Epidemiology, Risk Factors, And Effectiveness Of Treatment Of Crimean Congo Hemorrhagic Fever In Turkey, 2007-2012

Objective: Crimean Congo Hemorrhagic Fever (CCHF) is caused by a Nairovirus of the Bunyaviridae family. It was first reported in Turkey in 2002. Infections commonly result from bites from ticks of Hyalomma marginatum marginatum or Rhipicephalus bursa species. Nosocomial infections also occur. CCHF infection occurs in over 30 countries in Europe, Asia and Africa. No vaccine exists and the effectiveness of ribavirin treatment remains controversial. This study\u27s objective was to identify significant epidemiological, environmental, and clinical risk factors associated with disease and death caused by CCHF in Turkey. This study also evaluated the effectiveness of ribavirin as treatment for patients infected by CCHF. Methods: Chi-square, t-tests and univariate statistical comparisons were used to determine associations between risk factors and death by CCHF. Multivariate logistic regression was used to determine variables associated with death. ArcGIS was used to map the yearly and cumulative incidence of CCHF per province. Propensity scores were used to evaluate the effectiveness of ribavirin treatment. Data were obtained from a surveillance database maintained by the Turkish Ministry of Health, Section of Zoonosis. Results: A total of 6,070 laboratory confirmed cases of CCHF was reported from Turkey between 2007 and 2012. The six-year case fatality was 5%. A greater percentage of cases were male (54.7%), persons residing in villages (82.5%), those visiting rural areas (52.9%), farmers (34.5%), persons exposed to animals (75.6%) and those reporting a tick bite (75.9%). However, except for age and tick bite history, none of these risk factors were significant in fatal cases. Significant risk factors for death included exposure to infected persons (OR: 2.16, 95%CI: 1.10-4.24) and days of symptoms before hospital admission (OR: 0.92, protective, 95%CI: 0.86-0.98). Clinical risk factors for death included leukopenia (OR: 0.20, 95%CI: 0.14-0.30), thrombocytopenia (OR: 8.75, 95%CI: 3.46-22.17), hypotension (OR: 3.54, 95%CI: 2.43-5.15), bleeding (OR: 3.88, 95%CI: 2.75-5.48), anemia (OR: 2.72, 95%CI: 1.92-3.84) and combined elevated plasma aspartate aminotransferase/ alanine aminotransferase (AST/ALT), lactate dehydrogenase (LDH) and creatine kinase (CK) levels (OR: 1.74, 95%CI 1.01-2.98). Ribavirin treatment was not found to significantly affect mortality (OR: 0.85, 95%CI: 0.57-1.26). Stratified propensity score analysis verified the ineffectiveness of ribavirin as treatment for CCHF as no statistically significant benefits of treatment were identified. Conclusion: Despite environmental control and public health education measures to prevent the spread of CCHF in Turkey, the case fatality remains stagnant and incidence has increased. While gender, village residence, and exposure to animals are not significant risk factors of death caused by CCHF, exposure to infected individuals, average days of symptoms before hospital admission, and clinical factors including hypotension, leukopenia, thrombocytopenia, bleeding, anemia and elevated AST/ALT, LDH, CK levels are significantly associated with death and increase the odds of death by CCHF. While history of tick bite is significantly associated with death, it does not significantly increase the odds of death in an infected individual when all other variables are considered. Significant risk factors should be studied further to understand prevention of disease and death

A Fictitious Play Algorithm for Matrix Games with Fuzzy Payoffs

Fuzzy matrix games, specifically two-person zero-sum games with fuzzy payoffs, are considered. In view of the parametric fuzzy max order relation, a fictitious play algorithm for finding the value of the game is presented. A numerical example to demonstrate the presented algorithm is also given

Application of prismatic constructions to gauge field theory

AbstractWe give a variational formula for the Chern–Simons invariants for a given bundle on a simplicial set with a connection using prismatic subdivision

Dependence on Initial Conditions of Attainable Sets of Control Systems with p-Integrable Controls

Quasi-linear systems governed by p-integrable controls, for 1 < p < ∞ with constraint ‖u(·)‖p ≤ µ0 are considered. Dependence on initial conditions of attainable sets are studied

Fuzzy Risk Analysis for a Production System Based on the Nagel Point of a Triangle

Ordering and ranking fuzzy numbers and their comparisons play a significant role in decision-making problems such as social and economic systems, forecasting, optimization, and risk analysis problems. In this paper, a new method for ordering triangular fuzzy numbers using the Nagel point of a triangle is presented. With the aid of the proposed method, reasonable properties of ordering fuzzy numbers are verified. Certain comparative examples are given to illustrate the advantages of the new method. Many papers have been devoted to studies on fuzzy ranking methods, but some of these studies have certain shortcomings. The proposed method overcomes the drawbacks of the existing methods in the literature. The suggested method can order triangular fuzzy numbers as well as crisp numbers and fuzzy numbers with the same centroid point. An application to the fuzzy risk analysis problem is given, based on the suggested ordering approach

Visual narrative through hypermedia: İki project as a case study

Visual narrative is an essential element in communication via images, which can appear in many different media and forms. To apprehend visual narrative one must know, how image and text work coordinately. Examples of this can be observed in many paintings, comics and photography, which includes text to enhance it's artistic expression. Selfportraiture also provides a rich expression domain for visual narrative, especially personal narrative. In today's information era, hypertext and hypermedia are used for many purposes in computer, business, intellectual, educational and leisure applications. With their convenience in easy navigation and interaction, they are also being used in interactive electronic literature. Hypertext and hypermedia are perfect tools for non-linear or multilinear narrative on Internet based platforms and websites. Narrator is a very important narrative element for telling a well-developed story. In order to comprehend the uses of narrator in a narrative, whatever it's medium may be, one must study narrative modes and point of view narrators. This thesis discusses the use of hypermedia with various creative content such as image, text, audio and video in visual narrative, while approaching İki project as a case study