St Clements University

Siyasi aktörler, siyasal seçimlerde oy oranlarını yükseltebilmek için çeşitli iletişim araçları vasıtasıyla seçmen kitlesine ulaşmaya çalışmaktadırlar. Önceleri radyo, televizyon, gazete gibi geleneksel medya araçlarıyla kitlelere hitap etmeye çalışan siyasi aktörler, sosyal medyanın etki alanının genişlemesiyle birlikte Twitter, Facebook, Instagram, YouTube gibi mecraları aktif bir biçimde kullanmaya başlamışlardır. Bu çalışmada siyasal pazarlama iletişimi kapsamında 2023 yılı Mayıs ayında yapılan iki turlu cumhurbaşkanlığı seçiminde, cumhurbaşkanı adaylarının 31 Mart ile 28 Mayıs tarihleri arasında resmi Twitter (X) hesapları üzerinden paylaştıkları tweetlerin karşılaştırmalı içerik analizi yapılmıştır. Tweet içerikleri kapsamında adayların hesaplarını; rakip aday ve partisini eleştirmek, vaat ve projelerini seçmen ile paylaşmak, miting, toplantı ve etkinliklerinden seçmenleri haberdar etmek amacıyla kullandıkları ve bu yolla geniş kitlelere ulaştıkları gözlemlenmiştir.

Accurate assessment of perfusion in diabetic patients with critical limb threatening ischemia (CLIT) is a vital, and sometimes challenging, endeavor. Not only is it critical in determining the etiology of a diabetic foot ulcer (DFU), but it can also help providers understand the likelihood of wound healing and risk of amputation. The assessment can provide insight into the presence, location, and extent of peripheral arterial disease, as well as the potential treatment strategies required to avoid amputation. Conventional methods used to assess perfusion in diabetic patients are often unreliable, and despite their ubiquity, can sometimes have limited utility. Fundamentally, the assessment begins with a thorough physical exam focusing on the assessment of pulses, which in turn can be supplemented with arterial noninvasive studies. Additionally, cross-sectional imaging and angiography can be utilized to gain more detailed anatomic information. The use of all these tools allows for the creation of a therapeutic plan, which ultimately will optimize perfusion and promote wound healing.

Toplumu oluşturan fertler arasında huzur, barış ve güvenli bir ortamın oluşması sadece ekonomik ve sosyal kalkınma ile sağlanmaz. Bunu yanında hukuk devletini ayakta tutan yasama ve yürütme erklerinin sağlıklı bir şekilde işlenmesi; her gerçek ve tüzel kişinin beklentisi olan yargı mekanizmasının hızlı ve aktif bir gerçekleşmesi gerekir. Teknolojik gelişmenin, kültürel ve sosyoekonomik kalkınmanın yolu, adalet ve hukukun üstülüğünden geçmektedir. Bu durum, adalet alanında istihdam edilecek bireylere eğitim veren Hukuk Fakultesi, Adalet Meslek Yüksekokulları ve Adalet Meslek Liselerini mühim bir noktaya taşımaktadır. Bu çalışmada Türkiye’de adalet ve hukuk eğitimi bağlamında Adalet Meslek Liselerinin tarihçesi, güncel durumu, öğretim programları, alana yapılan atamalar ile mezunlarının iş olanakları ele alınmıştır.

Background GLI1 is a transcription factor protein that has recently gained recognition in a morphologically distinct group of epithelioid soft tissue tumors characterized by GLI1 fusions or amplifications. The head and neck region, particularly the tongue, is a common location for GLI1-altered tumors. DDIT3 break apart fluorescence in situ hybridization (FISH), commonly used to identify translocations in myxoid/round cell liposarcoma, has been used as a surrogate test to detect both fusions and amplifications of the 12q13.3 region encompassing DDIT3 and GLI1 gene loci. Methods We herein report 5 cases of GLI1-altered soft tissue tumors. Three arose in the oropharynx (base of tongue/vallecula, tonsil) and two arose in the tongue. Given the frequent oropharyngeal location and epithelioid morphology, p16 immunohistochemistry was performed on cases with available material. Commercially available DDIT3 break apart FISH, custom GLI1 specific FISH, and RNA sequencing were performed on select cases. Results Two cases showed amplification using DDIT3 FISH which was confirmed using GLI1 specific FISH. The remaining cases harbored ACTB::GLI1, one of which showed rearrangement of the 12q13.3 region by DDIT3 FISH with absence of amplification by GLI1 specific FISH. STAT6 immunoexpression was positive in the GLI1-amplified cases and negative in the GLI1-rearranged cases while MDM2 expression was positive in the 4 cases tested. CDK4 expression was strong and diffuse in the GLI1-amplified cases. p16 immunohistochemistry showed strong nuclear and cytoplasmic staining in 50–70% of tumor cells in all four tested cases. Conclusion Here we show that GLI1-altered soft tissue tumors are frequently positive for p16 and can occur in tonsillar regions of the oropharynx. As such, positive p16 immunohistochemistry alone cannot be used as evidence for the diagnosis of HPV-related squamous cell carcinoma as strong and diffuse p16 expression may also occur in GLI1-altered soft tissue tumors. Commercially available DDIT3 break apart FISH, which is readily available in many cytogenetic laboratories, may be useful as a sensitive surrogate test for GLI1 fusions and amplifications.

Background The occurrence of cardiovascular events is a major cause of death in patients with cancer. Small studies have documented a connection between specific brain alterations and autonomic cardiac dysfunctions, possibly resulting in a worse prognosis. We aimed to refine the knowledge of fatal cardiac events in patients with brain metastasis (BM). Methods We performed a Surveillance, Epidemiology, and End Results SEER registry-based investigation (timeline: 2010–2016) and extracted all the advanced patients who had experienced fatal cardiac outcomes. Populations were compared according to the presence or not BM. Kaplan–Meier (KM) methodology was used for survival analysis and a multivariate model was developed by adjusting for multiple possible confounders. Results Most related BM and cardiac death were observed at the site of lung cancer (81.4%). We extracted 3187 patients with lung cancer site, including 417 patients who had experienced fatal heart-specific with a history of BM, which is considered a BM group. The second group of heart-specific death included 2770 patients was stated as a non-BM group. Patients who had experienced heart-specific death in the BM group were predominately male, right side, upper site, and non-small type (62.11%, 54.92%, 51.56%, 69.78%), respectively. The survival outcomes between BM and the non- BM was significantly prominent (p = 0.003; median: 2 months vs. 3 months).The negative prognostic independent significance of heart-fatal events was confirmed after adjusting for multiple variables (HR = 0.76, CI = 0.68–84, p < 0.0001). The metastatic liver site was significantly associated with poorer survival rates (HR = 0.68; CI = 0.52–0.88, p = 0.005). We revealed a possible connection between the brain and heart functions. Conclusions The prognosis of heart-specific death patients in BM is unfavorable compared to non-BM settings in lung cancer. We may be at the gates of a new field of neurocardiooncology.

Nuclear protein in testis (NUT) carcinoma is a rare and highly aggressive epithelial malignancy defined by rearrangement of the NUTM1 gene on chromosome 15q14. Histologically, NUT carcinoma is an undifferentiated carcinoma formed by sheets and nests of primitive and monotonous "round blue cells" with foci of abrupt keratinization in a subset. NUT carcinoma runs a fulminant clinical course and is almost always quickly lethal, with a median overall survival of only 6.7 months. There is no consensus regarding treatment for this disease, and most patients respond poorly to conventional chemotherapy and radiation. We report a case of NUT carcinoma in an African-American man who initially presented in 2009 with a tracheal mass at age 28. Although fluorescence in situ hybridization (FISH) assays for NUTM1 and BRD4 rearrangements were negative, he was diagnosed based on diffusely positive NUT immunostaining and BRD4-NUTM1 on RNA sequencing. Since his initial presentation, he has undergone multiple surgical procedures and radiation therapy. His tumor has recurred twice, but he has survived for 129 months and is currently alive without disease. Long-term survival of patients with NUT carcinoma is incredibly unusual, especially in patients with tumors that exhibit a BRD4 rearrangement. False negative FISH is a pitfall in diagnosing NUT carcinoma; NUT immunostaining and RNA sequencing are more sensitive diagnostic methods.

Hybrid Renewable Energy Systems (HRESs) have been touted as an appropriate way for supplying electricity to remote and off-grid areas in developing countries, especially in sub-Saharan Africa (SSA), where rural electrification challenges are the most pronounced. This study proposes a two-step methodology for optimizing and analyzing a stand-alone photovoltaic/wind/battery/diesel hybrid system to meet the electricity needs of Fanisua, an off-grid and remote village of northern Nigeria. In the first step, the MATLAB environment was used to run simulations and optimize the system via the genetic algorithm. Then, techno-economic and emissions analysis was carried out in the second step to compare the proposed system to the existing traditional modes of rural electrification in sub-Saharan Africa, namely, the grid-extension and diesel generator. The break-even distance parameter was adopted in the comparison with grid-extension. Besides, the hypothetical project of replacing the diesel generator by the optimal system was analyzed using the Simple Payback Period (SPP) and Net Present Value (NPV) parameters. The resulting optimal design architecture included an 89.271-kW photovoltaic array, a 100.31-W diesel generator, and 148 batteries with a total annualized cost (TAC) and cost of energy (COE) of USD 43,807 and USD 0.25/kWh, respectively. The break-even distance found was 16.2 km, while the NPV and SPP of the hypothetical project were USD 572,382 and 2.8 years, respectively. The savings in carbon dioxide (CO2) emissions of the proposed system compared to the grid extension and the diesel generator were found to be 85,401.08 kg/year and 122,062.85 kg/year, respectively. This study highlighted the role that solar PV-based HRESs could play in the sustainable electricity supply in rural areas of sub-Saharan Africa.

Sinonasal glomangiopericytoma (GPC) is an uncommon primary sinonasal neoplasm showing a perivascular myoid differentiation. Originally perceived as an intranasal counterpart to soft tissue hemangiopericytomas, initial immunohistochemical reports showed mostly negative to focal weak reactivity for CD34 as useful in separating GPC (almost always benign) from morphologic mimics, mainly solitary fibrous tumor (potentially aggressive). In anecdotally encountering cases of GPC with CD34 reactivity beyond the expected weak/negative immunoprofile, we sought to formally evaluate CD34 staining in 10 cases of GPC from two different vendors in conjunction with a meta-analysis of other GPC series reporting CD34 staining. Ten cases of GPC were retrieved from the authors’ pathology archives (left nasal cavity = 7, right nasal cavity = 3; 5 men, 5 women; average age 59.0 years with range of 43–77 years). Follow-up showed no evidence of disease after complete resection from all 10 cases (average follow-up length of 53.3 months, range 6–106 months). All 10 GPC cases (100%) showed positivity using CD34 from Leica (QBend10 clone), with most showing moderate to diffuse staining intensity and moderate extent, while only 2 of 10 cases (20%) showed positivity using CD34 from Ventana (QBend10 clone), with both positive cases showing weak staining intensity and focal extent. Literature review of other studies (reporting ≥ 5 GPC cases) found a wide spectrum of CD34 positivity ranging from 0 to 100%; including our GPC cases, CD34 showed a cumulative positivity of 28%. Although negative CD34 reactivity has been historically regarded as prototypic for GPC, in this study we have exposed laboratory variability in CD34 expression and have shown that reliance on expected negative reactivity in GPC can be a clinically relevant diagnostic pitfall. Our findings suggest a panel approach in selecting diagnostic immunostains rather than relying on CD34 alone in the assessment of spindle cell neoplasms in the sinonasal tract with admixed prominent staghorn-like vasculature.

“Discharge planning” is the term used to describe the individual plan created for hospitalized patients by their care team when a patient is approaching discharge. Once a patient is medically stable for discharge, the interdisciplinary care team (physician, advanced practitioners, case managers, physical therapists, and social workers) will identify a post-discharge setting that suits the patient’s post-acute care needs. Determining the most appropriate post-discharge setting requires attention to a patient’s medication regimen, functional status pre- and post-discharge, home support, and therapeutic plan. This chapter will explore the discharge planning process in detail, including current standards of care and best practices as they pertain to medication reconciliation, post-acute care, and safe discharge approaches.

Türkiye’de oldukça yoğun geçen siyasi gündemlerin gölgesinde kalan fakat gündelik hayatımızda sıkça karşılaştığımız önyargı sorunu aslında maddi, sosyal ve kültürel koşulların yarattığı bir sorundur. Bu çalışmada toplumsal önyargıların kökenleri ve sebepleri araştırılmıştır. Çalışmada toplumsal önyargıların sebep olduğu ötekileştirme, yabancılaştırma gibi sonuçlar üzerinde tartışılmış ve olası çözüm yöntemleri ortaya konmuştur. Gruplararası ilişkilerin yapısı ve öteki kavramının ortaya çıkışına değinilmiştir. Değerler hipotezi, toplumsal temas kuramı gibi bilimsel temelleri baz alınarak Türkiye’de Türk ve Kürtler özelinde önyargıların oluşumu ve etkileri örneklerle incelenmiştir. Araştırmamızda Türkiye'de Türk ve Kürt toplumlarının birbirine karşı önyargıları ve bu önyargıların sebepleri örneklendirilmiş ve bunun üstesinden nasıl gelineceği üzerine tezler ortaya sürülmüştür.

The field of head and neck pathology was just developing 50 years ago but has certainly come a long way in a relatively short time. Thousands of developments in diagnostic criteria, tumor classification, malignancy staging, immunohistochemistry application, and molecular testing have been made during this time, with an exponential increase in literature on the topics over the past few decades: There were 3506 articles published on head and neck topics in the decade between 1969 and 1978 (PubMed source), with a staggering 89266 manuscripts published in the most recent decade. It is daunting and impossible to narrow the more than 162000 publications in this field and suggest only a few topics of significance. However, the breakthrough in this anatomic discipline has been achieved in 3 major sites: oropharyngeal carcinoma, salivary gland neoplasms, and sinonasal tract tumors. This review will highlight selected topics in these anatomic sites in which the most profound changes in diagnosis have occurred, focusing on the information that helps to guide daily routine practice of surgical pathology.

This chapter addresses frequently encountered questions in invasive breast carcinoma, not otherwise specified (NOS), with emphasis on clinically relevant diagnostic issues in the era of precision medicine. This chapter discusses how to correctly evaluate tumor response to neoadjuvant therapy in invasive breast carcinoma and the definition of pathologic complete response (pCR); the clinical significance of Oncotype DX test and indications for ordering the test; how to score tumor infiltrating lymphocytes (TILs); and the clinical significance of the TILs. This chapter also discusses tumor heterogeneity of triple-negative breast cancer.

Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) are tumor markers for breast cancer and are recommended for use on all primary breast cancers and, more recently, on metastatic breast cancer. They are critical tumor markers for breast cancer patients as they are both prognostic (Tumors with expression of ER and PR and lack of overexpression of HER2 carry a better prognosis) and predictive (ER-positive tumor could be treated with hormonal therapy, and HER2-positive tumor could be treated with HER2-targeted therapy). Ki67, which is a proliferation marker, has not been recommended by the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) for routine testing for breast cancer due to its poor reproducibility among different labs; however, most cancer centers in the United States do use it routinely in their practice to guide clinical management. This chapter extensively discusses how to solve problems on these tumor biomarkers frequently and uncommonly encountered in clinical practice. The chapter also discusses prognostic and diagnostic values of p53, p16, androgen receptor (AR), CK5/6 and cancer stem cell markers for primary and metastatic triple-negative breast cancer (TNBC) which is a heterogeneous group of tumors having a poor survival and lacking targeted therapy. Differential immunohistochemistry for breast tumor marker positive metastatic non-breast carcinoma versus primary breast cancer is also discussed.

Arnold-Chiari malformations (ACM) are a group of congenital disorders defined by downward displacement of cerebellar tonsils, and possibly the brainstem, through the foramen magnum. Type 1 ACM is the most frequent of the Chiari malformations and is characterized by a ≥5 mm tonsillar descent below the foramen magnum. Headache is the most common presenting symptom, however many patients are asymptomatic. This congenital anatomic variation can lead to potentially challenging obstetric and anesthetic implications during pregnancy and delivery, such as a greater risk for increased intracranial pressure. Although literature discussing ACM management in pregnancy and delivery is scarce and controversial, both neuraxial and general anesthetic techniques have been described safely. However, neither technique is without significant potential risk. The delivery and anesthetic plan for each parturient with ACM must be formulated individually at a multidisciplinary center utilizing a team approach with the patient, obstetrician, anesthesiologist and neurosurgeon.

Acute necrotizing pancreatitis remains a significant problem with significant morbidity and mortality. Keys to management include proper diagnosis, admission to the intensive care unit, aggressive resuscitation, and a multidisciplinary approach for management options. The care team should include a designated surgeon, gastroenterologists with expertise in endoscopic retrograde pancreaticography and stent placement, interventional radiologists, infectious disease physicians, nutritionists, respiratory therapists, and physical therapists. Antibiotics, nutritional support, and a dedicated team with expertise in managing these patients are keys to successful outcomes. This chapter provides current state-of-the-art management of necrotizing pancreatitis with particular emphasis on managing complex complications a surgeon may encounter.

Despite advances in the science of sedation and pain assessment, few studies have examined the impact of various assessment tools on nursing confidence. This study examines how bispextral index monitoring impacts nursing confidence in the assessment and comfort in medication administration based on that assessment. In this prospective observational Quality Improvement project, nurses using bispectral index (BIS) and the Richmond Agitation Sedation Scale (RASS) were randomly selected to complete a self-assessment survey intended to measure their personal confidence and comfort regarding care they were providing for a specific patient on the day the survey was completed. From 110 nurse surveys, nurses had higher confidence assessing pain and sedation when BIS monitor was used in concert with RASS assessments for patients with neuromuscular blockade agents. There was no different in confidence in- nor comfort with- sedation and pain assessments for patients not receiving neuromuscular blockade agents.

The transcription factor SOX2 has been identified as an oncogene involved in the pathogenesis of squamous cell carcinoma (SCC) of multiple sites, including the uterine cervix. The relationship between SOX2 overexpression and the continuum of precancerous lesions of the cervix has not been previously elucidated. We evaluated SOX2 immunohistochemical expression in normal cervix, low-grade squamous intraepithelial lesion (LSIL) (mild squamous dysplasia), high-grade squamous intraepithelial lesion (HSIL) (moderate and severe dysplasia) and SCC of the cervix in comparison with p16 and Ki-67. Staining patterns were scored as negative, basal one third of the epithelium, lower two third, or full thickness. The results showed that SOX2 expression was limited to the basal one third in 84% of LSIL cases, whereas 95% of HSIL showed SOX2 expression up to two third or full thickness (P<0.0001). p16 and Ki-67 displayed similar results. The difference in SOX2 expression between moderate and severe dysplasia was not statistically significant (P=0.53). Invasive SCC positivity was as follows: SOX2 94%; p16 89%; and Ki-67 100%. Our findings support a role for SOX2 in the progression of squamous dysplasia to SCC. The Lower Anogenital Standardization Terminology Project's recent assertion of a lack of a biological correlate to cervical intraepithelial neoplasia II is also upheld by SOX2. For equivocal situations in which a diagnosis of cervical intraepithelial neoplasia II would have been made, Lower Anogenital Standardization Terminology recommends p16, or other biomarkers such as Ki-67 to clarify the diagnosis. SOX2, with a clean nuclear staining pattern, may also be suitable for this role.

Sociological research on inequality has increasingly moved beyond the examination of inequalities as they presumably exist to explore the generic narrative processes that perpetuate that inequality. Unfortunately, however, this research remains concentrated on either individual or ideological grand narratives and ignores the fact that the work narratives do, including the production and structuring of inequality, occurs at multiple levels: cultural, structural, organizational, and personal, and never exclusively at just one of these. In this study, we use Somali origin narratives to describe conceptually the ways in which narratives produced at different personal and societal levels—cultural, institutional, organizational—dialectically structure the generic processes that produce and perpetuate social inequality.