Trends in Occupational Fatalities and Industry Growth for Construction Industry in the United States

The construction industry is one of the largest industries in the United States and in the world. The U.S. construction industry accounted for 4.5% of the U.S. Gross Domestic Product (GDP) in 2006, and 8% of the workforce. Thus, the relationship between GDP, population, and construction volume could show an impact on the number of construction fatalities. The results of this study showed that an increase in GDP is an indicator of an increase in construction volume as well as an increase in population at the state level. The study also shows that an increase in these variables has led to an increase in construction related work fatalities. The relationship between these four variables and union membership (approximated by each state's right to work laws) was also investigated. It is concluded that population is a strong predictor of fatalities. Statistically the union states have a lower fatality rate than non-union (right to work) states

Are treatment guides and rational drug use policies adequately exploited in combating respiratory system diseases?

SummaryThe aim of the present study was to increase awareness regarding the rational use of medicines. The data were obtained via the Material Resources Management System Module of the Ministry of Health. For the appropriateness of treatments, the Global Initiative for Asthma, the Global Initiative for Chronic Obstructive Lung Disease, and the guidelines for the rational use of medicines were used. We also investigated whether any de-escalation method or physical exercise was performed. Statistical analyses were performed using descriptive statistics to determine the mean, standard deviation, and frequency. The results showed that healthcare providers ignored potential drug reactions or adverse interactions, and reflecting the lack of adherence to the current treatment guides, 35.8% irrational use of medicines was recorded. Thus, de-escalation methods should be used to decrease costs or narrow the antibiotic spectrum, antibiotic selection should consider the resistance patterns, culturing methods should be analyzed, and monotherapy should be preferred over combination treatments

The Levels of Tumor Necrosis Factor-Alpha and Interleukin-6 in Patients with Isolated Coronary Artery Ectasia

Background/Aim. Coronary artery ectasia (CAE) is considered as a variant of atherosclerosis. Tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) are among the sensitive markers of systemic inflammation. The aim of this study was to evaluate the plasma levels of the cytokines; TNF-α and IL-6 in CAE patients. Methods. Plasma concentrations of TNF-α and IL-6 were measured in 36 patients with CAE (28 males, mean age: 58.2 ± 12 years), and results were compared with age and sex-matched controls (n = 32) without coronary artery ectasia. TNF-α and IL-6 concentrations in blood were assesed by enzyme-linked immunosorbent assay (ELISA). Results. Baseline characteristics of the two groups were similar. TNF-α and IL-6 levels were significantly higher in CAE group than controls (15.6 ± 11.2 pg/mL versus 7.8 ± 3.7 pg/mL, P < .001, and 17.2 ± 12.6 versus 7.6 ± 2.1 P < .0001, resp.). Conclusion. CAE patients showed increases in TNF-α and IL-6 levels compared to the controls. This study provides evidence for alterations in the proinflamatory cytokines which suggest the involvement of the immune system in the pathophysiology of CAE. Further placebo-controlled studies are needed to evaluate the clinical significance of this increase in TNF-α and IL-6 levels

Profile differences of medical doctors from three different hospitals in Turkey concerning burnout, job satisfaction, and depression

Objective: This study aimed to compare job satisfaction, burnout, and depression scores of medical doctors from different regions in Turkey. Method: A cross-sectional study was performed during October 2013 in three cities from Turkey. Participants were asked to self-administer a demographic information questionnaire, the Minnesota Satisfaction Questionnaire (Internal work satisfactionIWS and External work satisfaction-EWS), the Beck Depression Inventory (BDI), the Maslach Burnout Inventory (MBI), Maslach Emotional Exhaustion Score (MEES), and Maslach Personal Accomplishment Score (MPAS). Results: Mean (±SD) Total work satisfaction score was 66.2±12.6. 118 participants had BDI scores of 10 or less while 40 participants had 11 or higher scores. Proportions for poor depersonalization, emotional exhaustion, and personal accomplishment were 18.6% (n=29), 5.8% (n=9), and 81.9% (n=127) respectively. There were significant differences concerning some variables between the three cities. Most of the doctors in Şırnak and Hakkari were younger, single, and less experienced compared to the more developed Çanakkale (p<0.05). Discussion: In a hierarchical regression analysis, independent of the other factors, MPAS and MEES were predictors of the total job satisfaction score. MPAS and MEES are the most significant independent variables affecting job satisfaction. Decreasing stressors and assuring a motivating and supportive environment may prove to be helpful in the enhancement of job satisfaction

Different Types of Intraoperative Hypotension and their Association with Post-Anesthesia Care Unit Recovery

Background: The underlying causative mechanism leading to intraoperative hypotension (IOH) may vary depending on the stage of anesthesia and surgery, resulting in different types of IOH. Consequently, the incidence, severity, and postoperative complications associated with IOH types may differ. This study explores the association between IOH types and post-anesthesia care unit (PACU) recovery, with a focus on duration and complications. Methods: From May 2022 to December 2022, we included 4776 consecutive surgical patients aged ≥18 who underwent elective surgery with planned overnight stays at Acibadem Altunizade Hospital and received general anesthesia. Post-induction hypotension (pIOH) was defined as a decrease in blood pressure during the first 20 minutes after anesthesia induction, while maintenance intraoperative hypotension (mIOH) referred to a decrease in blood pressure occurring after the 20th minute following induction, with or without preceding pIOH.Results: Among the included patients, 22.13% experienced IOH, with a higher prevalence observed among females. Patients with mIOH exhibited higher rates of bleeding, transfusions, hypothermia, longer stays in the PACU, and increased oxygen requirements. The duration of anesthesia did not increase the likelihood of IOH. Multivariate logistic regression analysis revealed that ephedrine usage, hypothermia, the need for additional analgesics, nausea, and vomiting were factors associated with longer PACU duration. Older patients (≥65), patients with ASA≥2 status, those undergoing major surgery, experiencing unexpected bleeding, and exhibiting hypothermia at the end of anesthesia had a higher likelihood of requiring vasopressor support. Conclusions: Patients experiencing hypotension, particularly during the maintenance of anesthesia, are more prone to complications in the PACU and require closer monitoring and treatment. Although less common, mIOH has a more significant impact on outcomes compared to other factors affecting PACU recovery. The impact of mIOH on PACU duration should not be overlooked in favor of other factors. Registration: Clinicaltrials.gov identifier: NCT05671783

Designing Excited States: Theory-Guided Access to Efficient Photosensitizers for Photodynamic Action

Cataloged from PDF version of article.The in silico design of tetraradical S 1 states was validated experimentally through synthesis, followed by characterization including phosphorescence measurements, use of trap molecules, and cell culture studies, leading to a series of orthogonal dimers of Bodipy chromophores with remarkable singlet oxygen efficiencies (see picture). A new path for the rational development of efficient photosensitizers is thus revealed. Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim

New advantageous tool in single incision laparoscopic cholecystectomy: the needle grasper

Introduction: During single-incision laparoscopic cholecystectomy (SILC), the gallbladder is suspended with stitches, resulting in perforation risk and difficulty in exploration. Aim: We used the needle grasper in SILC to hang and manipulate the gallbladder. Material and methods : Sixty-five patients (43 female, 22 male) who underwent SILC between December 2013 and December 2014 were analyzed retrospectively for patient demographics, duration of operation, laparotomy or conventional laparoscopy necessity, drain use, complications, and hospital stay periods. To place the SILC port (Covidien, Inc.), the needle grasper was inserted at the right upper abdominal quadrant without an incision to hang and manipulate the gall-bladder. Results : The mean age was 47.9 ±13.068 years; the mean body mass index (BMI) was 26.94 ±3.913 kg/m2. ASA scores were 1, 2, and 3. Two patients with high BMI with additional trocar use were excluded. The operations were completed without any additional trocar in 59 patients. The mean operation time was 89 ±22.41 min. Eighteen patients required a drain; all were discharged after drain removal. One patient needed re-hospitalization and percutaneous drainage and was discharged on the 9th day. Fifty-three patients were discharged on the 1st post-operative day. Eleven patients with drains were discharged on the 2nd day, and 1 was discharged on the 7th day. The mean hospital stay period was 1.26 ±0.815 days. Conclusions : The main difficulty of SILC is to manipulate hand tools because the triangulation principle of laparoscopy use is not possible in SILC. Inserting a needle grasper into the abdominal cavity at the right subcostal area to manipulate the gallbladder helps and does not leave a visible scar

Minimal access median sternotomy for aortic valve replacement in elderly patients

BACKGROUND: We report our clinical experience with a approach for aortic valve replacement (AVR) via minimal access skin incision and complete median sternotomy. This approach was used in patients with higher age and multiple co-morbidities, facilitating an easy access with short bypass and cross clamp times. It was especially performed in patients asking for an excellent cosmetic result, who did not qualifying for minimally-invasive AVR via partial upper sternotomy. METHODS: AVR via minimal-access median sternotomy, was performed in 58 patients between 01/2009 and 11/2011. Intra- and postoperative data including cross clamp time, cardiopulmonary bypass time, mortality, stroke, pacemaker implantation, re-operation for bleeding, ventilation time, ICU and hospital stay, wound infection, sternal dehiscence or fracture and 30 day mortality were collected. RESULTS: Mean patients age was 76.1 +/−9.4 years, 72% were female. Minimal-access AVR could be performed with a mean length of midline skin incision of 7.8 cm. Aortic cross-clamping time was 54.6 +/−6.3 min, cardiopulmonary bypass time 71.2+/−11.3 min and time of surgery 154.1 +/−26.8 min. Re-operation for bleeding had to be performed in 1 case (1.7%). There were no strokes or pacemaker implantations needed. Mean ventilation time was 4.5 h, ICU stay was 2 days and mean length of hospital stay was 6 days. 6 months follow up showed mortality of 0% and no sternal dehiscence or wound infection was observed. CONCLUSION: Minimal-access AVR via complete median sternotomy can be performed safely,in this elderly patient cohort without adding additional operative risk compared to conventional AVR. By avoidiance of large skin incisions this approach combines excellent cosmetic results with fast surgery time and excellent postoperative recovery

Magnetic resonance imaging based kidney volume assessment for risk stratification in pediatric autosomal dominant polycystic kidney disease

IntroductionIn the pediatric context, most children with autosomal dominant polycystic kidney disease (ADPKD) maintain a normal glomerular filtration rate (GFR) despite underlying structural kidney damage, highlighting the critical need for early intervention and predictive markers. Due to the inverse relationship between kidney volume and kidney function, risk assessments have been presented on the basis of kidney volume. The aim of this study was to use magnetic resonance imaging (MRI)-based kidney volume assessment for risk stratification in pediatric ADPKD and to investigate clinical and genetic differences among risk groups.MethodsThis multicenter, cross-sectional, and case-control study included 75 genetically confirmed pediatric ADPKD patients (5–18 years) and 27 controls. Kidney function was assessed by eGFR calculated from serum creatinine and cystatin C using the CKiD-U25 equation. Blood pressure was assessed by both office and 24-hour ambulatory measurements. Kidney volume was calculated from MRI using the stereological method. Total kidney volume was adjusted for the height (htTKV). Patients were stratified from A to E classes according to the Leuven Imaging Classification (LIC) using MRI-derived htTKV.ResultsMedian (Q1-Q3) age of the patients was 6.0 (2.0–10.0) years, 56% were male. There were no differences in sex, age, height-SDS, or GFR between the patient and control groups. Of the patients, 89% had PKD1 and 11% had PKD2 mutations. Non-missense mutations were 73% in PKD1 and 75% in PKD2. Twenty patients (27%) had hypertension based on ABPM. Median htTKV of the patients was significantly higher than controls (141 vs. 117 ml/m, p = 0.0003). LIC stratification revealed Classes A (38.7%), B (28%), C (24%), and D + E (9.3%). All children in class D + E and 94% in class C had PKD1 variants. Class D + E patients had significantly higher blood pressure values and hypertension compared to other classes (p &gt; 0.05 for all).DiscussionThis study distinguishes itself by using MRI-based measurements of kidney volume to stratify pediatric ADPKD patients into specific risk groups. It is important to note that PKD1 mutation and elevated blood pressure were higher in the high-risk groups stratified by age and kidney volume. Our results need to be confirmed in further studies