Thomas Kuhn'un Fen Eğitimine Yönelik Görüşlerinin İncelenmesi: Endoktrinasyon Çerçevesinde Gelen Tepkiler

Bu makalede, bilim felsefecisi kimliğiyle tanınan Thomas Kuhn’un eğitim ve özellikle fen eğitimi alanındaki görüşlerine değinilmektedir. Fen eğitimi, bilim, bilimin doğası ve bilim uygulamaları hakkında düşünceler geliştirmeye odaklanarak fen öğrenimi için gerekli olan beceri ve anlayışın geliştirilmesini amaçlamaktadır. Fen eğitiminin temel amaçlarından biri bilimin gerçek doğasının tespit edilmesi ve bu doğrultuda bir eğitim modelinin belirlenmesidir. Bu çerçevede Kuhn’un bilim tarihine yönelik incelemeleri neticesinde ileri sürdüğü paradigma kavramı bilimin doğası ve fen eğitimi konusundaki görüşlerin değişimine yol açmıştır. Kuhn açısından fen eğitimi yürürlükteki bilim yapma tarzının temelinde yatan paradigma ve öğretilerinin bilim insanlarına ve öğrencilere aktarılması sürecidir, bu nedenle fen eğitimi yalnızca olağan bilim döneminde mümkündür. Kuhn’un eğitim modeli, mevcut paradigmayla ilişkili olarak karşılaşılan bulmaca ya da sorunları çeşitli örneklerden hareketle tekrar tekrar çözmeye çalışan öğrenciler aracılığıyla gerçekleştirilir. Kuhn’un olağan bilimin sınırları içerisinde kalarak değerlendirdiği fen eğitimi anlayışı eleştirel düşünceyi engellediği iddiasıyla Karl Popper, John Watkins ve Richard Bailey tarafından katı, tutucu, dogmatik ve endoktrinasyonu vurgulayan bir eğitim anlayışı olarak görülmektedir. Bu çerçevede makalede, öncelikli olarak Kuhn’un bilimin doğası ve bilimin gelişim tarzına yönelik belirlemeleri doğrultusunda fen eğitimine yönelik düşünceleri ve bu düşüncelerin eğitim alanındaki yansımaları incelenmektedir. Ardından, Kuhn’un fen eğitimi üzerine görüşlerinin iddia edildiği gibi dogmatik bir yapıda olmadığı, endoktrinasyonu ya da zorla öğretimi vurgulamadığı, bu tür yorumların radikal bir yaklaşımdan öteye gidemediği ileri sürülmektedir. Son olarak makalede, Kuhn’un fen eğitimi anlayışının yalnızca bir durum tespiti ya da bir fen eğitimi tasviri olarak değerlendirilmesi gerektiği düşüncesi ön plana çıkarılmaktadır. In this article, Thomas Kuhn’s impact, who is known as a philosopher of science, on science education are mentioned. Science education aims to develop the skills and understanding necessary for science learning, with a focus on developing ideas about science and the nature of science. One of the main purposes of science education is to determine the true nature of science and to determine an education model in this direction. In this context, the concept of paradigm, which Kuhn put forward as a result of his studies on the history of science, has led to a change in views on the nature of science and science education. For Kuhn, science education is the process of conveying the paradigm underlying the current way of doing science to scientists and students because science education is possible only in the normal science period. Kuhn’s educational model is carried out through students who repeatedly try to solve puzzles or problems encountered in relation to the current paradigm. Kuhn’s understanding of science education is seen by Karl Popper, John Watkins and Richard Bailey as a rigid, conservative, dogmatic and indoctrinational education approach with the claim that it prevents critical thinking. In this context, the article primarily examines Kuhn’s thoughts on science education and the reflections of these thoughts in the field of education. Then, it is argued that Kuhn’s views on science education are not dogmatic as claimed, he does not emphasize indoctrination, and that such interpretations cannot go beyond a radical approach. Finally, in the article, it is emphasized that Kuhn’s understanding of science education should be evaluated only as a description of science education

An Unusual Case of Aplastic Anemia Caused by Temozolomide

Radiotherapy and concomitant/adjuvant therapy with temozolomide are a common treatment regimen for children and adults with high-grade glioma. Although temozolomide is generally safe, it can rarely cause life-threatening complications. Here we report a case of a 31-year-old female patient who underwent surgical resection followed by radiotherapy plus concomitant temozolomide. She developed pancytopenia after adjuvant treatment with temozolomide. A bone marrow aspiration and biopsy showed hypocellularity with very few erythroid and myeloid cells, consistent with aplastic anemia. In the English literature, aplastic anemia due to temozolomide is extremely rare

Piezo Elektriksel Etki İle Aktive Edilen Dokunmatik Ekranların Titreşim Analizleri

Konferans Bildirisi-- İstanbul Teknik Üniversitesi, Teorik ve Uygulamalı Mekanik Türk Milli Komitesi, 2017Conference Paper -- İstanbul Technical University, Theoretical and Applied Mechanical Turkish National Committee, 2017Taşınabilir elektronik cihazlar üzerindeki dokunmatik ekranlarda genellikle görsel ve işitsel geri bildirimler kullanılmaktadır. Bu cihazlar, gürültülü ve dikkat dağıtıcı ortamlarda kullanıldığı zaman çoğunlukla mevcut geri bildirim yöntemleri yetersiz kalmakta ve cihazın kullanılabilirliği ciddi derecede azalmaktadır. Bu nedenle yeni bir teknolojiye ihtiyaç duyulmaktadır. Dokunmatik ekranlara hareket verilerek parmak uçlarındaki sinirlerin uyarılması ile oluşturulan dokunsal geri bildirimler son zamanlarda bu sektörde önem kazanmaya başlayan konulardan birisidir. Dokunmatik geri bildirim düzeneği için piezo elemanlar kullanılmaktadır. Piezo elemanlar malzeme özellikleri gereği üzerlerine gerilim uygulandığında şekil değiştirmektedirler. Eğer bu zorlama sinüzoidal ise bu aktivasyon ile bağlı oldukları eleman olan ekranı da titreştirmektedirler. Piezo elemanlara mekanik çalışma sınırları içerisinde tüm titreşim fonksiyonları uygulanabilmektedir. Böylelikle kalp atışı, patlama sesi gibi her çeşit titreşim fonksiyonu dokunmatik ekran üzerinde oluşturulabilmektedir. Bu çalışmada sektörde kullanılan farklı tasarım parametrelerine sahip ekran camlarının titreşim mod yapıları incelenmiştir. Ekranın mod yapıları sonlu elemanlar mantığı (SEM) ile çalışan COMSOL programında elde edilmiştir. Bu programda piezo elemanların malzeme ve elektriksel özellikleri dikkate alınmaktadır. Ekran üzerinde en iyi titreşim fonksiyonunu üretebilmek için farklı piezo sayısı ve farklı piezo yerleşimleri için titreşim analizleri COMSOL programı ile karşılaştırılmıştır. Sonuç olarak en iyi titreşim fonksiyonunu üreten tasarım elde edilmiştir.An audiovisual feedback is used on touch screens in portable electronic devices. When these devices are used in noisy and distracting environments, suitable available feedback methods is severely inadequate and the availability of the device severely reduced. For this reason, the users need a new technology. The fingertip nerves are warned by the vibration of the touch screen. Tactile feedback is one of the issues that have recently gained importance in this sector. Piezo elements are used for the touch feedback mechanism. Piezo elements can change shape when the tension applied due to material properties. If this coercion is sinusoidal, the screen, which is the component of those connected by this activation, will also vibrate. All vibration functions can apply to piezo elements within mechanical working limits. Thus, all kinds of vibration functions such as heartbeat, explosion sound can be created on the touch screen. In this study, vibration mode structures of glasses with different design parameters are investigated. The results are obtained with software with COMSOL program. In this program, the material and electrical properties of the piezo elements are taken into account. The vibration analysis for different piezo numbers and different piezo locations were compared with the COMSOL program. As a result, a design that produces the best vibration function is determined

In a Real-Life Setting, Direct-Acting Antivirals to People Who Inject Drugs with Chronic Hepatitis C in Turkey

Background: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naive patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization's objective of eliminating viral hepatitis

Composite materials for thermal energy storage: enhancing performance through microstructures

Chemical incompatibility and low thermal conductivity issues of molten-salt-based thermal energy storage materials can be addressed by using microstructured composites. Using a eutectic mixture of lithium and sodium carbonates as molten salt, magnesium oxide as supporting material, and graphite as thermal conductivity enhancer, the microstructural development, chemical compatibility, thermal stability, thermal conductivity, and thermal energy storage performance of composite materials are investigated. The ceramic supporting material is essential for preventing salt leakage and hence provides a solution to the chemical incompatibility issue. The use of graphite gives a significant enhancement on the thermal conductivity of the composite. Analyses suggest that the experimentally observed microstructural development of the composite is associated with the wettability of the salt on the ceramic substrate and that on the thermal conduction enhancer.Chemical incompatibility and low thermal conductivity issues of molten-salt-based thermal energy storage materials can be addressed by using microstructured composites. Using a eutectic mixture of lithium and sodium carbonates as molten salt, magnesium oxide as supporting material, and graphite as thermal conductivity enhancer, the microstructural development, chemical compatibility, thermal stability, thermal conductivity, and thermal energy storage performance of composite materials are investigated. The ceramic supporting material is essential for preventing salt leakage and hence provides a solution to the chemical incompatibility issue. The use of graphite gives a significant enhancement on the thermal conductivity of the composite. Analyses suggest that the experimentally observed microstructural development of the composite is associated with the wettability of the salt on the ceramic substrate and that on the thermal conduction enhancer

In a real-life setting, direct-acting antivirals to people who inject drugs with chronic hepatitis c in Turkey

Background: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis

Which factors help to determine the long-term response to first-line tyrosine kinase inhibitors in patients with metastatic renal cell carcinoma: A Turkish multi-centre study

Many developing countries lack access to recommended first-line treatments for metastatic renal cell carcinoma (mRCC), such as immune checkpoint inhibitors (ICIs) or ICI-tyrosine kinase inhibitor (TKI) combinations. As a result, predictive markers are necessary to identify patients who may benefit from single-agent TKIs for long-term response. This study aims to identify such parameters. This was a multi-centre, retrospective study of patients with mRCC who were undergoing first-line treatment with sunitinib or pazopanib. Patients who had been diagnosed with mRCC and had not experienced disease progression for 36 months or more were deemed to have achieved a long-term response. Predictive clinical and pathological characteristics of patients who did not experience long-term disease progression were investigated. A total of 320 patients from four hospitals were included in the study. The median age of the patients was 60 years (range 20-89 years). According to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk classification, 109 patients were classified as having favourable risk and 211 were in the intermediate-poor risk group. The median progression-free survival (PFS) and overall survival (OS) for all patients were 12.5 months and 76.4 months, respectively. In the long-term responder’s group, the median PFS was 78.4 months. Among all patients, prior nephrectomy, the Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) <1, and the absence of brain metastasis were predictive factors for long-term response. For patients in the favourable risk group, the lack of brain metastasis was a predictor of long-term response. In the intermediate-poor risk group, prior nephrectomy and ECOG PS <1 were predictive factors for long-term response. Some individuals with mRCC may experience a durable response to TKIs. The likelihood of a long-term response can be determined by factors such as nephrectomy, ECOG PS < 1, and the absence of brain metastases

Skleroderma Hastalarında Sarkopeni İle Presarkopeni Sıklığının Değerlendirilmesi ve Nedenlerinin Belirlenmesi

Sari A, Evaluation of Prevalence and Causes of Presarcopenia and Sarcopenia in Patients with Scleroderma, Hacettepe University Faculty of Medicine, Thesis in Rheumatology, Ankara, 2019. The first aim of the study was to investigate the frequency of decreased muscle mass (sarcopenia or presarcopenia) in patients with systemic sclerosis (SSc, scleroderma) and its relationship with clinical features. The second objective was to reveal the role of ultrasonography (USG) in determining reduced muscle mass in SSc patients. Demographic and clinical data of 93 (86 female, 7 male) SSc patients were recorded. Appendicular skeletal muscle mass index (ASMI) and skeletal muscle mass index (SMI) were evaluated by bioelectric impedance analysis (BIA). The thicknesses of rectus abdominis, external oblique, internal oblique, transversus abdominis, rectus femoris and gastrocnemius muscles were measured by USG imaging. Muscle strength was measured with hand grip dynamometer. The frequency of decreased muscle mass was 13.9% according to ASMI and 9.6% according to SMI. Malnutrition and diffuse skin involvement were more frequent in patients with decreased muscle mass. In this group, the incidence of digital ulcers and the duration of the disease were also found to be increased however, a significant difference was observed only for the classification according to the SMI. There was no difference between groups regarding age, sex, organ involvement, current treatments, comorbidities, severity of gastrointestinal involvement and physical activity. Patients with decreased muscle mass had lower hand grip strength, however the correlation between muscle mass and hand grip strength was low-to-moderate. In patients with decreased muscle mass, the thickness of the gastrocnemius and rectus abdominis muscles were lower. Gastrocnemius thickness showed the highest correlation with ASMI and SMI. The cut off values for gastrocnemius thickness suggested by ROC analysis had a sensitivity of 92.3% and 100.0% and a negative predictive value of 97.9% and 100.0%, respectively. Intra and inter-observer agreement was very high for ultrasonographic measurements. In conclusion, decrease in muscle mass is not infrequent in patients with SSc. Patients with malnutrition and diffuse skin involvement are particularly at increased risk for this condition. Gastrocnemius thickness measurement with USG imaging may be used as a screening test due to its high sensitivity and negative predictive value in detecting the decrease in muscle mass in SSc patients. Key words: Systemic sclerosis, muscle mass, bioelectric impedance analysis, ultrasonography Alper Sarı, Skleroderma Hastalarında Sarkopeni ile Presarkopeni Sıklığının Değerlendirilmesi ve Nedenlerinin Belirlenmesi, Hacettepe Üniversitesi Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Romatoloji Bilim Dalı, Yan Dal Uzmanlık Tezi, Ankara, 2019. Çalışmanın ilk amacı sistemik skleroz (SSk, skleroderma) hastalarında azalmış kas kitlesi (sarkopeni veya presarkopeni) sıklığının ve klinik özellikler ile ilişkisinin incelenmesi, ikinci amacı ise ultrasonografinin (USG) SSk hastalarında azalmış kas kitlesinin değerlendirilmesindeki yerinin belirlenmesidir. Demografik ve klinik özellikleri kaydedilen 93 (86 kadın, 7 erkek) hastanın apendiküler iskelet kası kitlesi indeksi (ASMI) ve iskelet kası kitlesi indeksi (SMI) biyoelektrik impedans analizi ile değerlendirildi. Rektus abdominis, eksternal oblik, internal oblik, transvers abdominis, rektus femoris ve gastroknemius kaslarının kalınlıkları USG ile ölçüldü. Dinamometre ile el sıkma güçleri değerlendirildi. Azalmış kas kitlesi sıklığı ASMI’ya göre %13,9, SMI’ya göre ise %9,6 bulundu. Kas kitlesi azalmış hastalarda malnutrisyon ve diffüz cilt tutulumu daha sıktı. Bu grupta dijital ülser sıklığı ve hastalık süresi artmış bulundu ancak sadece SMI’ya göre yapılan sınıflamada anlamlı fark saptandı. Yaş, cinsiyet, organ tutulumları, güncel tedaviler, komorbiditeler, gastrointestinal tutulumun şiddeti ve fiziksel aktivite durumları arasında fark saptanmadı. Kas kitlesi azalmış hastalarda el sıkma gücü daha düşüktü ancak kas kitlesi ve el sıkma gücü arasında düşük-orta düzeyde korelasyon mevcuttu. Kas kitlesi azalmış hastalarda gastroknemius ve rektus abdominis kaslarının kalınlıkları daha düşüktü. Kalınlığı ASMI ve SMI ile en yüksek korelasyon gösteren kas gastroknemius idi. Gastroknemius kas kalınlığı için seçilen sınır değerlerin ASMI ve SMI’ya göre azalmış kas kitlesini öngörmede sensitivitesi sırasıyla %92,3 ve %100,0, negatif prediktif değeri ise %97,9 ve %100,0 olarak bulundu. Ultrasonografik ölçümler için gözlemci içi ve gözlemciler arası uyumun çok yüksek olduğu görüldü. Sonuç olarak kas kitlesinde azalma SSk hastalarında nadir olmayan bir klinik durumdur. Malnutrisyonu ve diffüz cilt tutulumu olan hastalar bu durum için artmış risk altındadır. USG ile gastroknemius kalınlığı ölçümü SSk hastalarında kas kitlesinde azalmanın saptanmasında yüksek sensitivitesi ve negatif prediktif değeri nedeniyle uygun bir tarama testi olarak kullanılabilir. Anahtar sözcükler: Sistemik skleroz, kas kitlesi, biyoelektrik impedans analizi, ultrasonograf

Meme Kanseri Hastalarında Tedavi Ilişkili Nötropeni Gelişimini Etkileyen Risk Faktörleri

Aim: This study aims to investigate treatment and patient related risk factors that influence development of chemotherapy induced neutropenia (CIN). Material and Method: 679 female breast cancer patients who received anthracycline, taxane or CMF containing chemotherapy regimens between 2006-2013 in Hacettepe University Oncology Hospital were participated in this study. Patients who received granulocyte colony stimulating factor as primary prophylaxis were excluded. To exclude impact of using colony stimulating factors as secondary prophylaxis and alternation in chemotherapy doses, we took into account the chemotherapy cycle in which neutropenia developed first. Data about demographic characteristics ( age, body mass index (BMI), menopausal status, comorbidities, Charlson Comorbidty Index score), treatment modalities ( type of surgery, chemotherapy regimen, receiving radiotherapy or trastuzumab), pretreatment blood count parameters ( white blood cell count, absolute neutrophil count, lymphocyte count, neutrophil/lymphocyte ratio) of patients were collected retrospectively from medical records. The relationship between these variables and development/severity of chemotherapy induced neutropenia was examined. The difference between the groups were accepted as significant if p<0.05 in all analyzes. Results: In univariate analysis, CIN was found associated with lower BMI and lower baseline white blood cell count (p= 0,001 ve p< 0,001). Similar neutropenia rates was monitored between patients who have neutrophil/lymphocyte ratio ≥3 and <3 (p=0,448). In multivariate logistic regression analysis; older age (≥60), lower baseline white blood cell count and having 2 or more comorbidities were shown to increase risk of neutropenia ((p=0,014,p=0,048 and p=0,002). CIN development and severity did not differ between chemotherapy regimen groups. Being overweight or obese decrease risk of CIN (p=0,001 and p<0,001). Grade 3-4 CIN incidence was statistically higher in metastatic patients (p=0,007). Conclusion: We conclude that older age ( ≥60), lower baseline white blood cell count, lower body mass index and having 2 or more comorbidities are associated with increased risk of CIN.Amaç: Bu çalışmada sistemik kemoterapi alan meme kanseri hastalarında kemoterapinin indüklediği nötropeni (CIN) gelişimini etkileyen tedavi ilişkili ve hasta ilişkili risk faktörlerinin ortaya konulması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya 2006-2013 yılları arasında Hacettepe Üniversitesi Onkoloji Hastanesi’nde sistemik antrasiklin, taksan ve CMF kemoterapileri alan 679 kadın meme kanseri hastası dahil edilmiştir. Primer koloni stimüle edici faktör profilaksisi alan hastalar çalışma dışında bırakılmıştır. Doz değişimi ve koloni stimüle edici faktörler ile sekonder profilaksi etkisini dışlamak için hastaların ilk kez nötropeniye girdikleri kemoterapi kürü dikkate alınmıştır. Hastaların demografik özellikleri (yaş, vücut kitle indeksi (VKİ), menapozal durum, komorbiditeler, Charlson Komorbidite İndeksi (CKİ) skoru), uygulanan tedaviler (cerrahi türü, kemoterapi rejimi, radyoterapi alma durumu, trastuzumab alma durumu) ve tedavi öncesi tam kan sayımı parametreleri (beyaz küre sayısı, nötrofil sayısı, lenfosit sayısı, nötrofil/lenfosit oranı) ile ilişkili veriler tıbbi kayıtlardan retrospektif olarak toplanmıştır. Bu değişkenler ile tedavi ilişkili nötropeni gelişimi/şiddeti arasındaki ilişki araştırılmıştır. Tüm analizlerde gruplar arası fark için istatistiksel anlamlılık sınırı p<0,05 olarak kabul edilmiştir. Bulgular: Yapılan tek yönlü analizlerde düşük VKİ ve düşük bazal beyaz küre sayısı ile nötropeni gelişimi arasında ilişki saptanmıştır (p= 0,001 ve p< 0,001). Nötrofil/lenfosit oranı 3’ün altında ve üstünde olan hastalara arasında benzer nötropeni gelişim oranları bulunmuştur (p=0,448). Çok değişkenli regresyon analizinde ileri yaş (≥60), düşük bazal beyaz küre sayısı ve 2 veya daha fazla komorbiditeye sahip olmanın nötropeni riskini artırdığı gösterilmiştir (p=0,014,p=0,048 ve p=0,002). Kemoterapi rejimi grupları arasında nötropeni gelişimi ve şiddeti açısından fark izlenmemiştir. Fazla kilolu veya obez olmanın ise riski azalttığı görülmüştür (p=0,001 ve p<0,001). Metastatik hastalığı olanlarda evre 3-4 nötropeni riskinin arttığı saptanmıştır (p=0,007). Sonuç: Sonuç olarak bu çalışmada ileri yaşta olmanın (≥60), düşük vücut kitle indeksinin, düşük bazal beyaz küre sayısının ve 2 veya daha fazla komorbiditeye sahip olmanın kemoterapi ilişkili nötropeni riskini artırdığı gösterilmiştir