The role of the military in transitons to democracy: a comparison of the Spanish and Turkish cases

Transitions from authoritarian rule to fully-fledged democracy do not always proceed in a linear fashion. The complexity of the political systems in different countries prevents us from establishing one single model to explain their different experiences. However, comparative analyses of differing transitions to democracy give us insight into the conditions and actors influencing the processes. This study aims to clarify the military’s influence over transitions to democracy in two Southern European countries: Spain and Turkey. Spain and Turkey shared an authoritarian past, and experienced a transition to democracy by the late 1970s in the former and the early 1980s in the latter. The military was a significant political actor in both countries. However, the Spanish military failed to influence the transition while their Turkish counterparts initiated and controlled the transition from above. These transitions differed not only in the initial conditions but also in the outcome. Spain, despite being ruled by an authoritarian regime almost a halfcentury, achieved a consolidated democracy while Turkey still struggles with different challenges to democratic consolidation, including the current influence of the military in politics. This thesis helps to comprehend the conditions which led to different outcomes by focusing on one of the neglected actors in transitions to democracy: the military. Ostensibly, initial conditions explain the different outcomes, to a certain extent.Yet, this thesis concludes that conditions in the post-transition years were as influential as the initial conditions. Therefore, explaining the outcome only by referring to the initial conditions would be reductionist and misleading

Maternal serum interlukin-6 level in preterm labor

Objective: The aim of this study was to measure interleukin-6 (IL-6) levels in maternal serum of women undergoing preterm labor without a clear infection. Materials and Methods: Twenty two pregnant women with diagnosis of preterm labor who presented to the outpatient clinic of 19 Mayıs University Faculty of Medicine from July 2011 through December 2011 were enrolled in the study group. Twenty two healthy pregnant women who were at the same gestational age as the study group were selected as the control group. Results: Gestational age in the study and control groups varied from 24 weeks and 4 days to 34 weeks and 6 days. In the study group, 11 patients (50%) underwent preterm birth. Pregnant women in preterm labor were compared to healthy pregnant women with regards to serum IL-6 levels. No significant difference was found in the IL-6 levels of maternal serum between the 2 groups. Conclusion: In this study, we have shown that there is no increase in IL-6 levels in patients undergoing preterm labor without clinical or biochemical infection signs

Integrating a Cogeneration System in Food Process Manufacturing

Abstract The goal of the project is to determine the benefits and drawbacks of implementing a combined heat and power (CHP) unit in a food processing plant. CHP system is an integrated energy system that produces electrical and thermal energy from a single fuel source. Different CHP technologies and vendors available were identified. The studied CHP technologies included steam and gas turbines, micro-turbines, reciprocating engines, and fuel cells. Of these technologies a 400 kW range reciprocating engine was deemed optimal due to physical size constraints, voltage output requirements (600 VAC), and costs. The plant's thermally intensive units were studied at the tunnel heating system and the boiler unit system as potential places to recover the waste heat. Simulations of these two units were conducted with based case and each of the three vendor specified CHP units. Based on the data, it was found that the optimal recovery process is the boiler unit system that provides a higher increase in temperature and mitigates the risk of potential errors in calculations. Rigorous economic analyses show the payback period of the CHP unit to be 2 years and 1 month. Furthermore, there is no significant increase in GHG emissions through the implementation of the CHP unit and potential hazardous noise exposure can be mitigated through a sound attenuated enclosure

Development and evaluation of a multiplex PCR assay for simultaneous detection of Flavobacterium psychrophilum, Yersinia ruckeri and Aeromonas salmonicida subsp. salmonicida in culture fisheries

Bacterial cold water disease, enteric red mouth disease and frunculosis are the common bacterial diseases of fish worldwide. The etiologic agents of these diseases are Flavobacterium (F.) psychrophilum, Yersinia (Y.) ruckeri and Aeromonas (A.) salmonicida subsp. salmonicida, respectively. In this study, a multiplex polymerase chain reaction (m-PCR) method with YER8/10-Fer3/4-FP1/3 primer pairs which can identify these fish pathogens simultaneously was developed and optimized. In optimized conditions, neither false specific nor nonspecific amplification occurred. The detection limits of the m-PCR method using DNA extracts from dilutions of pure cultures of bacteria were 35 pg for Y. ruckeri and F. psychrophilum and 70 pg for A. salmonicida subsp. salmonicida. It was determined that 15 CFU Y. ruckeri and F. psychrophilum and 30 CFU A. salmonicida subsp. salmonicida could be detected by m-PCR developed using genomic DNA extracted from dilutions of the suspensions. The detection limits in the presence of tissue debris were 125 CFU for Y. ruckeri and F. psychrophilum and 250 CFU for A. salmonicida subsp. salmonicida. In conclusion, we submit that the m-PCR method developed and optimized in this study can be used for accurate and rapid identification of these bacteria

Triglyceride-glucose index levels in patients with congenital hypogonadotropic hypogonadism and the relationship with endothelial dysfunction and insulin resistance

Introduction: The risk of cardiometabolic diseases is increased in patients with hypogonadism. The triglyceride-glucose (TyG) index is a novel surrogate marker of insulin resistance and is associated with cardiovascular diseases. We investigated the TyG index levels and the relationship with endothelial dysfunction and insulin resistance in patients with congenital hypogonadotropic hypogonadism (CHH). Material and methods: A total of 98 patients with CHH (mean age 21.66 ± 1.99 years) and 98 healthy control subjects (mean age 21.69 ± 1.21 years) were enrolled. The demographic parameters, TyG index, asymmetric dimethylarginine (ADMA), high-sensitivity C-reactive protein (hs-CRP), and homeostatic model assessment of insulin resistance (HOMA-IR) levels were measured for all participants. Results: The patients had higher waist circumference (p < 0.001), triglycerides (p = 0.001), insulin (p = 0.003), HOMA-IR (p = 0.002), ADMA (p < 0.001), and TyG index (p < 0.001) levels and lower HDL-C (p = 0.044) and total testosterone (p < 0.001) levels compared to healthy control subjects. TyG index levels significantly correlated with the ADMA (r = 0.31, p = 0.003) and HOMA-IR (r = 0.32, p < 0.001) levels. TyG index was also determinant of HOMA-IR levels (ß = 0.20, p = 0.018). Conclusion: The results of the present study show that patients with CHH had increased TyG index levels. Also, the TyG index is independently associated with insulin resistance in patients with CHH. Long-term follow-up studies are warranted to find out the role of the TyG index in determining cardiometabolic risk in patients with hypogonadism.

Postmarketing Safety Study Tool: A Web Based, Dynamic, and Interoperable System for Postmarketing Drug Surveillance Studies

Postmarketing drug surveillance is a crucial aspect of the clinical research activities in pharmacovigilance and pharmacoepidemiology. Successful utilization of available Electronic Health Record (EHR) data can complement and strengthen postmarketing safety studies. In terms of the secondary use of EHRs, access and analysis of patient data across different domains are a critical factor; we address this data interoperability problem between EHR systems and clinical research systems in this paper. We demonstrate that this problem can be solved in an upper level with the use of common data elements in a standardized fashion so that clinical researchers can work with different EHR systems independently of the underlying information model. Postmarketing Safety Study Tool lets the clinical researchers extract data from different EHR systems by designing data collection set schemas through common data elements. The tool interacts with a semantic metadata registry through IHE data element exchange profile. Postmarketing Safety Study Tool and its supporting components have been implemented and deployed on the central data warehouse of the Lombardy region, Italy, which contains anonymized records of about 16 million patients with over 10-year longitudinal data on average. Clinical researchers in Roche validate the tool with real life use cases.Publisher's Versio

Idiopathic isolated clitoromegaly: A report of two cases

BACKGROUND: Clitoromegaly is a frequent congenital malformation, but acquired clitoral enlargement is relatively rare. METHODS: Two acquired clitoromegaly cases treated in Atatürk Training Hospital, Izmir, Turkey are presented. RESULTS: History from both patients revealed clitoromegaly over the last three years. Neither gynecological nor systemic abnormalities were detected in either patient. Karyotype analyses and hormonal tests were normal. Abdominal and gynaecological ultrasound did not show any cystic lesion or other abnormal finding. Computerized tomography scan of the adrenal glands was normal. Clitoroplasty with preservation of neurovascular pedicles was performed for the treatment of clitoromegaly. CONCLUSION: The patients were diagnosed as "idiopathic isolated" clitoromegaly. To the best of our knowledge, there has been no detailed report about idiopathic clitoromegaly in the literature

A collaborative platform for management of chronic diseases via guideline-driven individualized care plans

Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans. We also report the results of usability studies carried out in four pilot sites by patients and clinicians

Assessment of cardiac remodeling in asymptomatic mitral regurgitation for surgery timing: a comparative study of echocardiography and magnetic resonance imaging

<p>Abstract</p> <p>Background</p> <p>Early surgery is recommended for asymptomatic severe mitral regurgitation (MR), because of increased postoperative left ventricular (LV) dysfunction in patients with late surgery. On the other hand, recent reports emphasized a "watchful waiting" process for the determination of the proper time of mitral valve surgery. In our study, we compared magnetic resonance imaging (MRI) and transthoracic echocardiography to evaluate the LV and left atrial (LA) remodeling; for better definitions of patients that may benefit from early valve surgery.</p> <p>Methods</p> <p>Twenty-one patients with moderate to severe asymptomatic MR were evaluated by echocardiography and MRI. LA and LV ejection fractions (EFs) were calculated by echocardiography and MRI. Pulmonary veins (PVs) were measured from vein orifices in diastole and systole from the tangential of an imaginary circle that completed LA wall. Right upper PV indices were calculated with the formula; (Right upper PV diastolic diameter- Right upper PV systolic diameter)/Right upper PV diastolic diameter.</p> <p>Results</p> <p>In 9 patients there were mismatches between echocardiography and MRI measurements of LV EF. LV EFs were calculated ≥60% by echocardiography, meanwhile < 60% by MRI in these 9 patients. Severity of MR evaluated by effective regurgitant orifice area (EROA) didn't differ with preserved and depressed EFs by MRI (p > 0.05). However, both right upper PV indices (0.16 ± 0.06 vs. 0.24 ± 0.08, p: 0.024) and LA EFs (0.19 ± 0.09 vs. 0.33 ± 0.14, p: 0.025) were significantly decreased in patients with depressed EFs when compared to patients with normal EFs.</p> <p>Conclusions</p> <p>MRI might be preferred when small changes in functional parameters like LV EF, LA EF, and PV index are of clinical importance to disease management like asymptomatic MR patients that we follow up for appropriate surgery timing.</p

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