Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Fuzzy adaptive resonance theory approach to supplier involvement in product development: a case study in Turkish automobile industry

This study proposes a mechanism to evaluate suppliers for involvement during product development process. The proposed methodology is discussed within a multinational automobile firm and preliminary analysis indicates that the approach provides an effective mechanism for selecting suppliers involved in the product development process. To remedy to supplier integration problems, a clustering approach – fuzzy adaptive resonance theory (Fuzzy ART) – is used. The proposed methodology is explained using a case study that is realised in an automobile firm. Eventually, the results are presented comparatively, which obtained by current supplier evaluation system of the firm and provided from Fuzzy ART methodology. [Submitted 14 July 2009; Revised 16 November 2009; Accepted 17 November 2009]supplier involvement; supply chain management; SCM; adaptive resonance theory; fuzzy ART; product development; classification; Turkey; automobile industry; automotive supply chains; clustering.

DER TÜRKISCHE TOMATENSEKTOR – REGIONALE GESICHTSPUNKTE UND RÄUMLICHE MARKTINTEGRATION

Tomatoes have the largest share among fruits and vegetables, which add substantially to the gross agricultural product in Turkey. We describe the structure and development of this sector from the year 1990 onwards, covering farms in primal production, trade facilities, processing firms, and marketing channels. An analysis of retail prices for table tomatoes in 22 provinces and their dynamics follows. Finally we employ a threshold vector error-correction model to analyse integration among the markets for table tomatoes in the presence of transaction costs. The results show a ring of integrated provinces along the coasts of Turkey, while the interior provinces are rather separated. In some cases price transmission only occurs when deviations from an interprovincial price equilibrium exceed a certain threshold

Using principal component analysis and fuzzy c–means clustering for the assessment of air quality monitoring

AbstractDetermining whether a reduction can be made in the total number of monitoring stations within the Air Quality Monitoring Network is very important since in case of necessity, the devices at one group of stations having similar air pollution characteristics can be transferred to another zone. This would significantly decrease the capital investment and operational cost. Therefore, the objective of this study was grouping the monitoring stations that share similar air pollution characteristics by using the methods of principal component analysis (PCA) and fuzzy c– means (FCM). In addition, this study also enables determining the emission sources, evaluating the performances of the methods and examining the zone in terms of pollution. In the classification of monitoring stations, different groups were formed depending on both the method of analysis and the type of pollutants. As a result of PCA, 5 and 3 classes have been determined for SO2 and PM10, respectively. This shows that the number of monitoring stations can be decreased. When reduced classes were analyzed, it was observed that a clear distinction cannot be made considering the affected source type. During the implementation of the FCM method, in order to facilitate comparison with the PCA, the monitoring stations were classified into 5 and 3 groups for SO2 and PM10, respectively. When the results were analyzed, it was seen that the uncertainty in PCA was reduced. When the two methods are compared, FCM was found to provide more significant results than PCA. The evaluation in terms of pollution, the results of the study showed that PM10 exceeded the limit values at all the monitoring stations, and SO2 exceeded the limit values at only 3 of the 22 stations

Effectiveness and safety of entecavir and tenofovir in chronic hepatitis b patients: A multicenter Turkish study in clinical practice

64th Annual Meeting and Postgraduate Course of the American-Association-for-the-Study-of-Liver-Diseases -- NOV 01-05, 2013 -- Washington, DCWOS: 000330252203197Amer Assoc Study Liver Di