Mastoid Emissary Vein Canal Incidence and Its Relationship with Jugular Bulb and Sigmoid Sulcus Anatomical Variations

Objective:We aimed to investigate the mastoid emissary vein (MEV) canal incidence and to identify its relationship with jugular bulb (JB) and sigmoid sulcus anatomical variations.Methods:We retrospectively reviewed 1,300 patients with temporal bone computed tomography (CT) scans in January 2016 to March 2020. The presence and the diameter of the MEV canal, and the anatomical variations of the sigmoid sulcus and the JB were reviewed by two radiologists. High riding JB, JB diverticulum, dehiscent JB, and anterior and lateral protrusion of the sigmoid sulcus were evaluated. All variables were summarized using descriptive statistics. The differences between the groups for categorical data were investigated using the chi-square test. Numeric variables were compared with the Mann-Whitney and the Kruskal-Wallis tests. Logistic regression models were constructed.Results:The study included 1,269 patients of whom 694 were female (54.7%) and 575 were male (45.3%). Their mean age was 39.01±18.47. Among them 915 (72.1%) had the right and 871 (68.6%) had the left MEV canal. Men were more likely to have the MEV canal on both sides. The presence of the right and left MEV canals was associated with the ipsilateral dominant JB/sigmoid sulcus. The left MEV canal was associated with the left high riding JB and right dehiscent JB.Conclusion:This is the largest patient population reported in the literature and allows a more precise estimate of the MEV canal incidence. We also classified the diameter of the MEV canal to identify clinically relevant, prominent MEV incidence. This is also the first study to demonstrate a relationship between the presence of the MEV canal, and the JB and sigmoid canal variations. Since both the prominent MEV and the JB variations may be symptomatic, knowing this association between them may have clinical relevance

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

Gudermannian Kayıp Fonksiyonu ve GudermannianBoost İkili Sınıflandırma Yöntemi

In this study, a robust loss function and binary boosting classification method are proposed. The purpose of classification methods is to obtain classifier function with generalization ability, i.e., high prediction performance. Boosting methods as iteratively algorithms, which include a loss function and weak classifier, are a way of predicting class labels of given inputs. Loss function is the way of penalizing conditional risk in boosting algorithm. While most of loss functions only penalize the misclassification, some robust loss functions give penalties not only large negative (misclassification) margin but also large positive (accurate classification) margin in order to get more stable classifiers. Robust loss functions stand up to outliers and contaminated part in training data. Therefore, classifiers are the methods which display high prediction performance in testing part. This study reports brief information about loss functions, robust loss functions and their properties. In addition, there is a correction to ensure statistical consistency on the algorithm of TangentBoost, one of the methods having all properties of robust loss functions. Finally, in order to get more stable classifiers, Gudermannian loss function, which gives more penalties for both small positive and small negative margin than Tangent loss function does, and GudermannianBoost as a corresponding binary classification boosting method are proposed. The advantages of GudermannianBoost method are discussed based on the applications of some spesific simulation scenarios and some real datasets.Türkiye Bilimsel ve Teknolojik Araştırma Kurumu (TÜBİTAK)ÖZET i ABSTRACT iii TEŞEKKÜR v İÇİNDEKİLER vi ÇİZELGELER viii ŞEKİLLER ix SİMGELER VE KISALTMALAR xi 1. GİRİŞ 1 1.1. İstatistiksel Öğrenme 3 1.2. Ayrım Tabanlı Sınıflandırma Yöntemlerinde Bazı Sağlam Öneriler 4 2. KAYIP FONKSİYONU 9 2.1. Kayıp Fonksiyonu 9 2.2. Sınıflandırma Yöntemlerinde Kullanılan ve Önerilen Kayıplar 10 2.1.1. Sıfır-Bir, Ağırlıklı Sıfır-Bir Kayıp ve Düzleştirilmiş Sıfır Bir Kayıp 11 2.1.2. Karesel, Kesilmiş Karesel ve Uyarlanmış Karesel Kayıp 12 2.1.3. Hinge, Kesilmiş Hinge, Düzleştirilmiş Hinge ve Genelleştirilmiş Düzleştirilmiş Hinge Kaybı 13 2.1.4. Lojistik, Kesilmiş Lojistik Kayıp 16 2.1.5. Üstel Kayıp 17 2.1.6. 2-Düzeyli Yapay Sinir Ağları Kaybı 17 2.1.7. Psi(Ψ) Kaybı 18 2.1.8. Sigmoid Kayıp 18 2.1.9. Huber ve Uyarlanmış Huber Kaybı 19 2.1.10. Savage Kayıp ve Tanjant Kayıp 20 3. BOOSTING YÖNTEMLERDE SAĞLAM KAYIP FONKSİYONU 21 3.1. Boosting 21 3.2. Boosting Yöntemlerde Sağlam Kayıp Fonksiyonlar ve Özellikleri 22 3.3. Sağlam Kayıp Fonksiyon Özellikleri 23 3.4. Tanjant Kayıp Fonksiyonu 24 3.5. Öneri: Gudermannian Kayıp Fonksiyonu 26 3.6. Gudermannian Kayıp Fonksiyon Özellikleri 30 3.7. TanjantBoost Algoritmasında Bir Düzeltme 32 3.8. GudermannianBoost Yöntemi 37 4. UYGULAMA 43 4.1. TanjantBoost ve GudermannianBoost Benzetim Çalışması 43 4.2. Çeşitli Boosting Yöntemlerde Öğrenme ve Test Kümeleri Doğru Sınıflandırma Oranı Karşılaştırması 52 5. SONUÇ ve TARTIŞMA 59 KAYNAKLAR 61 ÖZGEÇMİŞ 66Bu çalışmada bir sağlam kayıp fonksiyonu ve ilgili kayıp fonksiyonu üzerinden ikili boosting sınıflandırma yöntemi önerilmiştir. Sınıflandırma yöntemlerinin amacı genelleştirme becerisine sahip iyi sınıflandırıcı elde etmektir. Boosting yöntemler kayıp fonksiyon ve basit sınıflandırıcılardan oluşur. İteratif algoritmalar olarak girdilere göre sınıf etiketlerini tahmin eder. Kayıp fonksiyonlar boosting algoritmalarda koşullu riski minimize eder. Birçok kayıp fonksiyon sadece yanlış sınıflandırmaya ceza verirken sağlam (robust) kayıp fonksiyonlar sadece yanlış sınıflandırmaya değil aynı zamanda doğru sınıflandırmaya da ceza vererek daha kararlı sınıflandırıcı elde eder. Sağlam kayıp fonksiyonlar, öğrenme verisindeki aykırı değerlere ve bozulmaların olduğu yapıya karşı dayanıklıdır. Bu yüzden, test kümesinde yüksek performansla çalışan yöntemlerdir. Çalışma, kayıp fonksiyonlar, sağlam kayıp fonksiyonlar ve özellikleri hakkında özet bilgiler içermektedir. Sağlam kayıp fonksiyon özelliklerine sahip olan TanjantBoost algoritması verilmiş, istatistiksel tutarlılık için algoritmada bir düzeltme yapılmıştır. Son olarak, TanjantBoost yönteminin sınıflandırıcıya yakın gözlemler üzerindeki etkisini başarılı hale getirmek için daha büyük ceza veren kayıp fonksiyon incelemesi yapılmış ve Gudermannian kayıp fonksiyonu ile boosting algoritması olan GudermannianBoost ikili sınıflandırma yöntemi önerilmiştir. GudermannianBoost yönteminin etkin olduğu durumlar farklı benzetim senaryoları ve bazı gerçek veri kümeleri üzerinden tartışılmıştır

Red cell distribution width (RDW) is a prognostic factor for mortality in the patients with sepsis and septic shock

Objective: Red cell distribution width (RDW) is a measure of the range of variation of red blood cell (RBC) volume. It can be calculated automatically as part of a standard complete blood count. Our aim in this study is to evaluate the relationship between RDW and mortality in patients with sepsis and septic shock

KNOWLEDGE AND ATTITUDE OF HEALTH CARE WORKERS TOWARD PATIENTS WITH HEPATITIS C INFECTION

This study aimed to evaluate the level of knowledge of healthcare workers in Kutahya (a western province of Turkey) about HCV infection and their attitudes toward patients with hepatitis C infection. A total of 335 healthcare workers working in Kutahya Evliya Celebi Research and Training Hospital were included in the study. A questionnaire evaluating demographic characteristics, level of knowledge and attitudes of healthcare workers toward patients with hepatitis C infection was administered to the participants. Thirty-six point four percent of the participants were males. According to the occupations, distributions of the participants were as followings: 54.6% nurse, 25.1% physician, 11.6% trainee nurse, 4.5% intern and 4.2% anesthesia technician. The mean age of healthcare professionals was 30.32 +/- 8.10 years. Fifty-eight point eight percent of them experienced percutaneous injury. The mean knowledge score was 18.05 +/- 3.01 (from a total of 25). There was a statistically significant relationship between knowledge score and age, working year, occupational group (p<0.001). There was also a significant relationship between total attitude score and gender (p=0.006), age (p=0.002), working year (p=0.021) and occupational group (p<0.001). It was determined that as total knowledge score of the participants increased they exhibited a more positive attitude toward patients with hepatitis C infection (p<0.001). A positive relationship was determined between the level of knowledge of healthcare workers and positive attitudes toward patients with hepatitis C infection. Therefore, increasing the level of knowledge is necessary for more positive attitudes

Are eating behaviors related with by body mass index, gender and age?

The present study was carried out with parents of 520 healthy children between the ages of 2-12 and their parents who were referred to the diet polyclinic of a hospital in Ankara. The data were collected through personal interviews. The interviews included identifying the characteristics of the child and his/her parents, anthropometric measurements, questions investigating eating status, and the Children's Eating Behavior Questionnaire. According to the body mass index-Z scores, there were differences between subgroups of food responsiveness, emotional overeating, enjoyment of food, food fussiness, and slowness in eating. The gender-based desire to drink score was, on average, higher in boys. No gender-based differences were found in other subgroups, whereas the scores in the food fussiness and slowness in eating and emotional undereating were higher in the preschool group when analyzed by age. In conclusion, eating behaviors of overweight and obese children differ from those of normal and underweight children

A Comprehensive Framework Identifying Readmission Risk Factors Using The Chaid Algorithm: A Prospective Cohort Study

Objective: To identify frequency of readmission after discharge from internal-medicine wards, readmission risk factors, and reasons and costs of readmission. Design: Prospective cohort study. Setting: A tertiary-care hospital in Turkey. Participants: 2622 adult patients discharged from internal-medicine wards of the hospital between 1 February 2015 and 31 January 2016. Main outcome measures: Thirty day all-cause readmission rates, reasons and costs of readmission. To identify readmission risk factors Chi-square Automatic Interaction Detector (CHAID) analysis was conducted. Results: The same hospital readmission rate was 17.9%, while the same hospital or different-hospital readmission rate was 21.3%. Receiver operating characteristic (ROC) curve analysis showed that the predictive performance of the CHAID algorithm was high. According to the CHAID algorithm, the most significant readmission risk factor was the main diagnosis of neoplasm at the index admission. In other diagnosis groups, higher Charlson comorbidity score, higher level of education, having a regular physician, and three dimensions of Readiness for Hospital Discharge Scale were significant risk factors for readmission. The most frequent reason for readmission was neoplasm, and the total cost of readmissions was similar to$900 000. Conclusions: The CHAID algorithm for readmissions had a high predictive strength and provided details that aid physicians in decision-making. Measures must be taken from initial diagnosis to post-discharge follow-up, to minimize readmissions, especially in patients with neoplasm.WoSScopu