This study presents a comparative dynamic analysis of hybrid composites, which are suitable for new technological vehicles and possess greater advantages over non-hybrid fiber-reinforced composites. ...In this context, non-hybrid (NH), interply hybrid (IN) and intraply hybrid (IR) composites are manufactured. In the manufacturing process, NH and IN composites are utilized by using Carbon (C), Aramid (A), and Glass (G) while IR composites are manufactured with Aramid-Carbon (AC), Carbon-Glass (CG), Glass-Aramid (GA). In the manufacturing stage, a variety of layer numbers and fiber orientation angles is taken into consideration to determine the most advantageous structures for vibration characteristics. As there are a great number of productions required because of the parameters of interest, Taguchi production design is used. These composites are manufactured using Vacuum Assisted Resin Transfer Molding (VARTM). In accordance with the relevant standards, density, tensile, and dynamic properties are determined experimentally. Further, numerical models are developed using the ANSYS® software, and modal analysis is conducted. The results of the numerical analysis are compared with the experimental results. Taguchi analyses are performed to determine the most effective manufacturing configurations for the purpose. Consequently, IN and IR composites with similar content are compared to each other and the previous literature. According to the experimental and numerical results, the factors most effective in determining the natural frequency and damping ratio are layer numbers, orientation angles, and fabric types, respectively. The effectiveness of each parameter in the ranking is determined by using Taguchi levels.
CO2 fixed fire extinguishing system activation accidents may occur as a result of unintentional system activation or human error. Crew members present in the area could suffer serious consequences, ...including death, if CO2 gas is released into a protected compartment such as the engine room, CO2 room, or cargo area. It is therefore crucial to investigate and address the causes of such accidents. The use of Dempster-Shafer (D-S) theory and the Human Error Assessment and Reduction Technique (HEART) to the Human Reliability Analysis (HRA) of CO2 fixed fire extinguishing system activation accidents is discussed in this study. On the one hand, D-S theory allows for uncertainty-based reasoning and can be extremely advantageous, especially when analysing complex systems where there are many potential challenges. On the other hand, HEART is an organised method to examine and reduce human error in high-risk systems. Together, these techniques provide a powerful tool for identifying and addressing the underlying causes of CO2 fixed fire extinguishing system activation accidents. The study revealed that the total human error probability (HEP) for the CO2 fixed fire extinguishing system was 3.10E-01 and the reliability of human performance for the given process was 6.90E-01. The results of this paper highlight many factors such as equipment failure, inadequate training, and poor maintenance practices, as well as factors contributing to the risk of accidental system activation. By addressing these factors, the probability of CO2-fixed fire suppression system activation accidents can be significantly reduced.
•Integration of Dempster-Shafer theory (D-S) and HEART for Human Reliability Analysis (HRA).•HRA of fixed CO2 fire extinguishing system activation process.•Increasing safety awareness of fixed-CO2 fire system risks onboard.
The human factor is a hot topic for the maritime industry since more than 80 percent of maritime accidents are due to human error. Minimizing human error contributions in maritime transportation is ...vital to enhance safety levels. At this point, the maritime autonomous surface ships (MASS) concept has become one of the most significant aspects to minimize human errors. The objective of this research is to predict the human–machine interface (HMI)-based operational errors in autonomous ships to improve safety control levels. At this point, the interaction between shore-based operator and controlling system (cockpits) can be monitored and potential HMI operational errors can be predicted. This research utilizes a Success Likelihood Index Method (SLIM) under an interval type-2 fuzzy sets (IT2FSs) approach. While the SLIM provides a prediction of the human–machine interface (HMI) operational errors, the IT2FSs tackles uncertainty and vagueness in the decision-making process. The findings of this paper are expected to highlight the importance of human–machine interface (HMI) operational errors in autonomous ships not only for designers but also for operational aspects.
To reveal the number of cancer screenings in primary care during the pandemic period and whether there is a change in screening compared to the pre-pandemic period.
This record-based descriptive ...study was carried out by evaluating the number of people who applied to family health centers or cancer early diagnosis, screening, and education center (KETEM) units for cancer screening (breast, cervical, and colorectal) for any reason. The study data were scanned between January 2017 and December 2020 and were obtained from the Gaziantep Provincial Health Directorate Cancer Branch.
Breast cancer screening was the highest in December 2019 (n=2971), cervical cancer screening was the highest in October 2019 (n=4693), and colon cancer screening was the highest in September 2019 (n=2464). Breast cancer screening was the lowest in August 2020 (n=0), cervical cancer screening was the lowest in May 2020 (n=6), and colon cancer screening was the lowest in February and March 2018. Although the target populations and percentages in breast cancer, cervical cancer and colon cancer screenings increased with the following years, the screening populations and percentages decreased in 2020 compared to other years (percentages, 4.4%, 6.2%, 1.9%).
For cancers that can be prevented by early diagnosis, it is of great importance to increase cancer screenings, which have decreased with the pandemic, to the required level.
BACKGROUND—Atrial tachycardias (AT) often occur after ablation of long-lasting persistent AF (CAF) and are difficult to treat conservatively. This study evaluated mechanisms and success rates of ...conventional mapping and catheter ablation of recurrent ATs occurring late after stepwise ablation of CAF.
METHODS AND RESULTS—A total of 320 patients underwent de novo ablation of CAF using a stepwise ablation approach in 2006 to 2007 at our institution. This study comprised patients who presented with recurrent ATs at their first redo procedure after initial de novo CAF ablation. All procedures were guided by conventional mapping techniques exclusively. Sixty-one patients (63±10 years, 14 women) presented with their clinical AT at their redo procedure 7.7±4.4 months after initial de novo CAF ablation. A total of 133 ATs (2.2±0.9 per patient) were mapped. Forty-four (72%) were due to reentry; 17 (28%) were focal ATs. Reentry ATs were mainly characterized as roof and perimitral flutter (43% and 34%, respectively). Focal ATs mainly originated from the great thoracic veins (pulmonary veins41%, coronary sinus23%). Forty-five (74%) patients had conduction recovery of at least 1 pulmonary vein (mean, 1.2±0.8). Overall, 124 (93%) ATs could be ablated successfully. The mean procedure duration was 181±59 minutes, with a mean fluoroscopy time of 45±21 minutes. After a mean follow-up of 21±4 months, 50 (82%) patients were free of any arrhythmia recurrences after a single redo procedure.
CONCLUSIONS—Although late recurrent ATs may have complex mechanisms, catheter ablation guided exclusively by conventional techniques is highly effective with excellent acute and long-term success rates.
Recent studies have shown that subcutaneous or subfascial pacemaker- and ICD implantation with continued oral anticoagulation therapy is associated with lower risk for bleeding complications, when ...compared to heparin bridging strategies. However, ICD generators are often implanted submuscularly. We therefore compared the bleeding risk with continued phenprocoumon therapy vs. heparin bridging in patients receiving submuscular ICD implantation. Between 01/2013 and 12/2013, 104 patients with need for oral anticoagulation received submuscular ICD or CRT-D implantation in our institution. 46 patients were implanted under continued phenprocoumon therapy while 58 patients received heparin bridging for implantation procedure. All ICD generators were placed submuscularly. The primary outcome of the study was clinically significant bleeding or device pocket hematoma with need for surgical revision. Mean patients age was 63.7 years, 72.1% were male. In patients with heparin bridging therapy, preoperative INR prior to ICD implantation was 1.2 ± 0.31 while in the group of patients on continued phenprocoumon therapy, mean pre-OP INR was 2.4 ± 0.47. In heparin bridging group, 8 (13.8%) patients experienced a clinically relevant pocket hematoma, while only 1 (2.2%) patient on continued phenprocoumon therapy needed surgical revision for pocket hematoma (
P
= 0.04). No further bleeding complications or clinically relevant pericardial effusion was observed in any of the groups and no perioperative thromboembolic event occurred. Submuscular ICD implantation under continued phenprocoumon therapy was safe and feasible. Compared to patients with heparin bridging therapy, those with continued phenprocoumon therapy had a lower incidence of clinically relevant bleeding complications.
In this study, we fabricated a label-free electrochemical immunosensor for sensitive and selective detection of tumor marker p53. This immunosensor was based on chitosan/carbon black composite ...(Chitosan-CB) layer coated ITO electrode. This composite was utilized for enhancement of the conductivity of the immunosensor. Anti-p53 antibodies were captured on the modified ITO electrode through the cross-linking of chitosan and glutaraldehyde. Electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) techniques were utilized for electrochemical characterization of the proposed immunosensor. Moreover, the biosensor construction steps were monitored by using scanning electron microscopy (SEM) and atomic force microscopy (AFM). The immobilization of anti-p53 antibodies on the electrode surface was investigated by using Fourier-transform infrared spectroscopy (FTIR) and Raman spectroscopy. The change in impedance which formed during the specific interaction between anti-p53 antibody and p53 antigen was used to detect p53. Under optimized experimental conditions, the fabricated immunosensor had a wide linear range of 0.01–2 pg/mL and low detection limit of 3 fg/mL. The fabricated immunosensor had good sensitivity, stability and repeatability. Furthermore, it was successfully applied to analyze p53 in human serum.
•Chitosan- carbon black composite modified disposable ITO electrode was used as a biosensing platform for p53 detection.•The proposed immunosensor had good sensitivity, excellent selectivity and long-term stability.•A linear range of 0.01–2 pg/mL and LOD of 3 fg/mL was achieved.•The immunosensor is able to detect p53 at low concentration in real human serum samples.
ABSTRACT Background: After eradication of Helicobacter pylori (H. pylori) chronic gastritis will resolve, complications due to H. pylori infection and recurrence of infection will be prevented. ...Objective: To determine efficacy and safety of gemifloxacin containing treatment regimen in first line treatment of H. pylori with comparison to bismuth containing quadruple therapy. Methods: This retrospective study was conducted in a tertiary care university hospital between January 2018 and January 2021 with 410 participants who were diagnosed to have H. pylori infection with biopsies obtained during upper gastrointestinal system endoscopy. Patients were distributed into two groups according to their first-line treatment regimens. First group patients were treated with amoxicillin, gemifloxacin and pantoprazole and second group patients were treated with amoxicillin, metronidazole, bismuth subcitrate and pantoprazole for seven days. Results: Intention to treat and per protocol ratios for gemifloxacin containing regimen were 90.0% and 91.2%, while quadruple treatment has these ratios as 91.7% and 93.8% respectively. Treatment success rate in both regimens were similar. But adverse effects were lower and patient compliance were better in patients who had gemifloxacin containing treatment (P<0.001). Conclusion: Gemifloxacin containing treatment regimen is as effective as bismuth containing quadruple treatment regimen for H. pylori infection and patient compliance is better in this group. Gemifloxacin containing treatment regimens may be novel and effective alternatives for eradication of H. pylori infection.
RESUMO Contexto: Após a erradicação do Helicobacter pylori (HP), a gastrite crônica será resolvida, as complicações devido à infecção por HP e a recorrência da infecção serão prevenidas. Objetivo: Determinar a eficácia e segurança do regime de tratamento contendo gemifloxacino no tratamento de primeira linha do HP, em comparação com a terapia quádrupla contendo bismuto. Métodos: Este estudo prospectivo foi conduzido em um hospital universitário de atendimento terciário entre janeiro de 2018 e janeiro de 2021, com 410 participantes diagnosticados com infecção por HP, obtidos por meio de biópsias durante a endoscopia do sistema gastrointestinal superior. Os pacientes foram divididos em dois grupos de acordo com seus regimes de tratamento de primeira linha. Os pacientes do primeiro grupo foram tratados com amoxicilina, gemifloxacino e pantoprazol, e os pacientes do segundo grupo foram tratados com amoxicilina, metronidazol, subcitrato de bismuto e pantoprazol por 7 dias. Resultados: As taxas de intenção de tratar e por protocolo para o regime contendo gemifloxacino foram de 90,0% e 91,2%, enquanto o tratamento quádruplo apresentou essas taxas como 91,7% e 93,8%, respectivamente. A taxa de sucesso do tratamento em ambos os regimes foi similar. No entanto, os efeitos adversos foram menores e a adesão dos pacientes foi melhor nos que receberam o tratamento contendo gemifloxacino (P<0,001). Conclusão: O regime de tratamento contendo gemifloxacino é tão eficaz quanto o regime de tratamento quádruplo contendo bismuto para a infecção por HP, e a adesão dos pacientes é melhor neste grupo. Os regimes de tratamento contendo gemifloxacino podem ser alternativas novas e eficazes para a erradicação da infecção por HP.
Amaç: Aile hekimlerinin karşılaştıkları sağlık sorunlarının bir bölümünü de ortopedi ve travmatoloji ile ilgili hastalıklar oluşturmaktadır. Bir devlet hastanesinin ortopedi ve travmatoloji ...polikliniğine başvuran hastaların birinci basamakta yönetilebilirliğini belirlemek amaçlandı.
Gereç ve Yöntem: Çalışmaya Ekim 2022 - Şubat 2023 tarihleri arasında ikinci basamak bir devlet hastanesi ortopedi ve travmatoloji polikliniğine başvuran toplam 473 hasta dahil edildi. Katılımcıların sosyodemografik ve klinik özellikleri, başvuru şikayetleri, bu şikayetleri için aile hekimine başvurma durumları ile aile hekimliğini kullanma durumları sorgulandı. Veri toplama aracı olarak araştırmacılar tarafından oluşturulan 28 soruluk bir anket, yüz yüze görüşme tekniğiyle uygulandı. Muayene sonrasında hastalara uygulanan işlemler ve hastaların birinci basamakta yönetilebilirlikleri değerlendirildi.
Bulgular: Katılımcıların yaş ortalaması 45,1±18,8 yıl olup %55’i kadın, %45’i erkekti. En sık başvuru şikâyetleri diz ağrısı (%26,8), bel ağrısı (%8), ayak ve ayak bileği ağrısı (%7,9), el ve kol travması (%6,3) idi. Hastaların %66,6’sı ortopedi ile ilgili şikayetleri için aile hekimlerine başvurmadığını, aile hekimlerine başvuran hastaların %55,7’si aile hekimlerinin yönlendirmesi ile ortopedi polikliniğine başvurduğunu, %46,5’i herhangi bir yakınması olduğunda aile hekimlerine başvurmadığını belirtti. Aile hekimine başvurmayanların başvurmama sebepleri sorulduğunda; %33,3’ünün aile sağlığı merkezlerinde (ASM) görüntüleme yöntemi olmadığı için, %31,4’ünün branş uzman hekimine muayene olmak istediği için aile hekimine gitmediği öğrenildi. Ortopedi polikliniğine başvuran hastaların %17,3’ünün birinci basamakta tanısı konulup yönetilebileceği belirlenirken %51,4’ünün görüntüleme yapılamadığı için yönetilemeyeceği belirlendi. Hastane başvurusu öncesinde aile hekimine başvuran hastaların yaş ortalaması hastaneye başvuranlara göre anlamlı derecede daha yüksek olarak belirlendi (p
Introduction and Aim: Some of the health problems faced by family physicians are diseases related to orthopedics and traumatology. It was aimed to determine the manageability of patients admitted to the orthopedics and traumatology outpatient clinic of a public hospital in primary care.
Materials and Methods: A total of 473 patients who applied to the orthopedics and traumatology outpatient clinic of a secondary level state hospital between October 2022 and February 2023 were included in the study. The sociodemographic and clinical characteristics of the participants, their complaints, whether they consulted a family doctor for these complaints, and their use of family medicine were questioned. A 28-question survey created by the researchers as a data collection tool was applied using face-to-face interview technique. After the examination, the procedures applied to the patients and their manageability in primary care were evaluated.
Results: The average age of the participants was 45.1±18.8 years, 55% were women and 45% were men. The most common complaints were knee pain (26.8%), lower back pain (8%), foot and ankle pain (7.9%), and hand and arm trauma (6.3%). 66.6% of the patients stated that they did not consult their family physician for their orthopedic complaints, 55.7% of the patients who applied to their family physician applied to the orthopedic clinic with the guidance of their family physician, and 46.5% stated that they did not consult their family physician when they had any complaints. When those who did not consult a family doctor were asked about their reasons for not applying; It was learned that 33.3% did not go to the family physician because there was no imaging method in family health centers and 31.4% wanted to be examined by a branch specialist physician. It was determined that 17.3% of the patients who applied to the orthopedics outpatient clinic could be diagnosed and managed in primary care, while 51.4% could not be managed because imaging could not be performed. The average age of patients who consulted their family physician before admission to the hospital was significantly higher than those who applied to the hospital (p
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