“The Lolelaplap (Marshall Islands) in Us: Sailing West to East (Ralik→Ratak) to These Our Atolls (Aelon Kein Ad) Ad Jolet Jen Anij (Our Blessed Inheritance from God)”

This paper discusses the expansion of Oceania through a Marshallese indigenous lens as a focal point. It explains that decolonizing methodologies allows reclaiming of space for mental liberation and reassurement of constitutional rights. It highlights similar occurrences of decolonization practices meeting resistance in the 21st century all while strengthening the human right argument that no human deserves any less than their fellow human brothers and sisters. It argues that an indigenous imagery can only be viewed through an indigenous lens where the researches’ level of purity is retained and unfiltered. It nevertheless argues that Marshallese ethnolinguistics reveal the same cultural practices in America, Judeo-Christianity, and Oceania thus dictating the reality that “we are the same not withstanding one stays here and one there (Bedbedjin Bedbedjen, Bedbedjinma wot Kwe)”. It further explains the importance in these similarities and how Marshallese spirituality predates introduced American Judeo-Christianity despite the latter attempting to marginalize the former. It concludes by stating that Marshallese contributions on the global stage are rooted in that culture of love (IaKwe) which is echoed by the custom(s) revealing the significance of Marshallese validation academically, spiritually, economically, & socially to prevent institutionalized discrimination. This paper ends stating that the agency to know one’s self and how one should fit in the world, is a human right in itself and Marshallese are entitled to this sense of self worth through knowing thy self by thy self where real thinking takes place in one’s own mind as we all live our own lives

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

STABILITY ANALYSES FOR DOUBLE CROPPING IN SOYBEAN [(Glycine max L.) Merrill]

WOS: 000457338900001Double crop agriculture is a great advantage for the coastal Mediterranean climate. Although a number of soybean varieties have been recommended for cultivation, the information on the stability for double cropping is lacking for the agro-climatic conditions of Mediterranean coastal zone. Ten high-yielding advanced soybean [Glycine max (L) Merr] lines and four registered soybean varieties having maturity group III and IV (ARISOY, ATAEM7, BRAVO and NOVA) were evaluated for double cropping in different regions and years (2014, 2015 and 2016 in Izmir-Bornova, 2015 and 2016 in Antalya-Aksu). The F test was first applied to check differences of the deviation variances from the zero. In addition, statistics of ecovalance (W-i(2)) and stability variance (sigma(2)(i)), estimating the contribution of a genotype to total Genotype x Environmental interaction (GxE), were estimated. As a result of this research, two different conclusions were determined. If sufficient water is provide (500-700 mm) BATEM 306 and BATEM 317 lines can be grown, otherwise, the other two (BATEM 207 and BATEM 223) can be suitable to grow in the regional conditions.TUBITAK "The Scientific and Technological Research Council of TurkeyTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [113 O 082, 113 O 086]We are grateful to the TUBITAK "The Scientific and Technological Research Council of Turkey" funded this research with the Project codes of 113 O 082 and sub number: 113 O 086

ADAPTATION ABILITIES AND QUALITY PARAMETERS OF SELECTED SOYBEAN LINES UNDER DOUBLE CROPPING IN THE MEDITERRANEAN REGION

WOS: 000441467500006The objective of this study was to determine the adaptation abilities and quality parameters of selected advanced soybean breeding lines at the double cropped growing conditions. 20 advanced Soybean [Glycine max (L.) Merr] breeding lines (F-7) and four soybean varieties having maturity group HI and IV (ARISOY, ATAEM-7, BRAVO and NOVA) were used. The differences between the lines and varieties were significant for the grain yield. The mean grain yield of breeding lines and varieties ranged from 2460 to 3488 kg ha(-1) and from 2933 to 3440 kg ha(-1), respectively. Also KA-07-05-13 advanced soybean line had the highest grain yield in terms of two years' average. The highest plant height was obtained from KA-07-08-15 (82.2 cm) and the lowest pod height from KA-07-08-15 (12.2 cm) and BDNA-19 (12.1 cm) lines. Significant differences were determined for pod number per plant among the 24 soybean genotypes. The pod number per plant was the higher in BDNA-12 and BDNA-13 lines than the varieties. In this research, the number of day for flowering varied between 33.0-42.1 days and the number of days for maturating ranged from 102.4 to 113.6 days. The earliest flowering time was detected from KA-07-08-14 line and the earliest maturating time was observed from BDNE-14 line. In a two-year average, 100-seed weight ranged between 14.2-20.8 g in breeding lines. The highest 100-seed weight was obtained from KA-07-03-5 (20.8 g) and KA-07-03-9 lines (20.1 g). While the highest oil percentage was obtained from ARISOY, the highest and statistically same oil percentage was recorded from KA-07-05-9 (21,6%), KA-07-08-12 (21,2%) and KA-07-05-5 (21,2%). The average protein content of soybean lines and cultivars varied from 41.6% to 49.3%. The higher protein percentage value was obtained from the BDAF-4 (49.3%) breeding line.TUBITAK "The Scientific and Technological Research Council of Turkey"Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [113 O 082, 113 O 086]We are grateful to the TUBITAK "The Scientific and Technological Research Council of Turkey" funded this research with the project codes of 113 O 082 and sub number: 113 O 086

Comparison of Infection and Urosepsis Rates of Ciprofloxacin and Ceftriaxone Prophylaxis before Percutaneous Nephrolithotomy: A Prospective and Randomised Study

This study aimed at determining the choice and administration duration of ideal antibiotic prophylaxis before percutaneous nephrolithotomy (PNL) operation, a treatment modality for nephrolithiasis. The study included 90 patients who had no internal problem, yet had a negative urine culture and underwent a PNL operation. We compared infection rates between ciprofloxacin and ceftriaxone groups and their subgroups. The results showed no statistical difference between ciprofloxacin and ceftriaxone groups in terms of systemic inflammatory response syndrome (SIRS) (CIPP=0.306, CTX P=0.334. As a result of this study no statistical difference was observed between ciprofloxacin and ceftriaxone in terms of SIRS. It seems, however, reasonable to choose ceftriaxone, considering antibiotic sensitivity of microorganisms and detection of three cases accepted as urosepsis in the ciprofloxacin group. As there is no difference between short, and long-term prophylactic use of these antibiotics, preference of short-term prophylaxis for patients with no risk of infection will be important to avoid inappropriate antibiotic usage

UZAKTAN TÜRKÇE DERSLER ALAN BATI TRAKYALI TÜRK ÖĞRENCILERIN KENDILERINI DEĞERLENDIRME ÇALIŞMASI

Rehberlik, modern eğitimin vazgeçilmez bir parçası haline gelmiştir. Rehberlik alanını budenli vazgeçilmez yapan doğru karar verebilmeye destek olmasıdır. Öyle ki, doğru kararın olmadığıyerde bilginin de, çok çalışmanın da başarıya ulaştırması pek mümkün olmamaktadır. Eğitim süreçleriboyunca rehberlik hizmetinden mahrum kalmış olan Batı Trakyalı Türk öğrencilerin, son iki yıldırTürkiye ve Çanakkale Onsekiz Mart Üniversitesi destekli uzaktan Türkçe öğretimi projesi kapsamındarehberlik hizmetine kavuşması sağlanmıştır. Bu çalışmanın amacı, Batı Trakya Türklerinin yeni yeniulaşabildikleri rehberlik hizmeti doğrultusunda, öğrencilerin bireysel olarak kendilerinideğerlendirmelerini ve daha doğru kararlar alabilmelerini sağlayabilmek amacıyla “KendiniDeğerlendirme Envanteri” uygulayarak durumlarının tespitini yapmaktır. Gümülcine’de yaşayan liseson sınıftaki Türk öğrencilere, geçerlik ve güvenirlik çalışması yapılmış olan Kendini DeğerlendirmeEnvanteri uygulanmıştır. 94 öğrenci üzerinde uygulanan envanter değerlendirilmiş ve bu sonuçlardoğrultusunda bireysel yetenekleri belirlenerek, uygulamanın frekans değerlerine bakılarak, envanteriuygulayan öğrencilerin daha çok hangi mesleklere yatkın olduklarının tespiti yapılmıştır. Sonuçolarak araştırmadan en yüksek yüzdeliğe sahip olan alanlar “düzenli yaşam, yaratıcılık, işayrıntıları”, en düşük yüzdeliğe sahip alanlar ise “liderlik, ticaret, değişiklik, edebiyat, müzik ve güzelsanatlar” olarak çıkmıştır.Counselling has become a sine qua non of modern education. What makes the counsellingfield so indispensable is to support for the right decision. In fact, where there is no right decision, it isnot possible for knowledge and working hard to reach the success. Western Thrace Turkish students,who have been deprived of counselling services during the training process, have been provided withcounselling services through the distance Turkish Teaching Project supported by Çanakkale OnsekizMart University, Turkey for the last two years. The aim of this study is to determine the situation byapplying a "self-assessment inventory" in order to enable students to evaluate themselves individuallyand make more accurate decisions in the direction of the new guidance services that Western ThraceTurks can reach recently. A self-assessment inventory of which validity and reliability studies havebeen conducted, was administered to Turkish high school students living in Gümülcine. The inventorywas applied on 94 students has been evaluated and their individual abilities have been determinedaccording to the results obtained. By looking at the frequency values of the application, through this,the students’ aptitudes towards the occupation match to their talent has been determined. As a result,"regular life, creativity, work details" are found to be the highest and "leadership, trade, change,literature, music and fine arts" are the lowest area