Adiponectin and Cardiac Hypertrophy in Acromegaly

Background. Adiponectin is an adipocytes-derived hormone which has been shown to possess insulin-sensitizing, antiatherogenic, and anti-inflammatory properties. In acromegaly, the data on adiponectin is contradictory. The relationship between adiponectin levels and cardiac parameters has not been studied.Objectives. The aim of this study was to find out how adiponectin levels were affected in acromegalic patients and the relationship between adiponectin levels and cardiac parameters.Material and Methods. We included 30 subjects (15 male, 15 female), diagnosed with acromegaly and 30 healthy (10 male, 20 female) subjects. Serum glucose, insulin, GH, IGF-1 and adiponectin levels were obtained and the insulin resistance of the subjects was calculated. Echocardiographic studies of the subjects were performed.Results. We determined that adiponectin levels were significantly higher in the acromegalic group than the control group. In the acromegalic group, there was no statistically significant relation between serum adiponectin and growth hormone (GH), or insulin-like growth factor-1 (IGF-1) levels (p = 0.3, p = 0.1). We demonstrated that cardiac function and structure are affected by acromegaly. IVST, PWT, LVMI, E/A ratio, DT, ET, IVRT, VPR, and LVESV values were increased and the results were statistically significant. In the acromegalic group, adiponectin levels were positively related with left ventricle mass index (LVMI) but this correlation was found to be statistically weak (p = 0.03). In our study, there was a positive correlation between VAI and LVM. We also could not find any correlation between VAI and adiponectin levels.Conclusions. Although insulin resistance and high insulin levels occur in active acromegaly patients, adiponectin levels were higher in our study as a consequence of GH lowering therapies. Our study showed that adiponectin levels may be an indicator of the cardiac involvement acromegaly. However, the usage of serum adiponectin levels in acromegalic patients as an indicator of cardiac involvement should be supported with other, wide, multi-centered studies

Assessment of irrigation schemes in Turkey based on management types

Increasing population and demand for food, combined with finite land and water resources makes developing and monitoring the performance of irrigation systems inevitable in the 21st century. This study presents a comparative performance analysis of irrigation schemes based on their management types (State Hydraulic Works (SHW) and Water User Associations (WUAs)-operated schemes). The assessment used the International Water Management Institute (IWMI)’s six performance indicators for the year 2001. Analysis of variance (ANOVA) test results indicated that the differences in the output per cropped area (OPCA), output per unit water consumed (OPUWC), and irrigation intensity (II) between the two management types were statistically significant, whereas the differences in the output per unit command (OPUC), output per unit irrigation supply (OPUIS), and relative water supply (RWS) between the two management types were not significant. Although the II was higher and RWS was lower in the WUAs-operated schemes comparing with SHW, the other indicators (OPCA, OPUIS and OPWC) were also lower in the WUAs-operated schemes except for OPUC indicator. This suggests that the WUAs-operated schemes are not optimally managed, possibly due to factors such as inappropriate crop pattern and intensity, irrigation infrastructure, lack of an effective monitoring and evaluation system, insufficient awareness among managers and farmers, or unstable administrative structure.Key Words: Comparative indicators, irrigation project, management types, irrigation management, performance, Turkey

AlphaCo: A Teaching Case on Information Technology Audit and Security

Recent regulations in the United States (U.S.) such as the Sarbanes-Oxley Act of 2002 require top management of a public firm to provide reasonable assurance that they institute internal controls that minimize risks over the firm’s operations and financial reporting. External auditors are required to attest to the management’s assertions over the effectiveness of those internal controls. As firms rely more on information technology (IT) in conducting business, they also become more vulnerable to IT related risks. IT is critical for initiating, recording, processing, summarizing and reporting accurate financial and non-financial data. Thus, understanding IT related risks and instituting internal control mechanisms that minimize them have become important and created an urgent need for professionals who are equipped with IT audit and security skills and knowledge. However, there is severe shortage of teaching cases that can be used in courses aimed at training such professionals. This teaching case begins to address this gap by fostering classroom discussions around IT audit and security issues. It revolves around a hacking incident that compromised online order processing systems of AlphaCo and led to some fraudulent activity. The hacking incident raises a series of questions about IT security vulnerabilities, internal control deficiencies, integrity of financial statements, and independent auditors’ assessment of fraud in the context of the Sarbanes-Oxley Act. The case places students in the roles of executives, IT managers, and auditors and encourages them to discuss several important questions: how and why did the hacking incident happen; what harm did it cause to the firm; how can the firm prevent such hacking incidents in the future; if they do happen, how can the firm detect hacking incidents and fraud sooner; how do auditors assess the impact of such incidents in the context of a financial statement audit; and whether the management and auditors have responsibility in detecting and publicly reporting fraud? The case also facilitates the teaching of relevant conceptual frameworks such as COSO (Committee of Sponsoring Organizations of the Treadway Commission) and COBIT (Control Objectives for Information and related Technology)

Perspective of turkish medicine students on cancer, cancer treatments, palliative care, and oncologists (ares study): A study of the palliative care working committee of the turkish oncology group (TOG)

Cancer is one of the most common causes of death all over the World (Rahib et al. in Cancer Res 74(11):2913–2921, 2014; Silbermann et al. in Ann Oncol 23(Suppl 3):iii15–iii28, 2012). It is crucial to diagnose this disease early by effective screening methods and also it is very important to acknowledge the community on various aspects of this disease such as the treatment methods and palliative care. Not only the oncologists but every medical doctor should be educated well in dealing with cancer patients. Previous studies suggested various opinions on the level of oncology education in medical schools (Pavlidis et al. in Ann Oncol 16(5):840–841, 2005). In this study, the perspectives of medical students on cancer, its treatment, palliative care, and the oncologists were analyzed in relation to their educational status. A multicenter survey analysis was performed on a total of 4224 medical school students that accepted to enter this study in Turkey. After the questions about the demographical characteristics of the students, their perspectives on the definition, diagnosis, screening, and treatment methods of cancer and their way of understanding metastatic disease as well as palliative care were analyzed. The questionnaire includes questions with answers and a scoring system of Likert type 5 (absolutely disagree = 1, completely agree = 5). In the last part of the questionnaire, there were some words to detect what the words “cancer” and “oncologist” meant for the students. The participant students were analyzed in two study groups; “group 1” (n = 1.255) were phases I and II students that had never attended an oncology lesson, and “group 2” (n = 2.969) were phases III to VI students that had attended oncology lessons in the medical school. SPSS v17 was used for the database and statistical analyses. A value of p < 0.05 was noted as statistically significant. Group 1 defined cancer as a contagious disease (p = 0.00025), they believed that early diagnosis was never possible (p = 0.042), all people with a diagnosis of cancer would certainly die (p = 0.044), and chemotherapy was not successful in a metastatic disease (p = 0.003) as compared to group 2. The rate of the students that believed gastric cancer screening was a part of the national screening policy was significantly more in group 1 than in group 2 (p = 0.00014). Group 2 had a higher anxiety level for themselves or their family members to become a cancer patient. Most of the students in both groups defined medical oncologists as warriors (57% in group 1 and 40% in group 2; p = 0.097), and cancer was reminding them of “death” (54% in group 1 and 48% in group 2; p = 0.102). This study suggested that oncology education was useful for the students’ understanding of cancer and related issues; however, the level of oncology education should be improved in medical schools in Turkey. This would be helpful for medical doctors to cope with many aspects of cancer as a major health care problem in this country. © 2018, American Association for Cancer Education

Global fluctuations in magnetohydrodynamic dynamos

The spectrum of temporal fluctuations of total magnetic energy for several dynamo models is different from white noise at frequencies smaller than the inverse of the turnover time of the underlying turbulent velocity field. Examples for this phenomenon are known from previous work and we add in this paper simulations of the G.O. Roberts dynamo and of convectively driven dynamos in rotating spherical shells. The appearance of colored noise in the magnetic energy is explained by simple phenomenological models. The Kolmogorov theory of turbulence is used to predict the spectrum of kinetic and magnetic energy fluctuations in the inertial range

Knowledge, attitudes and anxiety towards influenza A/H1N1 vaccination of healthcare workers in Turkey

<p>Abstract</p> <p>Background</p> <p>This study aimed to analyze the factors associated with knowledge and attitudes about influenza A (H1N1) and vaccination, and possible relations of these factors with anxiety among healthcare workers (HCW).</p> <p>Methods</p> <p>The study used a cross-sectional descriptive design, and it was carried out between 23 November and 4 December 2009. A total of 300 HCW from two hospitals completed a questionnaire. Data collection tools comprised a questionnaire and the State-Trait Anxiety Inventory (STAI).</p> <p>Results</p> <p>Vaccination rate for 2009 pandemic influenza A(H1N1) among HCW was low (12.7%). Most of the respondents believed the vaccine was not safe and protective. Vaccination refusal was mostly related to the vaccine's side effects, disbelief to vaccine's protectiveness, negative news about the vaccine and the perceived negative attitude of the Prime Minister to the vaccine. State anxiety was found to be high in respondents who felt the vaccine was unsafe.</p> <p>Conclusions</p> <p>HCW considered the seriousness of the outbreak, their vaccination rate was low. In vaccination campaigns, governments have to aim at providing trust, and media campaigns should be used to reinforce this trust as well. Accurate reporting by the media of the safety and efficacy of influenza vaccines and the importance of vaccines for the public health would likely have a positive influence on vaccine uptake. Uncertain or negative reporting about the vaccine is detrimental to vaccination efforts.</p

Cost analysis of centralized viral load testing for antiretroviral therapy monitoring in Nicaragua, a low-HIV prevalence, low-resource setting

<p>Abstract</p> <p>Background</p> <p>HIV viral load testing as a component of antiretroviral therapy monitoring is costly. Understanding the full costs and the major sources of inefficiency associated with viral load testing is critical for optimizing the systems and technologies that support the testing process. The objective of our study was to estimate the costs associated with viral load testing performed for antiretroviral therapy monitoring to both patients and the public healthcare system in a low-HIV prevalence, low-resource country.</p> <p>Methods</p> <p>A detailed cost analysis was performed to understand the costs involved in each step of performing a viral load test in Nicaragua, from initial specimen collection to communication of the test results to each patient's healthcare provider. Data were compiled and cross referenced from multiple information sources: laboratory records, regional surveillance centre records, and scheduled interviews with the key healthcare providers responsible for HIV patient care in five regions of the country.</p> <p>Results</p> <p>The total average cost of performing a viral load test in Nicaragua varied by region, ranging from US$99.01 to US$124.58, the majority of which was at the laboratory level: $88.73 to$97.15 per specimen, depending on batch size. The average cost to clinics at which specimens were collected ranged from $3.31 to$20.92, depending on the region. The average cost per patient for transportation, food, lodging and lost income ranged from $3.70 to$14.93.</p> <p>Conclusions</p> <p>The quantitative viral load test remains the single most expensive component of the process. For the patient, the distance of his or her residence from the specimen collection site is a large determinant of cost. Importantly, the efficiency of results reporting has a large impact on the cost per result delivered to the clinician and utility of the result for patient monitoring. Detailed cost analysis can identify opportunities for removing barriers to effective antiretroviral therapy monitoring programmes in limited-resource countries with low HIV prevalence.</p