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A secondary analysis of a prospective multicenter cohort was performed in six intensive care units (ICU) in four European countries (France, Greece, Spain and Turkey). The main objective was to identify factors associated with ventilator-associated events (VAEs) in adults who underwent mechanical ventilation (MV) ≥ 48 h. Secondary objectives were to identify: variables influencing VAE in the subpopulation with endotracheal intubation and in those subjects who were ventilated > 7 days. Subjects who had undergone MV ≥ 48 h were included. In subjects with multiple episodes of MV, only the first one was eligible. The adult definitions for VAEs were adjusted to the 2015 update of the CDC’s 2013 National Healthcare Safety Network Association. Factors associated with VAE were estimated through multivariate Cox proportional hazards analysis. Among 163 adults (42 tracheostomies), 76 VAEs (34.9 VAEs/1,000 ventilator-days) were documented: 9 were Ventilator-Associated Conditions (VAC) and 67 Infection-related Ventilator-Associated Complications (IVAC)-plus (9 only IVAC and 58 Possible Ventilator-Associated Pneumonia). VAEs developed after a median of 6 days (interquartile range: 4–9). VAEs were independently associated with long-acting sedative/analgesic drugs (Hazard Ratio [HR]: 4.30), selective digestive decontamination (SDD) (HR: 0.38), and surgical/trauma admission (HR: 2.30). Among 116 subjects with endotracheal tube, SDD (HR: 0.21) and surgical/trauma admission (HR: 3.11) remained associated with VAE. Among 102 subjects ventilated >7 days, only long-acting sedative/analgesic agents (HR: 8.69) remained independently associated with VAE. In summary, SDD implementation and long-acting analgesic/sedative agents restriction prescription may prevent early and late VAEs, respectively. Bundles developed to prevent VAEs should include these two interventions.

Purpose To analyze the impact on patient outcome of ventilator-associated events (VAEs) as defined by the Centers for Disease Control and Prevention (CDC) in 2008, 2013, and the correlation with ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT). Methods This was a prospective, observational, multicenter, international study conducted at 13 intensive care units (ICUs); thirty consecutive adults mechanically ventilated for ≥ 48 h per site were eligible, with daily follow-up being recorded in a collaborative web database; VAEs were assessed using the 2013 CDC classification and its 2015 update. Results A total of 2856 ventilator days in 244 patients were analyzed, identifying 33 VAP and 51 VAT episodes; 30-day ICU mortality was significantly higher (42.8 vs. 19.6%, p

Low latency is a requirement for a variety of interactive network applications. The Internet, however, is not optimized for latency. We thus explore the design of cost-effective wide-area networks that move data over paths very close to great-circle paths, at speeds very close to the speed of light in vacuum. Our cISP design augments the Internet's fiber with free-space wireless connectivity. cISP addresses the fundamental challenge of simultaneously providing low latency and scalable bandwidth, while accounting for numerous practical factors ranging from transmission tower availability to packet queuing. We show that instantiations of cISP across the contiguous United States and Europe would achieve mean latencies within 5% of that achievable using great-circle paths at the speed of light, over medium and long distances. Further, we estimate that the economic value from such networks would substantially exceed their expense.

The recent publication of the `InterTubes' map of long-haul fiber-optic cables in the contiguous United States invites an exciting question: how much faster would the Internet be if routes were chosen to minimize latency? Previous measurement campaigns suggest the following rule of thumb for estimating Internet latency: multiply line-of-sight distance by 2.1, then divide by the speed of light in fiber. But a simple computation of shortest-path lengths through the conduits in the InterTubes map suggests that the conversion factor for all pairs of the 120 largest population centers in the U.S.\ could be reduced from 2.1 to 1.3, in the median, even using less than half of the links. To determine whether an overlay network could be used to provide shortest paths, and how well it would perform, we used the diverse server deployment of a CDN to measure latency across individual conduits. We were surprised to find, however, that latencies are sometimes much higher than would be predicted by conduit length alone. To understand why, we report findings from our analysis of network latency data from the backbones of two Tier-1 ISPs, two scientific and research networks, and the recently built fiber backbone of a CDN.

Bu çalışmada 2015ve 2016 yetiştirme sezonunda Hatay ilinin önemli marul (Lactuca sativa L.) yetiştiriciliği yapılan alanlarında rastgeleseçilmiş tarlalarda erken dönem fide ile hasat dönemlerinde sorun olan hastalıketmeni, zararlı ve yabancı ot türlerinin tanılanması ve yaygınlık durumlarıbelirlenmiştir. Tipik hastalık belirtileri gösteren bitki örneklerinden yapılanizolasyonlar sonucunda Sclerotiniasclerotiorum, Botrytis cinerea, Golovinomyces cichoracearum ve Bremia lactucae en sık karşılaşılanfungal etmenler olarak belirlenmiştir. Pectobacteriumcarotovorum subsp. carotovorum veEnterobacter cloacae, kök bölgesindeyumuşak çürüklük belirtilerine, Xanthomonascampestris pv. vitians iseyapraklarda lekelere neden olan bakteriyel hastalık etmenleri olarakbelirlenmiştir. Viral etmenlerden marul iri damar virüsü (Mirafiori lettuce big vein virüs) sadece 1 tarlada gözlenmiştir. Sörveylersonucunda yaprak bitleri (Aphis gossypii,Myzus persicae), trips (Thripstabaci, Frankliniella occidentalis), yaprak pireleri (Empoasca decipiens, Asymetresca decedens), beyazsinek (Bemisia tabaci) ve yaprak kurtları (Spodoptera littolaris ve Helicoverpa armigera) yetiştiricilikte değişenoranlarda karşılaşılan zararlı böcek türleri olarak belirlenmiştir.Zararlıların üretim alanlarındaki zarar düzeyleri türlere göre değişiklikgöstermekle birlikte daha çok ilkbahar döneminde belirlenmiştir. Salyangozzararı ise daha çok erken ilkbaharda görülmüştür. Yapılan sörveyler sonucunda24 bitki familyasına ait 59 adet yabancı ot türü belirlenmiştir. Ek olarak, sahipoldukları yabancı ot tür sayılarına göre en yaygın 5 familya: Poaceae (14),Asteraceae (12), Leguminosae (4), Caryophyllaceae ve Amaranthaceae (3)kaydedilmiştir. Sörveylerde belirlenen yabancı ot türlerinin 42 tanesininrastlama sıklığı % 12.5’un üzerinde olurken ilk sıraları Avena sterilis, Sinapis arvensis, Amaranthus retroflexus, Convolvulusarvensis ve Chenopodium album almıştır.

Objective: The aim of this study was to evaluate the adherence to recommendations for secondary prevention and the achievement of treatment targets for the control of risk factors in patients with established coronary heart disease (CHD) who were followed-up at various healthcare facilities in Turkey. Methods: According to the protocol of the international Survey of Risk Factor Management study, questionnaire forms were completed and demographic, anthropometric, and laboratory data of CHD patients who were followed-up at a total of 15 selected primary, secondary, and tertiary healthcare centers were recorded. Results: Among a total of 724 CHD patients (69.8\% male

Background: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. Methods: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. Results: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. Conclusions: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.

BACKGROUND: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. METHODS: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. RESULTS: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. CONCLUSIONS: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.

Background: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. Methods: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. Results: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. Conclusions: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients. © 2016 The Author(s).

Bu çalışma’da, 1850-1915 yılları arasında, Osmanlı Devleti’nin Suriye ve Lübnan bölgesinden, Arjantin ve Brezilya’ya yapılan emek göçü ele alınmaktadır. Bu ülkelerin, ihtiyaç duydukları işgücü açığını Avrupalı göçmenlerle karşılamak amacıyla yürürlüğe koydukları liberal göç yasalarından, Osmanlı vatandaşları da yararlanmıştı. Oysa işgücü talebinde bulunan Brezilya ve Arjantin, kendine kültürel ve dini bakımdan yakın olan Avrupalı göçmelerin gelmesini arzulamaktaydılar. Kendi topraklarından göçü, ülke menfaatleri açısında sakıncalı gören Osmanlı Devleti, almış olduğu tüm tedbirlere rağmen, 20. Yüzyılın başlarında, 100.000’in üzerinde Arjantin’de, 190.000 civarında da Brezilya’da bulunan vatandaşının göçüne engel olamamıştı.

The aim of this study was to compare the patella bone volume of sedentary men with that of elite male sportspeople, including judoka, cyclists, weightlifters, and taekwondo athletes who were members of Turkish National Professional Teams. All subjects had no history or clinical signs of an orthopaedic disorder such as osteoarthritis or acromegaly. The right and left knees of all groups were placed side by side in a supine position and were scanned by high resolution imaging with multidetector computed tomography. The differences between the volume of right and left patellae of sedentary men, judoka, cyclists, weightlifters, and taekwondo athletes were statistically significant. The average left patella of a professional cyclist and the average right patella volume of a sedentary man were maximum and minimum, respectively. The results demonstrated that the patella volume of cyclists was significantly larger. According to the literature, patella bone volume was associated with a reduced rate of annual patella cartilage volume loss, so cycling early in life may prevent patella cartilage loss in the future. El objetivo de este estudio fue comparar el volumen de la patela en hombres sedentarios con la patela de deportistas de elite, incluyendo judokas, ciclistas, levantadores de pesas y atletas de taekwondo, miembros de equipos profesionales nacionales turcos. Los sujetos del estudio no tenían antecedentes o signos clínicos de una enfermedad ortopédica como la osteoartritis. Las rodillas derecha e izquierda de los individuos de todos los grupos se colocaron una al lado de otra, en posición supina y fueron escaneadas por tomografía computarizada multidetector de alta resolución. Las diferencias entre el volumen de la patela derecha e izquierda de los hombres sedentarios, atletas judokas, ciclistas, levantadores de pesas y atletas de taekwondo fueron estadísticamente significativas. El volumen promedio de la patela izquierda de un ciclista profesional y el volumen promedio de la patela derecha de un hombre sedentario fueron de máximo y mínimo, respectivamente. Los resultados demostraron que el volumen de la patela de ciclistas fue significativamente mayor. De acuerdo a la literatura, el volumen del hueso de la patela fue asociado con una pérdida anual de volumen del cartílago, razón por la cual el ciclismo en una edad temprana puede prevenir la pérdida de cartílago de la patela en el futuro.

Background: Neuraminidase inhibitors were widely used during the 2009-10 influenza A H1N1 pandemic, but evidence for their effectiveness in reducing mortality is uncertain. We did a meta-analysis of individual participant data to investigate the association between use of neuraminidase inhibitors and mortality in patients admitted to hospital with pandemic influenza A H1N1pdm09 virus infection. Methods: We assembled data for patients (all ages) admitted to hospital worldwide with laboratory confirmed or clinically diagnosed pandemic influenza A H1N1pdm09 virus infection. We identified potential data contributors from an earlier systematic review of reported studies addressing the same research question. In our systematic review, eligible studies were done between March 1, 2009 (Mexico), or April 1, 2009 (rest of the world), until the WHO declaration of the end of the pandemic (Aug 10, 2010); however, we continued to receive data up to March 14, 2011, from ongoing studies. We did a meta-analysis of individual participant data to assess the association between neuraminidase inhibitor treatment and mortality (primary outcome), adjusting for both treatment propensity and potential confounders, using generalised linear mixed modelling. We assessed the association with time to treatment using time-dependent Cox regression shared frailty modelling. Findings: We included data for 29234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio [OR] 0·81; 95% CI 0·70-0·93; p=0·0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0·48; 95% CI 0·41-0·56; p

Aim: Different techniques are used to prevent bleeding during nephron-sparing renal surgery. In this study, our aim was to evaluate the results of partial nephrectomies performed with parenchymal clamping and pedicle clamping on postoperative renal function. Materials and Methods: The partial nephrectomy with parenchymal clamping and pedicle clamping technique was performed on 64 patients with renal cell carcinoma in our clinic. Operative time, ischemia time, and the total amount of blood loss was recorded. Creatinine levels were measured at the postoperative sixth month. Preoperative and postoperative glomerular filtration rates (GFR) were calculated using the Modification of Diet in Renal Disease formula. Patient age, basal metabolic index (BMI), tumor size, Fuhrman grade, ischemia time, operative time, amount of blood loss, preoperative and postoperative creatinine, and preoperative and postoperative GFR values were compared for both techniques. For statistical analysis, the student's t test and paired sample t tests were used. Results: There was a statistically significant deterioration of creatinine and GFR values for both groups postoperatively (p0.05). The amount of blood loss was significantly higher with the parenchymal clamping technique (377±65 vs 243±80; p=0.001). Conclusion: Parenchymal and pedicle clamping techniques can be used successfully in patients undergoing partial nephrectomy for renal tumors. There is a similar reduction in GFR values and an increase in creatinin values in both techniques. Although it carries the risk of large amounts of bleeding, the parenchymal clamping technique seems more advantageous because it does not necessitate pedicle dissection., Amaç: Nefron koruyucu cerrahi sırasında kanamanın engellenmesi için farklı teknikler uygulanmaktadır. Bu çalışmada parankimal klempaj ve pedikül klempajı ile yapılan parsiyel nefrektomilerin postoperatif böbrek fonksiyonuna etkilerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Kliniğimizde toplam 64 hastaya sırasıyla pedikül klempajı ve parankimal klempaj tekniğiyle parsiyel nefrektomi yapıldı. Tüm hastalarda operasyon süresi, iskemi süresi, aspiratörde toplanan kan miktarı kaydedildi. Hastaların postoperatif 6. ayda kreatinin değerleri ölçüldü. Preoperatif ve postoperatif glomerüler filtrasyon oranları Modification of Diet in Renal Disease formülü ile hesaplandı. Her iki klempaj tekniği yaş, bazal metabolizma indeksi (BMI), tümör çapı, Fuhrman derecesi, iskemi zamanı, operasyon süresi, kanama miktarı, preoperatif kreatinin, postoperatif kreatinin, preoperatif GFR, postoperatif GFR değerleri açısından karşılaştırıldı. İstatistiksel analiz için Student's t-test ve eşleştirilmiş örneklem t testi kullanıldı. Bulgular: Hastaların postoperatif kreatinin düzeylerinde artış, GFR düzeylerinde azalma görüldü. Bu bozulmalar istatistiksel olarak anlamlıydı (p0,05). Kanama miktarının parankimal klempaj tekniğinde anlamlı derecede yüksek olduğu görüldü (377±65'e karşı 243±80; p=0.001). Sonuç: Böbrek tümörü nedeniyle parsiyel nefrektomi yapılan olgularda pedikül ve parankimal klempaj teknikleri başarı ile uygulanır. Her iki yöntemde de GFR değerlerinde azalma ve kreatinin değerlerinde artış mevcuttur. Parankimal klempaj tekniği; kanama miktarının fazla olmasına rağmen pedikül diseksiyonu gerektirmediğinden avantajlı bir yöntemdir.

İstanbul için, XIX. yüzyılın ikinci yarısından itibaren, modern ve kurumsal anlamda bir kentiçi toplu taşıma hizmetinden söz edilebilir. Bu dönemde düzenli kentiçi vapur seferlerinin başlaması, tramvay ve tünel gibi raylı toplu taşıma sistemlerinin devreye girmesi kentsel toplu ulaşımda kilometre taşlarını oluşturmaktadır. Toplu ulaşım sistemlerinin kurulması İstanbul’un büyümesinde ve biçimlenmesinde belirleyici temel etkenlerden biri olmuştur. Dolayısıyla, İstanbul kentiçi ulaşım tarihi üzerinde yapılan çalışmaların İstanbul şehir tarihçiliği açısından da son derece önemli bir yere sahip olduğunu söylemek abartılı bir yaklaşım olmayacaktır. Son yıllarda bu alanda yapılan yayınlarda bir artış gözlemlenmektedir. Ancak bunun yeterli olduğunu söylemek oldukça güçtür. Dolayısıyla, bu konu üzerinde yapılacak araştırma faaliyetlerinin, gerek araştırma gerekse yayın aşamasında ilgili kurumlar tarafından desteklenmesi gerekir., It is possible to speak of modern and institutionalized public transportation services in Istanbul from the second half of the XIXth century onwards. During this period, the initiation of regular steamboat voyages in the city, as well as the construction of rail transportation systems such as the tram and the tunnel (Karaköy-Beyoğlu) constitute the milestones of the development of public transportation system in the city. The establishment of public transportation systems constitutes one of the main determinants that shaped the growth of Istanbul. Therefore, it will not be an exaggeration to state that the research on the history of public transportation in the city of Istanbul occupies an extremely important place within the context of urban historiography on Istanbul. Recent years have witnessed an increase in relevant publications. However, it is difficult to say that sufficient amount of work has been established. Therefore, scholarly work on the topic should be supported by relevant institutions at the stage of both research and publication.