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Managing Post-Disaster Primary Health Care: Experiences of Public Health Professionals After the 2023 Kahramanmaraş Earthquake
No full textObjectives To explore the post-earthquake experiences and perspectives of public health specialists, with a particular focus on the delivery of public health services following the 2023 Kahramanmara & scedil; earthquake.Methods This qualitative study employed a phenomenological approach, aiming to capture lived experiences and contextual understanding of the situation. In-depth interviews were conducted with 15 public health specialists. Participants were selected through purposive sampling. Data were collected via in-depth interviews and analyzed thematically using multiple coding by the research team.Results Public health specialists reported experiencing stress, burnout, and housing difficulties due to increased workloads and suboptimal working conditions, despite also expressing a sense of professional fulfillment in crisis management. Key challenges included problems in temporary housing, infectious disease control, and insufficient coordination in primary healthcare services and community-based approaches. Poor coordination, vague job roles, and inadequate training and resources were cited as significant barriers to effective disaster response.Conclusion The main challenges following the earthquake included increased workloads and unclear role definitions. These findings underscore the importance of establishing pre-defined job descriptions and clear lines of authority to improve disaster preparedness and response in the health sector.Science Citation Index Expanded - Social Science Citation Inde
Reweighting Simulated Events Using Machine-Learning Techniques in the CMS Experiment
No full textGarcia, Francisco/0000-0002-4023-7964; Reichert, Joseph/0000-0003-2110-8021; Usai, Emanuele/0000-0001-9323-2107; Pasztor, Gabriella/0000-0003-0707-9762; Ecklund, Karl/0000-0002-6976-4637; Diaz, Daniel/0000-0001-6834-1176; Tapper, Alexander/0000-0003-4543-864X; Vannerom, David/0000-0002-2747-5095; Karneyeu, Anton/0000-0001-9983-1004; Fouz Iglesias, Maria Cruz/0000-0003-2950-976X; Yazgan, Efe/0000-0001-5732-7950; Heredia De La Cruz, Ivan/0000-0002-8133-6467; Mitra, Soureek/0000-0002-3060-2278; Al Kadhim, Ali/0000-0003-3490-8407; Colaleo, Anna/0000-0002-0711-6319; Delgado Peris, Antonio/0000-0002-8511-7958; Hernandez Calama, Jose Maria/0000-0001-6436-7547; /0000-0002-6047-4211; Azzi, Patrizia/0000-0002-3129-828X; Navarro-Tobar, Alvaro/0000-0003-3606-1780; Bortignon, Pierluigi/0000-0002-5360-1454; Csanad, Mate/0000-0002-3154-6925; Moureaux, Louis/0000-0002-2310-9266; Mrenna, Stephen/0000-0001-8731-160X; Mitselmakher, Guenakh/0000-0001-5745-3658; De Moor, Alexandre/0000-0001-5964-1935; Pesaresi, Mark/0000-0002-9759-1083; Giacomelli, Paolo/0000-0002-6368-7220; Schwandt, Joern/0000-0002-0052-597X; You, Zhengyun/0000-0001-8324-3291; Papageorgakis, Christos/0000-0003-4548-0346; Ivanov, Andrew/0000-0002-9270-5643; Grandi, Claudio/0000-0001-5998-3070; Legger, Federica/0000-0003-1400-0709; Ferencek, Dinko/0000-0001-9116-1202; Zhang, Yousen/0000-0002-6812-761X; Klyukhin, Vyacheslav/0000-0002-8577-6531; Kyberd, Paul/0000-0002-7353-7090; Smith, Nicholas/0000-0002-0324-3054; Sculac, Ana/0000-0001-7938-7559; Hall, Geoffrey/0000-0002-6299-8385; Dozen, Candan/0000-0002-4301-634X; Bruschini, Davide/0000-0001-7248-2967; Kontaxakis, Pantelis/0000-0002-4860-5979; Gutsche, Oliver/0000-0002-8015-9622; Gomez Espinosa, Tirso Alejandro/0000-0002-9443-7769; Kunnawalkam Elayavalli, Raghav/0000-0002-9202-1516; Sahasransu, Abanti Ranadhir/0000-0003-1505-1743; De La Cruz Burelo, Eduard/0000-0002-7469-6974; Grunewald, Martin/0000-0002-5754-0388; Ruiz, Jose/0000-0002-3306-0363; D'Anzi, Brunella/0000-0002-9361-3142; Singh, Jasbir/0000-0001-9029-2462; Perez Adan, Danyer/0000-0003-3416-0726; Chatterjee, Suman/0000-0003-2660-0349; D'Enterria, David/0000-0002-5754-4303; Barroso Ferreira, Mapse/0000-0003-3904-0571; Hussain, Priya Sajid/0000-0002-4825-5278; Tytgat, Michael/0000-0002-3990-2074; Geurts, Frank/0000-0003-2856-9090; Wilson, Graham/0000-0003-0917-4763Data analyses in particle physics rely on an accurate simulation of particle collisions and a detailed simulation of detector effects to extract physics knowledge from the recorded data. Event generators together with a geant-based simulation of the detectors are used to produce large samples of simulated events for analysis by the LHC experiments. These simulations come at a high computational cost, where the detector simulation and reconstruction algorithms have the largest CPU demands. This article describes how machine-learning (ML) techniques are used to reweight simulated samples obtained with a given set of parameters to samples with different parameters or samples obtained from entirely different simulation programs. The ML reweighting method avoids the need for simulating the detector response multiple times by incorporating the relevant information in a single sample through event weights. Results are presented for reweighting to model variations and higher-order calculations in simulated top quark pair production at the LHC. This ML-based reweighting is an important element of the future computing model of the CMS experiment and will facilitate precision measurements at the High-Luminosity LHC.FWF; FNRS; FWO (Belgium); CNPq; CAPES; FAPERJ; FAPERGS; FAPESP (Brazil); BNSF (Bulgaria); MoST; NSFC (China); CSF (Croatia); RIF (Cyprus); SENESCYT (Ecuador); ERC PRG [MoER TK202]; Academy of Finland; MEC; CEA; CNRS/IN2P3 (France); SRNSF; BMBF; DFG; HGF (Germany); NKFIH (Hungary); DAE; DST; IPM; SFI (Ireland); INFN (Italy); NRF (Republic of Korea); MES (Latvia); MOE; UM (Malaysia); BUAP; CONACYT; UASLP-FAI (Mexico); PAEC (Pakistan); FCT (Portugal); MESTD (Serbia); PCTI (Spain); MOSTR (Sri Lanka); Swiss Funding Agencies (Switzerland); NSTDA; TUBITAK; DOE; NSF (USA); Marie-Curie programme; European Research Council; Horizon 2020 Grant [675440, 724704, 752730, 758316, 765710, 824093, 101115353, 101002207]; COST Action [CA16108]; Leventis Foundation; Alfred P. Sloan Foundation; Alexander von Humboldt Foundation; Science Committee [22rl-037]; Belgian Federal Science Policy Office; Fonds pour la Formation a la Recherche dans l'Industrie et dans l'Agriculture (FRIA-Belgium); FWO (Belgium) under the "Excellence of Science - EOS [30820817]; Beijing Municipal Science & Technology Commission [Z191100007219010]; Fundamental Research Funds for the Central Universities (China); Ministry of Education, Youth and Sports (MEYS) of the Czech Republic; Shota Rustaveli National Science Foundation [FR-22-985]; Deutsche Forschungsgemeinschaft (DFG) [EXC 2121, 390833306, 400140256 - GRK2497]; Hellenic Foundation for Research and Innovation (HFRI) [2288]; Hungarian Academy of Sciences [K 131991, K 133046, K 138136, K 143460, K 143477, K 146913, K 146914, K147048, 2020-2.2.1-ED-2021-00181, TKP2021-NKTA64]; Council of Science and Industrial Research, India - NextGenerationEU program (Italy); Latvian Council of Science [2022/WK/14]; National Science Center [Opus 2021/41/B/ST2/01369, 2021/43/B/ST2/01552]; Fundacao para a Ciencia e a Tecnologia [CEECIND/01334/2018]; National Priorities Research Program by Qatar National Research Fund; ERDF "a way of making Europe [MDM-2017-0765]; Programa Severo Ochoa del Principado de Asturias (Spain); National Science, Research and Innovation Fund via the Program Management Unit for Human Resources; Research and Innovation [B39G670016]; Kavli Foundation; Nvidia Corporation; SuperMicro Corporation; Welch Foundation [C1845]; Weston Havens Foundation (USA)Finally, we acknowledge the enduring support for the construction and operation of the LHC, the CMS detector, and the supporting computing infrastructure provided by the following funding agencies: SC (Armenia), BMBWF and FWF (Austria); FNRS and FWO (Belgium); CNPq, CAPES, FAPERJ, FAPERGS, and FAPESP (Brazil); MES and BNSF (Bulgaria); CERN; CAS, MoST, and NSFC (China); MINCIENCIAS (Colombia); MSES and CSF (Croatia); RIF (Cyprus); SENESCYT (Ecuador); ERC PRG, RVTT3 and MoER TK202 (Estonia); Academy of Finland, MEC, and HIP (Finland); CEA and CNRS/IN2P3 (France); SRNSF (Georgia); BMBF, DFG, and HGF (Germany); GSRI (Greece); NKFIH (Hungary); DAE and DST (India); IPM (Iran); SFI (Ireland); INFN (Italy); MSIP and NRF (Republic of Korea); MES (Latvia); LMTLT (Lithuania); MOE and UM (Malaysia); BUAP, CINVESTAV, CONACYT, LNS, SEP, and UASLP-FAI (Mexico); MOS (Montenegro); MBIE (New Zealand); PAEC (Pakistan); MES and NSC (Poland); FCT (Portugal); MESTD (Serbia); MCIN/AEI and PCTI (Spain); MOSTR (Sri Lanka); Swiss Funding Agencies (Switzerland); MST (Taipei); MHESI and NSTDA (Thailand); TUBITAK and TENMAK (Turkey); NASU (Ukraine); STFC (United Kingdom); DOE and NSF (USA). Individuals have received support from the Marie-Curie programme and the European Research Council and Horizon 2020 Grant, contract Nos. 675440, 724704, 752730, 758316, 765710, 824093, 101115353, 101002207, and COST Action CA16108 (European Union); the Leventis Foundation; the Alfred P. Sloan Foundation; the Alexander von Humboldt Foundation; the Science Committee, project no. 22rl-037 (Armenia); the Belgian Federal Science Policy Office; the Fonds pour la Formation a la Recherche dans l'Industrie et dans l'Agriculture (FRIA-Belgium); the F.R.S.-FNRS and FWO (Belgium) under the "Excellence of Science - EOS" - be.h project n. 30820817; the Beijing Municipal Science & Technology Commission, No. Z191100007219010 and Fundamental Research Funds for the Central Universities (China); the Ministry of Education, Youth and Sports (MEYS) of the Czech Republic; the Shota Rustaveli National Science Foundation, grant FR-22-985 (Georgia); the Deutsche Forschungsgemeinschaft (DFG), among others, under Germany's Excellence Strategy - EXC 2121 "Quantum Universe" - 390833306, and under project number 400140256 - GRK2497; the Hellenic Foundation for Research and Innovation (HFRI), Project Number 2288 (Greece); the Hungarian Academy of Sciences, the New National Excellence Program - UNKP, the NKFIH research grants K 131991, K 133046, K 138136, K 143460, K 143477, K 146913, K 146914, K147048, 2020-2.2.1-ED-2021-00181, and TKP2021-NKTA64 (Hungary); the Council of Science and Industrial Research, India; ICSC - National Research Centre for High Performance Computing, Big Data and Quantum Computing and FAIR - Future Artificial Intelligence Research, funded by the NextGenerationEU program (Italy); the Latvian Council of Science; theMinistry of Education and Science, project no. 2022/WK/14, and the National Science Center, contracts Opus 2021/41/B/ST2/01369 and 2021/43/B/ST2/01552 (Poland); the Fundacao para a Ciencia e a Tecnologia, grant CEECIND/01334/2018 (Portugal); the National Priorities Research Program by Qatar National Research Fund; MCIN/AEI/10. 13039/501100011033, ERDF "a way of making Europe", and the Programa Estatal de Fomento de la Investigacion Cientifica y Tecnica de Excelencia Maria de Maeztu, grant MDM-2017-0765 and Programa Severo Ochoa del Principado de Asturias (Spain); the Chulalongkorn Academic into Its 2nd Century Project Advancement Project, and the National Science, Research and Innovation Fund via the Program Management Unit for Human Resources& InstitutionalDevelopment, Research and Innovation, grant B39G670016 (Thailand); the Kavli Foundation; the Nvidia Corporation; the SuperMicro Corporation; the Welch Foundation, contract C1845; and the Weston Havens Foundation (USA).Science Citation Index Expande
Scabies Cases at a Dermatological Outpatient Clinic in Türkiye: Effects of the COVID-19 Pandemic
No full textIntroduction: Annually, scabies affects more than 400 million people worldwide and is an important public health problem. This study investigated the socio-demographic and clinical characteristics of patients with scabies at a major dermatologic clinic in Turkiye in the context Methodology: A retrospective evaluation was performed on outpatients diagnosed with scabies between 2014 and 2022. Statistical analyses Results: In total, 759 of the 48,381 patients (1.6%) who visited the dermatology outpatient clinic were diagnosed with scabies. The incidence rate of scabies was 0.5-0.9% before the pandemic, which increased to 3.1-4.4% in 2020-2022. Cases were more common in October- December (36.5%), and 57.9% of patients were 18-44 years old. Those aged 1-6 years showed an increased rate of scabies from 3% to 7.8% during the pandemic. There was no significant difference according to gender or nationality. All patients complained of itching, and 35% had a history of contact with individuals who were diagnosed with scabies. The recurrence rate was 27.3%. Lesions of 73.1% of patients showed a generalized distribution, as well as local lesions on the hands (7.9%), genital area (6.4%), trunk (4.0%), arms (3.0%), legs (2.8%), feet (1.6%), and head (1.2%). Conclusions: The results emphasize that scabies can develop regardless of age, gender, and ethnicity, and periods such as pandemics may delay diagnosis and treatment, leading to a higher occurrence of the disease.Science Citation Index Expande
Second Order Variations and the Overspinning Problem in Kerr-Taub Spacetime
No full textPreviously, we attempted to overspin Kerr-Taub-NUT (Kerr-Taub-Newman-Unti-Tamburino) black holes with test fields satisfying the null energy condition. We derived that a nongeneric overspinning could be achieved with strict restrictions on the test field modes and the initial spacetime parameters. Here, we incorporate the effect of the second order variations by evaluating the Sorce-Wald condition for Kerr-Taub-NUT black holes. We calculate the second variation of the area for the subcollection of Kerr-Taub-NUT black holes for which overspinning is possible due to first order perturbations. We carry out an analysis to second order, avoiding the common order of magnitude problems where the second order variations appear in the form of a product with the square of an additional small parameter. We derive that the contribution of the second order variations fix the final state of the spacetime parameters driving the Kerr-Taub-NUT black hole away from extremality. The event horizon is preserved in accord with the cosmic censorship conjecture and the laws of black hole dynamics. © 2025 American Physical SocietyScience Citation Index Expande
Effect of Rare Earth Doping on Structural, Optical, Dielectric, and Humidity Properties of Cu-Mg Ferrites
No full textRare earth (RE) doped ferrites with the chemical formula Cu0.3Zn0.3Mg0.4TxFe2-xO4 (x = 0, 0.1; T = La, Ce, Sr) were synthesized by chemical co-precipitation method. The structural, optical, electrical and humidity sensing properties of Cu-Mg-Zn ferrites with rare earth element doping were investigated. Single-phase cubic spinel structure was confirmed via X-ray diffraction (XRD), and the crystal size ranges from 22.12 to 63.17 nm according to the Scherrer formula and from 25.66 to 67.46 nm according to the Williamson-Hall method. Porous structure and elemental characterization of the samples were investigated by scanning electron microscopy (SEM). The optic band gap varies between 2.21 and 2.49 eV. Electrical measurements were conducted in the frequency range of 1 Hz-20 MHz and temperature range of 25-400 degrees C. It has been determined that the dielectric results are consistent with the Maxwell-Wagner method and exhibit a non-Debye relaxation model, as observed from the Nyquist plots. At a minimum frequency value of 1 Hz, the dielectric constants for pure, Ce, Sr, and La samples are 9 x 104, 5 x 104, 1 x 108, and 2 x 105 at 25 degrees C, and 1.85 x 108, 1.34 x 108, 1.15 x 1010, and 4.4 x 108 at 400 degrees C. In the same order, for the maximum frequency value of 20 MHz, the dielectric constants at 25 degrees C are 169, 166, 3799, and 60, while at 400 degrees C they are 734, 624,12108, and 774. The La doped sample's low dielectric loss makes it suitable for high-frequency applications. Humidity measurements were performed at room temperature and in the 5%-95% relative humidity range. The humidity properties of the samples were investigated through humidity mapping, sensitivity, hysteresis, and long-term stability tests. Compared to other samples, the results indicate that Ce exhibits better humidity performance with 99% sensitivity and the highest repeatability (91.2%). These results show that Ce-doped ferrite can be used as a low-cost, high-performance humidity sensor. (c) 2025 Chinese Society of Rare Earths. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.Ondokuz Mayis University [PYO.MUH.1901.21.001]This work is supported by the Ondokuz Mayis University Project Number PYO.MUH.1901.21.001. The use of facilities at Ondokuz May & imath;s University Black Sea Advanced Technology Research and Application Center (KITAM) is acknowledged.Science Citation Index Expande
Thermal Performance of Octadecane as a Phase Change Material in a Circular Tube: The Effect of External Heat Flux via Molecular Dynamics Simulation
No full textPhase change materials are a modern and effective technology in thermal energy systems. This paper investigates how external heat flux changes affected the thermal and atomic properties of octadecane as a phase change material to concentrate solar thermal energy and to store it. Alteration in the behavior of simulated samples was explored using maximal temperature, velocity, density, charging, discharging, heat flow, thermal conductivity, and thermal stability metrics. The first structure was subjected to varying external heat fluxes of 0.01, 0.02, 0.03, and 0.05 W/m2 during the early phase. The results suggest that increasing EHF (Effective Heat Flux) resulted in better atomic mobility, leading to increased molecular dynamics and improved heat transport characteristics. This is because elevated heat flow prompts atomic motion, causing the temperature to rise to 568.08 K, while raising the velocity to 0.0082 & Aring;/fs, and lowering the density to 0.028 atoms/& Aring;3. In addition, increased heat flow is associated with improved charging efficiency, and reduces charge time to 6.41 ns, while discharging time increased to 7.17 ns because of extended thermal energy discharging. Finally, thermal conductivity and heat flow increased to 1.71 W/m & sdot;K, and 5.96 W/m2, respectively. The changes improve thermal conductivity and overall heat transfer efficiency. The results are crucial in optimizing phase change material-based thermal management systems for applications requiring regulated energy dissipation and storage under variable thermal loads.Anhui Provincial Natural Science Foundation [2308085MF211]This work was supported by Anhui Provincial Natural Science Foundation (No. 2308085MF211) .Science Citation Index Expande
C. Dancla Op. 89 'Air Variations' Çalışma Kılavuzu ve Varyasyon Formunun Keman Eğitiminde Öğrencilere Katkıları
No full textBu çalışmada, varyasyon formundaki eserlerin keman öğrencilerinin teknik ve müzikal gelişimlerine sağladığı katkılar incelenmiştir. Keman eğitiminde bu formun, öğrencilerin teknik yeterliliklerini artırarak müzikal ifade yeteneklerini geliştirdiği ve motivasyonlarını olumlu yönde etkilediği gözlemlenmiştir. Literatür taraması sonucunda, özellikle küçük yaş gruplarındaki öğrenciler için uygun bir kaynak olarak Charles Dancla'nın Op. 89 'Air Variations' eseri öne çıkmıştır. Bu tez kapsamında, keman eğitiminin üçüncü yılından itibaren müzikal ve teknik gelişimi desteklemek amacıyla, Op. 89 'Air Variations' eserleri basamak sistemi (kolaydan zora) ilerleyen bir sistem çerçevesinde analiz edilmiştir. Çalışmamızda, Charles Dancla'nın yaşamı, müzik hayatı ve eserleri ele alınarak, literatürde yer alan kaynaklar ve önceki araştırmalar incelenmiştir. Ayrıca, farklı dönemlerdeki varyasyon formu incelenmiş, Op. 89 'Air Variations' için yay ve duate önerileri sunulmuştur. Sonuç olarak, elde edilen bulgular doğrultusunda, varyasyon formunun sağ ve sol el tekniklerini geliştirmedeki önemi vurgulanmış ve keman eğitmenleri ile öğrenciler için bir çalışma kılavuzu oluşturulmuştur. Bu tez, keman eğitimi sürecinde varyasyon formunun pedagojik açıdan nasıl etkin bir şekilde kullanılabileceğine dair kapsamlı bir kaynak sunmayı amaçlamaktadır.In this study, the contributions of works in variation form to the technical and musical development of violin students were analysed. It has been observed that this form in violin education increases the technical competences of students, improves their musical expression skills and positively affects their motivation. As a result of the literature review, Charles Dancla's Op. 89 'Air Variations' came to the fore as a suitable source especially for younger students. Within the scope of this thesis, in order to support musical and technical development from the third year of violin education, Op. 89 'Air Variations' were analysed within the framework of a progressive system (from easy to difficult). In our study, the life, musical life and works of Charles Dancla were analysed and the sources in the literature and previous researches were examined. In addition, variation forms from different periods were analysed and bowing and duate suggestions for Op. 89 'Air Variations' were presented. As a result, in line with the findings, the importance of the variation form in developing right and left hand techniques was emphasised and a study guide for violin instructors and students was created. This thesis aims to provide a comprehensive resource on how variation form can be used pedagogically in the violin education process
Examination of the Relationship Between Nutrition Knowledge Level, Sleep Quality, Social Apparance Anxiety, and Nutritional and Ergogenic Supplement Intake in Exercising Men
No full textBu çalışmanın amacı, rekreasyonel olarak spor salonlarında antrenman yapan yetişkin erkeklerin sporcu beslenme bilgi düzeylerini ve ergojenik destek alımlarını değerlendirmek, uyku kalitelerini incelemek ve diğer değişkenlerle ilişkilerini araştırmak, sosyal görünüş kaygısı taşıyıp taşımadıklarını değerlendirmek ve diğer değişkenlerle ilişkilerini araştırmaktır. Kesitsel tipteki bu araştırmaya Bursa'nın İnegöl ilçesindeki üç adet spor salonunda antrenman yapan 217 yetişkin erkek katılmıştır. Veriler araştırmacı tarafından yüz yüze toplanmıştır ve kullanılan anket altı bölümden oluşmaktadır. İlk bölüm katılımcıların, antropometrik (boy uzunluğu, vücut ağırlığı vb.) ve sosyo-demografik (yaş, eğitim durumu, gelir seviyesi vb.) özelliklerini öğrenmeye yönelik sorulardan oluşur. İkinci bölümde besin ve ergojenik destek tüketim kaydı istenmektedir. Üçüncü bölümde Sporcu Beslenmesi Bilgisi Ölçeği kullanılmıştır. Dördüncü bölümde Spor Besin Takviyeleri İnanç Ölçeği kullanılmıştır. Beşinci bölümde Sporcu Uyku Ölçeğinden faydalanılmıştır. Altıncı bölümde Sosyal Görünüş Kaygısı ölçeği kullanılmıştır. Çalışmanın bulgulara göre, katılımcıların Sporcu Beslenme Bilgisi Düzeyleri ortalama seviyede bulunmuştur. Antrenman geçmişi bir yıl ve üzeri olan bireylerde beslenme bilgisi ve takviye inancı puanlarının daha yüksek olduğu gözlenmiştir. Ayrıca, beslenme bilgisi düzeyi arttıkça protein ve fosfor alımı da artarken, enerji alımıyla zayıf düzeyde pozitif bir ilişki saptanmıştır. Katılımcıların yaklaşık %40'ı besin desteği kullandığını ve en çok kullanılan desteklerin kreatin ile protein tozu olduğunu ifade etmiştir. Katılımcıların neredeyse yarısının uyku kaliteleri düşük seviyededir. Uyku kalitesinin sporla ilgili faktörlerle güçlü ilişkiler gösterdiği ve antrenman geçmişi arttıkça sporla ilgili uyku bozukluklarının daha belirgin hale geldiği gözlenmiştir. Ayrıca, sporcuların sosyal görünüş kaygısı puanları genel olarak düşük bulunmuş, egzersiz yapmanın bu kaygıyı azaltabileceği vurgulanmıştır. Sosyal görünüş kaygısı ile medeni durum arasında anlamlı farklılık bulunmuş; bekar bireylerde daha yüksek olduğu, yaşla birlikte ise hafifçe azaldığı belirlenmiştir. Çalışmada, sosyal görünüş kaygısı yüksek olan bireylerde protein ve enerji alımının biraz daha düşük olabileceği ve yetersiz beslenme davranışlarının zamanla yeme bozuklukları riskini artırabileceği de tartışılmıştır. Yapısal eşitlik modeline göre, yalnızca uyku bozukluğu ile sosyal görünüş kaygısı arasında istatistiksel olarak pozitif anlamlı bir ilişki bulunmuştur. Bu ilişkinin doğrusal değil, daha karmaşık bir yapı izlediği ve belirli eşiklerin ötesinde etkisinin zayıflayabileceği belirlenmiştir.The aim of this study is to evaluate the sports nutrition knowledge levels and ergogenic aid intake of adult men who train recreationally in gyms, to examine their sleep quality, to investigate the relationships between these variables, and to assess whether they experience social appearance anxiety and its relationship with other variables. This cross-sectional study included 217 adult men training in three different gyms located in İnegöl district of Bursa, Turkey. Data were collected face-to-face by the researcher, and the questionnaire used consisted of six sections. The first section included questions regarding the participants' anthropometric characteristics (e.g., height, body weight) and socio-demographic information (e.g., age, education level, income status). The second section involved recording their food and ergogenic supplement consumption. The third section employed the Sports Nutrition Knowledge Questionnaire. The fourth section used the Sports Nutrition Supplements Belief Scale. The fifth section utilized the Athlete Sleep Behavior Questionnaire. In the sixth section, the Social Appearance Anxiety Scale was applied. According to the findings of the study, participants' sports nutrition knowledge levels were found to be at an average level. Individuals with one year or more of training history had higher scores in both nutrition knowledge and supplement belief. Additionally, as nutrition knowledge increased, protein and phosphorus intake also increased, while a weak positive relationship was observed with energy intake. Approximately 40% of participants reported using dietary supplements, with creatine and protein powder being the most commonly used. Nearly half of the participants had poor sleep quality. Sleep quality was found to have strong associations with sport-related factors, and sleep disturbances related to sports became more prominent as training history increased. Furthermore, participants' social appearance anxiety scores were generally low, and it was emphasized that exercise might help reduce this type of anxiety. A significant difference was found between social appearance anxiety and marital status, with higher anxiety among single individuals, and a slight decrease with age. The study also discussed that individuals with high social appearance anxiety might have slightly lower protein and energy intake, and that inadequate dietary behaviors over time could increase the risk of developing eating disorders. According to the structural equation model, only the relationship between sleep disturbances and social appearance anxiety was found to be statistically significant and positive. This relationship was determined to follow a complex pattern rather than a linear one, and its effect may weaken beyond certain thresholds
Evaluating the Impact of Perceived Fear of Malpractice on Physicians' Attitudes and Behaviors in Medical Practice
No full text'Tıbbi kötü uygulama' anlamına gelen 'malpraktis' kavramının, son yıllarda hekim popülasyonu arasında gittikçe daha fazla konuşulan bir kavram haline geldiği ifade edilebilir. Küresel sağlık yükünün artması, sağlık hizmetine yönelik talebin artması, toplumun sağlık hukuku alanındaki farkındalığının artması, diğer yandan, hastalar tarafında malpraktis ile komplikasyon arasındaki ayırımın yapılamaması, hekim ile hasta arasındaki anlaşmazlıkların daha fazla olması sonucunu beraberinde getirmiştir. Sundukları sağlık hizmetinin sonuçlarından dolayı hukuki yaptırım ile karşılaşma olasılığının giderek artmasının, hekim popülasyonunda tedirginlik ve korku sonucunu doğurduğu söylenebilir. Bu çalışmada, hekimleri etkilediğini düşündüğümüz bu tedirginlik ve malpraktis korkusunun, hekimlerin tutum ve davranışları üzerine etkisinin ortaya koyulması amaçlanmıştır. Araştırma, anket, odak grup çalışmaları, Türkiye Cumhuriyeti Adalet Bakanlığı Adli Tıp Kurumu ve Türk Tabipler Birliği'nden (İstanbul Tabip Odası) elde edilen veriler ile yapılmıştır. Anket çalışmasının evrenini, bir hastane zincirindeki 27 hastanede hekimlik hizmeti vermekte olan cerrahi branş ve girişimsel işlem yapan hekimler oluşturdu. Anket sayılarının belirlenmesinde G-power analizi kullanıldı, analiz neticesine göre örneklem sayısı en az 396 olarak hesaplandı. Evreni temsil eden hekimlerin isimlerinin yerleştirildiği Excel formatındaki dosyanın ilgili kolonundaki isimler, 'S_SAYI_ÜRET' fonksiyonu kullanılarak rastgele karıştırılıp, ilk sıradaki isim '1' olacak şekilde 1-4-7-10-13… sıralaması ile seçilen 396 hekime anket gönderilmiştir. Yeterli sayıda anket dönüşü olmadığından birer atlayarak 2-5-8-11-14… sıralaması ile seçilen 413 hekime de anket gönderilmiştir ve cevaplanan 516 anketten eksiksiz doldurulmuş olan 409 adedine ait veriler değerlendirilmiştir. Toplanan anketlerden elde edilen veriler SPSS programı ile değerlendirildi, ayrıca, örnekleme giren ve görüşme zamanına uygunluğu olan hekimlerden 6'şarlı gruplar halinde toplamda 30 hekim ile odak grup görüşmesi yapıldı. Görüşmede elde edilen yorumlar, MAXQDA adlı program ile analiz edildi. Analizlerden elde edilen bulguların değerlendirilmesinde; ankete katılan 409 hekimin en düşük 31, en yüksek 75 yaşında; yaş ortalamasının 46,52±9,52, katılımcıların ise %79,95 erkek, %20,05 kadın olduğu anlaşıldı. Hekimlerin, uzmanlık sonrası mesleki deneyim süreleri en kısa 1 yıl, en uzun 46 yıl, ortalama 15,91±9,34 yıl olarak tespit edildi. Katılımcıların branşlara göre dağılımı, ana uzmanlık dallarında %0,73 ile en düşük radyoloji, %18,09 ile en yüksek kadın hastalıkları ve doğum olarak; yan dal uzmanlık dallarında ise mesleki deneyim süresi 3,2 yıl ile en kısa Çocuk Kalp ve Damar Cerrahisi ve Yoğun Bakım, 22,6 yıl ile en uzun Jinekolojik Onkoloji Cerrahisi olarak bulundu. Hekimlerin, %53,3'ünde, haklarında en az 1 kere hastane yönetimine ya da diğer kurumlara şikâyet edildiği veya haklarında soruşturma açıldığı, bunların da %63,3'ünde soruşturmaya yer olmadığı, %10,55'inde soruşturma açılmış olduğu ve devam ettiği, %2,29'unda hastaya tazminat ödendiği sonucuna ulaşılmıştır. Ayrıca, hekimlerinin, 'sağlıkta şiddete maruziyet yaşadınız mı?' sorusuna, %37,90 oranında evet, %62,10 oranında hayır cevabı verdikleri, buna karşın, %85,33'ünün sağlık hukuk alanında herhangi bir eğitim almadığı, %66,01'inin ise sağlık hukuku alanında bir eğitim almayı planlamadıkları görülmüş, %95,35'inin, Türk Ceza Kanunu'nun, hekim malpraktis davalarının değerlendirilmesinde yeterli olmadığını düşündükleri görülmüştür. Sağlık hizmet sunumuna yönelik hukuki gelişmeler nedeni ile mesleki uygulamalarımda önemli değişiklikler yapmak zorunda kalıp kalmadıkları sorulan hekimlerin 5'li Likert cevaplarının ortalama puanı 3,06±1,15 (orta düzey algı); gelecek 10 yıl içinde herhangi bir malpraktis davasına dâhil olacağım diye endişelenip endişelenmedikleri ile ilgili olarak ise 3,67±1,03 (yüksek düzey endişe) olarak analiz edilmiştir. Aynı biçimde sadece malpraktisden kaçınmak için bazı testler ve konsültasyon istediğim olur önermesine 3,70±1,15 (yüksek düzey önleyici davranış); teknolojiden ziyade klinik bulgulara güvenerek tanı koymanın ve tedaviye başlamanın, medikolegal açıdan giderek daha riskli hale geldiğini düşünenlerin ortalama puanı 4,09±0,97 olarak saptanmıştır. Bu değer de 'yüksek düzeyde' bir endişeyi göstermektedir. Hekimlerin, malpraktis konusundaki kaygıları, mesleki uygulamalarında baskı altında olmalarına, bilimsel tıp normlarını, bu kaygılara göre şekillendirmelerine yol açmaktadır. Bu ise, tedaviden kaçınma, olası davalarda kanıt biriktirme amaçlı gereksiz tetkik isteme eğilimine yol açmakta, hem hasta yararı zarar görmekte ve hem de kamusal kayıplar ortaya çıkmaktadır. Anahtar Kelimeler: Malpraktis, Sağlık, Hukuk, Şikayet Tarih:The concept of 'malpractice,' which refers to medical misconduct, has increasingly become a prevalent topic among the physician population in recent years. Factors such as the growing global burden of disease, increased demand for healthcare services, rising public awareness of health law, and the inability of patients to distinguish between malpractice and complications have all contributed to a rise in disputes between patients and physicians. The increasing likelihood of physicians facing legal sanctions due to the outcomes of the healthcare services they provide has led to a sense of apprehension and fear among them. This study aims to reveal the impact of this perceived anxiety and fear of malpractice—believed to affect physicians—on their attitudes and behaviors. The research was conducted using data obtained from surveys, focus group studies, and institutions such as the Forensic Medicine Institute of the Ministry of Justice of the Republic of Turkey and the Turkish Medical Association (Istanbul Medical Chamber). The target population for the survey consisted of physicians from surgical and interventional specialties working in 27 hospitals within a hospital chain. The sample size was determined using G*Power analysis, which calculated the minimum required number of participants as 396. An Excel spreadsheet containing the names of eligible physicians was used, and the 'RAND' function was applied to randomly shuffle the list. Starting with the first name as '1', participants were selected following a sequence of every third entry (1-4-7-10-13...). Since the initial response rate was insufficient, additional invitations were sent to the physicians listed at every third interval starting from the second name (2-5-8-11-14...), increasing the outreach to 413 additional physicians. Out of the 516 returned questionnaires, 409 fully completed responses were included in the final analysis. Survey data were analyzed using SPSS software. Additionally, focus group interviews were conducted with a total of 30 physicians, grouped into sessions of six, selected from among the survey respondents based on availability. The qualitative data from these interviews were analyzed using the MAXQDA software. Analysis of the findings showed that the 409 physicians who completed the survey were between 31 and 75 years old, with a mean age of 46.52±9.52 years. Of the participants, 79.95% were male, and 20.05% were female. Post-specialization professional experience ranged from 1 to 46 years, with a mean of 15.91±9.34 years. The distribution of participants by specialty showed that Radiology had the lowest representation among core specialties (0.73%), while Obstetrics and Gynecology had the highest (18.09%). Among subspecialties, Pediatric Cardiovascular Surgery and Intensive Care had the shortest mean professional experience (3.2 years), while Gynecologic Oncology Surgery had the longest (22.6 years). It was found that 53.3% of the physicians had been subject to at least one complaint or investigation by hospital administration or other institutions. Among these, 63.3% of investigations concluded with no action taken, 10.55% were ongoing, and in 2.29% of cases, compensation was paid to the patient. Furthermore, in response to the question 'Have you ever been exposed to violence in healthcare?', 37.90% answered yes, while 62.10% answered no. Despite this, 85.33% of the participants had not received any education in health law, and 66.01% did not plan to receive such education. Moreover, 95.35% of participants believed that the Turkish Penal Code is insufficient in evaluating malpractice cases. Regarding whether legal developments in healthcare delivery have forced changes in their clinical practice, participants responded with a mean score of 3.06±1.15 on a 5-point Likert scale (moderate perception). Concern about being involved in a malpractice lawsuit within the next 10 years was rated at a high level, with a mean score of 3.67±1.03. Similarly, the statement 'I sometimes request tests and consultations solely to avoid malpractice' received a high average score of 3.70±1.15. The opinion that relying on clinical findings rather than technology has become increasingly risky from a medicolegal perspective yielded a mean score of 4.09±0.97, indicating a high level of concern. These findings suggest that physicians' anxiety regarding malpractice puts them under professional pressure, leading them to modify scientific medical norms based on this concern. This, in turn, results in behaviors such as avoiding certain treatments or requesting unnecessary tests merely to collect potential legal evidence—practices that not only compromise patient benefit but also lead to public resource loss. Keywords: Malpractice, Health, Law, Complaint. Date
The Effect of Physical Restraint Using Toy Bracelets in a Pediatric Intensive Care Unit on Children's Physiological Parameters, Fear, and Anxiety Levels: A Randomized Controlled Trial
No full textYoğun bakım ortamı, çocuklar için hem fiziksel hem de psikolojik açıdan stres verici bir deneyim olabilir. Özellikle fiziksel kısıtlama gereksinimi olan çocuklarda bu durum, korku ve anksiyete düzeylerini artırabilir. Bu araştırmanın amacı, fiziksel kısıtlama ihtiyacı olan 4-12 yaş arası çocuklara takılan oyuncaklı bilekliklerin fizyolojik parametreler, korku ve anksiyete düzeyleri üzerindeki etkilerini incelemektir. Bu randomize kontrollü deneysel çalışma, Aralık 2023 - Aralık 2024 tarihleri arasında İstanbul Şehit Prof. Dr. İlhan Varank Eğitim ve Araştırma Hastanesi Çekmeköy Devlet Hastanesi 3. Düzey Çocuk Yoğun Bakım Ünitesi'nde 65 çocuk (deney grubu: 32, kontrol grubu: 33) ile yürütülmüştür. Veriler Çocuk Bilgi Formu, Çocuk Korku Ölçeği ve Çocuk Anksiyete Skalası-Durumluluk (ÇAS-D) ile toplanmış, fizyolojik veriler kalibre edilmiş cihazlarla izlenmiştir. Çocukların fizyolojik parametreleri ile (oksijen satürasyonu, solunum sayısı, kalp atım hızı, diastolik/sistolik basın) korku ve anksiyete puanları başlangıç, birinci, ikinci ve üçüncü saatte değerlendirildi. Deney grubunun üçüncü saat diastolik kan basıncı ortalaması kontrol grubundan yüksek bulunmuş, bu fark anlamlı çıkmıştır (p = 0.006). Nabız sayısında ise özellikle birinci, ikinci ve üçüncü saatte gruplar arasında anlamlı fark gözlenmiştir (p <0.05). Bununla birlikte, sistolik kan basıncı (p = 0.124), oksijen satürasyonu (p = 0.106), solunum sayısı (p = 0.304) açısından grupların zamanla arasında anlamlı fark bulunmamıştır. Korku ve anksiyete düzeylerinde zamanla anlamlı azalma gözlenmiş olup, özellikle zaman etkisi, korku (p < 0.001) ve anksiyete (p < 0.001) puanları için anlamlı olarak bulunmuştur. Anksiyete puanlarında grup*zaman etkileşimi anlamlılığa yakın değer göstermiştir. Sonuç olarak, çocukların yoğun bakım ortamına zamanla uyum sağladıkça korku ve anksiyete düzeylerinde azalma gözlenmiş, oyuncaklı bileklik uygulamasının özellikle korku düzeylerinde zamana bağlı etkileri olabileceği belirlenmiştir. Bu doğrultuda, oyuncaklı bilekliklerin hem fizyolojik hem psikolojik etkilerinin daha uzun süreli takiplerle değerlendirilmesi ve klinik kullanımı için daha geniş örneklemlerle desteklenmesi önerilmektedir. Anahtar Kelimeler: Fiziksel kısıtlama, Anksiyete, Korku, Ölçek, Oyuncaklı bileklik, PediatriThe intensive care unit can be a stressful experience for children, both physically and psychologically. This is particularly true for children who require physical restraint, as such procedures may elevate levels of fear and anxiety. The aim of this study was to examine the effects of toy bracelets used during physical restraint on physiological parameters, fear, and anxiety levels in children aged 4 to 12 years. This randomized controlled experimental study was conducted with 65 children (intervention group: 32, control group: 33) between December 2023 and December 2024 in the Level 3 Pediatric Intensive Care Unit of Istanbul Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Çekmeköy State Hospital. Data were collected using the Child Information Form, the Child Fear Scale, and the State-Trait Anxiety Scale for Children (STAI-C), and physiological parameters were monitored using calibrated devices. Children's physiological parameters (oxygen saturation, respiratory rate, heart rate, diastolic/systolic blood pressure), as well as fear and anxiety levels, were assessed at baseline and at the first, second, and third hour of observation. The mean diastolic blood pressure at the third hour was significantly higher in the intervention group compared to the control group (p = 0.006). A significant difference in heart rate between groups was also observed at the first, second and third hour (p < 0.05). However, no statistically significant differences were found between the groups in terms of systolic blood pressure (p = 0.124), oxygen saturation (p = 0.106), or respiratory rate (p = 0.304). A significant decrease over time was observed in both fear and anxiety levels, with time effects being statistically significant for fear (p < 0.001) and anxiety (p < 0.001). Notably, the group*time interaction was found to be significant only for anxiety scores. In conclusion, as children gradually adapted to the intensive care environment, their levels of fear and anxiety decreased. The toy bracelet intervention showed potential time-dependent effects on fear levels. Therefore, it is recommended that the physiological and psychological effects of toy bracelets be further investigated through long-term follow-ups and validated with larger sample sizes for broader clinical implementation. Keywords: Physical restraint, Anxiety, Fear, Scale, Bracelet with toys, Pediatri