 1.8 mg/dl. Also, he had hypocomplementemia. Antinuclear antibody, anti ds DNA, antineutrophil cytoplasmic antibody, anticardiolipine antibodies were negative. Urinalysis revealed macroscopic hematuria and proteinuria with a 24-h urinary protein excretion of 55 mg/m2/h. The renal biopsy specimen showed crescentic and necrotizing glomerulonephritis. He had also M694V/E148Q compound heterozygote mutation. Clinical symptoms and renal failure resolved with intermittant hemodialysis and medical therapy.

Cholecystectomy generally has no adverse effects on health. Studies demonstrating the association between metabolic diseases and long-term effects of cholecystectomy are increasing. preperitoneal fat thickness (PFT) is an important indicator of metabolic syndrome. Metabolic syndrome is a risk factor for sarcopenia. The aim of our study was to investigate the relationship between cholecystectomy and sarcopenia-visceral fat using the ISarcoPRM algorithm, which is an easy, reliable, and inexpensive method based on ultrasound measurement, to evaluate sarcopenia in patients with long-term previous cholecystectomy. This cross-sectional study included participants who had undergone cholecystectomy at least 5 years ago and a control group with similar characteristics. Sarcopenia was assessed using the ISarcoPRM algorithm, incorporating the sonographic thigh adjustment ratio (STAR), grip strength, and chair stand test (CST). Together with low STAR values (<1.0 for females and <1.4 for males), ow grip strength (<19 kg for females or <32 kg for males), and/or prolonged CST duration (≥12 seconds) were used to diagnose sarcopenia. Ultrasound was used to measure the visceral fat thickness. The investigation of sarcopenia and PFT values between individuals with and without cholecystectomy was planned. A total of 158 participants were included, including 89 post-cholecystectomy patients and 69 controls. Binary regression analysis revealed that cholecystectomy was positively associated with sarcopenia (OR = 2.788, 95% CI: 1.054-7.375, P = .039). However, when PFT was included, it was independently associated with sarcopenia (OR = 1.157, 95% CI: 1.067-1.254, P < .001), and the relationship with cholecystectomy disappeared (P > .05). PFT values of 10.0 mm or higher were associated with 5.875 times (95% CI: 2.035-16.961, P = .001) increased odds of sarcopenia. Sarcopenia was 2.8 times more frequent in patients who had undergone cholecystectomy than in those who had not, but this relationship was mediated by increased PFT. The risk of sarcopenia increased up to 5.875 times when the PFT exceeded 10 mm., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To investigate the contribution of the cervical sliding sign to conventional cervical length measurement in patients at risk of preterm labor., Methods: The study, performed as a prospective cohort study, included patients admitted to a tertiary research hospital with a diagnosis of threatened preterm labor. The participants were divided into two groups: those who gave birth before and after 37 weeks of gestation. The clinical and demographic characteristics, cervical length, presence of a short cervix (SC), and cervical sliding sign (CSS) were compared between the groups. Furthermore, correlation and regression analyses were conducted to investigate the relationship between the presence of a SC, the presence of CSS, and the coexistence of these two findings with preterm delivery, as well as the interval between the symptoms and delivery being less than four weeks., Results: The study included 77 patients who delivered prematurely and 65 patients who delivered at term. The following variables were significantly lower in the preterm delivery group: cervical length, gestational age at delivery, neonatal weight, and time between the first examination and delivery (p = 0.003, <0.001, <0.001 and < 0.001, respectively). A higher percentage of women in the preterm delivery group exhibited a diagnosis of a SC, the presence of CSS, and the coexistence of both conditions (p = 0.002, 0.012 and 0.018, respectively). The results of the logistic regression analysis indicated that the odds ratios for preterm delivery were 3.3 in the presence of a SC alone, 2.67 in the presence of CSS alone, and 2.85 in the association of both findings (p = 0.003, 0.013 and 0.021 respectively). The odds ratios for delivery in less than four weeks were 3.08 in the presence of a SC alone, 3.4 in the presence of CSS alone, and 3.54 in the association of both findings (p = 0.004, 0.002 and 0.005 respectively)., Conclusion: In singleton pregnant women presenting with threatened preterm labor, the presence of CSS is associated with an increased risk of preterm delivery and a decreased presentation-to-delivery interval. However, its contribution to conventional cervical length measurement appears to be relatively limited., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aim: The aim of this study is to examine the effect of web based self-breast examination education on nursing students' knowledge, skills, and self-directed learning skills in self-breast examination., Background: Breast cancer is the most prevalent type of cancer among women, mortality rates are still high today. It is critical to improve the knowledge and skills and raise the self-awareness and health consciousness of individuals and society about self-breast examination, which is important in the early diagnosis of breast cancer, in order to lower mortality rates. Accordingly, one of the basic nursing skills aimed to be acquired by nursing students future nursing professionals is a self-breast examination., Design: This study was conducted with a randomised, controlled, and experimental trial., Methods: A total of 90 students were included in the study: the intervention group (n=43) and the control group (n=47). Intervention group students participated in web-based SBE Education.Control group students participated in SBE Education based on a traditional learning model.A Student Information Form, the Self-Breast Examination Knowledge Test, the Self-Breast Examination Skill Rubric, and the Self-Directed Learning Skills Scale were used in the study. Descriptive statistics, Mann-Whitney U test, and Wilcoxon test were run to analyse the data., Results: It was observed that the control group had a higher score in self-breast examination knowledge than the intervention group during the intervention period and the follow-up period after 15 days. No difference was noticed between the groups after the intervention for self-breast examination skill score, but the intervention group had a higher score than the control group for self-breast examination skill during the follow-up period after 15 days. No significant difference was noted between the groups for self-directed learning scores. This result validated hypothesis H 4 . This result refuted hypothesis H 1 , H 2, H 3 , H 5 ., Conclusions: Web based education on self-breast examination improves students' breast self-examination skills and self-directed learning skills, but not their knowledge level of self-breast examination., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: The objective of this study was to investigate the ultrasonographic characteristics and outcomes of fetuses with atypical and non-visualized fetal gallbladder in our tertiary care hospital., Methods: A retrospective analysis was conducted on cases in which the fetal gallbladder was not visualized or exhibited atypical characteristics at our institution over a four-year period. The patients were divided into two groups: absent gallbladder and atypical gallbladder. The groups with isolated and additional anomalies were analyzed according to their ante- and postnatal characteristics., Results: The study comprised 78 patients (37 absent, 41 atypical gallbladder). In the isolated fetal absence of gallbladder group, the gallbladder was visualized in three of 13 patients during antenatal ultrasonographic follow-up and in half of the remaining 10 patients during postnatal follow-up. In the postnatal period, five newborns with absent isolated gallbladder are being followed up with suspicion of biliary atresia and isolated gallbladder agenesis. In the absence of a gallbladder with an additional anomaly group, 58% of fetuses died during the intrauterine and neonatal period. Fetuses in the isolated atypical gallbladder group are being followed as healthy after birth. Pregnancies with atypical gallbladder appearance and additional anomalies resulted in 33% neonatal death, 12% intrauterine demise, and 25% termination of pregnancy., Conclusion: In instances where the fetal gallbladder is not consistently discernible, it is imperative to exercise caution with regard to the possibility of biliary atresia. In the event that the fetal gallbladder exhibits unusual characteristics, a meticulous examination for the presence of additional anomalies is recommended., (© 2024 International Federation of Gynecology and Obstetrics. Published by John Wiley & Sons Ltd.)

Objectives: To examine the relationship between the lower uterine segment (LUS) thickness and the onset of labor in dichorionic twin pregnancies experiencing threatened preterm labor., Methods: This prospective cohort study included dichorionic twin pregnancies between 24 and 32 weeks of gestation, presenting with symptoms of preterm labor. The LUS thickness and mid-anterior wall thickness were measured via transabdominal ultrasonography, cervical length, and posterior cervical lip thickness were measured transvaginally. The presence of the cervical sliding sign and funneling findings were recorded., Results: Among the patients with an onset of labor before the 34th week, the mean LUS thickness was 3.8 ± 0.9 mm, compared to 4.6 ± 1.1 mm in those with an onset of labor at or after 34 0/7  GW, indicating a statistically significant difference (p=0.012). Similarly, accepting the GW threshold as 35 0/7 weeks, a statistically significant difference was found in the mean LUS thickness, which was 4.0 ± 1.0 mm in those with an earlier onset of labor and 4.7 ± 1.0 mm in those with a later onset of labor (p=0.022). While univariate analysis indicated that the LUS thickness was a significant predictor (p=0.017 for <34 GW and p=0.028 for <35 GW), multivariate analysis showed a reduced effect (p=0.04 and p=0.06, respectively)., Conclusions: LUS was significantly thinner in pregnancies with an onset of labor before the 34th and 35th GW. The measurement of the LUS thickness can be considered an alternative method for predicting spontaneous preterm birth in dichorionic twin pregnancies., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)