Turkey's international development framework case study: Somalia

This policy report provides an overview of Turkey’s development and humanitarian approaches in the territories of Somalia. For the past three decades, Turkey has been an active participant in multilateral peace efforts in a diversity of conflict-affected states such as Bosnia, Pakistan and Afghanistan. Traditionally Turkey has offered assistance to peacekeeping and military initiatives particularly through the United Nations and NATO. Since early 2000, however, Turkey’s approach to conflict-affected countries has shifted away from being primarily military to an increasingly civilian capacity focus. In its role as an emerging power, Turkey has stepped onto the development platform long dominated by “Western” donors. This shift reflects the change in foreign policy under the guidance of Foreign Minister Ahmet Davutoğlu’s visionary leadership. As a majority Muslim state that is emboldened with a pluralistic democratic constitution, Turkey has resisted aspects of the traditional Western framework. Instead, civilian development actors have been engaged in a hybrid model through which Turkey’s own unique global perspective and positioning is reflected. There is growing international interest in Turkey’s regional leadership and in particular, its influence upon the Horn of Africa. This report analyzes Turkey’s development efforts in Somalia and investigates its alternative strategy for working within a stagnant conflict-affected state

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Simulation games in teaching international relations: insights from a multi-day, multi-stage, multi-issue simulation on Cyprus

This article reviews experiences from a large-scale student simulation that concluded the Istanbul Conference on Mediation: Enhancing Peace through Mediation that took place in February 2012. We share insights on two unique aspects of the simulation. First, the paper examines a rare case where the simulation crossed paths with real life: a number of the impersonated officials (and offices) including the president of the General Assembly of the UN, the Minister of Foreign Affairs of Turkey, and the Director of the Policy and Mediation Division of the UN Department of Political Affairs were in the audience and shared their impressions. Second, the setup of the simulation was more complex than its typical in-class counterparts. Our insights from this multi-day, multi-stage and multi-issue simulation can inform colleagues who plan to run larger scale simulations. Besides sharing experiences on a number of logistical points, we especially draw attention to the constructive role facilitators can play in augmenting the learning benefits accruing to the students from simulations

Update to Our Reader, Reviewer, and Author Communities—April 2020

The research community faces unprecedented disruption from the global COVID-19 pandemic. Some researchers are beginning to return to lab work after a hiatus, but others continue to work as best as they can from home, including ourselves. The global editorial, support, and production staff of ACS journals continue to work as usual, even though most are working from locations that are not their usual work environment.Throughout this period, we seek to assist our authors, reviewers, and readers, despite the exceptional disruption to their normal research workflow. One area of particular concern is that authors may require extra time to prepare revised manuscripts, especially if additional laboratory-based experimental work is required to address specific reviewer or editor concerns. At this time, reviewers may consider limiting their recommendations for additional experimental work, except in those cases where they deem it necessary to support the central claims of the paper and maintain high standards of science/engineering. Please let us know if you require extra time to complete a revision of your manuscript as we are happy to work with you to determine an appropriate course of action. Should authors or reviewers have questions or concerns during this period regarding the need for additional time for a review or revision, please do not hesitate to contact the editorial office responsible for the manuscript and/or the editor-in-chief.ACS Publications has a resource page for readers, authors and reviewers and it can be accessed here.The editors and staff at our journals wish our community the best as it faces multiple challenges arising from the pandemic. Among those most impacted are young scientists and other early career members of the community, and we hope everyone does their best to support one another, especially those most affected by the disruption, and that, globally, we observe a quick resolution to the situation.This joint Editorial was simultaneously published in other American Chemical Society journals

Spectrum of neurodevelopmental disease associated with the GNAO1 guanosine triphosphate-binding region

Objective To characterize the phenotypic spectrum associated with GNAO1 variants and establish genotype-protein structure-phenotype relationships. Methods We evaluated the phenotypes of 14 patients with GNAO1 variants, analyzed their variants for potential pathogenicity, and mapped them, along with those in the literature, on a three-dimensional structural protein model. Results The 14 patients in our cohort, including one sibling pair, had 13 distinct, heterozygous GNAO1 variants classified as pathogenic or likely pathogenic. We attributed the same variant in two siblings to parental mosaicism. Patients initially presented with seizures beginning in the first 3 months of life (8/14), developmental delay (4/14), hypotonia (1/14), or movement disorder (1/14). All patients had hypotonia and developmental delay ranging from mild to severe. Nine had epilepsy, and nine had movement disorders, including dystonia, ataxia, chorea, and dyskinesia. The 13 GNAO1 variants in our patients are predicted to result in amino acid substitutions or deletions in the GNAO1 guanosine triphosphate (GTP)-binding region, analogous to those in previous publications. Patients with variants affecting amino acids 207-221 had only movement disorder and hypotonia. Patients with variants affecting the C-terminal region had the mildest phenotypes.

Spectrum of neurodevelopmental disease associated with the GNAO1 guanosine triphosphate-binding region

OBJECTIVE: To characterize the phenotypic spectrum associated with GNAO1 variants and establish genotype-protein structure-phenotype relationships. METHODS: We evaluated the phenotypes of 14 patients with GNAO1 variants, analyzed their variants for potential pathogenicity, and mapped them, along with those in the literature, on a three-dimensional structural protein model. RESULTS: The 14 patients in our cohort, including one sibling pair, had 13 distinct, heterozygous GNAO1 variants classified as pathogenic or likely pathogenic. We attributed the same variant in two siblings to parental mosaicism. Patients initially presented with seizures beginning in the first 3 months of life (8/14), developmental delay (4/14), hypotonia (1/14), or movement disorder (1/14). All patients had hypotonia and developmental delay ranging from mild to severe. Nine had epilepsy, and nine had movement disorders, including dystonia, ataxia, chorea, and dyskinesia. The 13 GNAO1 variants in our patients are predicted to result in amino acid substitutions or deletions in the GNAO1 guanosine triphosphate (GTP)-binding region, analogous to those in previous publications. Patients with variants affecting amino acids 207-221 had only movement disorder and hypotonia. Patients with variants affecting the C-terminal region had the mildest phenotypes. SIGNIFICANCE: GNAO1 encephalopathy most frequently presents with seizures beginning in the first 3 months of life. Concurrent movement disorders are also a prominent feature in the spectrum of GNAO1 encephalopathy. All variants affected the GTP-binding domain of GNAO1, highlighting the importance of this region for G-protein signaling and neurodevelopment.status: publishe