The Effects of Material Properties on Building Performance

In recent earthquakes during the last two decades, severe damages have been occurred on the existing buildings in Turkey. Destructive earthquakes revealed that the existing building stock in urban regions is significantly vulnerable to seismic hazard. A large number of residential buildings located in regions of high seismicity require performance evaluation before the next big earthquake hits the region. In many earthquake resistant codes, several procedures are proposed to determine the building performance. The investigations on the damaged buildings show that material strengths are very important parameters on the building performance. In this study, material strengths’ effects on the building performance were investigated by using a nonlinear elastic analysis method

Port assisted closure of laparoscopic wound: A safe and feasible technique

Objective: Various techniques and instruments have been developed to provide safe and secure closure of laparoscopic wounds. Herein we describe a simple method to close laparoscopic supraumbilical wounds with the aid of a laparoscopic port. Method: This was a retrospective review of prospective data, which were from 151 patients who underwent laparoscopic cholecystectomy for symptomatic gallstone disease from December 2009 to December 2010 in Sultanah Bahiyah Hospital. A senior consultant hepato-pancreato-biliary (HPB) surgeon and two HPB trainee surgeons performed the operations. Postoperatively, all patients were followed up at 4 weeks. Results: All patients successfully underwent closure of the supraumbilical wound with the assistance of a 5mm laparoscopic port. None of the patients had incisional hernia on follow up. Conclusion: Port assisted closure of supraumbilical laparoscopic wounds is a feasible and safe technique

Aplastic Crisis as Primary Manifestation of Systemic Lupus Erythematosus

Aplastic crisis is an unusual feature of systemic lupus erythematosus (SLE). We report the case of a 54-year-old woman presenting with both (extravascular) Coombs-positive hemolytic anemia and laboratory findings of bone marrow hyporegeneration with concomitant severe neutropenia. A bone marrow biopsy confirmed aplastic crisis. Diagnostic work-up revealed soaring titers of autoantibodies (anti-nuclear, anti-double-stranded DNA, anti-cardiolipin-IgM, and anti-beta 2-glykoprotein-IgM antibodies), indicating a connective tissue disease as the most plausible reason for bone marrow insufficiency. As the criteria for SLE were fulfilled, we initiated an immunosuppressive therapy by steroids, which led to a rapid complete hematologic and clinical remission in our patient. In this case, we could report on one of the rare cases of SLE-induced aplastic crisis showing that this condition can be entirely reversed by immunosuppressive treatment and that SLE-induced aplastic crisis yields a good prognosis. In conclusion, in a case of aplastic crisis, physicians should be aware that SLE can be a rare cause that is accessible to specific treatment

New horizons from novel therapies in malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is a relatively rare, but highly lethal cancer of the pleural mesothelial cells. Its pathoge-nesis is integrally linked to asbestos exposure. In spite of recent developments providing a more detailed understanding of the pathogenesis, the outcomes continue to be poor. To date, trimodality therapy involving surgery coupled with chemotherapy and/or radiotherapy remains the standard of therapy. The development of resistance of the tumor cells to radiation and several che-motherapeutic agents poses even greater challenges in the management of this cancer. Ionizing radiation damages cancer cell DNA and aids in therapeutic response, but it also activates cell survival signaling pathways that helps the tumor cells to overcome radiation-induced cytotoxicity. A careful evaluation of the biology involved in mesothelioma with an emphasis on the workings of pro-survival signaling pathways might offer some guidance for treatment options. This review focuses on the existing treatment options for MPM, novel treatment approaches based on recent studies combining the use of inhibitors which target different pro-survival pathways, and radiotherapy to optimize treatment

Non-western contexts: the invisible half

Like many other disciplines within the broad area of social sciences (e.g., anthropology, gender studies, psychology, sociology, etc.), consumer research is also highly navigated by scholars from Western countries. This, however, does not mean, by any means, that consumer research is devoted to studying Western contexts only. As evident from the ever-increasing number of regional conferences (e.g., Asia-Pacific and Latin American conferences of the Association for Consumer Research) and non-Western students' enrolment in doctoral programs at Western universities, there are many more researchers (from non-Western countries) who are entering the field and enriching it by their colourful contributions. Yet, given the low number of publications on consumer research in non-Western contexts, it seems that our current knowledge in these societies has a long way to go to flourish. More specifically, and in the domain of consumption culture research, this gap is even further widened by the fact that the culture of consumption in such contexts is largely interpreted with reference to the 'grand narratives' of Western scholars (e.g., Foucault, Mafessoli, Bourdieu, Deleuze, Baudrillard, Nietzsche, Durkheim, Derrida, etc.). Therefore, from an ontological perspective, it seems that our existing knowledge about non-Western societies lies heavily on the 'theoretical structures' that are 'constructed' by Western philosophy as a set of ideas, beliefs, and practices (Said, 1978). As Belk (1995) reminds us, consumption culture always existed in all human societies. What makes contemporary societies different from that of our predecessors' is not the fact that consumption culture did not exist in those societies, but that consumption culture has become a prevailing feature in modern society (Slater, 1997; Lury, 1996; Fırat and Venkatesh, 1995; McCracken, 1988). Therefore, the nature and dynamics of consumption culture in each society should be studied not only against the sociocultural, historical, and economic background of a given context (Western or non-Western) but also with reference to the philosophical and epistemological viewpoints that analyse and interpret cultural practices of that society from within that culture. Addressing such issues, this paper discusses some of the key reasons for lack of theory development in the field from non-western contexts. The paper invites scholars in non-Western contexts to introduce the less articulated, and sometime hidden, body of knowledge from their own contexts into the field of marketing in general and consumer research in particular

Current treatment strategies in malignant pleural mesothelioma with a treatment algorithm

Malignant pleural mesothelioma (MPM) is a rare disease with a poor prognosis. The main therapeutic options for MPM include surgery, chemotherapy, and radiation therapy (RT). Although multimodality therapy has been reported to improve survival, not every medically operable patient is able to undergo all recommended therapy. With improvements in surgical techniques and systemic therapies, as well as advancements in RT, there has been a potential new paradigm in the management of this disease. In this review, we discuss the current literature on MPM management and propose a functional treatment algorithm

Perceived barriers for treatment of chronic heart failure in general practice; are they affecting performance?

BACKGROUND: The aim of this study is to determine to what extent barriers perceived by general practitioners (GPs) for prescribing angiotensin-converting enzyme inhibitors (ACE-I) in chronic heart failure (CHF) patients are related to underuse and underdosing of these drugs in actual practice. METHODS: Barriers were assessed with a semi-structured questionnaire. Prescribing data were extracted from GPs' computerised medical records for a random sample of their CHF patients. Relations between barriers and prescribing behaviour were assessed by means of Spearman rank correlation and multivariate regression modelling. RESULTS: GPs prescribed ACE-I to 45% of their patients and had previously initiated such treatment in an additional 3.5%, in an average standardised dose of 13.5 mg. They perceived a median of four barriers in prescribing ACE-I or optimising ACE-I dose. Many GPs found it difficult to change treatment initiated by a cardiologist. Furthermore, initiating ACE-I in patients already using a diuretic or stable on their current medication was perceived as barrier. Titrating the ACE-I dose was seen as difficult by more than half of the GPs. No significant relationships could be found between the barriers perceived and actual ACE-I prescribing. Regarding ACE-I dosing, the few GPs who did not agree that the ACE-I should be as high as possible prescribed higher ACE-I doses. CONCLUSION: Variation between GPs in prescribing ACE-I for CHF cannot be explained by differences in the barriers they perceive. Tailor-made interventions targeting only those doctors that perceive a specific barrier will therefore not be an efficient approach to improve quality of care

Heart failure guidelines and prescribing in primary care across Europe

BACKGROUND: Major international differences in heart failure treatment have been repeatedly described, but the reasons for these differences remain unclear. National guideline recommendations might be a relevant factor. This study, therefore, explored variation of heart failure guideline recommendations in Europe. METHODS: Treatment recommendations of 14 national guidelines published after 1994 were analyzed in relation to the heart failure treatment guideline of the European Society of Cardiology. To test potential relations between recommendations and prescribing, national prescribing patterns as obtained by a European study in primary care (IMPROVEMENT-HF) were related to selected recommendations in those countries. RESULTS: Besides the 14 national guidelines used by primary care physicians in the countries contacted, the European guideline was used in four countries, and separate guidelines for specialists and primary care were available in another four countries. Two countries indicated that no guideline was used up to 2000. Comprehensiveness of the guidelines varied with respect to length, literature included and evidence ratings. Relevant differences in treatment recommendations were seen only in drug classes where evidence had changed recently (β-blockers and spironolactone). The relation between recommendation and prescribing for selected recommendations was inconsistent among countries. CONCLUSION: Differences in guideline recommendations are not sufficient to explain variation of prescribing among countries, thus other factors must be considered