Performance of a high-rate membrane bioreactor for energy-efficient treatment of textile wastewater.

High-rate membrane bioreactors (MBR), where the wastewater undergoes partial oxidation due to the applied short sludge retention time (SRT) and hydraulic retention time (HRT) values, retain the majority of the organic substances in the sludge through growth and biological flocculation. Thus, a raw material source with a high biomethane production potential is created for the widespread use of circular economy or energy-neutral plants in wastewater treatment. While high-rate MBRs have been successfully employed for energy-efficient treatment of domestic wastewater, there is a lack of research specifically focused on textile wastewater. This study aimed to investigate the textile wastewater treatment and organic matter recovery performances of an aerobic MBR system containing a hollow fiber ultrafiltration membrane with a 0.04 µm pore diameter. The system was initially operated at short SRTs (5 and 3 d) and different SRT/HRT ratios (5, 10, and 20) and subsequently at high-rate conditions (SRT of 0.5-2 d and HRT of 1.2-9.6 h) which are believed to be the most limiting conditions tested for treatment of real textile wastewater. The results showed that chemical oxygen demand (COD) removal averaged 77% even at SRT of 0.5 d and HRT of 1.2 h. Slowly biodegradable substrates and soluble microbial products (SMP) accumulated within the MBR at SRT of 0.5 and 1 d, which resulted in decreased sludge filterability. The observed sludge yield (Yobs) exhibited a considerable increase when SRT was reduced from 5 to 1 d. On the other hand, the SRT/HRT ratio displayed a decisive effect on the energy requirement for aeration.

Sex-based electroclinical differences and prognostic factors in epilepsy with eyelid myoclonia.

Although a striking female preponderance has been consistently reported in epilepsy with eyelid myoclonia (EEM), no study has specifically explored the variability of clinical presentation according to sex in this syndrome. Here, we aimed to investigate sex-specific electroclinical differences and prognostic determinants in EEM. Data from 267 EEM patients were retrospectively analyzed by the EEM Study Group, and a dedicated multivariable logistic regression analysis was developed separately for each sex. We found that females with EEM showed a significantly higher rate of persistence of photosensitivity and eye closure sensitivity at the last visit, along with a higher prevalence of migraine with/without aura, whereas males with EEM presented a higher rate of borderline intellectual functioning/intellectual disability. In female patients, multivariable logistic regression analysis revealed age at epilepsy onset, eyelid myoclonia status epilepticus, psychiatric comorbidities, and catamenial seizures as significant predictors of drug resistance. In male patients, a history of febrile seizures was the only predictor of drug resistance. Hence, our study reveals sex-specific differences in terms of both electroclinical features and prognostic factors. Our findings support the importance of a sex-based personalized approach in epilepsy care and research, especially in genetic generalized epilepsies.

Development and psychometric properties of the sleep problems and coping with sleep problem scales for pregnant women.

AIMS: The aim of this study is to develop a sleep problems scale and a coping with sleep problems scale for pregnant women and assess their reliability and validity. DESIGN: An empirical research quantitative design. REVIEW METHODS: Self-reported instruments were developed through (1) item generation, (2) preliminary item evaluation and (3) scale refining and evaluation. Item pools were created via literature review, opinions of experts and women with experience in pregnancy sleep. Content, construct and criterion validities were tested. Reliability was assessed using Cronbach's alpha, split-half reliability and corrected item-total correlation. DATA SOURCES: Data were collected between January 23 and July 22, 2020, at a hospital's obstetrics polyclinic. In the pilot and main study, 30 and 368 pregnant women (gestational age: 8-42 weeks) were included, respectively. RESULTS: The content validity index was >0.9 for each scale. Factor analysis showed 24 and 18 items in the two scales, both with four subdimensions. The corrected item-total correlations were acceptable, and Cronbach's alpha coefficient was 0.883 and 0.799, respectively. CONCLUSION: Both scales developed in this study are valid and reliable for the Turkish society. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE/GLOBAL CLINICAL COMMUNITY: This study's findings may prevent the lack of validated screening instruments to identify pregnancy-specific sleep features. IMPACT: We developed two scales to assess sleep problems in pregnant women. These were valid and reliable, can be routinely used by health professionals and may guide nurses and midwives in assessing and managing sleep problems during pregnancy. REPORTING METHOD: The study conforms to the COSMIN checklist. PATIENT OR PUBLIC CONTRIBUTION: Data were collected during face-to-face surveys. Ten women contributed to the item pool generation, 30 pregnant women participated in the pilot study, and 368 antenatal service users participated in the main study.

Performance of sulfur-based autotrophic denitrification process for nitrate removal from permeate of an MBR treating textile wastewater and concentrate of a real scale reverse osmosis process.

Textile is one of the industrial sectors generating the highest amount of wastewater with various polluting substances. Lately, water reuse in textile industries, especially, with the reverse osmosis (RO) process following membrane bioreactor (MBR) treatment has been applied more commonly. In this study, an autotrophic sulfur-based denitrifying column performance was evaluated, for the first time, for nitrate reduction from permeate of a lab-scale MBR receiving real textile wastewater and from the concentrate stream of a real scale-RO plant used for recovering water from textile wastewater. Nitrate concentration in the MBR effluent and RO concentrate averaged 35 ± 3 and 12 ± 2 mg-N/L, respectively. With the sulfur-based column bioreactor, quite high (≥90%) denitrification performances were attained both for MBR effluent and RO concentrate up to nitrate loadings of 0.432 and 0.12 g-N/(L.d), respectively. COD present in wastewater was not utilized in the column bioreactor, which illustrates no or minimal contribution of heterotrophic denitrification. Alkalinity concentration in the wastewater was enough to buffer the acid formation during autotrophic denitrification. Sulfate was generated accompanied by nitrate reduction and sulfide was formed at low nitrate loadings. In the batch tests, the denitrification rates for the MBR effluent and RO concentrate were 0.31 and 0.28 g-N/(g-VSS.d), respectively, which were relatively higher than the ones observed for the synthetic nitrate-contaminated groundwater. Autotrophic sulfur-based denitrification is a promising and robust process alternative even for textile RO concentrate with high concentrations of salinity, non-biodegradable COD, and color.

The Effect of Music on Labor Pain and Duration: A Systematic Review and Meta-Analysis.

Context: The use of music in obstetrics increases every day, and it is extensively used in the control of labor pain. Objective: This study was conducted to determine the effect of music on labor pain and duration. Design and Setting: This systematic review and meta-analysis was carried out between October 15 and November 15, 2022. The search was done in the PubMed and ScienceDirect, MEDLINE, Ovid, EBSCO CINAHL Plus, and Cochrane Library databases. Outcomes meassures: According to the inclusion criteria, 12 studies included in the systematic review and meta-analysis were determined. The data were analyzed using Review Manager 5.4. The methodological quality of the studies was assessed with the RoB 2 tool. Results: Twelve articles were included in this study. According to the study results, listening to music was revealed to be statistically significantly effective in reducing pain intensity in terms of relieving labor pain (SMD:-0.98, Z=8.33, P < .001). Listening to music in the active phase was found to further decrease pain intensity compared to the latent phase (latent phase: SMD:-0.56 and active phase: SMD:-1.26), but it did not affect labor duration (MD:-0.76, Z=1.72, P = .09). Conclusion: Listening to music was determined to be effective in reducing pain intensity. The music genre selected by the researchers was found to further reduce pain intensity during labor compared to pregnant women's own choices, and it was elucidated that listening to music with headphones was effective in pain control but listening to music did not affect labor duration. PROSPERO Registration no: CRD42022367480.

Psychometric properties of the Turkish version of BUMPs and its relationship with prenatal attachment.

OBJECTIVE: The present research aims to adapt the Body Understanding Measure for Pregnancy Scale (BUMPs) to Turkish, determine its psychometric properties, and examine the correlation between prenatal attachment and body image perception of pregnant women. METHODS: Three hundred seventy-one pregnant women were enrolled in the research. The original English version of the BUMPs was translated into Turkish using forward-backward translation logic. The scale's reliability was evaluated with item analysis, internal consistency analysis, and test-retest reliability. Turkish version of the BUMPs and Prenatal Attachment Inventory (PAI) were filled out by pregnant women. The relationship between them was evaluated by correlation analysis. RESULTS: The mean week of gestation was 25.25 ± 8.26 (min: 12, max: 41). The Turkish version of the BUMPs exhibited satisfactory psychometric properties. The t-values, factor loadings, and fit indices of the scale items of the Turkish version were at an acceptable and excellent level. As a result of confirmatory factor analysis, the 18-item, three-factor construct was confirmed for the Turkish version of the scale. In the Turkish version of the scale, there are three subscales, including satisfaction with appearing pregnant, weight gain concerns, and physical burdens of pregnancy. Cronbach's alpha internal consistency coefficient of the overall scale was 0.84. A significant correlation was determined between the scores of the Turkish version of the BUMPs and the PAI (r = -0.263; p < 0.001). CONCLUSION: The Turkish version of the BUMPs is a valid and reliable measurement tool for determining pregnant women's body image perception. Prenatal attachment increases with the increasing body image perception of pregnant women.

The spectrum of epilepsy with eyelid myoclonia: delineation of disease subtypes from a large multicenter study.

OBJECTIVE: Epilepsy with eyelid myoclonia (EEM) has been associated with marked clinical heterogeneity. Early epilepsy onset has been recently linked to lower chances of achieving sustained remission and to a less favorable neuropsychiatric outcome. However, much work is still needed to better delineate this epilepsy syndrome. METHODS: In this multicenter retrospective cohort study, we included 267 EEM patients from 9 countries. Data about electroclinical and demographic features, intellectual functioning, migraine with or without aura, family history of epilepsy and epilepsy syndromes in relatives were collected in each patient. The impact of age at epilepsy onset (AEO) on EEM clinical features was investigated, along with the distinctive clinical characteristics of patients showing sporadic myoclonia over body regions other than eyelids (body-MYO). RESULTS: Kernel density estimation revealed a trimodal distribution of AEO and Fisher-Jenks optimization disclosed three EEM subgroups: early-onset (EO-EEM), intermediate-onset (IO-EEM) and late-onset subgroup (LO-EEM). EO-EEM was associated with the highest rate of intellectual disability, antiseizure medication refractoriness and psychiatric comorbidities and with the lowest rate of family history of epilepsy. LO-EEM was associated with the highest proportion of body-MYO and generalized tonic-clonic seizures (GTCS), whereas IO-EEM had the lowest observed rate of additional findings. A family history of EEM was significantly more frequent in IO-EEM and LO-EEM compared with EO-EEM. In the subset of patients with body-MYO (58/267), we observed a significantly higher rate of migraine and GTCS but no relevant differences in other electroclinical features and seizure outcome. SIGNIFICANCE: Based on AEO, we identified consistent EEM subtypes characterized by distinct electroclinical and familial features. Our observations shed new light on the spectrum of clinical features of this generalized epilepsy syndrome and may help clinicians towards a more accurate classification and prognostic profiling of EEM patients.

Psychometric properties of the Pregnancy-Unique Quantification of Emesis (PUQE-24) Scale.

The objective of this study is to conduct a reliability and validity study of the Turkish version of the 'Pregnancy-Unique Quantification of Emesis (PUQE-24)' in pregnant women. In the Turkish version, Cronbach's alpha coefficient was 0.75, and the item-total score correlations were between 0.75 and 0.85. In the exploratory factor analysis it was determined that the scale had a single-factor structure explaining 65.968% of the total variance. The factor load values of the scale were found to be between 0.776 and 0.831. The Turkish version of scale was found to be a valid and reliable measurement in pregnant women.IMPACT STATEMENTWhat is already known on this subject? Complaints of nausea and vomiting during pregnancy are common. Therefore, it is important to evaluate nausea and vomiting during pregnancy with a valid and reliable tool. Pregnancy-Unique Quantification of Emesis (PUQE-24) is a reliable tool for assessing the severity of nausea and vomiting symptoms. The original scale was translated into various languages, its validity and reliability were made in some countries and it was used in many studies.What do the results of this study add? The present study showed that Pregnancy-Unique Quantification of Emesis (PUQE-24) is valid and reliable for Turkish pregnant women. Thus, the scale can be used as a reliable tool in Turkish population.What are the implications of these findings for clinical practice and/or further research? As a result of this study, Pregnancy-Unique Quantification of Emesis (PUQE-24) can be used as a validated tool for the Turkish population during clinical practice by healthcare professionals and researchers, who are evaluating nausea and vomiting during pregnancy. In future studies, it can be used as an objective assessment tool to determine whether an intervention is needed for nausea and vomiting during pregnancy or to reveal whether the intervention has worked.

Sexual myths during pregnancy: a comparative study.

This study was conducted to determine the prevalence of sexual myths during pregnancy among pregnant women in Turkey and Iran and to compare the similarities and differences between the countries. This is a comparative and descriptive study. The sample included 200 pregnant women from Turkey and Iran. The data were collected using the Descriptive Information Form and Sexual Myths During Pregnancy Form. It was determined that the women in Turkey agreed more with statements, such as 'the infant feels sexual intercourse', 'the infant becomes happy and healthy', 'sexual intercourse during pregnancy is safe'. As for pregnant women in Iran, it was determined that they were more hesitant to agree with statements, such as 'sexual intercourse is a sin' and 'sexual intercourse causes infections'. In both countries, education on sexuality during pregnancy is needed to eliminate information deficiencies.Impact StatementWhat is already known on this subject? Sexual myths during pregnancy are exaggerated beliefs with no scientific accuracy. These beliefs affect the attitudes and behaviours related to sexuality during pregnancy.What do the results of this study add? This study has revealed that sexual myths during pregnancy are common among pregnant women in Turkey and Iran, and there are similarities and differences between the countries in terms of myths.What are the implications of these findings for clinical practice and/or further research? Healthcare professionals should question pregnant women about sexuality during pregnancy, identify missing and incorrect information, and provide counselling.

Sequential sulfur-based denitrification/denitritation and nanofiltration processes for drinking water treatment.

Efficient and cost-effective solutions for nitrogen removal are necessary to ensure the availability of safe drinking water. This study proposes a combined treatment for nitrogen-contaminated groundwater by sequential autotrophic nitrogen removal in a sulfur-packed bed reactor (SPBR) and excess sulfate rejection via nanofiltration (NF). Autotrophic nitrogen removal in the SPBR was investigated under both denitrification and denitritation conditions under different NO3- and NO2- loading rates (LRs) and feeding strategies (NO3- only, NO2- only, or both NO3- and NO2- in the feed). Batch activity tests were carried out during SPBR operation to evaluate the effect of different feeding conditions on nitrogen removal activity by the SPBR biofilm. Bacteria responsible for nitrogen removal in the bioreactor were identified via Illumina sequencing. Dead-end filtration tests were performed with NF membranes to investigate the elimination of excess sulfate from the SPBR effluent. This study demonstrates that the combined process results in effective groundwater treatment and evidences that an adequately high nitrogen LR should be maintained to avoid the generation of excess sulfide.

Complex Structured Fluorescent Polythiophene Graft Copolymer as a Versatile Tool for Imaging, Targeted Delivery of Paclitaxel, and Radiotherapy.

Advances in polymer chemistry resulted in substantial interest to utilize their diverse intrinsic advantages for biomedical research. Especially, studies on drug delivery for tumors have increased to a great extent. In this study, a novel fluorescent graft copolymer has been modified by a drug and targeting moiety and the resulting structure has been characterized by alterations in fluorescent intensity. The polythiophene based hybrid graft copolymer was synthesized by successive organic reactions and combination of in situ N-carboxy anhydride (NCA) ring opening and Suzuki coupling polymerization processes. Initially, targeted delivery of the graft copolymer was investigated by introducing a tumor specific ligand, anti-HER2/neu antibody, on the structure. The functionalized polymer was able to differentially indicate HER2-expressing A549 human lung carcinoma cells, whereas no signal was obtained for Vero, monkey kidney epithelial cells, and HeLa, human cervix adenocarcinoma cells. After integrating paclitaxel into the structure, cell viability, cell cycle progression, and radiosensitivity studies demonstrate HER2/neu targeting polymers were most effective to inhibit cell proliferation. Importantly, the graft copolymer used had no cytotoxic effects to cells, as evidenced by cell viability and cell cycle analysis. This work clearly confirms that a specially designed and fabricated graft copolymer with a highly complex structure is a promising theranostic agent capable of targeting tumor cells for diagnostic and therapeutic purposes.

The effect of using birth ball and squatting position during labor on pain, duration, and satisfaction: A randomized controlled trial.

AIM: The aim of this study is to assess the effect of using a birth ball and squatting position during labor on labor pain, duration of labor, and satisfaction. METHODS: This study is a randomized controlled experimental trial. It was conducted in the delivery unit of Basaksehir Çam and Sakura City Hospital. The study sample consisted of a total of 159 women, 53 in the birth ball application room, 53 in the squatting position group, and 53 in the control group. The "Information Form," "Visual Analog Scale," "Partograph," and "Maternal Satisfaction Assessment at Delivery Scale-Normal Birth" were used in the data collection. Data were analyzed using analysis of variance, Pearson's Chi-square test, Pillai's trace test. RESULTS: The present study revealed that the pain perception level was lower in the birth ball and squatting position groups compared to the control group, and there was a statistically significant difference between them (p < .05). The duration of the first and second stages of labor and the total duration of labor decreased in the birth ball and squatting position groups (p < .05). The difference was statistically significant in comparing the level of satisfaction (p < .05). It was found that the highest satisfaction was in the birth ball group. CONCLUSION: Using a birth ball and squatting position during labor are effective methods of reducing labor pain, shortening the duration of labor, and increasing the level of satisfaction. There is a need for more studies on the effects of the birth ball and squatting position. CLINICALTRIALS: gov Identifier: NCT05360823.

Body image perceptions of pregnant women in the third trimester in Turkey: A qualitative study.

RATIONALE: Body image undergoes significant changes during pregnancy, marking a pivotal phase in a woman's life. AIM AND OBJECTIVE: This study aimed to explore the body image perceptions of primiparous pregnant women during their third trimester. METHODS: Employing a qualitative research approach grounded in phenomenology, the study involved interviews to explore the experiences of primiparous pregnant women in their third trimester. The interviews were conducted via an online platform, with a sample group of 13 participants chosen through purposive sampling. Data analysis followed a content analysis approach, with the information being transferred to MAXQDA Analytics Pro Qualitative Data Analysis Programme for coding. The study adhered to the reporting guidelines outlined in the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS: Systematic analysis of the interview transcripts led to the identification of three main themes under the overarching framework of body image experiences among primiparous pregnant women during the third trimester: Physical Changes, Mental Changes, and Behavioural and Social Changes. Among the identified themes, pregnant women demonstrated a relatively lower level of discourse regarding Physical Changes, in contrast to a significant emphasis on Mental Changes. Within the latter theme, pregnant women exhibited significant dissatisfaction with their pregnancy experiences significantly. CONCLUSION: It was determined that pregnant women experience physical and psychological changes related to body image during pregnancy.

Views of healthcare professionals on gender roles: A qualitative study.

Problem: Gender equality is one of the most important determinants of health. Discriminatory interventions, values, beliefs, and prejudices of healthcare professionals during their service affect health adversely. Background: There is not adequate information about the views of healthcare professionals on gender roles. Aim: This study was conducted to understand and define the views of healthcare professionals involved in the health system on gender roles. Methods: This study was performed using the "phenomenological method," one of the qualitative research methods. A total of 28 healthcare professionals - 10 midwives, 12 nurses, and 6 doctors - were included in the research. Individual in-depth interviews were held with the healthcare professionals included in the study. Findings: As a result of the descriptive analysis performed after the individual interviews about the views of healthcare professionals on gender roles, 6 main themes were determined. These themes are (1) the neglect of women by society, (2) using force on women, (3) seeing women as sexual objects, (4) having a say in society, (5) glorified masculinity and femininity roles, and (6) gender equality. Discussion: In this study, healthcare professionals expressed that women were neglected by societies since gender roles were determined by patriarchal societies. This situation adversely influences the health of individuals. Importance should be attached to equality between women and men to improve health. Healthcare professionals who support equality will improve the quality of care. Conclusion: Healthcare professionals should provide equitable services without discrimination. This equitable care they provide will positively affect the health of individuals.

The effect of Pilates on pain during pregnancy and labor: a systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis study was conducted to reveal the effect of Pilates on pain during pregnancy and labor. METHODS: The PubMed, ScienceDirect, MEDLINE, Ovid, EBSCO, CINAHL Plus, Cochrane Library databases, and Google Scholar databases were used to access the articles published in international journals, and the Dergipark, Turkish Clinics, and ULAKBIM databases were scanned to access the articles published in national journals between October 30 and November 30, 2022. The data were analyzed using Review Manager 5.4. RESULTS: This study included four articles. According to the meta-analysis results, it was elucidated that Pilates exercise during pregnancy was not statistically effective in reducing pain during pregnancy (Z=0.61, p=0.54), but it was effective in reducing pain intensity during labor (Z=11.20, p<0.00001). CONCLUSION: This study concluded that Pilates exercise was not effective in reducing pain during pregnancy but was effective in reducing labor pain. There is a need for more research on the subject. PROSPERO REGISTRATION NO: CRD42023387512.

Photosensitive occipital lobe epilepsy: Delineation of an under-recognized reflex epilepsy syndrome according to the new ILAE criteria and long-term follow-up.

OBJECTIVE: Photosensitive occipital lobe epilepsy (POLE) should be suspected in patients with occipital lobe seizures triggered by photic stimuli, who have normal motor-mental development and brain imaging. We aimed to examine the clinical, electrophysiological, and prognostic features of POLE, which is a rare and under-investigated syndrome. METHODS: Archives from two tertiary epilepsy centers were retrospectively scanned and patients with normal neurological examination and cranial imaging were identified with POLE if they had: (1) seizures consistently triggered by photic stimuli; (2) non-motor seizures with visual symptoms; and (3) photosensitivity documented on EEG. The clinical and electrophysiological features and prognostic factors were evaluated for patients who had follow-up ≥5 years. RESULTS: We identified 29 patients diagnosed with POLE with a mean age of 20.1 ± 7.6 years. In one-third of the patients, POLE syndrome overlapped with genetic generalized epilepsy (GGE). The overlap group had higher rates of febrile seizure history and self-induction; when compared to pure POLE patients, their EEGs showed more frequent interictal generalized epileptic discharges and posterior multiple spikes during intermittent photic stimulation. During long-term follow-up, the remission rate for POLE was 80%, but EEG photosensitivity persisted in three quarters of patients despite clinical remission, and more than half had relapsed after clinical remission. SIGNIFICANCE: This first long-term follow-up study, utilizing newly suggested criteria of the International League Against Epilepsy, showed that POLE syndrome shows a notable overlap with GGE but also has distinctive features. POLE has a good prognosis; however, relapses are common, and photosensitivity persists as an EEG finding in the majority of patients.

The effect of yoga on sexual function and body image in primiparous pregnant Women: A randomized controlled single-blind study.

OBJECTIVE: This study was conducted to examine the effect of yoga practice during pregnancy on sexual function and body image. STUDY DESING: This study was planned as a randomized controlled single-blind trial. The study was performed with 140 pregnant women randomized in a pregnancy outpatient clinic of a hospital in Istanbul, Turkey, between March and September 2021. Two groups (A: yoga group and B: routine hospital care) were included in this study. The Personal Information Form, Female Sexual Function Index (FSFI), and Body Exposure During Sexual Activity Questionnaire (BESAQ) were used to collect the data. CLINICAL TRIAL ID: "NCT04764838″ RESULTS: The groups were homogeneously distributed, except for age and income status. The mean score of the Female Sexual Function Index in the yoga group was significantly higher in the post-test (24.71 ± 3.48) compared to the pre-test (22.95 ± 4.14) (t:-3.142; p: 0.002). In the control group, there was no difference between the pre-test (24.82 ± 6.15) and post-test (25.79 ± 2.47) mean scores of the Female Sexual Function Index (t:-1.351; p: 0.181). There was no significant difference between the groups' pre-test and post-test mean BESAQ scores (Z = -0.670, p = 0.503; Z = -0.225, p = 0.822, respectively). No correlation was found between the pre-test and post-test scores of the FSFI and BESAQ (r = -0.105; p = 0.218; r = -0.099; p = 0.244). CONCLUSION: Yoga can have a positive effect on sexual function during pregnancy. However, the effect of yoga on body image during sexual function has not been observed. Midwives can direct pregnant women toward yoga practice to increase the positive effects on sexual function.

Electroclinical Features and Long-term Seizure Outcome in Patients With Eyelid Myoclonia With Absences.

BACKGROUND AND OBJECTIVES: Eyelid myoclonia (EM) with absences (EMA) is a generalized epilepsy syndrome with a prognosis and clinical characteristics that are still partially undefined. We investigated electroclinical endophenotypes and long-term seizure outcome in a large cohort of patients with EMA. METHODS: In this multicenter retrospective study, patients with EMA with ≥5 years of follow-up were included. We investigated prognostic patterns and sustained terminal remission (STR), along with their prognostic factors. Moreover, a 2-step cluster analysis was used to investigate the presence of distinct EMA endophenotypes. RESULTS: We included 172 patients with a median age at onset of 7 years (interquartile range [IQR] 5-10 years) and a median follow-up duration of 14 years (IQR 8.25-23.75 years). Sixty-six patients (38.4%) displayed a nonremission pattern, whereas remission and relapse patterns were encountered in 56 (32.6%) and 50 (29.1%) participants. Early epilepsy onset, history of febrile seizures (FS), and EM status epilepticus significantly predicted a nonremission pattern according to multinomial logistic regression analysis. STR was achieved by 68 (39.5%) patients with a mean latency of 14.05 years (SD ±12.47 years). Early epilepsy onset, psychiatric comorbid conditions, and a history of FS and generalized tonic-clonic seizures were associated with a lower probability of achieving STR according to a Cox regression proportional hazards model. Antiseizure medication (ASM) withdrawal was attempted in 62 of 172 patients, and seizures recurred in 74.2%. Cluster analysis revealed 2 distinct clusters with 86 patients each. Cluster 2, which we defined as EMA-plus, was characterized by an earlier age at epilepsy onset, higher rate of intellectual disability, EM status epilepticus, generalized paroxysmal fast activity, self-induced seizures, FS, and poor ASM response, whereas cluster 1, the EMA-only cluster, was characterized by a higher rate of seizure remission and more favorable neuropsychiatric outcome. DISCUSSION: Early epilepsy onset was the most relevant prognostic factor for poor treatment response. A long latency between epilepsy onset and ASM response was observed, suggesting the effect of age-related brain changes in EMA remission. Last, our cluster analysis showed a clear-cut distinction of patients with EMA into an EMA-plus insidious subphenotype and an EMA-only benign cluster that strongly differed in terms of remission rates and cognitive outcomes.

Evaluation of the Attitudes of Midwifery Students Towards Gender Roles.

Gender is the whole of behaviors, responsibilities, and roles that society expects from women and men. This study was conducted to evaluate the attitudes of midwifery students studying at a university toward gender roles. This is a cross-sectional and descriptive study. This study was conducted at a public university in Istanbul between March and June 2015. The study was completed with 213 midwifery students. During the planning stage of the study, written consent was obtained from the ethics committee and the institution from which the data would be obtained. The "Personal Information Form" and the "Gender Roles Attitude Scale - GRAS" were used in the data collection. SPSS 21 package program was used in the data analysis. It was determined that the age average of the students included in the study was 19.85 ± 1.54 years, 33.3% of them graduated from a Private High School/Anatolian High School, and 38% of them studied in the first grade. The total score obtained by students from the Gender Role Attitudes Scale was 153.48 ± 17.44, and it was found out that they had an egalitarian attitude. It is observed that students who have graduated from a Private/an Anatolian High School have a higher level of scores on the attitude toward gender than those who have graduated from other high school types. It can be stated that midwifery students have an egalitarian attitude toward gender roles and that the education they receive has a positive effect on the egalitarian attitude.

Factors associated with infertility distress of infertile women: a cross-sectional study.

BACKGROUND: Women undergoing infertility treatment may suffer infertility distress. OBJECTIVE: The aim of this study was to determine factors associated with infertility distress in women with infertility problems. MATERIALS AND METHODS: Women (N = 368) who received infertility treatment and agreed to participate in the study constituted the sample of this cross-sectional descriptive study. The participants filled out the "Descriptive Information Form on Women with Infertility" and the "Infertility Distress Scale (IDS)". The data analysis of the study was performed using the Statistical Package for Social Sciences (SPSS-20.0). The statistical significance was accepted to be p < .05. RESULTS: It was found out that the mean IDS score of women was 37.4 ± 9.96 (min: 21-max: 80). A significant difference was found between women's educational level, employment status, difficulty in taking time off work, economic situation, the person who paid for treatment expenses and cause of infertility and mean IDS scores (p < .05). No significant relationship was found between women's social security, family type, having children and previous infertility treatment and mean IDS scores (p > .05). A positive and statistically significant linear relationship was found between the IDS score and marriage duration, desiring time for a baby and duration of infertility treatment (p < .05). CONCLUSIONS: The study revealed that the infertility distress level increased as the marriage duration, desiring time for a baby and the duration of infertility treatment of women admitted to the infertility clinic increased. Infertile women should be provided with care and support by considering these variables.