Erector spinae plane block vs interscalene brachial plexus block for postoperative analgesia management in patients who underwent shoulder arthroscopy

Background Interscalene brachial plexus block (ISB) is the gold standard method used for postoperative analgesia after arthroscopic shoulder surgery. Ultrasound guided erector spinae plane block (ESPB) is an interfascial plane block. The aim of this study is to compare the analgesic efficacy of ESPB and ISB after shoulder arthroscopy. The primary outcome is the comparison of the perioperative and postoperative opioid consumptions. Methods Sixty patients with ASA score I-II planned for arthroscopic shoulder surgery were included in the study. ESPB was planned in Group ESPB (n = 30), and ISB was planned in Group ISB (n = 30). Intravenous fentanyl patient-controlled analgesia was administered to both groups in the postoperative period. Intraoperative and postoperative opioid and analgesic consumption of both groups, side effects and complications related to opioid use, postoperative pain scores and rescue analgesic use were recorded in the first 48 h postoperatively. Results Pain scores were significantly higher in the ESPB group in the first 4 h postoperatively than in the ISB group (p < 0.05). The total fentanyl consumption and number of patients using rescue analgesics in the postoperative period were significantly higher in the ESPB group (p < 0.05). The incidence of nausea in the postoperative period was significantly higher in the ESPB group (p < 0.05). Conclusions In our study, it was seen that ISB provided more effective analgesia management compared to ESPB in patients underwent shoulder arthroscopy surgery

Novel strategies in nephrology: what to expect from the future?

Artificial kidney; Chronic kidney disease; XenotransplantationRonyó artificial; Malaltia renal crònica; XenotrasplantamentRiñón artificial; Enfermedad renal crónica; XenotrasplanteChronic kidney disease (CKD) will become the fifth global case of death by 2040. Its largest impact is on premature mortality but the number of persons with kidney failure requiring renal replacement therapy (RRT) is also increasing dramatically. Current RRT is suboptimal due to the shortage of kidney donors and dismal outcomes associated with both hemodialysis and peritoneal dialysis. Kidney care needs a revolution. In this review, we provide an update on emerging knowledge and technologies that will allow an earlier diagnosis of CKD, addressing the current so-called blind spot (e.g. imaging and biomarkers), and improve renal replacement therapies (wearable artificial kidneys, xenotransplantation, stem cell-derived therapies, bioengineered and bio-artificial kidneys).Research by A.O. is supported by IS/Fondos FEDER (PI18/01 366, PI19/00 588, PI19/00 815, DTS18/00 032, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00 064) and PERSTIGAN AC18/00 071, ISCIII-RETIC REDinREN RD016/0009), Sociedad Española de Nefrología, FRIAT, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM, Instituto de Salud Carlos III (ISCIII) RICORS program to RICORS2040 (RD21/0005/0001) and SPACKDc PMP21/00 109, FEDER funds. RD16/0009

Attitudes and practices against COVID-19 vaccines in Turkiye

OBJECTIVE: Vaccination is the primary way to mitigate the COVID-19 pandemic. Vaccine hesitancy and refusal are one of the most important challenges against to reach herd immunity. The aim of this study is to examine the reasons for not get-ting vaccinated and the attitudes toward vaccines by people in Turkiye, who were not vaccinated, even though a COVID-19 vaccine was available for them.METHODS: This cross-sectional study is conducted in Eyupsultan district of Istanbul. The study population is 12,540. A questionnaire consisted of three sections as sociodemographic characteristics, attitudes toward COVID-19 vaccines, and Vaccination Attitudes Examination (VAX) scale was used. Among the sample size, participation rate is 69.4%.RESULTS: About 50.2% of the participants (n=259) are male, 80.3% are married, 13.1% are university graduates, and 44.0% are working in a job. About 32.8% of the participants have COVID-19 history. About 34.4% of the participants stat-ed that they would be vaccinated against COVID-19. Although those who define themselves as vaccine refuser are 5.4%, those who still refuse to be vaccinated for COVID-19 are 20.1%. In addition to this, those who are hesitant about COVID-19 vaccines are 45.6%. The most frequently preferred vaccine is comirnaty (41.7%). About 13.1% of the participants stated that "if we had a domestic COVID-19 vaccine, I would have it." The most common sources of information about vaccines are television with 78.4%, and health workers are in the last place with 14.7%. "Concerns about side effects" are the most frequently cited (85.9%) reason for not vaccinating. The mean score of the VAX scale is 42.34 +/- 10.93, and the "mistrust of vaccine benefit" is higher among primary school graduates than other educational status groups (p=0.001).CONCLUSION: Anti-vaccination attitudes have increased with the COVID-19 vaccines during pandemic. Our study is valu-able in terms of examining the reasons of individuals who have not gotten vaccinated even though they had no access prob-lems. Prominent concerns of the population should be approached seriously. Otherwise, vaccine hesitancy can be a decisive factor that would prevent the success of the struggle against pandemic

Shared decision making in patients with kidney failure

'Elderly' is most commonly defined as an individual aged 65 years or older. However, this definition fails to account for the differences in genetics, lifestyle and overall health that contribute to significant heterogeneity among the elderly beyond chronological age. As the world population continues to age, the prevalence of chronic diseases, including chronic kidney disease (CKD), is increasing and CKD frequently progresses to kidney failure. Moreover, frailty represents a multidimensional clinical entity highly prevalent in this population, which needs to be adequately assessed to inform and support medical decisions. Selecting the optimal treatment pathway for the elderly and frail kidney failure population, be it hemodialysis, peritoneal dialysis, or conservative kidney management is complex, because of the presence of comorbidities associated with low survival rates and impaired quality of life. Management of these patients should involve a multidisciplinary approach including doctors from various specialties, nurses, psychologists, dieticians, and physiotherapists. Studies are mostly retrospective and observational, lacking adjustment for confounders or address selection and indication biases, making it difficult to use these data to guide treatment decisions. Throughout this review we discuss the difficulty of making a one-size-fits-all recommendation for the clinical needs of older patients with kidney failure. We advocate that a research agenda for optimization of the critical issues we present in this review be implemented. We recommend prospective studies that address these issues, and systematic reviews incorporating the complementary evidence of both observational and interventional studies. Furthermore, we strongly support a shared decision making process matching evidence with patient preferences to ensure that individualized choices are made regarding dialysis vs. conservative kidney management, dialysis modality, and optimal vascular access

Turkish music generation using deep learning

This is an accepted manuscript of an article published by IEEE in 28th IEEE Conference on Signal Processing and Communications Applications (SIU), available online at: https://ieeexplore.ieee.org/document/9302283 The accepted version of the publication may differ from the final published version.Bu çalı¸smada derin ögrenme ile Türkçe ¸sarkı bes- ˘ teleme üzerine yeni bir model tanıtılmaktadır. ¸Sarkı sözlerinin Tekrarlı Sinir Agları kullanan bir dil modeliyle otomatik olarak ˘ olu¸sturuldugu, melodiyi meydana getiren notaların da benzer ˘ ¸sekilde nöral dil modeliyle olu¸sturuldugu ve sözler ile melodinin ˘ bütünle¸stirilerek ¸sarkı sentezlemenin gerçekle¸stirildigi bu çalı¸sma ˘ Türkçe ¸sarkı besteleme için yapılan ilk çalı¸smadır. In this work, a new model is introduced for Turkish song generation using deep learning. It will be the first work on Turkish song generation that makes use of Recurrent Neural Networks to generate the lyrics automatically along with a language model, where the melody is also generated by a neural language model analogously, and then the singing synthesis is performed by combining the lyrics with the melody. It will be the first work on Turkish song generation

Hypertension Awareness İn Namik Kemal University Faculty Of Medicine Students And Employees

Hipertansiyon (HT) tüm dünyada ve Türkiye’de yaygın görülen bir hastalıktır. Türkiye’de HT prevelansı % 31.8’dir. HT aynı zamanda önemli hayati organları etkileyen, önemli morbidite ve mortaliteye yol açan, maliyeti yüksek bir hastalıktır. HT’un belki de en önemli özelliği semptomlarının silik olması nedeniyle farkındalığının düşük olmasıdır. Türk Hipertansiyon ve Böbrek Hastalıkları derneği tarafından yapılan HT prevelans çalışmasında, Türkiye’de HT farkındalığı %40 olarak saptanırken, Hipertansif bireylerin % 31’inin antihipertansif tedavi aldığı ve % 8’inin kan basıncının (KB) kontrol altında olduğu saptanmıştır. Biz çalışmamızda Tıp fakültesi öğrencileri ve çalışanları arasındaki HT farkındalığını değerlendirmeyi amaçladık.Hypertension (HT) is a common disease worldwide and in Turkey. The prevalence of HT in Turkey is 31.8%. HT is also a costly disease that affects important vital organs, leading to significant morbidity and mortality. The most important feature of HT is its low awareness because of its symptoms are faint. In the HT prevalence study conducted by the Turkish Hypertension and Kidney Disease Association, HT awareness was determined as 40%, 31% of the hypertensive individuals used antihypertensive medications and 8% of them were under control of blood pressure (BP). In our study, we aimed to evaluate HT awareness among medical faculty students and employee

Hypertension Awareness in Namik Kemal University Faculty of Medicine Students And Employees

Aim:Hypertension (HT) is a common disease worldwide and in Turkey. The prevalence of HT in Turkey is 31.8%. HT is also a costly disease that affects important vital organs, leading to significant morbidity and mortality. The most important feature of HT is its low awareness because of its symptoms are faint. In the HT prevalence study conducted by the Turkish Hypertension and Kidney Disease Association, HT awareness was determined as 40%, 31% of the hypertensive individuals used antihypertensive medications and 8% of them were under control of blood pressure (BP). In our study, we aimed to evaluate HT awareness among medical faculty students and employees.Material and Methods:A number of questions were asked to the employees and students in order to evaluate the knowledge of HT. Our question briefly; Is there HT in the family, have you ever done the BP measurement, where did you get the BP measurement, Do you have a BP measurement device at home, do you know the brand name of the BP measuring device? ın which case the BP measurement should be made, do you know about the HT frequency, Do you know the effects of HT, If you have HT and you are taking antihypertensive medications. After the questionnaire forms were completed, the data were analyzed.Results:A total of 456 people responded to the survey questions. The average age of the participants was 21.49 ± 4.10 (39.5% female) while 85.5% were university students. 45% in family with HT, 67.5% had a BP measurement, 42.8% had BP measurements in the hospital, 47.4% had the BP measuring device at home, 11.8% indicated that the measurement was performed routinely without any symptoms, 27% have knowledge about HT frequency , 45.8% had knowledge of HT effects, while 54 of those with high BP were receiving antihypertensive treatment. In the logistic regression analysis, those who had HT in the family, had a home BP measuring device, had information about the HT frequency, and knew the effects of HT were determined as parameters affecting the BP measurement.Conclusion:For the first time in our work, we evaluated HT awareness in NKU Medical faculty students and employees. We have found that our knowledge of HT frequency and effectiveness is very low. We think that awareness should be increased with training meetings

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

Deep learning in cyber security for internet of things

Tezin basılısı İstanbul Şehir Üniversitesi Kütphanesi'ndedir.Cyber threats are a showstopper for Internet of Things (IoT) which has recently gained popularity. Network layer attacks on IoT can cause significant disruptions and loss of information. Among such attacks, routing attacks are especially hard to defend against because of the ad-hoc nature of IoT systems and resource constraints of IoT devices. Hence a an efficient approach for detecting and predicting IoT attacks is needed. For the security of IoT, detecting malicious attacks is vital to avoid of unintended consequences such as lack of availability, integrity and confidentiality. For secure IoT needs a system that is able to robust detection against routing attacks. We propose a deep-learning basedforcontinuoussecuritymonitoringanalysisforIoT.Applicationofdeeplearningfor cyber-security in IoT requires the availability of substantial IoT attack data, however the lack of IoT attack data is an important issue. In our study, the Cooja IoT simulator has beenutilizedforgenerationofhigh-fidelityattackdata, withinIoTnetworksrangingfrom up to 1000 nodes. We propose a highly scalable, deep-learning based attack detection methodology for detection of IoT routing attacks with high accuracy and precision.Abstract iv Öz v Acknowledgments vii List of Figures x List of Tables xii Abbreviations xiii 1 Introduction 1 1.1 Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Security Problems of Internet of Things . . . . . . . . . . . . . . . . . . . 2 1.3 Proposed Methodology in the Thesis . . . . . . . . . . . . . . . . . . . . . 3 1.4 Contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.5 Outline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2 Background 8 2.1 Internet of Things (IoT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.1.1 Cyber-Physical Systems (CPS) . . . . . . . . . . . . . . . . . . . . 8 2.1.2 IoT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.1.3 Challenges of IoT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.1.4 Threats and Risks of IoT . . . . . . . . . . . . . . . . . . . . . . . 11 2.1.5 Simulation of Routing Attacks . . . . . . . . . . . . . . . . . . . . 12 2.1.5.1 Routing Attacks to IoT . . . . . . . . . . . . . . . . . . . 14 2.2 Deep Learning for Cyber Security . . . . . . . . . . . . . . . . . . . . . . . 19 2.2.1 Machine Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.2.2 Deep Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 3 Related Work 27 3.1 Deep Learning based Cyber Security Methods . . . . . . . . . . . . . . . . 34 4 IoT Routing Attack Dataset(IRAD) 36 4.1 Feature Extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 4.2 Feature Normalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 4.3 Feature Importance and Selection . . . . . . . . . . . . . . . . . . . . . . . 43 4.4 Overview of Datasets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 5 Deep Learning Based Detection of Routing Attacks 48 5.1 Routing Attack Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 5.2 Deep Learning Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 6 Evaluation and Conclusion 53 6.1 Performance Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 6.2 Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 6.2.1 Decreased Rank Attack . . . . . . . . . . . . . . . . . . . . . . . . 55 6.2.2 Hello Flood Attack . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 6.2.3 Version Number Attack . . . . . . . . . . . . . . . . . . . . . . . . 58 6.3 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 6.4 Future Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Appendix 61 Bibliography 7