Implementation of an Overall Design of a Flexible Manufacturing System

AbstractIn this study, an implementation of the design of an FMS is performed to calculate necessary number, utilization and sequence of workstations and plant layout for given production quantities of different parts, processing sequence and times. Analytical bottleneck model and rank order clustering techniques are used in the calculation and analysis of the system. Manufacturing cells are constituted for similar parts to simplify the analysis of the system and to efficient use of workstations. Results are compared with the conventional manufacturing conditions to determine the effectiveness of the implementation

Thyroid fine needle aspiration reporting rates and outcomes before and after Bethesda implementation: A single-center experience over 8 years

Aimː To evaluate data from our hospital system before and after the implementation of the Bethesda System for Reporting Thyroid Cytology (TBSRTC) and comparison of our data with the previously published studies. Methods: Seven hundred seventy-one patients with thyroid nodules who underwent fine needle aspiration biopsy (FNAB) and surgery at our institution were analyzed retrospectively. FNAB results were divided into two parts in terms of the period they related to: pre-TBSRTC (between 2005 and 2010) and TBSRTC (between 2011 and 2013). Results: 341 FNAB were applied in the period of TBSRTC. Of the 341 FNAB, 53(16%) were non diagnostic, 82(24%) were benign, 62(18%) were atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 28(8%) were follicular neoplasms and/or suspicion of follicular neoplasms (FN/SFN), 95(28%) were suspicion for malignancy (SuspM), and 21(6%) were malignant. Rates of malignancy reported on follow-up histopathological examination were non diagnostic in 11%, benign in 4.9%, AUS/FLUS in 23%, FN/SFN in 32%, SuspM in 44%, and malignant in 95.3%. Conclusions: In this study, the distribution of cases in TBSRTC categories and malignancy rates, differed from, recommended by TBSRTC and some studies. Implementation of TBSRTC did significantly affect our institution’s reporting rates

Is Positron Emission Tomography Reliable to PredictPost-Chemotherapy Retroperitoneal Lymph NodeInvolvement in Advanced Germ Cell Tumors of theTestis?

PURPOSE: To evaluate if 18 fluorodeoxyglucose positron emission tomography(18FDG-PET) scan could identify post-chemotherapy retroperitoneal lymphnode (RPLN) involvement in advanced germ cell tumors of the testis.MATERIALS AND METHODS: Between January 2005 and January 2009, 16patients with advanced germ cell tumors of the testis underwent RPLNdissection (RPLND) following chemotherapy. Before RPLND, abdominalcomputed tomography (CT), magnetic resonance imaging (MRI), and18FDG-PET were performed in all the patients. Findings on 18FDG-PETwere compared with pathological evaluation of the removed lymphatic tissue.RESULTS: Both abdominal CT and MRI demonstrated retroperitonealmasses in all the patients following chemotherapy. Although PET did not demonstrate any activity in 8 patients, tumor was detected histopathologically.In 1 patient, 18FDG-PET demonstrated activity; however, no tumor wasdetected on pathology. Of the remaining 7 patients, 18FDG-PET findingswere concordant with the histopathological findings. No activity wasdetected in 2 patients with no tumors whereas all 5 patients harboring viabletumor cells showed positive 18FDG-PET activity. In our study, sensitivityand specificity of 18FDG-PET in detecting RPLN involvement were detectedto be 39% and 67%, respectively.CONCLUSION: 18FDG-PET imaging does not seem to be a reliable methodin detecting RPLN involvement in advanced germ cell tumors of the testisfollowing chemotherapy. Therefore, we neither recommend routine use of18FDG-PET scanning nor decide the treatment work-up by solely relying onthe 18FDG-PET findings in this patient group

Dobrava Hantavirus Infection Complicated by Panhypopituitarism, Istanbul, Turkey, 2010

We identified Dobrava-Belgrade virus infection in Turkey (from a strain related to hantavirus strains from nearby countries) in a patient who had severe symptoms leading to panhypopituitarism, but no known risk for hantavirus. Our findings emphasize the need for increased awareness of hantaviruses in the region and assessment of symptomatic persons without known risk factors for infection

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

The genetic history of the Southern Arc: a bridge between West Asia and Europe

By sequencing 727 ancient individuals from the Southern Arc (Anatolia and its neighbors in Southeastern Europe and West Asia) over 10,000 years, we contextualize its Chalcolithic period and Bronze Age (about 5000 to 1000 BCE), when extensive gene flow entangled it with the Eurasian steppe. Two streams of migration transmitted Caucasus and Anatolian/Levantine ancestry northward, and the Yamnaya pastoralists, formed on the steppe, then spread southward into the Balkans and across the Caucasus into Armenia, where they left numerous patrilineal descendants. Anatolia was transformed by intra–West Asian gene flow, with negligible impact of the later Yamnaya migrations. This contrasts with all other regions where Indo-European languages were spoken, suggesting that the homeland of the Indo-Anatolian language family was in West Asia, with only secondary dispersals of non-Anatolian Indo-Europeans from the steppe

Hydraulic Planning in Insular Urban Territories: The Case of Madeira Island—São Vicente

This study aims to examine the flood propensity of the main watercourse of São Vicente drainage basin and, if relevant, to propose two methodologies to alleviate the impacts, i.e., detention basin sizing and riverbed roughness coefficient adjustment. Geomorphological data were obtained from the watershed characterization process and used through the SIG ArcGIS software for the flood propensity assessment and then for the calculation of the expected peak flow rate for a return period of 100 years through the Gumbel Distribution. Subsequently, the drainage capacity of the river mouth was verified using the Manning-Strickler equation, in order to establish whether the river mouth of the watershed has the capacity to drain the entire volume of rainwater in a severe flood event. In summary, it was possible to conclude that São Vicente’s watershed river mouth is not able to completely drain the rain flow for the established return period. Thus, its drainage capacity was guaranteed by modifying the walls and streambed roughness coefficient and by sizing the detention basin using the Dutch and the Simplified Triangular Hydrograph methods