Effect of Continuous Glucose Monitoring Device Assistance on Glycemic Control of 2023 Kahramanmaras Doublet Earthquake Survivors with Type 1 Diabetes in Adana, Turkey.

OBJECTIVE: The aim of this study was to investigate the effects of the devastating 2023 Kahramanmaras earthquake on the glycemic control of children with type 1 diabetes (T1DM) in Adana, Turkey. Additionally, the study aimed to assess the impact of continuous glucose monitoring (CGM) device assistance on glycemic control after the earthquake. MATERIALS AND METHODS: A retrospective study was conducted involving 134 children with T1DM receiving intensive insulin treatment. Participants were divided into 2 groups: CGM (+) (n = 58), who benefited from CGM device assistance, and CGM (-) (n = 76), who did not utilize CGM device after the earthquake. Glycated hemoglobin (HbA1c) levels were recorded before and after the earthquake. RESULTS: Following the earthquake, the median HbA1c for all participants changed insignificantly from 8.9% to 8.6% (P = .491). However, in the CGM (+) group, HbA1c levels significantly improved post earthquake (P = .001). Conversely, the CGM (-) group experienced a deterioration in glycemic control (P = .027). A 2-way repeated measures ANOVA revealed a significant interaction effect between CGM device usage and the earthquake on HbA1c levels (F = 17.257, P <.001). Subgroup analysis based on age indicated that the effectiveness of CGM was more pronounced in adolescents (≥12 years) than in younger children (<12 years). CONCLUSION: This study highlights the adverse impact of the earthquake on glycemic control in children with T1DM and underscores the effectiveness of CGM in improving glycemic control, particularly among adolescents. The provision of CGM devices following the earthquake led to enhanced outcomes, mitigating the negative effects of the disaster on glycemic control.

Computed Tomography-Based Radiomics Using Tumor and Vessel Features to Assess Resectability in Cancer of the Pancreatic Head.

The preoperative prediction of resectability pancreatic ductal adenocarcinoma (PDAC) is challenging. This retrospective single-center study examined tumor and vessel radiomics to predict the resectability of PDAC in chemo-naïve patients. The tumor and adjacent arteries and veins were segmented in the portal-venous phase of contrast-enhanced CT scans, and radiomic features were extracted. Features were selected via stability and collinearity testing, and least absolute shrinkage and selection operator application (LASSO). Three models, using tumor features, vessel features, and a combination of both, were trained with the training set (N = 86) to predict resectability. The results were validated with the test set (N = 15) and compared to the multidisciplinary team's (MDT) performance. The vessel-features-only model performed best, with an AUC of 0.92 and sensitivity and specificity of 97% and 73%, respectively. Test set validation showed a sensitivity and specificity of 100% and 88%, respectively. The combined model was as good as the vessel model (AUC = 0.91), whereas the tumor model showed poor performance (AUC = 0.76). The MDT's prediction reached a sensitivity and specificity of 97% and 84% for the training set and 88% and 100% for the test set, respectively. Our clinician-independent vessel-based radiomics model can aid in predicting resectability and shows performance comparable to that of the MDT. With these encouraging results, improved, automated, and generalizable models can be developed that reduce workload and can be applied in non-expert hospitals.

The utility of annual growth velocity standard deviation scores and measurements of biochemical parameters in long-term treatment monitoring of children with 21-hydroxylase deficiency.

PURPOSE: This study aimed to investigate the utility of annual growth velocity (GV) standard deviation scores (SDSs) and compatibility and effectiveness of biochemical parameters in long-term treatment monitoring and management of 21-hydroxylase deficiency (21-OHD) in children. METHODS: Fifty children with 21-OHD were included in this study, and the biochemical parameters obtained during 402 visits were retrospectively evaluated. The follow-up period was divided between two GV SDS groups (GV SDS < 2 and GV SDS ≥ 2) and compared with auxological, biochemical, and clinical findings. RESULTS: Elevation of 17-hydroxyprogesterone (17-OHP) values was observed at 193/402 visits, and both adrenocorticotropic hormone (ACTH) and total testosterone (tT) were observed at 53 of 193 (27.5%) visits. The calculated cut-off value for 17-OHP was > 4.3 ng/ml, with a sensitivity of 85.48% and specificity of 37.59% in the GV SDS ≥ 2 group. In the GV SDS ≥ 2 group, the corrected final height SDS (cFH SDS) was lower, and the delta height was higher than in the GV SDS < 2 group (p = 0.005 and p = 0.008, respectively). Linear regression analysis of the GV SDSs revealed that 17-OHP values and the hydrocortisone dose (mg/m2) were affected (ß = 0.037, p = 0.035, and ß = - 0.147, p = 0.001, respectively). CONCLUSIONS: Annual GV was critical in the final height (FH) of children with 21-OHD. However, we observed inconsistency between the biochemical parameters in the follow-ups, and there were difficulties in evaluating these markers. Therefore, annual GV SDSs and biochemical findings should be used together in patients with 21-OHD at follow-ups.

Supply chain resilience during the COVID-19 pandemic.

The COVID-19 pandemic has challenged supply chains more seriously challenged than ever before. During this prolonged global health crisis, supply chain managers were forced to rely primarily on solutions developed for limited and foreseeable crises. This study aimed to understand how well existing solutions facilitated supply chain resilience in the UK perishable goods market. Consistent with this aim, we developed a research model based on the supply chain resilience literature and tested it with covariance-based structural equation modelling. Data were collected from 282 retail employees. Supply chain velocity was the preferred measure of resilience. The findings demonstrate that pandemic-related disruptions have affected resilience-building activities. While both proactive and reactive approaches have promoted resilience building during the pandemic, they have not been sufficient to ameliorate all the pandemic's negative effects. Innovation featured as the most effective factor, followed by robustness, empowerment, and risk management via reduced risk. The effect of firm size was significant only on supply chain risk management, with larger companies more efficiently applying risk management practices. The results emphasise the importance of innovation for supply chain resilience. Regardless of firm size, innovation works for every company. Empowerment is another costless and effective tool. Therefore, it is safe to conclude that innovation and empowerment can help organisations to manage their supply chains effectively during crises. Companies can strengthen their supply chain resilience by developing strong relationships with their supplier and employees.

Experience with the targeted next-generation sequencing in the diagnosis of hereditary hypophosphatemic rickets.

OBJECTIVES: Hereditary Hypophosphatemic Rickets (HHR) is a heterogeneous group of disorders characterized by hypophosphatemia. Although the X-linked dominant HHR is the most common form, the genetic etiology of HHR is variable. Recently, developed next-generation sequencing techniques may provide opportunities for making HHR diagnosis in a timely and efficient way. METHODS: We investigated clinical and genetic features for 18 consecutive probands and their 17 affected family members with HHR. All patient's clinical and biochemical data were collected. We first analyzed a single gene with Next-generation sequencing if the patients have a strong clue for an individual gene. For the remaining cases, a Hypophosphatemic Rickets gene panel, including all known HHR genes by Next-generation sequencing, was employed. RESULTS: We were able to diagnosis all of the consecutive 35 patients in our tertiary care center. We detected nine novel and 10 previously described variants in PHEX (9; 50%), SLC34A3 (3; 17%), ENPP1 (3; 17%), SLC34A1 (1; 5%), CLCN5 (1; 5%), and DMP1 (1; 5%). CONCLUSIONS: To delineate the etiology of HHR cases in a cost and time-efficient manner, we propose single gene analysis by next-generation sequencing if findings of patients indicate a strong clue for an individual gene. If that analysis is negative or for all other cases, a Next-generation Sequence gene panel, which includes all known HHR genes, should be employed.

The increases and decreases of the environment Kuznets curve (EKC) for 8 OECD countries.

In this paper, we investigate the validity of the environmental Kuznets curve (henceforth, EKC) hypothesis for 8 OECD countries. To this aim, we decompose the per capita GDP series into its increases and decreases and consider only increases by excluding decreases from the model. Therefore, this method may enable us to test the EKC hypothesis more accurately, in accordance with the original theory. Following decomposition, we apply the fixed-effect regression model with Driscoll-Kraay standard errors, and the common correlated effects mean group (CCEMG) estimator. Empirical findings indicate that while the undecomposed model with undecomposed per capita GDP series supports the EKC hypothesis for 4 out of 8 countries, the decomposed model with decomposed per capita GDP series does not do so for any country. Hence, these mixed results reveal a need to employ different alternative techniques, such as the data transformation/decomposition applied in this study, for testing the EKC hypothesis.

Convergence analysis of the ecological footprint: theory and empirical evidence from the USMCA countries.

The lower ecological footprint (EF) is the sine qua non condition of cleaner energy. The purpose of this study is to investigate the convergence of per capita ecological footprint for the USMCA (The North American Free Trade Agreement) countries, involving the USA, Canada, and Mexico, over the 1961 to 2016. To this aim, the TAR (threshold autoregressive) panel unit root test is applied. Empirical findings indicate that convergence of the EF exists in the second regime, which represents 48.08 percent of the sample, and divergence in the first. Canada is the transition country between two regimes. These results signify common environmental policies-actions among the USMCA countries to mitigate-stop their environmental degradation. Additionally, detected convergence and divergence also might help the policymakers of the USMCA countries to understand which strategies-policies-actions converge or diverge them in the case of EF.

Mutations Within the Transcription Factor PROP1 in a Cohort of Turkish Patients with Combined Pituitary Hormone Deficiency

Objective: Mutations of the genes encoding transcription factors which play important roles in pituitary morphogenesis, differentiation and maturation may lead to combined pituitary hormone deficiency (CPHD). PROP1 gene mutations are reported as the most frequent genetic aetiology of CHPD. The aim of this study was to describe the phenotypes of Turkish CPHD patients and define the frequency of PROP1 mutations. Methods: Fifty-seven CPHD patients from 50 families were screened for PROP1 mutations. The patients were affected by growth hormone (GH) and additional anterior pituitary hormone deficiencies. Results: All patients had GH deficiency. In addition, 98.2% had central hypothyroidism, 45.6% had hypogonadotropic hypogonadism, 43.8% had adrenocorticotropic hormone deficiency and 7.1% had prolactin deficiency. Parental consanguinity rate was 50.9% and 14 cases were familial. Mean height standard deviation score (SDS) and weight SDS were -3.8±1.4 and -3.1±2.0, respectively. Of 53 patients with available pituitary imaging, 32 (60.4%) showed abnormalities. None had extra-pituitary abnormalities. Eight index patients had PROP1 gene mutations. Five sporadic patients were homozygous for c.301_302delAG (p.Leu102CysfsTer8) mutation, two siblings had exon 2 deletion, two siblings had complete gene deletion and two siblings were homozygous for the novel c.353A>G (p.Q118R) mutation. The frequency of the PROP1 mutations was 16% in our cohort. Mutation rate was significantly higher in familial cases compared to sporadic cases (42.8% vs 11.6%; p<0.01). Conclusion: Phenotype of patients regarding hormonal deficiencies, pituitary morphology, presence of extra-pituitary findings, family history of CPHD and parental consanguinity are important for deciding which pituitary transcription factor deficiency should be investigated. PROP1 mutation frequencies vary in different populations and its prevalence is high in Turkish CPHD patients.

The economic growth/development and environmental degradation: evidence from the US state-level EKC hypothesis.

This study investigates the validity of the EKC (environmental Kuznets curve) hypothesis for the 50 US states and a Federal District (Washington, D.C.). To this aim, the common correlated effects (CCE) and the augmented mean group (AMG) estimation procedures are applied between 1980 and 2015. While the CCE estimation does not support EKC hypothesis, the AMG does. The empirical findings of the AMG estimation indicate that only 14 states verify the EKC hypothesis. Additionally, the expected negative impacts of fossil energy consumption on the environment (CO2 emissions) are strongly detected in all states except Texas. However, the expected positive impacts of renewable energy consumption on the CO2 emissions are detected only in 13 states. Furthermore, the expected negative impacts of the population are not detected in some mostly populated states like New York, Texas, and Ohio. The overall findings of this study may help the US state-level policy makers in two ways: first, to understand whether their economic growths are sustainable (eco-friendly); second, to see how their fossil and renewable energy consumptions affect their environments and to review their energy policies.

Testing the EKC hypothesis for ten US states: an application of heterogeneous panel estimation method.

This study aims to test the EKC (Environmental Kuznets Curve) hypothesis for the ten states, having the highest levels of carbon dioxide emissions in the USA, through the independent variables of real GDP, population, and renewable energy and fossil energy consumptions. To this aim, the panel estimation method with cross-sectional dependence is applied to data from 1980 to 2015. The empirical findings of the study indicate that the EKC (inverted U-shaped) hypothesis is valid only for Florida, Illinois, Michigan, New York, and Ohio. Interestingly, the negative impacts of fossil energy consumption on CO2 emission levels in Texas are not detected statistically although this state is the leading oil-producing state. Furthermore, the positive impacts of renewable energy consumption in Florida, officially known as "Sunshine State", are considerably low when compared with the other states.

The role of the public sector in the provision of housing supply in Turkey, 1950­2009.

This study examines the changing role of the public sector in Turkey with regard to housing provision since 1950, and particularly since 2000, and seeks to clarify how public intervention has affected housing provision and urban development dynamics in major cities. Three periods may be identified, with central government acting as a regulator in a first period characterized by a 'housing boom'. During the second period, from 1980 to 2000, a new mass housing law spurred construction activity, although the main beneficiaries of the housing fund tended to be the middle classes. After 2000, contrary to emerging trends in both Northern and Southern European countries, the public sector in Turkey became actively involved in housing provision. During this process, new housing estates were created on greenfield sites on the outskirts of cities, instead of efforts being made to rehabilitate, restore or renew existing housing stock in the cities. Meanwhile, the concept of 'urban regeneration' has been opportunistically incorporated into the planning agenda of the public sector, and ­ under the pretext of regenerating squatter housing areas ­ existing residents have been moved out, while channels for community participation have been bypassed.

Comparison of the effect of single-dose and multiple-dose methotrexate therapy on tubal patency.

OBJECTIVE: To compare tubal patency by using hysterosalpingography (HSG) in women with unruptured ectopic tubal pregnancy who were treated with either single-dose or multiple-dose methotrexate (MTX) regimen. DESIGN: A case series with a retrospective statistical analysis. SETTING: Maternity and teaching hospital in Turkey. PATIENT(S): Sixty-one patients treated with MTX therapy for unruptured tubal ectopic pregnancy. INTERVENTION(S): Thirty-one patients received single-dose and 30 multiple-dose MTX treatment. The HSG was performed 4 to 6 months after treatment to assess tubal patency. MAIN OUTCOME MEASURE(S): Ipsilateral and contralateral tubal obstruction rates. RESULT(S): Free passage through the ipsilateral tube was observed in 17 of 30 cases (56.7%) after multiple-dose, and 26 of 31 cases (83.9%) after single-dose MTX therapy. Patency of the contralateral tube was higher after single-dose than multiple-dose MTX treatment, although the value was not statistically significant. Binary logistic regression analysis was used to evaluate the parameters of age, gravida, parity, initial titers of beta human chorionic gonadotropin, size of the adnexal mass, and MTX regimen and their correlation with the HSG results after the clinical treatment for unruptured ectopic pregnancy. Only the type of MTX regimen was found to be used as a predictor of ipsilateral tubal obstruction. CONCLUSION(S): In terms of ipsilateral tubal obstruction, multiple-dose MTX therapy appears to have a greater negative effect on tubal patency than single-dose therapy.