The effect of N95 respirators on vital parameters, PETCO2, among healthcare providers at the pandemic clinics

Background Wearing face shields and masks, which used to have very limited public use before the COVID-19 outbreak, has been highly recommended by organizations, such as CDC and WHO, during this pandemic period. Aims The aim of this prospective study is to scrutinize the dynamic changes in vital parameters, change in end tidal CO2 (PETCO2) levels, the relationship of these changes with taking a break, and the subjective complaints caused by respiratory protection, while healthcare providers are performing their duties with the N95 mask. Methods The prospective cohort included 54 healthcare workers (doctors, nurses, paramedics) who worked in the respiratory unit of the emergency department (ED) and performed their duties by wearing valved N95 masks and face shields. The vital parameters and PETCO2 levels were measured at 0-4th-5th and 9th hours of the work-shift. Results Only the decrease in diastolic BP between 0 and 9 h was statistically significant (p = 0.038). Besides, mean arterial pressure (MAP) values indicated a significant decrease between 0-9 h and 5-9 h (p = 0.024 and p = 0.049, respectively). In terms of the vital parameters of the subjects working with and without breaks, only PETCO2 levels of those working uninterruptedly increased significantly at the 4th hour in comparison to the beginning-of-shift baseline levels (p = 0.003). Conclusion Although the decrease in systolic blood pressure (SBP) and MAP values is assumed to be caused by increased fatigue due to workload and work pace as well as increase in muscle activity, the increase in PETCO2 levels in the ED healthcare staff working with no breaks between 0 and 4 h should be noted in terms of PPE-induced hypoventilation

Dört bacaklı robotlarda merkezi örüntü üreteci ve genetik algoritmalar ile referans sentezi

Bu çalışmada Merkezi Örüntü Üretimi (MÖÜ) ile referansları sentezlenen dört bacaklı robotun dengeli yürüyüşü önerilmiştir. MÖÜ biyolojiden ilham alınarak oluşturulan bir referans sentezi yöntemidir. Bu yöntemde kullanılan uygun parametleri belirlemek, robotun düşmesini engellemek için önemlidir. Çalışmamızda bu parametreleri belirlemek için yine biyolojiden ilham alınarak oluşturulan Genetik Algoritma (GA) optimizasyon yöntemi kullanılmıştır. Genetik Algoritma’nın amaç fonksiyonu denge ve enerji tüketimi olarak seçilmiştir. MÖÜ yöntemi ile üretilen referanslar, 16 serbestlik dereceli dört bacaklı robotumuza üç boyutlu (3D) tam dinamikli benzetim ortamında uygulanmıştır. Benzetim sonuçları önerilen metodun geçerliliğini kanıtlamıştır

Results of reference pricing and reimbursement discount rate schemes of Turkey

OBJECTIVES: General Directorate of Pharmaceuticals and Pharmacy (IEGM) is responsible for setting all prices for human medicinal products. The reference pricing system is used for setting these prices. Reference countries are reviewed annually and may be subject to certain alterations. There were 5 reference countries in 2009: Spain, Italy, Germany, France and Greece. The aim of this study is to show the distribution of reference countries which were used for reference pricing.METHODS: The price list of pharmaceuticals which was published by IEGM on 15.04.2011 was used for analysis. Distribution of reference countries and prices were evaluated.RESULTS: Prices of 6,251 generic and 3,703 original products were set according to the price list. 5,283 of generics and 3,306 of originals were in the positive list for reimbursement. Reference pricing was used for 2,352 generics and 2,281 originals. Prices of the remaining were set outside of reference pricing. 32 different countries were used for reference pricing. Italy was the most popular country for reference pricing. Even if it was not a reference country, Germany was used in some of the pharmaceuticals. The average reimbursement discount rate and price were 24.43% and 249 TL, respectively. There were no colerations between price and reimbursement discount rate, or reference country and reimbursement rate.CONCLUSION: It has been shown that Italy has the highest impact on the pricing of all pharmaceuticals in Turkey. Even if it was not a reference country, Germany showed to affect pharmaceuticals more than other countries which were also not used for reference pricing. Even if reimbursement discount rates are stated by the Social Security Institution (SGK), there are different discount rates for pharmaceuticals. The analysis stated that there were correlation between price, country and discount rates. This analysis is first for the literature. Further analysis is necessary in the light of price changes and newly launched pharmaceuticals

The comparison of high and standard definition computed tomography techniques regarding coronary artery imaging

Objective: The aim was to compare coronary high-definition CT (HDCT) with standard-definition CT (SDCT) angiography as to radiation dose, image quality and accuracy. Material and Methods: 28 patients with history of coronary artery disease scanned by HDCT (Discovery CT750 HD) and SDCT (Somatom Definition AS). The scan modes were both axial prospective ECG-triggered. The vessel diameters and vessel attenuation values of totally 280 measurements from 140 coronary arteries were analyzed by two experienced radiologists. All data was analyzed by intraclass correlation test. Image quality graded by motion and stair step artifacts (grade 1, poor, to grade 4, excellent), accuracy of vessel inner and outer diameters were compared between the two CT units using the independent samples t-test and Mann-Whitney U test. Results: The intraclass correlation coefficient (ICC) of measured vessel attenuation values in SDCT between the two radiologists was exceedingly good. The ICC was higher in HDCT. The radiation dose of HDCT was higher than that of SDCT. The mean tube current was 180 (mA) in HDCT and 147(mA) in SDCT with the same tube voltage (kVp). There was no significant difference between image quality. Conclusion: HDCT has a higher radiation dose but has much more atenuation and the spatial resolution which improve measurement accuracy for imaging coronary arteries

Dört bacaklı robotlar için önizleme kontrolü ve sıfır moment noktası esaslı yürüyüş yörüngesi üretimi

Robota verilen görevde engel aşımı gerektiğinde bacaklı robotların geri kalan mobil robotlara göre önemli avantajları bulunmaktadır. Bu makalede dört bacaklı robotların düz bir yüzeyde yürüyüşü için bir ölçümleme üretimi yöntemi sunuldu. Bu yaklaşım sıfır moment noktası (SMN) temelli kararlılık ve doğrusal ters sarkaç modeli (DTSM) üzerinedir. Yürüyüş için SMN referans gezingeleri ileri sürülüp oradan önizleme kontorü vasıtasıyla robotun ağırlık merkezi (RAM) referansı için referans gezingeleri elde edildi. Bacak eklemlerinin pozisyonları RAM referans gezingeleri üzerine ters kinematik uygulanarak hesaplandı. Öne sürülen referans gezinge üretimi sentezi, tamamen dinamik 3 boyutlu benzetimle test edildi. Benzetimde 16 serbestlik derecesine (SD) sahip dört bacaklı robot modeli kullanıldı. Benzetim sonuçları, yürüyüş için yapılan referans üretim tekniğinin başarıya ulaştığını gösteriyor

The Rose Bengal Test in Human Brucellosis: A Neglected Test for the Diagnosis of a Neglected Disease

Brucellosis is a highly contagious zoonosis affecting livestock and human beings. The human disease lacks pathognomonic symptoms and laboratory tests are essential for its diagnosis. However, most tests are difficult to implement in the areas and countries were brucellosis is endemic. Here, we compared the simple and cheap Rose Bengal Test (RBT) with serum agglutination, Coombs, competitive ELISA, Brucellacapt, lateral flow immunochromatography for IgM and IgG detection and immunoprecipitation with Brucella proteins. We tested 208 sera from patients with brucellosis proved by bacteriological isolation, 20 contacts with no brucellosis, and 1559 sera of persons with no recent contact or brucellosis symptoms. RBT was highly sensitive in acute and long evolution brucellosis cases and this related to its ability to detect IgM, IgG and IgA, to the absence of prozones, and to the agglutinating activity of blocking IgA at the pH of the test. RBT was also highly specific in the sera of persons with no contact with Brucella. No test in this study outperformed RBT, and none was fully satisfactory in distinguishing contacts from infected patients. When modified to test serum dilutions, a diagnostic titer >4 in RBT resulted in 87.4% sensitivity (infected patients) and 100% specificity (contacts). We discuss the limitations of serological tests in the diagnosis of human brucellosis, particularly in the more chronic forms, and conclude that simplicity and affordability of RBT make it close to the ideal test for small and understaffed hospitals and laboratories

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The impact of COVID-19 on emerging stock markets

The goal of this study is to investigate the impact of COVID-19 on emerging stock markets over the period March 10 – April 30, 2020. Findings reveal that the negative impact of pandemic on emerging stock markets has gradually fallen and begun to taper off by mid-April. In terms of regional classification, the impact of the outbreak has been the highest in Asian emerging markets whereas emerging markets in Europe have experienced the lowest. We also find that official response time and the size of stimulus package provided by the governments matter in offsetting the effects of the pandemic

A Linear Brushless Direct Current Motor Design Approach for Seismic Shake Tables

The progress in material and manufacturing technologies enables the emergence of new research areas in electromagnetic actuator applications. Permanent magnet (PM) linear motors are preferred to achieve precise position control and to meet the need for high dynamic forces in the seismic shake tables that are used in analyzing reactions of structure models. The design approaches on the linear motors used in the seismic shake tables may vary depending on the desired force, stroke and acceleration values. Especially, the maximum width, the maximum depth, the maximum linear motor length in longitudinal direction and the maximum travelling distance parameters are the primary design criteria in seismic shake table drive systems. In this paper, a design approach for a linear PM brushless direct current (BLDC) motor with high force/volume, force/weight and force/input power ratios is developed. The design was analyzed using two-dimensional (2D) and three-dimensional (3D) finite element method (FEM) approaches through the ANSYS Maxwell software. The mathematically designed linear BLDC motor was manufactured and subjected to displacement, acceleration and force tests that are used in seismic analyses. The results of the experimental tests validate the convenience of the proposed design approach and the selected parameters