bluuebunny/crossref_metadata_2025 huggingface dataset:
SIFIR ATIK YÖNETİMİNİN ÇEVRE ETİĞİ YAKLAŞIMLARI AÇISINDAN İNCELENMESİ
Authors: BİLGİLİ Muhammed Yunus
Published: April 2023

İnsan ihtiyaçlarının karşılanabilmesi amacıyla gerçekleştirilen üretim ve tüketim faaliyetleri atıkların ortaya çıkmasına neden olmaktadır. Atıkların insan ve çevre sağlığını riske atmadan işlenmesi ve/ veya bertaraf edilmesi atık yönetiminin temel amacıdır. Günümüzde birçok ülke, atık kaynaklı risklerin önlenebilmesi adına sıfır atık yönetimini benimsemiştir. Sıfır atık yönetimi kapsamında gerçekleştirilen atıkların yeniden kullanılması, geri dönüştürülmesi ve kazanılması gibi uygulamaların çevresel unsurlar üzerinde çeşitli etkileri bulunmaktadır. Sıfır atık yönetimi kapsamındaki uygulamaların hangilerinin çevre ve insan sağlığı açısından iyi ve doğru olduğunun tespit edilmesine yönelik tartışmalar, konuya insan ve çevre ilişkilerini sistematik bir şekilde inceleyen çevre etiği perspektifinden bakmayı mümkün kılmaktadır. Bu çalışmanın amacı, sıfır atık yönetiminin çevre etiği yaklaşımları açısından incelenmesi ve ilgili yönetimin söz konusu yaklaşımlar içerisindeki konumunun tespit edilmesidir. Çalışma kapsamında, sıfır atık yönetimi ve çevre etiği yaklaşımları incelenmiş, söz konusu atık yönetim sisteminin çevre merkezli etik yaklaşım içerisinde konumlandırılmasının daha doğru bir bakış açısı olacağı tespit edilmiştir.
CDS PRİMLERİ İLE SEÇİLİ BIST ENDEKSLERİ ARASINDAKİ VOLATİLİTE YAYILIMI
Authors: SÖNMEZ Yahya , BAYDAŞ Yunus , KILIÇ Ethem
Published: April 2023

Türkiye gibi gelişmekte olan ülkelerin yabancı yatırımcıya ve dış portföy yatırımcılarına ihtiyacı bulunmaktadır. Finansal piyasaları gelişmekte olan ülkelerde piyasalara olan güven ve şeffaflık oldukça önemlidir. Son yıllarda teknolojik ve inovatif üretim artış bunun önemini daha da arttırmıştır. Finansal oynaklıklara gerçekte nelerin sebep olduğu ciddi derecede araştırma konusu haline gelmiştir. Artan küreselleşme ile birlikte finans piyasalar, finansal oynaklık üzerinde etki gösteren faktördür. Dünya’da meydana gelen bu artışlar belirli bir şekilde piyasaların oynaklığına da yansıtmıştır. Piyasalardaki belirsizlik ve oynaklık yatırımlardaki istikrarı ve belirsizliği de etkilemektedir. Bu çalışmadaki amaç, CDS primleri ve seçili BIST endeksleri arasındaki volatilite yayılımını incelemektir. Değişkenler olarak, beş yıllık temerrüt takasları (CDS), BIST-100 Endeksi (BIST100), BIST-30 Endeksi (BIST30), BIST Banka Endeksi (XBNK), BIST Hizmet Endeksi (XUHIZ) ve BIST Sınai Endeksi (XUSIN) değişkenleri kullanılmıştır. 2010- 2022 dönemine ait günlük veriler kullanılmış olup; Dinamik İlişkili Çok Değişkenli Stokastik Volatilite (DC-MSV) modeli ile ölçülmüştür. Elde edilen sonuçlara göre, CDS primleri, BIST 30, BIST 100, BIST Hizmet (XUHIZ), BIST Banka (XBNK) ve BIST Sınai (XUSIN) endekslerinin volatilitelerinin kalıcı olduğu tespit edilmiştir. Ayrıca, CDS primleri, BIST 30, BIST 100, BIST Hizmet (XUHIZ), BIST Banka (XBNK) ve BIST Sınai (XUSIN) endeks volatilitelerinin öngörülebilir olduğu saptanmıştır.
MAĞAZA ATMOSFERİNİN MARKA EVANGELİZMİ ve POZİTİF WOM ÜZERİNDEKİ ETKİSİ: MÜŞTERİ TATMİNİNİN ARACILIK ROLÜ
Authors: GÜNER Sümer , KURTOĞLU Ramazan
Published: April 2023

Yeni nesil pazarlama anlayışı, salt kâr ve müşteri memnuniyetini sağlamanın ötesinde hizmete yönelik bütün değerlerin birlikte yaratılarak hem işletmelerin hem de müşterilerin kazanım sağladıkları bir yapıya dönüşmüştür. Bu değişim klasik anlayıştan uzaklaşarak işletmelerin yanında tüketicilerin de faal olarak pazarlama etkinliğinin içerisine dâhil edilmesini gerekli kılmıştır. İşletmeninin ürünlerinden memnun olan müşteriler, süreci sonlandırmak yerine ağızdan ağıza iletişim yoluyla memnuniyetlerini paylaşabilmekte hatta bir adım daha ileri giderek evangelist bir tutumla markanın gönüllü savunuculuğunu yapabilmektedirler. İşletmeler, bu sayede müşterilerini tutundurma faaliyetlerinin bir parçası haline getirmiş olmaktadır. Bu çalışmanın amacı, mağaza atmosferinin marka evangelizmi ve pozitif WOM üzerindeki etkisini ve bu etkide müşteri tatmininin aracılık rolünü test etmektir. Bu amaca yönelik olarak daha önce üçüncü nesil kahve mağazalarından hizmet almış bireylerin değerlendirmeleri incelenmiştir. Geliştirilen araştırma modeli, çevrimiçi olarak uygulanan anketlerden elde edilen veriler kullanılarak test edilmiştir. Çalışma sonucunda, mağaza atmosferinin pozitif ağızdan ağıza iletişim (WOM) ve müşteri tatmini üzerinde pozitif yönlü ve anlamlı bir etkisinin olduğu, marka evangelizmi üzerinde ise anlamlı bir etkisinin olmadığı tespit edilmiştir. Ayrıca mağaza atmosferinin marka evangelizmi ve pozitif ağızdan ağıza iletişim (WOM) üzerindeki etkisinde müşteri tatmininin aracılık rolü olduğu da çalışmada ulaşılan bir başka sonuçtur.
YENİ SANAYİLEŞEN ÜLKELERDE (N11) ENERJİ YOKSULLUĞU VE EKONOMİK BÜYÜME İLİŞKİSİ
Authors: ÖZTÜRK Yusuf Kemal , ÇELİK Bekir
Published: April 2023

Ülkelerin ekonomik büyüme hedeflerini gerçekleştirmelerinde enerji önemli bir araçtır. Enerjiye erişim, endüstrileşmenin temel konuları arasındadır. Dolayısıyla yeni sanayileşen ülkelerin (N11) enerji yoksulluğu ile ekonomik büyüme ilişkisinin incelenmesi bu çalışmanın temel amacını oluşturmaktadır. N11 ülkelerinin 2000-2019 dönemine ait verileri; Westerlund panel eşbütünleşme, FMOLS (Fully modified ordinary least squares), DOLS (Dynamic ordinary least squares) ve Dumitrescu-Hurlin nedensellik testleri kullanılarak incelenmiştir. Yapılan analizler sonucunda, enerji yoksulluğu ile ekonomik büyüme arasında eşbütünleşme ilişkisi tespit edilmiştir. Enerji yoksulluğunda yaşanacak %1’lik artışın ekonomik büyümeyi %0.45 (FMOLS), %0.34 (DOLS) artıracağı tespit edilmiştir. Son olarak, enerji yoksulluğu ve ekonomik büyüme arasında çift yönlü nedensellik vardır hipotezi istatistiki olarak anlamlı bulunmuştur. Bu sonuçlardan hareketle, enerji yoksulluğunun azaltılması adına; yenilebilir enerji kaynaklarının artırılması, elde edilen enerjinin etkin ve verimli kullanılması konusunda politika yapıcılara önerilerde bunulmuştur.
DENETİMLİ ÇEVRİMİÇİ SINAV UYGULAMALARI İÇİN WEB TABANLI BİR KONTROL SİSTEMİ: “ERÜ İİBF ONLINE İŞLEMLER SİSTEMİ” ÖRNEĞİ
Authors: GÜNGÖR Sabri
Published: April 2023

2019 yılında Çin’de ortaya çıkarak bütün dünyayı etkisi altına alan COVID-19 pandemisi gündelik hayatımızda yürüttüğümüz birçok uygulamanın dijital ortamlara taşınmasını zorunlu kılmıştır. Eğitim sektörü ise bu zorunlu dönüşümden en erken ve en büyük oranda etkilenen sektör olmuştur. Özellikle yüksek öğretim kurumlarında sürdürülen yüz yüze eğitime ara verilerek zorunlu uzaktan eğitime geçilmiştir. Zorunlu uzaktan eğitim sürecinde yüksek öğretim kurumları dersleri senkron ya da asenkron yöntemlerle yürütmüştür. Bu kurumlar açısından en önemli zorluklardan birinin çevrimiçi sınavları sınav güvenliğini sağlayacak şekilde yapmak olduğu görülmüştür. Bu amaçla birçok yüksek öğretim kurumu gözetmenler tarafından denetlenen çevrimiçi sınav uygulamaları yapmıştır. Fakat kurumlar bu uygulamaların koordinasyonu için bir kontrol sistemi kullanmamıştır. Bu çalışma ile önerilen web tabanlı sistem, denetimli çevrimiçi sınavların öğrenciler, gözetmenler ve ders sorumluları arasından tam koordinasyon sağlayacak şekilde yürütülmesine imkân sunmaktadır. Erciyes Üniversitesi İktisadi ve İdari Bilimler Fakültesi (ERÜ İİBF) tarafından 2020-2021 öğretim yılı güz dönemi yarıyıl sonu sınavları ile birlikte kullanılmaya başlanan sistem başarı ile uygulanmıştır. Öğrencilerin aldıkları derslerin dönem sonu sınavlarına %77 oranında katıldığı, sınava katılan öğrencilerin %97,4’ününün kamera açtığı ve öğrencilerin %1,8’i hakkında gözetmenler tarafından sınav kurallarını ihlal gerekçesi ile ihlal kaydı girildiği tespit edilmiştir. Gözetmenler sistemin tanımış olduğu imkânı kullanarak kendi aralarında sınav görevlerini %4,6 oranından değiştirmiştir. Yüz yüze eğitim için de gerekli uyarlamaların yapıldığı sistem ERÜ İİBF tarafından halen kullanılmaktadır
Respiratory Syncytial Virus among Hospitalised Children in an Era of Pneumococcal Vaccination
Authors: Chandy Sara , Manoharan Anand , Subramanian T. , Balasubramanian Sundaram
Published: April 2023

Background: Acute respiratory tract infection (ARTI) is the leading cause of paediatric hospitalisations in India, especially ≤5 years of age. Aim: The study attempts to investigate RSV disease burden in the under-five and any association between NP carriage and viral ARTI. Methods: This study was conducted from 2019-2020 in Chennai (South India) on hospitalised children with ARTI, between 1 to 60 months of age. Multiplex real-time PCR was employed on nasopharyngeal (NP) samples (n=256) for respiratory pathogens including respiratory syncytial virus (RSV) and Streptococcus pneumoniae (SPN). Results:). Viral and RSV positivity was 81% and 48.6% respectively. Viral co-infections were evidenced in about a quarter of RSV positive children, common being human parechovirus with RSV. Fever, high respiratory rate, severe respiratory distress, cough, difficulty in breathing, chest indrawing and bronchiolitis were significant clinical findings in paediatric viral ARTI. Pneumococcal conjugate vaccine uptake was high (89.4%) in subjects yet 31.87% of vaccinated children had NP pneumococcal carriage. 75% of those with SPN carriage had viral ARTI of which 35.6% were RSV positive. We observed statistically significant association between NP carriage and viral ARTI (p<0.05). Antibiotic usage in suspected RSV versus non-RSV viral ARTI was 68% and 93.8% respectively. Conclusion: Significant RSV disease burden in children < 5 years of age, with ARTI is evidenced with a positive association between SPN carriage and viral acute respiratory tract infections.
Are rapid antigen detection tests capable of detect different SARS-COV-2 variants?
Authors: Martin Gabriel , Martínez Zulema , Alba Susana , Alba Jose , Pérez Mercedes , Boga Jose , Melón Santiago , Argüelles Marta
Published: April 2023

Rapid Antigen Detection Tests can be a good approach to in time SARS-CoV-2 detection as they are easy to use and provide a result in few minutes. However, they have shown to have lower sensitivities than desirable for a diagnostic technique that has come to be used for mass screening. With the aim of continuing to define the limits of RAgDT, their possible variability of sensitivity has been analysed against different variants of SARS-CoV-2. In this study, three different Tests from different manufacturers (Abbott, Roche and Lambra) were tested with a set of 100 nasopharyngeal samples, of which 93 were determined as positive by RT-qPCR and 7 as negative. Total sensitivities were: 72.04% for Abbott and 59.14% both for Roche and Lambra. Attending to variants, the three with higher sensitivity were: Alfa, Omicron and Delta (Abbott); Alfa, Omicron and Mu (Roche) and Alfa, Beta and Gamma (Lambra). Results show great variability between the tests analysed, which reinforces the idea that any negative diagnosis made with them should be taken with caution, especially in seasons of alternating circulation of variants.
Mortality from Sexually Transmitted Diseases: Immigration and Socioeconomic Factors
Authors: Kposowa Augustine , Ezzat Dina
Published: April 2023

Objectives: The purpose of the study was to investigate associations between immigration status and mortality from sexually transmitted diseases (STDs) in the United States. It was hypothesized that there are no mortality differentials between native-born and foreign-born Americans once controls are made for socioeconomic factors. Methods: Data were obtained from the United States National Longitudinal Mortality Study. Cox Proportional hazards regression models were fit to the data, with the entire sample of male and female respondents. Analysis was then stratified to do separate models for each sex group. Results: Immigrants were much less likely to die of sexual diseases than their native-born counterparts. Results held even after controlling for a place of residence, marital status, educational attainment and household income. The sample was disaggregated by sex. In the male sample, immigration was negatively associated with mortality from Sexually transmitted diseases. Among women, negative associations were also observed association between immigration and sexually transmitted diseases. The ever married and the never married were much more likely to die of sexually transmitted disease. Men experienced mortality risk that was over 3 times that of women. Conclusion: Debates continue in the United States about the possible effects of immigration on health. Findings from this study show that using a relatively large sample of over 1 million individuals, immigrants were much less likely to die from STDs than native-born Americans. It was concluded that foreign-born are not contributing positively to US STD mortality.
Development of a Conceptual Framework for Integrated Vector Management in the Heterogeneous Malaria Ecosystem of Western Kenya Highlands
Authors: PM Wamae , GO Otieno , EW Kabiru , S Munga , SJ Kibet , SO Duombia , AK Githeko
Published: April 2023

Malaria heterogeneity in the highlands is due to range of factors including seasonal weather changes, climate variability, land-use changes, topography, drug resistance, and malaria control programs. High coverage of long lasting insecticide treated nets is the basis of vector control in epidemic prone western Kenya highlands. Long lasting insecticide treated nets have effectively controlled malaria in the hypo-endemic zones, but not in meso-endemic and hyper-endemic zones where significant residue of transmission remains despite control efforts. Inadequate policy on integrated vector management application for ecologically heterogeneous ecosystems hinders effective malaria control. Advances in ecological and epidemiological studies have improved our understanding on vector distribution determinants and malaria transmission enabling us to effectively integrate indoor residual spraying into the existing long lasting insecticide treated nets programme. Data on malaria vector abundance and parasite prevalence for different malaria ecosystems within western Kenya highlands before and after mass insecticide treated bed-net distribution campaigns was gathered to assess the efficacy of the long lasting insecticide treated nets based control efforts. Field tests were carried out to determine the impact of combined indoor residual spray and long lasting insecticide treated nets on vector indoor resting densities in zones where insecticide treated nets alone had limited efficacy or zero efficacy was observed. Female An. gambiae s.l resting densities of 0.1 mosquitoes/ house/night were associated with a plasmodium falciparum (pf) prevalence rate of 10% or below. This observation enabled the development of a framework for the inclusion of indoor residual spray in integrated vector management with the suggestion that IRS should be applied in malaria eco-epidemiological zones where An. gambiae s.l resting densities exceeds 0.1 females/ house/ night. Similarly, only those houses with a resting density of 0.1 females An. gambiae s.l and above should be targeted during spraying. Such an approach would significantly reduce the cost associated with indoor residual spray and provides a rationale for judicious integration of indoor residual spray within existing long lasting insecticide treated nets control programmes.
Mitigating the impact of breathlessness in Chronic Obstructive Pulmonary Disease: can a structured specialty palliative care intervention fill in the gap in our treatment algorithms?
Authors: Swami Mehak , Provost Karin
Published: April 2023

Breathlessness is a distressing symptom, uniformly faced at some point in the disease process in all patients with Chronic Obstructive Pulmonary Disease (COPD). Despite maximal medical therapy and pulmonary rehabilitation, patients with COPD continue to experience refractory dyspnea, pain, poor appetite, limitations of physical activity, emotional distress, depression and overall poor health-related quality of life. Our current GOLD ABE pharmacologic treatment algorithm provides maximal disease specific therapy directed at optimization of physiologic airflow obstruction and exacerbation frequency, however leaving a gap in how best to approach the complex and multifactorial symptom of refractory breathlessness that occurs despite these pharmacologic interventions and pulmonary rehabilitation. The comprehensive and multidisciplinary approach of specialty palliative care may well fill this gap in our treatment algorithms. In this review, we will review the growing body of literature on the definitions and role of primary and specialty palliative care in the treatment of patients with COPD, review the components of a structured palliative care intervention in advanced lung disease, review the current pharmacologic and non-pharmacologic treatments for breathlessness, the identified barriers to palliative care intervention and consider the future direction of palliative care engagement in patients with COPD.
Resilience and Spirituality as Moderators between Several Concerns and Psychological Distress during the COVID-19 Pandemic
Authors: Kosic Ankica , Kenfack Corine , Ai Amy
Published: April 2023

The COVID-19 pandemic has led to psychological stress caused by several threats such as concerns for health, economic problems, and several others. This study aims at exploring if inner resilience and belief in spiritual support may moderate the relationship between the concerns, on one side, and distress and the attitudes towards anti-COVID-19 vaccines, on the other side. We conducted a study involving 235 participants through an online survey from March to April 2021 in Italy, immediately after the last lockdown that took place in March 2021. Several scales were used to measure various difficulties and concerns, resilience, beliefs about spiritual support, conspiracy beliefs about COVID-19, psychological distress, and acceptance of the anti-COVID-19 vaccines. We found that resilience moderates the relationship between several concerns and psychological distress during the COVID-19 pandemic, especially among the participants who have strong beliefs in spiritual support.
Evaluation of LFA-1 Peptide-Methotrexate Conjugates in Modulating Endothelial Cell Inflammation and Cytokine Regulation
Authors: Makagiansar Helena , Yakovleva Tatyana , Weldele Meagan , Mahadik Rucha , Siahaan Teruna
Published: April 2023

Interactions between vascular endothelial cells and inflammatory leukocytes are intermediated via cell adhesion molecules and they become one of the key events for vascular cell injury and development of atherosclerosis. This study evaluated the effects of MTX-peptide conjugates as anti-inflammatory agents on human coronary artery endothelial cells (HCAEC) and Molt-3 T cells. Cyclic peptides, cLABL and cLBEL, were derived from the a- and b-subunits of leukocyte function-associated antigen-1 (LFA-1), respectively. They interact with intercellular adhesion molecule-1 (ICAM-1) to inhibit LFA-1/ICAM-1-mediated homotypic or heterotypic T-cell adhesion. cLABL and cLBEL were linked to the anti-inflammatory drug, methotrexate (MTX), to produce MTX-cLABL and MTX-cLBEL conjugates. This study showed that peptides and MTX-peptide conjugates inhibited T cell adhesion to HCAEC monolayers while MTX alone did not. The conjugates, but not MTX, inhibited binding of anti-ICAM-1 monoclonal antibody (mAb) to ICAM-1 on the HCAEC. This indicates that conjugation of MTX to cLABL and cLBEL peptides did not dramatically change their binding properties to ICAM-1. The conjugates had relatively lower toxicity to cells compared to MTX alone, while they were more toxic than the parent peptides. At low concentrations, MTX, MTX-cLABL and MTX-cLBEL decreased production of IL-6 and IL-8 as inflammatory cytokines. In contrast, higher concentrations of the parent peptides compared to the conjugates were required to inhibit IL-6 and IL-8 productions. Overall, both MTX-cLABL and MTX-cLBEL were more active than both free-peptides. In addition, the conjugates were less toxic than MTX alone. In conclusion, the conjugate can selectively target MTX to ICAM-1-expressing cells to increase cell targeting and to lower MTX toxicity.
The Effect of Mitral Valve Prostheses Design and Orientation on Left Ventricular Flow during Left Ventricular Assist Device Support
Authors: V. Vu , R. Montes , J. Campos , K. May
Published: April 2023

The mitral valve affects the shape and timing of incoming flow to the left ventricle of the heart, establishing a strong central jet that generates a vortex ring that conserves momentum during the cardiac cycle. When the vortex is disrupted, regions of stasis are introduced that increase blood residence time and the risk of thrombus formation. This risk is increased when multiple medical devices are combined, as occurs in the fraction of patients with mitral valve prostheses that experience heart failure and receive treatment with a left ventricular assist device (LVAD). LVADs are attached directly to the apex of the left ventricle, continuously pumping blood from the heart into the ascending aorta. While LVADs ameliorate the symptoms of heart failure, they are associated with thromboembolic events that result from disrupted blood flow. In this study, six different mitral prosthesis designs/orientations were studied in combination with LVAD support in a mock circulatory loop. Hemodynamics and the intraventricular velocity field were measured and the vortex characteristics determined. The bioprosthetic valve produced the standard flow pattern with a dominant clockwise vortex that circulated within the left ventricle before exiting through the LVAD. The tilting disk valve exhibited skewed inflow that produced a reverse vortex pattern when oriented towards the septum, which greatly increased stasis and residence time. The bileaflet valves split the incoming flow into two streams directed towards the apex but produced weaker vortices than the bioprosthesis. The results inform the surgical planning for LVAD patients with preexisting mitral prostheses, enabling concomitant repair procedures that would decrease the risk of thromboembolic events.
Comparison of Cardiac Mortality Rates in the European Countries and Territories in Hungary Producing Red or White Wines
Authors: Sipka Sándor , Nagy Andrea , Nagy János
Published: April 2023

The goal of this work was to elucidate the potential role of “red wine producing background” in the prevention of cardiac mortality. In 20 European countries with the lowest cardiac mortality rates it was found that in South-Europe producing mainly red wines and showing low cardiac mortality rates the type of drinking waters were hard everywhere. This fact could have a greater impact on the good results than the role of red wines. Besides, the higher values of “general domestic product” had a protective role against cardiac mortality in general. In a further study, also on large populations, five Hungarian wine territories were divided in two groups on the basis of similarities in the values of mortality rates, hardness of drinking waters and social backgrounds. Group I: Tokaj and Hódmezővásárhely: with higher cardiac mortality, soft drinking waters and worse social backgrounds; Group II: Szekszárd-Villány, Balaton, Eger: with lower cardiac mortality, hard drinking waters and better social backgrounds. In Group II the white wine producing Balaton region also presented low (good) cardiac mortality rates together with the two red wine producing territories (Szekszárd and Eger), they all had similarly hard drinking waters and good social backgrounds. It could be concluded that the red or white characters of wines produced in these territories did not make any differences in the data of cardiac age-adjusted death rates. On the other hand, the positive roles of similarly hard drinking waters and better social conditions had a greater impact on cardiac prevention than the red or white types of wines produced and supposedly consumed here. In the case of Tokaj, the soft drinking waters plus the worse social backgrounds and not the type of wines involved the bad results. The difference in the red or white types of wines produced in a region seemed negligible in the prevention of cardiac mortality compared to the roles of harder drinking waters and wealthier social backgrounds. Thus, neither the red or white wines were found to be special antidotes for cardiac diseases. However, they will remain crucial parts of the general gastronomic culture of mankind.
Immunohistochemical Evaluation of COL11A1 and FGD3 Expression in Invasive Breast Cancer
Authors: Susini Tommaso , Renda Irene , Giani Milo , Vezzosi Vania , Baroni Gianna , Bianchi Simonetta
Published: April 2023

Background: Collagen type XI, alpha 1 (COL11A1) is a minor component of extracellular matrix and its overexpression is associated with tumoral progression and poorer outcome in several human cancers; data on breast cancer are promising but scarce. FGD3 expression has been shown to be a strong independent prognostic factor in breast cancer. The aim of our study was to investigate whether COL11A1 expression correlates with other classic pathologic prognostic factors including FGD3 expression, as well as with clinical outcome, to evaluate its potential use as prognostic factor in breast cancer patients. Methods: We evaluated by immunohistochemistry COL11A1 expression and we studied the relationship between this protein expression and traditional breast cancer prognostic factors, FGD3 expression, as well as with patients’ outcome. Results: We found that higher stromal COL11A1 expression was associated with higher tumour grade (G3) (p = 0.001), higher Ki67 proliferation index (p = 0.006), more advanced AJCC stage (p = 0.031) and lower FGD3 expression (p = 0.039). In a case-control analysis, we observed that patients with high-COL11A1 had a higher risk of recurrence (OR = 2.0) and of dying of the disease (OR = 2.0). Patients with high-COL11A1-expressing tumours had shorter disease-free survival and overall survival (difference not significant). There was a linear positive correlation between COL11A1 expression on epithelial tumoral cells and surrounding stromal cells (r = 0.247, p = 0.04). Conclusion: Our findings suggest that COL11A1 may represent a marker of aggressiveness in invasive breast cancer and that its detection warrants further study on larger series to evaluate its possible use in clinical practice.
In-Vitro Screening of Repurposed Drug Library against Severe Acute Respiratory Syndrome Coronavirus-2
Authors: Rudramurthy Gudepalya , Shandil Radha , Narayanan Shridhar
Published: April 2023

The current pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) demands rapid identification of new antiviral molecules from the existing drugs. Drug repurposing is a significant alternative for pandemics and emerging diseases because of the availability of preclinical data, documented safety in clinic and possibility of immediate production and scalable capacity and supply. Several drugs such as ivermectin and hydroxy chloroquine have been repurposed as anti-SARS-CoV-2 agents, but the effect of these compounds in treating the COVID-19 patients remains sub-optimal. In the present study repurposed drug libraries consisting of 560 compounds from two different sources have been screened against SARS-CoV-2 isolate USA-WA1/2020 in Vero-E6 cell line and 24 compounds were found active. The SARS-CoV-2 virus propagated in Vero E6 cell line and used in screening the drug libraries was sequenced by Next Generation Sequencing to identify any mutations that may have accumulated in the virus genome. The whole genome sequencing data of SARS-CoV-2 showed 9 and 6 single nucleotide polymorphisms in spike protein with reference to Wuhan-Hu-1(NC045512.2) and USA/WA-CDC-WA1/2020 (MN985325.1) isolates respectively. The present study identified 24 compounds active against SARS-CoV-2 isolate USA-WA1/2020 out of 560 repurposed drugs from two libraries. The IC-50 values of the identified hits range from 0.4 µM to 16 µM. Further studies on the repurposed drugs identified in the present screen may be helpful in the rapid development of antiviral drugs against SARS-CoV-2.
A Review of the Role of Lymphocytes in Chronic Neuropathic Pain: A Clinical Perspective
Authors: McCrory Connail , Galvin DA
Published: April 2023

Chronic neuropathic pain is one of the most common morbidities in the developed world. It has a lifetime incidence of 80% with females being affected more than males. Chronic neuropathic pain pathogenesis and its associated “sickness syndrome” has been poorly understood but recent research has shown a neuroimmune basis. Many studies performed to date have been pre-clinical or animal-based with a lack of human studies in chronic neuropathic pain. Background: We performed a review of literature with emphasis on clinical and human studies. The numbers of such studies are low due to limitations with ethical approval, recruitment and heterogeneity of humans. We aimed to investigate the most recent studies as well as important seminal research in this area. Methods: Literature search was performed using Stella search engine, Pubmed and National Library of Medicine search engines. Pre-clinical, animal and human studies were included. Conclusion: The immune system, in particular the adaptive immune system, regulates the initiation, progression and resolution of chronic neuropathic pain in humans. The exact “switch” which mediates initiation, upregulation and downregulation of the components of the immune system is not known. Further research in this area is needed but the challenge of recruiting patients for CNP studies remains. Study sample sizes tend to be small. However, clinically relevant findings although small can offer important information to further our understanding of CNP.
Chromatin research and epigenetics - historical perspectives, current research, open questions, and misconceptions
Authors: Deichmann Ute
Published: April 2023

The concept of chromatin as a complex of nucleic acid and proteins in the cell nucleus was developed by cytologists and biochemists in the late 19th century. It was the starting point for biochemical research on DNA and nuclear proteins. Interest in chromatin declined rapidly at the beginning of the 20th century, but a few decades later a new focus on chromatin emerged, which was not only related to its structure, but also to its function in gene regulatory processes in the development of higher organisms. Since the late 20th century, research on chromatin modifications as well as DNA methylation that emerged in the 1970s have also been conducted under the label epigenetics, a term originally introduced for the complex processes between genotype and phenotype during development. These processes - in particular gene regulation - were subsequently scrutinized by molecular biologists. Research termed epigenetics remained marginal until the end of the 20th century but experienced a rapid rise when heritability was added to its definition. This was accompanied by an increasing diversity in researchers' understanding and definitions of epigenetics. Epigenetics now includes research on histone and DNA-modifying enzymes, nucleosome remodelers, histone chaperones, chromatin-binding proteins to facilitate transcription factor and polymerase action, and the role of long non-coding RNA and small interfering RNA in transcriptional regulation. This article highlights the major phases of chromatin and epigenetics research until the present time and illuminates how different scientific contexts changed the relevance and meaning of chromatin from the 19th century. The paper also points to misconceptions and media hype about epigenetics, for example unsupported claims about transgenerational inheritance in humans or questioning of the basic biological principles of gene regulation based on specific regulatory sequences of the genome.
Stability of Thyroid Function Test Analytes Whose Serum Levels Are Determined by Immunoassay
Authors: Christian Manan , Minkowitz Jeremy , Gabutan Elmer , Bluth Martin , Steimetz Eric , Guzman Juan , Pincus Matthew
Published: April 2023

We have performed stability studies on thyroid function tests, i.e., T4, T3, free T4, free T3 and thyroid stimulating hormone (TSH), over a five-day period on the sera of ten patients. We find that the levels for each analyte were stable; the mean coefficients of variation (CV) ranged from 3.2 % for TSH to 8.7% for T4. ANOVA statistical analysis of group means for each analyte over the five-day period indicated that there was no statistically significant difference in these means, confirming the reproducibility of values. On the other hand, the CVs are significantly larger than those found in our prior stability studies for other critical analytes such as electrolytes (sodium, potassium, chloride, calcium). In addition, significant variations in values over the five-day period occurred for T4 which showed the largest variations in values of the five analytes studied. In one patient, the values ranged from a low of <10 ug/dL to over 14 ug/dL over the five-day period. A two-tailed t test comparing the mean CV for TSH with the mean CVs of the other four analytes showed that the mean CV for TSH was statistically significantly lower than that for the other four analytes indicating that the assay for TSH yield the most precise results. These results parallel those obtained in our prior electrolyte study that showed very low CVs for sodium, potassium and chloride and a significantly higher CV for calcium. Since approximately half of total serum calcium is bound to albumin and since very high percentages of T4 and T3 (≥99%) are bound to thyroid binding globulin and albumin, protein binding of these analytes may introduce a possible source of assay imprecision.
Inflammation in Diabetic Kidney Disease: Focus on New Therapeutic Considerations
Authors: Leehey David , Zhang Xin
Published: April 2023

Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease (ESRD) in the U.S. and worldwide. A role of chronic low-grade inflammation in the microvascular complications in diabetic patients has now been widely accepted, and anti-inflammatory therapies for DKD are being actively pursued. Such therapies may be especially useful in the treatment of patients with chronic kidney disease (CKD) with normal to only moderately increased albuminuria, a DKD phenotype which is becoming more frequent. Current pharmacologic treatment for DKD includes inhibitors of the renin-angiotensin-aldosterone system (RAAS) and the sodium-glucose co-transporter 2 (SGLT2) in the proximal tubule. Both classes of agents are known to reduce blood pressure but also are thought to have anti-inflammatory, antioxidant, and anti-fibrotic effects independent of their hemodynamic actions. Large clinical trials with experimental agents such as bardoxolone and selonsertib that target inflammation and oxidative stress in DKD have been carried out or are in progress. The non-specific phosphodiesterase inhibitor pentoxifylline (PTX) is also being studied in a large US trial to see if this FDA-approved drug may be able to be repurposed to treat DKD. Other agents have also shown promising effects in small clinical trials but require further large-scale investigation.
The Central Role of Relevant Health Information for Promoting Cancer Prevention and Control
Authors: Kreps Gary
Published: April 2023

Despite major scientific gains in important new knowledge about risks, biological processes, prevention practices, and advanced treatments for many forms of cancer, epidemiological evidence shows that cancer continues to evolve as an increasingly dangerous health issue responsible for unacceptably high levels of death and disability world-wide. Sadly, many major advances in cancer knowledge have not been adequately translated into needed personal and institutional actions that could significantly reduce cancer morbidity and mortality. Disseminating relevant and actionable cancer-related health information to those who are confronting cancer is essential for promoting needed cancer prevention and control. Cancer information dissemination efforts should clearly and persuasively communicate complex cancer information to diverse and often vulnerable audiences who desperately need relevant information about key cancer issues, including cancer prevention, early detection, informed diagnosis, cancer treatment, and successful cancer survivorship. Strategic health communication can build needed awareness about cancer risks and responses, promote trust, cooperation, and personal engagement, as well as support informed cancer decision-making. Communicating meaningfully with those who are at greatest risk from cancer, such as members of the most vulnerable segments of society who suffer from high levels of cancer morbidity and mortality, is especially important for promoting cancer prevention and control. However, effective communication with members of these high-risk populations is often fraught with communication barriers. Since many members of at-risk groups are among the poorest, lowest educated, and most disenfranchised members of society, they may encounter serious challenges to accessing and making sense of relevant health information. They often experience health literacy deficits that make it difficult for them to understand complex cancer information. Their cultural backgrounds may not support their following recommended cancer prevention and control health and life-style practices. They may experience economic limitations that make it difficult to access needed care, as well as to navigate complicated and bureaucratic health care systems. This review and policy article examines these serious challenges to effectively communicating relevant health information to vulnerable populations and suggests strategies for enhancing strategic use of communication messages and media to promote cancer prevention and control.
Routine Preoperative Tests in Low-Risk Surgery. What About Adherence to Clinical Guidelines?
Authors: Ruiz María , Olmedo Itzé , González María , Zuñiga Wence , F Jessica
Published: April 2023

In 2002, the American Heart Association guidelines established that routinary preoperative studies in low-risk patients (ASA I and II) are unnecessary. This fact has been supported by many other publications after that. However, the medical adherence to these recommendations in clinical practice is low. The aim of this review is to identify the reasons associated with a poor guideline’s adherence. Articles published between 2002 and 2022 reporting data on “preoperative test”, “routine preoperative test”, and “low-risk surgery” were identified through a computerized literature research using Pubmed, Scopus, Medigraphic and Cochrane databases and by selecting all of the articles related to adherence to clinical guidelines. The full text of relevant articles was reviewed by all authors. This review found that some of the causes of the limited adherence to clinical guidelines are: lack of awareness regarding current recommendations or lack of familiarity with them; physician attitudes about the guidelines (including outcome expectancy, lack of agreement, poor motivation to modify previous practice, question efficacy); and environmental labor factors of medical institutions, including lack of communication among the consultants involved in the perioperative care, and medicolegal concerns and fear of litigation. Hence, in order to propose effective alternatives to improve guidelines adherence, this review discuss some of the main reasons why in clinical practice there is still a poor compliance to surgical preoperative guidelines, even when more than 20 years have passed since the concept of routinary preoperative studies in low risk patients was eliminated by a myriad of clinical guidelines and medical associations.
Advancing Health Equity: A Safety Net Hospital Perspective
Authors: Agrawal Abha
Published: April 2023

Equitable care has been recognized as one of the six core components of quality for over two decades, yet scant attention has been paid to understand and address healthcare disparities in the US. There is long-standing evidence of substantial health disparities and poor health outcomes along race, ethnicity and income levels in the US. The COVID-19 pandemic both exacerbated and exposed these inequities and catalyzed a national imperative to achieve equitable healthcare. The objective of this article is to provide a case study of a resource-challenged safety net hospital’s journey to advance health equity in Chicago. Humboldt Park Health (HPH) is a 200-bed independent community teaching hospital located on the West side of Chicago serving a multiracial, multilingual and socioeconomically disadvantaged population. Our journey started with the formation of a multidisciplinary health equity committee in 2021, reporting to the Board of Trustees, that was charged with formulating a strategy, developing an evidence-based framework and priorities for action, and implementing the action plan. We addressed four groups of stakeholders: our patients, our people, our organization, and our community. Our actions to advance equity have included (a) collection of patients’ demographic data such as race, ethnicity, language, sexual orientation, and gender identity; (b) assessment of social determinants of health (SDOH) along with connecting patients with social services; (c) the development of health disparities dashboards for various ambulatory preventive measures for stratification of quality data along race, ethnicity and language; (d) focus on LGBTQ+ community’s access to well-informed and sensitivity-trained behavioral health service providers, and (e) organization-wide training to embed the concepts of diversity, equity and inclusivity in the fabric of the organization. Other initiatives include the building of a community wellness center and a 100-unit affordable housing complex in the community. Digital health equity is an important domain that is being addressed by the launch of a patient portal to empower patients by providing them access to their information, and remote patient monitoring solutions. The next phase of our work involves evaluation studies to understand the impact of our interventions on health disparities and outcomes in our community.
Measuring Social Determinant Access and Equity by Race in U.S. States
Authors: Hahn Robert
Published: April 2023

The effective design, implementation, monitoring, and evaluation of state programs to reduce racial health inequities requires measures of societal resource access (e.g., education, home ownership, voting) and access inequity by race in each state. This paper proposes criteria for the selection of social determinants to assess, and ways to combine data to assess overall access and overall access inequity in states. Access and equity can be compared across geographic regions assessed. Hypotheses regarding the determinants and consequences of access and equity can be examined. Means of validating metrics are proposed. An example of analysis of access and inequity for Blacks and Whites in U.S. states yields surprising results—social determinant access and access equity are generally greatest in southern states. These metrics can be used to target and measure the effects of interventions to advance health equity for racial minority populations. The condition of state access and equity by race indicates the culmination of structural racism.
The Ergodic Moment as a Way to Enable the Individual Measurement in Clinics
Authors: Gomes Cristiano
Published: April 2023

Is the measurement in clinics of tests based on performance, when only one measurement is taken, a correct way to indicate the true measure of that individual's ability? In this theoretical article we show that this is a wrong way. We first recall Molenaar’s approach when he invokes the ergodic theorems to show that only in ergodic populations it is possible to transpose the population parameters to measure the individuals. Since the individual processes which develops in time are non-ergodic by their own nature, the first author developed the concept of Ergodic Moment and we show that in tests based on performance, a vocabulary test in our example, we may create an ergodic population, which allows us to transpose the population ability to measure the ability of the individual.
Inhibition of the Mechanistic Targets of Rapamycin Beyond Transplant Immunosuppression: A Mini-Review
Authors: Taee Huda , Ali Ala
Published: April 2023

It has been about thirty years since identifying the target of rapamycin and using mTOR inhibitors in organ transplantation. There was a promise that they would replace calcineurin inhibitors with fewer nephrotoxic effects and better graft survival. Unfortunately, with time, the enthusiasm for using them in transplantation decreased due to the unpleasant profile of adverse events and limited evidence of tangible clinical benefit. With more understanding of physiology and judicious clinical application, new venues for mTOR inhibitors emerged. The mTOR pathway regulates primary cellular functions, including cell growth, metabolism, proliferation, and survival, and is critical for autophagy induction. Thus, as a master regulator, mTOR inhibitors emerged as anticancer therapies. In addition, such action proved beneficial for native or post-transplant malignancies. Signaling through components of the mTOR pathway is an essential regulator of normal cardiac growth and pathological hypertrophy. mTOR inhibitors are effective in reducing left ventricular thickness and mass. It could be an add-on benefit in kidney transplant recipients with high cardiovascular risk or attenuate cardiac allograft vasculopathy in heart transplant recipients. The mTOR inhibitors may help manage viral infections like cytomegalovirus, human herpesvirus 8-related Kaposi sarcoma, and possibly the BK virus. Furthermore, the mTOR pathway is modulated in many RNA viruses. Based on these facts, the idea of using mTOR inhibitors to treat COVID-19 infection has been evaluated. Accordingly, a new therapeutic role for mTOR inhibitors for treating COVID-19 infection t has emerged through reducing viral replication, and autophagocytosis, improving T cells function and preventing cytokine storm. This paper will review these applications of mTOR inhibitors beyond the horizon of transplant immunosuppression.
Electrical Design of a Portable Pure Sine Wave Inverter Using Ferrite Core Transformer and Double Stage Technique
Authors: Purwanto Kunnu , Wijayanto Aditya Agus , Ardiyanto Yudhi , Putra Karisma Trinanda
Published: April 2023

The size of the iron core transformer in an inverter is large and heavy because it has more conductor turns and works at low frequencies. In contrast, ferrite core transformers are designed to work at high frequencies, so the number of turns of the conductor is less, and the transformer size is relatively small and light. Device portability is a significant challenge in designing high-power inverters. This research uses a ferrite core transformer to design a portable pure sine wave inverter. A two-stage technique is proposed in designing the inverter so that the dc-link voltage and capacitor size can be flexibly selected, and the device size can be compacted. The design consists of two stages. First, a circuit to generate a 400-Volt DC voltage is designed using IC SG3525, a MOSFET power amplifier, and a ferrite core step-up transformer. Second, a pure sine wave generator circuit is constructed using an EGS002 module, MOSFETs, and a filter circuit. Experiments are performed by measuring the output voltage, monitoring power and frequency, and observing the waveform with an oscilloscope. The results reveal that the designed inverter can generate a 220-volt pure sine wave output, a maximum power of 500 Watts, a frequency of 50 Hz, and an efficiency between 91.4% to 98.1%.