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Long-term effects of various exercise training modalities on balance, gait and fatigue in patients with multiple sclerosis: a randomized controlled study
No full textObjective: To investigate the long-term effects of vestibular exercises (VE), cervical stabilization exercises (CSE) and standard balance exercises (SBE) on balance, gait and fatigue in patients with multiple sclerosis. Methods: Thirty-five patients were randomly allocated to three groups, performing different exercises three days a week for 12 weeks. Assessments were conducted at baseline, at Week 12 and at a 6-month follow-up using the Functional Reach Test (FRT), Four-Square Step Test (FSST), 2-Minute Walk Test (2MWT), Timed Up and Go (TUG) test, and Fatigue Impact Scale (FIS). Results: At 12 weeks, both CSE and VE groups improved on FRT and 2MWT, with the CSE group also experiencing improvements on FSST, TUG, and FIS (p < 0.05). The SBE group showed no significant changes. At 6 months, FRT, FSST, and 2MWT improvements persisted in the VE group, while the CSE group-maintained TUG and FIS gains. The VE group had superior FRT at 6 months, while the CSE group showed greater FSST improvements at 12 weeks. The VE group exhibited greater 2MWT improvements than the CSE group at 6 months, while the CSE group had better TUG results at both timepoints. Both CSE and VE groups showed greater reductions in fatigue (FIS) than the SBE group at 6 months. Discussion; VE provide long-term benefits for balance and gait speed, while CSE enhance gait endurance and postural control during training. Both modalities contribute to long-term fatigue reduction. SBE are less effective, highlighting the need for targeted interventions such as VE and CSE for sustained improvements
The role of popular culture in urban consumption: urban sustainability and revitalisation proposals in Gaziantep
Get PDFGaziantep is one of Turkey's most geographically and culturally significant cities and has been home to many civilizations since its foundation. The region faces challenges in terms of environmental, social and economic sustainability due to rapidly increasing urbanisation, migratory movements and consumerist lifestyles. In terms of environmental sustainability, uncontrolled construction activity, the loss of green spaces and air pollution are among the issues to be mentioned. In terms of social sustainability, rapid demographic change has altered the fabric of the neighborhood, leading to problems of social cohesion and security. In terms of economic sustainability, some areas are rapidly being devalued by consumer culture, while investment in new development areas is leading to economic imbalances. The aim of this study is to develop solutions for transforming urban sustainability by analyzing the impact of popular culture on the creation of a consumer society. It also aims to analyses the extent to which the lifespan of buildings can be extended by refunctionalising existing buildings, how awareness-raising efforts can be evaluated, what is feasible for the refunctionalisation of buildings and how transformation scenarios can ensure sustainability. The study focuses on the districts of Bah & ccedil;elievler, & Ouml;& gbreve;retmenevleri and Kavakl & imath;k, which are the first preferred areas of Gaziantep in the transition from the traditional structure to the modern city center. As part of the study, a comprehensive literature review was carried out. In addition, spatial analyses were carried out, the past and present situation of the area was documented with photos, and housing plan diagrams were generated. The analyses were carried out using the scenario writing method and interviews. Surveys were conducted with locals and experts and possible scenarios were examined. This study makes an original contribution to the literature on urban sustainability and the impact of popular culture on urbanization by considering ecological, social and economic dimensions together. The methods and scenarios developed in the study are based on the specific case of Gaziantep and include model proposals that can be applied not only at the local level but also to other cities. The results show that converting buildings into student dormitories and residences would be the most sustainable long-term solution for urban development. In this context, the necessity of controlling the consumerist effects of popular culture is emphasized and a broader sustainability perspective is presented. The study has the potential to be applicable not only to Gaziantep but also to other cities with similar sustainability issues
Drivers of eco-efficiency and the criticality of environmental policy stringency in OECD countries
Get PDFExisting studies show that environmental policies can improve eco-efficiency, but their moderating effect has been ignored in the literature. In this study, we investigate how the multidimensional reality of environmental policy stringency influences the interplay between export diversification and eco-efficiency in the nine most economically diversified OECD (Organisation for Economic Co-operation and Development) economies. Adopting balanced panel data from 1995 to 2020, empirical results based on Method of Moments Quantile Regression indicate that environmental policy stringency and technological innovation improve the eco-efficiency of OECD countries. Export diversification, energy utilisation, and financial deepening, on the other hand, are found to have negative relationships with eco-efficiency in OECD countries. The results also indicate that the relationship between economic growth and eco-efficiency follows a U-type pattern, confirming the environmental Kuznets curve hypothesis. Furthermore, the marginal effect of export diversification on eco-efficiency increases as environmental policy stringency increases, suggesting that a simultaneous increase in export diversification and environmental policy stringency can improve eco-efficiency. The implication of these findings is that export diversification policies must be combined with more stringent environmental policies and programs to facilitate eco-efficiency and ecological sustainability. © 2025 Elsevier Lt
The mediating role of affective commitment in the relationship between perceived employability and intention to quit in the hospitality industry
No full textThis study explores the mediating role of affective commitment in the relationship between perceived employability and the intention to quit, focusing on the tourism sector-a field often marked by high employee turnover. Data were collected from 615 employees working in 4- and 5star hotels in Antalya and Mu & gbreve;la, T & uuml;rkiye. The relationships among perceived employability, affective commitment, and intention to quit were analysed using SPSS and AMOS. The results revealed that affective commitment significantly mediates the link between perceived employability and turnover intentions. While high perceived employability generally increases employees' intentions to leave their jobs, strong affective commitment was shown to offset this effect, thereby reducing the likelihood of turnover. Thesefindings highlight the need for HR strategies that prioritise building and maintaining affective commitment among employees, particularly in high-mobility industries like hospitality, to retain highly employable staff. By offering a deeper understanding of how affective commitment can buffer the turnover risks associated with high employability, this study provides practical insights for HR practitioners in industries facing labour retention challenges
24-saatlik besin tüketim kaydı ve besin tüketim sıklığı yöntemlerinin geçerliliğinin idrar atım biyobelirteçleri ile değerlendirilmesi
Get PDFUlusal beslenme araştırmaları bireylerin ve toplumların beslenme ve sağlık durumlarını saptamak üzere yapılmaktadır. Elde edilen veriler toplumun sağlık ve beslenme durumunun izlenmesi, maruziyet analizlerinin yapılması, ulusal besin ve beslenme program ve politikalarının oluşturulması ve beslenme rehberlerinin hazırlanması amacıyla kullanılmaktadır. Bu çalışmada amaç, 24 saatlik besin tüketim kaydı ve besin tüketim sıklığı yöntemleri ile toplanan verilerin doğruluğunun, idrarda üre azotu, potasyum ve sodyum atımı ile karşılaştırarak değerlendirilmesidir. Araştırmaya 18-44 yaş aralığında 37 yetişkin kadın dahil edilmiştir. Yüz yüze görüşme yoluyla katılımcıların genel bilgileri, beslenme alışkanlıkları, fiziksel aktivite düzeyleri sorgulanmış ve antropometrik ölçümleri alınmıştır. Ayrıca yaz ve kış mevsimlerinde ve 14 gün ara ile birbirini izlemeyen günlerde iki kez olmak üzere toplamda 4 kez katılımcılardan 24 saatlik idrar toplamaları istenmiştir. Bireylerin en sık (%56,8) kullandığı tuz çeşidi iyotlu sofra tuzudur. 24 saatlik besin tüketim kaydından hesaplanan sodyum alım miktarı kış mevsiminde 3142,2±905,7 mg iken yaz mevsiminde ise 2479,6±793,5 mg olarak bulunmuştur ve aralarındaki fark istatistiksel olarak anlamlıdır (p<0,05). Besin tüketim kayıt yöntemi ile tahmin edilen sodyum ve potasyum alımının ortalama değeri iki mevsimde de idrarla sodyum ve potasyum atımı ile ölçülen miktarla benzer bulunmuştur. Besin tüketim sıklığı ve besin tüketimi kayıt yöntemi ile tahmin edilen protein alım miktarı benzer iken idrar atımından hesaplanan protein alımı tahmin edilen miktardan yüksektir. Sonuç olarak, beslenme durumunun değerlendirilmesinde sıklıkla kullanılan besin tüketim kaydı yöntemi sodyum ve potasyum alım miktarını iyi tahmin ederken bu çalışmada protein miktarını yeterli düzeyde saptayamamıştır.National nutrition surveys are conducted worldwide to assess people's health status and nutritional intake. Furthermore, they are utilized to develop national nutritional programs and policies, to develop dietary guidelines and to assess exposure risk analysis. The aim of this study was to evaluate the accuracy of 24-hour food consumption records and food consumption frequency methods using urinary urea nitrogen, potassium and sodium excretion. The study included 37 adult women between the ages of 18-44 years. The general information, dietary habits, physical activity levels of the participants were questioned, anthropometric measurements were taken by the researcher. In addition, was collected 24-hour urine excretion twice in summer and winter, twice on non-consecutive days with a 14-day interval, for a total of 4 times. The most frequently used salt type by individuals (56.8%) was iodized table salt. While the sodium intake calculated from the 24-hour food consumption record was 3142.2±905.7 mg in winter, 2479.6±793.5 mg in summer (p<0.05). The mean value of sodium and potassium intake estimated by food consumption recording method was found to be similar to the amount determined by urinary sodium and potassium excretion in both seasons. While the amount of protein intake estimated by food consumption frequency and food consumption recording method was similar, the protein intake calculated from urine was higher than the estimated amount. As a result, the food consumption recording method frequently used in the assessment of nutritional status estimated the amount of sodium and potassium well but could not determine the amount of protein sufficiently in this study
Rituximab in pediatric B-cell Non-Hodgkin Lymphoma: Clinical outcomes and prognostic implications
Get PDFObjective: B-cell Non-Hodgkin Lymphoma (B-NHL) is an aggressive malignancy in children requiring prompt multidisciplinary management. This retrospective cohort study aims to evaluate the clinical characteristics, treatment outcomes, and impact of rituximab (RTX) in pediatric B-NHL patients. Methods: We retrospectively analyzed 62 pediatric B-NHL patients treated at tertiary centers. Patient demographics, clinical presentation, histopathological subtypes, disease stage, treatment regimens, and survival outcomes were assessed. Event-free survival (EFS) and overall survival (OS) rates were analyzed based on lactate dehydrogenase (LDH) levels and RTX administration. Results: The mean age at diagnosis was 8.73±4.3 years, with a male predominance (79%). The most common histological subtype was Burkitt lymphoma (BL) (53.2%), followed by diffuse large B-cell lymphoma (DLBCL) (33.8%). Advanced-stage disease (III-IV) was observed in 74.1% of cases. RTX was administered in 72.5% of patients, with a mean of 5.1±2.7 doses. Febrile neutropenia (FEN) was noted in 74.1%, with intensive care unit (ICU) admission required for seven patients. Mortality was observed in 12 (19.3%) patients, including all patients with primary immunodeficiency (PID). The 5-year EFS for the entire cohort was 67.2%, and OS was 81.3%. Patients with LDH <400 U/L had superior 5-year EFS (88.9%) and OS (96.3%) compared to those with LDH >400 U/L (EFS: 49.6%, OS: 70.7%; p=0.004 and p=0.015, respectively). In RTX-treated patients without PID, EFS was 76.5% versus 73.2% in those without RTX, but the difference was not statistically significant (p=0.53). Conclusions: Although not statistically significant, EFS was found to be higher in the RTX-treated group, suggesting that adding RTX to standard chemotherapy regimens may improve survival, particularly for high-risk patients, though its benefit in low-risk cases remains uncertain. Despite improved survival, patients with PID had poor outcomes, likely due to increased infections and disseminated disease. Risk-adapted, targeted treatment strategies are essential for optimizing outcomes in pediatric B-NHL. Further large-scale, randomized controlled trials are needed to confirm the efficacy of RTX in different risk groups and to optimize treatment regimens for pediatric B-NHL. © 2025 The Author(s)
Critical limit assessment and optimization of airline fleet service strategy
Get PDFGiven the recent changes in the world, it is fair to say that there have been many changes in air transport. It is a fact that there is a great intensity of demand in the civil aviation sector, especially with the increasing demand for fast transportation trends. On the other hand, reasons such as the pandemic that affected the whole world and the disruption of air transportation made operations expensive, affecting operations on a sectoral basis and the world economy. It is known that although many airlines went bankrupt under these conditions, new airlines were also founded. In this study, a fleet analysis using the Response Surface Methodology and the Load factor Profitability Rate is conducted to examine the purposes of the existing airlines’ fleet structures and what is required to build a fleet. The main reason for all these discussions is to show the most realistic parameters and limits to ensure the economic sustainability of airlines. The Response Surface Methodology was used for fleet analysis and optimization for the first time in the literature
The role of environmental protection expenditures, urbanization, and economic growth in promoting sustainable natural resources
No full textOverexploitation of natural resources poses significant challenges to the global ecosystem. Because the world's natural resources are finite, maintaining ecological balance is essential to ensuring their sustainable production, consumption, and efficient use. Furthermore, one of the most essential elements in achieving sustainable development goals is the protection of natural resources. Therefore, knowing what influences and sustains natural resources offers essential information to help shape sustainable resource management practices. In this regard, the study investigates the effects of environmental protection expenditures, urbanization, fossil fuel consumption, and economic growth on the depletion of natural resources in 10 countries with the lowest natural depletion between 1995 and 2021 through causality testing. Moreover, because they may impact natural resources, population, globalization, and population density were included as control variables in the study's model. The important aim of the study is to achieve Sustainable Development Goals 7, 8, 9, and 12. The test findings of the study show that these policies have a positive effect on the protection of natural resources and indicate a causal relationship supporting this finding. Governments should allocate affordable and easily accessible funds for initiatives that will reduce the negative consequences of processes that ensure the sustainability of natural resources. Additionally, the study highlights its contribution to the literature by proposing several concrete conclusions that determine the factors affecting the sustainability of natural resources
Evaluation of the Carbon Footprint, Water Footprint,Nutrient Profiles and Cost of Sustainable Menus PlannedWith Digital Modeling
Get PDFThis study aimed to evaluate the sustainability of digital program menus (DPMs) and compare them with the Turkish National Menu Planning Guide (TNMPG) and internet-accessible menus (IAM). A menu planning program was developed in Microsoft Excel, which also calculates the sustainability criteria (carbon footprint, water footprint, NRF 9.3, SAIN-LIM and cost) of the menus with the recommendations of the TNMPG. The digital menus were compared with the sustainability criteria of the TNMPG sample menus and menus accessed from the internet. DPM was found to be similar to the sample menus of the TNMPG in terms of sustainability features. All the meals on the menus were similar in terms of their carbon footprint (p > 0.05), whereas the II-type meals of the kindergarten menu of DPM and the IV-type meals of the hospital menu of IAM were found to have greater water footprints (p < 0.05). Some meals (II/III) in DPM had higher NRF-9.3 scores (p < 0.05). The I-type meals of the kindergarten and prison menus of DPM and the II-type meals of the prison menu were found to have significantly higher costs (p < 0.05). Digitalization could provide great benefits in service, as digital menus in food services can be prepared in a very short time, and sustainability criteria can be easily achieved
Impact of Environmental Concern and Awareness on Passengers' Intentions to Participate in Carbon Offset Schemes in Aviation: The Mediating Role of Attitude
No full textThis study investigates the influence of Environmental Concern (EC) and Awareness of Consequences (AC) on passengers' Intentions to Participate in Carbon Offset Schemes (IPCOS) in aviation, with particular emphasis on the mediating role of Attitude (ATT). The research hypotheses were assessed using Partial Least Squares Structural Equation Modeling (PLS-SEM), with the measurement and structural models evaluated using Smart-PLS 4 software. The findings indicate that AC has a direct and positive effect on both ATT and IPCOS. In contrast, EC does not directly influence IPCOS, suggesting that concern alone is insufficient to drive participation without presence of a positive ATT. The results confirm that ATT plays a crucial mediating role in the relationships between both EC and IPCOS, as well as AC and IPCOS. To enhance participation rates, policymakers should focus on increasing public awareness through targeted campaigns that highlight the environmental benefits and ethical dimensions of carbon offset schemes