Tuberkuloosi iseärasused madala ravikatkestamise, kuid kõrge ravimresistentsusega iseloomustuvates vanglatingimuses

Väitekirja elektrooniline versioon ei sisalda publikatsiooneTuberkuloosi (TB), selhulgas ravimresistentse TB-i, esinemissagedus vanglas viibivate inimeste seas on 28 korda kõrgem kui tavaelanikkonna hulgas. Hilinenud diagnostika ja ravi suurendab TB-I levikut vanglates ja ühsikonnas tervikuna ning tõstab ebasoodsa ravitulemuse tõenäosust. TB-i ja eriti multiresistentset TB-i põdevate patsientide ravi edukuse määr on kogu maailmas madal, kusjuures viibimist kinnipidamisasutuses peetakse üheks ebasoodsa ravitulemuse riskiteguriks. Elmira Gurbanova uuring viidi läbi Aserbaidžaani Vabariigi kinnipidamisasutustes. Aserbaidžaan kuulub 30 kõrge RR-TB-i haigestumisega riigi hulka maailmas. Uuringu eesmärk oli hinnata Maailma Terviseorganisatsioon (MTO) poolt soovitatava sõeluuringu, diagnostika ja ravi mõju TB-i ja ravimresistentse TB-i esinemissagedusele vanglas, mida iseloomustab kõrge ravimresistentse TB-i esinemissagedus ja madal ravikatkestamise tase. Selleks, et hinnata tuberkuloosi sõeluuringu mõju TB-i haigestumisele ja ravitulemustele enne ja pärast kiirtestide, nagu Xpert MTB / RIF ja vedelkultuuri, kasutuselevõttu, kaasati uuringusse 2315 TB-i põdevat patsienti 19-st vanglast. Tuvastati, et kiirtestide kasutuselevõtt TB-i diagnostikaalgoritmides alandas suhteliselt lühikese aja jooksul vastavalt 3-, 10- ja 5-kordselt kogu TB-i haigestumist, mikroskoopial positiivsete uute juhtude esinemissagedust ja RIF-resistentsete juhtude esinemissagedust. Lisaks, peale kiirtestide kasutuselvõttu olid ravitulemused paremad patsientidel, keda raviti esimese rea TB-I ravimitega. Selleks, et tuvastada, kas selliste juhtude, kus erinevate määramismeetoditega, nagu Xpert MTB/RIF ja MGIT-vedelkultuur, saadud rifampitsin (RIF)-tundlikkuse määramistulemused lahknevad, testiti 532 patsiendilt võetud proove mõlema meetodiga. Analüüsiti, kas RIF-tundlikkuse esinemissagedus sõltub sellest, kas kasutatakse ühte ja sama rögaproovi või järjestikuseid, eri aegadel kogutud rögaproove. Vastuolulisi RIF-tundlikkuse tulemusi esines 6,2% proovidest. Leiti, et lahknevate RIF-tundlikkuse tulemuste määr ei sõltu sellest, kas kasutatakse üht ja sama proovi või erinevaid järjestikuseid proove. Kõige sagedamini täheldatud lahknevate tulemuste muster oli selline, kus RIF-resistentsus Xpert MTB/ RIF-l kombineerus RIF-tundlikkusega MGIT-kultuuris ning kus RIF-resistentsus oli peamiselt tingitud L511P mutatsioonist. RIF-resistentsuse kliiniline tähendus on aga sellistel juhtudel tõenäoliselt vähene, kuna raitulemused oluliselt ei erinenud. Kasutades Aserbaidžaani kinnipidamisasutuste eelist, mis seisneb madalas ravikatkestajate hulgas, analüüsiti RIF-resistentse TB-ga patsientide ebasoodsa ravitulemusega seotud riksifaktorid. Uuringusse kaasati 444 kinnipidamisasutustes viibivat RIF-resistentse TB-ga patsienti. Efektiivne ravitulemus saavutati 78,4%-l haigetest. Suurema arvu efektiivsete bakteritsiidsete ravimite kasutamine pärast RIF-resistentse TB-i ravikuuri kuuendat kuud oli peamiseks efektiivse raviga seotud teguriks. Olukord, kus kopsudes ei olnud nähtavaid patoloogiale viitavaid radioloogilisi muutusi ja kehamassiindeks oli vähemalt 18,5 kg/m2, suurendab samuti oluliselt efektiivse ravi tõenäosust. Vangustusega seotud teguritel, nagu karistuse liik või varasemate vangistuste arv, ei olnud ravitulemustele olulist mõju.Compared with the general population, prevalence of TB including its drug-resistant forms among prisoners is up to 28 times higher. Delayed diagnosis and treatment increase TB transmission and prevalence in prisons, which spills over the community. Treatment success rates among patients with TB and multidrug-resistant TB are globally low and historically, imprisonment is considered a risk factor for poor treatment outcome. Elmira Gurbanova’s study was performed in prisons of Azerbaijan, which is among the 30 high rifampicin resistant (RR) TB-burden countries in the world. The study aimed to evaluate the impact of the WHO-recommended screening, diagnostics, and treatment to the burden of TB and multi/extremely drug-resistant TB (M/XDR-TB) in the high-burden, but low-default prison settings. To evaluate the impact of TB screening on the notification and treatment outcomes in prisons before and after introduction of Xpert MTB/RIF and Mycobacteria growth indicator tube (MGIT) culture into the screening algorithms, a total of 2,315 TB patients were identified in 19 prisons and analyzed at this study. The 3-, 10-, and 5-fold significant decrease in the annual rates of the notified, smear-positive, and RR-TB cases, respectively, with significant linear trends towards decrease was identified. The treatment success with first-line drugs also increased significantly. To identify the rate of discordant rifampicin (RIF) susceptibility results by Xpert MTB/RIF and MGIT when the same sputum sample or sequential ones are used for the tests, samples from 532 patients were prospectively tested with both methods. Out of the tested samples, 6.2% had discordant RIF-susceptibility results. No significant association of the discordant RIF-susceptibility results with application of both tests on one sample versus sequential ones was found. L511P mutation accounted significantly on the discrepancy among those RIF-resistant on Xpert MTB/RIF, but sensitive on MGIT, while no significant association was identified between the outcomes of treatment with the first- or second-line drugs and the presence of any mutation. To identify the pure factors associated with the cure among RR-TB patients, taking the advantage of very low loss-to-follow-up rate among patients with TB in Azerbaijan prisons, 444 RR-TB patients identified and enrolled into the treatment, of them 78.4% were cured. Higher number of effective bactericidal drugs in the regimen after the 6th month of treatment, chest x-ray without visible pathology, and BMI ≥18.5 at the treatment start significantly increased the chances for cure. The prison-related factors, such as the type of sentence or number of previous imprisonments, had no significant impact on the treatment outcomes.https://www.ester.ee/record=b522842

The Dynamics of Some Carbon and Nitrogen Metabolism Enzymes in Daytime in Various Wheat Genotypes during Drought

PEPC plays a pivotal role in various metabolic processes in C3 plants including by providing intermediates for the Krebs cycle, maintaining intracellular pH and osmotic pressure, regulating the movement of stomatal guard cells, refixing CO2 formed by respiration, forming a carbon skeleton for lipid synthesis during grain development and nitrogen assimilation. Aspartate aminotransferase is essential to primary nitrogen assimilation, the transportation of reducing equivalents and the exchange of carbon and nitrogen resources among cellular subcompartments. Durum (Barakatli 95 and Garagylchyg 2) and bread wheat genotypes (Gobustan and Tale 38) cultivated in the experimental field of the Research Institute of Crop Husbandry were used as study materials. The high level of activity of PEPC and NAD-MDH during morning hours and a positive correlation between them in daytime suggest that, functioning mutually, these enzymes participate in the biosynthesis of malic acid

Study of electrochemical deposition of Ni-Mo thin films from alkaline electrolytes

The process of co-deposition of Ni with Mo from alkaline electrolytes was studied by taking linear and cyclic polarization curves of Pt electrode at various concentrations of initial components and potential scan rates. Solutions of Na2MoO4∙2H2O and NiSO4∙7H2O were used as sources of ions of the main components in NH4OH electrolyte. It was found that co-deposition of nickel with molybdenum goes through the oxide formation stage, and a solid solution of these two metals is deposited on the cathode surface. The film obtained at constant current on Ni electrode under optimal conditions was found amorphous, but additional thermal treatment at 500 °C for one hour made it polycrystalline. This was confirmed by peaks in X-ray diffraction patterns, corresponding to NiMoO4, Ni, and MoO3. The proposed electrolyte and electrolysis conditions allow to obtain thin films with molybdenum content ranging from 17.1 to 50.9 at.%. The co-deposition of Ni with Mo is limited by diffusion of these ions to the cathode surface. The knowledge of the mechanism of co-deposition of Ni and Mo will make possible a selection of optimal conditions for deposition of alloys of the required composition with satisfactory electrocatalytic properties

SISTEM INFORMASI PENDAFTARAN PASIEN DI KLINIK MITRA KITA SEMARANG

Sistem Informasi Pendaftaran Pasien di Klinik Mitra Kita Semarang masih menggunakan sistem manual yaitu dengan mengisikan data identitas dengan media kertas. Pada kenyatannya sering kali terjadi kesalahan Sistem Manajemen Informasi pada penginputan data pasien dan proses pengambilan kembali data pasien. Hal ini mengakibatkan kesalahan dalam penulisan data pasien khususnya kesinambungan informasi kesehatan pasien. Tujuan penelitian ini adalah menghasilkan rancangan sistem informasi pendaftaran pasien di Klinik Mitra Kita Semarang. Jenis penelitian yang digunakan adalah deskriptif yaitu peneliti mengamati sumber penelitian untuk melihat gambaran permasalahan secara obyektif, sedangkan metode yang digunakan adalah metode observasional dimana data diperoleh saat penelitian dilakukan. Instrumen penelitian menggunakan pedoman wawancara dan pedoman observasi. Sistem informasi pendaftaran pasien yang dibuat dapat mempermudah dalam pencatatan dan pelaporan

VARIOUS APPROACHES TO E-LEARNING CONTINUE TO EVOLVE

E-learning has made its entrance into educational institutions. Compared to traditional learning methods, e-learning has the benefit of enabling educational institutions to attract more students. E-learning not only opens up for an increased enrollment, it also gives students who would otherwise not be able to take the education to now get the possibility to do so. This paper introduces Axel Honneth’s theory on the need for recognition as a framework to understand the role and function of interaction in relation to e-learning. The paper argues that an increased focus on the dialectic relationship between recognition and learning will enable an optimization of the learning conditions and the interactive affordances targeting students under e-learning programs. The paper concludes that the engagement and motivation to learn are not only influenced by but depending on recognition.E-learning has made its entrance into educational institutions. Compared to traditional learning methods, e-learning has the benefit of enabling educational institutions to attract more students. E-learning not only opens up for an increased enrollment, it also gives students who would otherwise not be able to take the education to now get the possibility to do so. This paper introduces Axel Honneth’s theory on the need for recognition as a framework to understand the role and function of interaction in relation to e-learning. The paper argues that an increased focus on the dialectic relationship between recognition and learning will enable an optimization of the learning conditions and the interactive affordances targeting students under e-learning programs. The paper concludes that the engagement and motivation to learn are not only influenced by but depending on recognition

Uus teadusdoktor Elmira Gurbanova

Eesti Arst 2019; 98(7):41

Positive Gender Responses to Hate Speech of ‘The Little Mermaid’ on Twitter: Critical Discourse Analysis

Hate speech indicates hatred, prejudice, or discrimination toward individuals or groups due to appearance, race, religion, etc. Hate speech quickly occurs on social media; everyone can be the victim, like Disney posted about Little Mermaid on Twitter. People filling the comment section of Disney posted with the reactions, including hate speech and positive responses toward Halle as the character of Ariel. This study aims to find the different positive responses of women and men toward hate speech using women's and men's language features, stereotyped language that appears in a positive response, present the category of hate speech, and why people spread hate in The Little Mermaid post. The research uses the Critical Discourse Analysis approach by Van Dijk (1995) and Fowler (1991). The data were analyzed using the qualitative research method and presented with descriptive text. The data object is taken from the two Tweets Disney posted about The Little Mermaid on Twitter. The result proved that there is a different way when women and men respond positively to hate speech through women's and men's features but the positive responses of females are more polite than males. Although in positive responses, this study showed that stereotyped language of perceived category essentialism appeared, focused on the term of race. This study presented only seven categories of hate speech that occurred and why people spread hate to convey their disappointment with Disney's decision that the main actress did not meet the expectation like in animation. Keywords: hate speech, critical discourse analysis, gender, positive response

Features of The Family Context in the Emergence of Anxiety in Adolesence

The article reveals the current problems of the modern family, in which the relationship and behavior of parents are a factor in the formation of emotional instability and anxiety in adolescents. At the present stage of development of society, the study of psychological and pedagogical conditions for reducing the level of anxiety in adolescents is relevant, since a high level of anxiety reduces school performance, has a negative impact on the development and formation of a teenager's personality. In this regard, the study of this problem and the development of programs aimed at reducing anxiety is relevant. Comprehensive measures carried out by psychologists with parents and students make it possible to organize a timely diagnostic examination, followed by the introduction of corrective and preventive programs aimed at creating a favorable psychological climate, both in the school community and in the families of teenagers. The experimental part of the study revealed the relationship between the type of family education and the development of anxiety in this age group. High levels of anxiety were identified on indicators of General school anxiety, the relation between the anxiety scale and the "authoritarian giperstimulyatsia" (for methodology A. Y. Varga and V. V. Stolin), and also high indicators on scales "the instability of parenting style" and "dominant giperprodukcia" (ASV method E.Eidemiller). The results of our empirical research allow us to conclude that the psychological climate in the family is the most important factor in the favorable psycho-emotional development of children of this age category. The use of the wrong style of family education encourages the formation of emotional instability and anxiety in adolescents, which affects the overall emotional background and the learning process

Language and Cognition

The article examines the issues of cognitive linguistics, which is considered a new branch of linguistics. Here, various scientists' approaches to the unity of language and thinking are widely analyzed. In general, speech expresses information that arises in human thinking, or the product of thinking is encoded through speech. A person is a social factor, the creator of the joint function of language and thinking, and the person's role in forming language as a sign system in the construction of communication is great. Cognitive linguistics studies the act of speech at the extralinguistic level. It also studies language from another aspect and linguistic phenomena in a broad framework and comprehensively to other branches of science. The emergence of cognitive linguistics makes it possible to approach the issue of language and speech from different perspectives. The listener understands what the speaker is saying in the process of communication. In the act of speech, the main goal is to comprehend the ideas expressed in speech, but the coding of information in the language is not limited to linguistic knowledge. Social and psychological factors also play an essential role here. Thus, communication between the speaker and the listener goes through mental processes; during communication, cognitive processes are always open to new information. In the article, observation and subjective assessment were used