Measurement of Natural Radioactivity in Beach Sand of Akkuyu Mersin, Turkey

Distribution of natural radionuclide gamma rays produced by 232Th, 226Ra and 40K, were determined for the sand collected along the cost of Mersin in Akkuyu. Gamma radiation in beach sand samples collected from Akkuyu nuclear power plant region has been measured by NaI(Tl) gamma ray spectrometer. Gamma spectrometer has been calibrated with IAEA reference set which were RGK, RGU and RGTH. The radioactivity concentration of were calculated and expressed in Bqkg-1. The source of  cause for the total doses of beach sand was formed due to three primordial radionuclide which were 232Th, 226Ra and 40K. The activity of radionuclide were between 3.96-17.18, 15.82-39.48 and 133.54-287.06Bqkg-1 respectively. Radiological hazard, radium equivalent, external hazard and total dose rate were also calculated. Results were discussed with UNCEAR reports. Keywords: Natural Radioactivity, Sand, Gamma-Ray Spectrometry, Dose Rate, Akkuy

Investigation of behavioral ıntentions according to unified technology acceptance and use theory 2 (Utaut-2) of wearable technologies in sports: Example of the heart monitor

Teknolojinin her alanda gösterdiği gelişim, spor ekipmanları konusunda da önemli mal ve hizmet çeşitliliğini doğurmaktadır. Bunlardan biri olan nabız monitörleri aktif spor yapan bireylerin egzersiz kalitesini etkilemektedir. Bu ise, söz konusu mal ve hizmetlere dair geliştirilen davranışsal niyetlere etki etmektedir. Nabız monitörleri spor yapan bireylerin antrenmanın yeri, antrenman süresi, antrenman mesafesi, kalori tüketimi gibi birçok aktivite göstergesini yakalamasına imkân veren cihazlardır. Birleştirilmiş teknoloji kabul ve kullanım teorisi 2 üzerinden yapılan bu araştırma ile nabız monitörlerinin spora dair katkıları ve kullanıcıların davranışsal niyetleri incelenmiştir. Tarama araştırmalarının veri toplama metodu olan anket aracılığıyla yürütülen çalışma sonucunda katılımcıların cinsiyet, yaş, eğitim durumu ve spor alışkanlıklarına göre oluşturulan değişkenlerin davranışsal beklenti temelindeki niyetleri araştırılmıştır. Bu niyetler performans beklentisi, çaba beklentisi, sosyal etki, kolaylaştırıcı koşullar, ücret değeri ve hedonik motivasyon olarak belirlenmiştir. Araştırmanın sonucunda kullanıcı deneyimine işaret eden kolaylaştırıcı koşulların önemli bir değişken olduğu bulgulanırken hedonik motivasyon ve ücret değerinin de davranışsal beklenti niyetinin önemli yordayıcıları olduğu gözlemlenmiştir.The modern world encourages individuals to be conscious of sports routines for a healthy life, by means of popularized approaches to sports and health. Health and sports industries, which are affected by developing technology, reshape accordingly the wearable technologies. The heart rate monitors used in those industries adapt for the different parts of the body and can measure by taking heart rate inputs from different parts of the body through wearable technologies such as skin patches, body bands, smart shoes or smart clothes. These devices can also monitor the consuming calories and performance tracking over the measured heart rate and time. This generates a numerical output of intentional reactions during body activity. Various factors which are affecting the use of heart rate monitors originate from the Technology Acceptance Theories. Approaches and attitudes of individuals affect their purchasing and usage levels towards these products. It has become possible to mention an increasing market share due to the widespread use of the wearable technologies. The industry, which is associated with sports and activity, falls within the scope of sports marketing. And wearable technologies in sports marketing have been in the Turkish market for the last 10 years. An increasing number of users experience over the heart rate monitors and their behavioral intentions about the product are shaped in the next process. The athletes which are the target audience, within the framework of sports marketing and the behavioural intentions of these individuals create one of the important determinants of marketing. The question that needs to be answered is which behavioural intention variable has an impact on a sectoral basis. It is aimed to contribute to the sports marketing literature in Turkey regarding the wearable technologies in sports marketing by the answer to the question is replied in the light of the findings in this study.In the literature review, especially in Turkish literature, it has been done that a limited number of researches on wearable technologies carried out in sports marketing. A study named Using Smartwatches for Fitness and Health Monitoring: The UTAUT2 Combined With Threat Appraisal As Moderators, which is among the studies on this subject, was carried out on individuals who are users or nonusers the heart rate monitors. The screening question was determined as 'Have you heard of smartwatches before?'.Individuals who answered "No" were not included in the survey.However, the participants consisted of individuals who use heart rate monitors and do sports in our study. Contrary to the research conducted in Malaysia, this research was conducted on the basis of behavioral intent regarding the users of the heart rate monitor and did not include the subheadings of perceived vulnerability and perceived severity in the survey questions. Although the study conducted in Malaysia focused on both sports and health fields, it was aimed to measure the behavioral intentions of individuals who only do sports and use heart rate monitors in this study. The perceived vulnerability and perceived severity which are the survey questions of the Malaysian study under the sub-headings about health issues. Thus, these sub-headings were not included in this survey questions because health issues were not included in this research.The survey research, which is one of the quantitative research methods, was used in the study. Informations collected from the respondents by the survey. The survey was conducted through the SurveyMonkey which is online survey platform in order to reach people easier, considering the pandemic conditions.After determinated the questions of the scale, communicated with a gym to find the participants for the study. After the survey was conducted to the trainers and members of the gym, other gym trainers and members were reached through the snowball sampling technique, which is one of the non-probability sampling techniques. The key point in the snowball sampling technique is that the participants have social bonds. Thus, the number of samples increases thanks to the participants interacting with their social environment

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

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2\ub75th percentile and 100 as the 97\ub75th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59\ub74 (IQR 35\ub74–67\ub73), ranging from a low of 11\ub76 (95% uncertainty interval 9\ub76–14\ub70) to a high of 84\ub79 (83\ub71–86\ub77). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of 'leaving no one behind', it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. METHODS: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

© 2018 The Author(s). Background: Assessments of age-specifc mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Afairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specifc mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in diferent components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 18·7% (95% uncertainty interval 18·4-19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2-59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5-49·6) to 70·5 years (70·1-70·8) for men and from 52·9 years (51·7-54·0) to 75·6 years (75·3-75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5-51·7) for men in the Central African Republic to 87·6 years (86·9-88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3-238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6-42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2-5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specifc mortality shows that there are remarkably complex patterns in population mortality across countries. The fndings of this study highlight global successes, such as the large decline in under-5 mortality, which refects signifcant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Customer loyality in paid digital music platforms: A quantitative research

Çevrim içi platformların hizmet sektörünün her alanında yaygınlaşmasıyla ihtiyaçlar bu yönde evrilmektedir. Günümüzün dijital kullanıcı profili ise geniş ölçüde global alışkanlıklara sahip bireylerden oluşmaktadır. Artan talep ile birlikte çeşitlenen sektörlerden biri olan dijital müzik hizmetleri ücretli ve ücretsiz olmak üzere farklı ihtiyaçlara cevap vermektedir. Çeşitlenen ücretli dijital müzik platformları arasında ortaya çıkan rekabette markanın halkla ilişkileri, müşteri memnuniyeti, reklamlar, sosyal sorumluluk gibi unsurların yanı sıra müşteri sadakati de önemli bir öge olarak karşımıza çıkmaktadır. Söz konusu sektörde hem Türkiye hem de Dünya devi olan Spotify'ın sektörde yapılan analizler neticesinde her geçen gün daha fazla abone sayısına ulaştığı görülmektedir. Bu akademik çalışmanın kapsamı, Spotify özelinde marka güvenilirliği, kullanım kolaylığı, gizlilik ve güvenlik, marka sadakati, müşteri hizmetleri, kişiselleştirme, seçim yapabilme, algılanan değer ve sadakat niyetleri ilişkilerinden oluşmaktadır. Sonuçlarda Spotify markasını rakiplerinden ayıran unsurun marka sadakati ile bağlantısını ve marka sadakati teminini nasıl sağladığı ortaya çıkmıştır. Kullanıcının müzik platformunda zaman geçirirken, şarkı ararken ve ödeme yaparken zorlanmaması, belirli marka müzik platformu kullanımının hızlı ve pratik olduğunu düşünmesi, benzer platformlardan farklı olarak çeşitli ücret tarifelerine ulaşabiliyor olması ve platformu kullanım kaynaklı haz duygusu olması dijital müzik platformları için olumlu müşteri deneyimini ve müşteri sadakatini oluşturmaktadır. Platformun sağladığı güvenlik ve gizlilik koşulları ise dijital kullanıcılar için önemli unsurların başında gelmektedir. Çalışmada nicel araştırma metotlarından biri olan anket yöntemi kullanılmıştır. COVİD-19'dan kaynaklı pandemi sürecinden dolayı anket çevrim içi bir uygulama olan SurveyMonkey ile yapılmıştır. Çalışmanın evreni Spotify kullanan herkesi kapsamaktadır, ancak bu geniş kitleye ulaşılamayacağından dolayı yargısal örneklem metoduyla 793 kişi ile çevrim içi anket çalışması yapılmıştır. Araştırmanın amacı marka sadakati kavramı üzerinden dijital müzik platformlarından biri olan Spotify markasının kullanıcılarının marka kullanım alışkanlıkları, marka beklentileri ve sadakat ile sonuçlanabilecek davranışları üzerine açıklık getirilerek literatür ve sektörel çalışmalara kaynak sağlamaktır. Araştırmanın sonucunda dijital müzik platformu kullanıcılarının ücretli veya ücretsiz kullanımlarında marka beklentilerinin farklılaştığı izlenmiştir. Ayrıca kadın ve erkek kullanıcılarda gözlemlenen kullanım alışkanlıkları ve sadakat niyetleri, algılanan değer, güvenlik ve gizliliğe verilen önem farklılık göstermektedir.With the spread of online platforms in all areas of the service industry, needs are evolving in this direction. Today's digital user profile consists of individuals with a wide range of global habits. Digital music services, one of the diversified sectors with increasing demand, respond to different needs, as paid and free. In the competition that emerges among the diversified paid digital music platforms, customer loyalty is an important element in addition to the brand's public relations, customer satisfaction, advertisements and social responsibility. The sector is seen that both Turkey and the world giants like Spotify result of analysis in the industry reached the more subscribers every day. The scope of this academic study consists of brand reliability, ease of use, privacy and security, brand loyalty, customer service, personalization, selection, perceived value and loyalty intentions in Spotify. In the results, it is revealed how the factor that distinguishes the Spotify brand from its competitors is its connection with brand loyalty and ensuring brand loyalty. The user does not have difficulty spending time on the music platform, searching for songs and paying, considering that the use of certain brand music platform is fast and practical, Unlike similar platforms, it can access various price tariffs and the pleasure of using the platform creates a positive customer experience and customer loyalty. The security and privacy conditions provided by the platform are among the most important factors for digital users. The survey method which is one of the quantitative research methods, was used in the research. Due to the pandemic process originating from COVID-19, the questionnaire was conducted with SurveyMonkey, an online application. The universe of the study covers everyone using Spotify, but since this large participants cannot be reached, an online survey was conducted with 793 people using the judgement sampling method. The aim of the research is to provide resources through the brand loyalty concept for the literature and sectoral studies by clarifying the brand usage habits, brand expectations and behaviors that may result in loyalty,of the users of the Spotify brand, which is one of the digital music platforms. As a result of the research, it was observed that the brand expectations of the users of digital music platforms differed in paid or free use. Furthermore, the usage habits and loyalty intentions observed in female and male users, perceved value, importance given to security and privacy differ

Social reflections of renewable energy: Wind energy in Turkey

The Renewable energy consumption is promoted nationally by various organizations and countries due to its environmentally friendly feature within the measures taken against the global climate crisis. Wind energy, which is one of the clean energy sources, can provide important environmental, economic, and social contributions. Wind power plants, which have been increased in Turkey, are causing social change within environmentalist views, thanks to the benefits. Social views on environmentalism can characterized as a driving force for development by forming the social footing for the spread of renewable energy. Thus, public consciousness is seen as with cause and effect. The environmental awareness of individuals living in Çanakkale city, where Çanakkale Wind Power Plant, one of the wind power plants producing the largest amount of electricity in Turkey, is located. The study was carried out with 591 participants by a survey method in Çanakkale. According to the results of the research, the education variable is the most important factor in environmental awareness. The place of residence of individuals is both the cause and the result of education