Balıkesir Üniversitesi Kurumsal Akademik Arşivi
DSpace@Balıkesir, Balıkesir Üniversitesi tarafından doğrudan ve dolaylı olarak yayınlanan; kitap, makale, tez, bildiri, rapor, araştırma verisi gibi tüm akademik kaynakları uluslararası standartlarda dijital ortamda depolar, Üniversitenin akademik performansını izlemeye aracılık eder, kaynakları uzun süreli saklar ve yayınların etkisini artırmak için telif haklarına uygun olarak Açık Erişime sunar.
Güncel Gönderiler
Psychometric properties of the Turkish version of the pediatric-friendly care assessment scale in the emergency department
(Elsevier, 2026) Kösem, Dilek Demir; Bektaş, Murat; Ergün, Sibel; Kaynak, Serap
Aim: This study aimed to adapt and evaluate the validity and reliability of the Pediatric-Friendly Care Assessment Scale in the Emergency Department, which assesses nurses' perceptions of the importance of pediatric-friendly care. Method: This methodological study was conducted with 301 nurses working in pediatric emergency departments. Linguistic adaptation was performed using forward-backward translation, and content validity was evaluated using the Davis technique. Construct validity was assessed through confirmatory factor analysis (CFA). Reliability was examined using Cronbach's alpha, split-half method, and Spearman-Brown and Guttman coefficients. Additionally, item-total correlations and known-group comparisons were conducted. Results: The mean age of the participants was 39.35 +/- 5.80 years, and 82.1% were female. The scale-level content validity index was found to be 0.98 based on expert evaluations. CFA results showed that the model fit was acceptable (CMIN/DF = 2.485, RMSEA = 0.070, CFI = 0.88, IFI = 0.88, GFI = 0.83, NFI = 0.82, TLI = 0.86). The Cronbach's alpha coefficient of the total scale was 0.93, and the alpha values for the sub-dimensions ranged from 0.60 to 0.84. Item-total scale score correlations were between 0.25 and 0.79. Conclusion: The findings indicate that the Turkish form of the scale is a valid and reliable tool for evaluating nurses' perceptions of the importance of pediatric-friendly care in pediatric emergency departments. Implications for practice The scale can be used to evaluate pediatric-friendly care practices in pediatric emergency departments and to guide training and quality improvement initiatives in this field. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Inflammatory cytokine IL-6 regulates ADAMTS14 expression through MAPK and PI3K signaling in colorectal cancer
(Wiley, 2026) Hacıoğlu, Nelin; Ondul, Rümeysa Nur Vapur; Ismael, Ghufran Haqi; Köçkar, Feray
Extracellular matrix (ECM) remodeling is a critical component of colorectal cancer (CRC) progression and tumor microenvironment organization. Members of the A Disintegrin and Metalloproteinase with Thrombospondin Motifs (ADAMTS) metalloproteinase family are known regulators of ECM structure; however, the transcriptional regulation of ADAMTS14 and its potential role in inflammation-associated ECM remodeling remain poorly understood. In this study, we investigated whether inflammatory signaling regulates ADAMTS14 expression and explored its association with ECM organization in CRC. Interleukin-6 (IL-6) stimulation significantly increased ADAMTS14 expression at both mRNA and protein levels in CRC cells. Promoter deletion analyses identified a critical IL-6-responsive region between -145 and -43 bp upstream of the transcription start site, suggesting transcriptional responsiveness of ADAMTS14 to inflammatory signaling. Inhibition experiments demonstrated that Extracellular Signal-Regulated Kinase, c-Jun N-terminal Kinase, Phosphatidylinositol 3-Kinase, and Nuclear Factor Kappa B pathways were associated with IL-6-induced ADAMTS14 expression. Transcriptomic analyses of The Cancer Genome Atlas CRC datasets revealed that ADAMTS14 expression is elevated in tumors and is associated with inflammatory signaling, stromal activation, fibroblast-related gene expression, and ECM organization pathways. Functional enrichment analyses indicated that ADAMTS14-correlated genes are primarily involved in ECM organization, collagen fibril organization, and connective tissue development. Together, these findings identify ADAMTS14 as an inflammation-responsive ECM-associated metalloproteinase and suggest that IL-6 signaling may be associated with ECM-related transcriptional programs through regulation of ADAMTS14 expression. Our findings further suggest that ADAMTS14 expression may be associated with inflammatory and stromal-related transcriptional programs in CRC.
An evaluation of breast augmentation: accuracy, utility, and accessibility of knowledge for patient education and consultation with artificial intelligence
(Springer, 2026) Işıktekin, Emrah; Kırış, Yusuf Furkan; Kılıç, Salih; Gözel, Betül
BackgroundThe purpose of this study is to compare the answers of the 12 most frequently asked questions regarding breast augmentation surgery on both Google Gemini and ChatGPT-4.5. Our research highlights the growing importance and differential performance of artificial intelligence models in informing patients before surgery.MethodsThe 12 most asked questions about breast augmentation, based on user engagement metrics, were obtained from the Realself website. These twelve questions were investigated on both Google Gemini and ChatGPT-4.5. Information received from both platforms was analyzed and evaluated by ten plastic surgeons with European Board of Plastic Reconstructive and Aesthetic Surgery (EBOPRAS) certification. The surgeons, who reached a consensus on the application of the Global Quality Score (GQS) scale prior to evaluation, were blinded to the source of the answers. The GQS scale was used for the evaluation.ResultsThe average results obtained were compared with each other. While the average of Google Gemini responses was calculated at 2.842, the average of ChatGPT-4.5 responses was calculated at 3.867. For this calculation, the Wilcoxon signed-rank test was used. It was found that the ChatGPT-4.5 responses were statistically superior to Google Gemini according to the Global Quality Score (GQS) (p = 0.003).ConclusionWhile there is emerging research on AI in plastic surgery, studies specifically comparing ChatGPT and Gemini for breast augmentation patient education using a blinded evaluation by board-certified surgeons remain limited. We suggest that AI-powered chatbots offer significant advantages for patient education but should be used cautiously. While ethical concerns persist, this study underscores the practicality of ChatGPT in informing patients about plastic surgery procedures, emphasizing the need for careful usage and collaboration to optimize benefits while minimizing risks.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Adaptive resilience in educational leadership: navigating structural constraints in centralized school systems
(Emerald Group Publishing Ltd, 2026) Güneş, Ahmet Melih; Yünkül, Eyüp
Purpose This study examines how elementary school principals lead within T & uuml;rkiye's centralized education system under conditions of inadequate facilities, limited resources and demanding bureaucratic processes.Design/methodology/approach This study adopts an interpretive phenomenological approach to explore how elementary school principals navigate structural constraints within a centralized education system. Data were collected through semi-structured, in-depth interviews with 17 elementary school principals in Balikesir province, T & uuml;rkiye, conducted between March and April 2025. Participants were selected using stratified typical case sampling to capture variation across urban and rural school contexts. Interview transcripts were analyzed using an inductive qualitative content analysis approach, allowing patterns of leadership practice to emerge from principals' lived experiences under conditions of resource scarcity, bureaucratic pressure and limited decision-making authority.Findings Analysis identified nine themes grouped into three interrelated domains shaping principals' leadership practice: resource challenges, human-centered challenges and systemic challenges. These constraints frequently overlapped, creating layered pressures on school leadership. Principals responded through practices conceptualized as adaptive resilience, including exercising bounded discretion, recombining scarce resources, mobilizing relational networks and implementing compliant incremental improvements. While these strategies helped sustain school functioning, notable disparities emerged between urban and rural schools, with rural principals facing more severe infrastructure, staffing and connectivity limitations. Overall, the findings indicate that leadership in centralized, resource-constrained systems is enacted through context-sensitive, adaptive practices rather than formal authority alone.Research limitations/implications This study is based on interviews with 17 elementary school principals in one Turkish province and therefore does not aim for statistical generalization. The findings reflect participants' lived experiences within a specific centralized and resource-constrained context. Future research could examine whether similar leadership patterns emerge in other regions or in different centralized education systems. Comparative or mixed-method studies may also help further refine the concept of adaptive resilience and examine how structural constraints shape leadership practices across diverse institutional settings.Practical implications The findings suggest that principals working in resource-constrained environments may benefit from adopting adaptive resilience strategies. These include flexible use of available resources, collaboration with community actors and neighboring schools, and incremental improvements implemented within existing regulatory frameworks. Leadership preparation programs may help future administrators develop skills in stakeholder mobilization, context-sensitive decision-making and problem-solving under constraint. For policymakers, the results highlight the importance of recognizing contextual differences across schools and considering more flexible support mechanisms for schools operating under sustained resource limitations.Social implications The study highlights how educational inequalities may be reinforced when uniform policies do not adequately account for local school contexts.
Rural and socioeconomically disadvantaged schools often face compounded challenges, including infrastructure limitations, staffing shortages and restricted access to technology. Recognizing these disparities underscores the importance of socially responsive education policies and more context-sensitive resource allocation. The findings also suggest that collaborative engagement among schools, communities and local stakeholders can help support schools operating under structural constraints. Greater awareness of these dynamics may contribute to more equitable educational opportunities across diverse school contexts.Originality/value This study contributes to the literature by conceptualizing adaptive resilience as a context-embedded leadership orientation emerging under conditions of structural constraint in centralized education systems. Drawing on principals' lived experiences in T & uuml;rkiye, the study shows how leadership practice involves bounded discretion, resource recombination and relational mobilization within limited institutional authority. By linking these practices to street-level bureaucracy theory, the study offers a refined understanding of how leadership is enacted when autonomy and resources are restricted. The findings provide a conceptual lens for examining leadership in centralized, resource-limited education systems and contribute to ongoing discussions on leadership practice under structural constraint.
Early detection of tamoxifen-induced retinal injury: ellipsoid zone reflectivity as a sensitive structural marker
(BMC, 2026) Ünlü, Barbaros Hayrettin; Köksaldı, Seher; Engin, Ceren Durmaz; Varol, Umut
Purpose To investigate early structural alterations in the outer retina and choroid of tamoxifen-treated patients without clinically detectable retinopathy by quantitatively assessing reflectivity changes of the external limiting membrane (ELM), ellipsoid zone (EZ), and retinal pigment epithelium (RPE), along with the choroidal vascularity index (CVI). Methods The study included 45 eyes of 45 tamoxifen-treated women and 50 eyes of 50 age- and sex-matched healthy female controls. ELM, EZ, and RPE reflectivity was measured along foveal, parafoveal, and perifoveal axes. CVI was derived using a standardized binarization method. Correlations between reflectivity metrics and tamoxifen exposure indices were analyzed. Results Tamoxifen users showed a marked reduction in EZ reflectivity at the central fovea and at the temporal perifovea (p = 0.005 and p = 0.037, respectively), accompanied by a corresponding decrease in relative EZ values at the central fovea and at the temporal parafovea (p = 0.012 and p = 0.039, respectively). In contrast, ELM and RPE reflectivity metrics remained stable across all evaluated regions (p > 0.05). CVI measurements revealed no significant differences between the patient and control groups (p > 0.05). Within the tamoxifen cohort, treatment duration demonstrated weak but significant positive associations with central foveal ELM reflectivity (r = 0.389, p = 0.008), whereas age was negatively correlated with EZ reflectivity in the nasal parafoveal region (r = - 0.331, p = 0.026). Conclusions Early tamoxifen exposure appears to affect the EZ before detectable alterations become evident in the ELM, RPE, or choroid. These findings suggest that subtle EZ disruption may represent an early structural indicator of tamoxifen-related retinal involvement and could potentially aid in identifying patients who may require closer monitoring. However, longitudinal studies are needed to confirm these findings and clarify their clinical significance.
