A study on performance based logistics/performance based service acquisitions and their applicability to Turkish Navy service acquisition activities

MBA Professional ReportThe purpose of this MBA professional report is to investigate and analyze Performance Based Logistics (PBL)/Performance Based Service Acquisitions (PBSA) and provide implementation alternatives for Turkish Navy service acquisitions. This Professional MBA Report includes a literature review and background information about PBL and PBSA; current PBL and PBSA implementations in the U.S.A.; current Turkish acquisition rules and regulations, along with the legal constraints as to the applicability of PBSA; Turkish Navy service acquisition activities and associated problematic areas; problems with the implementation of PBL and PBSA in the U.S.A. and recommendations for alternative implementation solutions based on the findings.http://archive.org/details/astudyonperforma1094510026Turkish Navy authorApproved for public release; distribution is unlimited

The importance of probiotics in antibiotic associated diarrhea

Antibiotics are the most frequently prescribed drugs in children and antibiotic-associated diarrhea (AAD) is frequently observed in this population. Antibiotic treatment cause different symptoms mostly diarrhea. by impairing resistance of colonization in gastrointestinal flora. In particular, antibiotics with anaerobic activity, such as penicillin, cephalosporin, clindamycin frequently cause diarrhea. Symptoms range from mild clinical findings such as self-limiting diarrhea, to severe particularly Clostiridium difficile associated diarrhea. Antibiotic-associated diarrhea is an important reason for the noncompliance with antibiotic treatment. Probiotics maintain and restore intestinal microecology by improving microbial balance in the intestinal tract with their antibacterial and immune regulatory effects during or after antibiotic treatment. There is growing interest in studies on probiotics and evidence of the effectiveness of probiotics in the prevention and treatment of AAD is also increasing. Despite heterogeneities concerning probiotic strain, dose, duration of use, and the qualities of the studies performed, the evidence obtained supports the protective effect of probiotics in preventing AAD. Nevertheless, further studies are needed to determine which probiotics have the greatest efficacy and for which patients receiving which specific antibiotics. There are limited data regarding the effectiveness of probiotics in the prevention of C. difficile infection in children. There are limited data about the place of probiotics in the treatment of C. difficile infection in adults, and adequate number of studies have not been performed in children about this issue

Predictive Factors for Determining the Clinical Severity of Pediatric Scorpion Envenomation Cases in Southeastern Turkey

Objective.-The aim of this study was to define the epidemiological, clinical, and laboratory manifestations of scorpion envenomation and to identify factors that are predictive of severe cases

Luc abscess: an extraordinary complication of acute otitis media

Luc abscess is an uncommon suppurative complication of otitis media. Unfamiliarity of this complication leads to delayed diagnosis and treatment. This abscess is usually benign. Infection in the middle ear spreads via anatomic preexisting pathways, and this process results with subperiosteal pus collection. Conservative treatment with drainage under empirical wide spectrum antibiotic is efficient. Here, we present a 9-year-old boy who had left facial swelling after a period of otalgia, diagnosed as Luc abscess without mastoiditis

A novel experimental and density functional theory study on palladium and nitrogen doped few layer graphene surface towards glucose adsorption and electrooxidation

At present, few layer graphene (G) and nitrogen doped few layer graphene (N doped-G) are firstly coated on Cu foil via chemical vapor deposition (CVD) method and G and N doped-G coated Cu foil is transferred to the indium tin oxide (ITO) substrate surface to obtain electrodes. Pd metal is electrodeposited onto the N doped-G/ITO electrode (Pd-N doped-G/ITO). Pd-N doped-G/ITO electrode are characterized with advanced surface characterization methods such as Raman spectroscopy and SEM-EDX. Characterization results reveal that G and N structures are succesfully obtained and the presence of Pd on Pd-N doped-G/ITO is confirmed with SEM-EDX mapping. The cyclic voltammetry (CV), chronoamperometry (CA), and electrochemical impedance spectroscopy (EIS) are employed to examine glucose electrooxidation of G/ITO, N-doped G/ITO, and Pd-N-doped G/ITO electrodes. P-N-dopedG/ITO electrode exhibits the best glucose electrooxidation activity with 2 mA/cm(2) specific activity. Density functional theory (DFT) calculations are also carried out to better understand the interaction of the molecules on Pd modified G (Pd-G) and Pd modified N-doped G (Pd-3NG) surfaces

A comparative experimental and density functional study of glucose adsorption and electrooxidation on the Au-graphene and Pt-graphene electrodes

At present, the graphene is covered on Cu foil with the 5 sccm hexane (C6H14) flow rate, 50 sccm hydrogen (H-2) flow rate, and 20 min deposition time parameters by the CVD method. The graphene on the Cu foil is then covered onto few-layer ITO electrode. Furthermore, the Pt and Au metals are electrodeposited on graphene/ITO electrode with electrochemical method. These electrodes are characterized by Raman spectroscopy and Scanning Electron Microscopy-Energy Dispersive X-Ray analysis (SEM-EDX). The graphene structure is approved via Raman analysis. Au, Pt, and graphene network are openly visible from SEM results. In addition, glucose (C6H12O6) electrooxidation is investigated with cyclic voltammetry (CV), chronoamperometry (CA), and electrochemical impedance spectroscopy (EIS) measurements. As a result, Pt-graphene/ITO indicates the best C6H12O6 electrooxidation activity with 9.21 mA cm(-2) specific activity (highly above the values reported in the literature). In all electrochemical measurements, Pt-graphene/ITO exhibits best electrocatalytic activity, stability, and resistance compared to the other electrodes. The adsorption of the C6H12O6 molecule is examined theoretically over metal atom (gold and platinum)-doped graphene surfaces using the density functional theory (DFT) method. The interaction between C6H12O6 molecule and OH adsorbed Pt-doped surface is stronger than that of OH adsorbed Au-doped graphene surface thermodynamically according to the reaction energy values. (C) 2019 Hydrogen Energy Publications LLC. Published by Elsevier Ltd. All rights reserved

Predictive Factors for Clinical Severity and Cardiopulmonary Arrest in Pediatric Electrical Injuries in Southeastern Turkey

Objective An electrical injury (EI) is an emergency that causes high morbidity and mortality each year. The aim of this study was to define the epidemiological, clinical, and laboratory factors that might predict severe patients and cardiac arrest in pediatric EI cases

Use of cerebral and somatic regional tissue oxygen saturation in monitoring critically ill children who were admitted to the pediatric emergency department: A prospective descriptive study

Amaç: Çocuk acil servise başvuran kritik hastaların takibinde kalp tepe atımı, solunum sayısı, arteriyel tansiyon basıncı, nabız oksimetri, idrar çıkışı ve laktat günümüzde kullanılan en önemli takip parametreleridir. Bu çalışmanın amacı, akut solunum yetmezliği ya da şok tablosu ile acil servise başvuran hastalarda beyin ve splankinik bölgesel doku oksijenizasyonunun (rSO2) takibinin rutin takip sistemlerine bir üstünlüğü olup olmadığını araştırmaktır.Yöntem: Çocuk acil kliniğine Mayıs 2014-Mart 2016 tarihleri arasında başvuran, akut solunum yetmezliği ya da şok tablosunda olan hastalar prospektif olarak çalışmaya dahil edildi. Tüm hastaların, rutin takip parametrelerine (solunum sayısı, kalp tepe atımı, nabız oksimetri, arteriyel tansiyon basıncı) ek olarak, NIRS monitörü (INVOS 510°C serebral/somatik oximetre Covidien, Mansfield, MA, USA) ile beyin ve splankinik rSO2 değerleri kaydedildi. Hastaların tedavi öncesi ve sonrası değerleri Wilcoxon Signed Rank testi kullanılarak karşılaştırıldı. İstatistiksel anlamlılık p&lt;0,05 olarak kabul edildi.Bulgular: Çalışmaya 15 hasta dahil edildi. Hastaların ortanca (ÇAA) yaşı 16,0 (10,0-66,0) ay idi. Solunum sayısı, kalp tepe atımı değerleri tedavi ile anlamlı olarak azalırken (sırasıyla p=0,02 ve p=0,03), SpO2 ve SrSO2 değerleri istatistiksel olarak anlamlı yükselme gösterdi (sırasıyla p=0,01 ve p=0,04). Beyin rSO2 değeri ve beyin/splankinik rSO2 oranı (BSOO)’nda anlamlı değişiklik görülmedi (p&gt;0,05).Sonuç: Bu çalışmada kritik hastalarda SrSO2 değerinin tedavi sonrası anlamlı olarak artış gösterdiğisaptanmıştır.Objective: Heart rate, respiratory rate, arterial blood pressure, pulse oximetry, urine ouput, and lactate level are the most important parameters in the follow-up of the critically ill child who is admitted to the pediatric emergency department. The aim of this study is to determine if there is an advantage of follow-up with cerebral and splanchnic regional tissue saturation (rSO2) over routine monitoring systems in children who applied to the pediatric emergency department with manifestations of acute respiratory failure or shock. Method: Children admitted to pediatric emergency department between May 2014 and March 2016 with acute respiratory failure or shock were prospectively included into this study. The cerebral and splanchnic rSO2 levels were recorded via NIRS monitor (INVOS 510°C cerebral/ somatic oximetre Covidien, Mansfield, MA, USA) in addition to conventional monitoring parameters (heart rate, respiratory rate, pulse oxymeter, and arterial blood pressure). Prez-, and post-treatment values of the patients were compared with Wilcoxon Signed Rank test. Statistical significance was accepted as p&lt;0.05 for all tests.Results: Fifteen children were included into this study. The median age of the patients was 16.0 (10.0-66.0) months. The respiratory rate and hearth rate decreased significantly (p=0.02 and p=0.03, respectively) whereas SpO2 and splanchnic rSO2 increased (p=0.01 and p=0.04, respectively). A significant difference was not seen in cerebral rSO2 and cerebral/splanchnic rSO2 ratio (p&lt;0.05).Conclusion: In this study, we showed that the splanchnic rSO2 values in critically ill children increased after the treatment.</div

Is lung ultrasonography a useful method to diagnose children with community-acquired pneumonia in emergency settings?

Background: Lung ultrasonography is a new method for diagnosing community-acquired pneumonia. Lung ultrasonography has some advantages over chest X-ray, such as lack of ionizing radiation risk, bedside performance, and cost-effectiveness. Objectives: In this study, we aimed to determine the feasibility of lung ultrasonography in emergency settings in children with community-acquired pneumonia. Methods: The study included patients younger than 18 years of age with suspicion of community-acquired pneumonia. On the first evaluation, patients with positive clinical and/or chest X-ray findings were defined to have community-acquired pneumonia, and this was accepted as the gold standard. The chest X-rays were evaluated by the chief of the pediatric emergency department, who was blinded to the patients and the lung ultrasonography results. Lung ultrasonography was performed by another pediatric emergency physician who was also blinded to the chest X-ray results and clinical findings such as fever, respiratory distress, rales, and wheezing. Results: Of the 91 patients enrolled, 71 (78.0%) were diagnosed with community-acquired pneumonia based on clinical and chest X-ray findings. The median (interquartile range) duration of the lung ultrasonography procedure was 4.0 (3.5-6.0) min. Shred sign, air bronchogram, and hepatization were significantly more frequent in the patients with community-acquired pneumonia (p < 0.01, p < 0.01, and p = 0.01, respectively). Sensitivity and specificity of lung ultrasonography were 78.5% (67.1-87.4) and 95.2% (76.1-99.8), respectively. Conclusion: Lung ultrasonography is a useful diagnostic method for children with suspicion of community-acquired pneumonia