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IntroductionMicroaggressions, or subtle expressions of discrimination directed towards individuals because of their membership in marginalized social groups, are the subject of a growing body of literature (Sue, 2010). As a result of growing understanding of politically correct beliefs over time, they’ve been defined as subtler types of discrimination that have replaced formerly overt discrimination. Microaggressions differ from traditional prejudice in that they are frequently perpetrated by well-intentioned people who are oblivious of the negative implications and consequences of their conduct. Microaggressions have been documented in a variety of social groups, including racial/ethnic minorities (Sue et al., 2008; Torres et al., 2010), gender (Swim et al., 2001), sexual orientation (Shelton and Delgado-Romero, 2011), and ability status (Shelton and Delgado-Romero, 2011). Many people with mental illnesses have reported social rejection experiences that are similar to microaggressions, according to research (Cechnicki et al., 2011; Lundberg et al., 2009; Wright et al., 2000; Yanos et al., 2001).ObjectivesExisting measures of stigmatizing attitudes and behaviors may not capture much of the nuance in behavior that people with mental illness report to be particularly upsetting, so we thought it would be important to examine reliability and validity of the mental illness microaggressions scale-perpetrator version (MIMS-P) for measuring microaggression behavior in the general public in Turkey.MethodsThe methodological study will be conducted to establish the validity and reliability of the The mental illness microaggressions scale-perpetrator version (MIMS-P) scale to Turkish Culture and to determine the microaggression levels against individuals with mental illness in the general population. The sample of the study will consist of individuals who are reached through an online questionnaire and who agree to participate in the study. Individuals who have psychiatric disorders will not be included in the study.ResultsData collection process is still ongoing. Description of studies and the key findings will be presented.ConclusionsThe MIMS-P is designed to aid future study on the frequency of endorsement of microaggressions performed against people with mental illnesses, with the ultimate goal of understanding the mechanisms that lead to these acts.The development of an extra scale to measure microaggressions from the perspective of people with mental illnesses who encounter them is one of the future research objectives.With a better knowledge of these viewpoints and how they interact, effective therapies and public policy initiatives for reducing stigma against mental illness can be developed.Disclosure of InterestNone Declared

On 6 April 2009 an earthquake of magnitude 6.3 occurred in L'Aquila city, Italy. In the city center and surrounding villages many masonry and reinforced concrete (RC) buildings were heavily damaged or collapsed. After the earthquake, the inspection carried out in the region provided relevant results concerning the quality of the materials, method of construction and the performance of the structures. The region was initially inhabited in the 13th century and has many historic structures. The main structural materials are unreinforced masonry (URM) composed of rubble stone, brick, and hollow clay tile. Masonry units suffered the worst damage. Wood flooring systems and corrugated steel roofs are common in URM buildings. Moreover, unconfined gable walls, excessive wall thicknesses without connection with each other are among the most common deficiencies of poorly constructed masonry structures. These walls caused an increase in earthquake loads. The quality of the materials and the construction were not in accordance with the standards. On the other hand, several modern, non-ductile concrete frame buildings have collapsed. Poor concrete quality and poor reinforcement detailing caused damage in reinforced concrete structures. Furthermore, many structural deficiencies such as non-ductile detailing, strong beams-weak columns and were commonly observed. In this paper, reasons why the buildings were damaged in the 6 April 2009 earthquake in L'Aquila, Italy are given. Some suggestions are made to prevent such disasters in the future.

This study evaluates seismic capacity of the unreinforced masonry buildings with the selected template designs constructed per pre-modern code in Albania considering nonlinear behaviour of masonry. Three residential buildings with template designs were selected to represent an important percentage of residential buildings in medium-size cities located in seismic regions of Albania. Selection of template designed buildings and material properties were based on archive and site survey in several cities of Albania. Capacity curves of investigated buildings were determined by pushover analyses conducted in two principal directions. The seismic performances of these buildings have been determined for various earthquake levels. Seismic capacity evaluation was carried out in accordance with FEMA (Federal Emergency Management Agency) 440 guidelines. Reasons for building damages in past earthquakes are examined using the results of capacity assessment of investigated buildings. It is concluded that of the residential buildings with the template design, with the exception of one, are far from satisfying required performance criteria. Furthermore, deficiencies and possible solutions to improve the capacity of investigated buildings are discussed.

This study proposes continuous density-based three-dimensional topology optimization (TO) approaches developed by coupling the peridynamic theory (PD) with optimality criteria (OC) and proportional approach (PROP). These frameworks, abbreviated as PD-OC-TO and PD-PROP-TO, can be practically utilized to enhance the fracture toughness of the structures during the optimization process by taking critical regions into account as pre-defined cracks. Breaking the non-local interactions (bonds) between relevant PD particles enables us to readily model cracks. Utilizing this advantage, we solve several benchmark optimization problems including different numbers, positions, and alignments of the cracks. The major differences between the proposed methods are examined by comparing optimum topologies for various cracked scenarios. Moreover, the mechanical behaviour of the optimized structures is investigated under dynamic loads to prove the significant improvements achieved by the present approach in the final designs. The results of dynamic analyses reveal the viability of both PD-TO methods for increasing the fracture toughness of the structure in the optimization stage. Overall, the proposed approach is confirmed as a superior design and optimization tool for future engineering structures.

Ghrelin, an endogenous ligand for growth hormone secretagogue receptor (GHS-R), has been identified in the rat and human gastrointestinal tract. Ghrelin has been proposed to play a role in gastric acid secretion. Nitric oxide (NO) was shown as a mediator in the mechanism of ghrelin action on gastric acid secretory function. However, there is a little knowledge about this topic. We have investigated the role of ghrelin in gastric acid secretion and the role of NO as a mediator. Wistar albino rats were used in this study. The pyloric sphincter was ligated through a small midline incision. By the time, saline (0.5 ml, iv) was injected to the control group, ghrelin (20 μg/kg, iv) was injected to the first experimental group, ghrelin (20 μg/kg, iv) + L-NAME (70 mg/kg, sc) was injected to the second group and L-NAME (70 mg/kg, sc) was administered to the third group. The rats were killed 3 h after pylorus ligation; gastric acid secretion, mucus content and plasma nitrite levels were measured. Exogenous ghrelin administration increased gastric acid output, mucus content and total plasma nitrite levels, while these effects of ghrelin were inhibited by applying L-NAME. We can conclude that ghrelin participates in the regulation of gastric acid secretion through NO as a mediator.

This prospective, randomized controlled study aims to compare opioid doses in patients undergoing intracranial tumor surgery managed with Total Intravenous Anesthesia using Target Controlled Infusion (TIVA-TCI) combined with Nociception Level (NOL) monitoring. The NOL index, an artificial intelligence-driven multiparameter index, integrates physiological signals such as heart rate, skin conductance, and photoplethysmography to provide an objective measure of nociception and guide personalized opioid administration. Additionally, the study evaluates the consumption of hypnotic drugs, hemodynamic parameters, variability in the NOL index, and changes in Heart Rate (HR) in the study group patients who received NOL monitoring following severe noxious stimuli. The study involved 50 ASA II-III patients undergoing intracranial tumor surgery, with 25 in the standard care guided group and 25 in the NOL guided group. The control group received standard monitoring while NOL monitoring added in the study group. Propofol and remifentanil were titrated to maintain hemodynamic parameters or NOL values. Hemodynamic parameters, propofol and remifentanil doses were recorded and compared between groups. NOL index changes before and after noxious stimuli were compared with HR changes. No significant differences were found in demographic data between the two groups. The remifentanil dose administered was similar in both groups. The study group received a higher dose of propofol. However, the control group had a longer duration of operation. The NOL index showed a significantly higher change after severe noxious stimuli compared to Heart Rate, indicating greater sensitivity. This study compares NOL index monitoring to standard monitoring during intracranial tumor surgery. The results indicate that NOL monitoring is reliable in detecting and monitoring nociception events compared to heart rate changes. However, it does not lead to a significant reduction in opioid dose administration.

Primary hypothyroidism can result in reactive enlargement of the pituitary gland which is indistinguishable from primary pituitary lesions on magnetic resonance imaging (MRI), and this results from the loss of thyroxine feedback inhibition and the subsequent over-production of thyroid-stimulating hormone (TSH).3 Moreover, although not firmly established in humans, the occurrence of an autonomous TSHproducing pituitary adenoma in the context of pituitary hyperplasia remains theoretically possible.4 The case presented here, involving thyroid disease, could cause the presenting symptoms as well as the apparent growth retardation and short stature. If secretion of thyroid hormones is inadequate, the serum TSH level wül increase, eventually resulting in hyperplasia of thyrotrophinproducing ceUs, which correlates with TSH levels.4 Pituitary enlargement associated with hypothyroidism responds well to medical treatment, and complete regression of a pituitary mass can be confirmed by repeat MRI after thyroxine treatment.

To determine the influence of timing of systemic ketamine administration on postoperative morphine consumption. Prospective randomized study. Operating rooms, postanesthesia care unit, and gynecology service of a university hospital. Forty-five patients undergoing laparotomy for benign gynecologic pathologies were randomized into 3 groups. In Group 1, before surgical incision, patients received 0.5 mg/kg ketamine IV, followed by normal saline infusion and normal saline IV at wound closure in group 1 (n = 15). In group 2 (n = 15), patients received 0.5 mg/kg ketamine IV before surgery, followed by ketamine infusion 600 μg · kg −1 · h −1, until wound closure and normal saline IV at that time. In the other group (group 3, n = 15), patients received normal saline IV before surgery, followed by saline infusion and then 0.5 mg/kg ketamine IV at wound closure. In the postoperative period, patient-controlled analgesia IV morphine was used for postoperative pain relief. First requested analgesic medication time was recorded. Postoperative pain was assessed by measuring morphine consumption at 0 to 2, 0 to 4, and 0 to 24 hours and visual analog scale (VAS) pain scores in response to cough at 2nd, 4th, and 24th hours and during rest at 0 to 2, 0 to 4, and 0 to 24 hours after surgery. First requested analgesia was shorter in group 1 than the others ( P < .01). Mean VAS pain scores in response to cough at 24th hour in groups 2 and 3 were significantly lower than in group 1 ( P < .001 and P < .01, respectively). Mean VAS pain scores during rest at 0 to 24 hours in groups 2 and 3 were significantly lower than in group 1 ( P < .01 and P < .05, respectively). Morphine consumption was lower in groups 2 and 3 at 0 to 2 hours ( P < .001 and P < .01). Moreover, morphine consumption at 0 to 4 hours in group 2 was significantly lower ( P < .01). Lower pain scores and morphine consumption in groups 2 and 3 may be related to higher plasma ketamine concentrations caused by the higher doses and later administration. Our findings suggest that a single preoperative dose of ketamine provided less analgesia compared with other dosing regimens that included intraoperative infusions or postoperative administration.

This is a prospective, randomized, controlled trial that compared the efficacy of different protocols of local tissue infiltration with levobupivacaine or levobupivacaine-methylprednisolone at the surgical site for pain relief after lumbar discectomy. The objective of the study was to determine the efficacy of preemptive wound infiltration with levobupivacaine and levobupivacaine-methylprednisolone at the surgical site for pain relief. Patients usually suffer significant pain after lumbar discectomy. Wound infiltration with local anesthetics with or without corticosteroids is one method to address this. A total of 100 patients were randomly allocated to five equal groups as follows: Group I had the musculus multifidi near the operated level infiltrated with 30 mL 0.25% levobupivacaine and 40 mg methylprednisolone just before wound closure; Group II had the same region infiltrated with 30 mL 0.25% levobupivacaine alone before closure; Group III had this region infiltrated with 30 mL 0.25% levobupivacaine and 40 mg methylprednisolone before the incision was made; in Group IV this region was infiltrated with 30 mL 0.25% levobupivacaine alone before incision; and in Group C (controls) this region was infiltrated with 30 mL 0.9% NaCl just before wound closure. Demographics, vital signs, postoperative pain scores and morphine usage were recorded. All four treatment groups showed significantly better results than the control group for most parameters. The treated groups had lower parenteral opioid requirements after surgery, lower incidences of nausea and shorter hospital stays. Further, the data indicate that, compared with infiltration of these drugs at wound closure, preemptive injection of levobupivacaine or levobupivacaine-methylprednisolone into the muscle near the operative site provides more effective analgesia after lumbar discectomy. Our data suggest that preemptive infiltration of the wound site with levobupivacaine alone or combined with methylprednisolone provides effective pain control with reduced opiate dose after unilateral lumbar discectomy.