Arc magmatism as a window to plate kinematics and subduction polarity: Example from the eastern Pontides belt, NE Turkey

AbstractThe Eastern Pontides orogenic belt in the Black Sea region of Turkey offers a critical window to plate kinematics and subduction polarity during the closure of the Paleotethys. Here we provide a brief synthesis on recent information from this belt. We infer a southward subduction for the origin of the Eastern Pontides orogenic belt and its associated late Mesozoic–Cenozoic magmatism based on clear spatial and temporal variations in Late Cretaceous and Cenozoic arc magmatism, together with the existence of a prominent south-dipping reverse fault system along the entire southern coast of the Black Sea. Our model is at variance with some recent proposals favoring a northward subduction polarity, and illustrates the importance of arc magmatism in evaluating the geodynamic milieu associated with convergent margin processes

Incisional hernia as an unusual cause of hepatic encephalopathy in a 62-year-old man with cirrhosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hepatic encephalopathy may be initiated by many factors such as gastrointestinal bleeding, infections, fluid and electrolyte disturbances. Hypokalemia is one of the most commonly encountered electrolyte abnormalities causing hepatic encephalopathy in patients with cirrhosis.</p> <p>Case presentation</p> <p>We present the case of a 62-year-old Caucasian man with decompensated liver cirrhosis having multiple episodes of hepatic encephalopathy precipitated by vomiting. He had an incisional hernia at the right lumbar region. A barium contrast study of the small intestine and magnetic resonance imaging showed that the hernial sac included gastric antrum and bowel. We observed that hepatic encephalopathy coincided with hypokalemia as a result of a large volume of vomiting triggered by the collapsed hernial sac. Hepatic encephalopathy was resolved by administration of intravenous potassium.</p> <p>Conclusion</p> <p>This case illustrates that a hernia causing a large volume of vomiting may be a precipitant factor in the development of hepatic encephalopathy.</p

Levosimendan accelerates recovery in patients with takotsubo cardiomyopathy

Background: The aim of this study was to determine the efficacy and safety of levosimendanin takotsubo cardiomyopathy (TC).Methods: The study was conducted in a retrospective design and 42 consecutive patients were enrolled in 6 cardiovascular centers in Turkey. The records of TC patients having left ventricular ejection fraction (LVEF) £ 35% were examined at admission, discharge and recovery period including their clinical and echocardiographic data.Results: Of these 42 TC patients, 17 were treated with loading dose and i.v. infusion of levosimendan (group 1) and 25 were treated without levosimendan (group 2). Echocardiographic findings at admission and at discharge were similar and no serious complications were observed in either group. However recovery period including the interval of 50% increase in LVEF, time to achieve the baseline troponin values and hospitalization were significantly lowerin patients taking levosimendan.Conclusions: This is the first study using loading dose and subsequent continuous intravenous administration of levosimendan demonstrating accelerated recovery in patients with TC

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 &lt; 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

Level of Public Education Center Students' Digital Literacy: An Example of Duzce

Aim to this research to observe level of public education center students' digital literacy and state new suggestions in literacy field. In this research, data was carried out through Digital Literacy Scale. Also were associated 100 students who study in Duzce Public Education Cenr. SPSS program was used to analyze research's data. Gender, age, education level, technological ownership, computer ownership and time of use internet are our variables were used to identify digital literacy level. Of quantitative research method, survey research method was specified for our research. In public education center with 170 students, 100 students were attended voluntarily. Data in performed from research; percentage, frequency, average, standard deviation was calculated and prepared as tables in research. In this research, observed that have no relation level of digital literacy based on gender as statistics in public education center students. When analyzed to other variables, it has been observed that doesn't differentiation between male and female variables as statistics. Also, all variables ( handing an internet connection, handing a technological material) tested in analyze. But, it hasn't been observed that any variables have differentiation with level of digital literacy as statistics. Moreover; according to the age groups, level of digital literacy doesn't differentiation significantly

Designing cost-effective content distribution networks,” to appear in

Abstract In this paper, we present a novel technique for the problem of designing a Content Distribution Network (CDN), which is a technology used to efficiently distribute electronic content throughout an existing IP network. Our design proposal consists of jointly deciding on (i) the number and placement of proxy servers on a given set of potential nodes, (ii) replicating content on the proxy servers, and (iii) routing the requests for the content to a suitable proxy server such that the total cost of distribution is minimized. We model the problem using a nonlinear integer programming formulation. The novelty of the proposed formulation lies in simultaneously addressing three interdependent problems in this context as well as explicitly representing the distribution structure of a CDN through the objective function. We offer a linearization for the model, develop an exact solution procedure based on Benders&apos; decomposition and also utilize a variant of this procedure to accelerate the algorithm. In addition, we provide a fast and efficient heuristic that can be used to obtain near-optimal solutions to the problem. Finally, the paper concludes with computational results showing the performance of the decomposition procedure and the heuristic algorithm on randomly generated Internet topologies.

Optimization of Shielding Effectiveness of Coaxial Double Braided Screens in Contact

In this paper, the optimization of the shielding effectiveness of double braided coaxial screens in contact is obtained using semi-empirical single braid optimization formulas. Also the effect of the mutual inductance term between the double braided screens in contact is investigated. A sample optimization has been obtained practically, on one of the standard double braided RF coaxial cable namely, RG-142

Dissemination of dynamic multimedia content in networked virtual environments

This paper aims to design an infrastructure for distribution of dynamic multimedia objects in a Networked Virtual Environment (NVE) based on a distributed proxy architecture. Dynamic objects (such as audio, video and images) are generated by the users on-the-fly, are often short lived and must be disseminated to others in their area of interest while the application is running. It is expected that a significant portion of network traffic for future NVE applications will be due to these objects. However, because of the upstream bandwidth constraints of clients, a peer-to-peer model for dissemination of these objects is unlikely to be scalable. We develop a distributed server infrastructure for this purpose and produce a mathematical model for optimal establishment of proxy servers, assignment of clients to proxies, and replication pattern of objects among the proxies. The formulation is non-linear (quadratic)in both the objective function and one set of constraints. We provide a technique to linearize the model, which provides the opportunity to solve reasonable size problems for benchmarking. In addition, we provide a fast and efficient heuristic that can be used to obtain near-optimal solutions to the problem in real-time. Finally the paper concludes with computational results showing the performance of the linearization procedure and the heuristic algorithm on randomly generated Internet topologies. It is shown that our heuristic algorithm produces solutions that are within 20% of the optimal

On separating cover inequalities for the multidimensional knapsack problem

We propose a simple and a quite efficient separation procedure to identify cover inequalities for the multidimensional knapsack problem. It is based on the solution of a conventional integer programming model. Solving this kind of integer programs is usually considered expensive and the proposed method may have been overlooked because of this assumption. The results of our experiments with a small set of randomly generated problems and problems taken from the literature indicate that the method may be a reasonable alternative to the one currently in us