bluuebunny/crossref_metadata_2025 huggingface dataset:
KENTSEL MEKÂN DÜZENLERİNİN PASİF HAVALANDIRMA ve GÜNEŞLENME KRİTERLERİ ÜZERİNDEN SORGULANMASI
Authors: ÇAMAŞ Nurdan Çağla , EKŞİOĞLU ÇETİNTAHRA Gözde
Published: November 2022

Kentsel alanlar, yoğun insan faaliyetleri ve yapılaşma koşulları nedeniyle iklim değişikliğinde etken bir rol oynamaktadır. Özellikle yerel iklimsel koşullara uygun olmayan kentsel dokularda kentsel ısı adası etkisi artmakta ve bu durum küresel ısınmaya, ekolojik dengelerin bozulmasına neden olmakta ve toplum ve birey için kentsel yaşantıyı sağlıksız bir duruma getirmektedir. Ancak kentsel mekânda pasif tasarım ilkelerine uygun mekânsal düzenlemeler yapılarak bu tür olumsuz durumların azaltılabileceği akademik alanda sıklıkla tartışılmaktadır. Pasif aydınlanma-ısınma ve havalandırma-serinleme esaslarına dayalı olan pasif tasarım ilkeleri, yerel iklimsel koşullara uygun mekânsal düzenler kurgulanarak sağlanabilecektir. Bu kabulden yola çıkılarak hazırlanan bu çalışmada, yapılaşmış bir alanda güneş ve rüzgâr parametreleri üzerinden pasif havalandırma ve güneşlenmeye uygunluk durumuna ilişkin nesnel ölçüm yöntemlerine dayalı bir sorgulama yapılmıştır. Çalışmada, İzmir İli Karşıyaka İlçesindeki farklı morfolojik özelliklere sahip alanlarda bilgisayar destekli yazılımlar kullanılarak güneş ve rüzgâr analizleri yapılmıştır. Analizler sonucunda elde edilen güneşlenme ve havalandırma verileri, yapı adası formu, yönlenmesi, mahalle genelinde doluluk-boşluk oranı, yapı yüksekliği, yapılar arası mesafe kriterleri üzerinden tartışılmıştır. Çalışmanın sonuçları, yapı adası formlarının, yapılar arası mesafelerin, alanlardaki doluluk-boşluk oranlarının farklılaştığı durumlarda pasif tasarım kriterlerinin karşılanmasında birtakım sorunlu durumlar oluştuğunu göstermektedir. Çalışma, mevcut kentsel bir dokunun yapılaşma düzeninin yerel iklimsel değişkenlere ne düzeyde uyumlu olduğunu belirlemeye çalışması açısından mekân düzenleme disiplinleri ile ilişkili literatüre önemli katkı sunmaktadır.
YAŞAM KALİTESİ YAKLAŞIMLARININ ÇEVRE, KENT VE PLANLAMA EKSENİNDE DEĞERLENDİRİLMESİ
Authors: EKİCİ Yağmur Ecenaz , ZENGİN ÇELİK Hayat
Published: November 2022

Yaşam kalitesi, günümüzde tüm toplumların ulaşmak istediği evrensel bir hedef haline gelmiştir. Çok boyutlu ve multidisipliner bir kavram olarak, birden çok disiplinin ortak tartışma konusu haline gelmesi nedeniyle, farklı tanım ve göstergeler ile ele alınarak değerlendirilmektedir. Bununla birlikte araştırmacılar, yaşam kalitesinin iki boyutu olduğu konusunda ortak fikir birliğindedir. Bunlardan ilki, bireyin yaşadığı hayattan duyduğu tatmin ve memnuniyet düzeyini belirleyen öznel göstergeler; ikincisi ise bireyin öznel algısını şekillendiren nesnel göstergelerdir. Zaman içerisinde yaşanan toplumsal ve sosyal değişimler ile, tartışma konusu olduğu disiplinin değerlendirme sistemine göre, yaşam kalitesi, yaşamın farklı boyutlarıyla değerlendirilmektedir. Kent planlama alanında da farklı biçimlerde kavramsallaştırılan yaşam kalitesi, çevre ve kent kalitesinin etkileşimine odaklanarak daha özel bir alan olan ‘kentsel yaşam kalitesi’ kavramını ortaya çıkarmaktadır. Ülkemizde yaşanan hızlı kentleşme ve göç oranlarının artması ile buna bağlı olarak yaşanan kentleşme, kentlileşme ve uyum problemleri, kentsel hizmetlerin yetersiz kalması, nüfus grupları arasında yaşanan sosyo-ekonomik ve kültürel yapıda yaşanan farklılaşmalar gibi sorunlar, kentsel yaşam kalitesini olumsuz yönde etkilemeye başlamıştır. Bu nedenle, ülkemiz kentlerinde yaşanan hem mekânsal hem de toplumsal iyileşmenin gerekliliği karşısında, yaşam kalitesi, sorunların tespit edilmesi için bir yöntem ve ulaşılmak istenen bir hedef olmaktadır. Aynı zamanda, mekânsal bir müdahale biçimi olan kentsel dönüşüm uygulamaları ile ilişkilenmektedir. Bu çalışmada, yaşam kalitesinin farklı disiplinlerde yeraldığı biçimi ile ölçümünde kullanılan göstergeler üzerinde durulmakta ve kent planlama disiplini içindeki ele alış şekilleri ile bağlantı kurulmaya çalışılmaktadır.
Uppdragsarkeologiska möjligheter
Authors: Högberg Anders , Alfsdotter Clara , Dutra Leivas Ivonne , Eboskog Mikael , Engström Elin , Holtorf Cornelius , Jonsson Kristina , Knutson Charina , Smits Vivian , Svedin Marie , Söderström Ulrika
Published: November 2022

In this text we discuss how Swedish contract archaeology can develop its socialengagement by creating new areas of relevance to society, beyond the generalactivities of disseminating results. We do so by giving concrete examples of howthis can be done, using archaeological excavations as a starting point. The examplesinclude engaging the local community in future planning for a social sustainableliving environment, collaboration with the tourism sector, development of teachingmaterials for secondary schools, memory training for people with acquired braindamage, and school programs focusing on a socially sustainable and inclusive society.The purpose of the text is to inspire change, by showing development opportunitiesfor future contract archaeology that will benefit both performers and recipients,and contribute to society’s multifaceted needs.
RETRACTED - Clergy Sexual Abuse and an Ethics of Recognition: An Example of the #ChurchToo Movement in South Korea
Authors: Kwon David ,   Philosophy Documentation Center
Published: November 2022

RETRACTION NOTICE: This article has been retracted at the request of its author, David Kwon. The author acknowledges citation irregularities throughout the article as the reason for the retraction. The editors of the journal supports this retraction. The article will only be available with this retraction notice.
Rahner’s Idea of Freedom in Selected Secondary Literature
Authors: Doud Robert E. ,   Philosophy Documentation Center
Published: November 2022

The importance and influence of Karl Rahner’s theology is due in great part to the number of excellent scholars who have elucidated his thinking over the years. This article assembles considerations of Rahner’s idea of freedom as found in the rich secondary literature on Rahner. Rahner’s ethics, and indeed much of his theology, rests upon the idea of discernment, his own spiritual experience, and the Ignatian practice of discernment of spirits. Discipleship with Jesus and the love of neighbor, all undergirded by the person’s free response to God’s grace and revelation, is the horizon that embraces all of what Rahner has to say. The idea of freedom rests at the basis of Rahner’s understanding of the human person, our call to discipleship, and our fundamental choice to grow in God’s grace.
Air-Lasing: High-Resolution Spectroscopy for Atmospheric Remote Sensing
Authors: Haisu Zhang  , Lingling Qiao  , Ya Cheng  ,   1) (State Key Laboratory of Precision Spectroscopy, East China Normal Univeristy, Shanghai 200241, China),   2) (Shanghai Institute of Optics and Fine Mechanics, Chinese Academy of Sciences, Shanghai 201800, China)
Published: November 2022

Air-lasing is a cavityless coherent radiation generated in free space from air constituents as the gain medium, featuring significant advantages such as high collimation, high coherence and high intensity. Benefited from the long-range filamentation of high-power ultrashort laser pulses propagating in air, the air-laser can be induced remotely which provides an ideal light source for atmospheric remote sensing and chemical specie-resolved detection. Thanks to the coherent atomic/molecular excitation process accompanying the generation of air laser, remote sensing based on air-laser has high spectral resolution and high detection sensitivity, which is recently proved to be a powerful tool for important applications such as trace molecule detection, greenhouse gas monitoring and industrial pollutant detection. In this short review, the physical mechanism of air laser is briefly introduced, and various applications of air laser remote sensing are reviewed emphatically, and the future research is prospected.
Optimization of beam arrangement for tunable diode laser absorption tomography reconstruction based on fractional Tikhonov regularization
Authors: Pang Wei-Xu , Li Ning , Huang Xiao-Long , Kang Yang , Li Can , Fan Xu-Dong , Weng Chun-Sheng ,   National Key Laboratory of Transient Physics, Nanjing University of Science and Technology, Nanjing 210094, China
Published: November 2022

Beam arrangement with limited projections based on tunable diode laser absorption spectroscopy is the key to achieving a more accurate two-dimensional reconstruction of the combustion. Using fractional calculus theory, a beam optimization method based on fractional Tikhonov regularization is proposed. The beam arrangement function based on fractional Tikhonov regularization is established by extending the standard Tikhonov regularization to fractional modes. The genetic algorithm is used to analyze the calculation results of different orders in a range of (0, 1), and the beam arrangement is obtained. Using 20 laser beams to scan the characteristic absorption spectrum of H2O in the near-infrared band 7185.6 cm–1, modeling the calculations in a 10×10 element discrete tomography domain, and comparing the reconstruction results of the five beam arrangements for different Gaussian distribution models, the beam arrangement based on fractional Tikhonov regularization shows more obvious advantages. This design method proposed in this work is valuable for the theoretical study of the optimal design of two-dimensional measurement beams based on the tunable diode laser absorption spectroscopy technique, which can promote the application of this technique in the two-dimensional reconstruction of complex engine combustion and combustion efficiency improvement.
Time-inversion technique based correction of complex radome radiation beam distortion
Authors: An Teng-Yuan , Ding Xiao , Wang Bing-Zhong ,   Institute of Applied Physics, University of Electronic Science and Technology of China, Chengdu 611731, China
Published: November 2022

In the electromagnetic wave radiated by radome, there often occur pointing angle deviation, beam distortion and other phenomena, due to the complex electromagnetic medium composition, special contour and complex working environments. For conventional optimization methods, harsh and complex situations increase its workload, especially in the case that the specific location parameter information is unknown. In this paper, a method with time-inversion technique for correcting the radiation beam distortion of the complex radome is proposed. With the time-inversionl method, the concrete parameters of different positions for the radome and the surrounding environment information are not necessary to be determined in advance. The derivation shows that the environmental information is eliminated adaptively by the conjugate convolution operation, and it is proved by numerical operation that the signal of maximum radiation gain in target angle is time-inversion signal. Then based on the adaptive focusing properties of time-inversion electromagnetic waves, a top wedge radome and an icing working radome are taken as the case study. The equal amplitude phase shifting serves as the control group to highlight the advantages of time-reversal. In the end, the results show that the radiation beam pointing error can be reduced from ±10° to ±0.9° within ±45° scanning range for the top wedge radome in C-band. And the annihilated main beam can be converged again for the radome in the icing state. In addition, all the improvements are in a broadband range, and the robustness of the entire radome system is enhanced by increasing target angle energy caused by the increasing the directionality of the array radiation and the narrowing the 3 dB beamwidth. This paper provides an effective method of analyzing the complex radomes and radio wave propagations in complex media.
The Protection of the EU's Financial Interests and Pandemic Emergency Tools: an Analysis of the Control Mechanism between the EU and the Member States
Authors: Nato Alessandro , Bontempi Valerio
Published: November 2022

The paper examines three case studies: RescEU, SURE, and EU support for SMEs. These case studies represent three relevant EU actions that responded to the first phase of the Covid-19 emergency in the sectors of health, work, and economic support for businesses. The main research questions
are: What kind of actions have been financed in these sectors with EU funds? What kind of administrative checks were carried out for these EU emergency funds? The paper looks at these issues from a multilevel perspective: starting from the EU framework it reaches national levels, especially
Italy, Poland, Belgium, and Germany. In the conclusions, the paper seeks to understand how promptly the EU emergency actions were taken and whether the planned controls prevented fraud.
Ocular Manifestations in Psoriasis Patients Attending a Tertiary Care Centre, Srikakulam, Andhra Pradesh, India: A Cross-sectional Study
Authors: Sativada Lakshmi , Vudayana Dineshkanth , Chintada Dilipchandra , Vudayana Kirankanth , Sappa Ramatulasi
Published: November 2022

Introduction: Psoriasis is known to be proliferative, relapsing inflammatory disorder affecting mainly skin and other parts of body. There are several co-morbidities associated with psoriasis, of which ocular findings go unnoticed. Aim: To study the spectrum of ocular manifestations in psoriasis patients in Srikakulam, north coastal region of Andhra Pradesh, India and also to identify relationship between frequency of ocular involvement in psoriasis patients with age, gender, type and severity of psoriasis. Materials and Methods: The present cross-sectional study was conducted from March 2019 to March 2021 at Great Eastern Medical School and Hospital, Ragolu, Srikakulam, Andhra Pradesh, India. The study included 80 psoriasis patients attending dermatology Outpatient Department (OPD) to know various ophthalmological manifestations. Detailed dermatological examination was done followed by ophthalmological examination. Clinical types of psoriasis, site of involvement, and the severity of the disease using Psoriasis Area and Severity Index (PASI) were noted. Statistical analysis was done using Z-test, Pearson’s correlation coefficient and linear regression coefficient. Results: Out of 80 patients with psoriasis, 51 (63.75%) were males and 29 (36.25%) were females. Out of total 80 patients, 56 (70%) patients had ophthalmic manifestations. The mean age of presentation was noted to be 49.22±8.53 years with range from 18-76 years. Most of the patients i.e. 30 (54%) had bilateral manifestations in both the eyes. Nearly 10 (18%) of psoriasis patients had multiple ocular manifestations. The p-value was calculated based on PASI score and with ocular manifestations which was found to be 0.0485 and was statistically significant. Cconclusions: Regular screening of psoriasis patients is useful in identification of ocular problems which may not be noticed by the patients until symptomatic.
COVID-19 Vaccine Hesitancy among the Non Medical Adult Population Attending a Tertiary Care Hospital of Kolkata, India: A Cross-sectional Study
Authors: Roy Atanu , Paloh Oyimang , Bhattacharya Saikat , Mondal Soumitra
Published: November 2022

Introduction: Vaccines play an important role in the fight against diseases whose cure is unavailable. In the battle against pandemics such as Coronavirus Disease-2019 (COVID-19), the vaccine is the only available course of prevention. The hesitancy has been found all over the world, while some find it against their religious values, others are concerned about safety, or have doubts about its efficacy. Some are hesitant due to fear of needles while some show brass negligence. Being the second most populated country globally and a developing nation, India had faced its fair share of struggles with her citizens vaccinated. Even a minute percentage of people accounts for millions; hence, it is of utmost importance to get to the root of the causes of delay in vaccination. Aim: To find the causes of delay or hesitancy among the people attending COVID-19 vaccination centre of a tertiary care hospital of Kolkata, (a year after vaccines were introduced to the general population). Materials And Methods: A cross-sectional study was performed in the COVID-19 vaccination centre of Medical College Kolkata, West Bengal, India, from 14th January to 14th April 2022. Total 74 non medical (not related to healthcare work) people who had come for 1st or 2nd dose of COVID-19 vaccination were included in the study. A prestructured, pretested, prevalidated questionnaire was used to collect data from the participants of the study. The Likert scale comprising of nine questions were used to assess hesitancy. Data were analysed using Chi-square test. Binary logistic regression was done to confirm any predictability of occupation, literacy rate, age and gender on vaccine hesitancy. Results: The participants comprised of 45 (60.8%) females and 29 (39.2%) males, aged between 18 to 60 years with the mean age of 33.75±11.06 years. The participants included 22 (29.7%) people who had just taken their first dose. Twenty six (35.1%) participants were hesitant. The most common causes of hesitancy were individuals’ fear of the vaccine and its impact on general health, unavailability of slots for vaccination and reluctance. Out of total, 58 (78.4%) people had faith in vaccines made in India and 48 (64.9%) persons believed that the vaccine would provide complete protection against COVID-19. Conclusion: People were mainly concerned about safety issues as adequate and reliable information was not available to them. Some of them ignored the importance of vaccination while some could not get vaccinated due to the unavailability of slots.
Aerococcus viridans Bacteraemia in a COVID-19 Positive Patient: A Rare Case Report from Northern India
Authors: Kar Mitra , Dubey Akanksha , Singh Romya , Sahu Chinmoy , Patel Sangram Singh
Published: November 2022

Aerococcus viridans is a rare Gram positive microorganism identified largely as environmental or skin contaminants. With the advent of an increase in the immunosuppressed population due to diabetes, the use of steroids and the Coronavirus Disease 2019 (COVID-19) pandemic, this bacteria caused a variety of infections like bacteraemia, urinary tract infections, and endocarditis. The use of Matrix-Assisted Laser Desorption Ionisation Time-of-Flight Mass-Spectrometry (MALDI-TOF MS), a unique technique of microorganism identification, has placed Aerococci among human pathogens, capable of causing infection among immunocompromised patients. The present case was of a 48-year-old female presented with dry cough, high-grade fever associated with chills and rigors, and generalised body ache and weakness for the past one week. She was a known case of bronchial asthma. She tested positive for COVID-19 and over the course of hospital stay, her BACTEC blood culture performed due to high fever which flagged positive indicated her as a case of Aerococcus viridans bacteraemia. Despite of all the efforts she developed respiratory distress followed by an episode of asystole following which she could not be revived.
Genetic Variability, Correlation and Path Coefficient Analysis in Hybrid Maize (Zea mays L.)
Authors: Matin Mohammad Quamrul Islam , Hossain Mohammad Golam , Khan Mohammad Anwar Hossain , Khan Md. Mustafa , Haque Mohammad Shaidul , Banu Maksuma Akter
Published: November 2022

The goal of the current investigation was to determine correlation coefficient, path analysis and genetic variability among twenty four maize hybrids for ten characters in a Randomized Block Design (RBD) with three replications at the research field of Plant Breeding Division, Regional Agricultural Research Station, Barisal, Bangladesh Agricultural Research Institute (BARI), Bangladesh during rabi season of 2014-15.

The measured traits were Days to 50% tasseling (DT), days to 50% silking (DS), anthesis silking interval (ASI), plant height (PH), ear height (EH), days to maturity (DM), cob length (CL), cob diameter (CD), thousand seed weight (TSW) and yield(yield t/ha). Here yield was considered as dependent variable and the rest of the parameters were independent variable. The data were submitted to analysis of variance and mean values were compared by DMRT test at both 5% and 1% of probability. Positive and significant genotypic, phenotypic correlation coefficient were recorded for yield with cob diameter (rg=0.75**, rp=0.61**), cob length (rg=0.66**and rp=0.42**), plant height (rg=0.62**and rp=0.55**), ear height (rg=0.66**and rp=0.55**) and thousand seed weight (rg=0.36**and rp=0.44**). High genotypic coefficient of variation (GCV) was obtained from anthesis silking interval (17.26), yield (15.17), ear height (13.80) and thousand seed weight (9.43). The highest phenotypic coefficient of variation (PCV) were observed in anthesis silking interval (26.49) followed by yield (20.51), ear height (16.19) and the lowest in days to maturity (0.70). The difference between GCV and PCV of yield indicated that the characters had some environmental influence. The highest heritability was observed for plant height (73.78) followed by ear height (72.67), thousand seed weight (59.52) and days to maturity (55.97) but the lowest heritability identified for days to silking (18.98). The characters with higher values of GCV and heritability of the aforementioned traits were indicative for selection. The plant height had the highest positive direct effect (1.34) on yield followed by days to silking (0.75), cob diameter CD (0.46) and thousand seed weight (0.41), days to maturity (0.21) and cob length (0.20) indicating the effectiveness of direct selection. Direct negative effect on yield was shown by ear height (-1.03), days to tasseling  (-0.52) and anthesis silking interval (-0.50) was indicating the effectiveness of indirect selection.
Perception of Farmers towards Soil Health Card Recommendations in East Godavari District of Andhra Pradesh
Authors: Babu N. Nagendra , Venkataramulu M. , Sarma A. S. R. , Prasad Venu
Published: November 2022

Realizing the importance of Soil Health Card as a tool for efficient nutrient management, the decision to participate in new agricultural technologies depends on farmer’s perception which does a key determinant in influencing adoption and importance of the soil health card. The present study was undertaken during the year 2018-19 in East Godavari districts of Andhra Pradesh with a sampling of 200 farmers based on number of respondents who had soil health cards. The main objective of the study is to find out the significant relationship between the profile characteristics and the perception of the farmers on SHC recommendations. The data indicated that majority of the respondent (47 percent) from middle age group with majority (59 percent) of the respondents was educated up to primary school showing almost (94.5 percent) respondents had farming as occupation. From the results it is evident that half of the respondents (54 percent) had medium level of perception followed by high level of perception (28.5 percent) and low level of perception observed is 17.5 percent. The majority of respondents had a moderate level of perception regarding the suggestions on soil health cards and their application, according to the aforementioned data. Further, it also found that extension contact had positive and significant relationship with the perception about soil health card recommendations.
Quality Assessment of Sub-base Highway Pavement Materials in Lagelu Local Government Area, Ibadan, Oyo State, Nigeria
Authors: Okeniyi A. G. , Raheem S. B. , Durojaye A. J. , Oladiran G. F. , Adesogan S. O.
Published: November 2022

Road development quality delivery in West Africa mostly depends on the quality of available sub-base pavement materials within economic distance. This paper thus aimed at assessing the quality of sub-base road pavement material in Lagelu Local Government Area of Ibadan, South-Western, Nigeria. Soil samples were collected from four different locations at depths ranging from 0.5m to 1.0m. Samples were subjected to Natural moisture content, Specific gravity, Grain size analysis, Atterberg limits, Compaction and California bearing ratio laboratory tests. The sieve analysis results indicate that the fine grain content varying from 16.80 % and 30.70 %. The soil samples are well graded ranging from coarse to clay particle sizes. The compaction test results revealed the maximum dry density range from 2.25 Mg/m3 to 2.28 Mg/m3 and optimum moisture content of between 7.1 % and 7.3 %. The materials were classified after AASHTO soil classification system as A-1-b with California Bearing Ratio (CBR) test results ranging from 74% to 76%. The variation in the values depends on the moisture content and the density of the materials. It was observed that the values were well within the permissible specification by the Federal Ministry of Works General Specifications of the country, rated as excellent to good sub-base materials.
Endovascular aortic repair via carbon-dioxide imaging in renal insufficiency?
Authors:   Clinic of Cardiovascular Surgery, Ankara City Hospital, Ankara, Türkiye, Mola Serkan , Askin Goktan ,   Clinic of Cardiovascular Surgery, Ankara City Hospital, Ankara, Türkiye, Aytekin Bahadir ,   Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Türkiye, Hasanzade Sabir ,   Clinic of Cardiovascular Surgery, Ankara City Hospital, Ankara, Türkiye, Girgin Abdullah Kusay ,   Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Türkiye, Tumer Naim Boran ,   Department of Cardiovascular Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey, Unal Ertekin Utku ,   Department of Cardiovascular Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey, Iscan Hakki Zafer ,   Clinic of Cardiovascular Surgery, Ankara City Hospital, Ankara, Türkiye
Published: November 2022

Aim: In our study, we aimed not only if CO2 is a safe and effective vascular roadmap for EVAR procedure instead of ICM but if it is a feasible opportunity for patients with hostile neck anatomy as well. Material and Methods: From January 2019 to July 2022, 42 patients with renal insufficiency had elective EVAR procedures for infrarenal abdominal aortic aneurysm in our Cardiovascular Surgery Clinic with CO2-guided DSA. Results: There were no conversions to open surgery or no need for ICM for the CO2-guided DSA. Technical success for CO2 guidance EVAR was 100% with the second shot. There was no decline in GFR values, only one patient showed transient manifestations of CIN without need for hemodialysis. Conclusion: CO2 DSA is a safe and effective technique that can guide not only the standard but endovascular procedures with a hostile neck for renal insufficiency below the diaphragm allowing virtually unlimited images. With modern automated closed systems, CO2-specific complications will be negligible if the operator has experience with the limitations and contraindications of the technique.
Edoxaban in cardiovascular medicine from scientific evidence to clinical practice
Authors:   Department of Cardiovascular Surgery, Liv Hospital Ulus, Istanbul, Türkiye, Budak Ali Baran , Gencpinar Tugra ,   Department of Cardiovascular Surgery, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey, Dogan Emre ,   Department of Cardiovascular Surgery, Şişli Kolan International Hospital, Istanbul, Türkiye, Totan Sahin ,   Daiichi Sankyo, Istanbul, Türkiye, Akay Hakki Tankut ,   Başkent University Faculty of Medicine, Department of Cardiovascular Surgery, Ankara, Türkiye
Published: November 2022

Direct oral anticoagulants have become a reasonable treatment option replacing warfarin in preventing stroke in patients with non-valvular atrial fibrillation and in treating and preventing venous thromboembolism. This article aims to summarize the rationale behind the development of direct oral anticoagulants and to review the key pharmacological properties, clinical and reallife data of the factor Xa inhibitor edoxaban, that may contribute to improving patient outcomes in cardiovascular clinical practice.
Effects Of Rivaroxaban And Apixaban On Intimal Hyperplasia In Rabbits
Authors:   Department of Cardiovascular Surgery, Kent Hospital, İzmir, Turkey, Kemahli Mustafa Baris , Gencpinar Tugra ,   Department of Cardiovascular Surgery, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey, Dursun Huseyin ,   Department of Cardiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey, Bilen Cagatay ,   Department of Pediatric Cardiovascular Surgery, Behçet Uz Children Training and Research Hospital, İzmir Türkiye, Akokay Pinar ,   İzmir Kavram Vocational School, Medical Laboratory Technigues Programme, İzmir, Turkey, Bayrak Serdar ,   Department of Cardiovascular Surgery, Dokuz Eylül University Medical Faculty, Izmir, Turkey, Erdal Abidin Cenk ,   Department of Cardiovascular Surgery, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
Published: November 2022

Aim: Intimal hyperplasia causes vascular occlusion and its optimal treatment is unknown. In this study, we evaluated the effectiveness of Apixaban and Rivaroxaban treatment for preventing intimal hyperplasia in rabbits. Material and Methods: The rabbits (n = 15) were randomly divided into three groups. Reanastomoses are applied to the carotid artery. All groups received 100 U/kg heparin sodium during the operation period. Group A (n = 5) as a control group had no medication. Group B (n = 5) was given Rivaroxaban 3 mg/kg/day. In-group C (n = 5) Apixaban was administered per orally 10 mg/kg. At the end of the treatment on the 28th day, carotid artery specimens were excised and evaluated histologically. Results: Increased intima thickness was observed in the control group than the drug groups (P=0.019, P=0.007). It was found that there was no difference between groups in terms of lumen diameter, lumen area, tunica media area and tunica media thickness. There was difference between groups in terms of caspase 3 or TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) staining (p<0.05). Conclusion: Apixaban and Rivaroxaban may have protective efficacy against intimal hyperplasia after vascular surgical intervention.
Pulmonary artery angiosarcoma mimicking chronic thromboembolic pulmonary hypertension
Authors:   Başkent University Faculty of Medicine, Department of Cardiovascular Surgery, Ankara, Türkiye, Akay Hakki Tankut , Ayva Ebru Sebnem ,   Gazi University School of Medicine, Department of Pulmonary Diseases, Ankara, Türkiye, Oguzulgen Ipek Kivilcim ,   Gazi University School of Medicine, Department of Pulmonary Diseases, Ankara, Türkiye, Kahraman Gokhan ,   Baskent University Faculty of Medicine, Department of Radiology, Ankara, Türkiye  ORCID, Gültekin Bahadır ,   Department of Cardiovascular Surgery, Başkent University Faculty of Medicine, Ankara, Turkey, Hekimoglu Omer Koray ,   Department of Radiology, Başkent University Faculty of Medicine, Ankara, Turkey  ORCID
Published: November 2022

Pulmonary artery angiosarcoma (PAA) is an extremely rare malignancy that arises from endothelial cells. The pulmonary trunk is the most common anatomic site of these tumors. However, so far, there have only been a few examples of PAA reported. PAAs are aggressive and have a bad prognosis, thus early diagnosis is critical. In this study, we present the case of a 27-year-old male who was initially diagnosed with acute pulmonary thromboembolism (PTE) before being diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary endarterectomy was performed, and PAA was diagnosed histopathologically. The patient died three months after diagnosis.
Thoracoabdominal aortic aneurysm repair: A Single center experience
Authors:   Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey, Aydin Unal , Duman Zihni Mert ,   Department of Cardiovascular Surgery, Cizre State Hospital, Şırnak, Türkiye, Yasar Emre ,   Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey, Bayram Muhammed ,   Department of Cardiovascular Surgery, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey, Eltutan Sefa ,   Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey  ORCID, Kadirogullari Ersin ,   Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey, Sen Onur ,   Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
Published: November 2022

Aim: The gold standard repair of thoracoabdominal aortic aneurysm (TAAA) is still open surgery. However, few cardiovascular centers are experienced in TAAA repair. The aim of this study was to examine the methods and four-year outcomes of the open TAAA repair program initiated by a single surgical team. Material and Methods: In this retrospective cohort, patients who were operated for TAAA between August 2018 and March 2022 were collected. Patients treated with the endovascular approach were excluded. After exclusion, 19 patients were included in our analysis. As postoperative outcomes, in-hospital mortality, spinal cord deficit, major neurologic complications, need for dialysis, and visceral ischemia were collected. Results: Crawford extent II TAAA repair was performed in 10 (52.6%) patients, Crawford extent III in 5 (26.3%) patients, and Crawford extent IV in 4 (21.1%) patients. In hospital mortality occurred in 6 (31.6%) patients. The causes of mortality were perioperative myocardial infarction in 2 (10.5%) patients, visceral ischemia in 1 (5.3%) patient, multisystem organ failure in 3 (15.8%) patients. The highest mortality rate (50.0%) occurred in Crawford extent II repair. Spinal cord deficit developed in 2 (10.5%) patients. Conclusion: Thoracoabdominal aortic aneurysm surgery is associated with high mortality rates. Open thoracoabdominal aortic aneurysm repair programs in tertiary vascular centers should be supported, to improve the surgical results of thoracoabdominal aortic aneurysm repair.
Proximal venous outflow obstructions and transfemoral approach in patients with arteriovenous fistula
Authors:   Department of Cardiovascular Surgery, Isparta City Hospital, Isparta, Turkey, Çelik Ersin , Çora Ahmet ,   Department of Cardiovascular Surgery, Isparta City Hospital, Isparta, Turkey  ORCID
Published: November 2022

Congratulations to the authors for their effort [1]. Endovascular treatment for central venous occlusions, which cause many vascular access problems among hemodialysis patients, has increased in recent years. Although most of these procedures have been applied via forearm vessels, there were studies reporting the use of the transfemoral approach in complicated cases [2,3]. In the publication, the authors reported that they applied a fistulogram by using a 6 Fr sheath from forearm veins and diagnosed the occlusion site. After the fistulogram, the authors used transfemoral access for other invasive procedures not to injure forearm vessels. We conclude that the invasive endovascular procedures for treating the occluded segment could be completed via the same access point, and the transfemoral approach must not be a routine route for access and reserved for more complicated cases or when the forearm is unavailable.
Association Of D-Dimer/Fibrinogen Ratio With Pulmonary Embolism In COVID-19 Patients
Authors:   Department of Cardiovascular Surgery, University of Health Sciences, Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Türkiye, Topcu Ahmet Can , Yigit Fatih , Ozturk Altunyurt Gozde ,   Department of Infectious Diseases and Clinical Microbiology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Türkiye, Batirel Ayse ,   Department of Infectious Diseases and Clinical Microbiology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Türkiye, Rabus Murat Bulent ,   Department of Cardiovascular Surgery, University of Health Sciences, Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Türkiye
Published: November 2022

Aim: This study aimed to investigate whether the D-dimer / fibrinogen ratio (DDFR) measured on admission could be used as a diagnostic marker of pulmonary embolism (PE) in coronavirus disease 2019 (COVID-19) patients. Material and Methods: This single-center, retrospective, case-control study was conducted with 204 COVID-19 patients (131 males, 73 females; mean age: 62±15.4 years; range, 28 to 97 years) between October 18, 2020, and December 18, 2020. Patients were followed during the hospital stay and for 30 days after discharge. The primary outcome was the occurrence of radiologically confirmed PE. The DDFR was calculated using the following formula: DDFR=D-dimer (ng/mL) / fibrinogen (mg/dL). Results: Six (2.9%) patients experienced PE during the follow-up. D-dimer had 63.6% sensitivity and 76.2% specificity on admission to predict thromboembolism at a cut-off of 1,375 ng/mL (area under the curve (AUC)=0.687, 95% confidence interval (CI): 0.530-0.845, p<0.05). The DDFR had 75% sensitivity and 90.5% specificity on admission to predict thromboembolism at a cut-off of 5.41 (AUC =0.846, 95% CI: 0.728-0.965, p<0.05). Conclusion: A measurement of DDFR on admission does not provide incremental value over D-dimer to recognize patients who are at risk of developing PE during and early after hospitalization for COVID-19.
Rotational atherectomy for below the knee lesions in critical limb threatening ischemia: Is it a wild goose chase?
Authors:   Department of Cardiovascular Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey, Yaprak Engin Aysen , Serefli Deniz ,   Department of Cardiovascular Surgery, Başkent University Faculty of Medicine, Ankara Turkey
Published: November 2022

Aim: Treatment of infrapopliteal peripheral arterial disease is still challenging. Rotational atherectomy (RA) is a novel option that aims removal of calcium from the lumen and improvement in outcomes. Material and Methods: Data of 27 patients (19 males, 8 females; mean age: 59.8±13.7 years; range, 25 to 79 years) with infrapopliteal occlusions treated by RA between January 2017 and December 2019 was retrospectively collected. The Global Limb Anatomic Staging System (GLASS) and the Rutherford classification (RC) were used for evaluation. The objective performance goals of Conte et al. (major adverse limb event [MALE] and major adverse cardiovascular event [MACE]) were used for assessing outcome performance. Visits were scheduled at 1, 6, 12, 18, and 24 months after treatment. In each visit, symptoms, RC, wound status, smoking status, lifestyle modifications, and medications were questioned, laboratory tests and Doppler ultrasonography were carried out, and the next visit was planned. Results: Device success was 88.89%, whereas procedural success was 100%. Unanticipated amputation rate was 11.1% in the 12-month follow-up. Over half of the patients (66.67%) showed RC improvement with a mean change of 3±1.17. Thirty-day safety endpoints were as follows: MALE, MACE, and amputation rates were 12.5%, 0%, and 8.33%, respectively. One-year efficacy endpoints were as follows: freedom from MALE+perioperative death was 71.42%, amputation-free survival was 76.19%, freedom from reintervention (amputation was 75%, limb salvage was 80%, and survival was 90.47%. Associations between RC (5-6) and calcification, chronic renal insufficiency and amputation, being a nonsmoker and failure to improve RC, and smoking and high infrapopliteal GLASS were found. Smoking cessation came with RC improvement in every case. Nonquitters experienced worsening more often compared to quitters (0% vs. 25%). Conclusion: Rotational atherectomy is feasible and effective in infrapopliteal chronic total occlusions. Closer follow-up is suggested for nonsmokers and patients with chronic renal insufficiency or advanced GLASS stages as they are prone to unfavorable clinical results. Quitting smoking should be underlined with its potential positive clinical effect even after the procedure.
Effect Of Surgical Techniques In The Treatment Of Small Saphenous Vein Insufficiency On Clinical Outcomes
Authors:   Department of Cardiovascular Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey, Engin Aysen Yaprak , Islamoglu Fatih ,   Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Türkiye
Published: November 2022

Effect Of Surgical Techniques In The Treatment Of Small Saphenous Vein Insufficiency On Clinical Outcomes
Öğretmenlerin Mesleki Tükenmişlik Düzeylerini Azaltmada Öncelenmesi Gereken Mesleki Sosyal Destek Faktörleri
Authors: TOPRAK Emre , ÇELEBİ Mustafa , ORMAN Pınar
Published: November 2022

Öğretmenler, tükenmişliğe çok maruz kalan meslek gruplarındandır. Öğretmenlerin mesleki tükenmişlik düzeylerini azaltmak için çeşitli önlemler geliştirilebilir. Mesleki tükenmişliği nelerin etkilediğini belirlemek, bu etkileri azaltmak için öncelenmesi gereken konular hakkında bakış açıları sunabilir. Mevcut araştırmada mesleki sosyal destek faktörlerinin arttırılması önemli bir destek kaynağı olarak ele alınmıştır. Araştırma, öğretmenlerin mesleki tükenmişlik düzeylerini azaltmada öncelik verilmesi gereken mesleki sosyal destek faktörlerinin öncelik sıralamasını belirlemeyi amaçlamıştır. Araştırmada nicel araştırma yöntemlerinden ilişkisel araştırma deseni kullanılmıştır. Araştırma verileri İç Anadolu’da büyükşehir statüsündeki bir il merkezinde farklı okul türlerinde görev yapan ve uygun örnekleme yöntemiyle belirlenen 397’si (%56.0) kadın, 312’si (%44.0) erkek toplam 709 öğretmenden toplanmıştır. Mesleki tükenmişlik düzeyine etki eden değişkenlerin öncelik sıralamasını belirlemek amacıyla yapay sinir ağları kullanılmıştır. Araştırmada mesleki tükenmişliği azaltmada öncelenmesi gereken mesleki sosyal destek faktörlerinin başında yönetim desteği ve öğrenci desteği faktörlerinin geldiği belirlenmiştir. Bu araştırmanın sonuçlarına dayanarak okullarda yönetim ve öğrenci desteğinin iyileştirilmesine yönelik çalışmaların öğretmenlerin mesleki tükenmişliklerinin önlenmesine ya da azaltılmasına imkân vereceği düşünülmektedir.
Use Trends and Recent Expenditures for Cervical Cancer Screening–Associated Services in Medicare Fee-for-Service Beneficiaries Older Than 65 Years
Authors: Qin Jin , Holt Hunter K. , Richards Thomas B. , Saraiya Mona , Sawaya George F.
Published: November 2022

Importance

Since 1996, the US Preventive Services Task Force has recommended against cervical cancer screening in average-risk women 65 years or older with adequate prior screening. Little is known about the use of cervical cancer screening–associated services in this age group.

Objective

To examine annual use trends in cervical cancer screening–associated services, specifically cytology and human papillomavirus (HPV) tests, colposcopy, and cervical procedures (loop electrosurgical excision procedure, cone biopsy, and ablation) in Medicare fee-for-service beneficiaries during January 1, 1999, to December 31, 2019, and estimate expenditures for services performed in 2019.

Design, Setting, and Participants

This population-based, cross-sectional analysis included health service use data across 21 years for women aged 65 to 114 years with Medicare fee-for-service coverage (15-16 million women per year). Data analysis was conducted between July 2021 and April 2022.

Main Outcomes and Measures

Proportion of testing modalities (cytology alone, cytology plus HPV testing [cotesting], HPV testing alone); annual use rate per 100 000 women of cytology and HPV testing, colposcopy, and cervical procedures from 1999 to 2019; Medicare expenditure for these services in 2019.

Results

There were 15 323 635 women 65 years and older with Medicare fee-for-service coverage in 1999 and 15 298 656 in 2019. In 2019, the mean (SD) age of study population was 76.2 (8.1) years, 5.1% were Hispanic, 0.5% were non-Hispanic American Indian/Alaska Native, 3.0% were non-Hispanic Asian/Pacific Islander, 7.4% were non-Hispanic Black, and 82.0% were non-Hispanic White. From 1999 to 2019, the percentage of women who received at least 1 cytology or HPV test decreased from 18.9% (2.9 million women) in 1999 to 8.5% (1.3 million women) in 2019, a reduction of 55.3%; use rates of colposcopy and cervical procedures decreased 43.2% and 64.4%, respectively. Trend analyses showed a 4.6% average annual reduction in use of cytology or HPV testing during 1999 to 2019 (P < .001). Use rates of colposcopy and cervical procedures decreased before 2015 then plateaued during 2015 to 2019. The total Medicare expenditure for all services rendered in 2019 was about $83.5 million. About 3% of women older than 80 years received at least 1 service at a cost of $7.4 million in 2019.

Conclusions and Relevance

The results of this cross-sectional study suggest that while annual use of cervical cancer screening–associated services in the Medicare fee-for-service population older than 65 years has decreased during the last 2 decades, more than 1.3 million women received these services in 2019 at substantial costs.
Effect of Irrigation Fluid Temperature on Recurrence in the Evacuation of Chronic Subdural Hematoma
Authors: Bartley Andreas , Bartek Jiri , Jakola Asgeir S. , Sundblom Jimmy , Fält Marie , Förander Petter , Marklund Niklas , Tisell Magnus
Published: November 2022

Importance

The effect of a physical property of irrigation fluid (at body vs room temperature) on recurrence rate in the evacuation of chronic subdural hematoma (cSDH) needs further study.

Objective

To explore whether irrigation fluid temperature has an influence on cSDH recurrence.

Design, Setting, and Participants

This was a multicenter randomized clinical trial performed between March 16, 2016, and May 30, 2020. The follow-up period was 6 months. The study was conducted at 3 neurosurgical departments in Sweden. All patients older than 18 years undergoing cSDH evacuation during the study period were screened for eligibility in the study.

Interventions

The study participants were randomly assigned by 1:1 block randomization to the cSDH evacuation procedure with irrigation fluid at room temperature (RT group) or at body temperature (BT group).

Main Outcomes and Measures

The primary end point was recurrence requiring reoperation within 6 months. Secondary end points were mortality, health-related quality of life, and complication frequency.

Results

At 6 months after surgery, 541 patients (mean [SD] age, 75.8 [9.8] years; 395 men [73%]) had a complete follow-up according to protocol. There were 39 of 277 recurrences (14%) requiring reoperation in the RT group, compared with 16 of 264 recurrences (6%) in the BT group (odds ratio, 2.56; 95% CI, 1.38-4.66; P < .001). There were no significant differences in mortality, health-related quality of life, or complication frequency.

Conclusions and Relevance

In this study, irrigation at body temperature was superior to irrigation at room temperature in terms of fewer recurrences. This is a simple, safe, and readily available technique to optimize outcome in patients with cSDH. When irrigation is used in cSDH surgery, irrigation fluid at body temperature should be considered standard of care.

Trial Registration

ClincalTrials.gov Identifier: NCT02757235.