Determinants of Recurrent Melioidosis

Recurrent melioidosis represents relapse following failure to eradicate bacteria responsible for the primary infection or re-infection with a new strain. The first results chapter (chapter 3) evaluates the proportion of recurrent melioidosis due to relapse versus re-infection. Isolates from the same patient with an identical genotype were considered as relapse and those with a different genotype as re-infection. Three quarters of recurrent cases were due to relapse and one quarter were due to re-infection. There are two ways in which this approach could be confounded. First, ‘re-infection’ could actually represent relapse if primary infection was caused by simultaneous infection with multiple B. pseudomallei strains, followed by chance selection of different strains from the two episodes for genotyping. The chance of this mistake occurring is based on the rate of polyclonal B. pseudomallei infection. Chapter 4 describes the rate of polyclonal infection in a large group of unselected patients in northeast Thailand, which was very low (2/133 cases, 1.5%). Second, ‘relapse’ could actually represent reinfection in the event that re-infection was caused by a B. pseudomallei strain that was by chance identical to the primary strain. The probability of this happening is based on the degree of genetic diversity of B. pseudomallei in the environment. Chapter 5 demonstrates that the population of B. pseudomallei in even a small sampling site is extremely diverse. Thus, it is unlikely that the assessment of the causes of recurrent melioidosis contained significant errors due to polyclonal infection or low genetic diversity of the organism. Chapter 6 examines specific risk factors of relapse and reinfection. Duration and choices of antibiotics used for the primary episode were major determinants of relapse. Chapter 7 compares the clinical manifestations of relapse and re-infection and develops a simple scoring index to predict relapse or re-infection in patients presenting with recurrent melioidosis

Eğitim örgütlerinde sosyal sermaye ve şiddet eğilimi düzeyi

06.03.2018 tarihli ve 30352 sayılı Resmi Gazetede yayımlanan “Yükseköğretim Kanunu İle Bazı Kanun Ve Kanun Hükmünde Kararnamelerde Değişiklik Yapılması Hakkında Kanun” ile 18.06.2018 tarihli “Lisansüstü Tezlerin Elektronik Ortamda Toplanması, Düzenlenmesi ve Erişime Açılmasına İlişkin Yönerge” gereğince tam metin erişime açılmıştır.Sanayi Devrimi'nin ardından meydana gelen büyük toplumsal değişimleri ve dönüşümleri anlama, anlamlandırma çabasının bir sonucu olarak ortaya çıkan sosyolojinin son yıllarda ilgi duyduğu kavramlardan biri de sosyal sermayedir. Kuram üzerinde çalışma yapan bilim adamları sosyal sermayeyi Alexis de Tocqville'in Amerikan demokrasisi hakkında yazdığı esere dayandırmaktadır. Kavramın içerdiği boyutlara bakılacak olursa antik dönemden bu yana insanoğlunun ürettiği masal, efsane, öykü, atasözleri, menkıbeler ve türkülerde sosyal sermayenin izlerini bulmak mümkündür. Bu nedenle kavramın adını ilk kez kullanan L.J. Hanifan'ı esas başlangıç noktası olarak ele almanın daha sağlıklı olacağı düşünülmektedir. Bourdieu, Coleman ve Putnam'ın çalışmaları; ardından Fukuyama'nın güven boyutunu önemsemesi sosyal sermaye kavramına zenginlik katmıştır. Eğitim örgütlerinde akademik başarı ile sosyal sermaye ilişkisini ölçen araştırmalarla karşılaşılmaktadır. Yapılan araştırmalarda eğitim örgütlerinin sosyal sermayesinin öğretmenler ve yöneticiler üzerinden ölçüldüğü gözlenmiştir. Zaten sorunlu olan sosyal sermayenin ölçümünün öğretmen-öğrenci-veli gibi üçlü paydaşı bulunan bir örgütte bir paydaşın sosyal sermayesi ile diğer paydaşın sosyal sermaye düzeylerinin karşılaştırılması sonucu elde edilecek bilgilerin daha sonraki çalışmalara ışık tutacağı düşünülmektedir. Düzce ilinde 2550 öğrenci ve 292 öğretmenin katılımıyla yapılan bu çalışmada öğretmen ve öğrencilerin sosyal sermaye düzeyleri arasında fark saptanmıştır. Ayrıca öğrencilerin sosyal sermaye düzeyleri ile şiddet eğilimleri arasında anlamlı bir ilişki olduğu belirlenmiştir. Öğrencilerin bazı demografik değişkenlerinde sosyal sermaye ve şiddet eğilimleri arasında anlamlı farka rastlanmıştır. Sigara, alkol ve madde kullanan öğrencilerin sosyal sermayelerinin düşük, şiddet eğilimlerinin yüksek düzeyde saptanması araştırmanın diğer bulgularındandır.Social capital has been one of the interests which sociology, emerging as a result of effort of understanding the importance of social changes and transformation after tha Industry Revolution, has given importance to in the recent years. The notion of social capital, which took its name in the early 20th century and was later conceived by the French sociologist Pierre Bourdieu and carried on academic adjustment, attracted much attention with the work of Coleman and especially Putnam. Later, Fukuyama brought a new dimension to social capital by considering the dimension of trust. Scientists working on the theory base social capital on what Alexis de Tocqville wrote about American democracy. If we look at the dimensions of the concept, it is possible to find the traces of social capital in the fairy tales, myths, stories, proverbs, old tales and folk songs that human beings have produced since ancient years. So considering Hanifan L.J. as a starting point is considered to be healthier. There are researches that measure the relation between academic achievement and social capital in educational organizations. It has been observed that the social capital of education organizations is measured by teachers and administrators. The measurement of the social capital which is already problematic is thought to be the result of comparing the social capital of a stakeholder with the social capital levels of the other stakeholder in an organization with a triple stakeholder such as a teacher-student-parent. The social capital levels of teachers and students were measured separately in 2550 students and 292 teachers in Düzce province and the difference between them was determined. It was also determined that there was a significant relationship between the social capital levels of students and their tendency to violence. That social capital of the students who smoke,drink alcohol and use substance is low and their violence tendency is high of the another findings of the research

Comparative and Exergetic Study of a Gas Turbine System with Inlet Air Cooling

The efficiency of the combined cycle is significantly influenced by the temperature, pressure and humidity of the ambient air. The aim of this study is to investigate the influence of the inlet air cooling system (fogging cooling system) on the gas turbine performance by energy and exergy analyses. Energy and exergy analysis was carried out for nine cases based on the operation data of a gas turbine. Performance parameters include fuel consumption, specific fuel consumption, thermal efficiency, net power output, exergetic efficiency and exergy destruction rates of the components for the cases. It is concluded that the net power output of the gas-turbine system increases at lower inlet air temperatures, and based on the mean values, exergetic efficiency and exergy destruction ratio were found as 37.35% and 33.02%, respectively

The impact of personal, housing, and neighbourhood factors on personal wellbeing

This study assesses how subjective wellbeing is related to housing and neighbourhood characteristics, controlling for personal variables. The secondary data analysis was based on the English Housing Survey, 2017: Housing Stock Data and the English Housing Survey: Fuel Poverty Dataset, 2017, collected in the period April 2016 to March 2018 (N= 9205). Subjective wellbeing was measured with four variables-life satisfaction, the perception of things being worthwhile in life, feeling happy and feeling anxious-that were dichotomized into low and high wellbeing. Logistic regression analysis showed that personal variables are most strongly related to wellbeing but that both housing and neighbourhood variables are also significantly related to it. Finding it difficult to keep the living room warm, being in fuel poverty, and finding it difficult to meet heating costs were associated with lower wellbeing. Low area satisfaction and not feeling safe were also significantly associated with lower wellbeing. The effects of variables are not constant across all four wellbeing measures used which raises the question ‘which wellbeing’should be addressed

Impact of low blood culture usage on rates of antimicrobial resistance

Abstract Objectives The magnitude of impact caused by low blood culture utilization on estimates of the proportions and incidence rates of antimicrobial-resistant (AMR) bacterial infections is largely unknown. Methods We used routine electronic databases of microbiology, hospital admission and drug prescription at Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand, from 2011 to 2015, and bootstrap simulations. Results The proportions of Escherichia coli and Klebsiella pneumoniae bacteraemias caused by 3rd generation cephalosporin resistant isolates (3GCREC and 3GCRKP) were estimated to increase by 13 and 24 percentage points (from 44% to 57% and from 51% to 75%), respectively, if blood culture utilization rate was reduced from 82 to 26 blood culture specimens per 1,000 patient-days. Among patients with hospital-origin bloodstream infections, the proportion of 3GCREC and 3GCRKP whose first positive blood culture was taken within ±1 calendar day of the start of a parenteral antibiotic at the study hospital was substantially lower than those whose first positive blood culture was taken later into parenteral antibiotic treatment (30% versus 79%, p<0.001; and 37% versus 86%, p<0.001). Similar effects were observed for methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter spp. and carbapenem-resistant Pseudomonas aeruginosa. Conclusion Impacts of low blood culture utilization rate on the estimated proportions and incidence rates of AMR infections could be high. We recommend that AMR surveillance reports should additionally include blood culture utilization rate and stratification by exposure to a parenteral antibiotic at the hospital