Palliative Care Services from Past to Present

Palliative care (PC) refers to all services provided to make the remaining life of a patient meaningful and valuable. It is recommended that palliative care that is applied to improve the life quality of the patients should not be based only on the diagnosis and prognosis of the disease but also on the need of the patients. Even, palliative care was administered only in the late stages of diseases in the past, but these days it is recommended to be administered in addition to therapies starting from the diagnosis of life-threatening diseases. Palliative care requires a multidisciplinary team approach consisting of professionals who serve for a common purpose. No single palliative care model can be fit for all conditions. However, there is a universal fundamental principle of palliative care: it should address the individual wishes and needs of each patient and the relatives of patients. The development and training of palliative care services vary from country to country: palliative care services are in the development stage in developing countries, compared to developed countries. This chapter provides necessary information about palliative care services, a multidisciplinary health service

The Effectiveness of a Peer Support Program on Coping with Bullying

Bu araştırmada zorbalıkla baş etmeye yönelik akran destek programının, ortaokul öğrencilerinin zorbalıkla baş etme becerileri üzerindeki etkileri incelenmiştir. Çalışma grubunu; deney grubunda 42 öğrenci, akran yardımcısı grubunda 16 öğrenci ve kontrol grubunda 42 öğrenci olmak üzere toplam 100 katılımcı oluşturmuştur. Eşitlenmemiş control gruplu yarı-deneysel desende yürütülmüş olan araştırma karışık desen özelliklerini de yansıtmaktadır. Deney ve kontrol gruplarının ölçümlerinin karşılaştırılmasında ANCOVA ile tekrarlı ölçümler için ANOVA kullanılmıştır. Deney grubundan programla ilgili “görüşme tekniği” yoluyla elde edilen veriler içerik analizine tabi tutulmuştur. Gruplar arasında ön test, son test ve izleme testlerinden elde ettikleri ortalama puanlar açısından anlamlı bir farklılık bulunmamasına rağmen, kontrol grubunun kurban puanlarının deneyden sonra anlamlı düzeyde azaldığı tespit edilmiştir. Kontrol grubunun kurban puanlarının da son testte ve izleme testlerinde beklenmedik düzeylerde düşmesi kontrol edilememiş bir değişkenle ilişkili bulunmuştur. Deney grubu öğrencilerinin büyük çoğunluğu akran destek programının zorbalıkla baş etme becerilerini geliştirmede etkili olduğunu, uygulamadan fayda gördüklerini ifade etmişlerdir.The purpose of this study is to examinethe effects o a peer support program onsecondary school students’ skills to cope with bullying. There were total 100 subjects, 42 ofwhom were in experimental group, 16 of whom were peer supporter group and 42 of whomwere in control group. The research carried out with quasi experimental nonequivalentcontrol group design reflects also mixed design characteristics. In the comparison ofexperimental and control group measurements, ANCOVA and ANOVA for repeated measureswere used. Data obtained from interview technique were analyzed by means of contentanalysis. Although there were no significant differences between the groups in respect to theiraverage victim scores that they obtained from repeated measures, it was determined that thevictim scores of these groups decreased significantly after the experiment. The unexpecteddecreases in the victim scores of control group in the final and follow-up tests was associatedwith an uncontrollable vairable. However majority of the students in the experiment groupstated that their experiences and feelings during the implementation process were positive

Depressive Symptoms in a General Population: Associations with Obesity, Inflammation, and Blood Pressure

To determine whether obesity, inflammation, or conventional risk factors are related to depressive symptoms (DeprSy) in the general population. Responses to 3 questions served to assess sense of depression. Body mass index (BMI), C-reactive protein (CRP), and other epidemiologic data of participants were available. In 1940, individuals who consulted a psychiatrist in the preceding year, or felt depressed (together DeprSy), 248 were female. Logistic regressions for adjusted associations of BMI with DeprSy were not significant as was serum CRP level. Diabetes and, in men, fasting glucose concentrations were associated with DeprSy. Systolic blood pressure (SBP) was robustly inversely associated with DeprSy in diverse models at ORs of 0.74 (95%CI 0.63; 0.89) independent of confounders, including antihypertensive and lipid-lowering medication. The use of antidepressants could not explain the reduced BP. Women are predisposed to depression with which, not BMI and CRP, but SBP is inversely associated. Anti-inflammatory substances produced in depressed persons might explain the slightly lower BP

Relatively high levels of serum adiponectin in obese women, a potential indicator of anti-inflammatory dysfunction: Relation to sex hormone-binding globulin

It is unclear whether serum adiponectin concentrations diminish linearly with increasing adiposity and, if not, which factors codetermine this association. These issues were investigated cross-sectionally in 1188 men and women, representative of middle-aged and elderly Turkish adults. Serum total adiponectin was assayed by ELISA. Serum adiponectin values in men, though declining significantly in transition from the bottom to the mid tertile of body mass index (BMI) and waist circumference (WC), were similar in the two respective upper tertiles. In women, serum adiponectin concentrations were not significantly different in any tertile of these indices, were significantly correlated with BMI or WC within the low tertiles and not within the two higher tertiles. In a linear regression analysis for WC (or BMI) in a subset of the sample in which serum sex hormone-binding globulin (SHBG) was available and which additionally comprised adiponectin, fasting insulin and other confounders, only insulin and, in women SHBG, were significantly associated, but not adiponectin. In linear regression analyses for covariates of adiponectin in two models comprising 12 variables, insulin and SHBG concentrations were significantly associated in both genders though not BMI. Whereas in men HDL-cholesterol and CRP were covariates of adiponectin (both p<0.01), SHBG and apolipoprotein B positively associated in women (p<0.001), independent of BMI and fasting insulin levels

Prevalence of allergic rhinitis and risk factors in school children

Objective: To evaluate the prevalence and the risk factors of allergic rhinitis in a particular area. Methods: The main study group consisted of all school children in Kemalpasa district aged 13-14 years. Children with current rhinitis based on responses given in ISAAC questionnaire survey were further evaluated for confirmation. Parents responded to a more detailed questionnaire about allergic diseases and risk factors. Then peak nasal inspiratory flow (PNIF) was evaluated to objectively assess nasal patency. Skin-prick test was performed for ten common allergens. Results: The questionnaire was answered by 90.8% (1373) of children. The prevalence of physician-diagnosed AR was 11.1%. Current rhinitis was found to be 31.3%. Of this group, 55.0% were admitted for the parent questionnaire and tests. Precisely, 90.3% of children accepted PNIF evaluation, and %10.1 of them had a nasal obstruction. Skin-prick tests revealed allergy for at least 1 allergen in 16.6% of children. The present study showed that the children with maternal allergic rhinitis history had 2,18 fold, and the children with seasonal allergic rhinitis had 2,11 fold higher possibility of sensitization to an allergen. The probability of perennial allergic rhinitis was 3,1 fold higher in the children who had siblings with allergic rhinitis. Conclusion: We included all children in a specific age group living in an area in our survey. As well as we found the prevalence of current rhinitis with the ISAAC questionnaire; we also evaluated peak nasal inspiratory flow and used skin-prick tests that yielded objective results

Heterologous booster COVID-19 vaccination elicited potent immune responses in HCWs

The objective of our study was to evaluate the antibody responses of health care workers (HCWs) who were vaccinated with booster dose BNT162b2 6 months after 2 doses of the CoronoVac vaccine. The study included 318 HCWs vaccinated with inactive CoronaVac SARS-CoV-2 vaccine in 2 doses. Anti-spike/RBD IgG levels were measured immediately before and 1 month after the booster dose. In the sixth month after CoronaVac vaccination, the median of antibody levels of 1212.02 AU/ML, while it was 9283 AU/mL after BNT162b2 vaccination. IgG antibody titers of over 1050 AU/mL (which is equivalent to 1:80 dilution in the plaque reduction neutralization test) were detected in HCWs 15.09% and 97.8%, respectively. Our results showed that antibody titers increased 8-fold after the booster dose. We believe that the administration of the mRNA vaccine as a booster dose can provide more effective protection against COVID-19 infection, especially in individuals with risk factors.IU-Cerrahpaşa Scientific Research Projects Uni

Waning immunity to inactive SARS-CoV-2 vaccine in healthcare workers: Booster required

Aims Despite high vaccination rates, increasing case numbers continue to be reported with the identification of new variants of concern, and the issue of durability of the vaccine-induced immune response remains hot topic. Real-life data regarding time-dependent immunogenicity of inactivated COVID-19 vaccines are scarce. We aimed to investigate the changes in the antibody at the different times after the second dose of the CoronaVac vaccine. Methods The study included 175 HCWs vaccinated with inactive CoronaVac (Sinovac Life Sciences, China) SARS-CoV-2 vaccine in two doses. Anti-spike/RBD IgG levels were measured first, third, and sixth months after the second dose. Chemiluminescent microparticle immunoassay (IgG II Quant test, Abbott, USA), which is 100% compatible with plaque reduction neutralization test, was used. Results Mean age of the participants was 38 +/- 11.23 years (range between 22 and 66) of whom 119 (63.9%) were female, and 56 (32%) were male. Dramatic reductions were demonstrated in median antibody levels particularly in the infection-naive group, comprising 138 HCWs compared to those with prior history of COVID-19 infection (n = 37) (p < 0.001). There was no difference between the two groups in terms of age, gender, blood groups, BMI, and comorbid diseases. Conclusions While antibody positivity remained above 90% in the 6th month after two doses of inactivated vaccine in HCWs, the median titers of neutralizing antibodies decreased rapidly. The decrease was more rapid and significant in those with no history of prior COVID-19 infection. In this critical phase of the pandemic, where we are facing the dominance of the Omicron variant after Delta, booster doses have become vital.IU-Cerrahpasa Scientific Research Projects Uni

DLR Design Challenge 2022: Design of a next generation VTOL firefighting aircraft

Since 2017, the German Aerospace Center (DLR) has been organizing an annual student competition on conceptual aircraft design titled DLR Design Challenge. This education and training initiative is set to challenge the next generation of aircraft designers with topics tailored to current research questions in the field of aeronautics. This year’s challenge was about the development of an aerial firefighting system of systems including vehicle and fleet design with a strong emphasize on operationally-driven design aspects. This paper proposes a design for a next generation vertical take-off and landing firefighting aircraft with an expected entry into service in 2030, that is working intelligently and interconnected in a group of four. The design won the DLR Design Challenge 2022 and the underlying work covers the preliminary design including the structural concept, aerodynamic simulations, weight and balance calculations and the concept for water intake and deployment. The designed aircraft is characterized by a considerable high payload ratio that features vertical take-off and landing capabilities while showing efficient horizontal flight properties with a very competitive cost basis. The 24-hr operability during various weather conditions and challenging fire scenarios is ensured using a wide variety of sensors and a modern glass-cockpit combining pilot comfort with indispensable safety aspects. Due to its modular design, every aircraft can be comfortably converted to a passenger or freight version during firefighting off-season or for cargo and crew supply during the missions

DLR DESIGN CHALLENGE 2022: DESIGN OF A NEXT GENERATION VTOL FIREFIGHTING AIRCRAFT

Since 2017, the German Aerospace Center (DLR) has been organizing an annual student competition on conceptual aircraft design titled DLR Design Challenge. This education and training initiative is set to challenge the next generation of aircraft designers with topics tailored to current research questions in the field of aeronautics. This year’s challenge was about the development of an aerial firefighting system of systems including vehicle and fleet design with a strong emphasize on operationally-driven design aspects. This paper proposes a design for a next generation vertical take-off and landing firefighting aircraft with an expected entry into service in 2030, that is working intelligently and interconnected in a group of four. The design won the DLR Design Challenge 2022 and the underlying work covers the preliminary design including the structural concept, aerodynamic simulations, weight and balance calculations and the concept for water intake and deployment. The designed aircraft is characterized by a considerable high payload ratio that features vertical take-off and landing capabilities while showing efficient horizontal flight properties with a very competitive cost basis. The 24-hr operability during various weather conditions and challenging fire scenarios is ensured using a wide variety of sensors and a modern glass-cockpit combining pilot comfort with indispensable safety aspects. Due to its modular design, every aircraft can be comfortably converted to a passenger or freight version during firefighting off-season or for cargo and crew supply during the missions

Mild-to-Moderate Kidney Dysfunction and Cardiovascular Disease: Observational and Mendelian Randomization Analyses

BACKGROUND: End-stage renal disease is associated with a high risk of cardiovascular events. It is unknown, however, whether mild-to-moderate kidney dysfunction is causally related to coronary heart disease (CHD) and stroke. METHODS: Observational analyses were conducted using individual-level data from 4 population data sources (Emerging Risk Factors Collaboration, EPIC-CVD [European Prospective Investigation into Cancer and Nutrition-Cardiovascular Disease Study], Million Veteran Program, and UK Biobank), comprising 648 135 participants with no history of cardiovascular disease or diabetes at baseline, yielding 42 858 and 15 693 incident CHD and stroke events, respectively, during 6.8 million personyears of follow-up. Using a genetic risk score of 218 variants for estimated glomerular filtration rate (eGFR), we conducted Mendelian randomization analyses involving 413 718 participants (25917 CHD and 8622 strokes) in EPIC-CVD, Million Veteran Program, and UK Biobank. RESULTS: There were U-shaped observational associations of creatinine-based eGFR with CHD and stroke, with higher risk in participants with eG FR values 105 mL.min(-1).1.73 m(-2), compared with those with eG FR between 60 and 105 mL.min(-1).1.73 m(-2). Mendelian randomization analyses for CHD showed an association among participants with eGFR 105 mL.min(-1).1.73 m(-2). Results were not materially different after adjustment for factors associated with the eGFR genetic risk score, such as lipoprotein(a), triglycerides, hemoglobin Alc, and blood pressure. Mendelian randomization results for stroke were nonsignificant but broadly similar to those for CHD. CONCLUSIONS: In people without manifest cardiovascular disease or diabetes, mild-to-moderate kidney dysfunction is causally related to risk of CHD, highlighting the potential value of preventive approaches that preserve and modulate kidney function