Applicability of working abroad for physicians with a specialization in Global Health and Tropical Medicine.

BACKGROUND: In The Netherlands, physicians specialized in global health and tropical medicine (Ps-GHTM) are trained to work in low-resource settings (LRS) after their training program of 27 months. After working for a period of time in LRS, many Ps-GHTM continue their careers in the Dutch healthcare system. While there is limited evidence regarding the value of international health experience for medical students and residents, it is unknown to what extent this applies to Ps-GHTM and to their clinical practice in the Netherlands. METHODS: In this qualitative study we conducted semi-structured interviews and focus group discussions (FGDs) with Ps-GHTM to explore the perceived applicability of their experience abroad for their subsequent return to the Netherlands. Topic guides were developed using literature about the applicability of working abroad. Findings from the interviews served as a starting point for FGDs. The interviews and FGDs were analysed using directed content analysis. RESULTS: 15 themes are described relating experience abroad to healthcare delivery in The Netherlands: broad medical perspective, holistic perspective, adaptive communication skills, creativity, flexibility, cultural awareness, self-reliance, clinical competence, cost awareness, public health, leadership, open-mindedness, organization of care, self-development, and teamwork. Highlighting the variety in competencies and the complexity of the topic, not all themes were recognized by all respondents in the FGDs nor deemed equally relevant. Flexibility, cultural awareness and holistic perspective are examples of important benefits to work experience in LRS. CONCLUSION: Ps-GHTM bring their competencies to LRS and return to the Netherlands with additionally developed skills and knowledge. These may contribute to healthcare delivery in the Netherlands. This reciprocal value is an important factor for the sustainable development of global health. Identifying the competencies derived from work experience in LRS could give stakeholders insight into the added value of Ps-GHTM and partly help in refining the specialization program.

Suitable site selection by using full consistency method (FUCOM): a case study for maize cultivation in northwest Turkey.

The agricultural land evaluation procedure is a valuable guide for growing plants where they are best suitable, and it has a critical role in actualizing sustainable plans for providing food security for the growing population. In agricultural land suitability analysis, different multi-criteria decision-making methods are applied. The main objective of this study is to introduce the potential usage of a new multi-criteria decision-making method the Full Consistency Method (FUCOM) in agricultural land suitability analysis. The study was carried out in the northern part of the Karamenderes plain in NW Turkey. Nine land characteristics (soil texture, soil depth, organic matter content, electrical conductivity, pH, slope, drainage, CaCO3%, and cation exchange capacity) were used for the land evaluation study. The weighting values of the land characteristics were calculated by the FUCOM. According to the results, 223 ha (6.26%) were highly suitable, 2650 ha (74.40%) were moderately suitable, 508 ha (14.26%) were marginally suitable, and 181 ha (5.08%) were not suitable for maize cultivation. The weighted values of the parameters were also tested with Analytic Hierarchy Process (AHP) and the Best-Worst Method (BWM). There is a general compatibility between the methodologies. The data obtained from these methods showed that analysis consists of a very positive relationship with each other. The comparisons of these methodologies showed that FUCOM's prioritization order simplicity in parameter weighting and ability to reduce the processing intensity would provide a significant contribution and advantage to the land evaluation experts and planners. It is recommended that the Full Consistent Method could be reliably used in agricultural land suitability analysis.

Applying multivariate statistics for identification of groundwater resources and qualities in NW Turkey.

This study, performed in Çanakkale-Ezine in NW of Turkey, analyzes the physicochemical properties of 37 groundwater wells. These 37 wells were chosen to represent each geological unit in the study area. The main purpose of the study and its contribution to the literature is to produce information about the resources and availability of groundwater by using multivariate statistical methods and lithology. For determination hydrochemical facies of groundwater, Piper trilinear diagram was used. Gibbs diagram was applied for determining the mechanism of groundwater chemistry and diagram showed that the interaction of rock-water is more dominant in the study area. Multivariate statistics were applied to physicochemical properties for identification origins of waters. According to the Piper diagram, 16 of the wells were identified as Ca-HCO3 type, 13 of them as Ca-Cl type, 5 of them as mixed Ca-Mg-Cl type, 2 of them as Na-Cl type, and 1 as Ca-Na-HCO3 type. In the study with the purpose of determining the resources of groundwater, the physicochemical properties of the wells are analyzed with hierarchical cluster (HCA) and non-hierarchical cluster (K-means) methods, and the resources are associated with the lithology based on these methods. A total of 37 wells are divided into five different clusters through the HCA method. Further, for the interpretation of the resources of the groundwater, the facies of the waters on the Piper diagram are evaluated based on the five clusters generated through the HCA method and on the lithology. In the study, the results obtained from the K-means method are not significant and in line with the lithology for the interpretation of the resources of the groundwater. In conclusion, this study with limited dataset reveals that using HCA method is very effective to identify the origins of groundwater and present the association with lithology.

Effect of carotid artery stenting on ophthalmic artery flow patterns.

OBJECTIVES: The purpose of this study was to assess the effect of carotid artery stenting on ophthalmic artery blood flow using transorbital color and spectral Doppler sonography and review the changes in relation to cerebral hemodynamics. METHODS: Twenty-eight consecutive patients with severe internal carotid artery stenosis (≥ 70%) who were scheduled for carotid stenting were included. Ophthalmic artery Doppler sonography was performed bilaterally before and after stenting. The flow direction, peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistive index in the ophthalmic artery were recorded. RESULTS: Twenty male and 8 female patients with 10 right-sided and 18 left-sided stenoses were studied. The mean overall carotid stenosis ratio ± SD was 87.3% ± 9.9%. After stenting in the ophthalmic artery ipsilateral to the stenosis, significant increases in the PSV (-3.87 ± 48.81 to 46.70 ± 25.33 cm/s; P < .001), and EDV (-3.02 ± 16.31 to 11.24 ± 7.37 cm/s; P < .001) were detected, and the increase in the PI approached significance (1.40 ± 0.59 to 1.62 ± 0.52; P = .055). A change in the flow direction from retrograde to antegrade was noted in 11 patients (39%) after stenting, and in 1 patient with no detectable flow, reconstitution of flow was observed. Increases in the PSV and EDV (P= .03 for ΔEDV) were more pronounced in symptomatic patients than asymptomatic patients after stenting. CONCLUSIONS: Substantially decreased ophthalmic artery velocity and retrograde flow are suggestive of high-grade carotid artery stenosis (≳90%). Stenting improves ophthalmic artery perfusion and positively changes cerebral hemodynamics in high-grade carotid artery stenosis, especially in symptomatic patients, which can be monitored with ophthalmic artery Doppler sonography.

Stability of some quality traits in bread wheat (Triticum aestivum) genotypes.

This study was carried out in order to determine some quality traits such as thousand grain weight (TGW), hectoliter weight (HW), grain protein content (GPC), Zeleny sedimentation volume (ZSV) and stability of quality traits of 25 bread wheat genotypes. The experiment was conducted at seven environmental conditions during 2 growing periods (2003-2004 and 2004-2005) using randomized complete block design with four replicates. The ANOVA showed that out of the total sum of squares, 48.4, 28.0 and 23.6% for TGW, 71.4, 14.9 and 13.7% for HW, 54.4, 23.0 and 22.6% for GPC, 44.7, 41.7 and 13.6% for ZSV was attributable to E, G and G x E interaction effects, respectively. Thousand grain weight, hectoliter weight, grain protein content and Zeleny sedimentasyon volume of genotypes changed from 34.5 to 41.4 g, from 76.5 to 80.4 Kg, from 11.49 to 13.37% and from 22.1 to 46.0 ml, respectively. Seven stability parameters, covering a wide range of statistical approaches, were used so as to predict the genotypes. The study of genotypic stability showed that Bezostaya and advanced lines numbered 11 and 24 had high stability for quality traits and proved to be the best within the pool of the studied genotypes. Also, 8 and 17 numbered genotypes demonstrated high stability for TGW, HW, GPC and HW, GPC and ZSV, respectively.

Geochemical and radionuclide profile of Tuzla geothermal field, Turkey.

Tuzla geothermal basin is situated in north-western Turkey on the Biga Peninsula, which is located at the west end of the Northern Anatolian Fault system. Soil and water samples were collected between August 2003 and June 2004 to initiate development of a geochemical profile of surface and subsurface waters in the geothermal basin and radionuclide concentrations in soils. All water samples were found to fall within Turkish Water Quality Class 4, meaning they were remarkably contaminated for any water consumption sector (industrial, human use or agricultural) based on sodium and chloride ions. Such waters could be used only after appropriate water treatment. The water samples are of the chloride type in terms of geochemical evaluation. Preliminary geochemical evidence shows that the N-S flowing part of the Tuzla River acts as a natural barrier within the basin. Heavy metal concentrations in the soil samples show slight elevations, especially those obtained from the east part of the basin where thermal springs are dominant. Geochemical calculations were carried out with PHREEQC software to determine equilibrium concentration of chemical species and saturation indices, by which it is suggested that chloride is the most important ligand to mobilize the heavy metals in the studied system. In addition, the activity concentration and gamma-absorbed dose rates of the terrestrial naturally occurring radionuclides were determined in the soil using gamma-ray spectrometry. The soil activity ranged from 42.77 to 988.66 Bq kg(-1) (averaging 138 Bq kg(-1)) for ( 238 )U, 13.27 to 106.31 Bq kg(-1) (averaging 32.42 Bq kg(-1)) for ( 232 )Th, and 99.28 to 935.36 Bq kg(-1) (averaging 515.44 Bq kg(-1)) for ( 40 )K. The highest value of ( 238 )U was found in the soil samples obtained from an area close to the hot spring.

Assessment of the water quality of Troia for the multipurpose usages.

The aim of this study was to determine the origin and quality of waters in Troia. For this purpose total of 25 water samples including 2 springs, 14 surfaces and 9 groundwaters, were collected at eight different times. Global positioning system (GPS) was used to determine to coordinates of sampling points. The concentration of 6 minor elements (B, Cu, F, Fe, Pb and Zn), 9 major anions and cations (Na(+), Ca(2+), K(+), Mg(2+), SO(4)(2-), PO(4)(3-), HCO(3)(-), Cl(-) and, CO(3)(2-)) were determined by spectrometric, colorimetric and volumetric methods. Water pH, EC, DO, ORP and TDS were measured in situ using probes. The data showed that the concentrations of most of minor elements were below the EPA and TSE limits except Pb which ranged between 0.001 and 4.832 mg L(-1). Statistically significant relationships (P<0.01 and r>0.70) were observed between Fe and Cu, Cu and K(+), Cu and Ca(2+), B and Na(+), Na(+) and K(+). Assessing the water based on irrigation using Wilcox model showed that some well waters were not suitable for irrigation. Troia water was found to be highly corrosive and the average corrosion coefficients varied from 0.5 to 4.6. According to the Piper and Schoeller diagrams results, the water in Troia was classified as mixed water type.

Asymptomatic splenic artery occlusion in a child: incidental detection with Doppler ultrasonography.

Splenic arterial occlusion is a rare condition usually presenting with signs that are due to splenic infarction. To the best of our knowledge, splenic artery occlusion without splenic infarction has not been reported in the literature. The case presented here was asymptomatic, except for hypertension. The splenic artery occlusion was detected incidentally during the color Doppler examination of renal arteries that was performed to rule out stenosis as a cause. The striking Doppler finding that led to the final diagnosis was peri-pancreatic multiple tubular structures consistent with collateral flow.

Doppler ultrasound evaluation of the structural and hemodynamic changes in the brachial artery following two different exercise protocols.

PURPOSE: Examine the effects of incremental and submaximal exercise on structural and hemodynamic changes in the brachial artery flow parameters using Doppler ultrasonography. MATERIALS AND METHODS: Twenty four healthy sedentary males (aged 19.54+/-0.59) performed submaximal (15 minutes heart rate to 75% maximal) and incremental (workload was increased 20W every 3 minutes until exhaustion) exercises by upper extremity ergometer. Before and after exercises the brachial artery diameter, peak systolic maximum velocity (Vmax), end-diastolic minimum velocity (Vmin) and time-averaged mean flow velocity (Vmean), volume blood flow and flow waveform patterns were recorded in a controlled environment. RESULTS: The diameter of the brachial artery, flow velocities, and blood flow increased significantly after each exercise protocol (p < 0.001). The Vmax (p < 0.05), Vmean (p < 0.01), and volume blood flow (p < 0.01) after the incremental exercise were significantly higher than those measured after the submaximal exercise. However, no significant differences were noted between the two exercise protocols when arterial diameters and Vmin were concerned. The flow pattern was monophasic in all subjects after incremental exercise. Nevertheless, the flow pattern remained triphasic in two of the subjects after submaximal exercise. CONCLUSION: Blood flow velocities played important role in hemodynamic mechanism than conduit arterial diameter during arm exercises. Changes in conduit artery diameter did not significantly contribute to blood flow increase during high and moderate intensity exercises. There is minimal variation in waveform shapes of normal individuals after exercise. Doppler ultrasonography proved a practical tool in the studies of the dynamic responses of blood flow and vascular resistance during rest and exercises.

[Effect of propranolol on renal hemodynamics in patients with cirrhosis: assessment with Doppler US]. / Siroz hastalarinda propranololün renal hemodinamik etkileri: Doppler US ile degerlendirme.

PURPOSE: To determine the renal resistive index profile in cirrhotic patients before and after propranolol treatment and assess the effects of propranolol on renal hemodynamics. MATERIALS AND METHODS: Thirty-six patients with cirrhosis and ascites (decompensated group), 39 patients with cirrhosis but no ascites (compensated group) and 25 patients with normal renal and hepatic functions (control group) were studied. All had normal blood urea nitrogen and serum creatinine levels. The renal resistive index was calculated in all patients before and after oral propranolol treatment. RESULTS: Resistive index was significantly higher in the decompensated group (p<0.05) than in other groups. After propranolol treatment, resistive indices decreased in the compensated patients (p<0.05) but increased in the decompensated group (p<0.05). There was a slight but statistically insignificant increase in the control group. CONCLUSION: In patients with cirrhosis renal failure is a significant risk factor for liver transplantation. In these patients, Doppler sonography provides early detection of renal dysfunction even before renal function tests are abnormal. Doppler sonography is a useful noninvasive method to evaluate the effects of drugs on renal hemodynamics.

Ultrasonography guided fine needle aspiration biopsy of parotid gland masses.

OBJECTIVES: The exact preoperative diagnosis of parotid gland masses requires highly specific and sensitive diagnostic techniques. The specificity, sensitivity and accuracy of ultrasonography guided fine needle aspiration biopsy of parotid gland masses were assessed. PATIENTS AND METHODS: There were 46 female and 36 male patients. The mean age was 39 years (range 18 to 74 years). Ultrasonography guided fine needle aspiration biopsies were performed and cytologic diagnoses were compared with postoperative histopathologic findings of specimens. RESULTS: In our series, 65 of the lesions (79%) were found to be benign and 17 (21%) were malignant. There were one false negative and one false positive results. The sensitivity, specificity and accuracy rates were found to be 94.1%, 98.4% and 97.6% for parotid tumors, respectively. CONCLUSION: Ultrasonography guided fine needle aspiration biopsy of parotid gland masses have been proven to be a highly specific, sensitive, and a safe preoperative diagnostic technique when performed by an experienced clinician and cytopathologist.

Monitoring and assessment of land use status by GIS.

The objectives of this study were to assess land suitability and to monitor the spatial and temporal changes in land use types (LUTs) by using GIS. The study was conducted in an irrigated area of 920 ha. located in the East Mediterranean region of Turkey. Archived data of LUTs were utilized. Data analysis was conducted by using ArcInfo and ArcView GIS softwares. The land characteristics were compared with land requirements of present LUTs by taking into account the land evaluation results. Three major soil series and twelve different LUTs were identified. Corn and citrus were the most planted LUTs in the assessment period. Generated maps demonstrated how LUTs changed spatially and temporally. Most LUTs were clustered in certain areas indicating that farmer's selection of LUTs was affected by their habits and neighbor's behavior. Land suitability assessment results indicated that Canakci and Mursel soil series were found to be highly suitable for all LUTs while Arikli soil series was determined to be moderately suitable citrus, vegetables and watermelon. Citrus plantation maps overlaid on soil series maps demonstrated that the citrus has not been planted completely on suitable areas. Land suitability assessment showed that citrus plantation in Arikli series would result in 40% yield loss and 58% of land is not used at its potential.

Correlation between the diameter of the main renal artery and the presence of an accessory renal artery: sonographic and angiographic evaluation.

OBJECTIVE: To evaluate whether the diameter of the main renal artery is an indicator of the presence of an accessory renal artery in sonographic examination. METHODS: Of cases undergoing renal intraarterial digital subtraction angiography for any reason, those with no renal arterial disease detected on digital subtraction angiography were included in the investigation. Accessory renal arteries were disclosed by digital subtraction angiographic examinations. The dimensions of the kidney were measured sonographically. The lowest, highest, and mean values of diameters of main renal arteries were determined by sonography and angiography in both the group with accessory renal arteries and the group without accessory renal arteries. RESULT: Of kidneys with sonographically normal dimensions, angiographic evaluation was made in 107, and sonographic evaluation was made in 97, the renal arteries of which could be visualized optimally. Both radiologic methods showed that diameters of main renal arteries were significantly smaller in the presence of the accessory renal artery (P < .001, Student t test, Mann-Whitney U test, and receiver operating characteristic curve). CONCLUSIONS: In sonographic examination, the presence of the main renal artery with a diameter smaller than usual in a kidney with normal dimensions is indicative of the presence of an accessory renal artery. Taking this into account, we can obtain higher rates of detection of accessory renal arteries in sonographic examinations.

Hemodynamic effect of transdermal glyceryl trinitrate on newly constructed arteriovenous fistula.

Transdermal glyceryl trinitrate (GTN) administration may have a beneficial effect in the creation of an arteriovenous fistula (AVF) by increasing blood flow through the access and by inhibiting platelet aggregation. We evaluated the hemodynamic effects of transdermal GTN administration on newly constructed arteriovenous fistula. Radiocephalic fistula at the wrist (Brescia fistula) was constructed as the initial vascular access in 31 uremia patients (study = 16, control = 15). The patient demographics and the etiology of chronic renal disease were similar in the two groups. None of the patients had severe vasculitis. The mean duration of chronic renal disease was 8 months (1-24 months). The diameter, blood flow rate, and blood output at the drainage vein and the subclavian vein were measured by duplex ultrasonography 24 hours after the procedure. The measurements were performed again with transdermal GTN (10 mg/24 hours adhesive patch) administration in the study group and, without any medication, in the control group 4 hours after the initial measurements were taken. In the study group, all of the hemodynamic parameters were significantly increased over the initial measurements (p <0.05) whereas in the control group all hemodynamic parameters were unchanged, except the diameter of the subclavian vein (p <0.05). The actual change in hemodynamic parameters was significant in the study group when compared to the control group (p <0.05). Our data showed that transdermal GTN administration at the forearm increases flow through the Brescia fistula.

Intrarenal arteriovenous fistula causing a "pseudonutcracker effect".

We report a case in which an intrarenal arteriovenous fistula caused the nutcracker effect. Color Doppler sonography of the left renal artery showed a peak systolic velocity of 150 cm/second and renoaortic ratio of 2.1. The left renal vein was significantly dilated, and the adjacent renal artery was kinked. A stenosis in the left renal vein at the aorto-mesenteric bifurcation was demonstrated, with a maximum velocity of 201 cm/second. Renal Doppler evaluation showed an area of high-velocity, low-resistance arterial flow consistent with an arteriovenous fistula in the inferior half of the left kidney. Angiography confirmed the fistula. The fistula was successfully occluded by coil embolization. Follow-up sonography showed almost complete obliteration of the fistula, regression of the renal vein dilatation, and a reduction in renal venous and arterial flow velocities. Given the reversibility of the fistula's effects, we suggest the term "pseudonutcracker effect" to describe this case.