The Unbearable Failure of Decentralisation in Turkey

Due to the country’s then drive towards European Union membership, a comprehensive administrative reform agenda had emerged in Turkey during early 2000s. But a brusque reversal of decentralisation reforms followed the 2010 constitutional referendum. The democratic reform agenda adopted in the 2000s has been overturned to lead to an increasingly authoritarian and centralised power. This recentralisation movement had a direct impact on local governance, triggering a decline of local autonomy accompanied by the dismissal of elected mayors and city council members in some Kurdish-populated cities. The fast decay of democratic accountability was accompanied by clientelism and corruption. Indeed, modifications to the system of local administration in the direction of recentralisation stem from the determination to strengthen the central state. Embracing an extremely nationalist discourse, on the one hand, the state put the screws to HDP-ruled municipalities and disqualified mayors-elect in major Kurdish-populated cities. On the other hand, the provision of public welfare as ‘charitable patronage’, redistribution of public resources, and access to public jobs, health services and public housing constituted the major assets of dependency networks created between the AKP and its electors. Taking into account the crucial role played by municipalities in the constitution of these networks, control over municipalities became imperative for the central state. Nevertheless, even in a marginalised local democracy, mayors still have some tools at their disposal and should put them into service to reinforce and expand democratic rights

Head and neck cancer with synchronous nodules of the lung as a diagnostic and therapeutic challenge - A systematic review.

Head and neck squamous cell carcinoma (HNSCC) often presents with synchronous nodules of the lung (sNL), which may be benign nodules, second primary malignancies or metastases of HNSCC. We sought to gain an insight into the incidence of sNL and synchronous second primary of the lung (sSPML) in HNSCC patients and current opinions on useful diagnostic and therapeutic approaches. We conducted a systematic search of the PubMed database for articles that reported the simultaneous detection of HNSCC and sNL/sPML, within the timeframe of diagnosis and staging. Only studies involving humans were included, without restrictions for sex, age, ethnicity, or smoking history. All articles were categorised according to the Oxford Centre of Evidence-Based Medicine levels and their data collected. Data from 24 studies were analysed. Amongst HNSCC, the mean overall incidence rate of sNL and sSPML was 11.4% (range: 1.3-27%) and 2.95% (range: 0.4-7.4%), respectively. The possibility of a sNL to be a sSPML cannot be ignored (mean: 35.2%). Studies investigating smoking habits showed that the majority (98-100%) of HNSCC patients with sSPML were previous or active smokers. Detection of human papillomavirus through DNA analysis, p16 immunohistochemistry, and identification of clonal evolution were useful in differentiating metastasis from sSPML. 18FDG-PET scan was the most reliable method to diagnose sSPML (sensitivity: 95%; specificity: 96%; positive predictive value: 80%). With early sSPML detection and curative treatment, the 5-year overall survival rate is 34-47%. However, the proposed advantage of early detection warrants further evidence-based justification

Izbjeglička kriza i lokalni odaziv: kako se lokalni kapaciteti nose s priljevom migranata u Istanbul

Although Turkey has been gradually transforming into a country of asylum, its legislation concerning refugees remains inadequate to guarantee the fundamental rights and basic needs of this population, such as accommodation, healthcare, and employment. However, following legal modifications in 1994 and 2013, persons from non-European countries have been allowed to apply for “temporary asylum” in Turkey. Currently, almost 90% of Syrian refugees in Turkey live in different Turkish cities, and Istanbul is hosting the highest number of out-of-camp Syrians. Temporary asylum status provides these refugees with some basic needs. Refugees living in camps have access to education, water, food, shelter, and health services, while others may benefit only from the right to free healthcare and medication if they are registered. Consequently, the noncamp populations living in different cities have exerted considerable pressure on municipalities. The present study tries to analyse the legal a nd administrative ramework in Turkey which provides assistance to refugees at the local level. For this purpose, the experiences of lower tier municipalities in Istanbul have been described, and their capacities as well as difficulties in dealing with the crisis have been assessed. The study focuses on three municipalities: Zeytinburnu, Sultanbeyli, and Sisli. In Istanbul, services delivered to Syrian refugees vary noticeably from one unicipality to another. The lower tier municipalities generally incorporate the services they offer to refugees within the framework of emergency management, and more specifically, assistance to the poor and needy. However, a few municipalities do carry out well-developed, integration-oriented, and longer-term programmes. It would not be wrong to claim that muddling through determines local action, which has been built gradually. The lack of legal clarity surrounding local administrations’ responsibilities towards refugees and the lack of long-term governmental policies constitute major obstacles to the enhancement of local action.Iako Turska postupno postaje zemlja azila, zakonodavstvo koje se bavi izbjeglicama i dalje je nedostatno da bi se izbjegličkoj populaciji zajamčila osnovna prava i osigurale osnovne potrebe, primjerice smještaj, zdravstvena zaštita i zaposlenje. Izmjenama zakona uvedenih 1994. i 2013. godine državljani izvaneuropskih država stekli su mogućnost dobivanja “privremenog azila“ u Turskoj. Trenutno gotovo 90% sirijskih izbjeglica u Turskoj živi u gradovima, a najveći broj izbjeglica smještenih izvan kampova živi u Istanbulu. Status privremenog azila osigurava im osnovne potrebe. Izbjeglicama smještenima u kampovima osigurano je sklonište, hrana, voda, zdravstvena skrb i mogućnost školovanja, no ostali mogu iskoristiti pravo na besplatnu zdravstvenu skrb i lijekove jedino ako su registrirani. Stoga izbjeglice izvan kampova stvaraju velik pritisak na općine u gradovima u kojima žive. U radu se analizira turski zakonski i administrativni okvir unutar kojega se na lokalnoj razini pruža pomoć izbjeglicama. Razmatraju se iskustva istanbulskih općina niže razine te se ocjenjuju njihovi kapaciteti i načini na koji su se nosili s poteškoćama u kriznom razdoblju. U radu se u tom smislu detaljnije opisuju tri općine: Zeytinburnu, Sultanbeyli i Sisli. Usluge namijenjene sirijskim izbjeglicama u Istanbulu znatno se razlikuju u svakoj općini. Općine niže razine obično smještaju takve usluge u područje upravljanja kriznim situacijama, posebice u područje pomoći siromašnim i potrebitim osobama. Samo mali broj općina provodi dobro osmišljene i dugoročnije programe usmjerene integraciji. Ne bi bilo netočno tvrditi da se lokalni potezi temelje na snalaženju. Glavnu prepreku unaprjeđenju lokalnih poteza čini nedovoljno jasna pravna situacija što se tiče odgovornosti lokalne administracije prema izbjeglicama kao i nedostatak dugoročne državne politike

Municipalites métropolitaines et municipalites d'arrondissement en Turquie

Les grandes villes turques sont marquées par une dualité aiguë de l'espace physique, social et économique. Face à une explosion urbaine démesurée et désordonnée, ces métropoles sont devenues extrêmement difficiles à gérer. La loi n° 3030 du 9 juillet 1984 porte essentiellement sur une réorganisation municipale des «grandes villes», des municipalités métropolitaines. Ces dispositifs administratifs sont suivis par un transfert de compétences en matière de planification urbaine. Les bases juridi..

Soybean (glycine max. (l.) Merrill) vegetative growth performance under chemical and organic manures nutrient management system

Optimization of fertilizers sources and doses occupies pivotal position for triggering crops growth along with reducing a halt to environmental pollution caused by excessive use of mineral fertilizers. This field research was conducted to determine the effect of chemical and organic fertilizers on vital vegetative growth parameters including leaf area index and chlorophyll content of soybean (cv. Nova).Treatments included four different sources of fertilizers manures from sheep and cattle barns, liquid manure from cattle barn, chemical fertilizers and a control treatment was kept for comparison purpose. The chlorophyll contents of plants at different growing stages Beginning bloom (R1) and Beginning seed (R5) were measured using SPAD-502 and CM 1000 chlorophyll meter. The results indicated that physiological growth parameters including leaf area index and chlorophyll content of soybean differed significantly at stage R1 and R5 growth stages under varying fertilization regimes. The chemical fertilizers remained unmatched for recording the maximum physiological growth, while liquid manure from cattle barn performed superiorly by exhibiting the maximum leaf area index and chlorophyll content. It is recommended to use liquid manure from cattle barn for boosting physiological growth of soybean and these research findings also necessitate evaluation of different doses of liquid cattle manure to sort out the best performing dose for soybean production under changing climate

Diagnostic accuracy of MRI and PET/CT for neck staging prior to salvage total laryngectomy

Aim: Lymph node (LN) metastases are associated with poor outcomes in patients with recurrent larynx squamous cell carcinoma (LSCC). Neck dissection (ND) is therefore commonly performed along with salvage total laryngectomy (STL). Here, we assess the rate of occult LN metastases and the diagnostic value of MRI and PET/CT for detecting them in recurrent LSCC. Methods: This retrospective study included patients with recurrent LSCC after primary (chemo)radiotherapy [(C)RT] who were re-staged by MRI and/or PET/CT and treated with STL and ND between 2004 and 2019. The histopathology of ND samples was used as the reference standard. Results: Forty-one patients were included. The prevalence of occult metastases in MRI-negative and PET/CT-negative neck nodes was between 3.2% and 6.1%. Negative predictive values of neck node re-staging were 93.9% for MRI, 96.8% for PET/CT, and 96.2% for MRI and PET/CT combined. Conclusion: Both MRI and PET/CT afforded good negative predictive values for nodal staging in patients with recurrent LSCC after (C)RT prior to STL. In selected patients, these radiological modalities, particularly PET/CT, could help to avoid unnecessary surgery to the neck and its associated morbidity

Risk Factors for Fear of Recurrence in Head and Neck Cancer Patients

Objective: Fear of recurrence (FoR) affects the quality of life of head and neck cancer survivors. Identification of factors predisposing to FoR may help to recognize and treat patients at risk. Materials and methods: For this exploratory study, 101 disease-free head and neck cancer survivors completed a cross-sectional survey in 2017 that included the FoR questionnaire at a random point in time during their follow-up. Additionally, the patients were asked to choose their favorite among four follow-up schedules with or without systematic imaging and varying frequency of visits. Results: Elevated FoR was present in 36.6% of patients. Females and patients ≤65 years showed significantly higher FoR overall scores than males (score difference 3.40; CI 0.49-6.32; p = 0.022) and patients >65 years (score difference 4.25; CI 1.58-6.92; p = 0.002). A history of cancer recurrence or second primary malignancy increased the relative risk (RR) for elevated FoR (RR 1.7; CI 1.01-2.86; p = 0.046). Tumor stage and treatment modality were not significantly associated with elevated FoR or FoR overall score. Higher FoR overall scores were recorded in patients who favored intensive follow-up plans (mean overall FoR score 18 vs. 15; SD 7.7; p = 0.076) and systematic imaging in follow-up (17 vs. 13, SD 7.1; p = 0.034). Conclusion: Fear of recurrence in head and neck cancer patients is associated with female sex, younger age, and history of a past recurrence or second primary malignancy. Due to its high prevalence, it should be addressed in clinical practice and future research

a retrospective analysis

Purpose: We looked for any predictive value of change in primary tumor and metastatic lymph node volumes after induction chemotherapy (IC) on oncologic outcome in head and neck squamous cell carcinoma (HNSCC). Methods: Nineteen patients with stage IVA/B HNSCC treated between 2004 and 2010 with at least one cycle of IC (docetaxel, cisplatin and 5-fluorouracil / TPF) and concomitant chemoradiotherapy (CRT) with cisplatin were retrospectively analyzed. Volumes were calculated separately for primary tumor (Vtm), lymph node metastases (Vln) and their sum (Vsum) on computed tomography (CT) images before and after IC. The effect of volumetric changes on locoregional failure (LRF), distant metastasis (DM) and overall survival (OS) was assessed. P values <0.05 were considered as statistically significant. Results: The median follow-up of surviving patients was 25 months (range: 10.7-83.3). The median number of cycles and duration of TPF was 3 (range: 1-4) and 44 days (range: 4-116), respectively. Empirical area under the curve (AUC) analyses for death, LRF and DM revealed optimal cut-off values of Vtm diminution (30.54%, AUC: 87%) and Vsum decrease (35.45%, AUC: 64.55%) only for OS (p <0.05). Among those, a reduction in Vsum more than 35.4% between pre- and post-IC was significantly correlated with better OS (100 vs 43% at 2 years, p <0.05). Conclusion: Volumetric shrinkage of the tumor load after IC assessed with CT seems to predict OS. The assessment of volumetric shrinkage upon IC might be used to decide whether to offer patients alternative strategies like palliative/de-intensified treatments or more aggressive combined modalities after IC

Relationship between survival and increased radiation dose to subventricular zone in glioblastoma is controversial

To test the hypothesis on prolonged survival in glioblastoma cases with increased subventricular zone (SVZ) radiation dose. Sixty glioblastoma cases were previously treated with adjuvant radiotherapy and Temozolamide. Ipsilateral, contralateral and bilateral SVZs were contoured and their doses were retrospectively evaluated. Median follow-up, progression free survival (PFS) and overall survival (OS) were 24.5, 8.5 and 19.3months respectively. Log-rank tests showed a statistically significant correlation between contralateral SVZ (cSVZ) dose >59.2Gy (75th percentile) and poor median PFS (10.37 [95% CI 8.37-13.53] vs 7.1 [95% CI 3.5-8.97] months, p=0.009). cSVZ dose>59.2Gy was associated with poor OS in the subgroup with subtotal resection/biopsy (HR: 4.83 [95% CI 1.71-13.97], p=0.004). High ipsilateral SVZ dose of >62.25Gy (75th percentile) was associated with poor PFS in both subgroups of high performance status (HR: 2.58 [95% CI 1.03-6.05], p=0.044) and SVZ without tumoral contact (HR: 10.57 [95% CI 2.04-49], p=0.008). The effect of high cSVZ dose on PFS lost its statistical significance in multivariate Cox regression analysis. We report contradictory results compared to previous publications. Changing the clinical practice based on retrospective studies which even do not indicate consistent results among each other will be dangerous. We need carefully designed prospective randomized studies to evaluate any impact of radiation to SVZ in glioblastoma