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Pasifik Puma Ülkelerinde Demokrasinin Çevresel Bozulma Üzerindeki Etkisi: Gelir Düzeyinin Rolü
No full textBu çalışmanın amacı Pasifik Puma ülkelerinde (Şili, Kolombiya, Meksika ve Peru) demokrasinin çevresel bozulma üzerindeki etkisini gelirin moderatörlüğünde test etmektir. Bu amaçla 1990-2018 dönemine ait veriler kullanılarak Westerlund (2007) eş bütünleşme analizi ve Ortak İlişkili Etkiler Tahmincisi (CCE) uygulanmıştır. Demokrasi ve çevresel bozulma arasındaki ilişkiyi açıklayan yaklaşımlar göz önünde bulundurulduğunda demokrasinin çevre üzerindeki etkisi farklılaşmaktadır. Bu farklılaşmanın önemli bir nedeni demokrasi- çevre ilişkisini açıklamada gelirin düzenleyici rolünün göz ardı edilmesi olabilir. Bu bağlamda çalışmada çarpımsal etkileşim modeli kullanılarak gelir ve demokrasi düzeyindeki değişikliklerin çevresel bozulmayı nasıl etkilediği incelenmiştir. Çalışmada çevresel bozulma göstergesi olarak ekolojik ayak izi (EF) endeksi kullanılmıştır. Elde edilen bulgulara göre uzun dönemde değişkenler arasında eş bütünleşme ilişkisi bulunmaktadır. Çalışmanın diğer bulgularına göre demokrasi ve gelir düzeyindeki artış ekolojik ayak izini artırmaktadır. Bununla birlikte demokrasinin ekolojik ayak izi zerindeki etkisinde gelirin rolü önemli olmaktadır. Gelir düzeyi arttıkça demokrasideki artış ekolojik ayak izini azaltmaktadır. Dolayısıyla demokrasinin ekolojik ayak izi üzerindeki etkisi gelir düzeyi ile koşullandırılmaktadır.</jats:p
Real-Life Use of Asciminib in Patients with Chronic Myeloid Leukemia in Chronic Phase (CML-CP): Results of the Turkish Managed Access Program
No full text Introduction: Asciminib (ASC), a first-in-class BCR::ABL1 inhibitor Specifically Targeting the ABL Myristoyl Pocket (STAMP), differs from other tyrosine kinase inhibitors (TKIs) with its unique mechanism of action and it has the potential to overcome failure to approved TKIs. It is active against both wild-type and mutated BCR::ABL1, including the T315I. Clinical trials show the high potency and a relatively favorable safety profile of ASC in patients (pts) with CML-CP. In Turkey, ASC has been available through Managed Access Program for CML-CP pts who failed at least two previous TKIs and/or with T315I mutation since May, 2023. The aim of this study is to demonstrate the real-life efficacy and safety of ASC. Methods: All information on demographics, previous treatments, TKI responses and toxicities, and follow-up data were gathered retrospectively. Early molecular response (EMR) was defined as a BCR::ABL1IS transcript level &lt;10% at 3 months. Major molecular response (MMR) and deep molecular response (DMR) were defined as BCR::ABL1IS transcript levels ≤0.1% and ≤0.01% (MR4.0) or deeper, respectively. Results: We included 49 pts from 25 centers, of which 25 (51%) were female and the median age was 61 years (range, 26-80 years). All patients received ASC at recommended doses (200 mg BID for cases harboring T315I and 40 mg BID or 80 mg QD for the rest). The most common comorbidities were hypertension (29%), cardiovascular diseases (20%), and diabetes mellitus (6%). The median number of previous TKIs was 4 (range, 2-6), and median follow-up until ASC start was 78 months (range, 14-322 months). Twenty-three (47%), 10 (20%), and 10 (20%) pts received ASC due to resistance, intolerance, or both resistance and intolerance to previous TKIs, respectively. The remaining 6 pts were switched to ASC due to inaccessibility to ponatinib (PON). Eighteen pts (37%) had previous PON exposure, and PON was the latest TKI in 15 (31%). Of these 15 pts, three and 2 pts were switched to ASC due to resistance or intolerance, respectively, and four pts received ASC both due to resistance and intolerance. Seven of 49 pts (14%) had T315I, and one had G250E. With a median ASC therapy of 8 months (range, 2-13 months), seven pts (14%) experienced all grades hematological adverse events (AEs), of which four (8%) were grade 3-4. Non-hematological AEs were observed in 11 pts (22%), and four (8%) were grade 3-4 toxicities. No pts discontinued ASC for AEs. ASC dose was reduced in 10 pts (20%) due to AEs, and subsequently in five pts, daily dose could be increased to the standard dose. Eight of 49 pts did not have a molecular testing at 3 months, and EMR rate was 80%. EMR rate in pts who were switched to ASC due to intolerance were higher when compared to pts receiving ASC due to resistance (90% vs. 74%, p=0.311). EMR rate in PON-pretreated pts was higher than those achieved in PON-naïve group (94% vs. 72%, p=0.090). For all pts, cumulative MMR and DMR rates were 20% and 35%, respectively. Cumulative MMR rates under ASC in pts with resistance and intolerance to prior TKIs were 26% and 20%, respectively (p=0.712). Cumulative DMR rate in pts who were intolerant to previous TKIs were significantly higher than those who received ASC due to resistance (80% vs. 22%, p=0.02). In PON-naïve group, cumulative MMR and DMR rates were 23% and 26%, respectively, and these were 17% and 50% among PON-pretreated pts, respectively (p=0.624 for MMR and p=0.090 for DMR). Forty-one pts (83.6%) maintained or deepened their responses under ASC, and eight pts who lost their molecular responses and/or experienced progression were all receiving ASC due to resistance. Four pts (8%) discontinued ASC permanently (3 due to progression to advanced-phase disease and one due to unresponsiveness), and two harbored T315I. Among four pts who quit ASC, two died of blast crisis (none had T315I). Conclusion: Although the follow-up is relatively short, we showed that ASC is an effective and safe treatment option in a heavily pretreated population in the real-life setting. Pts with intolerance to previous TKIs had superior molecular responses than those who received ASC for resistance. Nearly 85% of the pts maintained or deepened their responses during ASC therapy. It was expected to observe better response rates under ASC in PON-naïve pts than in PON-pretreated cases, and this is most probably due to the high percentage of pts with optimal responses under PON needing to quit the drug due to the inaccessibility of PON in Turkey. </jats:sec
Matematik Öğretiminde İlişkilendirmeyle İlgili Eğitimin Öğretmen Adaylarının Matematiksel İlişkilendirme Becerilerine Yönelik Öz Yeterlik Algılarına Etkisi
No full textBu araştırmanın amacı matematiksel ilişkilendirmeye yönelik verilen eğitimin öğretmen adaylarının matematiksel ilişkilendirmeye yönelik öz yeterliklerine katkısını incelemektir. Araştırmanın katılımcılarını 2021-2022 eğitim-öğretim yılının bahar döneminde bir devlet üniversitesinde öğrenim görmekte olan 50 ortaokul matematik öğretmeni adayı oluşturmaktadır. Katılımcıların belirlenmesinde uygun örnekleme yönteminden faydalanılmıştır. Bu araştırmada ön test ve son test uygulanması sebebiyle yarı deneysel desen kullanılmıştır. Matematik öğretmen adaylarının öz yeterlik düzeyleri matematiksel ilişkilendirme dersini almadan önce ölçülmüş daha sonra araştırmacılar tarafından altı haftalık matematiksel ilişkilendirme dersi eğitimi uygulanmıştır. Verilen eğitimin sonunda matematik öğretmen adaylarının matematiksel ilişkilendirme öz yeterlik düzeyleri tekrar ölçülmüştür. Veriler “Matematiksel İlişkilendirme Öz Yeterlik Ölçeği” kullanılarak elde edilmiştir. Araştırmadan toplanan verilerin analizinde betimsel istatistikler ve bağımlı örneklem t testi kullanılmıştır. Matematiksel ilişkilendirmeye yönelik öz yeterlik ölçeğinin ön test uygulamasının analiz edilmesi ile elde edilen sonuçta öğretmen adaylarının öz yeterlikleri orta düzey olarak bulunurken, son test uygulamasının analizinde ise yüksek düzey bulunmuştur. Araştırma sonucunda öğretmen adaylarının öz yeterlik düzeyleri arasında son test lehine anlamlı bir fark bulunmuştur.</jats:p
Idiopathic Parkinson's Disease and Neuro-ophthalmic Findings: A Study on Neurodegeneration in the Retinal Nerve Fiber Layer and Cognition
No full textAnadolu Selçuklularında Kadılık
No full textBir mülkün ayakta kalmasını sağlayan en önemli unsur adalettir. Adaletin sağlanmasında en önemli kurum ise kadılık müessesesidir. Adalete verilen önemden dolayı kadılık, İslam hukuk tarihinin her döneminde var olmuş ve önemli bir görev olarak kabul edilmiştir. Kadılığın bu önemli konumu Anadolu Selçuklu Devleti için de benzerlik göstermektedir. Genel anlamda Selçuklularla ilgili birçok çalışma yapılmıştır. Ancak Anadolu Selçuklu Devleti özelinde kadılık ile ilgili yeterli derecede çalışma mevcut değildir. Çalışmamız bu alandaki boşluğu doldurmaya mütevazı bir katkı sağlamayı amaçlamaktadır. Tarama yöntemi kullanılan çalışmamızda Anadolu Selçuklu dönemi hukuk sisteminin, Hz. Peygamber (s.a.v) ve Hülefâ-yi Râşîdîn dönemi ile Emevîler, Abbâsîler ve Büyük Selçuklu Devletleri’nin örfi ve şer'i sistemlerini bünyesinde barındıran bir yapıda olduğu, Anadolu Selçuklu Devleti'nde yargı ve kadılık kurumunun önemli bir yere sahip olduğu, kadıların, davaları çözerken zengin-fakir veya yabancı-tanıdık gibi durumlara karşı fark gözetmedikleri, davaların çözümünde Kur’an ve sünnet başta olmak üzere diğer fıkıh delillerini de dikkate alarak hüküm verdikleri tespit edilmiştir.</jats:p
Exploring the Impact of ChatGPT on Improving 21st-Century Skills for Future English Teachers During Lesson Planning
No full textACUTE MYELOID LEUKEMIA DIAGNOSED WITH CUTANEOUS INVOLVEMENT; A RARE CASE
No full textObjective: Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy characterized by clonal expansion of myeloid blasts in peripheral blood, bone marrow, and/or other tissues. It is the most common type of acute leukemia in adults with an age-adjusted incidence of 3.6/100,000 in the population (1). Extramedullary leukemia (EM AML), also known as myeloid sarcoma, is a rare manifestation of acute myeloid leukemia and is usually accompanied by bone marrow involvement (2). Leukemia cutis characteristically demonstrates the infiltration of the skin by neoplastic leukocytes(3). While the extramedullary collection of leukemic cells is generally regarded as myeloid sarcoma (previously chloroma/granulocytic sarcoma), leukemia cutis is a generic term to describe specific cutaneous involvement. Although any subtype of leukemia can involve the skin, the most common types seen in clinical practice are chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML) with monocytic or myelomonocytic morphology(4). We present a case diagnosed with Extramedullary AML with skin involvement, but without bone marrow involvement. Case report: Case: A 60-year-old female patient who presented to the dermatology outpatient clinic in March 2023 due to painful lesions on the trunk for the past 3 months. Physical examination revealed widespread palpable firm nodular lesions on the trunk and back(figüre-1). Methodology: The patient underwent a punch biopsy with differential diagnoses including eosinophilic angiomatous hyperplasia, cutaneous metastasis, lupus tumidus panniculitis, T/B-cell lymphoma. CD68, Lysozyme, CD 33, CD16, CD123, TCL-1, TdT were investigated as antibodies.Immunohistochemical examination revealed widespread positivity for lysozyme, CD68, and faint diffuse CD33 in infiltrative cells. CD16, TdT, CD123, TCL-1 were negative. Histopathological diagnosis suggests compatibility with myeloid sarcoma characterized by blast cells with myelomonocytic features, demonstrating infiltration of immature atypical hemolymphoid cells in the skin and subcutaneous biopsy material. The patient was referred to our clinic due to compatibility with myeloid sarcoma and extramedullary myeloid leukemia. Initial tests during admission showed:WBC: 3.6 10^3/µL, HGB: 11.2 g/dL, PLT: 215 10^3/µL, NE: 2.3 10^3/µL, EO: 0.1 10^3/µL, BA: 0.0 10^3/µL, LDH: 297 U/L, with other biochemical values within normal range.In the bone marrow biopsy pathology of the patient revealed increased cellularity in the bone marrow elements, grade 1 increase in reticulin and reticular fibers,positive CD34 in vascular structures, blast cell ratio of 2-3%, mild increase and aggregation of megakaryocytes with CD61, decrease in myeloid series with MPO, and increase in erythroid cell islands with Glycophorin A. Flow cytometry showed 4.6% blast cells. The cytogenetic evaluation of the patient resulted in FLT3 negative, t (15, 17), (q22, q21) PML/RARA negative. The patient received ARA-C+Mitoxantrone (7+3) induction chemotherapy for extramedullary AML and recovered from neutropenia on the 18th day of treatment. Subsequent evaluations showed near-complete improvement (figüre-2). Results: After the patient's discharge, BMT was planned. However, the patient was excluded at the center where they applied for BMT Conclusion: A variant of extramedullary leukemia is leukemic skin involvement. This condition may or may not be accompanied by bone marrow involvement. The case presented here is a rare instance of Leukemia Cutis without bone marrow involvement. The patient received a myeloid leukemia treatment protocol, and significant regression was observed in skin lesions after treatment. However, our patient was excluded prior to BMT.'
Structural monitoring of elevator guide rail bracket under normal running condition
No full textAbstract In parallel with the need for high-rise building structures over the last five decades, challenge in the field of elevator technology has increased. Elevator facilities are one of the most important mechanical systems among the vertical transport systems that have vast variety of usage areas. Guide rails and connection equipment are used to guide the vertical movement of elevators, prevent horizontal movement, and help to stop cabin in case of emergency. The state of stresses and deformations in guide rails and their brackets that perform different and important tasks and their association with elevator safety is a very important issue that needs to be investigated. In this study, three different load distributions that result in forces, stresses, and deflections on guide rail and rail brackets have been considered to attain analytical solutions described in related standards. Finite element modeling and stress analysis of guide rail connection system have been performed. In addition, experimental studies were carried out to measure the normal stresses on the guide rail brackets during the movement of the elevator. About 15.46 % higher experimental normal stress values were observed on the rail bracket during the movement of the elevator in accordance with FEA results.</jats:p
The effects of alternative fuels, cruising duration and variable generators combination on exhaust emissions, energy efficiency existing ship index (EEXI) and carbon intensity rating (CII)
No full textComparison of the Effects of Long-term Hemodialysis and Peritoneal Dialysis Modalities on Left Ventricular Functions
No full textBackground: Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) affect left ventricular hemodynamics. This study compared the effect of two treatment modalities, CAPD and HD, on left ventricular systolic and diastolic functions in maintenance dialysis patients. Methods: A total of 47 patients (24 CAPD and 23 HD) undergoing long-term dialysis were included in the study. Left ventricular functions, left ventricular hypertrophy, and left ventricular geometry were evaluated using echocardiography. Results: The mean age of the patients was 58.6 ± 11.2 years. The mean dialysis time was 125.1 ± 35.2 months. When echocardiographic parameters were examined, left ventricular muscle mass, mass index, E/e’ ratios, and global longitudinal strain were significantly higher in the CAPD group. The rates of diastolic dysfunction (66.7% vs. 26.1%) and left ventricular hypertrophy (91.7% vs. 60.9%) were higher in the CAPD group than in the HD group. Dialysis modality CAPD, abnormal global longitudinal strain (GLS), and increased serum calcium were associated with an increased risk of diastolic dysfunction. Conclusions: The study results demonstrated that left ventricle (LV) diastolic dysfunction and deterioration in left ventricular geometry were significantly higher in patients receiving long-term CAPD treatment than for long-term HD treatment.</jats:p