Hierarchical modeling and analysis of container terminal operations

After the breakdown of trade barriers among countries, the volume of international trade has grown significantly in the last decade. This explosive growth in international trade has increased the importance of marine transportation which constitutes the major part of the global logistics network. The utilization of containers and container ships in marine transportation has also increased after the eighties due to various advantages such as packaging, flexibility, and reliability. Parallel to the container throughput, the capacities of ships and sizes of fleets as well as the number of terminals have been increased considerably. Substantial pressure of competition on ship operators and terminal managers has forced them to consider the issues regarding operational efficiency more deeply. Thus, the operational efficiency at port container terminals has become the major concern of terminal managers to satisfy the rapid transshipment of goods. In this thesis, we focus on a set of decision problems regarding container terminal operations. Since these problems are interrelated hierarchically, we attempt to model and analyze them consecutively. First, we consider the storage space allocation problem over a rolling horizon as an aggregate planning model. Since the model has the minimum cost flow network structure there exist polynomial time solution procedures via linear programming models. Although ship turnaround time is the principal performance criteria for whole container terminal operations, the total distances traveled by containers in the terminal throughout the planning horizon is determined as the surrogate objective function for the allocation model. The output of the storage space allocation problem is used as the input for the next step of our methodology, namely the location matching model. With the location matching model, the routes of vehicles for each time period have been identified while minimizing the total distance traveled by the vehicles, which reveals the ship turnaround times. The routes that are found subject to the output of storage space allocation models are better than those of random allocation in terms of total distances traveled. Next, the vehicle scheduling problem is discussed for different levels of complexity. The solution procedures proposed for similar problems in the machine scheduling literature are provided. Finally, we discuss the problem of simultaneous vehicle dispatching with precedence constraints. We have modeled the problem as a nonlinear mixed integer programming model and proposed an iterative solution procedure to obtain reasonable solutions in considerable times. Moreover, we have presented the worst-case performance analysis for this heuristic

Demographic, clinical and laboratory characteristics of adult-onset minimal change disease in Turkey: Turkish Society of Nephrology-Glomerular Diseases (TSN-GOLD) Working Group

Purpose In our study, diagnostic and demographic characteristics of patients diagnosed with minimal change disease (MCD) by biopsy, clinical and laboratory findings in our country were investigated. Methods Data were obtained from the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group database. Demographic characteristics, indications for biopsy, diagnosis of the glomerular diseases, comorbidities, laboratory and biopsy findings of all patients were recorded. The data presented are cross-sectional and includes application data for the biopsy period. Results Of 3875 patients, 233 patients with MCD (median age 35.0 years) were included in the study, which constitutes 6.0% of the total glomerulonephritis database. Renal biopsy was performed in 196 (84.1%) patients due to nephrotic syndrome. Median serum creatinine was 0.7 (0.6-1.0) mg/dl, mean eGFR was 104 +/- 33 ml/min/1.73 m(2) and median proteinuria 6000 mg/day. The number of patients under the age of 40 years was 139 (59.7%) (Group A), and the number of patients aged 40 years and over was 94 (40.3%) (Group B). Compared to Group A, global sclerotic glomeruli (24 vs. 43, p < 0.001) interstitial inflammation (15 vs. 34, p < 0.001), interstitial fibrosis (20 vs. 31, p = 0.001, vascular changes (10 vs. 25, p < 0.001) and tubular atrophy (18 vs. 30, p < 0.001) were found to be significantly higher in Group B. There was no difference in immunofluorescent staining properties between the two groups. Conclusion Our data are generally compatible with the literature. Chronic histopathological changes were more common in patients aged 40 years and older than younger patients. Studies investigating the effects of these different features on renal survival are needed

Atrial Fibrillation Management in Acute Stroke Patients in Türkiye: Real-life Data from the NöroTek Study

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Turkiye. Within the scope of NoroTek-Turkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms.Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis.Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received "effective" treatment [international normalization ratio >= 2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug.Conclusion: NoroTekTR revealed the high but expected frequency of AF in acute stroke in Turkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Turkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF