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    Adherence to Growth Hormone Treatment in Children During the COVID-19 Pandemic
    (Galenos Publ House, 2024) Eren, Erdal; Cetinkaya, Semra; Ongen, Yasemin Denkboy; Tercan, Ummahan; Darcan, Sukran; Turan, Hande; Aydin, Murat
    Objective: Treatment adherence is crucial for the success of growth hormone (GH) therapy. Reported non-adherence rates in GH treatment have varied widely. Several factors may have an impact on adherence. Apart from these factors, the global impact of the Coronavirus disease-2019 (COVID-19) pandemic, including problems with hospital admission and routine follow-up of patients using GH treatment, may have additionally affected the adherence rate. The primary objective of this study was to investigate adherence to treatment in patients receiving GH. In addition, potential problems with GH treatment during the pandemic were investigated. Methods: This was a multicenter survey study that was sent to pediatric endocrinologists during the pandemic period (June-December 2021). Patient data, diagnosis, history of pituitary surgery, current GH doses, duration of GH therapy, the person administering therapy (either parent/patient), duration of missed doses, reasons for missed doses, as well as problems associated with GH therapy, missed dose data and the causes in the recent year (after the onset of the pandemic) were questioned. Treatment adherence was categorized based on missed dose rates over the past month (0 to 5%, full adherence; 5.1 to 10% moderate adherence; >10% non-adherence). Results: The study cohort consisted of 427 cases (56.2% male) from thirteen centers. Median age of diagnosis was 8.13 (0.13-16) years. Treatment indications were isolated GH deficiency (61.4%), multiple pituitary hormone deficiency (14%), Turner syndrome (7.5%), idiopathic GH deficiency (7.5%), small for gestational age (2.8%), and others (6.8%). GH therapy was administered by parents in 70% and by patients in 30%. Mean daily dose was 32.3 big/kg, the annual growth rate was 1.15 standard deviation score (minimum-2.74, maximum 9.3). Overall GH adherence rate was good in 70.3%, moderate in 14.7%, and poor in 15% of the patients. The reasons for non-adherence were mainly due to forgetfulness, being tired, inability to access medication, and/or pen problems. It was noteworthy that there was a negative effect on adherence during the COVID-19 pandemic reported by 22% of patients and the main reasons given were problems obtaining an appointment, taking the medication, and anxiety about going to hospital. There was no difference between genders in the adherence rate. Non-adherence to GH treatment decreased significantly when the patient: administered the treatment; was older; had longer duration of treatment; and during the pandemic. There was a non-significant decrease in annual growth rate as non-adherence rate increased. Conclusion: During the COVID-19 pandemic, the poor adherence rate was 15%, and duration of GH therapy and older age were important factors. There was a negative effect on adherence during the pandemic period.
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    Comparative study of destructive, nondestructive, and numerical procedures for the determination of moisture dependent shear moduli in Scots pine wood
    (Walter De Gruyter Gmbh, 2021) Aydin, Murat; Ciritcioglu, Hasan Huseyin
    In this study, moisture dependent shear moduli in Scots pine (Pinus sylvestris L.) wood were determined by a 45 degrees off-axis (longitudinal, radial, and tangential) compression test and ultrasonic transverse wave propagation. Finite element modeling was performed to ascertain how the results agree with the numerical method. Ultrasonic transverse wave velocities on the LR, LT, and RT planes were decreased from 1347, 1323, and 589 m x s(-1) to 1286, 1269, and 561 m x s(-1) when relative humidity increased from 45 % to 85 % at a constant temperature of 20 +/- 1 degrees C, respectively. The dynamic and static shear modulus on the LR, LT, and RT planes were decreased from 988, 953, and 189, and 966, 914, and 182 MPa to 927, 903, and 176, and 845, 784, and 154 MPa when relative humidity increased from 45 % to 85 % at a constant temperature of 20 +/- 1 degrees C, respectively. Therefore, both velocity and modulus values at all principal axes and planes were decreased with an increase in moisture. Maximum (15.2 %) and minimum (2.3 %) differences between dynamic and the static shear modulus were observed for G(LT) at 85 % and G(LR) at 45 % relative humidity, respectively. Coefficients of determinations between the dynamic and static shear moduli were ranged from 0.68 (G(LR) at 65 % RH) to 0.97 (G(LR) at 85 % RH). Finite element analysis, only for 65 % RH values, was performed using Solid 45 element, and, according to results, load-deformation curves created by linear orthotropic material properties, are well-matched with the static curves.