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In this study, a new three-phase ergonomic risk assessment approach was proposed for manual lifting tasks to determine which worker has the highest ergonomic risk level considering two criteria sets as lifting-related criteria and human-related criteria. In the first phase, Modified Kemeny Median Indicator Ranks Accordance (KEMIRA-M) and a novel two-dimensional best–worst method (BWM) integration were proposed for weighting ergonomic risk criteria in two sets. In this way, weighting procedure of KEMIRA-M was advanced by the proposed two-dimensional BWM in a consistent manner and subjectivity in determining the best and the worst criteria in traditional BMW was prevented by using KEMIRA-M. Thus, the weaknesses of both methods have been developed. In the second phase, the rankings of workers were determined via utilizing multi-objective optimization on the basis of simple ratio analysis, multi-objective optimization by ratio analysis (MOORA) ratio, MOORA reference point and complex proportional assessment to see how worker rankings differ despite using the same advanced weighting approach based on KEMIRA-M and two-dimensional BWM integration. Finally, to aggregate these different ranking results, technique of precise order preference was applied. In this way, different viewpoints of each ranking approach can be reflected on a single worker’s priority. The applicability of the proposed ergonomic risk assessment approach was demonstrated with a real application in tube manufacturing.

Purpose Selecting the most appropriate healthcare waste treatment technology (HCWTT) is an uncertain and complex decision-making problem because there exist more than one alternative and many conflicting qualitative and quantitative criteria. However, the use of fuzzy and comparative values, instead of specific crisp values, provides more accurate results, so that the alternatives may be evaluated in accordance with hesitant human nature. The purpose of this paper is to select the best HCWTT using a hesitant fuzzy linguistic term set (HFLTS). Design/methodology/approach Five main criteria were identified for HCWTT selection, such as economic, social, environmental, technical and ergonomic criteria. In total, 19 sub-criteria were examined, and the hierarchy of the criteria was formed. The criteria weights were determined using the multi-criteria hesitant fuzzy linguistic term set (MC-HFLTS). The selection processes of incineration (A1), steam sterilization (A2), microwave (A3) and landfill (A4) alternatives were carried out using the multi-attributive ideal-real comparative analysis (MAIRCA) and multi-attributive border approximation area comparison (MABAC) methods. In the comparative analyses, Vise Kriterijumska Optimizacija I Kompromisno Resenje (VIKOR) and technique for order preference by similarity to an ideal solution (TOPSIS) methods were used. Findings The comparison of the results of the MABAC and MAIRCA methods with the results of VIKOR and TOPSIS methods indicated that A2 (steam sterilization) alternative was the best one and produced the same ranking of the technology alternatives (A2 > A3 > A1 > A4). As a result, the study concluded that these methods can be successfully used for HCWTT selection problems. Originality/value To the best of the authors’ knowledge, MC-HFLTS has not been used to select HCWTT in the existing literature. For the first time, MC-HFLTS&MAIRCA and MC-HFLTS&MABAC approaches were used in order to choose the best treatment method for healthcare waste under the effect of multiple conflicting hierarchical criteria. It has been provided that MABAC and MAIRCA select alternative choices by taking into consideration the hierarchical criteria. Unlike other studies, this study also considered ergonomic criteria that are important for people working during the process of using the treatment technology.

Backgrounds To evaluate the effect of colored vs. white coat wear on dental anxiety in children using psychometric, projective, and physiological methods. Methods The participants were divided into two groups by the pediatric dentist based on the participants’ coat color (white vs. colored), and procedures were performed during two separate appointments for both groups: dental examination (DE) and preventive dental treatments (PDT). The blood pressure, pulse rate, and saturation were recorded before and after each appointment. Anxiety was assessed using the Modified Child Dental Anxiety Scale Faces Version (MCDAS f ) before and after the appointments and the Child Drawing: Hospital (CD: H). Chi-Square, Mann-Whitney U test, Wilcoxon Signed-Rank test, and t-test were used for analysis. The statistical significance level was evaluated as P < 0.05. Results Compared to the colored coat group, MCDAS f values ​​recorded before both appointments were higher in the white coat group ( P  = 0.019; P  = 0.034). Also, it was observed that the CD: H values of the colored coat group were significantly lower after PDT ( P  = 0.037). According to the coat groups, there was a significant difference between pulse rates measured before and after both appointments ( P  = 0.026; P  = 0.017; P  = 0.008; P  = 0.004). Conclusions The clinician’s coat color selection impacts children’s dental anxiety. The findings suggest that colored coats are more effective than white coats in relieving dental anxiety.

Shopping malls (SMs) are one of the prides of cities with their attractive appearance, charming stores and different consumer types. The heavy competition, ever increasing and diversifying consumer expectations alongside the changes in the demand equilibrium in the mall sector force managers to a really hard struggle to remain alive in the sector. This study aims to resolve the decision-making problem of SM selection by considering several different main criteria such as universal design, technical characteristics, esthetic appearance etc. The method used to resolve this problem is a task-based integrated fuzzy multi-criteria decision-making (TB-IFMCDM) approach that includes Modified Fuzzy Decision-Making Trial and Evaluation Laboratory (MF-DEMATEL) and Fuzzy Multi-Objective Optimization on the Basis of Ratio Analysis (F-MOORA). It also aims to determine the best SM through the support of universal design criteria by simultaneously considering the needs of all consumers including those of diverse populations, which is a rapidly growing market. As such, SM-selection-related tasks are given to experts who are treated like and act as consumers. Criteria weights are computed considering direct and indirect effect relations by transforming criteria importance to criteria effect, via utilization of MF-DEMATEL. Additionally, rankings of four SMs are obtained by implementing F-MOORA. Finally, a comparative analysis is conducted to determine the consistency of the ranking of the proposed approach by comparing them with the results of the fuzzy complex proportional assessment. As a result of this study, it is identified that design-related criteria are most important for SM selection.

The median patient age, follow-up period, colchicine treatment rates, childhood vaccination and influenza vaccination rates, median parental age, parental vaccination rate, and parental education level were higher in vaccinated patients (p<0.05 for all). Based on data from the World Health Organization, approximately 13 billion doses of COVID-19 vaccines have been administered globally.1 Observational studies have demonstrated that COVID-19 vaccines are safe and highly effective in reducing hospitalization and mortality rates.2 In general, COVID-19 tends to result in mild symptoms in children, and hospitalization rates are lower compared to adults.3 COVID-19 can rarely cause a more severe disease course in children, and life-threatening complications, such as multisystem inflammatory disease, can occur, leading to rapid deterioration of the clinical status.4 In addition, it is known that children may spread the virus for several weeks, even in the absence of symptoms.5 Therefore, it is important to vaccinate children both to control the outbreak by preventing the spread of infection and to ensure a milder disease course. [...]depending on the disease and treatment-related factors, patients may have worse clinical outcomes and higher mortality compared to the general population. [...]it is recommended that patients with rheumatic diseases receive the COVID-19 vaccination.7,8 The aim of this study was to investigate the COVID-19 vaccination rates and factors affecting vaccination in children with rheumatic diseases. The study sample consisted of people who participated in the survey between the specified dates, and no sample size calculation was made. Since the COVID-19 vaccination program in our country only includes children aged 12 years and older, children under the age of 12 were not included.

IntroductionSLE is a chronic autoimmune disease characterised by multisystem involvement and fluctuating clinical course, often leading to permanent organ damage. Childhood-onset SLE (cSLE) tends to be more aggressive with increased organ involvement compared with adult-onset SLE. Despite advances in treatment, there is a rising incidence of morbidity and chronic damage in cSLE patients. This study aims to evaluate the patterns of damage and identify risk factors associated with damage accrual in a cohort of cSLE patients.Materials and methodsWe conducted a retrospective cohort study of 120 patients meeting the Systemic Lupus International Collaborating Clinics 2012 criteria for cSLE, followed by the paediatric rheumatology clinic from 2004 to March 2023. After excluding 18 patients for monogenic lupus or inadequate follow-up, 102 patients were analysed. Damage accrual was assessed using the Paediatric Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (PedSDI) and associations between clinical, laboratory and demographic variables with damage accrual were evaluated using univariate and multivariate analyses.ResultsThe mean age at diagnosis was 12.9 years, with a mean disease duration of 6.3 years. At the end of the study, 33.3% of patients had accrued damage (PedSDI≥1). The most frequently involved domains were growth failure (24%), renal (11.8%), neuropsychiatric (8.8%) and mucocutaneous (5.9%). Multivariate analysis revealed that higher median SLE Disease Activity Index-2000 scores, haemolytic anaemia and renal involvement were independent risk factors for damage accrual.ConclusionsOur study confirms that higher median disease activity over time, haemolytic anaemia and renal disease are significant predictors of long-term damage in cSLE. Additionally, growth failure was the most frequently involved domain in PedSDI, followed by renal and neuropsychiatric domains. These findings underscore the importance of early and effective disease management and regular monitoring for these risk factors.

Re-evaluation of the patient’s previous ALP levels revealed a decrease during remission and an increase during relapse. The patient was then admitted to the department of endocrinology for examination because of isolated ALP elevation, where he underwent X-ray and photon emission computed tomography/computed tomography (SPECT/CT). Interleukin-6 functions as an intracellular growth factor in hairy cell leukemia in vitro.

Cargo transportation is part of the logistic sectors. Both service quality and customer satisfaction are very important for companies which provide cargo transportation services. This study aims to evaluate cargo companies via DMs (customers) preferences in Erzurum, Turkey. Evaluating cargo companies is the multi-criteria decision making (MCDM) problem and DMs often use uncertain linguistic terms to express their assessments because DMs hesitate among different linguistic terms to provide their preferences. In this study, an integrated MC-HFLTS&MAIRCA (Multi-criteria Hesitant Fuzzy Linguistic Term Set and Multi Attribute Ideal-Real Comparative Analysis) method is used for evaluating and selecting the best cargo company. From this point of view, alternatives, criteria and DMs are defined and the integrated method is applied for the selection of the best cargo company. In order to test the results, MABAC, TOPSIS and VIKOR methods were used.

The aim of this study is to evaluate the association between seven important H. pylori virulence factors and antibiotic resistance in patients with gastritis. H. pylori strains isolated from 33 patients with gastritis were examined. Antimicrobial susceptibilities were tested by GenoType® HelicoDR (Hain Life Science, Germany) test kit and RT-PCR. The virulence-factors were determined using conventional PCR. 39% of patients were resistant for clarithromycin and 27% of patients were resistant for fluoroquinolone. 15% of patients were resistant to both clarithromycin and fluoroquinolone. The H. pylori vacA m1/s2 genotype was the most frequent allelic combination. Patients were possessed the vacA s1, m1 (6.1%); s1, m2 (6.1%); s2, m1 (15.1%); and s2, m2 (3.0%) genotypes. 94% of patients with gastritis were positive for H. pylori napA gene. Also, there were no dupA gene-positive gastritis patients. There was no significant correlation between the vacA, cagA, oipA, hpaA, babA, napA, dupA, ureA, ureB virulence genes, clarithromycin, and fluoroquinolone resistance. Herein, we report that the relationship between the H. pylori napA gene and gastritis. Although we found a correlation between H. pylori virulence factor and clinical outcome, there is a need for further studies to enlighten the relation between H. pylori virulence genes and antibiotic resistance.

Background/ObjectivesThe aim of the study is to assess the effect of juvenile idiopathic arthritis (JIA) and biologic disease-modifying anti-rheumatic drugs (bDMARDs) on ovarian reserve in children.Materials and MethodsA cross-sectional study was performed from March 2021 to March 2022 and included 81 patients with JIA and 49 healthy children. Serum anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol levels were analyzed using electrochemiluminescence methods.ResultsThe mean of current age (13.5 ± 3.2 vs. 14.4 ± 2.4 years), height standard deviation score (SDS) (− 0.35 ± 1.18 vs. − 0.44 ± 0.94), body mass index SDS (0.12 ± 1.33 vs. 0.25 ± 1.28), and the median weight SDS (− 0.13 (− 2.27–3.23) vs. − 0.52 (− 3.4–3.3)) were similar in JIA patients and controls (p > 0.05). Patients with JIA were divided into two groups according to their treatment regimens: treated with methotrexate (MTX) (biologic naive) (n = 32) and treated with MTX plus bDMARDs (n = 49). No significant differences were detected between the 3 groups regarding menarche age, menstrual cycle length, and flow duration (for all p > 0.05). The median serum concentration of AMH was 2.94 (1.12–7.88) ng/ml in the control group, 3.02 (0.36–8.54) ng/ml in the biologic naïve group, and 3.01 (0.99–8.26) ng/ml in the MTX plus bDMARD group. There were no significant differences between 3 groups according to serum AMH, FSH, LH, and estradiol levels (p > 0.05).ConclusionBiologic DMARDs are reassuring in terms of ovarian reserve in girls with JIA and demonstrate that AMH is unaffected by treatment. Prospective studies with larger sample sizes are needed to confirm our findings and to evaluate the impact on the future fertility of patients. Key Points• Although biologic disease-modifying anti-rheumatic drugs (bDMARDs) are being game-changing treatment options in juvenile idiopathic arthritis, their effect on fertility and ovarian reserve is one of the most discussed issues.• In addition to treatment used, autoimmune diseases might also have a negative effect on fertility.• In this cross-sectional study, we found that anti-Mullerian hormone level of patients who were on bDMARDs, patients who were on methotrexate, and healthy controls were similar.• Our results suggest that bDMARDs are reassuring in terms of ovarian reserve in girls with JIA and demonstrate that AMH is unaffected by treatment.