Approach to Gastroesophageal Reflux: A Cause of Chest Pain in Infants with Congenital Heart Disease

The life expectancy and quality of life of infants with congenital heart disease have increased in the last 30 years with significant advances in technological facilities, treatment methods, and surgeries. GER is a condition that can be seen in infants with CHD, which needs to be well followed up and to be differentiated between physiological and nonphysiological reflux. GER is a physiological condition that is common in infants with CHD and usually resolves spontaneously in the first 6–12 months of life. If the baby has adequate weight gain and nutrition status and there is no abnormal restlessness, the baby is considered to be uncomplicated GER. GERD is a pathological clinical entity that is accompanied by insufficient weight gain, esophagitis, and persistent respiratory system findings. When gastroesophageal reflux disease is considered, the first thing to be done is to complete the detailed anamnesis and physical examination of the infant. The reflux status of the infants can be examined with the surveys that were prepared for GERD and followed up for 1–2 months. If necessary, diagnostic methods such as esophageal pH monitoring and radiological and endoscopic examinations can be used. Conservative approaches such as thickening of formulas and thickening of formulas and positional feeding are the the first treatment approaches for reflux

MARCOS yöntemi ile online yemek sipariş web sitelerine yönelik müşteri şikayetlerinin değerlendirilmesi

Customer complaints against businesses are considered as communication that provides the chance to identify and resolve the factors limiting competition in the current situation by allowing direct market data to be obtained. However, the concept of complaint inherently contains negative feedback, so the numerical increase that may occur in complaints also brings into account the errors that occur in the activities of the enterprises. For this reason, a correct complaint management process should be planned for businesses to provide a customer-oriented competitive advantage. This study aims to evaluate and analyze customer complaints about companies named "getir, yemeksepeti, tiklagelsin, and Trendyol Yemek" operating in the field of online food ordering in Turkey, by obtaining the data from the website named "sikayetvar". The MARCOS Method (Measurement Alternatives and Ranking according to the COmpromise Solution), which is among the multi-criteria decision-making techniques in recent years, has been used in the analysis process, in which thirteen criteria are used in total and the most recent 500 orders of each company are taken into consideration. As a result of the study, it was found that the ranking of the companies in terms of complaint management is "yemeksepeti, tiklagelsin, getir, and trendyol yemek".İşletmelere yönelik gerçekleşen müşteri şikayetleri doğrudan pazar verisinin elde edilmesine imkân tanıyarak mevcut durumda rekabeti kısıtlayan faktörlerin tanımlanması ve çözüme kavuşturulması şansını sunan bir iletişim olarak değerlendirilmektedir. Ancak öz itibari ile şikâyet kavramı olumsuz bir geribildirimi barındırmakta dolayısı ile şikâyet sayısındaki sayısal artış işletmelerin faaliyetlerindeki ortaya çıkan hataları da göz önüne getirmektedir. Bu nedenle işletmelerin müşteri odaklı rekabetçi üstünlüğü sağlamalarında doğru bir şikâyet yönetimi sürecinin planlanması gerekmektedir. Bu çalışma Türkiye’de online yemek siparişi alanında faaliyet gösteren “getir, yemeksepeti, tıklagelsin ve trendyol yemek” isimli firmalara yönelik müşteri şikayetlerini “sikayetvar” isimli web adresinden elde ederek değerlendirme ve analiz etme amacı taşımaktadır. Toplamda on üç kriterin kullanıldığı ve her bir firmaya ait en güncel 500 siparişin göz önünde bulundurulduğu analiz sürecinde son yıllarda çok kriterli karar verme teknikleri arasında yer alan MARCOS Yöntemi (Measurement Alternatives and Ranking according to the COmpromise Solution) (Ölçüm Alternatifleri ve Uzlaşık Çözüme Göre Sıralama) kullanılmıştır. Çalışma sonucunda şikâyet yönetimi açısından firmaların sıralanmasında en iyi firma yemeksepeti, ikinci firma tıklagelsin, üçüncü firma getir ve son firma ise trendyol yemek olarak bulgulanmıştır

Lower-Critical Spin-Glass Dimension from 23 Sequenced Hierarchical Models

The lower-critical dimension for the existence of the Ising spin-glass phase is calculated, numerically exactly, as $d_L = 2.520$ for a family of hierarchical lattices, from an essentially exact (correlation coefficent $R^2 = 0.999999$) near-linear fit to 23 different diminishing fractional dimensions. To obtain this result, the phase transition temperature between the disordered and spin-glass phases, the corresponding critical exponent $y_T$, and the runaway exponent $y_R$ of the spin-glass phase are calculated for consecutive hierarchical lattices as dimension is lowered.Comment: 5 pages, 2 figures, 1 tabl

Evaluation of thiol disulfide balance in adolescents with vitamin B12 deficiency

Background: Vitamin B12 is an important vitamin for metabolism and affects many mechanisms in the body including neuronal migration, DNA synthesis, neurotransmitter synthesis, brain and cognitive development. Increased oxidative stress in the body leads to the damage of the child development, but also plays a crucial role in the pathogenesis of many diseases encountered in the childhood period. Our aim is to investigate whether or not B12 deficiency is associated with dynamic thiol/disulfide homeostasis in adolescent patients. Methods: This is a case-controlled observational study consisting of 45 adolescent patients with vitamin b12 deficiency and a control group consisting of 45 healthy adolescent. Patients between 11 and 18 ages who applied to the outpatient clinic for the first time with one of the complaints of headache were selected due to their decreased school performance, dizziness, and fatigue. Hemogram, vitamin B12, homocysteine levels and oxidative stress parameters such as native and total thiol disulfide levels and ratios of disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol were measured from the patients. Results: Vitamin B12 level was found to be significantly lower in vitamin B12 deficiency group (p < 0.001). The serum disulfide level was found to be 27.5 ± 8.38 in the case group and 20.5 ± 8.36 in the control group (p < 0.001). In the multiple linear regression analysis, it was determined that the independent variables of native thiol, homocysteine and disulfide levels effected of vitamin B12 levels (p < 0.001, p < 0.001, p < 0.005 respectively; R2 = 0.62). Conclusion: The results obtained in terms of the effect of vitamin B12 deficiency on oxidative stress in adolescents are remarkable. The increase in oxidative stress parameters in the patient group may also suggest that oxidative stress plays a vital role in vitamin B12 deficiency in adolescence

To determine the performance of the cotton harvesting machine attachable to a tractor on some cotton varieties and to evaluate an economic analysis

Çalışmada traktöre monte edilebilir tip pamuk hasat makinasının bazı pamuk çeşitleri üzerindeki performansının belirlenerek, ekonomik analizin yapılması amaçlanmıştır. Materyal olarak Nazilli 84-S, Nazilli 342, Barut 2005, Carmen pamuk çeşitleri ile N727/C125 ileri hattı kullanılmıştır. Bu çalışma 2005 yılında Nazilli Pamuk Araştırma Enstitüsü Müdürlüğü deneme arazisinde, split plot deneme desenine göre 4 tekerrürlü olarak; parseller 8.4m eninde (12 x 0.7) ve 120m uzunluğunda oluşturulmuş, makinalı hasat parselleri 100m, elle hasat parselleri ise 20 m olarak hasat edilmiştir. Makinalı hasat parsellerine %60 koza açım döneminde 60cc/da defoliant uygulaması yapılmıştır. Elle hasat parselleri birinci el ve ikinci el olmak üzere iki, makinalı hasat parselleri ise tek seferde hasat edilmiştir. Elde edilen sonuçlar JMP istatistik paket programında, α-0.05 önemlilik seviyesinde, analiz edilmiştir. Denemede makinalı ve elle hasat parsellerinde doğal döküm, hasat öncesi ve sonrası ve bitkide kalan kütlü miktarları tespit edilmiştir. Pamuk hasadının makina ile yapılmasından dolayı fazladan oluşan kayıp oranı Nazilli 342 çeşidinde %2.71, Nazilli 84-S çeşidinde %2.77, N727/C125 ileri hattında %3.07, Barut 2005 çeşidinde ise %3.57 Carmen çeşidinde %5.74 olmuştur. Makinalı hasattan dolayı fazladan meydana gelen kayıp kütlü miktarları da değerlendirilerek 300 kg/da verim veren bir tarlada elle hasat maliyeti 54.00YTL/da makinalı hasatta 52.58YTL/da; 350 kg/da verim veren bir tarlada elle hasat maliyeti 63.00YTL/da makinalı hasatta 54.10YTL/da; 400 kg/da verim veren bir tarlada elle hasat maliyeti 72.00YTL/da makinalı hasatta 55.61YTL/da hasat maliyeti elde edilmiştir. Bu araştırma sonucunda; pamuk hasadının makine ile yapılması ile hasat maliyetinin düşürülebileceği ortaya konmuştur.The aim of this study was to evaluate economical analysis by determining of a harvest machine type applicable a tractor on some cotton varieties. As a material; Nazilli 84-S, Nazilli 342, Barut 2005 and Carmen varieties and N727/C125 line including Gossypium hirsutum L. were used in this study. This study was carried out at Cotton Research Institute research field in 2005. Field trials were conducted in split plot design with four replications. Each plot was comprised of 12 rows each 120 m long and 70 cm apart from each other. But machine picking plots were harvested 100 m long, hand picking plots 20 m long. Defoliant application (60 cc/da) was made when machine picking plots were 60 %boll opening growth period. Hand picking plots were harvested two times as first and second picking but machine picking harvest was made at first time. Statistical analyses have been examined with the help of JMP statistical package program in α level 0.05. The waste of seed cotton preharvest and postharvest and remains on plants were determined both machine and hand picking plots. Extra losses ratio due to the machine harvest was 2.71%in Nazilli 342, 2.77%in Nazilli 84-S, 3.07%in N727/C125, 3.57%in Barut 2005 and 5.74%in Carmen. This investigation showed that; the cost of hand picking is 54.00 YTL/da, cost of machine picking is 52.58 YTL/da when the seed cotton yield was 300 kg/da. If the seed cotton yield is 350 kg/da, cost of picking is 63.00 YTL/da by hand but 54.10 YTL/da by machine. If the seed cotton yield is 400 kg/da, cost of picking is 72.00 YTL/da by hand but 55.61 YTL/da by machine. In the result of this study was exposed that; the cost of cotton harvest can be reduced by machine picking

Öğretmen Adaylarının Öğretmenlik Mesleğine Yönelik Tutumları (İnönü Üniversitesi, Eğitim Fakültesi Örneği)

This study intends to determine the attitudes of the students in the faculty of education towards profession of teaching. To this end, it is questioned whether “the attitudes of students towards the profession of teaching differ according to the variables including their gender, the type of the department/program they study, the order of the program in the UEE (University Entrance Examination) preference list, the socio-economic status (SES) of the neighborhood and family they live in, the grade they attend, type of schooling, and the reasons for choosing teaching profession”. The participants of the study comprise 593 students who are selected using rated cluster sampling method for the departments and rated element sampling method for the classes. All of the prospective teachers participating this study were administered the instrument for data collection. The instrument used to collect data in this study was the “Attitude Scale towards the Profession of Teaching”, a single-dimension Likert type scale with 5 points, originally developed by Üstüner (2006). A significant difference was observed between the attitudes of prospective teachers with intrinsic motivations towards the profession of teaching and those of latter teachers with extrinsic motivations towards the profession of teaching. Other variables for which significant differences were observed include gender, the type of the department/program they study, the order of the program in the UEE (University Entrance Examination) preference list, and the socio-economic status (SES) of the neighborhood and family they live in.Bu çalışmanın amacı, eğitim fakültesi öğrencilerinin öğretmenlik mesleğine yönelik tutumlarını belirlemektir. Bu amaçla “öğrencilerin öğretmenlik mesleğine yönelik tutumlarının; adayların cinsiyetleri, okumakta oldukları bölüm/programın türü, ÖSS’de tercih sıraları, yaşadıkları çevre, ailenin sosyoekonomik düzeyi (SED), kaçıncı sınıfta oldukları, öğrenim türü ve öğretmenlik mesleğini tercih nedenleri değişkenlerine göre farklılık gösterip göstermediği” sorularına yanıt aranmıştır. Araştırmanın örneklemini bölümlerden oranlı küme örnekleme yoluyla, sınıflardan da oranlı eleman örnekleme yoluyla seçilen toplam 593 öğretmen adayı oluşturmaktadır. Örneklemde yer alan öğretmen adaylarının tamamına veri toplama aracı uygulanmıştır. Araştırmada veri toplama aracı olarak Üstüner (2006) tarafından geliştirilen ve Likert tipi beşli olarak derecelendirilen tek boyutlu bir ölçme aracı olan “Öğretmenlik Mesleğine Yönelik Tutum Ölçeği” kullanılmıştır. Öğretmenlik mesleğini içsel nedenlerden dolayı seçen öğretmen adaylarının mesleğe yönelik tutumları ile dışsal nedenlerden dolayı seçen öğretmen adaylarının mesleğe yönelik tutumları arasında anlamlı farklılığın olduğu gözlenmiştir. Öğrencilerin öğretmenlik mesleğine yönelik tutumları ile adayların cinsiyetleri, okumakta oldukları bölüm/programın türü, okumakta oldukları programı ÖSS’de tercih sıraları, yaşadıkları çevre ve ailenin sosyoekonomik düzeyi (SED) arasında anlamlı farklılıklar gözlenmiştir.  

Arthroscopic stabilization of anterior shoulder instability using a single anterior portal

Objective: The aim of this study was to compare the effects of the use of a single anterior portal in the arthroscopic surgery treatment of traumatic anterior shoulder instability with those in the literature. Methods: The study included 72 patients (60 males, 12 females; mean age: 23.9 years) who underwent surgery using a single arthroscopic anterior portal for the treatment of traumatic anterior shoulder instability between 2002 and 2011. Clinical outcomes were assessed using the Rowe and Oxford scales, forward flexion range and external rotation limitation. Redislocation was considered failure. Results: Mean follow-up was 49.3 months. Bankart lesion was determined in 38 patients and Bankart and SLAP lesions in 34. An average of 3.7 (range: 2 to 5) anchors were used. Redislocation was observed in 4 (5.6%) patients in the postoperative period. Postoperative Rowe and Oxford scores were 93.4 and 42.6, respectively. Conclusion: Instability surgery performed using a single arthroscopic anterior portal provided findings comparable with the literature regarding clinical outcomes, postoperative shoulder movements and low recurrence rates, emphasizing the importance of appropriate patient selection rather than the number of the portals. The use of a single portal is less invasive and reduces the surgical period

The Pathogenesis of Congenital Anomalies: Roles of Teratogens and Infections

Congenital anomalies present with significant financial, social, and moral issues and questions to the family and society and are difficult to rehabilitate. In utero exposure to teratogenic agents and infection are the two most important causes of nongenetic acquired anomalies presenting at birth. Teratogens such as drugs, adverse maternal conditions, and toxins are environmental factors that cause permanent structural or functional malformations or death of the embryo or fetus. Teratogens may cause significant congenital anomalies if encountered during the organogenesis period of 3–8 weeks of fetal life, which is the stage of tissues and organs formation, whereas minor morphological and functional disorders may occur with exposure during the fetal period of first 2 weeks. TORCH group infections (toxoplasmosis, others, rubella, cytomegalovirus, and herpes) are the most serious infectious diseases during pregnancy due to the severity of possible embryo-fetal lesions. With expanding scientific knowledge and clinical experience about the association of these toxins and infections with significant, at times crippling congenital anomalies, the avoidance of exposure to pregnant mothers has become the most important part of their prevention and management

Clinical evaluation of an antero-medial approach for plate fixation of the proximal humeral shaft

Objective Surgical approach of fractures of the proximal humeral shaft should protect the muscular insertions and the vascularisation of fragments, improving bone union and functional recovery. The aim of this study is to review cases operated with an original anteromedial approach, in cases of specific fractures of the proximal humeral shaft. Materials and methods Prior to clinical application, a cadaveric study was accomplished. Based on the results, six clinical cases had surgery using an approach medial to the biceps and brachialis. The osteosynthesis was performed with locked plates and 4.5 screws. The approach was indicated in fractures presenting with a large lateral wedge including the deltoid muscle insertion. Stable osteosynthesis achieved with this approach allowed early postoperative mobilization of the arm in all cases. Results The case-series consisted of three women and three men with a mean age of 52.1 years (range 38–68). The minimal follow-up was 1 year. Bone union was observed at an average time of 11.2 weeks. There were no intra- or postoperative complications. Discussion Open reduction and internal fixation with compression plating is a standardized and successful procedure in the treatment of humeral fractures. Internal fixation with lateral plating is difficult in the proximal third of the humeral shaft, where the positioning of the implant may hurt the long biceps tendon and the deltoid insertion. This approach was successful and safe in the presented cases. Conclusion The antero-medial approach with metaphyseal locking plate protects the muscular insertions and the vascularisation of the wedge fragment, leading to good results in all the cases in this series

Arthroscopic release of the subscapularis for shoulder contracture of obstetric palsy

Objective Retrospective study of one surgeon’s experience with arthroscopic release in obstetrical brachial plexus palsy. Methods Over a four-year period, 6 patients who presented with a shoulder contracture secondary to obstetric palsy before the age of 8 years were treated arthroscopically. Small arthroscopy instruments, small shaver blades, including a 2.7-mm, 30° angled scope, and 90° radiofrequency probe, were used for this surgery. Patient selection for this approach was based on the lack of bone deformity and targeted soft tissue release. Postoperative brace immobilization for 6 weeks was used in all patients. Functional status of the patients was evaluated pre- and postoperatively with the assessment of external rotation. Results The case series consisted of 2 girls and 4 boys with a mean age of 5.1 years (range, 3–8 years). No patient was lost to follow-up, and all patients completed a minimum 1 year of clinical and radiographic follow-up. Increases in external rotation were observed in all patients. There was no intra- or postoperative complications. Conclusion Arthroscopic treatment of the shoulder contracture in obstetric palsy was found to be a safe and eVective procedure in patients who are likely to undergo future tendon transfer or bone surgery