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Revisiting turkish esophageal atresia regisrty data for quality indicators
No full textAim The Turkish Esophageal Atresia Registry (TEAR) data were revisited using quality indicators (QIs) to evaluate quality care provided to patients with esophageal atresia (EA). Methods Among 36 centers registering data in the TEAR database, only those treating more than four patients per year were included. Based on predefined QIs, each center was assessed for structural, procedural and outcome indicators. Mean percentages were calculated for each QI. Centers with a lower-than-mean percentage for adverse outcomes were determined as 'meeting' that QI, while those with higher percentage were defined as 'not meeting' it. Results Fifteen centers and 525 patients were analyzed. MDTs existed in 80 % centers while 33 % had transition-to-adulthood programs. One center met the 91 % of all QIs, whereas, 2 centers met 82 % of them and 3 of them met 73 %. Two centers met only 36 % of all indicators. The most frequently met QIs were the presence of MDTs and low intraoperative complications (n = 12, 80 %) whereas anastomotic strictures were the least met (n = 6, 40 %). No correlation was found between the number of patients treated per centers and the number of QIs met (p > 0.05). The presence transition-to-adulthood facilities was associated with a significantly reduced rate of intraoperative complications compared with centers lacking such resources (p = 0.008). Conclusions QIs allow centers to gain insight into their EA care and compare their performance with that of other centers. Although the centers in TEAR met most of the QIs, certain measures-such as the rate of anastomotic stricture-should be improved at the national level. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies
Discrepancies between expected and recovered individuals in exhumed mass graves at paterna cemetery (spain): Aggregate analysis of 15 official exhumation reports
No full textBackground: Pre-exhumation estimates of the number of individuals expected to be present in a grave are routinely used to guide fieldwork planning, laboratory workflows, and communication with families. However, the degree to which these expectations match the number of individuals actually recovered can vary across contexts and burial features. Aim: To quantify the discrepancy between the number of individuals expected prior to exhumation and the number recovered after exhumation in a set of exhumed mass graves at Paterna Cemetery, using an aggregate (global) recovery proportion derived from official reporting. Materials and methods: For each mass grave, two counts were extracted from official reporting: a) the number of subjects to be found before exhumations (NSTBF; expected); and b) the real number of subjects found after the exhumations (RNSF; recovered). Recovery percentage per mass grave was defined as RNSF/NSTBF. The primary outcome was the global recovery proportion computed as Sigma RNSF/Sigma NSTBF across all included mass graves. Results: Across 15 mass graves, 1180 individuals were expected and 1048 were recovered, yielding a global recovery proportion of 0.888 (88.8 %). The overall shortfall relative to expectations was 132 individuals (11.2 %). Mass graves recovery ranged from 0 % (0/20) to 100 % (e.g., 42/42; 98/98; 107/107). Eight of fifteen mass graves showed >= 90 % recovery, whereas two showed < 10 % recovery (1/19 and 0/20). Conclusions: In this set of exhumed mass graves, recovery totals were lower than expected overall when aggregated across features. The magnitude and variability of the shortfall support incorporating uncertainty into operational planning for recovery and identification rather than assuming expected counts will be fully recovered
Solution-focused therapy for self-handicapping behaviors among Turkish high school students
No full textPurpose: This randomized controlled trial examined solution-focused brief therapy (SFBT) effectiveness for reducing self-handicapping behaviors among Turkish high school students during the 2018-2019 academic year. Methods: Forty-five students (aged 14-16) scoring above 1 SD on the Self-Handicapping Scale were randomly assigned to SFBT intervention (n = 15), placebo control (n = 15), or waiting list groups (n = 15). The experimental group received 6 weekly 60-min SFBT sessions. Assessments occurred at pretest, posttest, and 6-week follow-up. Results: No significant between-group differences emerged at posttest (chi(2) = 3.588, p > .05). However, significant differences favoring experimental group appeared at follow-up (chi(2 )= 6.212, p < .05), particularly versus placebo (U = 34.50, p = .016, r = .46). Within-group analyses showed significant reductions for experimental group from pretest to follow-up (Z = -2.555, p < .05, r = .74). Discussion: SFBT effectively reduced self-handicapping with delayed benefits, supporting strength-based school approaches for at-risk adolescents
The multiple steady states in ventilation: Turbulence and buoyancy approach effects on flow pattern
No full textPurposeThe effects of inlet turbulence parameters on the flow pattern in the ventilation of the IEA Annex 20 room were investigated in detail by also considering the effects of the buoyancy approach and iteration number. The flow pattern under the effects of the inlet turbulence intensity (Tu) and the length scale (LS) in a wide range of intervals has been predicted from the solution multiplicity point of view to check the hypothesis of Hancock and Bradshaw. Boussinesq and ideal gas approaches for buoyancy have been used for both converged iteration numbers of 3,000 and 9,000.Design/methodology/approachBuoyant ventilation flow has been considered and the finite volume ANSYS-Fluent code was used to solve the turbulent conservation equations from the solution multiplicity point of view. RNG k-e turbulence model that is validated and the most used by ventilation community has been used in the computations with the enhanced wall treatment. Solution multiplicity is related to the extreme sensitivity on initial conditions and/or system parameters. Both the effects of initial conditions and system parameters on solution multiplicity have been considered.FindingsThe main flow pattern in the room may be clockwise, counter-clockwise or intermediate cases dependent on the used buoyancy approach and iteration number. The number of intermediate cases in the ideal gas approach is less than the Boussinesq approach for both iteration numbers. In any room ventilation study, turbulence inlet parameters have the same importance as Archimedes number, used software, computational scheme and iteration number. It was found that Tu has an effect on flow patterns not only for low and medium LS values but also for high LS values.Research limitations/implicationsOnly a mixed ventilation scenario has been considered. The current study is related to a turbulent flow regime, and flow is assumed two-dimensional, steady, incompressible and non-isothermal. Inlet turbulence parameters' effects on flow patterns have been investigated for an empty room with a single aspect ratio.Practical implicationsUnderstanding of solution multiplicity phenomenon in ventilation applications can be used to prevent multiple steady states that cause undesired thermal comfort conditions.Originality/valueThere are opposite arguments in the literature about the effect of inlet turbulence conditions on the flow field and flow reversal. The first aim of this study is to investigate the effects of the inlet turbulence parameters on solution multiplicity in detail by considering these controversial points. Furthermore, many of the available studies are restricted to transitional flows. Secondly, as inlet turbulence parameters, Tu and LS values in a wide range have been investigated for the effects on flow pattern to check the hypothesis of Hancock and Bradshaw. Additionally, solution multiplicity has been shown under the fixed Tu and LS values by changing the buoyancy approach and converged iteration numbers as initial conditions
Investigation of antitumoral effectiveness of oral and local co-applied propolis in skin and subcutaneous tumors (melanoma and fibroma) of thoroughbridged Arabian horses: Case series
No full textBu çalışmada, Safkan Arap atlarında deri ve deri altı dokularda gelişen melanoma ve fibroma üzerine propolisin antitümöral etkisinin araştırılması amaçlandı. Çalışmada, hem sistemik (oral yolla) hem de lokal uygulanan propolisin klinik, hematolojik ve histopatolojik düzeyde oluşturduğu etkiler değerlendirildi. Deney grubunu oluşturan beş tümörlü Safkan Arap atına 3 ay boyunca günlük 150 mg/kg dozda ham toz propolis yemine karıştırılarak oral yolla verildi, aynı zamanda tümör üzerine 70% etil alkol içerisinde hazırlanan propolis tentürü lokal olarak uygulandı. İki adet sağlıklı ve tümörü bulunmayan dişi Arap atı kontrol grubu olarak kullanıldı. Tümör çapı ölçümleri, tam kan sayımı, biyokimyasal parametreler ve histopatolojik analizler yapılarak propolisin terapötik etkileri değerlendirildi. Malonomalı tümör çaplarında bir miktar azalma olmakla birlikte bu azalma istatistiki olarak önemli bulunmadı. Hematolojik sonuçlar genellikle referans aralığı ile kontrol grubu sonuçlarıyla uyumluluk göstermekle birlikte, WBC (p=0,014) için kan alınan dört dönem için ve detayda 0.Ay ile 2.Ay arasında düşmekte ve bu fark istatistiki olarak (p=0,009) anlamlıdır. NEU (p=0,003) için kan alınan dört dönem için ve detayda 0.Ay ile 2.Ay arasındaki düşüşün (p=0,001) WBC’de olduğu gibi anlamlı olduğu görülmektedir. HGB (p=0,026) için kan alınan dört dönem için ve detayda 2.Ay ile 3.Ay arasındaki düşüş (p=0,016) istatistiksel olarak anlamlı bulunmuştur. Biyokimyasal sonuçlar da genellikle referans aralığı ile kontrol grubu sonuçlarıyla uyumluluk göstermekle birlikte, TCHO (p=0,028) için kan alınan dört dönem için ve detayda 1.Ay ile 3.Ay arasındaki yükselme (p=0,020) anlamlı bulundu. CA (p=0,006) için kan alınan dört dönem için ve detayda 0.Ay ile 2.Ay (p=0,020) ve 0.Ay ile 3.Ay arasındaki yükselme (p=0,042) istatistiksel olarak anlamlı bulundu. Sonuç olarak, bu çalışma atlarda propolisin sistemik olarak kullanıldığı ilk çalışmalardan biridir. Propolisin atlarda herhangi bir olumsuz etkisi gözlenmemiştir. Propolisin belirtilen doz, uygulama yolları ve sürede, belirtilen tümör çapları üzerinde önemli bir etkinliği gözlenmemiştir. Bu çalışmaların detaylandırılarak daha yakın dönemde oluşmuş türmörlerde ve daha yüksek dozlarda propolis kullanılarak devam ettirilmesi uygun olacaktır.The aim of the study was to search antitumoral effects of propolis on melanoma and fibroma observed in cutaneous and subcutaneous of Arabian mares. Clinical, haematologic and histotpathologic effects of propolis were evaluated applicated both systemic (oral) and local. The experimental design involved a combined application of crude powdered propolis with feed administered orally (150 mg/kg/day) and alcoholic tincture of propolis (70%) applied locally to tumor surfaces for a three-month treatment period in five Arabian mares diagnosed with tumors. Two healthy mares used as the control group. Tumor sizes measurements, hematological, biochemical assessments, and histopathological evaluations were evaluated for therapeutic effects of propolis. However, there was a little decreasing in melanoma sizes, this differences were not significant. In addition, hematological results were generally consistent with reference range and control group results, but statistically, blood collected in four times for WBC (p=0.014), and in detail the decreasing between 0.Month and 2.Month (p=0.009) were significant. Blood collected in four times for NEU (p=0.003), and in detail the decreasing between 0.Month and 2.Month (p=0.001) were also significant. Blood collected in four times for HGB (p=0.026), and in detail the decreasing between 2.Month and 3.Month (p=0.016) were also significant. However biochemical results were also generally consistent with reference range and control group results, statistically, blood collected in four times for TCHO (p=0.028), and in detail the increasing between 0.Month and 3.Month (p=0.020) were significant. Blood collected in four times for CA (p=0.006), and in detail the increasing between 0.Month and 2.Month (p=0.020) and between 0.Month and 3.Month (p=0.042) were significant. As a result, the study is the first study for systemic uses of propolis, and no observed any adverse effects of propolis on horses. The propolis uses were not significant effective on tumor sizes with the applicated dose, application routes, application period. The studies that including antitumoral effecs of propolis in horses should search in detail with fresh melanoma tumors and higher doses
Clinical practice of the endothelial activation and stress index and its modified versions in multiple myeloma and the effects on prognosis
No full textObjective: Here, we aimed to evaluate the prognostic values of the endothelial activation and stress index (EASIX) and its derivatives, modified EASIX (mEASIX) and simplified EASIX (sEASIX), in patients with multiple myeloma (MM). Methods: The data of 134 newly diagnosed MM patients between January 2020 and December 2024 were retrospectively analyzed. Patients were divided into groups based on EASIX and its derivatives, and the outcomes of survival rates in groups were compared. Optimal cut-off points were determined using the receiver-operating characteristic analysis, and mortality predictive values of the scores were investigated. The independent prognostic factors were evaluated through univariate and multivariate Cox regression analyses. Results: The optimal cut-off point for EASIX was detected as >1.03, and survival times were significantly shorter in patients with higher EASIX scores (p 26.5, showing higher specificity (area under curve (AUC) = 0.663; p = 0.003). The sEASIX score predicted lower mortality (AUC = 0.586; p = 0.123). In multivariate analysis, high EASIX scores, not performing autologous stem cell transplantation, and not receiving immunomodulatory therapy were identified as independent negative prognostic factors for survival. Conclusion: EASIX, especially mEASIX, is a valuable prognostic tool for predicting survival in MM patients. EASIX can be easily integrated into clinical practice due to its simple computability and reliance on commonly used laboratory parameters. However, larger prospective studies are needed to determine how these scores can be integrated with traditional prognostic systems such as the International Staging System (ISS) and Revised-ISS
The inclusion of media literacy skills in the 2023 and 2024 Social studies curriculum and textbooks
No full textBilim ve teknolojinin günümüz dünyasında etkisini artırmasıyla insan yaşamlarını medya araçları büyük ölçüde etkilemeye başlamıştır. Günümüzde özellikle internet, televizyon gibi medya araçları birçok insanın yaşamında vazgeçilmez bir yer tutmaktadır. İnsanlar konuşma biçimlerini, düşüncelerini, giyinişlerini, davranışlarını, yemeklerini, içeceklerini kısaca yaşamlarının her alanını etkileyen kültürel unsurlarını medya araçlarından etkilenerek değiştirebilmektedir. Bu gibi sebeplerle günümüz dünyasında medya okuryazarlığı becerisi insanların sahip olması gereken vazgeçilmez becerilerden biri haline gelmiştir. Medya okuryazarlığı becerisinin büyük ölçüde okullarda kazanılmasından dolayı mezun olan öğrencilerin medya okuryazarlığı becerisine sahip bireyler olması önemli hale gelmektedir. Bireyi etkin bir vatandaş olarak hayata hazırlama amacı olan sosyal bilgiler dersinde bu ders için hazırlanan ders kitaplarında medya okuryazarlığı becerisinin yer alması önemlidir. Bu araştırmada 2023 ve 2024 Sosyal bilgiler dersi öğretim programları (SBDÖP) ve sosyal bilgiler ders kitaplarında medya okuryazarlığı becerisinin yer alma durumunun değerlendirilmesi amaçlanmıştır. Bu amaçla araştırma süreci içerisinde nitel araştırma metotlarından doküman incelemesi yönteminden yararlanılmıştır. Araştırma bulguları 2023 öğretim programında becerinin sınıflar düzeyinde farklı öğrenme alanlarında verildiğini ortaya koymuştur. Güncel olan 2024 öğretim programında ise beceri doğrudan yer almamış bilgi ve dijital okuryazarlıkları çerçevesinde verilmiştir. Günümüz dünyasında önemli becerilerden biri olmasına rağmen 2023 öğretim programındaki 5, 6 ve 7. sınıflar sosyal bilgiler ders kitaplarında bu beceriye ait toplam sadece 7 kazanımın, 2024 programında ise sadece 4 öğrenme çıktısının bulunduğu görülmüştür. Beceri 2023 öğretim programı 6 ve 7. sınıf ders kitapları bilim, teknoloji ve toplum öğrenme alanında yer almazken 2024 öğretim programında ilişkilendirilen öğrenme çıktılarının tamamı teknoloji ve sosyal bilimler öğrenme alanında yer almaktadır.As science and technology continue to grow in influence in today's world, media has begun to significantly impact human lives. Media tools, particularly the internet and television, have become indispensable in many people's lives People can change the way they speak, think, dress, behave, eat, drink—in short, the cultural elements that influence every aspect of their lives—through the influence of media. For these reasons, media literacy has become an essential skill in today's world. Because media literacy skills are largely acquired in school, it's crucial for graduates to be media literate. In social studies, which aims to prepare students for life as active citizens, it's crucial that media literacy skills are included in textbooks prepared for this course. This study aimed to evaluate the inclusion of media literacy skills in the 2023 and 2024 Social studies curriculum (SSC) and social studies textbooks. For this purpose, document analysis, a qualitative research method, was utilized throughout the research process. Research findings revealed that in the 2023 curriculum, skills are taught in different learning areas at the grade level. However, in the current 2024 curriculum, skills are not directly included but are taught within the framework of information and digital literacy. Although it is one of the important skills in today's world, it has been seen that there are only 7 learning outcomes of this skill in the 5th, 6th and 7th grade social studies textbooks in the 2023 curriculum, and only 4 learning outcomes in the 2024 curriculum. While the 6th and 7th grade textbooks of the 2023 curriculum are not included in the science, technology and society learning area, all of the learning outcomes associated with the 2024 curriculum are included in the technology and social sciences learning area
Prevalence and risk factors of difficult-to-treat axial spondyloarthritis: Real-life evidence from the biostar database
No full textObjectives This study was aimed at determining the prevalence of difficult-to-treat (D2T) axial spondyloarthritis (axSpA) and identifying main associated factors for D2T axSpA. Method This multicenter observational cross-sectional study included axSpA patients from the BioSTaR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) from February 1, 2019, to January 1, 2025. Data from 1800 axSpA patients who have previously used or are currently using at least one biologic/targeted synthetic disease-modifying antirheumatic drug were analyzed. Patient data included demographic characteristics, body mass index (BMI), marital status, smoking and alcohol use, family history of SpA, and presence of comorbidities. The parameters related to SpA such as disease duration, type of axSpA (radiographic/non-radiographic), HLA-B27 status, the presence of extra-musculoskeletal manifestations (uveitis, psoriasis, and inflammatory bowel disease), arthritis, enthesitis, and dactylitis were also recorded. Comorbidities including hypertension, cardiovascular disease, diabetes, obesity, and hyperlipidemia were recorded, and Charlson Index scores were evaluated. Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and disease activity in means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) were also recorded. All medication history and currently used medications for axSpA and other diseases were noted. D2T and non-D2T axSpA patients were classified according to the suggested extrapolated definition. Results Of the 1800 axSpA patients recorded in the BioSTaR database, 204 (11.3%) were classified as D2T axSpA. Data of these patients were compared to the data from 1596 non-D2T axSpA patients. Disease duration was longer in D2T patients (p = 0.025). The presence of radiographic disease was more frequent in the D2T group (p = 0.047). In means of MASES and ASDAS-CRP, higher scores were recorded in the D2T group (both p < 0.001). Enthesitis and psoriasis were more frequent in the D2T group (p = 0.002 and p = 0.006). Regarding comorbidities, hypertension and cardiovascular diseases were more frequent in the D2T group (p < 0.001 and p = 0.009). The risk of D2T axSpA increased 2.37-fold with the presence of r-axSpA (p = 0.018), 1.92-fold with the presence of hypertension (p = 0.006), 2.12-fold with the presence of obesity (p = 0.024), and 3.63-fold with the presence of psoriasis (p = 0.004). Every 1-point increase in MASES increased D2T risk 1.08-fold (p = 0.017), and every 1-point increase in ASDAS-CRP increased D2T risk 1.62-fold (p < 0.001). Conclusions In conclusion, 11.3% of patients with axSpA met the proposed criteria for D2T axSpA. This subgroup was characterized by longer disease duration, higher frequency of r-axSpA, enthesitis, and psoriasis, as well as elevated MASES, CRP, ASDAS-CRP, and BASDAI scores. Hypertension and cardiovascular comorbidities were also significantly more prevalent among D2T patients. These parameters represent potential contributors to treatment complexity and should be carefully considered in therapeutic decision-making. In cases of suboptimal treatment response, reassessment and optimal management of comorbidities are essential, as comorbid conditions can increase disease burden and diminish therapeutic efficacy. Comprehensive care for axSpA should therefore include targeted management of accompanying comorbidities in parallel with disease-specific therapy.Monitoring blood pressure, optimizing body weight, and encouraging smoking cessation are particularly important. Additionally, concomitant rheumatic diseases such as psoriasis, uveitis, or inflammatory bowel disease should be actively evaluated and treated, given their association with more severe disease and reduced treatment response.Ankara Yıldırım Beyazıt Üniversites
Real-world effectiveness and safety of eculizumab in aqp4-igg-positive neuromyelitis optica spectrum disorder
No full textObjectiveTo evaluate the real-world effectiveness and safety of eculizumab in patients with AQP4-IgG-positive neuromyelitis optica spectrum disorder (NMOSD) and to identify predictors of disability outcomes.MethodsThis multinational, retrospective cohort study analyzed data from 46 patients across 26 centers. The outcomes included the annualized relapse rate (ARR), relapse-free status, change in expanded disability status scale (EDSS) scores, and adverse events. To identify predictors of EDSS improvement or worsening, patients were stratified into subgroups (improved vs. stable/worsened) at each follow-up time point and compared based on demographic, clinical, and radiological variables.ResultsThis retrospective cohort study included 46 patients with AQP4-IgG-positive NMOSD from 26 centers, followed for a mean of 27.3 months. The mean ARR significantly decreased from 1.1 in the 2 years pre-treatment to 0.1 during eculizumab therapy. The relapse-free rate increased from 6.5% pre-treatment to 80.4%. Mean EDSS scores improved from 4.2 at baseline to 3.6 at 24 months. The presence of area postrema syndrome was associated with a favorable prognosis, while the presence of spinal attacks was associated with a poor prognosis at 12 months. Adverse events occurred in 7 patients (18.9%), leading to permanent discontinuation in only two.ConclusionEculizumab demonstrated robust real-world effectiveness in reducing relapse rates and stabilizing disability, with an acceptable safety profile. Clinical outcomes may be influenced by attack phenotype, underscoring the importance of early intervention