bluuebunny/crossref_metadata_2025 huggingface dataset:
Reel Döviz Kurunda Eksik Değerlenme Ekonomik Büyüme İlişkisi: Ülke Gelir Gruplarına Göre Bir Analiz
Authors: İNCEKARA Ahmet , GÜRBÜZ Abdullah Şuhan , POYRAZ Gülden
Published: October 2022

Reel döviz kurunda eksik değerlenme ile ekonomik büyüme ilişkisi literatürde önemli bir yer tutmasına rağmen, birtakım yaklaşım farklılıkları sebebiyle konu hakkında henüz kesin bir fikir birliği sağlanmış değildir. Ancak tüm bu yaklaşım farklılıkları ile birlikte ilgili literatürde, gelişmekte olan ekonomilerde daha rekabetçi para biriminin ekonomik büyüme üzerinde pozitif etkisinin olduğu öne sürülmektedir. Bu çalışmada reel döviz kurunda eksik değerlenmenin ekonomik büyüme üzerindeki etkisi 1980-2019 döneminde yüksek gelirli, üst orta gelirli ve alt orta gelirli ülkeler için ayrı ayrı incelenmiştir. Çalışmanın örneklemi 81 ülkeden oluşmaktadır. Dinamik panel veri analiz yönteminin kullanıldığı çalışmadan elde edilen sonuçlara göre eksik değerlenme ve ekonomik büyüme ilişkisi sadece üst orta gelirli ülke grubu için istatistiksel ve iktisadi olarak anlamlı bulunmuştur. Analiz sonuçlarına göre üst orta gelirli ülkelerde yerli para biriminde meydana gelen %10’luk bir değer kaybı ekonomik büyümeyi %0,0049 arttırmaktadır.
Okul Yöneticilerinin Kendi Aralarındaki Çatışmalarının Nedenleri, Çatışmaların Önlenmesi İçin Yapılması Gerekenler ve Bu Çatışmaların Öğretmenlere Etkisi
Authors: KOÇYİĞİT Aysun , POLAT Soner
Published: October 2022

Bu araştırmanın amacı, okul yöneticilerinin kendi aralarındaki çatışmalarının nedenlerini, çatışmaların önlenmesi için yapılması gerekenleri ve bu çatışmaların öğretmenlere etkilerini ortaya koymaktır. Araştırma nitel araştırma türünde olup, olgubilim (fenomenoloji) araştırma deseni kullanılarak yapılmıştır. Araştırmanın çalışma grubunu 2021-2022 eğitim öğretim yılında Kocaeli ilinin İzmit ilçesindeki devlet ortaokullarında görev yapan, amaçlı örnekleme yöntemi türlerinden maksimum çeşitlilik örneklemesine göre seçilmiş 5 okul müdürü, 7 müdür yardımcısı olmak üzere 12 okul yöneticisi ile, 12 branş öğretmeni oluşturmuştur. Veriler, yarı yapılandırılmış görüşme formu ile elde edilmiş, içerik analizi kullanılarak çözümlenmiştir. Araştırmanın birinci alt probleminde yöneticilerin kendi aralarındaki çatışma nedenlerinin; görev ve sorumluluklardan kaynaklanan çatışma nedenleri, amaç, fikir ve görüş ayrılıklarından kaynaklanan çatışma nedenleri ve iletişimden kaynaklanan çatışma nedenleri olduğu anlaşılmıştır. Araştırmanın ikinci alt probleminde yöneticilerin kendi aralarındaki çatışmaların önlenmesi için alınacak önlemlerin; çatışma yönetiminin bilinmemesi ile ilgili alınacak önlemler, görev ve sorumluluklar ile ilgili alınacak önlemler ve iletişim ile ilgili alınacak önlemler olduğu sonucuna ulaşılmıştır. Araştırmanın üçüncü alt probleminde ise, öğretmen ve yönetici görüşlerine göre yöneticilerin kendi aralarındaki çatışmalarının öğretmenlerin motivasyonları ile görev ve sorumlulukları üzerinde olumsuz yönde çok sayıda farklı etkilerinin bulunduğu bulgularına ulaşılmıştır.
Materialism and Compulsive Buying: A Moderated Mediation Model of Impulsive Buying and Religiosity
Authors: ÖZDEMİR Neslişah
Published: October 2022

In the modern consumer society, compulsive buying as an unrestrained buying behavior has become widespread among university students. Therefore, it is essential to determine the factors that influence the compulsive buying behavior of students. In this vein, this study has two purposes. Firstly, this study aims to examine the mediating role of impulsive buying between materialism and compulsive buying. Secondly, it aims to investigate whether religiosity moderated this mediated relationship. For these purposes, data were obtained from 344 university students by online survey method. The moderated mediation analysis was performed using the PROCESS macro proposed by Hayes (2013). According to the results, it was revealed that materialism had a positive effect on impulsive and compulsive buying. Moreover, it was found that impulsive buying had a mediating role in the relationship between materialism and compulsive buying. However, the mediating role of impulsive buying between the relationship between materialism and compulsive buying was not moderated by religiosity. This study contributes to the body of knowledge by revealing the mechanism between materialism and compulsive buying behavior. In terms of addressing the moderator role of religiosity, it contributes to the endeavors of researchers who seek to investigate the role of religiosity in consumer behavior.
Hubungan Beban Kerja Fisik dan Durasi Kerja dengan Kejadian Heat Strain Pada Pekerja Industri Kerupuk
Authors: Anggraini Merry Tiyas
Published: October 2022

Pekerja industri kerupuk terutama industri informal memberikan beban kerja fisik rangkap dan durasi kerja lebih dari 8 jam pada pekerjanya, lingkungan kerja yang panas memberikan beban kerja menjadi lebih berat. Sehingga banyak pekerja di industri kerupuk yang mengeluhkan suhu yang terlalu panas, keringat berlebihan, dan rasa haus. Keluhan tersebut merupakan respon fisiologis manusia yang bertujuan untuk mengurangi panas dari tubuh setelah menerima efek paparan panas yang disebut dengan heat strain. Hal tersebut dapat memberi dampak akut maupun kronis bagi tubuh melalui fisik atau kejiwaan. Efek yang muncul beragam, mulai gejala kemerahan di tubuh, tidak sadarkan diri, sampai keluhan berat seperti keringat berhenti keluar dan terjadi heat stroke. Tujuan penelitian ini untuk menganalisis hubungan durasi kerja dengan kejadian heat strain pada pekerja industri kerupuk. Jenis penelitian yang digunakan dalam penelitian ini adalah observasional analitik dengan pendekatan cross-sectional. Sampel minimal adalah 40 orang dengan teknik total sampling. Alat yang digunakan meliputi kuesioner Heat Strain Score Index (HSSI), lembar wawancara untuk mengetahui durasi kerja dan beban kerja fisik dengan menghitung frekuensi denyut nadi secara manual. Penelitian ini menggunakan uji statistik Chi-square. Didapatkan hubungan antara beban kerja fisik (p=0,001, nilai PR=2,231) dengan kejadian heat strain dan durasi kerja (p=0,003, nilai PR=2,143) dengan kejadian heat strain. Terdapat hubungan signifikan antara beban kerja fisik dan durasi kerja dengan kejadian heat strain pada pekerja industri kerupuk. Kesimpulan pada penelitian ini bahwa beban kerja fisik dan durasi kerja merupakan faktor risiko munculnya kejadian heat strain.
Peran Tokoh Agama Dalam Pencegahan COVID-19: Studi Literatur Review
Authors: PATNI PUTRI DIYAH , Anshari Dien
Published: October 2022

Meningkatnya ketidakpatuhan masyarakat dalam melaksanakan protokol kesehatan menyebabkan terjadinya peningkatan kasus COVID-19 di Indonesia, serta masih besarnya pengaruh peran tokoh agama dalam mempengaruhi sikap dan perilaku masyarakat dalam pengambilan keputusan, khususnya di bidang kesehatan. Hal tersebut menyebabkan tokoh agama berpotensi untuk ikut berkontribusi dalam mencegah COVID-19. Penelitian ini bertujuan untuk mengkaji artikel secara global terkait peran tokoh agama dalam upaya pencegahan COVID-19. Metode yang digunakan dalam penelitian ini adalah literature review, dengan menggunakan metode PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses). Artikel dicari menggunakan kata kunci yang disesuaikan dengan topik penelitian. Selain itu juga disesuaikan dengan kriteria inklusi yang dibuat oleh peneliti. Hasil penelitian memuat 10 artikel yang diseleksi baik secara nasional maupun internasional, dalam bahasa Indonesia dan bahasa Inggris serta dengan rentang waktu artikel antara tahun 2016-2021. Selanjutnya, 10 artikel tersebut ditinjau dan dianalisis. Kesimpulan dari penelitian ini adalah banyak peran yang dapat dilakukan oleh tokoh agama yaitu sebagai pemberi fatwa, komunikator dalam memberikan edukasi dan sosialisasi terkait COVID-19 dan  sebagai tauladan di masyarakat . Peran tersebut dapat dimaksimalkan oleh pemerintah dan para tokoh agama dalam upaya pencegahan COVID-19 di masyarakat.
Pengaruh Pendidikan Pencegahan Stunting Terhadap Pengetahuan Kader Posyandu
Authors: Tri Astuti Dian Septyana
Published: October 2022

Stunting is a chronic nutritional problem characterized by a short body (stunted). Health education is held as a learning effort to improve the Posyandu cadres’ knowledge of stunting prevention. The Posyandu cadres’ role is vital to the early prevention of stunting. This study aimed to figure out the influence of health education on Posyandu cadres’ knowledge of stunting prevention in Keniten urban village, Ponorogo. This study used pre-experimental designs, namely a one-group pretest-posttest design. The sampling technique used in this study was total sampling with 35 samples in total. The data collection method was questionnaires. The statistical test was done using the Wilcoxon test. The result showed a significant improvement in the cadres’ knowledge level before and after giving health education with an average score of 81 increased to 90. The statistical test result showed a p-value of 0.005 (≤0.05), indicating a significant effect of health education on Posyandu cadres’ knowledge level of stunting prevention in Keniten urban village. The improvement on posyandu cadres’ knowledge of stunting prevention level happens due to health education. Providing information on stunting prevention or conducting training regularly by the Community Health Center to the Posyandu cadres to improve their knowledge to be better.
Características sociodemográficas, estado de saúde e capacidades de autocuidado de cuidadores familiares primários de pessoas idosas
Authors: Silva José Vitor da , Dias Bruno Vilas Boas , Nascimento Murilo César do , Melo Jessica Luanda Lemos , Francisco Rodolfo , Fava Silvana Maria Coelho Leite , Reis Rogério Donizeti
Published: October 2022

Introdução: O cuidador informal familiar primário requer para si próprio, em seu cotidiano, uma série de demandas que pode prejudicar o autocuidado. Objetivo: Identificar as características sociodemográficas e de saúde, dos cuidadores informais familiares primários de pessoas idosas e avaliar as capacidades de autocuidado. Métodos: Estudo quantitativo, descritivo e transversal, com 50 cuidadores, familiares primários de pessoas idosas. A amostragem foi não probabilística do tipo snow-ball. Utilizaram-se dois instrumentos: Caracterização Sociodemográfica e de Saúde do Cuidador e a Escala para Avaliar as Capacidades de Autocuidado (ASA-A). Para a análise dos dados, utilizou-se a estatística descritiva; para as variáveis categóricas e contínuas. Da estatística inferencial, empregou-se o coeficiente de alfa de Cronbach. Resultados: 62% dos participantes foram homens, idade média = 40,7 anos (DP= 15,8), com ensino fundamental incompleto (60%), casados (60%) e empregados (64%). As capacidades de autocuidado obtiveram média = 64,48 ± 17,76). Conclusão: Na condição de cuidador informal familiar primário, prevaleceram adultos do sexo masculino e com autocuidado em nível regular.
Objetivando subjetividades nos agenciamentos da enfermagem na gestão do centro cirúrgico: estudo observacional
Authors: Meneses Ricardo de Oliveira , Dias Nathalia Roberta Azevedo , Araújo Silvia Teresa Carvalho de , Fassarella Cintia Silva , Pinto Cecília Maria Izidoro , Figueiredo Nébia Maria Almeida de
Published: October 2022

Objetivo: Rastrear os agenciamentos político-organizacionais a que são submetidos a equipe de enfermagem durante seu processo de trabalho no espaço do centro cirúrgico. Métodos: Estudo descritivo, observacional quanti-qualitativo, utilizando-se das pistas 2, 3 e 5 da cartografia. O centro cirúrgico de um hospital universitário foi o cenário da coleta de dados de junho a setembro de 2021 pelos diários de campo. Observaram-se 32 intervenções cirúrgicas com 89 membros da equipe de enfermagem de um universo de 161. Resultados: Na sala de operações, 97,67% são técnicos de enfermagem com uma média de três membros por cirurgia. A urologia foi a especialidade mais frequente e a maioria ocorreu em período diurno. O tempo em sala de operações foi de 4h25’56”em média. Os agenciamentos capturados nas observações destacaram que a equipe médica é imperativa aos fluxos gerados, além da falta e falha como elementos molares-moleculares da instituição e da equipe. Conclusão: Gerir é um território/ato de enfermagem no centro cirúrgico durante ocorrências, falhas, desorganizações e faltas, mas atitudinalmente determinante para efetivação de ações molares do que está planejado dentro da organização político-institucional, considerando que o gerir de dentro das salas é do técnico de enfermagem e o de fora é do enfermeiro.
Influências da religiosidade e espiritualidade para o cuidado e autocuidado de pessoas com estomia intestinal
Authors: Ribeiro Wanderson Alves , Andrade Bianca Ribeiro Porto de , Souza Norma Valéria Dantas de Oliveira , Espírito Santo Fátima Helena do , Andrade Marilda , Santos Larissa Christiny Amorim dos
Published: October 2022

Objetivo: Descrever as influências da religião e da espiritualidade para o autocuidado da pessoa com estomia intestinal. Métodos: Estudo qualitativo, descritivo e exploratório, realizado em um Núcleo de Atenção à Saúde da Pessoa Estomizada, localizado no município de Niterói, Estado de Rio de Janeiro, cujos participantes foram 32 pessoas com estomias intestinais. A técnica de coleta foi a entrevista semiestruturada e o tratamento dos dados ocorreu por meio da técnica de análise de conteúdo. Resultados: Aplicação dessa técnica fez emergir 28 unidades de registro agrupadas em três: 1) aceitar a vontade de Deus; 2) a estomia intestinal e a fé para viver; 3) as rezas, orações e a religião. Conclusão: Este estudo evidenciou que a espiritualidade e a religiosidade são relevantes elementos para a aceitação da nova condição de saúde e para o desenvolvimento do autocuidado. Ademais, caracterizam-se como amenizadoras do sofrimento psíquico pelas perdas advindas da confecção da estomia.
Stress - An overview
Authors: Mahmud Arif , Azad Alya Fardous
Published: October 2022

Background: Stress can be described as a circumstance that disturbs or is likely to disturb the normal physiological or psychological functioning of a person. It may seem that there's nothing one can do about stress. But in fact the control can be more than one can think about.

Objective: Create awareness about psychological support in work-life balance, reduced stress levels at work and at home, greater focus and concentration, participate more fully in family and social life, pursue personal goals and hobbies, improved health.

Conclusion: The simple realization that one can be in control of his/her life is the foundation of stress management.

Pulse volumel.11 January-December 2018-2019 p.4-6
Sepsis: Updates
Authors: Noor Md Mahbub
Published: October 2022

Sepsis is a life-threatening organ dysfunction that results from the body's response to infection. To protect against sepsis prompt recognition, careful hemodynamic support, appropriate antibiotics, and control of the source of infection are required. With the trend in management, one should understand sepsis physiology and follow the best practice guidelines. Sepsis and particularly septic shock should be recognized as medical emergency as in stroke and acute myocardial infarction. Early recognition and rapid institution of resuscitative measures are critical. Although recognition of sepsis can be a challenge and the best management practices continue to evolve. This article reviews guidance on the diagnosis and management of sepsis and septic shock with attention to maximizing adherence to best practice and controversies in definition, diagnostic criteria, and management.

Pulse volumel.11 January-December 2018-2019 p.7-12
A Young Boy with Severe Leptospirosis (Weil's Disease): A Case Report
Authors: Ayrin Nur Nahar , Afsar Nikhat Shahla , Lslam Anita Marium , Nowreen Nusrat , Ahmad Borhan Uddin
Published: October 2022

Leptospirosis, a zoonotic disease is increasingly being recognized in developing countries. It is often underdiagnosed resulting in significant mortality as the presenting features mimic other commonly prevailing diseases like Malaria, Dengue, Acute hepatitis, Typhoid in developing world. We are reporting a case of 16 years old male student presented with acute febrile illness with icterus, hemorrhagic manifestation and pulmonary-renal involvement, diagnosed as Severe Leptospirosis (Weil's disease) confirmed by ICT method. This experience highlights the importance of considering Leptospirosis early in the diagnosis of acute nonspecific febrile illness with multi-organ involvement to cutoff mortality from this fatal disease.

Pulse volumel.11 January-December 2018-2019 p.22-26
A case of ventricular septal rupture complicating acute myocardial infarction - A rare lethal entity posing big challenge to surgeon
Authors: Hossain Mohammad Delwar , Nine Palash SMA Zulker , Mehar Tahera , Ahmed Niaz , Ahmed Sohail , Haider Md Zulfiqur
Published: October 2022

Rupture of the ventricular septum, a rare but potentially fatal complication of acute myocardial infarction, is usually observed in the setting of acute myocardial infarction associated with major coronary artery occlusion. It is often accompanied by severe circulatory failure. In this paper we describe a case of a 70-year-old lady who presented with cardiogenic shock 7 days after acute myocardial infarction and was found to have ventricular septal rupture.

Pulse volumel.11 January-December 2018-2019 p.27-32
CME Vol 11
Authors: Hussain Raihan
Published: October 2022

Abstract not available

Pulse volumel.11 January-December 2018-2019 p.38-42
Estrategias de marketing digital y su incidencia en el crecimiento sostenible de la micro y pequeña empresa: Análisis de casos
Authors: Cahui Torres Licely Patricia , Fernandez Sanchez Diego Gonzalo
Published: October 2022

La presente investigación muestra información relevante para poder adentrarnos en la situación actual de las mypes en América Latina, respecto al uso de estrategias de marketing digital. El interés de poder explorar este tema se da debido a la relevancia del uso de medios digitales, puesto que en la actualidad aún muchas de las micro y pequeñas empresas tienen temor a ingresar en estas áreas, esto debido a que tienen un conocimiento limitado de sus propiedades y de su manejo. Con esta investigación, se busca impulsar la continua adopción de estas herramientas digitales, aplicando soluciones apropiadas de comercialización electrónica que garanticen el éxito sostenido del negocio en el tiempo y que así estén preparados frente a los desafíos del entorno. Para la selección de las fuentes bibliográficas se utilizaron diferentes filtrados, precisando elegir investigaciones concordes a nuestro tema de estudio que hayan sido publicadas desde el año 2016 hasta el año 2021. Al final de este proceso se obtuvo un total de 12 artículos de revistas indexadas, 2 tesis de pregrado y 1 libro. Según los resultados encontrados, se puede observar que, en la mayoría de los países analizados, son las grandes empresas las que mejor y mayor beneficio han obtenido del marketing digital, por otro lado, las micro y pequeñas empresas aún no han podido aplicar eficientemente este tipo de herramientas digitales, debido al grado de desconocimiento de estas y también por la escasez de su presupuesto.
Tasa-arvoa, yhdenvertaisuutta ja oikeuksia edistävä peruskoulu? Oikeudelliset normit osana koulutuksellisen oikeudenmukaisuuden uudelleenmäärittelyä
Authors: Pynnönen Larimatti , Kallo Johanna , Silvennoinen Heikki
Published: October 2022

Artikkelissa tarkastellaan muutosta perusopetuksen opetussuunnitelman perusteiden käsiteavaruudessa. Aineistona ovat vuoden 2004 ja 2014 perusopetuksen opetussuunnitelman perusteet, vuoden 2014 perusopetuksen opetussuunnitelma-uudistusta koskeva muistio sekä perusopetusta, tasa-arvoa ja yhdenvertaisuutta koskeva lainsäädäntö. Analysoimme käsitteellistä muutosta määrällisesti ja laadullisesti ottaen huomioon myös käsitteiden historialliset kerrostumat. Analyysi paljastaa taitekohdan suomalaisen peruskoulun yhteiskunnallista tehtävää koskevassa määrittelyssä: koulutuspoliittisiksi tavoitteiksi tasa-arvon rinnalle ovat nousseet yhdenvertaisuus ja yksilölliset oikeudet. Keskitymme erityisesti yhdenvertaisuuteen, joka kamppailee pitkään koulutuspolitiikan keskiössä olleen tasa-arvo-käsitteen kanssa asemasta keskeisimpänä arvona, periaatteena ja tavoitteena. Taitekohdassa yhteiskuntafilosofinen tasa-arvon käsite kohtaa oikeudellisesta perinteestä juontuvan yhden-vertaisuuden periaatteen. Analysoimme havaittua muutosta liberalististen poliittisten rationaliteettien sekä Nancy Fraserin kolmiulotteisen oikeudenmukaisuus-käsityksen viitekehyksessä. Havaittu muutos ilmentää tasa-arvopoliittista siirtymää kohti hajautettua ja pehmeän säätelyn keinoin ohjautuvaa uus-liberalistista hallintotapaa sekä oikeudenmukaisuuden tun-nustuksen ulottuvuuteen painottuvaa tasa-arvon edistämistä, jossa kouluyhteisöt ja yksilöt vastuutetaan tasa-arvon edistäjiksi ja eettisiksi toimijoiksi.
Otizmli Çocuğa Sahip Ailelerin Finansal Yüklerine İlişkin Deneyimleri
Authors: Toper Ferhat , Özkan Yasemin
Published: October 2022

Otizm, sosyal yetenek, sosyal aktivite, iletişim ve hayal gücündeki bozukluklar ile tekrarlayan kısıtlı davranış kalıplarıyla ilişkili nöro-gelişimsel bir bozukluktur. Son yıllarda otizmin küresel yaygınlığının artması otizmli bireyler ve ailelerini odak alan çalışmaların öneminin artmasına neden olmuştur. Zira otizm sadece bireyi değil başta ailesi daha sonra yakın çevresini etkileyen gelişimsel bir bozukluktur. Otizmli çocuğa sahip aileler birçok zorlukla karşı karşıyadırlar ve bu zorluklardan belki de en önemlisi olan finansal zorluklar ailelerin yaşadığı birçok zorlukla da doğrudan ilişkilidir. Bu çalışmanın amacı otizmli çocuğa sahip ailelerin tan, tedavi, eğitim, terapiler ve diğer hesap dışı harcamalar dolayısıyla karşı karşıya oldukları finansal zorluklara ilişkin deneyimlerini anlamaktır. Bu doğrultuda tıbbi olarak otizm tanısı almış 18 yaş altı bireylerin ebeveynleri ile nitel bir araştırma olarak tasarlanmıştır. Çalışmaya 20 ebeveyn ve otizm alanında çalışan farklı meslek elemanlarından 17 profesyonel katılmış ve kendileri ile yarı yapılandırılmış görüşme formları aracılığıyla derinlemesine görüşmeler gerçekleştirilmiştir. Elde edilen verilen MAXQDA 2020 programı aracılığı ile analiz edilerek literatüre uygun ve anlaşılır bir dille açıklanmıştır. Aileler tanı, tedavi, eğitim ve rehabilitasyon harcamaları konusunda ciddi mali zorluklarla karşı karşıyadır. Bunlara ek olarak diyet ve diğer sağlık hizmetleriyle ilgili harcamalar aileleri finansal açıdan yıpratmaktadır.
Ortaçağ’dan Günümüze Çocuk Terki Uygulamaları
Authors: Yaman Fikret
Published: October 2022

Modern dönemde, çocuk terki ile mücadelede ön plana çıkan anonim çocuk terki uygulamalarını özellikle de bebek kutuları yöntemini doğru bir şekilde anlamak ve anlamlandırabilmek için bu uygulamaların ortaya çıktığı zeminin ve aktörlerinin bilinmesi gerekmektedir.
Kilise tarafından Ortaçağ’da çocuk terkinin ve ölümlerinin önlenmesi amacıyla başlatılan buluntu kutuları, farklı isimler altında günümüze kadar devam etmiş ve Dünyanın birçok ülkesine yayılmıştır. Bebek kutuları ile aynı kurguya sahip olan anonim doğum ve güvenli liman yasaları, anneler başta olmak üzere çocuğun yasal sorumluluğunu taşıyan kişilere hukuken çocuklarını terk etme ve ebeveynlik yükümlülüklerinden kurtulma imkânı tanımaktadır.
Bu çalışmanın amacı, istenmeyen çocukların hayatını kurtarma iddiasıyla hareket eden modern dönemdeki çocuk terki uygulamalarını tarihsel bağlamı içerisinde ele alarak okuyucuya çocuk korumanın tarihi konusunda bir bakış açısı sunmaktır.
New approaches to immunotherapy in house dust mite allergy
Authors: Kim In Sik
Published: October 2022

Allergen immunotherapy (AIT) has developed over the last few decades and has emerged as a promising treatment. House dust mite (HDM) is a target allergen in AIT, and various modified HDM allergens have been improved for their efficacy. Moreover, clinical trials have proved their significantly therapeutic effects in allergy. This article review focuses on HDM allergens developed for AIT efficacy, and determines that their action mechanisms are strongly based on immune tolerance. Treatments for HDM allergens have been optimized by modification or/and addition of adjuvants, and clinically evaluated by subcutaneous and sublingual administration. Representative allergens used in AIT are chemically modified allergoids and recombinant allergens, including altered epitopes. The effective mechanisms subsequent to AIT include the suppressive actions of interleukin-10 and transforming growth factor-β secreted by regulatory cells, including regulatory T cells and regulatory B cells, and isotype switching from immunoglobulin E to immunoglobulin G4. Further studies of AIT are needed to achieve the milestone in treating allergies.
Biological responses of the predatory blue crab and its hard clam prey to ocean acidification and low salinity
Authors: Longmire KS , Seitz RD , Seebo MS , Brill RW , Lipcius RN
Published: October 2022

How ocean acidification (OA) interacts with other stressors is understudied, particularly for predators and prey. We assessed long-term exposure to decreased pH and low salinity on (1) juvenile blue crab Callinectes sapidus claw pinch force, (2) juvenile hard clam Mercenaria mercenaria survival, growth, and shell structure, and (3) blue crab and hard clam interactions in filmed mesocosm trials. In 2018 and 2019, we held crabs and clams from the Chesapeake Bay, USA, in crossed pH (low: 7.0, high: 8.0) and salinity (low: 15, high: 30) treatments for 11 and 10 wk, respectively. Afterwards, we assessed crab claw pinch force and clam survival, growth, shell structure, and ridge rugosity. Claw pinch force increased with size in both years but weakened in low pH. Clam growth was negative, indicative of shell dissolution, in low pH in both years compared to the control. Growth was also negative in the 2019 high-pH/low-salinity treatment. Clam survival in both years was lowest in the low-pH/low-salinity treatment and highest in the high-pH/high-salinity treatment. Shell damage and ridge rugosity (indicative of deterioration) were intensified under low pH and negatively correlated with clam survival. Overall, clams were more severely affected by both stressors than crabs. In the filmed predator-prey interactions, pH did not substantially alter crab behavior, but crabs spent more time eating and burying in high-salinity treatments and more time moving in low-salinity treatments. Given the complex effects of pH and salinity on blue crabs and hard clams, projections about climate change on predator-prey interactions will be difficult and must consider multiple stressors.
Hypertension Care: It’s Time to Act
Authors: McEvoy Lynda
Published: October 2022

The satellite symposium was held in two separate sessions – the first a traditional symposium format, and the second as an interactive panel discussion in which the faculty answered questions from the delegates. The symposium objectives included consideration of the impact of suboptimal blood pressure (BP) control on the high levels of cardiovascular (CV) events in Europe; evaluation of the importance of patient adherence in improving management of BP; consideration of the management of treatment-resistant patients; discussion of a new initiative to drive improved management of hypertension; and how angiotensin receptor blocker (ARB)-based treatments and single-pill combinations may be used to treat hypertensive patients. Professor Burnier discussed the difficulties associated with achieving good BP control in the primary care setting and highlighted the utility of single-pill fixed-dose combinations (FDCs) for improving adherence and BP normalisation. Professor Ruilope discussed the clinical work-up and management of patients with treatment-resistant hypertension, while Professors Schmieder and Weiss outlined some initiatives taking place that aim to improve BP control rates. Finally, Professor Volpe described an ARB-based treatment platform which shows how patients can be effectively treated with single-pill combination therapy.
Recurrent Coronary Perforations in an Aneurysmal Coronary Artery Treated with Covered Stent
Authors: Prashant Ponangi Udaya
Published: October 2022

An elderly hypertensive lady presented to us with acute coronary syndrome; an angiogram revealed total thrombotic occlusion of large left circumflex artery. After thrombosuction, there was proximal tight stenosis followed by an aneurysmal segment of the culprit vessel that was stented successfully. Subsequent post-dilatation at the site of aneurysm produced a large perforation, which was sealed off immediately with a covered stent. Unfortunately, the patient had sudden cardiac tamponade and arrest later in the intensive cardiac care unit due to repeat perforation, and could not be resuscitated from this complication. Aneurysmal and ectatic arteries have fragile walls and aggressive post-dilatation for achieving optimal stent apposition should be avoided.
Near Circumferential Invasive Proliferative Gelatinous Mass in the Calf: An Unusual Presentation of Hidradenitis Suppurativa
Authors: Jia Janice Tan Shih , Ts’ung Tay Hsien
Published: October 2022

Hidradenitis suppurativa, or acne inversa, is a chronic, recurrent inflammatory disease of the skin and subcutaneous tissue, and is characterised by painful, recurrent nodules that results in abscesses and formation of chronic draining sinus tracts and scarring. It has been traditionally described as a disease of the apocrine gland. Present evidence, however, suggests it is a disease of the follicular epithelium and the pathogenesis is complex and multifactorial, implicating genetics, microbiome, physiological, and environmental factors. Recently, several cases of apparent hidradenitis suppurativa have been reported in the literature in areas of the body that defy Dessau’s typical topographic criteria. Herein, the authors described an unusual case of a 69-year-old female who presented with hidradenitis suppurativa in her calf post-thermal injury. This case will add to the sparse literature on hidradenitis suppurativa in apocrine-devoid sites and lends credence to the argument that the pathogenesis of hidradenitis suppurativa is multifactorial and complex in nature.
IL-23 Inhibition: From Pathophysiological Jungle to Clinical Clearance
Authors: Breuer Megan
Published: October 2022

The symposium “IL-23 Inhibition: From Pathophysiological Jungle to Clinical Clearance” took place during the 2019 annual European Academy of Dermatology and Venereology (EADV) congress in Madrid, Spain. The presentations gave an overview of how to navigate the complexities of the psoriasis treatment landscape, including updates on the newest developments in psoriasis, from pathophysiological considerations to clinical relevance, with a focus on how insights from recent trials can be applied in daily clinical practice.

Prof Reich discussed the pathophysiology of psoriasis and the scientific rationale for using different classes of biologics. It is likely that IL-17 and IL-23 have differential roles in psoriasis and psoriatic arthritis (PsA) disease domains, and these different mechanistic roles translate into differences in clinical behaviour of respective inhibitors.

Analyses of clinical trial data, as presented by Prof Warren, show that treatment with IL-23 inhibitors results in high levels of efficacy that can be maintained for up to 3 years, with extended maintenance of 90% reduction in the Psoriasis Area and Severity Index (PASI) 90 responses after treatment withdrawal. Furthermore, the majority of patients report improvements in quality of life during treatment, with improved Dermatology Life Quality Index (DLQI) scores after 1 year of treatment. IL-23 inhibitors are a safe treatment option for patients with psoriasis, as evidenced by data produced by long-term extension and randomised clinical trials.

Prof Kirby shared his experiences managing patients with specific clinical challenges and comorbidities, such as PsA, obesity, cardiovascular diseases, psychological disorders, and inflammatory bowel disease (IBD). Current evidence indicates that IL-23 may be an attractive treatment target for disease and comorbidity management. A multidisciplinary approach to the management of psoriasis and its associated comorbidities is therefore recommended.
Treatment of Atopic Dermatitis Using JAK Inhibitors: A Systematic Review
Authors: Siedlikowski Stefan , Sandhu Vijay , Lynde Charles
Published: October 2022

Background: The advent of JAK inhibitors (JAKi) has significantly modernised the treatment of atopic dermatitis (AD), offering a novel approach to treating this recalcitrant dermatological condition. Although topical treatment is shown to be effective, oral formulations are yet to be widely utilised in the treatment of AD.

Objectives: To review the efficacy, safety, and tolerability of JAKi in the treatment of AD.

Methods: A PRISMA systematic review of several databases was conducted: Cochrane Skin Specialised Register, Cochrane Central Register of Controlled Trials, Ovid Medline and Embase, LILACS, and Global Resource of EczemA Trials. Five clinical trial archives were also consulted. The following resources were manually searched: conference proceedings of the American Academy of Dermatology (AAD), FDA.gov, the European Medicines Agency (EMA), and Epistemonikos.

Results: Of the 34 articles meeting inclusion criteria, 6 were chosen for final qualitative review. A total of 827 patients were pooled from 5 randomised controlled trials and 1 cohort study. Improvements in objective and subjective scoring indices were observed in patients receiving topical or oral JAKi. Overall safety and tolerability were satisfactory in JAKi treatment.

Limitations: Due to the scarcity of randomised controlled trials and the small sample sets in the studies, a meta-analysis was not conducted.

Conclusions: Preliminary investigations show promising results for patients with AD treated with oral or topical JAKi. However, existing gaps should be addressed with more extensive and long-term trials before JAKi become a standard treatment for AD.
IL-23 Inhibition in Psoriasis: A Novel Approach to Convenient, Consistent Clearance
Authors: Saul Helen
Published: October 2022

Prof Reich outlined our latest understanding of relevant psoriasis pathophysiology. Psoriasis was believed to be a skin disease mediated by T helper cell 1 (Th1 cell) 20 years ago; it has now been shown to be driven by Th17 cells, which are stimulated by a number of proinflammatory cytokines, among which IL-23 is overexpressed. Characteristics of the individual antibodies determine clinical properties. IL-23 inhibitors have long injection intervals, and inhibit more regulatory than effector cytokines.

Prof Strober reviewed key clinical data on IL-23 inhibitors including that from VOYAGE 1 and 2, NAVIGATE, and ECLIPSE for guselkumab; reSURFACE 1 and 2 for tildrakizumab; and ultIMMa-1/2 and IMMvent for risankizumab. Taken together, the many comparator studies suggest that the IL-23 inhibitors deliver robust and long-lasting efficacy, with long treatment intervals and with relative safety; there are few contraindications to use an IL-23 inhibitor. Prof Strober said he believes that, over time, this class will replace ustekinumab and become the first-line therapeutic approach in psoriasis.

Prof Conrad gave an overview of patients’ needs and the drug, patient, and disease-related factors to be considered when choosing a therapy from the increasing numbers available. He stressed that no single agent or class is appropriate for all patients and that, in many instances, traditional anti-TNF are being superseded in terms of both efficacy and safety by newer drugs. Data on some disease-related factors, e.g., the presence of psoriatic arthritis, however, support the use of anti-TNF. Prof Conrad outlined his considerations regarding drug choice for patients with conditions such as pregnancy, inflammatory bowel disease (IBD), latent tuberculosis (TB), or hepatitis B virus (HBV).
Serum Sickness-Like Reaction in Children: Review of the Literature
Authors: Del Pozzo-Magaña Blanca R. , Lazo-Langner Alejandro
Published: October 2022

Serum sickness-like reaction (SSLR) is an acute inflammatory condition affecting children and adults characterised by the development of erythematous skin lesions and joint swelling with or without fever. Although these features resemble the ones seen in patients with classic serum sickness, the precise pathophysiology of SSLR remains unclear. It is considered that drugs, usually β-lactam antibiotics, and some infectious agents can trigger an immunologic reaction that leads to these clinical manifestations. This condition is usually under-recognised or mistakenly diagnosed as other conditions (e.g., urticaria, urticaria multiforme, reactive arthritis, erythema multiforme) and therefore infrequently reported. Until now, there was no standardised treatment for this condition and controversy regarding the use of antihistamines, nonsteroidal anti-inflammatory drugs, and oral corticosteroids remains. Most of the current literature on SSLR is based on occasional case reports series. The main objective of this manuscript is to offer an organised and updated review of the clinical features and current treatment options for paediatric SSLR, useful for physicians and other health professionals with interest in paediatrics and adverse drug reactions.
IL-23 Inhibitors for Moderate-to-Severe Plaque Psoriasis: A Review of Clinical Efficacy, Safety, and Tolerability
Authors: Amin Sima D. , Silfvast-Kaiser Annika S. , Yeon Paek So , Kivelevitch Dario , Menter Alan
Published: October 2022

Psoriasis is a chronic, immune-mediated skin condition with systemic involvement, frequently requiring long-term treatment. At present, there are 11 biologic agents available for the treatment of moderate-to-severe psoriasis, which target specific inflammatory cytokines involved in the immunopathogenesis of the disease. Among these, three monoclonal antibodies specifically inhibit the p19 subunit of IL-23. IL-23 is a heterodimeric cytokine consisting of two subunits: IL-23p19 and IL-23p40. IL-23 plays a key role in the immunopathogenesis of psoriasis by activating Th17 cells, leading to stimulation of downstream cytokines involved in the systemic inflammation and keratinocyte hyperproliferation observed in psoriasis. Overall, the anti-IL-23 agents demonstrate rapid clinical improvement along with a favourable safety profile. This review has analysed data on the clinical efficacy, safety, and tolerability of the three IL-23 agents (tildrakizumab, guselkumab, and risankizumab) in the treatment of moderate-to-severe plaque psoriasis.

INTRODUCTIO
Patients Understanding of Diabetes and Self-Management in Kigali University Teaching Hospital (CHUK)
Authors: Makiriro Gabriel , Mugeni Regine , Kailani Leway
Published: October 2022

Non-communicable diseases, including diabetes, account for 36% of total deaths in Rwanda.  Integration of diabetes self-management education improves patient glycemic control. This study assessed the understanding of diabetes and self-care practices among patients who have diabetes at Kigali University Teaching Hospital (Centre Hospitalier Universitaire de Kigali: CHUK). A descriptive cross-sectional study was conducted on people with diabetes attending CHUK from December 18th, 2017, to April 30th, 2018. Ninety-five participants were enrolled in this study, with a mean age of 56 years. 87.4% of participants had type 2 diabetes, 85.3% received information on diabetes from medical staff, and 40.0% had diabetes for less than 5 years. The mean knowledge score among the participants was 12.2±2.2/20 (range 5-16), however, the majority of participants did not know the etiology of diabetes and 45.3% did not know the role of the urine test. Only 36.8% of participants knew the recommended diabetic meal plan and 47.4% knew the normal fasting blood glucose range.  The mean score for attitude and practice towards diabetes were respectively 5.2±1.0/6 and 6.2±1.4/10.  Poor practice was observed in physical activity where 49.5% of participants never exercised.  There was good knowledge, attitude, and practice regarding diabetes and self-management among participants in general. However, there exists inadequate knowledge on the etiology of diabetes, the role of regular urine tests, fasting blood glucose normal values and diabetic meal plan, and poor practice of exercise among participants. Programs that promote awareness of diabetes and self-management education among patients with diabetes should be developed, enhanced, and utilized for better disease control.
Evaluating the impact of model village project in Nyamasheke district: Special references of Gihombo and Kirimbi sectors
Authors: Sibomana Providence , Karungi Cissy , Munyengabe Sylvestre
Published: October 2022

Project sustainability depends upon beneficiaries’ involvement in its operations which include but not limited to identification, planning, implementation, monitoring, evaluation, reporting etc. One of the most prominent issues of the present times to address is beneficiaries’ involvement. The present study was conducted under guidance of an objective as to determine the extent to which beneficiaries participated in project management and to measure the relationship between beneficiaries’ participation and project sustainability.  The study targeted 500 households headed by vulnerable women located in Gihombo and Kilimbi sectors from Nyamasheke district. By using Slovin’s formula a representative sample of 223 was drawn. The questionnaire was used as an instrument to collect data. The SPSS version 16 was used for descriptive and inferential statistical analyses. The study revealed that beneficiaries participated in all project phases but not in all activities. The beneficiaries’ participation at the initiation phase their involvement in needs assessment was at 54.3%, into the project design, the setting of objectives included beneficiaries at 52.9%.  Along the project implementation, the beneficiaries were poorly involved, only 23.8% were part of buying livestock, 83.4% in information sharing and 74% of the beneficiaries were included in the project reporting. 

After calculating the Spearman correlation by using SPSS, the coefficient is 0.123 which indicates the positive correlation between the beneficiaries’ involvement and project sustainability. The significant value of 0.067 is less than the Spearman correlation coefficient (0.123) which means that the correlation between the two variables is statistically significant.
Methylene blue-guided retroperitoneoscopy technique: alternative for percutaneous nephrolithotomy in cases with renal access failure
Authors: Karadağ Serdar , Ekşi Mithat
Published: October 2022

Objective: To present our ‘methylene blue-guided retroperitoneoscopy technique’ that we apply in cases where extravasation develops for various reasons and is complicated as a result in Percutaneous Nephrolithotomy surgery (PNL). Material and Methods: A total of 36 patients, who underwent PNL with the ‘methylene blue technique’ at Bakirkoy Dr. Sadi Konuk Training and Research Hospital between 2014 and 2020, were retrospectively evaluated. The study included only cases in which the ‘methylene blue-guided retroperitoneoscopy technique’ was used due to the inability to advance the Amplatz sheath to the targeted calyx due to renal scarring or a staghorn stone filling the targeted calyx, Amplatz sheath was withdrawn from the kidney with the guidewire due to the inattention of the assistant surgical team or contrast material extravasation. The patients’ demographic, preoperative, perioperative, and postoperative data were recorded, and stone-free and complication rates were noted. Results: The mean age of the patients was 45.1 (36-55) years, the mean body mass index was 27.8±4 kg/m2, the mean stone size was 3.4±0.7 cm, and the mean stone volume was 22.3±10.2 cm3. The mean operation time was calculated as 95.8±30.3 minutes. The stone-free rate was 68% on the postoperative first day and 75% on the third month. Eight patients (22.2%) underwent a secondary procedure (extracorporeal shock wave lithotripsy or flexible ureterorenoscopy). Conclusion: The ‘methylene blue-guided retroperitoneoscopy technique’ we apply under retroperitoneoscopic direct vision is a safe and practical option for re-accessing the kidney by locating the calyx, which is first partially or completely dilated. Keywords: methylene blue, retroperitoneoscopy, renal access failure, percutaneous nephrolithotomy
Untethered muscle tracking using magnetomicrometry
Authors: Taylor Cameron R. , Yeon Seong Ho , Clark William H. , Clarrissimeaux Ellen G. , O’Donnell Mary Kate , Roberts Thomas J. , Herr Hugh M.
Published: October 2022

Muscle tissue drives nearly all movement in the animal kingdom, providing power, mobility, and dexterity. Technologies for measuring muscle tissue motion, such as sonomicrometry, fluoromicrometry, and ultrasound, have significantly advanced our understanding of biomechanics. Yet, the field lacks the ability to monitor muscle tissue motion for animal behavior outside the lab. Towards addressing this issue, we previously introduced magnetomicrometry, a method that uses magnetic beads to wirelessly monitor muscle tissue length changes, and we validated magnetomicrometry via tightly-controlled in situ testing. In this study we validate the accuracy of magnetomicrometry against fluoromicrometry during untethered running in an in vivo turkey model. We demonstrate real-time muscle tissue length tracking of the freely-moving turkeys executing various motor activities, including ramp ascent and descent, vertical ascent and descent, and free roaming movement. Given the demonstrated capacity of magnetomicrometry to track muscle movement in untethered animals, we feel that this technique will enable new scientific explorations and an improved understanding of muscle function.
Shear-driven modelling of thrombus formation in type B aortic dissection
Authors: Jafarinia Alireza , Armour Chlöe H. , Gibbs Richard G. J. , Xu Xiao Yun , Hochrainer Thomas
Published: October 2022

Background: Type B aortic dissection (TBAD) is a dangerous pathological condition with a high mortality rate. TBAD is initiated by an intimal tear that allows blood to flow between the aortic wall layers, causing them to separate. As a result, alongside the original aorta (true lumen), a false lumen (FL) develops. TBAD compromises the whole cardiovascular system, in the worst case resulting in complete aortic rupture. Clinical studies have shown that dilation and rupture of the FL are related to the failure of the FL to thrombose. Complete FL thrombosis has been found to improve the clinical outcomes of patients with chronic TBAD and is the desired outcome of any treatment. Partial FL thrombosis has been associated with late dissection-related deaths and the requirement for re-intervention, thus the level of FL thrombosis is dominant in classifying the risk of TBAD patients. Therefore, it is important to investigate and understand under which conditions complete thrombosis of the FL occurs.

Method: Local FL hemodynamics play an essential role in thrombus formation and growth. In this study, we developed a simplified phenomenological model to predict FL thrombosis in TBAD under physiological flow conditions. Based on an existing shear-driven thrombosis model, a comprehensive model reduction study was performed to improve computational efficiency. The reduced model has been implemented in Ansys CFX and applied to a TBAD case following thoracic endovascular aortic repair (TEVAR) to test the model. Predicted thrombus formation based on post-TEVAR geometry at 1-month was compared to actual thrombus formation observed on a 3-year follow-up CT scan.

Results: The predicted FL status is in excellent agreement with the 3-year follow-up scan, both in terms of thrombus location and total volume, thus validating the new model. The computational cost of the new model is significantly lower than the previous thrombus model, with an approximate 65% reduction in computational time. Such improvement means the new model is a significant step towards clinical applicability.

Conclusion: The thrombosis model developed in this study is accurate and efficient at predicting FL thrombosis based on patient-specific data, and may assist clinicians in choosing individualized treatments in the future.