Analyzing Main and Interaction Effects of Length of Stay Determinants in Emergency Departments

Background: Measuring and understanding main determinants of length of stay (LOS) in emergency departments (EDs) is critical from an operations perspective, since LOS is one of the main performance indicators of ED operations. Therefore, this study analyzes both the main and interaction effects of four widely-used independent determinants of ED-LOS.Methods: The analysis was conducted using secondary data from an ED of a large urban hospital in Izmir, Turkey. Between-subject factorial analysis of variance (ANOVA) was used to test the main and interaction effects of the corresponding factors. P values <.05 were considered statistically significant.Results: While the main effect of gender was insignificant, age, mode of arrival, and clinical acuity had significant effects, whereby ED-LOS was significantly higher for the elderly, those arriving by ambulance, and clinically-categorized high-acuity patients. Additionally, there was an interaction between the age and clinical acuity in that, while ED-LOS increased with age for high acuity patients, the opposite trend occurred for low acuity patients. When ED-LOS was modeled using gender, age, and mode of arrival, there was a significant interaction between age and mode of arrival. However, this interaction was not significant when the model included age, mode of arrival, and clinical acuity. Conclusion: Significant interactions exist between commonly used ED-LOS determinants. Therefore, interaction effects should be considered in analyzing and modelling ED-LOS

A Pipeline for the ROTSE-IIId Archival Data

We have constructed a new, fast, robust and reliable pipeline to detect variable stars from the ROTSE-IIId archival data. Turkish share of ROTSE-III archive contains approximately one million objects from a large field of view (1.85\dgr) and it considerably covers a large portion of northern sky (\delta>-25\dgr). The unfiltered ROTSE-III magnitude of the objects ranges from 7.7 to 16.9. The main stages of the new pipeline are as follows: Source extraction, astrometry of the objects, light curve generation and inhomogeneous ensemble photometry. A high performance computing (HPC) algorithm has also been implemented into the pipeline where we had a good performance even on a personal computer. Running the algorithms of the pipeline on a cluster decreases analysis time significantly from weeks to hours. The pipeline is especially tested against long period variable stars with periods of a few hundred days (e.g Mira and SR) and variables having periods starting from a few days to a few hundred days were detected.Comment: 8 pages, 5 figures 2 tables; last revision before publishe

Investıgatıon Of Dıfferent Natural Extracts Effıcıancy On Dıfferentıatıon And Immunomodulatory Propertıes Of Mesenchymal Stem Cells For Alveolıtıte Preventıon

Alveolitis profilaksisi ve tedavisini bulmaya yönelik birçok çalışma yapılmıştır. Ancak çekim soketi ve çevresindeki kök hücre biyolojisinin yeteri kadar anlaşılamamasının, alveolitisin tedavisinde kesin başarı sağlanamamasının en önemli nedeni olduğu düşünülmektedir. Bundan dolayı mezenkimal kök hücrelerin canlılığını, migrasyonunu, osteojenik farklılaşmasını indükleyecek doğal ajanların kullanımının iyileşme soketinin rejenerasyonunu sağlamada ve alveolitisi önlemede yararlı olacağı düşünülmektedir. Çalışmada ilk olarak antimikrobiyal özelliği literatürden bilinen Pleurotus ostreatus (kavak mantarı), Syzgium aromaticum (karanfil), Ocimum basilicum (fesleğen), Thymbra spicata var. intricate (zahter otu) ile bu özelliklere ilave olarak antiinflamatuvar yetenekleri olduğu rapor edilmiş Cinnamomum zeylanicum (tarçın), Hypericum perforatum (sarı kantaron), Salvia triloba (adaçayı) bitkilerine ait ekstraktların dental pulpa kaynaklı mezenkimal stromal kök hücre (DP-MSKH) lerin proliferasyonu üzerindeki etkisi ve sitotoksik özellikleri eş zamanlı olarak xCelligence yöntemi ile araştırılmıştır. En iyi etki gösteren konsantrasyonun adipojenik ve osteojenik farklılaşması üzerinde etkinliği araştırılmıştır. Osteojenik farklılaşma, kantitatif olarak DICA-500 spektrofotometrik yöntemle, osteokalsin ve osteonektin miktarları ise ELİSA KİT yöntemi ile araştırılmıştır. Tümör nekroz faktör (TNF)-&#945; ile oluşturulan inflamasyon ortamında bitki ekstraktı ilaveli hücrelerin yanıtı araştırılmıştır. Elde edilen verilere göre en iyi etki gösteren H. perforatum ve C. zeylanicum ekstraktlarının DP-MSKH migrasyonunu uyarıp uyarmadığı araştırılmıştır. Ayrıca alveolitis oluşumunda adı sıklıkla geçen S. mutans ve S. gordonii ve S. aureus üzerinde antibakteriyel etkisi in vitro olarak belirlenmiştir. Migrasyonu uyaran ve antibakteriyel aktivitesi yüksek olan H. perforatum un DP-MSKH kıkırdak farklılaşmasına olan etkisi belirlenmiştir. Sunulan çalışmada elde edilen veriler doğrultusunda, DPMSKH lerin ikiye katlanma süresini kısaltan, osteojenik farklılaşmayı arttıran, antiinflamatuvar özellikte, DP-MSKH migrasyonunu arttıran, oral biofilmde yer alan S. gordonii ve S. mutans mikroorganizmaları üzerinde antibakteriyel aktiviteye sahip H. perforatum ekstraktının diş hekimliğinde alternatif terapilerde yer alabileceği düşünülmektedir.Alveolitis is one of the most common complication after tooth extraction, leading to significant discomfort and economical burden to the patient. Several studies are being performed to find convenient dry socket s prophylaxis and treatment. However the currently used agents either fail to induce complete resolution or have allergic and toxic effects. Mesenchymal stem cells are a major component of the healing tooth extraction site which is initiating bone healing. The aim of this study was to asses the effects of supplementary and/or alternative medicine on induction of differentation, migration, immunmodulation and antiinflammation acceleration of the healing process through activation of regional osteoprogenitor mesenchymal stem cells. It is known that the mesenchymal stem cells, which are in stromal tissues in oromaxillofacial region, take part in healing process. In this study it is sought to investigate the dental pulp mesenchymal stem cell s involvement in therapy of alveolitis by their differentiation and immunmodulation properties of these cells. it is planned to define the natural extracts accelerated healing mechanisms. According to our study; Pleurotus ostreatus, Syzgium aromaticum, Ocimum basilicum, Thymbra spicata var intricate which are known as antimicrobial and also Cinnamomum zeylaniccum, Hypericum perforatum, Salvia triloba which are reported as antiinflammatory at the same time, with these plant s extracts and their combination s cytotoxic effects on mesenchymal stem cells, is assesed with xCeligence technique. Osteogenic differentation, osteocalcin and osteonectin level s are investigated by DCA-500 spectrofotometric and ELISA technique respectively. The result of the study shows that H. Perforatum, is decreased the doubling time of DP-MSSC and increased osteogenic differentation and stem cell s migration and also it has antiinflamatory properties. H. Perforatum has antimicrobial effect on S. gordonii, S. mutans which are part of oral biofilm. The result of this study, H. Perforatum could be used in clinical practises after animal and human studies

Prognostic Factors in Blunt Eye Trauma

Pur po se: To determine the factors affecting the outcome of best-corrected visual acuity (BCVA) in blunt ocular trauma cases. Ma te ri al and Met hod: 142 eyes of 142 patients, who were admitted to the 2nd Eye Clinic Emergency Service of M.H. Ankara Training and Research Hospital between June 2007 and August 2008, with blunt ocular trauma were prospectively included in the study in terms of the last-measured BCVA, the factors affecting it, and the ensuing complications. Re sults: Patient age ranged from 3 to 76 years (mean age: 31.9 ± 17.6 years). One hundred and seven cases (75.4%) were male and 35 (24.6%) were female. The last-measured BCVA in 120 cases (84.5%) was found to be log MAR ≤ 1.00 and in 22 cases (15.5%) was log MAR > 1.00. According to the one-way analysis of variance, the effect of initial visual acuity (p = 0.039), incision size (p = 0.029), relative afferent pupillary defect (RAPD) (p<0.001), zone (p <0.001), posterior segment findings (p= 0.001.), and ocular trauma score (OTS) effect (p <0.001) on worsening of the last-measured BCVA were statistically significant. Dis cus si on: Blunt eye injury is a preventable cause of permanent visual loss, which can affect people of all ages. It is important to know the factors affecting the last-measured BCVA for the implementation of a systematic and accurate treatment approach to each patient. The effect of initial visual acuity, the size of the incision, the presence of RAPD, zone, posterior segment findings, and of a low value of the OTS on worsening of the last-measured BCVA were considered significant statistically. (Turk J Ophthalmol 2013; 43: 32-8

A novel biochemical marker for predicting the severity of ACS with unstable angina pectoris: Asprosin

WOS: 000439103800039PubMed ID: 29274804Ischemic Heart Disease (IHD) is the leading cause of death world-wide, accounting for 12.7% of global mortality[1] . Acute Coronary Syn-drome (ACS) covers a wide spectrum of clinical conditions ranging fromunstable angina to Non-ST Elevation Myocardial Infarction (N-STEMI)and ST Elevation Myocardial Infarction (STEMI). New treatments andmanagement guidelines emerge for the care of patients with ACS; riskstratification is the cornerstone in the initial evaluation of these patients[2] . That inflammatory mediators play a role duringthe evolution of ACSis indicated by the widespread coronary inflammation found during un-stable angina pectoris (UAP), throughout theentire coronary artery bed,and in the extent that ACS outcome is related to a concurrent inflamma-toryresponse[3,4] . Circulatingasprosin,a protein hormone, responds tolow dietary glucose by triggering the release of liver glucose stores, andthe reduction of asprosin protects against the hyperinsulinism associat-ed with metabolic syndrome

Reestablished rural settlements: The case study of Erzurum Başçakmak settlement

Bu araştırma, 2004 yılında yaşanan deprem sonrasında işletme binalarının oturulamaz duruma geldiği ve yerleşkenin başka bir alana taşınarak yeniden düzenlendiği Erzurum ili Aziziye ilçesi Başçakmak köyünde gerçekleştirilmiştir. Bu amaçla basit şansa bağlı örnekleme yöntemi ile seçilen işletmelerle yüz yüze anket uygulaması yapılmıştır. Kırsal yerleşkelerin oluşturulmasında dikkate alınması gereken etkenler, saha ve kaynak araştırmasından elde edilen veriler ile birlikte değerlendirilmiştir. Çalışmada yenilenen Başçakmak yerleşkesinin gereksinimlere ne ölçüde cevap verdiği konusunda durum analizi yapılmıştır. Yapılan Kullanım Sonrası Değerlendirme (KSD) sonucunda yaşam ve çalışma koşulları, yerleşke içi trafiği ve alt yapı tesislerine ilişkin hedeflerin gerçekleşme oranı sırasıyla %73, 75 ve 75 olarak belirlenmiştir. Yeni yerleşkeye ilişkin estetik unsurların değerlendirildiği hedeflerin (konutlar, yeşil alanlar ve dinlenme alanları) gerçekleşme oranı sırasıyla %15, 31 ve 18 olarak belirlenmiştir. Yerleşkenin işlevi ve ortak katılım hedefleri ise sırasıyla %42 ve 76 olarak gerçekleşmiştir.This study was carried out on the Başçakmak rural settlement of Erzurum Aziziye province which the most of buildings were uninhabitable, and reestablished on another area. For this purpose, a survey was planned and conducted according to simple random sampling. Factors to be considered on the reconstruction studies of rural settlements, data of the obtained from survey and literature search were evaluated together. The current situation analysis was conducted whether the renewed Başçakmak settlement was convenient for the settlers. As a result of the Post-Occupancy Evaluation (POE), the realization rates of living and working conditions, intra-campus traffic and infrastructure aims were determined as 73%, 75% and 75%, respectively. The realization rates for the aesthetic elements of the new settlement (housing, green spaces and rest areas) were determined as 15, 31 and 18, respectively. The settlement function and joint participation targets were 42 and 76%, respectively

Eye Involvement in Möbius Syndrome and its Treatment

Möbius syndrome is a congenital disease which is characterized by horizontal ophthalmoplegia and facial paralysis. Four patients who were referred to our clinic and were diagnosed as Möbius syndrome were included in the study. Of these, two cases were followed up on a regular basis. In one of these two cases, bilateral medial rectus recession and inferior oblique tenotomy were performed. The other case underwent strabismus surgery followed by amniotic membrane transplantation. In this patient, lateral rectus muscle was determined as hypoplastic during the surgery and medial rectus muscle resection was performed. It was observed that satisfactory refractive and surgical outcomes could be achieved in patients with esotropia. It should be considered that structural muscle anomalies and/or horizontal gaze palsy may accompany this condition, therefore, cranial and orbital magnetic resonance imaging can be helpful in determining these anomalies before the surgery. (Turk J Oph thal mol 2011; 41: 417-22

Effect of Ocimum basilicum on mesenchymal stem cell proliferation and differentiation: Does the effect change according to niches?

It is a big issue that reduced bone density and large fractıres in dentistry and orthopedics. Side effects caused by synthetic drugs lead to medical and ethical problems. Thus, plants and medicinal plant research take attention. Aim of this preliminary in vitro study is to investigate the effect of Ocimum basilicum extract on dental pulp (DP) and bone marrow (BM) derived mesenchymal stem cell (MSC) proliferation, osteogenic differentiation and immunological response to TNF-α. Human dental pulp tissue was obtained from patients (15-20 years of age) who were undergoing extraction of third molars for orthodontic reasons at the Department of Oral and Maxillofacial Surgery, University of Gazi University*. xCELLigence system was used to determine prolfieration of DP- and BM-MSCs. Adipogenic and osteogenic differentiation was shown and calcium concentration, osteocalcin and osteonectin levels were examined. Inflammatory environment was mimiced through TNF-α stimulation and IL-6 and IL-10 levels were defined by ELISA. Doubling time mwith O. basilicum was found in DP- MSCs (38 h) and BM-MSCs (76 h). IC50 value was shown as 148 µg/mL in DP-MSCs and 178 µg/mL in BM-MSCs. Calcium concentration of BM-MSCs was found decreased in O. basilicum treated groups. Level of ostoenectin was reduced in O. basilicum treated cells suggesting that the Extract accelerated the osteogenic differentiation. We suggest that O. basilicum could be a smart ostoeinductive agent where BM-MSCs should be investigated further. Rich flora of Turkey is an opportunity for us and encourangement can easily give inside to medicinal plant investigations. *B.30.2.GÜN.0.20-122 Ethics Committee Repor