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Purpose This study focuses on identifying potential challengers affecting cold chain performance in the pharmaceutical industry. Considering the history of humanity, every pandemic experienced could only be controlled with the vaccine found. While the world is fighting the unforgettable epidemic called COVID-19, scientists are also working to find the therapeutic vaccine. The vaccines studied have different temperature storage and transport properties. In the pharmaceutical industry, it is necessary to know and analyse every step of the cold supply chain to provide the most appropriate and safe cooling level. In addition, it is important to understand the relationship between all the facilities, equipment, tools and materials needed to avoid mistakes along the chain. Design/methodology/approach Hence, this study focuses on identifying potential challengers affecting sustainable cold supply chain performance in the pharmaceutical industry and proposing a conceptual framework that involves these main challengers. In this study, firstly, different main and sub-factors are defined from the literature, and fuzzy Decision Making Trial and Evaluation Laboratory method is applied to analyse the causal link between these factors for an effective application. Findings Results showed that packaging, transportation and shipping, storage specifications and handling practices, inventory management, technical issues and delivery delay are the most affected factors during the sustainable cold supply chain performance in the pharmaceutical industry. This study offers both managerial implications and a roadmap that are designed with a holistic view to guide manufacturer, logistics parties and even policymakers. Originality/value Some of the studies related to the pharmaceutical industry are monitoring and controlling the temperature in the cold supply chain steps; the other part is the studies where the chain steps are examined with a focus on production or transportation. While these issues are the focus, the requirements and conditions of each stage of the supply chain must be studied for a safe, effective and sustainable cold chain beyond the current global pandemic crisis. To the best of the authors’ knowledge, this is the first study that highlights identifying the potential challengers that affect cold supply chain performance for the pharmaceutical industry both theoretically and empirically, solving the causal relationships among these challengers and designing a holistic framework.

Purpose There is a large number of perishable foodstuffs produced, stored, distributed and delivered daily around the world. Almost all except for root vegetables are sensitive products to temperature. Thus, adopting uninterrupted and appropriate logistics activities with predetermined range of temperature from production site until end-user is critical for ensuring required quality and safety. If a mistake is made during either transport or storage, it not only becomes risky for human health, but also generates huge food waste for the environment and negative economic impact for food providers. Therefore, this study aims to identify all potential factors affecting the cold chain performance in the food industry and to design a framework that includes these factors. This framework is also a roadmap for managers, food providers and logistics parties for sustainable cold chain management. Design/methodology/approach Considering, tangible and intangible potential criteria, the ultimate goal of this study is to identify potential criteria affecting cold food chain performance and propose a conceptual framework including 12 main criteria. Next, the importance order of each criterion and the causal relationships between them are determined. In this study, this relationship among criteria is analyzed by using fuzzy Decision-making Trial and Evaluation Laboratory (DEMATEL) approach because of its ability to solve complex problems by ensuring causal relationship among factors, additionally to determine importance order. Finally, suggestions for administrative implications are presented. Findings Fuzzy DEMATEL was used to explain the causal link and importance order among identified drivers. The analysis shows that five criteria (C1, C3, C8, C9 and C12) belong to cause (influential) groups and remaining seven criteria belong to effect (influenced) groups. The highest influential criterion is staff (C8) and is followed by technical issues (C9) as the second most influential factor. Additionally, top three most important factors are traceability (C7), staff (C8) and cold transportation (C5). According to the numerical results of fuzzy DEMATEL implementations, suggestions for managerial implementations are presented. Practical implications The main contribution of the study is to propose meaningful suggestions for managerial implications about sustainable cold chain in food industry for businesses and to examine causal relations between criteria and to rank criteria in descending importance order. Originality/value To the best of the authors’ knowledge, this is the first study that focuses on determining the potential criteria affecting cold supply chain performance both theoretically and empirically in the sustainability environment. What are the enablers that affect the cold food supply chain stages is the research question of this study.

Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on PPE usage. Of those who received education only 36% was given both theoretical and applied education. Although there was no differences among different occupation groups, receiving education depended on regions. Conclusion: It is essential to educate healthcare personnel appropiately nationwidely for the continuity of qualified healthcare services during the pandemic.

Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on PPE usage. Of those who received education only 36% was given both theoretical and applied education. Although there was no differences among different occupation groups, receiving education depended on regions. Conclusion: It is essential to educate healthcare personnel appropiately nationwidely for the continuity of qualified healthcare services during the pandemic.

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific humoral immune persistence has been proposed to be affected by patients' characteristics. Moreover, available conflicting assay results are needed to be settled through comparative research with defined clinical specimens. Methods This prospective study investigated SARS-CoV-2-specific antibodies among 43 adults and 34 children at a mean of 12 weeks after the onset of COVID-19 symptoms using six serological assays and compared their performance. We used two Euroimmun (Euroimmun, Luebeck, Germany), two automated Roche Elecsys (Basel, Switzerland), and two rapid immuno-chromatographic Ecotest (Matrix Diagnostics, Assure Tech. (Hangzhou) Co., L, China) assays to investigate SARS-CoV-2 antibodies. Results The findings showed that the Roche Elecsys anti-S total test yielded the best positivity/sensitivity (children 94.1% and adults 93.0%; p = 0.877) while five immunoglobulin IgG targeting assays had similar positivity/sensitivity between children (88.2% to 94.1%) and adults (88.4% to 93.0%) (p0.05). Although IgM positivity was relatively low (p0.001), it was found in the majority of our pediatric and adult patients (67.6% and 86.0%, respectively; p = 0.098). SARS-CoV-2 S IgG titers were found to be higher among males in pediatric and adult groups compared to females (p = 0.027 and p = 0.041, respectively). Furthermore, we observed significantly higher antibody titers among pneumonia patients (p = 0.001). Conclusion Overall, we concluded SARS-CoV-2 antibody persistence over an average of 12 weeks after the onset of COVID-19 symptoms. While automated Roche Elecsys total antibody assays yielded the best sensitivity (90%) and five assays targeting IgG had acceptable performance. Patients with pneumonia and males have higher antibody titers. The effect of antibody persistence on re-infections should be monitored in longitudinal studies.

Micafungin is recommended especially in patients with liver and kidney failure and in the presence of other side effects due to antifungals apart from its known priority indications such as invasive candidiasis. The aim of this study was to evaluate the children who have received micafungin treatment. In the study, 125 children who were hospitalized in the pediatric wards and intensive care units of our hospital and had used micafungin between November 2016 and January 2019 were analyzed retrospectively. Clinical data, micafungin indication, blood values on the first and fourth days of the treatment, side effects of the drug and efficacy were evaluated. Sixty percent (75/125) of the patients were male and the mean age of all the patients were 58 ± 67 (0-215, 30) months. Approximately half of the cases (48%) had malignancy and 13% of them were premature. Sixty-two percent (n= 37) of the malignencies were hematological (27 acute lymphocytic leukemia, nine acute myeloid leukemia, one myelodysplastic syndrome) and 38% (n= 23) were oncological (six neuroblastoma, four Hodgkin lymphoma, two Non-Hodgkin's lymphoma, five sarcomas, one hepatoblastoma, five others) malignencies. The major cause of hospitalization was sepsis (53%). The patients had several risk factors like immunosuppressive therapy (n= 68, 54%), neutropenia (n= 61, 49%), central venous catheter (n= 102, 82%), nasogastric tube (n= 63, 50%), endotracheal intubation tube (n= 49, 39%), urinary catheter (n= 14, 11%) and total parenteral nutrition (n= 81, 65%). Thirteen percent (n= 16) of the cases were post-operative patients. Candida species were cultivated in 97 clinical specimens (blood, endotracheal aspirate, sputum, urine, etc.) among 23 (18%) of the patients. Thirteen (10%) of the patients had candidemia and 62% of them were non-albicans strains. In all candidemias, strains were echinocandin susceptible, and blood cultures were negative within four days. When all the patients (n= 125) were evaluated, a significant decrease in C-reactive protein, an increase in sodium, and a decrease in alanine aminotransferase were observed on the fourth day of micafungin treatment (p

Objectives: the aim of this study is to identify the epidemiological, clinical, and laboratory features of coronavirus disease 2019 (COVID-19) in children.Methods: a retrospective study was conducted by pediatric infectious disease specialists from 32 different hospitals from all over Turkey by case record forms. Pediatric cases who were diagnosed as COVID-19 between March 16, 2020, and June 15, 2020 were included. Case characteristics including age, sex, dates of disease onset and diagnosis, family, and contact information were recorded. Clinical data, including the duration and severity of symptoms, were also collected. Laboratory parameters like biochemical tests and complete blood count, chest X-ray, and chest computed tomography (CT) were determined. Results: there were 1,156 confirmed pediatric COVID-19 cases. In total, male cases constituted 50.3% (n = 582) and females constituted 49.7% (n = 574). The median age of the confirmed cases was 10.75 years (4.5-14.6). Of the total cases, 90 were younger than 1 year of age (7.8%), 108 were 1-3 years of age (9.3%), 148 were 3-6 years of age (12.8%), 298 were 6-12 years of age (25.8%), 233 were 12-15 years of age (20.2%), and 268 cases were older than 15 years of age (23.2%). The most common symptom of the patients at the first visit was fever (50.4%) (n = 583) for a median of 2 days (IQR: 1-3 days). Fever was median at 38.4 degrees C (38.0-38.7 degrees C). The second most common symptom was cough (n = 543, 46.9%). The other common symptoms were sore throat (n = 143, 12.4%), myalgia (n = 141, 12.2%), dyspnea (n = 118, 10.2%), diarrhea (n = 112, 9.7%), stomachache (n = 71, 6.1%), and nasal discharge (n = 63, 5.4%). When patients were classified according to disease severity, 263 (22.7%) patients were asymptomatic, 668 (57.7%) patients had mild disease, 209 (18.1%) had moderate disease, and 16 (1.5%) cases had severe disease. One hundred and forty-nine (12.9%) cases had underlying diseases among the total cases; 56% of the patients who had severe disease had an underlying condition (p < 0.01). The need for hospitalization did not differ between patients who had an underlying condition and those who do not have (p = 0.38), but the need for intensive care was higher in patients who had an underlying condition (p < 0.01). Forty-seven (31.5%) of the cases having underlying conditions had asthma or lung disease (38 of them had asthma). Conclusions: to the best of our knowledge, this is one of the largest pediatric data about confirmed COVID-19 cases. Children from all ages appear to be susceptible to COVID-19, and there is a significant difference in symptomatology and laboratory findings by means of age distribution., NA

Background: understanding SARS-CoV-2 seroprevalence among health care personnel is important to ex-plore risk factors for transmission, develop elimination strategies and form a view on the necessity and frequency of surveillance in the future. Methods: we enrolled 4927 health care personnel working in pediatric units at 32 hospitals from 7 different regions of Turkey in a study to determine SARS Co-V-2 seroprevalence after the first peak of the COVID-19 pandemic. A point of care serologic lateral flow rapid test kit for immunoglobulin (Ig)M/IgG was used. Seroprevalence and its association with demographic characteristics and possible risk factors were analyzed. Results: SARS-CoV-2 seropositivity prevalence in health care personnel tested was 6.1%. Seropositivity was more common among those who did not universally wear protective masks (10.6% vs 6.1%). Having a COVID-19-positive co-worker increased the likelihood of infection. The least and the most experienced personnel were more likely to be infected. Most of the seropositive health care personnel (68.0%) did not suspect that they had previously had COVID-19. Conclusions: health surveillance for health care personnel involving routine point-of-care nucleic acid testing and monitoring personal protective equipment adherence are suggested as important strategies to protect health care personnel from COVID-19 and reduce nosocomial SARS-CoV-2 transmission., NA

Micafungin is recommended especially in patients with liver and kidney failure and in the presence of other side effects due to antifungals apart from its known priority indications such as invasive candidiasis. The aim of this study was to evaluate the children who have received micafungin treatment. In the study, 125 children who were hospitalized in the pediatric wards and intensive care units of our hospital and had used micafungin between November 2016 and January 2019 were analyzed retrospectively. Clinical data, micafungin indication, blood values on the first and fourth days of the treatment, side effects of the drug and efficacy were evaluated. Sixty percent (75/125) of the patients were male and the mean age of all the patients were 58 ± 67 (0-215, 30) months. Approximately half of the cases (48%) had malignancy and 13% of them were premature. Sixty-two percent (n= 37) of the malignencies were hematological (27 acute lymphocytic leukemia, nine acute myeloid leukemia, one myelodysplastic syndrome) and 38% (n= 23) were oncological (six neuroblastoma, four Hodgkin lymphoma, two Non-Hodgkin's lymphoma, five sarcomas, one hepatoblastoma, five others) malignencies. The major cause of hospitalization was sepsis (53%). The patients had several risk factors like immunosuppressive therapy (n= 68, 54%), neutropenia (n= 61, 49%), central venous catheter (n= 102, 82%), nasogastric tube (n= 63, 50%), endotracheal intubation tube (n= 49, 39%), urinary catheter (n= 14, 11%) and total parenteral nutrition (n= 81, 65%). Thirteen percent (n= 16) of the cases were post-operative patients. Candida species were cultivated in 97 clinical specimens (blood, endotracheal aspirate, sputum, urine, etc.) among 23 (18%) of the patients. Thirteen (10%) of the patients had candidemia and 62% of them were non-albicans strains. In all candidemias, strains were echinocandin susceptible, and blood cultures were negative within four days. When all the patients (n= 125) were evaluated, a significant decrease in C-reactive protein, an increase in sodium, and a decrease in alanine aminotransferase were observed on the fourth day of micafungin treatment (p0.05). A total of 39 (31%) patients underwent various antifungal treatments for median seven (1-60) days prior to micafungin treatment. Fourteen (36%) of these 39 patients, had elevated liver function tests (LFT), 10 (26%) of them had hypokalemia, and five (13%) of them had elevated renal function tests. Ten (26%) patients had antifungal-induced hypokalemia previously; and potassium levels were normalized after micafungin treatment (p= 0.0001). The patients for which micafungin treatment was chosen due to elevated liver function tests (n= 47, 38%), whether the antifungalinduced or not; alanine aminotransferase and aspartate aminotransferase levels were decreased after micafungin treatment (p= 0.0001 and p= 0.0001, respectively). Nineteen (15%) of the patients have died within the first 30 days of micafungin treatment and one of them had candidemia. No micafungin treatment related significant side effects were observed in any of the patients. Our study showed that micafungin could be a safe and effective option in pediatric cases including newborns with high liver and kidney function tests.

Bu çalışma beş bölümden oluşmaktadır. Çalışmanın ilk bölümünde öncelikle çalışmanın tarihi süreci ele alınmıştır. İkinci bölümde ise bulanık kümelerin genel özelliklerine değinilmiş bulanık topolojik uzay tanımı verilmiştir. Ayrıca bu bölümde sezgisel bulanık küme kavramı tanıtılmıştır. Tezin üçüncü bölümünde sezgisel bulanık küme kavramının bazı özellikleri kullanılarak çeşitli teoremler ispatlanmıştır.Tezin dördüncü bölümde ise Sostak anlamında sezgisel bulanık topolojik uzay tanımı ve özellikleri verilmiştir. Son olarak bu bölümde bulanık (r,s)-yarı açık küme ve bulanık (r,s)- yarı kapalı küme tanımları incelenmiştir.Tezin son bölümde ise tartışma ve sonuç kısmı verilmiştir.Anahtar kelimeler : Bulanık kümeler, Sezgisel bulanık topoloji, Sostak anlamında sezgisel bulanık topolojik uzay, bulanık (r,s)- yarı açık küme ve bulanık (r,s)- yarı kapalı küme. This study consists of five parts. In the first part of the study, the historical process of study is was first considered. In the second part, the definition of fuzzy topological spaces is given, which refer to general properties of fuzzy clusters.In addition, this section introduces the concept of ıntuitionistic fuzzy sets. In the third part of thesis, various theorems have been proved by using some features of the concept of ıntuitionistic fuzzy sets.In the fourth part of the thesis, definition and properties of topological space in the sense of Sostak are given. Finally, in this section, fuzzy (r,s)-semiopen cluster and fuzzy (r,s)- semiclosed cluster definitious are examined.In the last part of the thesis, discussion and conclusion part are given.Key Words : Fuzzy topology,intuitionistic fuzzy sets, intuitionistic fuzzy topological space in Sostak'ın sense fuzzy (r,s)-semiopen cluster and fuzzy (r,s)-semiclosed cluster. 55