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The Organic Rankine Cycle (ORC) is one of the most promising systems to recover the waste heat sourced from internal combustion engines. In this study, thermodynamic, economic and environmental analyses of the scavenge air cooling water-driven Waste Heat Recovery System (WHRS) based on the organic Rankine cycle are conducted for a dual-fuel marine engine integrated with exhaust gas recirculation (EGR) system. Zero ozone-depleting and low global warming potential working fluids; R245fa, R236ea from hydrofluorocarbons, R600a, R601a from hydrocarbons, R1234ze and R1234yf from hydrofluoroolefins are selected for the low-grade WHRS. In addition to the thermal analyses, the mass and volume of the system along with the safety factors of the working fluids are evaluated to judge the physical applicability of the system for ships. Thermo-economic performances of the fluids are analyzed, optimized and compared under various engine loads, Tier II and Tier III modes to reveal the effects of different engine operating conditions on the parameters. According to the results, scavenge air has a significant amount of waste heat at medium and heavy loads and switching the engine mode remarkably affects the performance of the WHRS. R601a shows the best thermo-economic performance, however, considering the applicability of the system R236ea is the most suitable working fluid for the ORC WHRS. The overall thermal efficiency of the power generation system can be increased by about 2.8%. [ABSTRACT FROM AUTHOR]

Motor yacht design is a multidisciplinary process that includes qualitative, quantitative, and iterative analyses. There are many personalized design and engineering steps from construction material selection to interior design; therefore, a practical design guide is required. In this study, 27 active lobster-type motor yachts whose overall lengths range from 10.5 m to 22.6 m were investigated in terms of hull and superstructure design and propulsion. Hull forms are modeled with CAD and form characteristics are calculated. Moreover, the hull form, superstructure, and deckhouse design parameters are presented using CAD data, and length-based correlations are made using layouts. In addition, the Savitsky method is used for semi-planning and planning hulls to calculate resistance and power data. The existing conventional diesel-mechanical and diesel-pod drive propulsion systems onboard yachts are compared, and alternative propulsion systems are discussed. Finally, a novel and practical design framework is created for use in the preliminary design phase of lobster-type motor yachts. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to evaluate the frequency of emergency department admissions (EDA) and related factors in the last year among patients admitted to family health centers (FHC) with and without flexible working hours (FWH). Methods: This study was conducted in 6 regions in Turkey, 50 FHCs were selected for each study region by random sampling and the first nine patients who applied to the FHC were included in the study. Patients who applied to emergency department health services at least once for any health problem in the last year were considered to have EDA. Results: A total of 2605 patients were included in the study, and EDA was found in 1024 (39.3%) of the patients. EDA was detected in 246 (41.5%) patients with FHCs with FWH and 778 (36.7%) patients with FHCs without FWH (p=0.232). In addition, there was no significant difference between patients with and without FWH in the distance of the FHC from home, the frequency of making an appointment to see the FP, the ease of making an appointment, the waiting time after making the appointment, and the limitation of the working hours of the FHC (p>0.05). Conclusion: It has been determined that the presence of FWH did not cause a difference in terms of EDA, and further studies are needed on the reasons for this. [ABSTRACT FROM AUTHOR]

Objectives: In this study, it was aimed to evaluate the effect of structured short motivational interviewing in exercise and diet-related behavioral changes in type 2 diabetes patients in primary care. Methods: Participants were divided into control and intervention groups. The study was single-blinded, and only the researchers know the participants in each group. The intervention group received a motivating interview- based intervention a total of 4 times in the 1st month of the study and followed up in the 3rd month. The control group was followed by family physicians and evaluated at 3 months without any motivational intervention. One-week pedometer, international physical activity questionnaire (IPAQ2) scores, daily calorie intake, EuroQol (EQ5D), multidimensional diabetes questionnaire (MDQ), and motivational assessment scale were used at the beginning of the study and the 3rd-month follow-up. Results: The study included 84 (51.5%) participants in the intervention group and 79 (48.5%) patients in the control group. There was a significant difference between the control and intervention groups in terms of a 1-week pedometer (2785.0 [1002.0-7240.0] step/day vs. 5231.0 [1364.0-11827.0] step/day, p<0.001), IPAQ2 scores (0.0 [0.0-1056.0] vs. 495.0 [0.0-1396.0], p<0.001), EQ5D scale total scores (5.0 [5.0-10.0] vs. 5.0 [5.0-8.0], p=0.006), and MDQ scale total scores (607.0 [244.0-847.0] vs. 730.0 [235.0-847.0], p<0.001) at the 3rd-month follow-up. Conclusion: A structured motivational interviewing model that can be used in primary care may be effective in developing lifestyle changes in type 2 diabetes mellitus patients. [ABSTRACT FROM AUTHOR]

The ship-based greenhouse gas emissions along with the volumetric growth in maritime transportation have increased significantly over the years. International Maritime Organization (IMO) has tightened the emission limits by putting new regulations into effect to overcome the environmental impacts and therefore, the maritime industry has focused on energy-efficient ship design and operation, recently. Regarding the latest developments, dual-fuel engines operated with different fuels have been installed and new technological developments in emission control have been implemented onboard ships. In this context, the selection of engine systems where there are many options available has been a substantial problem in the design process of a ship, recently. The latest marine engines are capable of operating with various types of fuels at different emission control modes, therefore, energy efficiency and emission performance of the prime movers should be analyzed in detail. In this study, VLSFO, methanol, LPG, LNG and MDO-fueled engines with the same power output are investigated and the NOX reduction device integrated engines' technical specifications are compared. Then, the selected dual-fuel engines are thermodynamically analyzed and the environmental impacts are evaluated under different engine loads, Tier II, Tier III modes and ambient conditions. Moreover, EEDI calculations are conducted under the case study of powering a medium-range tanker and engine options are evaluated in terms of energy efficiency. Finally, a sensitivity analysis of engine performance is carried and the results are validated. According to the results, the energy efficiency of the ship can be increased by up to 20% by selecting the LNG-fueled engine as the prime mover while it requires more space and equipment compared to other engines. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Journal of Health Sciences / Türkiye Klinikleri Sağlık Bilimleri Dergisi is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: Family health centers (FHCs) are reimbursed for their current expenditures based on a classification of four clusters in Turkey. This study compared the coordination, comprehensiveness, continuity, accessibility, and the first contact of care among different reimbursement FHC groups. Methods: The data were obtained from the Turkish data of the Quality and Costs of Primary Care in Europe study. Data was collected in provinces from six geographical regions. Physicians and patients from Classes A and B FHCs were called the first group, and others were called the second group. Results: A total of 296 physicians and 2623 patients were enrolled. According to the reimbursement groups, 593 (22.6%) patients received services from the first group and 2012 (77.4%) patients from the second group. The first contact with care and the admission frequency of 3 or more in the last six months were higher in the first group (respectively, 99.2% vs. 97.7%, p=0.027; 55.4% vs. 49.6%, p=0.015). Conclusion: The reimbursement classification did not make a difference in coordination, comprehensive care, continuity, accessibility, and being the first contact of care. Therefore, the current classification does not contribute to improving the quality of primary care in terms of service provision. [ABSTRACT FROM AUTHOR]

Objective: In this retrospective study, we analyzed the in vitro fertilization (IVF) clinical and laboratory outcome of cryptozoospermia cases compared to the extremely severe oligospermia cases in a single IVF center. Materials and Methods: All the IVF laboratory and clinical outcomes of cryptozoospermia and extremely severe oligospermia cases were analyzed and compared between January 2014 and December 2019 in Istanbul Florence Nightingale IVF Center. The same reproductive group treated all couples. Virtual azoospermia or cryptozoospermia were diagnosed once the mature sperm cells could be recognized after centrifugation (group 1). Patients without motile sperm were excluded. Extremely severe oligospermia was defined as a sperm count was less than <1 mil/mL (group 2). The study consisted of 33 virtual azoospermic patients with 40 cycles, whereas there were 40 severely oligospermic patients with 45 cycles. All patients underwent the intracytoplasmic sperm injection (ICSI) procedure and all the embryos were let to grow until the blastocyst stage on day 5. Groups were compared for clinical and laboratory reproductive outcome. Results: Both the median maternal and paternal ages were similar. All outcomes including fertilization rates, blastulation rates, clinical pregnancy and delivery rates were comparable. The miscarriage rates did not also show any statistical difference. Conclusion: Reproductive outcomes in cryptozoospermic IVF patients are comparable to those of extremely severe oligospermic patients provided that the ICSI is performed using motile spermatozoa. Our results favor using sperm from fresh ejaculate rather than surgical sperm retrieval when motile sperm is available in cryptozoospermic IVF patients. [ABSTRACT FROM AUTHOR]

In this study, we investigate chemical and isotopic characteristics of low-temperature geothermal waters issuing from carbonate reservoirs in the Çürüksu Graben within the eastern termination of the Büyük Menderes Graben in western Turkey. Temperatures and pH values of geothermal waters vary from 20.1 to 24.6 ºC and 6.62 to 7.11 and those of cold waters are 17.1 to 19.9 ºC and 6.85 to 7.72, respectively. Geothermal waters are of Ca-HCO3 and Ca-SO4 types whereas cold waters are characterized by these two types and Mg-HCO3 as well. δ18O and δD values of samples vary from –9.27‰ to –7.69‰ (VSMOW) and –58.06‰ to –52.2‰ and indicate a meteoric origin with local recharge. Tritium contents are from 0.12 to 2.17 TU for thermal waters and 0.28 to 4.85 TU for the cold waters implying relatively longer residence time for the hot waters. Thermal water samples mostly have positive δ13C values (varying from –0.32‰ to +1.99‰) and carbon in these waters is likely derived from marine limestone or metamorphic CO2 . δ34S and δ18O values of dissolved sulfate in the waters indicate that sulfur originates from dissolution of marine evaporite deposits (e.g., gypsum). Çürüksu waters are generally oversaturated with respect to calcite, dolomite and quartz but undersaturated with respect to gypsum. Common ion effect exerted a strong control for the formation of travertine deposits in the area. Chemical and isotopic evaluations indicated that the diversity in the water chemistry of samples is attributed to a combination of processes including water-rock interaction, ion exchange and mixing of various types of waters. Çürüksu thermal waters are immature and not in chemical equilibrium with the reservoir rock. Among the various geothermometers applied to Çürüksu thermal waters, temperatures computed by chalcedony, quartz and CaMg geothermometers are 21–52 ºC, 49–83 ºC and 73–96 ºC, respectively. HCO3 -SO4 -F and anhydrite-chalcedony (quartz) diagrams estimated a temperature range of 63–86 ºC and δ18O(SO4 -H2O) isotope geothermometer yielded 67–78 ºC. [ABSTRACT FROM AUTHOR]

We report the learnings gleaned from a four-country panel (Australia, South Africa, Egypt and Nigeria) sharing their countries' COVID-19 primary healthcare approaches and implementation of policy at the World Organization of Family Doctor's World virtual conference in November. The countries differ considerably with respect to size, national economies, average age, unemployment rates and proportion of people living rurally. South Africa has fared the worst with respect to waves of COVID-19 cases and deaths. All countries introduced strategies such as border closure, COVID-19 testing, physical distancing and face masks. Australia and Nigeria mobilised primary care, but the response was mostly public health and hospital-based in South Africa and Egypt. All countries rapidly adopted telehealth. All countries emphasised the critical importance of an integrated response between primary care and public health to conduct surveillance, diagnose cases through testing, provide community-based care unless hospitalisation is required and vaccinate the population to reduce infection spread. [ABSTRACT FROM AUTHOR]

Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units. [ABSTRACT FROM AUTHOR]

Purpose: To develop an algorithm for the diagnosis of Behçet's disease (BD) uveitis based on ocular findings. Methods: Following an initial survey among uveitis experts, we collected multi-center retrospective data on 211 patients with BD uveitis and 207 patients with other uveitides, and identified ocular findings with a high diagnostic odds ratio (DOR). Subsequently, we collected multi-center prospective data on 127 patients with BD uveitis and 322 controls and developed a diagnostic algorithm using Classification and Regression Tree (CART) analysis and expert opinion. Results: We identified 10 items with DOR >5. The items that provided the highest accuracy in CART analysis included superficial retinal infiltrate, signs of occlusive retinal vasculitis, and diffuse retinal capillary leakage as well as the absence of granulomatous anterior uveitis or choroiditis in patients with vitritis. Conclusion: This study provides a diagnostic tree for BD uveitis that needs to be validated in future studies. [ABSTRACT FROM AUTHOR]

Energy efficient and environmentally friendly shipping have been primary concerns for the maritime industry. One of the alternatives to overcome these issues onboard is organic Rankine cycle (ORC) waste heat recovery system (WHRS). In this study, a transcritical ORC WHRS for a marine diesel engine is investigated at different engine operating loads by thermodynamic and environmental analysis. The engine exhaust gas is used as the waste heat source and R152a is selected as the working fluid. The energetic, exergetic and environmental parameters are analysed and the performance optimisation is conducted by using genetic algorithm. The results indicate that by employing the ORC system onboard, it is possible to increase the overall thermal efficiency of the ship power generation system by more than 2.5% and the system can save up to 678.1 tonnes CO2 per year when the system is operated at the optimal conditions. [ABSTRACT FROM AUTHOR]

Copyright of Konuralp Medical Journal / Konuralp Tip Dergisi is the property of Duzce University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To determine the presence of cardiovascular (CV) risk (CVR) factors in university students and evaluate how these factors are affected from the knowledge, attitudes, and habits of the individuals regarding healthy lifestyle., Background: Starting from early ages, lifestyle habits such as lack of physical activity, unhealthy eating, and inappropriate drug use increase CV and metabolic risks of individuals., Methods: In April-May 2018, sociodemographic characteristics of 770 undergraduate students, in addition to their knowledge, attitudes, and habits regarding their nutrition and physical activity status were obtained through face-to-face questionnaires. CVR factors were determined according to blood pressure, blood glucose, total cholesterol levels, and anthropometric measurements. Collected data were compared by CVR factor presence (CV[+] or CV[-]) in students., Findings: The mean age of the participants was 22.3 ± 2.6 years. 59.6% were female and 71.5% were students of non-health sciences. In total, 274 individuals (35.9%) belonged to CV(+) group (mean risk number: 1.3 ± 0.5) with higher frequency in males (42.1% versus 31.6%, P < 0.05). The most common CVR factors were smoking (20.6%), high total cholesterol (7.5%), and hypertension/high blood pressure (6.0%). 15.5% of the participants regularly used at least one drug/non-pharmaceutical product. 11.3% complied the Mediterranean diet well. 21.9% of CV(+) stated consuming fast food at lunch compared to 14.3% of CV(-) (P < 0.05). 44.6% stated exercising below the CV-protective level., Conclusions: This study showed one-third of university students was at CVR, independent of their sociodemographic characteristics. Furthermore, the students appear to perform below expectations in terms of nutrition and physical activity. Extensive additional measures are needed to encourage young individuals for healthy nutritional and physical activity habits.