Search results for: Onur Turkyilmaz

Authors: Onur Karaman, A. Gunes Tanir

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Photon radiation therapy used to treat cancer is one of the most important methods. However, photon beam collimator materials in Linear Accelerator (LINAC) head generally contains heavy elements is used and the interaction of bremsstrahlung photon with such heavy nuclei, the neutron can be produced inside the treatment rooms. In radiation therapy, neutron contamination contributes to the risk of secondary malignancies in patients, also physicians working in this field. Since the neutron is more dangerous than photon, it is important to determine neutron dose during radiotherapy treatment. In this study, it is aimed to analyze the effect of field size, distance from axis and depth on the amount of in-field and out-field neutron contamination for ElektaVmat accelerator with 18 MV nominal energy. The photon spectra at the distance of 75, 150, 225, 300 cm from target and on the isocenter of beam were scored for 5x5, 10x10, 20x20, 30x30 and 40x40 cm2 fields. Results demonstrated that the neutron spectra and dose are dependent on field size and distances. Beyond 225 cm of isocenter, the dependence of the neutron dose on field size is minimal. As a result, it is concluded that as the open field increases, neutron dose determined decreases. It is important to remember that when treating with high energy photons, the dose from contamination neutrons must be considered as it is much greater than the photon dose.

Keywords: radiotherapy, neutron contamination, linear accelerators, photon

Procedia PDF Downloads 313

Authors: Tahseen Saad, Halim Ceylan, Jonathan Weaver, Osman Nuri Çelik, Onur Gungor Sahin

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A new concept of uniform delay offset dependent mathematical optimization problem is derived as the main objective for this study using a differential evolution algorithm. To control the coordination problem, which depends on offset selection and to estimate uniform delay based on the offset choice in a traffic signal network. The assumption is the periodic sinusoidal function for arrival and departure patterns. The cycle time is optimized at the entry links and the optimized value is used in the non-entry links as a common cycle time. The offset optimization algorithm is used to calculate the uniform delay at each link. The results are illustrated by using a case study and are compared with the canonical uniform delay model derived by Webster and the highway capacity manual’s model. The findings show new model minimizes the total uniform delay to almost half compared to conventional models. The mathematical objective function is robust. The algorithm convergence time is fast.

Keywords: area traffic control, traffic flow, differential evolution, sinusoidal periodic function, uniform delay, offset variable

Procedia PDF Downloads 244

Authors: Mehmet Demir Kaya, Engin Gökhan Kulan, Onur İleri, Süleyman Avcı

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This research was conducted to determine the difference in seed vigor between the seed lots cultivated in main and second crop of soybean in Turkey. Seeds from soybean cv. Cinsoy and Umut-2002 were evaluated in the laboratory for germination, emergence, cool test at 18°C for 10 days, and cold test at 10°C for 4 days and 25°C for 6 days. Result showed that the initial oil contents of Cinsoy and Umut-2002 and seeds were determined to be 19.8 and 20.1% in main crop, and 18.7 and 22.1% in second crop, respectively. It was determined that a clear difference between main and second crop soybean seed lots for seed vigor was found. Germination and emergence percentage were higher in the seed from second crop cultivation of the cultivars. There was no significant difference in germination percentage in cool and cold test while seedling growth was better in the seeds of second crop soybean. The highest seed vigor index (477.6) was found in the seeds of the cultivars grown at second crop. Standard germination percentage did not give a sensitive separation for determining seed vigor of soybean lots. It was concluded that second crop soybean seeds were found the most suitable for seed production while main crop soybean gave higher protein lower oil content.

Keywords: Glycine max L., germination, emergence, protein content, vigor test

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Authors: Hans Frenk, Sonya Javadi, Semih Onur Sezer

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We consider the so-called end of life inventory problem for the supplier of a product in its final phase of the service life cycle. This phase starts when the production of the items stops and continues until the warranty of the last sold item expires. At the beginning of this phase, the supplier places a final order for spare parts to serve customers coming with defective items. At any time during the final phase, the supplier may also decide to switch to an alternative and more cost-effective policy. This alternative policy may be in the form of replacing a defective item with a substitutable product or offering discounts / rebates on new generation products. In this setup, the objective is to find a final order quantity and also a switching time which will minimize the total expected discounted cost. We study this problem under a general cost structure in a continuous-time framework where arrivals of defective items are given by a non-homogeneous Poisson process. We consider four formulations which differ by the nature of the switching time. These formulations are studied in detail and properties of the objective function are derived in each case. Using these properties, we provide exact algorithms for efficient numerical implementations. Numerical examples are provided illustrating the application of these algorithms. In these examples, we also compare the costs associated with these different formulations.

Keywords: End-of-life inventory control, martingales, optimization, service parts

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Authors: Onur Karaman, Ceren Karaman

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In this study, the adsorption of Methylene Blue (MB), a cationic dye, onto Orange Peel Derived Activated Carbon (OPAC) and chitosan(OPAC/Chitosan composite) composite (a low-cost absorbent) was carried out using a batch system. The composite was characterised using IR spectra, XRD, FESEM and Pore size studies. The effects of initial pH, adsorbent dose rate and initial dye concentration on the initial adsorption rate, capacity and dye removal efficiency were investigated. The Langmuir and Freundlich adsorption models were used to define the adsorption equilibrium of dye-adsorbent system mathematically and it was decided that the Langmuir model was more suitable to describe the adsorption equilibrium for the system. In addition, first order, second order and saturation type kinetic models were applied to kinetic data of adsorption and kinetic constants were calculated. It was concluded that the second order and the saturation type kinetic models defined the adsorption data more accurately. Finally, the evaluated thermodynamic parameters of adsorption show a spontaneous and exothermic behavior. Overall, this study indicates OPAC/Chitosan composite as an effective and low-cost adsorbent for the removal of MB dye from aqueous solutions.

Keywords: activated carbon, adsorption, chitosan, methylene blue, orange peel

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Authors: Onur Gönülal, Zafer Ceylan, Gülgün F. Unal Sengor

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The differences of Parapenaus longirostris caught from The North Aegean Sea and the Marmara Sea on proximate composition, sensorial analysis (for raw and cooked samples), flesh productivity of the samples were investigated. The moisture, protein, lipid, ash, carbohydrate, energy contents of shrimp caught from The North Aegean Sea were 74.92 ± 0.1, 20.32 ± 0.16, 2.55 ± 0.1, 2.13 ± 0.08, 0.08, 110.1 kcal/100g, respectively. The moisture, protein, lipid, ash, carbohydrate, energy contents of shrimp caught from Marmara Sea were 76.9 ± 0.02, 19.06 ± 0.03, 2.22 ± 0.08, 1.51 ± 0.04, 0.33, 102.77 kcal/100g, respectively. The protein, lipid, ash and energy values of the Northern Aegean Sea shrimp were higher than The Marmara Sea shrimp. On the other hand, The moisture, carbohydrate values of the Northern Aegean Sea shrimp were lower than the other one. Sensorial analysis was done for raw and cooked samples. Among all properties for raw samples, flesh color, shrimp connective tissue, shrimp body parameters were found different each other according to the result of the panel. According to the result of the cooked shrimp samples among all properties, cooked odour, flavours, texture were found to be different from each other, as well. Especially, flavours and textural properties of cooked shrimps of the Northern Aegean Sea were higher than the Marmara Sea shrimp. Flesh productivity of Northern Aegean Sea shrimp was found as 46.42 %, while that of the Marmara Sea shrimp was found as 47.74 %.

Keywords: shrimp, biological differences, proximate value, sensory, Parapenaus longirostris, flesh productivity

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Authors: Onur Potok, Deniz Deger, Kemal Ulutas, Sahin Yakut, Deniz Bozoglu

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Thalium Selenide (TlSe) is used for optoelectronic devices, pressure sensitive detectors, and gamma-ray detectors. The TlSe samples were grown as large single crystals using the Stockbarger-Bridgman method. The thin films, in the form of Al/TlSe/Al, were deposited on the microscope slide in different thicknesses (300-3000 Å) using thermal evaporation technique at 10-5 Torr. The dielectric properties of (TlSe) thin films, capacitance (C) and dielectric loss factor (tanδ), were measured in a frequency range of 10-105 Hz, and temperatures between 213K and 393K via Broadband Dielectric Spectroscopy analyzer. The dielectric constant (ε’) and the dielectric loss (ε’’) of the thin films were derived from measured parameters (C and tanδ). These results showed that the dielectric properties of TlSe thin films are frequency and temperature dependent. The capacitance and the dielectric constant decrease with increasing frequency and decreasing temperature. The dielectric loss of TlSe thin films decreases with increasing frequency, on the other hand, they increase with increasing temperature and increasing thicknesses. There is two relaxation region in the investigated frequency and temperature interval. These regions can be called as low and high-frequency dispersion regions. Low-frequency dispersion region can be attributed to the polarization of the main part of the chain structure of TlSe while high-frequency dispersion region can be attributed to the polarization of side parts of the structure.

Keywords: thin films, thallium selenide, dielectric spectroscopy, binary compounds

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Authors: Onur Kaya, Ilknur Tukenmez

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In this study, we consider vehicle routing problems on networks with alternative direct links between nodes, and we analyze a multi-objective problem considering the financial, environmental and social objectives in this context. In real life, there might exist several alternative direct roads between two nodes, and these roads might have differences in terms of their lengths and durations. For example, a road might be shorter than another but might require longer time due to traffic and speed limits. Similarly, some toll roads might be shorter or faster but require additional payment, leading to higher costs. We consider such alternative links in our problem and develop a mixed integer linear programming model that determines which alternative link to use between two nodes, in addition to determining the optimal routes for different vehicles, depending on the model objectives and constraints. We consider the minimum cost routing as the financial objective for the company, minimizing the CO2 emissions and gas usage as the environmental objectives, and optimizing the driver working conditions/working hours, and minimizing the risks of accidents as the social objectives. With these objective functions, we aim to determine which routes, and which alternative links should be used in addition to the speed choices on each link. We discuss the results of the developed vehicle routing models and compare their results depending on the system parameters.

Keywords: vehicle routing, alternative links between nodes, mixed integer linear programming, triple bottom line accounting

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Authors: Recep Keşli, Onur Türkyılmaz, Hayriye Tokay, Kasım Demir

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Objective: Coeliac disease (CD) is a primary small intestine disorder caused by high sensitivity to gluten which is present in the crops, characterized by inflammation in the small intestine mucosa. The goal of this study was to determine and to compare the sensitivity and specificity values of anti-endomysial IgA (EMA IgA) (IFA) and anti-tissue transglutaminase IgA (anti-tTG IgA) (ELISA) antibodies in the diagnosis of patients suspected with the CD. Methods: One thousand two hundred seventy three patients, who have applied to gastroenterology and pediatric disease polyclinics of Afyon Kocatepe University ANS Research and Practice Hospital were included into the study between 23.09.2010 and 30.05.2016. Sera samples were investigated by immunofluorescence method for EMA positiveness (Euroimmun, Luebeck, Germany). In order to determine quantitative value of Anti-tTG IgA (EIA) (Orgentec Mainz, Germany) fully automated ELISA device (Alisei, Seac, Firenze, Italy) were used. Results: Out of 1273 patients, 160 were diagnosed with coeliac disease according to ESPGHAN 2012 diagnosis criteria. Out of 160 CD patients, 120 were female, 40 were male. The EMA specificity and sensitivity were calculated as 98% and 80% respectively. Specificity and sensitivity of Anti-tTG IgA were determined as 99% and 96% respectively. Conclusion: The specificity of EMA for CD was excellent because all EMA-positive patients (n = 144) were diagnosed with CD. The presence of human anti-tTG IgA was found as a reliable marker for diagnosis and follow-up the CD. Diagnosis of CD should be established on both the clinical and serologic profiles together.

Keywords: anti-endomysial antibody, anti-tTG IgA, coeliac disease, immunofluorescence assay (IFA)

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Authors: Ceren Karaman, Onur Karaman

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The adsorption of Remazol Black B (RBB), an anionic dye, onto dried orange pulp (DOP) adsorbent prepared by only drying and by treating with cetyltrimetylammonium bromide (CTAB), a cationic surfactant, surface-modified orange pulp (SMOP) was studied in a stirred batch experiments system at 25°C. The adsorption of RBB on each adsorbent as a function of surfactant dosage, initial pH of the solution and initial dye concentration was investigated. The optimum amount of CTAB was found to be 25g/l. For RBB adsorption studies, while working pH value for the DOP adsorbent system was determined as 2.0, it was observed that this value shifted to 8.0 when the 25 g/l CTAB treated-orange pulp (SMOP) adsorbent was used. It was obtained that the adsorption rate and capacity increased to a certain value, and the adsorption efficiency decreased with increasing initial RBB concentration for both DOP and SMOP adsorbents at pH 2.0 and pH 8.0. While the highest adsorption capacity for DOP was determined as 62.4 mg/g at pH 2.0, and as 325.0 mg/g for SMOP at pH 8.0. As a result, it can be said that permanent cationic coating of the adsorbent surface by CTAB surfactant shifted the working pH from 2.0 to 8.0 and it increased the dye adsorption rate and capacity of orange pulp much more significantly at pH 8.0. The equilibrium RBB adsorption data on each adsorbent were best described by the Langmuir isotherm model. The adsorption kinetics of RBB on each adsorbent followed a pseudo-second-order model. Moreover, the intraparticle diffusion model was used to describe the kinetic data. It was found that diffusion is not the only rate controlling step. The adsorbent was characterized by the Brunauer–Emmett–Teller (BET) analysis, Fourier-transform-infrared (FTIR) spectroscopy, and scanning-electron-microscopy (SEM). The mechanism for the adsorption of RBB on the SMOP may include hydrophobic interaction, van der Waals interaction, stacking and electrostatic interaction.

Keywords: adsorption, Cetyltrimethylammonium Bromide (CTAB), orange pulp, Remazol Black B (RBB), surface modification

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Authors: Mehmet Demir Kaya, Engin Gökhan Kulan, Onur İleri, Süleyman Avcı

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Due to variation in seed size, shape and oil content of safflower cultivars, germination and emergence performance have been severely influenced by seed characteristics. This study aimed to determine genotypic variation among safflower genotypes for one thousand seed weight, oil content, germination and seed vigor using electrical conductivity (EC) and cold test. In the study, safflower lines ES37-5, ES38-4, ES43-11, ES55-14 and ES58-11 which were developed by single seed selection method, and Dinçer and Remzibey-05 were used as standard varieties. The genotypes were grown under rainfed conditions in Eskişehir, Turkey with four replications. The seeds of each genotype were subjected to standard germination and emergence test at 25°C for 10 days with four replications and 50 seeds per replicate. Electrical conductivity test was performed at 25°C for 24 h to assess the seed vigor. Also, cold test were applied to each safflower genotype at 10°C for 4 days and 25°C for 6 days. Results showed that oil content of the safflower genotypes were different. The highest oil content was determined in ES43-11 with 36.6% while the lowest was 25.9% in ES38-4. Higher germination and emergence rate were obtained from ES55-14 with 96.5% and 73.0%, respectively. There was no significant difference among the safflower genotypes for EC values. Cold test showed that ES43-11 and ES55-14 gave the maximum germination percentages. It was concluded that genotypic factors except for soil and climatic conditions play an important role for determining seed vigor because safflower genotypes grown at the same condition produced various seed vigor values.

Keywords: Carthamus tinctorius L., germination, emergence, cold test, electrical conductivity

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Authors: Onur Kaya, Halit Bayer

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Global grocery and supermarket sales are among the largest markets in the world and perishable products such as fresh produce, dairy and meat constitute the biggest section of these markets. Due to their deterioration over time, the demand for these products depends highly on their freshness. They become totally obsolete after a certain amount of time causing a high amount of wastage and decreases in grocery profits. In addition, customers are asking for higher product variety in perishable product categories, leading to less predictable demand per product and to more out-dating. Effective management of these perishable products is an important issue since it is observed that billions of dollars’ worth of food is expired and wasted every month. We consider coordinated inventory and pricing decisions for perishable products with a time and price dependent random demand function. We use stochastic dynamic programming to model this system for both periodically-reviewed and continuously-reviewed inventory systems and prove certain structural characteristics of the optimal solution. We prove that the optimal ordering decision scenario has a monotone structure and the optimal price value decreases by time. However, the optimal price changes in a non-monotonic structure with respect to inventory size. We also analyze the effect of 1 different parameters on the optimal solution through numerical experiments. In addition, we analyze simple-to-implement heuristics, investigate their effectiveness and extract managerial insights. This study gives valuable insights about the management of perishable products in order to decrease wastage and increase profits.

Keywords: age-dependent demand, dynamic programming, perishable inventory, pricing

Procedia PDF Downloads 217

Authors: Recep Keşli, Cengiz Demir, Onur Türkyılmaz

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Objective: The aim of this study was to determine the prevalence of Mycoplasma hominis and Ureaplasma urealyticum as the causative agents in men with non-gonococcal urethtritis, and anti-bacterial resistance rates. Methods: The Study was carried out in the two Medical Microbiology Laboratories belonging to: Konya Education and Research Hospital and ANS Practice and Research Hospital, Afyon Kocatepe University, between January 2012 and December 2015. Urethral samples were obtained from patients by using a swab. Mycoplasma hominis and Ureaplasma urealyticum were detected by using Mycoplasma IST-2 kit (bio-Mérieux, Marcy l'Étoile, France). Neisseria gonorrhoea was excluded by Gram staining and culture methods. Results: Of all the one hundred and eighty-eight male patients with urethritis, forty M. hominis and forty two U. urealyticum were detected. Resistance rates of M. hominis strains against to doxycycline, ofloxacin, erythromycin, tetracycline, ciprofloxacin, azithromycin, clarithromycin, and pristinamycin were found as 5 %, 65 %, 25 %, 5 %, 80 %, 20 %, 20 %, 20 %, 5 %, respectively. Resistance rates of U. urealyticum strains against to doxycycline, ofloxacin, erythromycin, tetracycline, ciprofloxacin, azithromycin, clarithromycin, and pristinamycin were found as 4.7 %, 66.6 %, 23.8 %, 4.75 %, 81 %, 19 %, 19 %, 4.7 % respectively. No resistance was detected against to josamycin, for both the strains. Conclusions: It was concluded that; ciprofloxacin and ofloxacin had the weakest; josamycin, doxycycline, and tetracycline had the strongest in vitro anti-bacterial activity, for treatment of the NGU. So josamycin, doxycycline, and tetracycline should be preferred as the first choice of anti-bacterial agents, for treatment of the patients with non-gonococcal male urethritis.

Keywords: antimicrobial resistance, Mycoplasma hominis, non-gonococcal urethritis, Ureaplasma urealyticum

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Authors: Onur Yel

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This study represents the removal of harmful dye substances from wastewaters by using waste and cheap adsorbents. Rapid population growth and industrialization occasion anthropogenic pollution which gives irreversible damage to the environment. One of the ways in which water pollution occurs is caused by the release of the dyestuffs in the textile industry. The release of dyestuffs to the environment directly damages the living creatures that have acquired water habitat. Especially, wastewater cannot be used for nutritional purposes. In addition, some adsorbents have mutagenic and/or carcinogenic effects. By blocking photosynthesis, it hinders the inhibition of photosynthetic bacteria in the water, which damages the ecological balance and also causes the formation of malodorous compounds. Moreover, the lack of oxygen can pose a serious danger to the lives of other living organisms that need oxygen. In recent years, some physical and chemical methods are preferred for the removal of dyestuffs. However, the utilization of these methods is expensive. For this reason, the availability of new and cheap adsorbents becomes the more significant issue. In this study, an investigation of various variables on the removal of Methylene Blue and Acid Red-88 dyestuffs from wastewaters by the usage of pulverized cypress cones has been carried out. Thus, various masses of absorbent (0.1-0.25-0.5-1-2-4-5 grams) are used in 50, 100, 150, 200, 300 ppm concentrations of Methylene Blue and Acid Red-88 dyestuffs’ solutions, and with a variety of the interaction time (0.25-0.5-1-2-4-5 hours). The mixtures were centrifuged and the absorbance of the filtrates was measured on a UV spectrophotometer to determine their remaining concentrations. In the study, the highest removal ratio of Acid Red-88 dyestuff was found to be 81% at 200 ppm of dyestuff with 2 grams of adsorbent at 300 minutes. For Methylene Blue experiments, the removal percentage was found as 98% where 2 grams of adsorbent is used in 200 ppm dyestuff solution at 120 minutes of interaction.

Keywords: acid red-88, biosorption, methylene blue, cypress cones, water pollution

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Authors: Ekin Ece Gürer, Tarık Onur Tiryaki, Sevgi Kalayoğlu Beşışık, Fatma Savran Oğuz, Uğur Sezerman, Fatma Erdem, Gülşen Günel, Dürdane Serap Kuruca, Zerrin Aktaş, Oral Öncül

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Aim: Chemotherapytreatment in HodgkinLymphomaandNon-HodgkinLymphoma (NHL) diseasescausesgastrointestinalepithelialdamage, disruptstheintestinalmicrobiotabalanceandcausesdysbiosis. Inourstudy, it wasaimedtoshowtheeffect of thedamagecausedbychemotherapy on themicrobiotaandtheeffect of thechangingmicrobiota flora on thecourse of thedisease. Materials And Methods: Seven adult HL and seven adult HL patients to be treatedwithchemotherapywereincluded in the study. Stoolsamplesweretakentwice, beforechemotherapytreatmentandafterthe 3th course of treatment. SamplesweresequencedusingNextGenerationSequencing (NGS) methodafternucleicacidisolation. OTU tableswerepreparedusing NCBI blastnversion 2.0.12 accordingtothe NCBI general 16S bacterialtaxonomyreferencedated 10.08.2021. Thegenerated OTU tableswerecalculatedwith R Statistical Computer Language version 4.04 (readr, phyloseq, microbiome, vegan, descrand ggplot2 packages) to calculate Alpha diversityandtheirgraphicswerecreated. Statistical analyzeswerealsoperformedusing R Statistical Computer Language version 4.0.4 and studio IDE 1.4 (tidyverse, readr, xlsxand ggplot2 packages). Expression of IL-12 and IL-17 cytokineswasperformedbyrtPCRtwice, beforeandaftertreatment. Results: InHL patients, a significantdecreasewasobserved in themicrobiota flora of Ruminococcaceae_UCG-014 genus (p:0.036) andUndefined Ruminococcaceae_UCG-014 species (p:0.036) comparedtopre-treatment. When the post-treatment of HL patientswerecomparedwithhealthycontrols, a significantdecreasewasfound in themicrobiota of Prevotella_7 genus (p:0.049) andButyricimonas (p:0.006) in the post-treatmentmicrobiota of HL patients. InNHL patients, a significantdecreasewasobserved in themicrobiota flora of Coprococccus_3 genus (p:0.015) andUndefined Ruminoclostridium_5 (p:0.046) speciescomparedtopre-treatment. When post-treatment of NHL patientswerecomparedwithhealthycontrols, a significantabundance in theBacilliclass (p:0.029) and a significantdecrease in theUndefinedAlistipesspecies (p:0.047) wereobserved in the post-treatmentmicrobiota of NHL patients. While a decreasewasobserved in IL-12 cytokineexpressionuntilbeforetreatment, an increase in IL-17 cytokineexpressionwasdetected. Discussion: Intestinal flora monitoringafterchemotherapytreatmentshowsthat it can be a guide in thetreatment of thedisease. It is thoughtthatincreasingthediversity of commensalbacteria can alsopositivelyaffecttheprognosis of thedisease.

Keywords: hodgkin lymphoma, non-hodgkin, microbiota, cytokines

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Authors: Ndeye Tiguida Sarr, Onur Akpinar

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The tourism industry, being the sector that includes all the activities related to the organization and satisfaction of tourists during their trip, also has a very important role in the national economy of the host country. In order to measure the stakes of tourism on the economy, microeconomic and macroeconomic factors are elements of analysis. While microeconomics is limited to an individual perspective, macroeconomics extends to a global perspective and treats the economy as a whole by focusing on social and economic actors in general. It is in this context that this study focuses on macroeconomic variables in order to determine the factors that influence the financial performance of tourism firms in Turkey, which is one of the world's major destinations. The aim of the study is to demonstrate the relationship between macroeconomic variables and the financial performance of tourism firms. Data from 2011 to 2020 are collected, from a sample of 16 companies that represent the tourism sector in Borsa Istanbul. Tobin’s Q ratio, Market to Book ratio, Return on Invested Capital, and Return on Assets as the financial performance indicators were dependent variables of the study. Gross Domestic Products, Inflation, Interest Rates, and Unemployment as macroeconomic indicators were independent variables. Again, Size, Liquidity, Leverage, and Age were control variables of the study. According to the results, value indicators, which are Tobin’s Q ratio and Market to Book ratio, have a statistically significant relationship with Inflation, Interest Rates, and Unemployment. A negative relationship is found between value indicators and Interest rates and a positive relationship between value indicators and Unemployment and Inflation. On the other hand, there is no significant relationship between profit indicators (Return on Invested Capital and Return on Assets) and macroeconomic variables. Accordingly, Interest rates negatively affect the financial performance of tourism firms and stand out as a factor that decreases the value.

Keywords: financial performance, macroeconomic variables, panel data, Tobin Q

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Authors: Yusuf Ersoy Yildirim, Ismail Tas, Ceren Gorgusen, Tugba Yeter, Aysegul Boyacioglu, K. Mehmet Tugrul, Murat Tugrul, Ayten Namli, H. Sabri Ozturk, M. Onur Akca

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In recent years, a lot of research has been done for the sustainable use of scarce resources in the world. Especially, effective and sustainable use of water resources has been researched for many years. Sub-surface drip irrigation (SDI) is one of the most effective irrigation methods in which efficient and sustainable use of irrigation water can be achieved. When the literature is taken into consideration, it is often emphasized that, besides its numerous advantages, it also allows the application of irrigation water to the plant root zone along with air. It is stated in different studies that the air applied to the plant root zone with irrigation water has a positive effect on the root zone. Plants need sufficient oxygen for root respiration as well as for the metabolic functions of the roots. Decreased root respiration due to low oxygen content reduces transpiration, disrupts the flow of ions, and increases the ingress of salt reaching toxic levels, seriously affecting plant growth. Lack of oxygen (Hypoxia) can affect the survival of plants. The lack of oxygen in the soil is related to the exchange of gases in the soil with the gases in the atmosphere. Soil aeration is an important physical parameter of a soil. It is highly dynamic and is closely related to the amount of water in the soil and its bulk weight. Subsurface drip irrigation; It has higher water use efficiency compared to irrigation methods such as furrow irrigation and sprinkler irrigation. However, in heavy clay soils, subsurface drip irrigation creates continuous wetting fronts that predispose the rhizosphere region to hypoxia or anoxia. With subsurface drip irrigation, the oxygen is limited for root microbial respiration and root development, with the continuous spreading of water to a certain region of the root zone. In this study, the change in sugar beet yield caused by air application in the SDI system will be explained.

Keywords: sugar beet, subsurface drip irrigation, air application, irrigation efficiency

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Authors: Recep Keşli, Gülşah Aşık, Cengiz Demir, Onur Türkyılmaz

Abstract:

Objective: Proteus mirabilis (P. mirabilis) is one of Gram-negative pathogens in human and it causes urinary tract and nosocomial infections. P. mirabilis is susceptible to β-lactams, aminoglycosides, fluoroquinolones, and trimethoprim/sulfamethoxazole. It was aimed to investigate the resistance status to antimicrobial agents of Proteus mirabilis strains produced from samples sent to Afyon Kocatepe University, ANS Research and Practice Hospital, Microbiology Laboratory from different clinics and polyclinics during the period of 24 months. Methods: Between October 2013 and September 2015, a total of 30 Proteus were isolated from clinical samples of patients were hospitalized in intensive care units and in various departments of Afyon Kocatepe University, ANS Research and Practice Hospital. Identification of the bacteria was determined by conventional methods and VITEK 2 system (bioMérieux, France) was used additionally. Antibacterial susceptibility tests were performed by Kirby Bauer disc (Oxoid, Hempshire, England) diffusion method following the recommendations of CLSI. Results: Of the total 30 Proteus strains isolated from clinical samples, 19 from urine, 7 from wound, 4 from tracheal aspiration materials were isolated. Antimicrobial resistant for these strains were determined to 24,3% for meropenem, 26.2% for imipenem, 20.2% for amikacin 10.5% for cefepim, 33.3% for ciprofloxacin and levofloxacine, 31.6% for ceftazidime, 20% for ceftriaxone, 15.2% for gentamicin and 26.6% for amoxicillin-clavulanate, 26.2% trimethoprim-sulfamethoxale. Conclusion: In the present study, the highest number of clinical isolates of P. mirabilis were isolated from urine (63,3%), followed by the others (36,6%). The distribution of samples P. mirabilis strains to the clinics were as fallows; 16,8% intensive care unit (ICU), 29,9% polyclinics, 53,3% hospital service units The most effective antibiotic on the total of strains were found to be cefepim, the least effective antibiotics on the total of strains were found to be trimethoprim-sulfamethoxale.

Keywords: proteus mirabilis, antibiotic resistance, intensive care unit, Proteus spp.

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Authors: Yunus Onur Yildiz, Mesut Kirca

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In this study, mechanical properties of a nanoporous metal coated with a different metallic material are studied through a new atomistic modelling technique and molecular dynamics (MD) simulations. This new atomistic modelling technique is based on the Voronoi tessellation method for the purpose of geometric representation of the ligaments. With the proposed technique, atomistic models of nanoporous metals which have randomly oriented ligaments with non-uniform mass distribution along the ligament axis can be generated by enabling researchers to control both ligament length and diameter. Furthermore, by the utilization of this technique, atomistic models of coated nanoporous materials can be numerically obtained for further mechanical or thermal characterization. In general, this study consists of two stages. At the first stage, we use algorithms developed for generating atomic coordinates of the coated nanoporous material. In this regard, coordinates of randomly distributed points are determined in a controlled way to be employed in the establishment of the Voronoi tessellation, which results in randomly oriented and intersected line segments. Then, line segment representation of the Voronoi tessellation is transformed to atomic structure by a special process. This special process includes generation of non-uniform volumetric core region in which atoms can be generated based on a specific crystal structure. As an extension, this technique can be used for coating of nanoporous structures by creating another volumetric region encapsulating the core region in which atoms for the coating material are generated. The ultimate goal of the study at this stage is to generate atomic coordinates that can be employed in the MD simulations of randomly organized coated nanoporous structures. At the second stage of the study, mechanical behavior of the coated nanoporous models is investigated by examining deformation mechanisms through MD simulations. In this way, the effect of coating on the mechanical behavior of the selected material couple is investigated.

Keywords: atomistic modelling, molecular dynamic, nanoporous metals, voronoi tessellation

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Authors: Yusuf Ulaş Kabukçu, Si̇nan Çeli̇k, Onur Salan, Mai̇de Altuntaş, Mert Can Dalkiran, Gökseni̇n Bozdağ, Metehan Bulut, Fati̇h Yaman

Abstract:

This study presents a more compact implementation of the 2.4GHz MIT Coffee Can Doppler Radar for 2.6GHz operating frequency. The main difference of our prototype depends on the use of microstrip antennas which makes it possible to transport with a small robotic vehicle. We have designed our radar system with two different channels: Tx and Rx. The system mainly consists of Voltage Controlled Oscillator (VCO) source, low noise amplifiers, microstrip antennas, splitter, mixer, low pass filter, and necessary RF connectors with cables. The two microstrip antennas, one is element for transmitter and the other one is array for receiver channel, was designed, fabricated and verified by experiments. The system has two operation modes: speed detection and range detection. If the switch of the operation mode is ‘Off’, only CW signal transmitted for speed measurement. When the switch is ‘On’, CW is frequency-modulated and range detection is possible. In speed detection mode, high frequency (2.6 GHz) is generated by a VCO, and then amplified to reach a reasonable level of transmit power. Before transmitting the amplified signal through a microstrip patch antenna, a splitter used in order to compare the frequencies of transmitted and received signals. Half of amplified signal (LO) is forwarded to a mixer, which helps us to compare the frequencies of transmitted and received (RF) and has the IF output, or in other words information of Doppler frequency. Then, IF output is filtered and amplified to process the signal digitally. Filtered and amplified signal showing Doppler frequency is used as an input of audio input of a computer. After getting this data Doppler frequency is shown as a speed change on a figure via Matlab script. According to experimental field measurements the accuracy of speed measurement is approximately %90. In range detection mode, a chirp signal is used to form a FM chirp. This FM chirp helps to determine the range of the target since only Doppler frequency measured with CW is not enough for range detection. Such a FMCW Doppler radar may be used in border security of the countries since it is capable of both speed and range detection.

Keywords: doppler radar, FMCW, range detection, speed detection

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Authors: Ecem Deniz Kırkpantur, Ozge Ecmel Onur, Tuba Cimilli Ozturk, Ebru Unal Akoglu

Abstract:

Moyamoya disease is a unique chronic progressive cerebrovascular disease characterized by bilateral stenosis or occlusion of the arteries around the circle of Willis with prominent arterial collateral circulation. The occurrence of Moyamoya disease is related to immune, genetic and other factors. There is no curative treatment for Moyamoya disease. Secondary prevention for patients with symptomatic Moyamoya disease is largely centered on surgical revascularization techniques. We present here a 62-year old male presented with headache and vision loss for 2 days. He was previously diagnosed with hypertension and glaucoma. On physical examination, left eye movements were restricted medially, both eyes were hyperemic and their movements were painful. Other neurological and physical examination were normal. His vital signs and laboratory results were within normal limits. Computed tomography (CT) showed dilated vascular structures around both lateral ventricles and atherosclerotic changes inside the walls of internal carotid artery (ICA). Magnetic resonance imaging (MRI) and angiography (MRA) revealed dilated venous vascular structures around lateral ventricles and hyper-intense gliosis in periventricular white matter. Ischemic gliosis around the lateral ventricles were present in the Digital Subtracted Angiography (DSA). After the neurology, ophthalmology and neurosurgery consultation, the patient was diagnosed with Moyamoya disease, pulse steroid therapy was started for vision loss, and super-selective DSA was planned for further investigation. Moyamoya disease is a rare condition, but it can be an important cause of stroke in both children and adults. It generally affects anterior circulation, but posterior cerebral circulation may also be affected, as well. In the differential diagnosis of acute vision loss, occipital stroke related to Moyamoya disease should be considered. Direct and indirect surgical revascularization surgeries may be used to effectively revascularize affected brain areas, and have been shown to reduce risk of stroke.

Keywords: headache, Moyamoya disease, stroke, visual loss

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Authors: Cansu Arslan Turan, Tuba Cimilli Ozturk, Ebru Unal Akoglu, Kemal Aygun, Ecem Deniz Kırkpantur, Ozge Ecmel Onur

Abstract:

Although the mechanism of action is not well known, Intravenous Lipid Emulsion (ILE) has been shown to be effective in the treatment of lipophilic drug intoxications. It is thought that ILE probably separate the lipophilic drugs from target tissue by creating a lipid-rich compartment in the plasma. The second theory is that ILE provides energy to myocardium with high dose free fatty acids activating the voltage gated calcium channels in the myocytes. In this study, the effects of ILE treatment on digoxin overdose which are frequently observed in emergency departments was searched in an animal model in terms of cardiac side effects and survival. The study was carried out at Yeditepe University, Faculty of Medicine-Experimental Animals Research Center Labs in December 2015. 40 Sprague-Dawley rats weighing 300-400 g were divided into 5 groups randomly. As the pre-treatment, the first group received saline, the second group received lipid, the third group received DigiFab, and the fourth group received DigiFab and lipid. Following that, digoxin was infused to all groups until death except the control group. First arrhythmia and cardiac arrest occurrence times were recorded. As no medication causing arrhythmia was infused, Group 5 was excluded from the statistical analysis performed for the comparisons of first arrhythmia and death time. According to the results although there was no significant difference in the statistical analysis comparing the four groups, as the rats, only exposed to digoxin intoxication were compared with the rats pre-treated with ILE in terms of first arrhythmia time and cardiac arrest occurrence times, significant difference was observed between the groups. According to our results, using DigiFab treatment, intralipid treatment, intralipid and DigiFab treatment for the rats exposed to digoxin intoxication makes no significant difference in terms of the first arrhythmia and death occurrence time. However, it is not possible to say that at the doses we use in the study, ILE treatment might be successful at least as a known antidote. The fact that the statistical significance between the two groups is not observed in the inter-comparisons of all the groups, the study should be repeated in the larger groups.

Keywords: arrhytmia, cardiac arrest, DigiFab, digoxin intoxication

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Authors: Onur Ercan, Buket Askin, Erdogan Kucukoner

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Blueberry (Vaccinium corymbosum, bluegold) has become popular beverage due to their nutritional values such as vitamins, minerals, and antioxidants. In the study, the effects of pressing, mashing, enzymatic treatment, and pasteurization on anthocyanins, colour, and polyphenolics of blueberry juice (BJ) were studied. The blueberry juice (BJ) was produced with two different methods that direct juice extraction (DJE) and mash treatment process (MTP) were applied. After crude blueberry juice (CBJ) production, the samples were first treated with commercial enzymes [Novoferm-61 (Novozymes A/S) (2–10 mL/L)], to break down the hydrocolloid polysaccharides, mainly pectin and starch. The enzymes were added at various concentrations. The highest transmittance (%) was obtained for Novoferm-61 at a concentration of 2 mL/L was 66.53%. After enzymatic treatment, clarification trials were applied to the enzymatically treated BJs with adding various amounts of bentonite (10%, w/v), gelatin (1%, w/v) and kiselsol (15%, v/v). The turbidities of the clarified samples were then determined. However, there was no significant differences between transmittances (%) for samples. For that, only enzymatic treatment was applied to the blueberry juice processing (DDBJ, depectinized direct blueberry juice). Based on initial pressing process made to evaluate press function, it was determined that pressing fresh blueberries with no other processing did not render adequate juice due to lack of liquefaction. Therefore, the blueberries were mash into small pieces (3 mm) and then enzymatic treatments and clarification trials were performed. Finally, both BJ samples were pasteurized. Compositional analyses, colour properties, polyphenols and antioxidant properties were compared. Enzymatic treatment caused significant reductions in ACN content (30%) in Direct Blueberry Juice Processing (DBJ), while there was a significant increasing in Mash Treatment Processing (MTP). Overall anthocyanin levels were higher intreated samples after each processing step in MTP samples, but polyphenolic levels were slightly higher for both processes (DBJ and MTP). There was a reduction for ACNs and polyphenolics only after pasteurization. It has a result that the methods for tried to blueberry juice is suitable into obtain fresh juice. In addition, we examined fruit juice during processing stages; anthocyanin, phenolic substance content and antioxidant activity are higher, and yield is higher in fruit juice compared to DBJ method in MTP method, the MTP method should be preferred in processing juice of blueberry into fruit juice.

Keywords: anthocyanins, blueberry, depectinization, polyphenols

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Authors: Onur Ozveri, Korkut Karabag, Cagri Keles

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It is an important issue that the occurring of production downtime and repair costs when machines fail in the machine intensive production industries. In the case of failure of more than one machine at the same time, which machines will have the priority to repair, how to determine the optimal repair time should be allotted for this machines and how to plan the resources needed to repair are the key issues. In recent years, Business Process Management (BPM) technique, bring effective solutions to different problems in business. The main feature of this technique is that it can improve the way the job done by examining in detail the works of interest. In the industries, maintenance and repair works are operating as a process and when a breakdown occurs, it is known that the repair work is carried out in a series of process. Maintenance main-process and repair sub-process are evaluated with process management technique, so it is thought that structure could bring a solution. For this reason, in an international manufacturing company, this issue discussed and has tried to develop a proposal for a solution. The purpose of this study is the implementation of maintenance and repair works which is integrated with process management technique and at the end of implementation, analyzing the maintenance related parameters like quality, cost, time, safety and spare part. The international firm that carried out the application operates in a free region in Turkey and its core business area is producing original equipment technologies, vehicle electrical construction, electronics, safety and thermal systems for the world's leading light and heavy vehicle manufacturers. In the firm primarily, a project team has been established. The team dealt with the current maintenance process again, and it has been revised again by the process management techniques. Repair process which is sub-process of maintenance process has been discussed again. In the improved processes, the ABC equipment classification technique was used to decide which machine or machines will be given priority in case of failure. This technique is a prioritization method of malfunctioned machine based on the effect of the production, product quality, maintenance costs and job security. Improved maintenance and repair processes have been implemented in the company for three months, and the obtained data were compared with the previous year data. In conclusion, breakdown maintenance was found to occur in a shorter time, with lower cost and lower spare parts inventory.

Keywords: ABC equipment classification, business process management (BPM), maintenance, repair performance

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Authors: Recep Keşli, Gülşah Aşık, Cengiz Demir, Onur Türkyılmaz

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Objective: Serratia species are identified as aerobic, motile Gram negative rods. The species Serratia marcescens (S. marcescens) causes both opportunistic and nosocomial infections. The genus Providencia is Gram-negative bacilli and includes urease-producing that is responsible for a wide range of human infections. Although most Providencia infections involve the urinary tract, they are also associated with gastroenteritis, wound infections, and bacteremia. The aim of this study was evaluate the antimicrobial resistance rates of S. marcescens and Providencia spp. strains which had been isolated from various clinical materials obtained from different patients who belongs to intensive care units (ICU) and inpatient clinics. Methods: A total of 35 S. marcescens and Providencia spp. strains isolated from various clinical samples admitted to Medical Microbiology Laboratory, ANS Research and Practice Hospital, Afyon Kocatepe University between October 2013 and September 2015 were included in the study. Identification of the bacteria was determined by conventional methods and VITEK 2 system (bio-Merieux, Marcy l’etoile, France) was used additionally. Antibacterial resistance tests were performed by using Kirby Bauer disc (Oxoid, Hampshire, England) diffusion method following the recommendations of CLSI. Results: The distribution of clinical samples were as follows: upper and lower respiratory tract samples 26, 74.2 % wound specimen 6, 17.1 % blood cultures 3, 8.5%. Of the 35 S. marcescens and Providencia spp. strains; 28, 80% were isolated from clinical samples sent from ICU. The resistance rates of S. marcescens strains against trimethoprim-sulfamethoxazole, piperacillin-tazobactam, imipenem, gentamicin, ciprofloxacin, ceftazidime, cefepime and amikacin were found to be 8.5 %, 22.8 %, 11.4 %, 2.8 %, 17.1 %, 40 %, 28.5 % and 5.7 % respectively. Resistance rates of Providencia spp. strains against trimethoprim-sulfamethoxazole, piperacillin-tazobactam, imipenem, gentamicin, ciprofloxacin, ceftazidime, cefepime and amikacin were found to be 10.2 %, 33,3 %, 18.7 %, 8.7 %, 13.2 %, 38.6 %, 26.7%, and 11.8 % respectively. Conclusion: S. marcescens is usually resistant to ampicillin, amoxicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefuroxime, cephamycins, nitrofurantoin, and colistin. The most effective antibiotic on the total of S. marcescens strains was found to be gentamicin 2.8 %, of the totally tested strains the highest resistance rate found against to ceftazidime 40 %. The lowest and highest resistance rates were found against gentamiycin and ceftazidime with the rates of 8.7 % and 38.6 % for Providencia spp.

Keywords: Serratia marcescens, Providencia spp., antibiotic resistance, intensive care unit

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Authors: A. Onur Kutlu, H. Tolga Bolukbasi

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Since the 1990s, governments, international organizations and scholars have drawn increasing attention to the significance of women in the labour force. While advanced industrial countries in North Western Europe and North America have managed to increase female labour force participation (FLFP) in the early post world war two period, emerging economies of the 1970s have only been able to increase FLFP only a decade later. Among these areas, Southern Europe features a wave of remarkable bounce backs in FLFP. However, despite striking similarities between the features in Southern Europe and those in Turkey, Turkey has not been able to pull women into the labour force. Despite a host of institutional similarities, Turkey has failed to reach to the level of her Southern European neighbours. This paper addresses the puzzle why Turkey lag behind in FLFP in comparison to her Southern European neighbours. There are signs showing that FLFP is currently reaching a critical threshold at a time when structural factors may allow a trend. It is not known, however, the constellation of conditions which may bring rising FLFP in Turkey. In order to gain analytical leverage from similar transitions in countries that share similar labour market and welfare state regime characteristics, this paper identifies the conditions in Southern Europe that brought rising FLFP to be able to explore the prospects for Turkey. Second, this paper takes these variables in the fuzzy set Qualitative Comparative Analysis (fsQCA) as conditions which can potentially explain the outcome of rising FLFP in Portugal, Spain, Italy, Greece and Turkey. The purpose here is to identify any causal pathway there may exist that lead to rising FLFP in Southern Europe. In order to do so, this study analyses two time periods in all cases, which represent different periods for different countries. The first period is identified on the basis of low FLFP and the second period on the basis of the transition to significantly higher FLFP. Third, the conditions are treated following the standard procedures in fsQCA, which provide equifinal: two distinct paths to higher levels of FLFP in Southern Europe, each of which may potentially increase FLFP in Turkey. Based on this analysis, this paper proposes that there exist two distinct paths leading to higher levels of FLFP in Southern Europe. Among these paths, salience of left parties emerges as a sufficient condition. In cases where this condition was not present, a second path combining enlarging service sector employment, increased tertiary education among women and increased childcare enrolment rates led to increasing FLFP.

Keywords: female labour force participation, fsQCA, Southern Europe, Turkey

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Authors: Buket Celik Ünal, Onur Ünal

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Communication is the most challenging part of maintenance operations. Communication between expert and fieldworker is crucial for effective maintenance and this also affects the safety of the fieldworkers. To support a machine user in a remote collaborative physical task, both, a mobile and a stationary device are needed. Such a system is called a shared vision system and the system supports two people to solve a problem from different places. This system reduces the errors and provides a reliable support for qualified and less qualified users. Through this research, it was aimed to validate the effectiveness of using a shared vision system to facilitate communication between on-site workers and those issuing instructions regarding maintenance or inspection works over long distances. The system is designed with head-worn display which is called a shared vision system. As a part of this study, a substitute system is used and implemented by using a shared vision system for maintenance operation. The benefits of the use of a shared vision system are analyzed and results are adapted to the wind turbines to improve the occupational safety and health for maintenance technicians. The motivation for the research effort in this study can be summarized in the following research questions: -How can expert support technician over long distances during maintenance operation? -What are the advantages of using a shared vision system? Experience from the experiment shows that using a shared vision system is an advantage for both electrical and mechanical system failures. Results support that the shared vision system can be used for wind turbine maintenance and repair tasks. Because wind turbine generator/gearbox and the substitute system have similar failures. Electrical failures, such as voltage irregularities, wiring failures and mechanical failures, such as alignment, vibration, over-speed conditions are the common and similar failures for both. Furthermore, it was analyzed the effectiveness of the shared vision system by using a smart glasses in connection with the maintenance task performed by a substitute system under four different circumstances, namely by using a shared vision system, an audio communication, a smartphone and by yourself condition. A suitable method for determining dependencies between factors measured in Chi Square Test, and Chi Square Test for Independence measured for determining a relationship between two qualitative variables and finally Mann Whitney U Test is used to compare any two data sets. While based on this experiment, no relation was found between the results and the gender. Participants` responses confirmed that the shared vision system is efficient and helpful for maintenance operations. From the results of the research, there was a statistically significant difference in the average time taken by subjects on works using a shared vision system under the other conditions. Additionally, this study confirmed that a shared vision system provides reduction in time to diagnose and resolve maintenance issues, reduction in diagnosis errors, reduced travel costs for experts, and increased reliability in service.

Keywords: communication support, maintenance and inspection tasks, occupational health and safety, shared vision system

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Authors: Jenn Gallup, Onur Kocaoz, Onder Islek

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In their pursuit of postsecondary transitions, individuals with disabilities tend to experience, academic, behavioral, and emotional challenges to a greater extent than their typically developing peers. These challenges result in lower rates of graduation, employment, independent living, and participation in college than their peers without disabilities. The lack of friendships and support systems has had a negative impact on those with a disability transitioning to postsecondary settings to include, employment, independent living, and university settings. Establishing friendships and support systems early on is an indicator of potential success and persistence in postsecondary education, employment, and independent living for typically developing college students. It is evident that a deficit in friendships and supports is a key deficit also for individuals with disabilities. To address the specific needs of this group, a mentor program was developed for a transition program held at the university for youth aged 18-21. Pre-service teachers enrolled in the special education program engaged with youth in the transition program in a variety of activities on campus. The mentorship program had two purposes: to assist young adults with disabilities who were transitioning to a workforce setting to help increase social skills, self-advocacy, supports and friendships, and confidence; and to give their peers without disabilities who were enrolled in a secondary special education course as a pre-service teacher the experience of interacting with and forming friendships with peers who had a disability for the purposes of career development. Additionally, according to researchers mobile technology has created a virtual world of equality and opportunity for a large segment of the population that was once marginalized due to physical and cognitive impairments. All of the participants had access to smart phones; therefore, technology was explored during this study to determine if it could be used as a compensatory tool to allow the young adults with disabilities to do things that otherwise would have been difficult because of their disabilities. Additionally, all participants were asked to incorporate technology such as smart phones to communicate beyond the activities, collaborate using virtual platform games which would support and promote social skills, soft-skills, socialization, and relationships. The findings of this study confirmed that a peer mentorship program that harnessed the power of technology supported outcomes specific to young adults with and without disabilities. Mobile technology and virtual game-based platforms, were identified as a significant contributor to personal, academic, and career growth for both groups. The technology encouraged friendships, provided an avenue for rich social interactions, and increased soft-skills. Results will be shared along with the development of the program and potential implications to the field.

Keywords: career outcomes, mentorship, soft-skills, technology, transition

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Authors: Sıdıka Kaya, Gülay Sain Güven, Seda Karsavuran, Onur Toka

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This study is part of an ongoing research project supported by the Scientific and Technological Research Council of Turkey (TUBITAK) under Project Number 114K404, and participation to this conference was supported by Hacettepe University Scientific Research Coordination Unit under Project Number 10243. Evaluation of hospital readmissions is gaining importance in terms of quality and cost, and is becoming the target of national policies. In Turkey, the topic of hospital readmission is relatively new on agenda and very few studies have been conducted on this topic. The aim of this study was to determine 30-day readmission rates and risk factors for readmission. Whether readmission was planned, related to the prior admission and avoidable or not was also assessed. The study was designed as a ‘prospective cohort study.’ 472 patients hospitalized in internal medicine departments of a university hospital in Turkey between February 1, 2015 and April 30, 2015 were followed up. Analyses were conducted using IBM SPSS Statistics version 22.0 and SPSS Modeler 16.0. Average age of the patients was 56 and 56% of the patients were female. Among these patients 95 were readmitted. Overall readmission rate was calculated as 20% (95/472). However, only 31 readmissions were unplanned. Unplanned readmission rate was 6.5% (31/472). Out of 31 unplanned readmission, 24 was related to the prior admission. Only 6 related readmission was avoidable. To determine risk factors for readmission we constructed Chi-square automatic interaction detector (CHAID) decision tree algorithm. CHAID decision trees are nonparametric procedures that make no assumptions of the underlying data. This algorithm determines how independent variables best combine to predict a binary outcome based on ‘if-then’ logic by portioning each independent variable into mutually exclusive subsets based on homogeneity of the data. Independent variables we included in the analysis were: clinic of the department, occupied beds/total number of beds in the clinic at the time of discharge, age, gender, marital status, educational level, distance to residence (km), number of people living with the patient, any person to help his/her care at home after discharge (yes/no), regular source (physician) of care (yes/no), day of discharge, length of stay, ICU utilization (yes/no), total comorbidity score, means for each 3 dimensions of Readiness for Hospital Discharge Scale (patient’s personal status, patient’s knowledge, and patient’s coping ability) and number of daycare admissions within 30 days of discharge. In the analysis, we included all 95 readmitted patients (46.12%), but only 111 (53.88%) non-readmitted patients, although we had 377 non-readmitted patients, to balance data. The risk factors for readmission were found as total comorbidity score, gender, patient’s coping ability, and patient’s knowledge. The strongest identifying factor for readmission was comorbidity score. If patients’ comorbidity score was higher than 1, the risk for readmission increased. The results of this study needs to be validated by other data–sets with more patients. However, we believe that this study will guide further studies of readmission and CHAID is a useful tool for identifying risk factors for readmission.

Keywords: decision tree, hospital, internal medicine, readmission

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Authors: Demet Devrimsel Dogan, Ecem Deniz Kirkpantur, Muharrem Dogan, Ahmet Aykut, Ebru Unal Akoglu, Ozge Ecmel Onur

Abstract:

Introduction: Median Arcuate Ligament Syndrome (MALS) is a rare cause of chronic abdominal pain due to external compression of the celiac trunk by a fibrous arch that unites diaphragmatic crura on each side of the aortic hiatus. While 10-24% of the population may suffer from compression of celiac trunk, it rarely causes patients to develop symptoms. The typical clinical triad of symptoms includes postprandial epigastric pain, weight loss and vomiting. The diagnosis can be made using thin section multi-detector computed tomography (CT) scans which delineate the ligament and the compressed vessel. The treatment of MALS is aimed at relieving the compression of the celiac artery to restore adequate blood flow through the vessel and neurolysis to address chronic pain. Case: A 68-year-old male presented to our clinic with acute postprandial epigastric pain. This was patients’ first attack, and the pain was the worst pain of his life. The patient did not have any other symptoms like nausea, vomiting, chest pain or dyspnea. In his medical history, the patient has had an ischemic cerebrovascular stroke 5 years ago which he recovered with no sequel, and he was using 75 mg clopidogrel and 100 mg acetylsalicylic acid. He was not using any other medication and did not have a story of cardiovascular disease. His vital signs were stable (BP:113/72 mmHg, Spo2:97, temperature:36.3°C, HR:90/bpm). In his electrocardiogram, there was ST depression in leads II, III and AVF. In his physical examination, there was only epigastric tenderness, other system examinations were normal. Physical examination through his upper gastrointestinal system showed no bleeding. His laboratory results were as follows: creatinine:1.26 mg/dL, AST:42 U/L, ALT:17 U/L, amylase:78 U/L, lipase:26 U/L, troponin:10.3 pg/ml, WBC:28.9 K/uL, Hgb:12.7 gr/dL, Plt:335 K/uL. His serial high-sensitive troponin levels were also within normal limits, his echocardiography showed no segmental wall motion abnormalities, an acute myocardial infarction was excluded. In his abdominal ultrasound, no pathology was founded. Contrast-enhanced abdominal CT and CT angiography reported ‘thickened diaphragmatic cruras are compressing and stenosing truncus celiacus superior, this is likely compatible with MALS’. The patient was consulted to general surgery, and they admitted the patient for laparoscopic ligament release. Results: MALS is a syndrome that causes postprandial pain, nausea and vomiting as its most common symptoms. Affected patients are normally young, slim women between the ages of 30 and 50 who have undergone extensive examinations to find the source of their symptoms. To diagnose MALS, other underlying pathologies should initially be excluded. The gold standard is aortic angiography. Although diagnosis and treatment of MALS are unclear, symptom resolution has been achieved with multiple surgical modalities, including open, laparoscopic or robotic ligament release as well as celiac ganglionectomy, which often requires celiac artery revascularisation.

Keywords: differential diagnosis, epigastric pain, median arcuate ligament syndrome, celiac trunk

Procedia PDF Downloads 228