TO REFER OR NOT TO REFER: WHAT SHOULD WE DO?

Referral system applications are important pieces of Health System of WHOsuggesting to developed and developing countries since decades. Starts withdefining health centers as primary, secondary and tertiary, sustained with healthstaff and patients attendance. Referral system which supplies countries to use theirhuman and economical resources, are in application in very few country because ofsome obstacles. In Turkey, it is first tried in 1960's, but because of primary healthcare was not developed enough. Also in Health Reform Program, which is started toapplied in 2003, "gradual referral system" idea is accepted theorically. In 2008November, it is tried in 4 city, after couple of months in January 2009 it iscancelled.Researches are showing that, societies most of health problems are can be solved inprimary health centers. (%80-90) Thats why,referral system, is a system supportedby people who are working in these issues, because of the reasons; using moreefficient of human and financial resources, decreasing the barriers of academicdevelopment, increasing the service quality of secondary and tertiary healthcenters. However there are obstacles against referral system, still. To pass beyondthese obstacles, referral system, the advantages, obstacles and solutions must bedefined and able to be measurable.The aim of our research is to make addition to researches about family physiciansand specialists thoughts about referral system. This search is planned asqualitative. We used a detailed questinaire form for physicians, and applied with a in-depth interview method. All of the physicians were agree that referral system isneeded. But in small details they were separating

A Psychoanalytic Qualitative Study of Subjective Life Experiences of Women With Breast Cancer

This article exemplifies research on the subjective life experiences of women with breast cancer, designed from a psychoanalytic perspective. Such research aims to reveal the subjective intrapsychic processes of women suffering from breast cancer, which can provide researchers and health care professionals with useful insight. Using Biographic narrative interpretative method, the study reveals some common denominators in the subjective life experiences of women with breast cancer. The study revealed that the subjects consider the diagnosis of breast cancer as one of the four main events in their lives. Even though these events are very different from each other, in terms of type and severity, the results indicate a common process in the way these life events are experienced by the participants. These results are relevant for health care practitioners in structuring their psychosocial support programs so as to better accommodate their patients' psychological needs

THE EFFECT OF HARVESTING TIMES ON OIL AND FATTY ACID COMPOSITION OF PEANUT VARIETIES GROWN IN MAIN CROPPED CONDITION IN CUKUROVA REGION (MEDITERRANEAN AREA) IN TURKEY

This study was conducted at the experimental area of the Department of Field Crops, Faculty of Agriculture, Cukurova University as a main crop in 2015. The objective of this study was to determinate the effect of harvesting dates on oil and fatty acid composition of peanut (Arachis hypogaea L.) varieties grown in main cropped condition in Cukurova region. The experimental design was a split plot with three replications. The Halisbey, Sultan, Arioglu-2003, Osmaniye-2005, NC-7, Batem-5025, Flower 22, Flower-32, Flower-36, Brantley and Wilson peanut varieties (Virginia market type) were used as a plant material in this research. The plants were harvested at 149, 156, 163 and 170 days after sowing (DAS). Oil and fatty acids (palmitic acid, stearic acid, oleic acid, linoleic acid, linolenic acid, arachidic acid, behenic acid and lignoceric acid) content and Oleic acid to Linoleic acid ratio (O/L) of peanut varieties were investigated. As a result, the oil percentage of peanut varieties was increased from 47.8% to 50.3% when the harvesting delayed from 149 DAS to 170 DAS. While the palmitic and linoleic acid percentage was decreasing, the stearic and oleic acid percentage was increased when the harvesting delayed from 149 DAS to 170 DAS in peanut varieties. The others fatty acids were not affected by the harvesting time

Modeling of Dislocation Structures in Materials

A phenomenological model of the evolution of an ensemble of interacting dislocations in an isotropic elastic medium is formulated. The line-defect microstructure is described in terms of a spatially coarse-grained order parameter, the dislocation density tensor. The tensor field satisfies a conservation law that derives from the conservation of Burgers vector. Dislocation motion is entirely dissipative and is assumed to be locally driven by the minimization of plastic free energy. We first outline the method and resulting equations of motion to linear order in the dislocation density tensor, obtain various stationary solutions, and give their geometric interpretation. The coupling of the dislocation density to an externally imposed stress field is also addressed, as well as the impact of the field on the stationary solutions.Comment: RevTeX, 19 pages. Also at http://www.scri.fsu.edu/~vinals/jeff1.p

Molecular structure, vibrational spectral investigation and the confirmation analysis of 4-Methylesculetin molecule

WOS: 000333614200003In this work, FT-IR, FT-Raman, and FT-NMR spectra of 4-Methylesculetin molecule are presented for the first time. FT-IR, FT-Raman, and FT-NMR spectra of 4MEC have been recorded and analyzed. The FT-IR and FT-Raman spectra of this molecule are recorded at 4000-400 cm(-1) and 50-3500 cm(-1), respectively. The infrared vibrational frequencies, absolute intensities, potential energy profile, HOMO-LUMO plot and NBO analysis of the molecule have been also predicted using Becke's three-parameter hybrid B3LYP method in the density functional theory DFT method. Calculated and experimental data are in good agreement.Ahi Evran University Research FundAhi Evran University [FEN.4003.12.013]Y. Erdogdu would like to thank Ahi Evran University Research Fund for its financial support. Project Numbers: FEN.4003.12.013. Computing resources used in this work were provided by the National Center for High Performance Computing of Turkey (UYBHM)

Congenital Portal Vein Aneurysm Associated with Peliosis Hepatis and Intestinal Lymphangiectasia

Portal vein aneurisym (PVA), peliosis hepatis (PH) and intestinal lymphangiectasia (IL) all are very uncommon entities. Herein, we presented a unique patient with these three rare entities who was admitted to our hospital because of portal hypertensive ascites rich in protein and lymphocyte. PVA was extrahepatic and associated with coronary vein aneurysm. Peliosis hepatis was of microscopic form. Lymphangiectasia was present in peritoneum and small intestine. Diagnoses of these rare entities were made by imaging techniques and histopathological findings. Patient also had hydronephrosis caused by ureteropelvic junction narrowing. Best of our knowledge, there is no such a case reported previously with the association of PVA, PH and IL. Therefore, we propose PVAPHIL syndrome to define this novel association

RNA interference and amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a debilitating neuro-degenerative disorder characterized by progressive loss of motor neurons. The etiology and molecular pathogenesis of cell death in most sub-types of the disease are largely unknown. The best documented cause of moto-neuron degeneration is the mutation in the superoxide dismutase-1 (SOD 1) gene, which occurs in 10% of the familial forms of ALS. Discovery of RNA interference (RNAi), which plays an important role in the regulation of gene expression, has proven to be a powerful tool to study the pathogenesis and to develop innovative treatment options for hereditary diseases, including familial variants of ALS. This review summarizes current research advances in RNAi in relation to ALS. © 2011 Bentham Science Publishers

Comparative effectiveness and safety of direct oral anticoagulants versus warfarin in UK patients with atrial fibrillation and type 2 diabetes: a retrospective cohort study

PURPOSE: To estimate the effectiveness and safety of direct oral anticoagulants (DOACs) compared with warfarin in AF patients with type 2 diabetes (T2DM). METHODS: A retrospective cohort study was designed, using the UK Clinical Practice Research Datalink (August 2011 - June 2018). Participants were 1-year naïve users of DOACs or warfarin, followed from the date of first prescription of an oral anticoagulant until the end of the study period, death, discontinuation of treatment, switching to another anticoagulant, or an outcome of interest, whichever came first. Cox regression analysis was performed to estimate the hazard ratio (HR) adjusted for potential confounders. RESULTS: A total of 8,555 patients were identified. No significant differences were found between DOACs and warfarin in the risk of stroke (adjusted HR 1.15; 95% CI 0.82 - 1.60), ischemic and unspecified stroke (adjusted HR 1.23; 95% CI 0.86 - 1.76) or haemorrhagic stroke (adjusted HR 0.75; 95% CI 0.30 - 1.85), and myocardial infarction (adjusted HR 1.39 ;95% CI 0.99 - 1.97). DOAC and warfarin users were comparable with respect to risk of major bleed (adjusted HR 0.83; 95% CI 0.68 - 1.03), intracranial bleeding (HR 0.66; 95% CI 0.34 - 1.30), gastrointestinal bleeding (HR 0.88; 95% CI 0.60 - 1.30), and bleeding on other clinically relevant sites (HR 0.89; 95% CI 0.60 - 1.31). In the subgroup analyses stratified by gender and diabetes severity, the risk for stroke and bleeding remained consistent. CONCLUSION: DOACs are effective and safe alternatives to warfarin for the prevention of stroke in AF patients with T2DM

Surgical antibiotic prophylaxis use and infection prevalence in non-cosmetic breast surgery procedures at a tertiary hospital in Western Australia—a retrospective study

Copyright 2018 Lavers et al. Background. Surgical site infections (SSIs) are a common complication following breast surgery procedures, despite being considered a clean surgery. The prevalence of SSIs can be minimised with the appropriate use of antibiotic prophylaxis as outlined in the Australian Therapeutic Guidelines (eTG). The aims of this study were to evaluate adherence to the eTG for antibiotic prophylaxis in breast surgery procedures at a Western Australian teaching hospital following an update of the guidelines in 2014 and examine the impact of prophylactic antibiotics on SSI incidence and length of hospital stay. Method. A retrospective cross-sectional study which reviewed medical records from a random sample of 250 patients selected from 973 patients who underwent breast surgical procedures between February 2015 and March 2017. Results. Overall adherence to current eTG occurred in 49.2% (123/250) of operations. Pre-operative and post-operative antibiotics were prescribed in 98.4% (246/250) and 11.2% (28/250) operations respectively. Adherence rates to three specific elements of the eTG (drug prescribed, drug dosage and timing of administration) were 91.6% (229/250), 53.6% (134/250) and 86.4% (216/250) respectively. For the 14.4% (36/250) patients with relevant drug allergies, there was zero adherence to the eTG. Overall recorded SSI prevalence was low at 5.2% (13/250). The mean length of stay in patients (2.3 ± 1.7 days) was not influenced by level of eTG adherence (p = 0.131) or SSIs (p = 0.306). Conclusion.These data demonstrate a significant improvement in overall adherence to the eTG from 13.3% to 49.2% (p = < 0.001). The level of detected SSIs in this study was low. Further improvement is necessary with respect to prescribing appropriate antibiotic dosages and for those with allergies

A new hope for obesity management: Boron inhibits adipogenesis in progenitor cells through the Wnt/β-catenin pathway

© 2017Obesity is a worldwide medical problem resulting in serious morbidity and mortality involving differentiation of pre-adipocytes into mature adipocytes (adipogenesis). Boron treatment has been reported to be associated with weight reduction in experimental animals; however, its effects on pre-adipocyte differentiation and anti-adipogenic molecular mechanisms are unknown. In this study, we demonstrate the inhibitory activities of boric acid (BA) and sodium pentaborate pentahydrate (NaB) on adipogenesis using common cellular models. Boron treatment repressed the expression of adipogenesis-related genes and proteins, including CCAAT-enhancer-binding protein α and peroxisome proliferator-activated receptor γ, by regulating critical growth factors and the β-catenin, AKT, and extracellular signal-regulated kinase signaling pathways. In addition, although boron treatment did not induce apoptosis in pre-adipocytes, it depressed mitotic clonal expansion by regulation of cell cycle genes. Overall, these data offer promising insights into the prevention/treatment of obesity and associated diseases