Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Pozitif psikolojik sermaye ile örgüte bağlılık arasındaki ilişki

Günümüz koşulları içerisinde düşünüldüğünde, örgütler için ekonomik durumve değerler kadar insan kaynakları da bir o kadar önemli hale gelmiştir. Geçmişyıllardan bugüne kadar pozitif psikoloji akımının getirmiş olduğu pozitif psikolojiksermaye, insan kaynaklarının gelişmesi adına çok önemli bir araçtır. Örgütsel bağlılığapozitif etkisinin bulunmasından bu yana pozitif psikolojik sermaye işletmelerin üzerindedüşündükleri kavramlardan biri haline gelmiştir.Bu tez çalışmasında temel amaç, örgütlerde çalışan insanların sahip olduğupozitif psikolojik sermaye ile örgüte olan bağlılıkları arasındaki ilişkiyi incelemek vepozitif psikolojik sermaye bileşenlerinden olan özyeterlilik, dayanıklılık, iyimserlik veumut ile örgütsel bağlılık arasındaki ilişkiyi ve hangi yönde etkilendiğini ortayakoymaktır. Bu amaçla birinci bölümde pozitif psikoloji, pozitif psikolojik sermaye,bileşenleri olan umut, öz yeterlik, psikolojik dayanıklılık, iyimserlik ile poizitifpskolojik sermaye değişkenlerine değinilmiştir.ivÇalışmanın ikinci bölümünde örgütsel bağlılık tanımı ve önemi, örgütsel bağlılığı etkileyen faktörler ve pozitif psikolojik sermaye ile örgütsel bağlılık ilişkisi anlatılmıştır.Çalışmanın son bölümünde ise pozitif psikolojik sermaye ile örgütsel bağlılık ilişkisini göstermek amacıyla İstanbul Emniyet Müdürlüğü içerisinde farklı pozisyonlarda çalışan 585 çalışana anket uygulanmıştır. Yapılan analizler neticesinde, ahlaki ve duygusal bağlılık üzerinde, “iyimserlik ve umut” faktörünün pozitif yönde katkısı olduğu, zorunlu bağlılık üzerinde, “özyeterlilik ve dayanıklılık” ve “negatif iyimserlik ve negatif dayanıklılık” faktörlerinin pozitif yönde katkısı olduğu ortaya çıkmıştır. Negatif duygusal bağlılık üzerinde ise, “negatif iyimserlik ve negatif dayanıklılık” ve “iyimserlik ve umut” faktörlerinin pozitif yönde katkısı olduğu ortaya çıkmıştır.--------------------Considering today's conditions, human resources have become as important as the economic situation and values for organizations. Positive psychological capital brought by positive psychology movement from past years to date is a very important tool for development of human resources. Since the positive impact of organizational commitment, positive psychological capital has become one of the concepts that enterprises think about.The main purpose of this thesis is to examine the relationship between the positive psychological capital of the people working in organizations and their commitment to the organization and to reveal the relationship between self-efficacy, resilience, optimism and hope and organizational commitment, one of the positive psychological capital components, and in which way it is affected. For this purpose, in the first part, positive psychology, positive psychological capital, and its components such as hope, self-efficacy, psychological resilience, optimism and positive psychological capital variables are mentioned.viIn the second part of the study, the definition and importance of organizational commitment, the factors affecting organizational commitment and the relationship between positive psychological capital and organizational commitment are explained.In the last part of the study, in order to show the relationship between positive psychological capital and organizational commitment, a questionnaire was applied to 585 employees working in different positions in Istanbul Police Department. As a result of the analyzes, it was found that there was a positive contribution of “optimism and hope” factor on moral and emotional commitment, and positive contribution of “self-efficacy and durability”, “negative optimism and negative endurance” on compulsory commitment. On negative emotional commitment “negative optimism and negative endurance” and “optimism and hope” factors were positively contributed

Pozitif psikolojik sermaye ile örgüte bağlılık arasındaki ilişki

Günümüz koşulları içerisinde düşünüldüğünde, örgütler için ekonomik durum ve değerler kadar insan kaynakları da bir o kadar önemli hale gelmiştir. Geçmiş yıllardan bugüne kadar pozitif psikoloji akımının getirmiş olduğu pozitif psikolojik sermaye, insan kaynaklarının gelişmesi adına çok önemli bir araçtır. Örgütsel bağlılığa pozitif etkisinin bulunmasından bu yana pozitif psikolojik sermaye işletmelerin üzerinde düşündükleri kavramlardan biri haline gelmiştir. Bu tez çalışmasında temel amaç, örgütlerde çalışan insanların sahip olduğu pozitif psikolojik sermaye ile örgüte olan bağlılıkları arasındaki ilişkiyi incelemek ve pozitif psikolojik sermaye bileşenlerinden olan özyeterlilik, dayanıklılık, iyimserlik ve umut ile örgütsel bağlılık arasındaki ilişkiyi ve hangi yönde etkilendiğini ortaya koymaktır. Bu amaçla birinci bölümde pozitif psikoloji, pozitif psikolojik sermaye, bileşenleri olan umut, öz yeterlik, psikolojik dayanıklılık, iyimserlik ile poizitif pskolojik sermaye değişkenlerine değinilmiştir. iv Çalışmanın ikinci bölümünde örgütsel bağlılık tanımı ve önemi, örgütsel bağlılığı etkileyen faktörler ve pozitif psikolojik sermaye ile örgütsel bağlılık ilişkisi anlatılmıştır. Çalışmanın son bölümünde ise pozitif psikolojik sermaye ile örgütsel bağlılık ilişkisini göstermek amacıyla İstanbul Emniyet Müdürlüğü içerisinde farklı pozisyonlarda çalışan 585 çalışana anket uygulanmıştır. Yapılan analizler neticesinde, ahlaki ve duygusal bağlılık üzerinde, “iyimserlik ve umut” faktörünün pozitif yönde katkısı olduğu, zorunlu bağlılık üzerinde, “özyeterlilik ve dayanıklılık” ve “negatif iyimserlik ve negatif dayanıklılık” faktörlerinin pozitif yönde katkısı olduğu ortaya çıkmıştır. Negatif duygusal bağlılık üzerinde ise, “negatif iyimserlik ve negatif dayanıklılık” ve “iyimserlik ve umut” faktörlerinin pozitif yönde katkısı olduğu ortaya çıkmıştır. -------------------- Considering today's conditions, human resources have become as important as the economic situation and values for organizations. Positive psychological capital brought by positive psychology movement from past years to date is a very important tool for development of human resources. Since the positive impact of organizational commitment, positive psychological capital has become one of the concepts that enterprises think about. The main purpose of this thesis is to examine the relationship between the positive psychological capital of the people working in organizations and their commitment to the organization and to reveal the relationship between self-efficacy, resilience, optimism and hope and organizational commitment, one of the positive psychological capital components, and in which way it is affected. For this purpose, in the first part, positive psychology, positive psychological capital, and its components such as hope, self-efficacy, psychological resilience, optimism and positive psychological capital variables are mentioned. vi In the second part of the study, the definition and importance of organizational commitment, the factors affecting organizational commitment and the relationship between positive psychological capital and organizational commitment are explained. In the last part of the study, in order to show the relationship between positive psychological capital and organizational commitment, a questionnaire was applied to 585 employees working in different positions in Istanbul Police Department. As a result of the analyzes, it was found that there was a positive contribution of “optimism and hope” factor on moral and emotional commitment, and positive contribution of “self-efficacy and durability”, “negative optimism and negative endurance” on compulsory commitment. On negative emotional commitment “negative optimism and negative endurance” and “optimism and hope” factors were positively contributed

Carbon nanofiber electrodes for PEM fuel cells

Increasing energy demand in the world and the environmental concerns due to air pollution and the greenhouse effect of fossil fuel resources stimulate the research into renewable alternative energy sources. Among these alternatives, hydrogen has a life changing opportunity for the human being for the future. The chemical energy stored in hydrogen can be converted into electricity via various types of fuel cells. The proton exchange membrane fuel cell is the most promising type providing high power densities at operating temperatures typically less than 100 °C. The necessity of increasing the platinum utilization in PEMFCs, due to its cost and availability, requires an optimization of the catalyst support and the gas diffusion layers. In many long term fuel cell tests, a decrease in water removal capacity leads to a gradual decrease of the PEMFC performance. The use of more graphitic and highly oriented carbon as an alternative material for use in the gas diffusion media combines a high electronic conductivity with an acceptable surface area. One approach, introduced in this thesis, is the direct growth of carbon nanofibers (CNFs) on a gas diffusion layer providing a strong network with a high surface area. Two methods are developed for the direct growth of CNFs on a carbon based gas diffusion layer: CNF growth via nickel complex particles (chapter 2) and via homogeneous deposition precipitation of nickel (chapter 3). The production of CNF grown carbon paper via the nickel complex particles was rather fast compared to the homogenous deposition precipitation of nickel, since deposition of nickel complex particles on a carbon paper took less than one hour whereas it took more than two days for the homogeneous deposition precipitation of nickel. The time of the deposition of nickel hydroxide in the deposition precipitation depends upon the decomposition rate of urea at the deposition temperature. Since the deposition was carried out near the boiling point of water, the decomposition rate of urea was nearly constant. It was attempted to increase the total amount of nickel by working with highly concentrated nickel and urea solutions. However, this caused a non-uniform deposition of nickel hydroxide which resulted in the detachment of CNFs during ultrasonic treatments. The loading of the nickel catalyst was controlled precisely during homogeneous deposition precipitation of nickel on carbon paper in this slow deposition process. In addition, the growth of nickel hydroxide layers covered the entire surface of the carbon paper and thereby closed the pores bigger than 1 µm. In our experiments, it was observed that open pores on the CNF grown carbon paper surface caused instabilities in operation due to water accumulation at these locations of the cathode compartment of the PEMFCs. Considering the two main factors described here, homogeneous deposition precipitation of nickel was utilized to obtain a highly controlled nickel deposition and thereby a highly controlled CNF loading on the carbon papers. The decoration of carbon paper with CNFs was investigated as a water management layer (chapters 4 and 5) and as a direct catalyst layer for platinum (chapter 6) in order to give more accessibility for the gas transport. The CNF grown carbon paper provided effective gas diffusion to the catalyst layer when they were used as a water management layer, especially under high gas flows. It suffered from performance losses at the mid-current density region (400-800 mA.cm-2), which can be improved by loading of a hydrophobic polymer. The CNF grown carbon paper can be a good alternative as a catalyst support, however, further optimization of the Nafion-platinum contact is required to get the benefits of using CNF grown carbon paper as a direct catalyst layer

In-situ Experiment on Dynamic Soil-Structure Interaction

The traditional methods utilized in today's seismic design of structures involve structure's foundation as a fixed base by assuming soil does not deforms. Earthquake input motion is also considered as a horizontal movement that is not being affected by the structure. On the other hand, the seismic analysis of dynamic soil-structure interaction which considers superstructure, foundation and surrounding soil of building, aims to evaluate structural response based on the interaction of these three components. In this study, presence of building, which is effecting on wave propagation, is experimentally investigated including soil-structure interaction. Acceleration record from the foundation of a two-story reinforced concrete, that is forced to vibrate by artificial dynamic load, is compared with the free ground surface vibration record around the building to indicate the effect of soil-structure kinematic interaction on foundation vibration. With this specific field study, differences in acceleration, displacements time histories and Fourier spectrums are comparatively presented using recorded vibrations from selected locations of interes

A new technique to avoid the intraoperative complications of septal myectomy in patients with obstructive hypertrophic cardiomyopathy

Although transaortic septal myectomy in obstructive hypertrophic cardiomyopathy (OHC) is accepted as a safe procedure, it may end up with serious peroperative complications. We developed a practical method to avoid this unfavorable outcome by using a 20-cc syringe body. We believe this apparatus will provide safe and effective septal myectomy procedures without additional cost

Synthesis, Anticholinesterase Activity and Molecular Modeling Studies of Novel Carvacrol Substituted Amide Derivatives

In the present study, 23 novel carvacrol derivatives involving the amide moiety as a linker between the alkyl chains and/or the heterocycle nucleus were synthesized and tested in vitro as acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) inhibitors. 2-(5-Isopropyl-2-methylphenoxy)-N-(quinolin-8-yl)acetamide (5v) revealed the highest inhibition properties against AChE and BuChE with the IC50 values of 1.93 and 0.05 µM, respectively. The blood–brain barrier (BBB) permeability of the potent inhibitor (5v) was also assessed by the widely used parallel artificial membrane permeability assay (PAMPA-BBB). The results showed that 5v is capable of crossing the BBB. Pharmacokinetic and toxicity profiles of the studied molecule predictions were investigated by MetaCore/MetaDrug comprehensive systems biology analysis suite. Bioactive conformations of the synthesized molecules, their predicted binding energies as well as structural and dynamical profiles of molecules at the binding pockets of AChE and BuChE targets were also investigated using different docking algorithms and molecular dynamics (MD) simulations. Communicated by Ramaswamy H. Sarma</p