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In this study, the green human resources management (G-HRM) functions, which will enable green management to be realized in enterprises, were discussed, and the Fuzzy AHP method was used to determine the importance levels of 10 different G-HRM functions in the literature. GHRM functions were evaluated by 3 experts with 10 years of experience in the field. According to the results obtained after the evaluation, it has been determined that the most important of the GHRM practices in health enterprises are respectively: “green organizational culture and green adoption strategies” with 29.8%, “green business design” with 17.4% and “green education and development” with 11.7%. It contributes to sustainability with the green organizational culture and the environmentalist identity and behaviors of the personnel in the health enterprises to adopt the green strategy. It is essential to increase the knowledge level of employees about green strategy through training and development practices. The full success of green management in enterprises is possible with the total consideration and application of the criteria included in the research. As a matter of fact, in the prepared study a comprehensive perspective on the functions of G-HRM is presented to the health managers and human resources professionals.

Abstract Background Bilateral sacral fractures result in traumatic disruption of the posterior pelvic ring. Treatment for unstable posterior pelvic ring fractures should aim for fracture reduction and rigid fixation to facilitate early mobilization. Iliosacral screw fixation (ISF) and lumbopelvic fixation (LPF) were recommended for the treatment of these injuries. No algorithm or gold standard exists for surgery of these fractures. Purpose The purpose of this study was to evaluate the differences between ISF and LPF in bilateral sacral fractures regarding intraoperative procedures, complications and postoperative mobilization. The secondary aim was to determine whether demographics influence surgical treatment. Methods Over a 4-year period (2016–2019), 188 consecutive patients with pelvic ring injuries were treated at one academic level 1 trauma center and retrospectively identified. Fractures were classified according to the AO/OTA classification system. Seventy-seven patients were treated with LPF or ISF in combination with internal fixation of pubic rami fractures and could be included in this study. Comparisons were made between demographic and perioperative data. Infection, hematoma and hardware malpositioning were used as complication variables. Mobilization with unrestricted weight bearing was used as outcome variable. Follow-up was at least 6 months postoperatively. Results Operative stabilization of bilateral posterior pelvic ring injuries was performed in 77 patients. Therefore, 29 patients (females 59%) underwent LPF whereas 48 patients (females 83%) had bilateral ISF. The ISF group was older (76 yrs.) compared to the LPF group (62 yrs.) (p = 0.001), but no differences regarding BMI or comorbidities were detected. Time for surgery was reduced for patients who were treated with ISF compared to lumbopelvic fixation (73 min vs. 165 min; respectively, p

Resumo Fundamento A insuficiência cardíaca com fração de ejeção reduzida (ICFEr) é uma doença de alta prevalência que requer hospitalizações repetidas e causa morbimortalidade significativa. Portanto, o reconhecimento precoce de preditores de resultados desfavoráveis é essencial para o manejo do paciente. Objetivo O objetivo do presente estudo é investigar a relação entre realce tardio pelo gadolínio (RTG) detectado por ressonância magnética cardíaca (RMC) e os parâmetros de repolarização, como o intervalo QT corrigido (QTc), intervalo Tp-e, ângulo QRS-T frontal detectado pelo eletrocardiograma (ECG) de 12 derivações na ICFEr. Método Neste estudo observacional, retrospectivo, de centro único, foram incluídos 97 pacientes consecutivos com ICFEr submetidos à RMC. A população do estudo foi dividida em dois grupos, de acordo com a presença de RTG. Foram registradas medidas ecocardiográficas e de RMC e características demográficas. Os intervalos QTc, intervalos Tp-e, e ângulos QRS-T frontais foram calculados a partir do ECG. Um valor de p

Abstract Background Even though surgical techniques and implants have evolved, periprosthetic joint infection (PJI) remains a serious complication leading to poor postoperative outcome and a high mortality. The literature is lacking in studies reporting the mortality of very elderly patients with periprosthetic joint infections, especially in cases when an intensive care unit (ICU) treatment was necessary. We therefore present the first study analyzing patients with an age 80 and higher suffering from a periprosthetic joint infection who had to be admitted to the ICU. Methods All patients aged 80 and higher who suffered from a PJI (acute and chronic) after THR or TKR and who have been admitted to the ICU have been included in this retrospective, observational, single-center study. Results A total of 57 patients met the inclusion criteria. The cohort consisted of 24 males and 33 females with a mean age of 84.49 (± 4.0) years. The mean SAPS II score was 27.05 (± 15.7), the mean CCI was 3.35 (± 2.28) and the most patient had an ASA score of 3 or higher. The PJI was located at the hip in 71.9% or at the knee in 24.6%. Two patients (3.5%) suffered from a PJI at both locations. Sixteen patients did not survive the ICU stay. Non-survivors showed significantly higher CCI (4.94 vs. 2.73; p = 0.02), higher SAPS II score (34.06 vs. 24.32; p = 0.03), significant more patients who underwent an invasive ventilation (132.7 vs. 28.1; p = 0.006) and significantly more patients who needed RRT (4.9% vs. 50%; p

Homogeneous charge compression ignition engines are engines with low temperature combustion tendency and high thermal efficiency. The operating range of these engines, where there is no direct control over combustion, is limited because of knock and misfire problems. At this point, it is aimed to eliminate the knocking problem especially at high loads with the mixture composition taken into the cylinder and different operating parameters. HCCI combustion is highly affected by engine operating parameters. In this study, a single-cylinder four-stroke spark-ignition engine was converted to a homogeneous charge compression ignition engine. The test engine was operated with hexane and n-heptane fuel mixtures at 1400 rpm and between 1.9 and 2.74 air excess ratio in full load HCCI combustion mode. The effects of hexane fuel on cylinder pressure, heat release rate, in-cylinder temperature, combustion duration, start of combustion, cyclic variations, knock density, indicated mean effective pressure (imep), thermal efficiency and emissions (HC and CO) were investigated experimentally. In the experiments carried out at constant intake air inlet temperature, it was observed that the cylinder pressure and heat release rate decreased with increasing air excess ratio. As a result, HCCI combustion was found to be highly affected by air excess ratio and fuel composition. It has also been found that the range of operation can be extended in the knock boundary zone in HCCI combustion.

To provide a summary and overview of the use of Hybrid Assistive Limb in spinal cord injured patients over the past 10 years. A review of the literature was performed via Web of Science and PubMed using the search terms “Hybrid assistive limb” or “HAL“ or “wearable robot“ or “exoskeleton” and “SCI” or “spinal cord injury” by two of the authors. Relevant articles were then studied in full text. Our review of the literature found 21 articles that met the inclusion criteria of this narrative review including 344 participants. Articles were sorted into two general categories: (1) clinical trials, and (2) single-case or two-case reports. The vast majority of patients improved functionally, showing increased walking distances, walking speeds, and endurance. In addition, a variety of other advances were described, such as temporary decrease in spasticity, improvement in bladder and bowel management, pain reduction, and change in muscle activity. Even though there is no uniform application of HAL training in people living with SCI the current study situation suggests that many patients could benefit from this innovative training within their means.

In recent years robotic devices became part of rehabilitation offers for patients suffering from Spinal Cord Injury (SCI) and other diseases. Most scientific publications about such devices focus on functional outcome. The aim of this study was to verify whether an improvement in physiological gait can be demonstrated in addition to the functional parameters after treatment with neurological controlled HAL® Robot Suit. Fifteen subjects with acute (12 months since injury, n = 10) incomplete paraplegia (AIS B, n = 0/AIS C, n = 2/AIS D, n = 8) or complete paraplegia (AIS A, n = 5) with zones of partial preservation participated. Subjects underwent a body weight supported treadmill training for five times a week over 12 weeks using HAL®. At baseline and at the end of the study a gait analysis was performed and additional functional parameters such as 10-Meter-Walk-Test, Timed-Up-and-Go-Test, 6-Minutes-Walk-Test, and WISCI II score were collected. Results were evaluated for whole group and individually for acute and chronic subgroups. All functional parameters improved. Differences were also found in physiological parameters such as phases of gait cycle and accompanied by significant improvement in all spatiotemporal and gait phase parameters. The presented study shows signs that an improvement in physiological gait can be achieved in addition to improved functional parameters in patients with SCI after completing 12-week training with HAL®.Trial Registration: DRKS, DRKS00020805. Registered 12 February 2020—Retrospectively registered, https://www.drks.de/DRKS00020805.

The results of the survey conducted on 59 fishermen have been evaluated within the scope of the study aiming at determining some data related to the socio-economic structure and fishing activities of the fishermen in the lakes of Eğirdir and Beyşehir in Isparta, and the lakes of Marmara and Demirköprü Dam in Manisa having great importance in terms of inland fishing. It has been determined that the highest percentage of fishermen was found to be between the ages of 46-65 in the other fishing grounds with the except of Beyşehir Lake. 75% of the fishermen in the other fishing places excluding Marmara Lake has been found married and the number of children, except for the Demirköprü Dam Lake, was mostly 1or 2. While the percentage of those fisherfolks was the highest in Beyşehir Lake (57.1%), it was followed by Demirköprü Dam Lake (50%), Eğirdir Lake (36.4%) and Marmara Lake (25%), respectively. The highest rate of fishing and agricultural income was found in Beyşehir Lake whereas the highest rate of agricultural and non-agricultural income sources as well as fishery was found in Lake Eğirdir. Materials of fishing vessels consist of fiber, wood and metal sheet. The 43.2% of fishing boats in Eğirdir Lake and the 75% of those in Demirköprü Dam Lake were 5-6 m length while all boats in Lake Beyşehir were 7.1-8 m length. The number of boats having 9-13 HP engine power was found to be higher in the lakes of Eğirdir and Beyşehir than that in the lakes of Marmara and Demirköprü Dam. It has been found that the fishing activities take place 5 days in a week in Eğirdir Lake and 7 days in the other three fishing grounds, and the daily fishing varied between 3-7 hours in all fishing grounds. The annual fishing income and expenditure values of Demirköprü Dam Lake, Marmara Eğirdir and Beyşehir Lakes was generally lower than TRY 25.000. It was found that fuel-maintenance and repair expenses were below TRY 5000 in all fishing grounds. Most of the fishermen in Marmara Lake have received a bank credit (20%: TRY 30.000) for purchasing a fishing tool while the ones in Eğirdir Lake have used this loan in order to buy a tractor as well as a fishing tool or for any other needs. It was seen that carp in Marmara Lake and Demirköprü Dam Lake and pikeperch in Beyşehir Lake were the species of fish mostly caught whereas the crayfish mostly caught in Lake Eğirdir. It has been determined that a trammel net was in use all of the fishing areas, and that trammel net, a crayfish trap and a fishing rod were not used at the same time.

In the current study, combustion and performance characteristics of a direct injection diesel engine fuelled with the blends of 10% fish oil biodiesel and 90% diesel fuel were investigated experimentally. For this reason, the test engine was run at 2200 rpm and 3.75, 7.5, 11.25 and 15 Nm engine loads. The variations of in-cylinder pressure, heat release, combustion duration, ignition delay, thermal efficiency and specific fuel consumption were observed. In-cylinder pressure and heat release increased while combustion duration was shortened with fish oil biodiesel. Test results showed that in-cylinder temperature increased with fish oil biodiesel. Indicated mean effective pressure (imep) and indicated thermal efficiency (ITE) decrased owing to lower calorific value of fish oil biodiesel. ITE was determined as 28.27% with diesel whereas 25.58% with B10 at 11.25 Nm engine load. Specific fuel consumption (SFC) was computed as 0.162 kg/kWh with diesel while 0.214 kg/kWh with B10 with the increase of about 32%. Test results showed that the blends of fish oil biodiesel-diesel can be utilized without modifications in diesel engines and combustion characteristics were improved.

Isolated fractures of the atlas are rare in the pediatric population and it is imperative to properly diagnose the injury with accurate radiological evaluation. Herein, we report a case of a six-year-old child who presented with posterior head and neck pain after a fall. His initial workup, which included plain radiographs, missed a fracture of his atlas, which was only later diagnosed with additional imaging. Aside from neck pain, the patient remained neurologically intact and was successfully treated with a hard cervical collar. Isolated pediatric anterior arch fractures of the atlas can be treated conservatively with a hard collar. The case presented here highlights a delayed diagnosis of a fracture of the anterior arch of the atlas. Despite their rarity, various clinicians should maintain a high level of suspicion as these fractures may be easily overlooked in children on plain radiographs. Keywords: Atlas, Fracture, Pediatric

Little is known about patients with Periprosthetic Joint Infection (PJI) admitted to the Intensive Care Unit (ICU). The purpose of this study was threefold: i) To report the microbiological findings of ICUpatients with PJI. ii) To compare the clinical data between Difficult-To-Treat (DTT) and non-DTT PJI. iii) To identify risk factors for mortality. This is a retrospective study from a tertiary healthcare center in Germany from 2012-2016. A total of 124 patients with 169 pathogens were included. The most common bacteria were Staphyloccous aureus (26.6%), Staphyloccus epidermidis (12.4%), Enterococci ssp. and Escherichia coli (respectively 9.4%). DTT PJI was diagnosed in 28 patients (22.6%). The main pathogens of DTT PJI were Staphylococus epidermidis (14.5%), Escherichia coli (12.7%), Staphylococcus aureus and Candida spp. (respectively 9.1%). Polymicrobial PJI, number of pathogens, ICU stay and mortality were significantly differrent between DTT PJI and non-DTT PJI (p≤0.05). Multivariate logistic regression identified prolonged ICU stay and DTT PJI as risk factors for mortality. In conclusion, we suggest, that the term of DTT pathogens is useful for the intensivist to assess the clinical outcome in ICU-patients with PJI.

NCI-2019-0309.R2

Abstract Objective: To evaluate the prognostic value of C-reactive protein to albumin ratio (CAR) in patients with severe aortic valve stenosis undergoing surgical aortic valve replacement (AVR). Methods: Four hundred seventy-six patients with severe degenerative aortic stenosis who underwent successful isolated surgical AVR were enrolled. Hospitalization due to heart failure, surgical aortic reoperation, paravalvular leakage rates, and long-term mortality were evaluated in the whole study group. The participants were divided into two groups, as 443 patients without mortality (group 1) and 33 patients with mortality (group 2) during the follow-up time. Results: CAR was lower in patients without mortality than in those with mortality during the follow-up time (0.84 [0.03-23.43] vs. 2.50 [0.22-26.55], respectively, P