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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14411/22
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Article Development and Validation of the Athlete Food Insecurity Scale (AFIS)(MDPI, 2026-04-10) Yıldırım, Gonca; Baş, Murat; Çetiner, Özlem; Sünbül, ÖnderBackground/Objective: Athletes' dietary needs are influenced by the physiological demands of their sport, so the impacts of disrupted food access may vary from those experienced by the general population. This study aimed to develop and validate the Athlete Food Insecurity Scale (AFIS), a sport-specific tool designed to measure food insecurity in athletes. Materials and Methods: The study included 500 young adult athletes from 18 different sports disciplines. The sample was divided for exploratory factor analysis (n = 300) and confirmatory factor analysis (n = 200). Standard procedures for scale development were followed, including content validity assessment, construct validity testing, convergent validity analysis, and reliability evaluation. Results: The final 23-item scale demonstrated a four-factor structure including performance changes, coping strategies, basic nutritional needs, and physical access restraints. Factor loadings ranged from 0.344 to 0.956, item-total correlations from 0.513 to 0.781, and Cronbach's alpha coefficients from 0.827 to 0.937. Confirmatory factor analysis supported the modified model with acceptable fit indices (chi(2)/df = 2.41, RMSEA = 0.080, TLI = 0.900, CFI = 0.910), and standardized factor loadings ranged from 0.53 to 0.89 (p < 0.05). Subscale scores differed significantly across Household Food Security Survey Module food security categories, supporting convergent validity. Conclusions: The AFIS demonstrates strong psychometric properties and may provide a sensitive tool for identifying and monitoring sport-specific food insecurity among athletes.Article Individual Domain Satisfaction Contributing to Nursing Students’ Subjective Well-Being: Family, Education and Health(BMC, 2026-02-02) Harkin, Sirin; Sari, TugbaIntroduction and aim Subjective Well-Being(SWB), defined as individuals' level of satisfaction based on their subjective evaluations of their own lives, has been shown to protect individuals from illnesses and help them successfully navigate life transitions. The SWB of nursing students (NSs), who are in a critical transitional phase between adolescence and adulthood, is associated with better physical and mental health, which in turn enhances their ability to provide quality care to patients. This study aims to evaluate the relationship between NSs SWB and their demographic characteristics, as well as satisfaction with family, school, and health-related domains, and to assess the impact of these variables on SWB. Methods The study data were collected from 650 nursing students using a descriptive and cross-sectional design, determined through G*Power analysis. Personal Information Form and Subjective Well-Being Scale were used for data collection. Statistical analyses included Mann-Whitney U and Kruskal-Wallis tests, while multiple logistic regression analysis was used to determine the contribution of variables to SWB. Results First, the SWBS score of NSs was 158 +/- 24, and SWB levels were found to be associated with demographic factors such as age, gender, parental education level, and place of residence (p < 0.05). Second, a democratic family environment and positive family relationships were associated with higher SWB (p < 0.05). Additionally, SWB was linked to perceived physical and mental health satisfaction and satisfaction with educational experiences (p < 0.05). The regression model revealed that independent variables accounted for 32.6% of the variance in the dependent variable. Conclusion and recommendations The SWB level of NSs was moderate and influenced by various factors. These findings underscore the importance of interventions targeting family, school, and health domains in supporting students' academic and personal development. It may be beneficial for educators to consider factors associated with SWB when designing educational content and practices.Article Social Determinants of Health and Risk of Lower Extremity Amputation in Patients with Peripheral Artery Disease in Canada: Protocol for a Systematic Review and Meta-Analysis(BMJ Publishing Group, 2026-02) Chowdhury, Abhiroop; Sheikh, Fatima; Azab, Sandi M.; De Souza, Russell J.; Banfield, Laura; Balakrishnan, Narayanaswamy; Anand, Sonia S.Introduction Peripheral artery disease (PAD) affected approximately 800 000 Canadians aged 25 years or older in 2015 and it poses a substantial risk of lower extremity amputation (LEA). While clinical risk factors for amputation are well-established, the impact of social determinants of health (SDoH) on amputation risk remains unclear, particularly in a Canadian context.Objectives This systematic review aims to: (1) synthesise evidence on the associations between multilevel SDoH domains and LEA (both major and/or minor) risk in Canadian PAD patients including intersectional effects of race and ethnicity with another SDoH domain, and (2) evaluate the statistical methodologies used in the researched literature to inform future study design and analysis approaches.Methods and analysis We will systematically search MEDLINE, Embase, EmCare, Global Health, Cumulative Index to Nursing and Allied Health Literature and Web of Science for studies examining SDoH and LEA in Canadian patients with PAD (including chronic limb-threatening ischaemia which is a severe form of PAD). Date limits for each database will be from inception through December 2025. SDoH will be categorised using a modified Healthy People 2030 SDoH framework under six domains: economic stability, education, food, neighbourhood and physical environment, healthcare system and community and social context. Two reviewers will independently screen titles, abstracts and full texts, with discrepancies resolved by a third reviewer. Data will be extracted on study characteristics, SDoH measures, outcomes and statistical methods. Risk of bias will be assessed using RoB 2 for randomised trials, ROBINS-I for non-randomised studies of interventions and ROBINS-E for studies investigating exposures. A narrative synthesis, and where data permit, a Bayesian hierarchical meta-analysis using both effect size and contingency table approaches will be conducted. Statistical heterogeneity will be explored through subgroup analyses and meta-regression, examining study design, SDoH measurement approaches and population characteristics.Ethics and dissemination As a systematic review and meta-analysis, ethics approval is not required. For institutional oversight, we provide the contact of Dr Sonia Anand (Associate Vice-President, Global Health, McMaster University; anands@mcmaster.ca). Results will be reported following PRISMA guidelines and disseminated through a peer-reviewed publication.PROSPERO registration number CRD420251115759.Article Skull Base Surgery in the Pediatric Population-The 2nd International Collaborative Study (1995-2015)(Wiley, 2026-02-11) Fliss, Dan M.; Ungar, Omer J.; Levyn, Helena; Valero, Cristina; Adilbay, Dauren; Eagan, Alana; Shah, Jatin P.Background The current study presents the efforts of a global collaborative group to review the management and outcomes of malignant tumors of the skull base in the pediatric population worldwide.Patients and Methods A total of 28 institutions contributed data on 3061 patients. From this, there were 64 pediatric patients (2.1%). Clinical variables, overall and disease-free survival (OS and DFS) outcomes, and multivariable factors associated with outcome were evaluated.Results The male-to-female ratio was 37:27 and the median [IQR] age at diagnosis was 14.0 [9.6-16.0] years. The most common malignancy was sarcoma (57.8%), followed by esthesioneuroblastoma (25.0%) and carcinoma (17.2%). Negative margins were achieved in 53.1% children. Dural invasion was associated with reduced OS and DFS. Adjuvant radiotherapy was associated with improved survival outcomes.Conclusions Open approaches were widely used for pediatric skull base tumor resection in the period between 1995 and 2015 but we saw a rise in the use of endoscopic and combined techniques by the end of the period covered by this study. Our results may represent a transitional era in which alternative endoscopic techniques continue to expand.Article Randomized Controlled Trials in Europe: A Call to Action to Protect National Healthcare Systems from the Upcoming Tsunami of Kidney Failure(Oxford University Press, 2026-01-24) Ortiz, Alberto; Arici, Mustafa; Goumenos, Dimitrios S.; Adamczak, Marcin; Eller, Kathrin; Ferreira, Ana Carina; Torra, RoserKidney diseases are among the fastest-growing global health burdens, with chronic kidney disease projected to become the third leading cause of death by 2050. Despite this, therapeutic innovation remains limited: no European Medicines Agency-approved treatment exists for acute kidney injury, and no drugs have demonstrated survival benefits in patients on dialysis. Randomized controlled clinical trials, although pivotal for advancing care, face persistent challenges in nephrology, including patient heterogeneity, multimorbidity, high dropout rates and small populations in rare diseases. In Europe, these intrinsic obstacles are compounded by fragmented implementation of the Clinical Trials Regulation (536/2014), excessive safety reporting demands and lack of nephrology-specific guidance, discouraging academic-led initiatives and limiting pragmatic research. The Coalition for Reducing Bureaucracy in Clinical Trials, a broad alliance of medical societies and patient advocates, has recently published the 'Clinical research in Europe: putting quality and patient safety first' recommendations calling for regulatory harmonization, simplified safety reporting and patient-centred consent. The European Renal Association, a member of the Coalition and contributor to the report, fully supports these recommendations. Implementing such measures is critical to fostering efficient, high-quality nephrology trials in Europe and delivering urgently needed, evidence-based, life-saving and safe therapies for patients with kidney disease.Article Investigation of Toxoplasma Gondii and Human Papillomavirus in Paraffin-Embedded Spontaneous Abortus Materials(Oxford Univ Press inc, 2026-01-05) Usluca, Selma; Bakir, Ayfer; Kurkcu, Muhammed Furkan; Caglar, Melike; Duran, Firdevs SahinObjective Toxoplasma gondii and human papillomavirus (HPV) can cause spontaneous abortus. This study aimed to investigate the prevalence of these pathogens in formalin-fixed, paraffin-embedded placenta samples from women diagnosed with spontaneous abortus.Methods A total of 288 formalin-fixed, paraffin-embedded placenta tissue blocks stored in the archives of Etlik City Hospital Pathology Laboratory were included in the study between October 1, 2022, and June 23, 2023. The presence of T gondii and HPV in formalin-fixed, paraffin-embedded placenta samples was investigated using real-time polymerase chain reaction.Results The T gondii DNA was not detected in the samples. However, anti-T gondii IgG antibody was positive in 10.4% (11/106) of the patients. Human papillomavirus DNA was positive in 5.4% of the samples, with HPV 18 and HPV 31/58/66 being the most frequently detected HPV types.Conclusions Our study revealed that HPV could infect the placenta by detecting high-risk HPV in placental samples. However, no relationship was found between HPV positivity and previous stillbirth or spontaneous abortus. Prospective studies with larger populations are needed to further understand the role of these factors in the cause of spontaneous abortus.Article Assessment of the Effectiveness of Serum-Infrared Spectroscopy in Conjunction with Multivariate Analysis Methods for Atherosclerosis Diagnosis(Nature Portfolio, 2026-01-03) Cevik, Dilek; Telkoparan-Akillilar, Pelin; Yonar, DilekAtherosclerosis is a progressive disease characterized by lipid accumulation and fibrous elements in large and medium-sized arteries, and remains a leading cause of death worldwide. A deeper understanding of its molecular nature is critical for developing novel strategies for the prevention, diagnosis, and treatment. This study evaluates attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy combined with multivariate analysis techniques to differentiate and classify atherosclerosis by identifying disease-specific spectral variations. Spectral analyses indicated statistically significant differences in lipid (p < 0.0001), protein (p < 0.01), nucleic acid (p < 0.0001), and glucose (p < 0.0001) content of serum samples in the atherosclerosis group compared to controls. Patients with atherosclerosis exhibit altered lipid metabolism, marked by a decrease in saturated lipids and an increase in unsaturated lipids compared to healthy individuals. Additionally, elevated levels of protein, RNA, glucose, and conformational changes in DNA were key spectral features, distinguishing atherosclerosis from controls. Principal component analysis (PCA) successfully differentiated patients from controls, while classification models based on linear discriminant analysis (LDA) and support vector machine (SVM) achieved accuracies of 96.61% and 93.22%, respectively. The ability of FTIR spectroscopy to detect subtle biochemical alterations suggests its potential for early diagnosis. These molecular markers may appear prior to clinical symptoms, highlighting the method's potential for future screening, pending validation in at-risk or preclinical cohorts.Article Artificial Intelligence Based Resuscitation Simulation: A Pilot Study of a Novel Approach to Team Leadership Training(BMC, 2026-01-05) Kanbakan, Altug; Berikol, Goksu Bozdereli; Ilhan, Bugra; Altintas, Emel; Doganay, FatihIntroduction Team leadership training is essential alongside with technical training for effective resuscitation management. Addressing this gap, we developed a novel simulation system leveraging Large Language Models (LLMs) to create Artificial Intelligence (Al) agents simulating team members in Advanced Cardiovascular Life Support (ACLS) scenarios. This pilot study aimed to to develop a novel LLM-based ACLS simulation training platform and evaluate its performance in simulated resuscitation scenarios on established protocols.<br /> Method Using the Claude 3.5 Sonnet API, we designed a simulation system with four Al agents assigned specific roles as healthcare staff within an ACLS team. Each agent strictly followed the 2020 American Heart Association (AHA) ACLS guidelines while interacting with an ACLS certified emergency medicine specialist user. The ten patient scenario transcripts were evaluated with three blinded emergency medicine specialists whether all the recommended steps are completed. Inter-rater reliability was assessed using Kendall's W and Krippendorff's Alpha statistics to evaluate agreement both within raters and the model.<br /> Results Al agents consistently adhered to the AHA 2020 ACIS algorithm across scenarios, with a high inter-rater reliability (Kendall's W > 0.75 ) . Krippendorff's Alpha values for agreement ranged from substantial (0.84) to almost perfect (0.99), indicating robust compliance with guidelines and effective simulation of resuscitation responses.<br /> Conclusion This study highlights the potential of LL.M-powered simulations as an adjunct to traditional resuscitation training. The system effectively supported team leadership training by providing consistent and guideline-compliant responses. While the results are promising, further research with larger participant samples is necessary to evaluate the long-term educational impact and scalability of such systems.Article Citation - WoS: 5Citation - Scopus: 3A Benchmark of Expert-Level Academic Questions to Assess AI Capabilities(Nature Portfolio, 2026-01-28) Phan, Long; Gatti, Alice; Li, Nathaniel; Khoja, Adam; Kim, Ryan; Ren, Richard; Scaramuzza, Davide; Park, Jongee; Hausenloy, Jason; Hendrycks, Dan; Mazeika, Mantas; Zhang, Oliver; Dodonov, DmitryBenchmarks are important tools for tracking the rapid advancements in large language model (LLM) capabilities. However, benchmarks are not keeping pace in difficulty: LLMs now achieve more than 90% accuracy on popular benchmarks such as Measuring Massive Multitask Language Understanding(1), limiting informed measurement of state-of-the-art LLM capabilities. Here, in response, we introduce Humanity's Last Exam (HLE), a multi-modal benchmark at the frontier of human knowledge, designed to be an expert-level closed-ended academic benchmark with broad subject coverage. HLE consists of 2,500 questions across dozens of subjects, including mathematics, humanities and the natural sciences. HLE is developed globally by subject-matter experts and consists of multiple-choice and short-answer questions suitable for automated grading. Each question has a known solution that is unambiguous and easily verifiable but cannot be quickly answered by internet retrieval. State-of-the-art LLMs demonstrate low accuracy and calibration on HLE, highlighting a marked gap between current LLM capabilities and the expert human frontier on closed-ended academic questions. To inform research and policymaking upon a clear understanding of model capabilities, we publicly release HLE at https://lastexam.ai.Article Glycaemic Control and Complications in Haemodialysis Patients: The TURK-HEMODIAB Study(Oxford University Press, 2025-04-18) Gungor, Ozkan; Korucu, Berfu; Oguz, Ebru Gok; Eren, Necmi; Ural, Zeynep; Dheir, Hamad; Arici, MustafaBackground The most common cause of end-stage kidney disease is diabetes mellitus (DM). The most commonly used renal replacement therapy in Turkey and in many countries around the world is haemodialysis (HD). Glycaemia control is important in these populations. In this study we aimed to screen for glycaemic control and complications in a large population of diabetic HD patients in Turkey. Methods A total of 16 043 patients were screened in 253 dialysis centres in Turkey and 5038 diabetic HD patients were included in the study. At participating centres, patients' diabetes history, complications, medications, haemoglobin A1c (HbA1c) and other laboratory data were reviewed and recorded by nephrologists. Results The average age of the patients was 64.0 +/- 11.2 years and 56% were male. The mean HbA1c was 7.4 +/- 1.5%. Patients were divided into three groups according to the HbA1c level (<6.5%, 6.5-8% and >8%). As the HbA1c levels increased, the mean systolic blood pressure and diastolic blood pressure increased significantly. In addition, as the HbA1c levels increased, the number of patients with coronary artery disease, patients undergoing coronary artery bypass graft surgery and the rate of patients with diabetic retinopathy and vision loss increased. Diabetic foot disease and amputation rates were also higher in the group with poor glycaemic control. The number of patients using intensive or mixed insulin was also higher in the group with high HbA1c levels. In ordinal logistic regression analysis, age significantly decreased and higher body mass index slightly increased the risk of a higher HbA1c. Also, the need for a diabetic diet was greater in those with high HbA1c levels. Conclusion Our study highlights that the target values for diabetic HD patients in Turkey are partially compatible with the 2022 Kidney Disease: Improving Global Outcomes guidelines for diabetes management. Nevertheless, more effort and teamwork are needed to improve patient outcomes.