Bir kurum hekimliğinde ideal hekim-hasta ilişkisinin uygulanması sonucunda hastanelere sevk edilen hasta sayısındaki değişim

Objectives: This study was designed to introduce an occupational health center serving as a primary health care facility and to address beneficial effects of instituting an ideal physician-patient relationship on the number of patients to be referred to secondary health care services. Study Design: This descriptive study investigated the patient population of a primary health center of izmir Police Department in three consecutive years, 1993, 1994 and 1995. Throughout this period there had been no changes in the technical and physical circumstances of the health center. in 1993 routine health services were provided, vvhereas during 1994 and 1995, all health services were implemented on the basis of a specific protocol designed to institute and maintain an ideal physician-patient relationship. Patient referral rates within each year were compared. Results: As a result of practicing an ideal physician-patient relationship, and compared with that found in 1993, patient referral rates to secondary health care ser-vices decreased significantly by 5.5% (p;lt;0.01) and 5% (p;lt;0.01) in 1994 and 1995, respectively. Conclusion: Institution of an ideal physician-patient relationship in primary health care centers may reduce the referral rates of patients to secondary health care services, thus decreasing the workload of these hospi-tals, vvhich in turn will contribute to improved health care services in these centers.Amaç: Bu çalışmada, birinci basamak sağlık hizmetlerine önemli katkılarda bulunan bir kurum hekimliği tanıtılarak, bu sağlık kuruluşunda sağlanan ideal hekim-hasta ilişkisinin hastanelere sevk edilen hasta sayısına olumlu etkisi irdelenmeye çalışıldı. Çalışma Planı: Tanımlayıcı tipte yürütülen araştırmanın evrenini 1993, 1994 ve 1995 yıllarında İzmir Emniyet Müdürlüğü Başhekimliği adlı kurum hekimliği polikliniğine başvuran hastalar oluşturdu. Emniyet Başhekimliği'nin her türlü fiziki imkanlarında ve teknik yapısında 1993, 1994 ve 1995 yıllarında herhangi bir değişiklik olmadı. 1994 ve 1995 yıllarında belirlenen bir protokol çerçevesinde ideal düzeyde hekim-hasta ilişkisi kurularak hizmetler yürütüldü. 1993 yılında bu uygulama yapılmadı. Belirtilen üç yıl içindeki hasta sevk oranları karşılaştırıldı. Bulgular: Çalışmanın yürütüldüğü kurumda, 1994 ve 1995 yıllarında hasta sevk oranları, 1993 yılına göre sırasıyla %5.5 (p0.01) ve %5.0 azaldı (p0.01). Her iki sevk oranındaki azalma istatistiksel olarak anlamlı bulundu. Sonuç: Kurum hekimliği temelinde verilen sağlık hizmetlerinde iyi bir hekim-hasta ilişkisinin kurulmasıyla, ikinci basamağı oluşturan sağlık kurumlarının (hastanelerin) yükünde anlamlı düzeyde bir azalma olacak; bu durum hastanelerin iş yükünü azaltarak daha nitelikli sağlık hizmeti verilmesine katkıda bulunacaktır

Identification and prioritization of stage-level KPIs for BOT projects - evidence from Turkey

Purpose The purpose of this paper is to identify and prioritize key performance indicators (KPIs) that can be used for stage-based performance assessment of build-operate-transfer (BOT) projects. Design/methodology/approach This research was conducted through focus group discussions and face-to-face questionnaires. Firstly, stage-level KPIs for BOT projects were identified by conducting a literature survey. The list of KPIs that can be used for measuring performance at different stages of a BOT project was finalized by conducting focus group discussions with 12 participants. The data related to the importance of identified KPIs were collected via a face-to-face questionnaire in which 30 high-level managers participated. Based on these data, KPIs were prioritized considering eight different stages of a BOT project by using Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). Findings The research findings reveal that 63 stage-level KPIs can be used for measuring the performance of BOT projects at eight different stages, which are "feasibility study and preliminary plan," "announcement and submission of application," "evaluation and selection," "negotiation and signing of concession agreement," "design," "construction," "operation" and "transfer." The most important KPIs were determined as "comprehensiveness of project technical feasibility," "detailed tendering procedure," "effectiveness of concessionaires' technical knowledge/capability evaluation," "good relationships between government and concessionaire," "technology transfer," "effectiveness of quality control," "effectiveness of facility management" and "effectiveness of hand-back management" for each stage. The findings can be used by companies to evaluate performance at each stage of a BOT project and, if necessary, take the necessary actions for performance improvement at the stage level. Research limitations/implications The main limitation is the size of the sample, which represents the perspectives of 30 Turkish high-level managers on KPIs in BOT projects. Besides, the selected method, namely, TOPSIS, does not provide quality measures related to the outputs; therefore, it is difficult to see the inconsistencies among the experts. Practical implications The study findings will help in devising appropriate performance evaluation practices for BOT projects to overcome the shortfalls of the existing practices and systems proposed in the literature and help in achieving the superior performance while developing infrastructure through the BOT route. Originality/value This paper proposes a process-based approach for measuring the performance of a BOT project considering eight different stages. It fills a research gap in the public-private partnership literature by focusing on stages rather than phases. The results can be used by practitioners to establish stage-level performance management systems for BOT projects

A knowledge-based risk management tool for construction projects using case-based reasoning

Construction projects are often deemed as complex and high-risk endeavours, mostly because of their vulnerability to external conditions as well as project-related uncertainties. Risk management (RM) is a critical success factor for companies operating in the construction industry. RM is a knowledge-intensive process that requires effective management of risk-related knowledge. Although some research has already been conducted to develop tools to support knowledge-based RM processes, most of these tools ignore some critical features, such as live knowledge capture, web-based platform for knowledge sharing and effective case retrieval for learning from past projects. Moreover, several RM phases, such as risk identification, analysis, response and monitoring are not usually integrated. Thus, this study aims to bridge these gaps by developing a knowledge-based RM tool (namely, CBRisk) via case-based reasoning (CBR). CBRisk has been developed as a web-based tool that supports the cyclic RM process and utilises an effective case retrieval method considering a comprehensive list of project similarity features in the form of fuzzy linguistic variables. Finally, the developed tool was evaluated and validated by conducting black-box testing and expert review meeting. Results demonstrated that CBRisk has a considerable potential to enhance the effectiveness of RM in construction projects and may be used in other project-based industries with minimal modifications

Development of a conceptual life cycle performance measurement system for build-operate-transfer (BOT) projects

Purpose The purpose of this paper is to develop a new conceptual life cycle performance measurement system (PMS) based on stage level key performance indicators (KPIs) to measure the performance of build-operate-transfer (BOT) projects. Design/methodology/approach This study uses a literature review to reveal the deficiencies of existing PMSs for public-private partnership (PPP) projects. Based on these deficiencies, four recommendations were proposed for developing a PMS. The validation of these recommendations was performed via focus group discussion sessions conducted with 12 experts. Then, a conceptual framework was developed based on the validated recommendations and the additional recommendations emerged during focus group discussions. Finally, the recommendations proposed by the focus group were tested by a questionnaire survey, the findings of the Friedman test and descriptive analysis validated these recommendations. Findings Findings of the focus group discussion, Friedman test and descriptive analysis indicated that the PMS should have four crucial features to develop an efficient, effective and comprehensible PMS for the BOT project. Firstly, non-financial and financial KPIs should be integrated. Secondly, the PMS should be developed as a process-based system with stage level KPIs. The performance of the BOT projects should be monitored and reviewed continuously, however the most important KPIs should be used for continuous performance measurement to increase the applicability of the system and allocate the resources more efficiently. Research limitations/implications This survey was conducted on experts who have experience with BOT projects located in Turkey, therefore, judgments of experts might be affected by external factors specific to Turkey such as geopolitical situations, investment environment. However, due to the nature of BOT projects, the experience of experts can also be utilized at the international level. Originality/value This is the first time a PMS has been developed to measure the performance of a BOT project. In addition, this system has unique features when compared with the PMS proposed in the literature. Especially, the stage level KPIs and continuous performance measurement with the most important KPIs throughout each stage has never been used. This research provides both public sector and private entities with an insight into effectively measure, control and manage their BOT infrastructure projects' performances throughout their life cycles

BXCOM: A software for computation of radiation sensing

WOS: 000469740700001The main objective of this work is to develop user-friendly software, called BXCOM, for computation of the exposure build-up factor (EBF) and the energy absorption build-up factor (EABF), using geometric progression (G-P) fitting method for element, compound or mixture in the energy region 0.015-15 MeV, and for penetration depths up to 40 mean free path (mfp). Furthermore, BXCOM can generate the equivalent atomic number and five fitting parameters used in the G-P method for mixtures and compounds over an interval of photon energies extended from 0.015 to 15 MeV. In addition, the program is designed to calculate the effective atomic number and effective electron number via the direct method. BXCOM program has been verified by comparing its results with approved data by American National Standards Institute. BXCOM runs under MS Windows (R) operating system. It has an improved user interface that provides examination of material's radiation interaction parameters. Finally, BXCOM allows rapid and reliable calculation of many gamma-ray interaction parameters such as , , , G-P fitting parameters and build-up factors that are essential in a wide range of applications such as radiation shielding, radiotherapy, technology and so on.Turkiye Bilimsel ve Teknolojik Arastirma Kurumu [2015-115F311]This work was supported by Turkiye Bilimsel ve Teknolojik Arastirma Kurumu [Grant Number 2015-115F311]

Radiation interaction parameters for blood samples of breast cancer patients: an MCNP study

The main goal of this study was to determine radiation interaction parameters such as mass attenuation coefficients, effective atomic numbers, and effective electron densities depending on element concentrations (Na, K, Cu, Zn, Al, Ca, Mg Cr, Fe, Se) in blood samples of patients with breast cancer. Eighty blood samples were collected and analyzed in this study (40 from breast cancer patients and 40 from healthy patients). The determination of element concentrations of the samples was performed with inductively coupled plasma-mass spectrometry (ICP-MS) and inductively coupled plasma-optical emission spectrometry (ICP-OES) after which the element concentrations were normalized to percentage. Mass attenuation coefficients were calculated by Monte Carlo simulation method. In addition, effective atomic numbers and effective electron density values of the blood samples were calculated with the ZXCOM program. One of the most important results of this study is that differences in radiation interaction parameters between the two groups were observed. More specifically, the mass attenuation coefficients of the healthy group's blood samples were higher than those of the cancerous group at photon energies of 50 keV, 100 keV, 250 keV and 500 keV, while they were lower at 1 MeV. All the MCNP results were consistent with the results obtained from ZXCOM. As the main result of this study it is concluded that photon atomic parameters such as mass attenuation coefficient, effective atomic number and electron density may be considered in cancer diagnosis or treatment modalities.Türkiye Bilimsel ve Teknolojik Araştırma KurumuBAP Yildiz Technical Universit

Determination of Se, Cr, Mn, Zn, Co, Na, and K in blood samples of breast cancer patients to investigate their variation using ICP-MS and ICP-OES

The aim of this study was to investigate the concentration changes of Se, Mn, Cr, Zn, Co, Na and K in blood samples of breast cancer patients. Determination of the elements was performed using ICP-MS and ICP-OES instruments. Kolmogorov- Smirnov normality tests, Mann-Whitney U tests, Independent sample T tests and Spearman’s rank correlation tests were performed for statistical comparisons. It was found that the concentrations of Na and K in breast cancer patients were higher than for healthy people. The Se, Mn, and Cr concentrations were found to be lower in patients with breat cancer. No increase/decrease in Zn concentrations between the two groups was observed. A positive correlation was found between the distribution of Zn and K elements. Independent sample t and Mann- Whitney U tests demonstrated that statistical differences were observed between patients having the diagnosis of breast cancer and healthy people in terms of the concentrations of Se, Cr and Na. The results presented in this study will contribute to the literature by showing the relationship between breast cancer and element concentrations.2210C 2015-01-01-YL04, 832Yildiz Technical Universit

A novel comprehensive utilization of vanadium slag/epoxy resin/antimony trioxide ternary composite as gamma ray shielding material by MCNP 6.2 and BXCOM

New research on composite materials was proposed for both gamma ray shielding and fireproofing. When compared to concrete, composite materials show up higher shielding properties in the 0.015 MeV–15 MeV incident energy range. The composite was prepared with vanadium slag, epoxy resin and antimony-trioxide. Different ratios of ternary composite were investigated in order to determine the optimum ratio for shielding and anti-flame properties. Photon atomic parameters with shielding were determined by BXCOM and MCNP 6.2. BXCOM program determines the buildup factors (both EBF and EABF) in the 0.015–15 MeV energy range for up to 40 mean free path (mfp) penetration depth. It uses geometric progression (G-P) fitting method. The effective electron number () and the effective atomic number () were also obtained with the BXCOM software. Furthermore, parameters such as the mass attenuation coefficients , half-value layer (HVL) and tenth-value layer (TVL) were determined by MCNP 6.2 in order to confirm and compare with WinXCOM results. Obtained results may be concluded to have preferable shielding properties for the composite as an alternative to concrete. Antimony-trioxide (x=0.03), was found to exhibit the minimum EBF and EABF values, and is a convenient radiation shielding material. The Epoxy resin-vanadium slag and antimony-trioxide ternary glassy composite indicates better radiation shielding properties than concrete, but weaker than lead

An investigation on gamma-ray shielding properties of quaternary glassy composite (Na2Si3O7/Bi2O3/B2O3/Sb2O3) by BXCOM and MCNP 6.2 code

Analytic and stochastic methods were proposed for the determination of gamma-ray radiation shielding properties of the glassy composites. Radiation shielding properties such as mass attenuation coefficients, effective atomic numbers, effective electron numbers, build-up factors (exposure build-up factors and energy absorption build-up factors) can be determined with these techniques. A versatile quaternary composite was studied with different mass ratios in order to optimize the gamma radiation attenuation. Exposure build-up factors (EBFs), energy absorption build-up factors (EABFs), effective atomic numbers (Z(eff)) and effective electron densities (N-eff) were calculated via BXCOM. Furthermore, MCNP transport code, version of 6.2, was used to simulate the mass attenuation coefficients (mu/rho) and the half-value layers (HVLs) of the composites. Since they are compatible, simulation and BXCOM results denote that these methods can be used to determine the radiation shielding parameters for the glassy composites for which there are no satisfactory experimental values available. All in all, the optimum mass ratio, having the highest radiation attenuation, was determined as [Na2Si3O7/Bi2O3(65/35)/B2O3(2)/Sb2O3(11)], so that glassy composite might be preferred as a radiation shield in various applications. The quaternary glassy composites investigated in this study, performs better than ordinary concrete, getting close to pure lead as a radiation shield