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Collecting behavioural data across countries during pandemics: Development of the COVID-19 Risk Assessment Tool
No full textTools that can be used to collect behavioural data during pandemics are needed to inform policy and practice. The objective of this project was to develop the Your COVID-19 Risk tool in response to the global spread of COVID-19, aiming to promote health behaviour change. We developed an online resource based on key behavioural evidence-based risk factors related to contracting and spreading COVID-19. This tool allows for assessing risk and provides instant support to protect individuals from infection. The Risk Estimation Questions assessed users' location, age, gender, work environment, day-to-day behaviours currently performed, and conditions under which these behaviours would change. Users were also asked to estimate how often they keep their distance from others in public and regularly wash their hands, and the procedures they follow to do so. A multidisciplinary research team of more than 150 international experts developed the tool. Over 60,000 users in more than 150 countries have assessed their risk and provided data. The majority of respondents reported that they almost always keep their distance from others in public places, and most participants reported washing their hands after touching public or shared surfaces or when entering buildings. The tool, data, and results were openly shared to support government and health agencies developing behaviour change interventions. This tool creates a blueprint for similar digital infrastructure that can be replicated and used in future pandemics
Long-Term Outcomes of Chenodeoxycholic Acid Therapy for Cerebrotendinous Xanthomatosis: A Nationwide Study on Prognostic Factors and Treatment Response.
No full textA mat-heuristic approach for the variable-sized cutting stock problem in dynamic environments
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Çin'in Kuşak ve Yol Girişimi: Küresel Ulaştırma Operasyonlarında Denizcilik ve Deniz Mühendisliği Perspektifinden Stratejik Karar Alma Motivasyonları
No full textÇin'in 2013 yılında duyurduğu Kuşak ve Yol Girişimi (BRI), küresel ulaşım altyapısını geliştirmek ve ekonomik kalkınmayı teşvik etmek amacıyla tasarlanmış dev bir projedir. Bu çalışma, Çin'in BRI'sini yönlendiren ana motivasyonel kaynakları, özellikle ekonomik, politik ve stratejik unsurlar açısından tanımlamayı ve önceliklendirmeyi amaçlamaktadır. PRISMA sistematik literatür taraması ve odak grup metotları kullanılarak, 26 motivasyonel faktör belirlenmiş olup, bunların 16'sı esas olarak ekonomik niteliktedir. Bu faktörler arasında 'Çinli yatırımcılar için yeni iş fırsatları' en önemli itici güç olarak ortaya çıkmıştır. Ekonomik motivasyonlara ek olarak, bu çalışma, BRI'nin deniz yollarının başarısında deniz mühendisliği, gemi risk yönetimi ve gemi makineleri inovasyonlarının operasyonel etkinliğini sağlamak için hayati bir unsur olarak tanımlanmıştır. Çalışma ayrıca, Çin'in daha geniş jeopolitik ve ekonomik hedeflerine ulaşmasında deniz güvenliği protokolleri, altyapı modernizasyonu ve risk azaltma stratejilerinin rolünü vurgulamaktadır. Bulgularımız, özellikle ekonomik büyüme ve deniz taşımacılığı altyapısına yönelik olan Çin'in iç motivasyonlarının dış faktörlerden daha önemli bir rol oynadığını göstermektedir. Bu durum, politika yapıcılar, deniz mühendisleri ve ulaştırma operatörlerinin, uzun vadeli stratejilerini Çin'in hedefleriyle uyumlu hale getirmeleri gerektiğini, deniz güvenliği, operasyonel verimlilik ve Çin'in deniz teknolojilerinin küresel rekabet gücüne odaklanmaları gerektiğini ortaya koymaktadır. Bu çalışmadan elde edilen bilgiler, BRI kapsamında deniz altyapısının küresel ulaştırma sistemlerinin geleceğini şekillendirmedeki stratejik önemine daha derin bir anlayış kazandırmaktadır.China’s Belt and Road Initiative (BRI), announced in 2013, is a mega project designed to enhance global transportation infrastructure and stimulate economic development. This study aims to identify and prioritize the key motivational sources driving China's BRI, with a particular focus on economic, political, and strategic considerations. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) systematic literature review and focus group methods, we identified 26 motivational factors, 16 of which are primarily economic in nature. Among these, 'New business opportunities for Chinese investors' emerged as the most significant driver. In addition to economic motivations, this study highlights the critical importance of marine engineering, ship risk management, and ship machinery innovations in the success of BRI's maritime routes. Safe, efficient maritime transportation is identified as a crucial element for ensuring the operational effectiveness of the Maritime Silk Road. The study further emphasizes the role of maritime safety protocols, infrastructure modernization, and risk mitigation strategies in achieving China's broader geopolitical and economic ambitions through the BRI. Our findings suggest that China’s internal motivations, particularly those related to economic growth and maritime transport infrastructure, play a more prominent role than external factors. This underscores the need for policymakers, marine engineers, and transport operators to align their long-term strategies with China’s ambitions, focusing on maritime safety, operational efficiency, and the global competitiveness of China’s maritime technologies. The insights gained from this study contribute to a deeper understanding of the strategic importance of maritime infrastructure in shaping the future of global transportation systems under the BRI
Comparison of the efficacy of mFOLFOX-6 and mDCF regimens in the treatment of metastatic gastric cancer: a multicenter retrospective study
No full textBackground: Metastatic gastric cancer (GC) and gastroesophageal junction (GEJ) cancer are associated with a poor prognosis. Recent advancements in treatment have incorporated trastuzumab, anti-PD-1 agents, and anti-claudin therapies alongside chemotherapy (ChT), significantly improving outcomes. Contemporary studies predominantly employ doublet ChT as the backbone for these regimens, although historically triplet ChT regimens have been favored, particularly in younger patients requiring rapid tumor shrinkage. Objective: The aim of this study was to compare the efficacy of mFOLFOX-6 and mDCF regimens in the treatment of advanced GC and GEJ adenocarcinoma. Design: This was a retrospective multicenter study. Methods: Patient data were obtained from the databases of 25 hospitals across Turkey. Demographic and clinicopathological characteristics were documented. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan–Meier method, and group discrepancies were assessed with log-rank test. Results: A total of 493 patients were included in the analysis, with similar baseline characteristics between the two groups. The objective response rate was 36.3% in the mDCF group and 38% in the mFOLFOX-6 group (p = 0.7). The median PFS was 6 months for mDCF and 7 months for mFOLFOX-6 (p = 0.2), while the median OS was 12 months for mDCF and 11 months for mFOLFOX-6 (p = 0.4). Grade 3–4 neutropenia occurred in 27.6% of patients treated with mDCF versus 17.8% with mFOLFOX-6 (p = 0.01). Likewise, grade 3–4 anemia was more frequent in the mDCF group (9.5%) compared to the mFOLFOX-6 group (4.8%; p = 0.04). Conclusion: Modified FOLFOX-6 demonstrated comparable efficacy to mDCF in the treatment of advanced GC and GEJ adenocarcinoma. Moreover, mFOLFOX-6 was associated with a lower incidence of hematological adverse effects
Türkiye Klinikleri Çocuk Acil -kardiyolojik Aciller
No full textİnfektif endokardit (İE) çocukluk çağının nadir bir enfeksiyonudur. Ancak tıbbi gelişmelere rağmen yüksek mortalite ve morbidite ile seyretmeye devam etmektedir. Kalbin endokardiyal yüzeyini tutan bu enfeksiyon, bakteriyel veya fungal nedenli olabilmektedir. Hastalığın; ateş, artralji, terleme,halsizlik gibi özgül olmayan semptomları nedeniyle tanıda gecikmeler olabilmektedir. Ancak özellikle altta yatan kalp hastalığı olan, damar içi uyuşturucu madde kullanan ve uzun süreli santral venöz kateteri olan hastalar, belirli bir odağın olmadığı ateşli hastalık söz konusu olduğunda, İE açısından değerlendirilmelidir. Tanısal yaklaşımın temel taşlarını kan kültürü incelemesi ve ekokardiyografi(EKO) oluşturur. İE olgularının bir kısmında başlangıçta EKO negatif olabilmektedir, bu nedenle klinik şüphe devam ediyorsa tekrarlayan değerlendirmeler önerilmektedir. Özellikle yüksek riskli hasta grubunda İE önleme stratejileri klinisyenler tarafından iyi bilinmeli, hastalar ve aileleri bu konuda eğitilmelidir.Infective endocarditis (IE) is a rare infection in children, yet it remains associated with significant morbidity and mortality despite advancements in medical care. This condition affects the endocardial surface of the heart and can be caused by either bacterial or fungal pathogens. Due to its nonspecific symptoms -including fever, joint pain, sweating, and fatigue- diagnostic delays are not uncommon. Patients with underlying heart conditions, those who use intravenous drugs, or individuals with long-term central venous catheters should be assessed for IE if they present with a febrile illness without an obvious source. The cornerstone of diagnostic evaluation comprises blood cultures and echocardiography. In some instances, initial echocardiography findings may be negative; therefore, it is advisable to conduct repeat assessments when clinical suspicion continues. Clinicians must be well-versed in prevention strategies for high-risk patient groups, and it is essential that both patients and their families receive thorough education on this matter.</p
