Epidemiology of surgery associated acute kidney injury (EPIS-AKI) : a prospective international observational multi-center clinical study

The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Is NATO ready for a cyberwar?

This thesis analyzes the sufficiency and effectiveness of the North Atlantic Treaty Organization's (NATO) cyber policies against cyber threats, considering the recent cyber cases and incidents that could be related to NATO's cyber defense. The authors use analytical and descriptive approaches to answer the research questions by examining the categories of cyber threats facing NATO and the policies implemented to fight against cyber operations and attacks. Finally, the authors make policy recommendations in order to respond to cyber threats more effectively in regard to eight specific areas: cooperation with the European Union; relations with business enterprises; information sharing among members; education, training, and exercises; capabilities of NATO Communications and Information Agency (NCIA); critical infrastructure protection; cyber law and legislature; and collective cyber defense. The cyber domain is a challenging arena in which to carry out operations and develop policies. NATO can be considered successful in cyberspace; however, the alliance should be aware that there is no limit to the development of capabilities, especially in cyber defense issues.http://archive.org/details/isnatoreadyforcy10945516621st Lieutenant, Turkish Army1st Lieutenant, Turkish Air ForceApproved for public release; distribution is unlimited

Determination of Land Use Classes and Erosion Risk Assessment in Kuzgun Watershed

Geographic information systems and remote sensing technologies have important tools for determination of some characteristics of natural resources enable us to get accurate results that by eliminating time, labor and processes that require high cost. The purpose of this study, determine land uses using geographic information systems and remote sensing technologies according to the European Environment Agency, air, water, soil, land cover, coastal erosion, biotopes and so on. Issues carried out under the project CORINE detected the parameters within the framework of watershed scale. Error level was determined by comparing the shapes of the actual terrain with the results obtained by using these technologies. According to the results detected sub class such as; 5 level of 1, 10 level of 2 and 15 level of 3. Assessed the relationship between land use map according to the CORINE and actual erosion risk map produced the for the same area. According to these results, low-risk areas are forests and meadow (24.66%), and medium and high risk areas are grassland and unproductive soil lands (34.98%) in terms of the actual erosion risk in the watershed area. Results provided by technologies such as geographic information systems and remote sensing were compared current land use maps of the classic method and identified a high correlation between them (%89.9). In this study, in the determination and monitoring of future changes in land use and incorrect land use, by reducing the negative effects of desertification and drought will be benefit for sustainable use natural resources

Supplier Selection in E-Procurement

Abstract- In today’s competitive business world, it is extremely important for decision makers to have access to decision support tools in order to make quick, right and accurate decisions. One of these decision making areas is supplier selection in e-procurement. Supplier selection is a multi-criteria decision making problem that deals with the optimization of conflicting objectives such as quality, cost, and delivery time. In spite of the fact that the term “supplier selection ” is commonly used in the literature, and many methods and models have been designed to help decision makers, few efforts have been dedicated to develop a system based on any of these methods. In this paper, we review, categorize, and discuss the literature, as well as the most widely used supplier selection criteria and their relative importance. We propose a supplier selection system based on the analytic hierarchy process (AHP) method which has been commonly used for multi-criteria decision making problems. Inasmuch as we believe that fuzzy concepts extend the capability of any modeling approach, integrating fuzzy concepts into our model will lead to a more powerful system. To support this idea and to facilitate decision making in the supplier selection process, we implemented linear and non-linear fuzzy programming approaches on a chosen business scenario.

Batı Kozluca sahasına uygulanabilecek gelişmiş üretim teknikleri üzerine bir çalışma

TÜBİTAK MİSAG01.09.2001Bu projenin amacı karbon dioksit ve buhar enjeksiyonu yöntemlerinin ağır petrol içeren B.Kozluca sahası ve benzerlerine uygulanabilirliğini tartışmaktır. Bu amaca ulaşmak için çeşitli labaratuvar deneyleri ve termal nümerik simulasyon yoluyla benzetim teknikleri kullanılmıştır. Proje sonuçlarının bu sahalarda yapılabilecek pilot ve asıl uygulamalara bir veri tabanı oluşturması için yatay ve dikey enjeksiyon/üretim çiftleri ve değişik buhar destekli gravite drenaj sisteminin sadece karbon dioksit enjeksiyonu ve dikey kuyuların kullanıldığı buhar ve/veya karbondioksit enjeksiyonu sistemlerinden daha avantajlı olduğu görülmüştür. Karşılaştırma amacıyla butan gazı kullanılarak yapıaln deneylerde elde edilen kurtarım karbon dioksit deneylerinde elde edilen kurtarım düzeyinde olmamıştır. Kireçtaşı karot tapaları kullanılarak yapılan tek boyutlu deneylerde de benzer sonuçlar elde edilmiştir. Sonuçlar termal nümerik simulator kullanılarak benzetilmiştir

Evaluation of Online Anatomy Education Given in Medicine and Dentistry Faculties of Universities During Covid-19 Pandemic with Student

Objective: We are experiencing the effects of Covid-19 pandemic as the whole world. All educational facilities have been negatively affected within this period. In this study, the aim was to evaluate online Anatomy education during Covid-19 pandemic with students’ feedbacks and it was questioned whether it would be efficient to use online education more actively in the following years.Methods: A total of 1127 first and second year students from Dentistry Faculty and Medicine Faculty of Düzce, Karabük and İnönü Universities were included in the study. The survey prepared in “Google Forms” was sent online to students via “WhatsApp” application. Descriptive statistical analyses were used in data.Results: According to analysis results, it was found that the students agreed on the content and efficiency of online anatomy education, not having learning difficulties, the layout of the lessons, the importance of the lesson, the necessity for their profession, the importance of visual tools, they are worried about not being able to do face-to-face lessons, and anatomy theoretical courses shouldn’t be taught online when the pandemics is over. It was found that medicine faculty students placed more importance on anatomy education in terms of professional aspects.Conclusions: As a result, we believe that the online Anatomy education students receive is important in terms of their professional development. However, we believe that it won’t be possible for online Anatomy education to replace face-to-face education. This study will be a resource for studies to be conducted in medicine and health sciences fields in terms of online education.Amaç: Dünya olarak Covid-19 pandemisinin etkilerini yaşamaktayız. Bu süreçte tüm eğitim faaliyetleri olumsuz etkilendi. Bu çalışmada Covid-19 pandemisi sürecinde online Anatomi eğitiminin öğrenci geri bildirimleri ile değerlendirilmesi amaçlandı ve online eğitimin sonraki yıllarda daha aktif kullanılmasının verimli olup olmayacağı sorgulandı. Gereç ve Yöntem: Çalışmaya Düzce, Karabük ve İnönü Üniversitesi’nin Diş Hekimliği ve Tıp Fakültesi Dönem I ve II öğrencilerinden toplam 1127 öğrenci dahil edildi. Öğrencilere “WhatsApp” uygulaması üzerinden “Google Forms”da hazırlanan anket online olarak gönderildi. Verilerde tanımlayıcı istatistiksel analizler kullanıldı. Bulgular: Analiz sonuçlarına göre öğrencilerin verilen online anatomi eğitimin içeri, verimliliği, öğrenme zorluğu çekmedikleri, derslerin düzeni, dersin önemi, meslekleri için gerekliliği, görsel unsurların önemi, dersi yüz yüze ders yapamamaktan dolayı endişeli oldukları ve pandemi bittikten sonra anatomi teorik derslerinin online olarak yapılmasını istemedikleri konularında hemfikir oldukları görüldü. Tıp fakültesi öğrencilerinin mesleki açıdan anatomi eğitimine daha çok önem verdikleri gözlendi. Sonuç: Sonuç olarak öğrencilerinin aldığı online anatomi derslerinin mesleki gelişimleri için önemli olduğu kanısındayız. Ancak yine de online eğitimin yüz yüze örgün eğitim sisteminin yerini almasının söz konusu olmayacağını düşünmekteyiz. Bu çalışma online eğitimler açısından tıp ve sağlık bilimleri alanlarında yapılacak çalışmalar için bir kaynak oluşturacaktır.WOS:00062876870000

The rectilinear distance Weber problem in the presence of a probabilistic line barrier

This paper considers the problem of locating a single facility in the presence of a line barrier that occurs randomly on a given horizontal route on the plane. The objective is to locate this new facility such that the sum of the expected rectilinear distances from the facility to the demand points in the presence of the probabilistic barrier is minimized. Some properties of the problem are reported, a solution algorithm is provided with an example problem, and some future extensions to the problem are discussed.Planar facility location Barriers to travel Probabilistic barriers Line barrier The Weber problem