Spatial interaction modeling of interregional commodity flows
In: Socio-economic planning sciences: the international journal of public sector decision-making, Band 41, Heft 2, S. 147-162
ISSN: 0038-0121
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In: Socio-economic planning sciences: the international journal of public sector decision-making, Band 41, Heft 2, S. 147-162
ISSN: 0038-0121
In: Computers and Electronics in Agriculture, Band 169, S. 105168
During the coronavirus disease-19 pandemic, the demand for specific medical equipment such as personal protective equipment has rapidly exceeded the available supply around the world. Specifically, simple medical equipment such as medical gloves, aprons, goggles, surgery masks, and medical face shields have become highly in demand in the health-care sector in the face of this rapidly developing pandemic. This difficult period strengthens the social solidarity to an extent parallel to the escalation of this pandemic. Education and government institutions, commercial and noncommercial organizations and individual homemakers have produced specific medical equipment by means of additive manufacturing (AM) technology, which is the fastest way to create a product, providing their support for urgent demands within the health-care services. Medical face shields have become a popular item to produce, and many design variations and prototypes have been forthcoming. Although AM technology can be used to produce several types of noncommercial equipment, this rapid manufacturing approach is limited by its longer production time as compared to conventional serial/mass production and the high demand. However, most of the individual designer/maker-based face shields are designed with little appreciation of clinical needs and nonergonomic. They also lack of professional product design and are not designed according to AM (Design for AM [DfAM]) principles. Consequently, the production time of up to 4 – 5 h for some products of these designs is needed. Therefore, a lighter, more ergonomic, single frame medical face shield without extra components to assemble would be useful, especially for individual designers/makers and noncommercial producers to increase productivity in a shorter timeframe. In this study, a medical face shield that is competitively lighter, relatively more ergonomic, easy to use, and can be assembled without extra components (such as elastic bands, softening materials, and clips) was designed. The face shield ...
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During the coronavirus disease-19 pandemic, the demand for specific medical equipment such as personal protective equipment has rapidly exceeded the available supply around the world. Specifically, simple medical equipment such as medical gloves, aprons, goggles, surgery masks, and medical face shields have become highly in demand in the health-care sector in the face of this rapidly developing pandemic. This difficult period strengthens the social solidarity to an extent parallel to the escalation of this pandemic. Education and government institutions, commercial and noncommercial organizations and individual homemakers have produced specific medical equipment by means of additive manufacturing (AM) technology, which is the fastest way to create a product, providing their support for urgent demands within the health-care services. Medical face shields have become a popular item to produce, and many design variations and prototypes have been forthcoming. Although AM technology can be used to produce several types of noncommercial equipment, this rapid manufacturing approach is limited by its longer production time as compared to conventional serial/mass production and the high demand. However, most of the individual designer/maker-based face shields are designed with little appreciation of clinical needs and nonergonomic. They also lack of professional product design and are not designed according to AM (Design for AM [DfAM]) principles. Consequently, the production time of up to 4 – 5 h for some products of these designs is needed. Therefore, a lighter, more ergonomic, single frame medical face shield without extra components to assemble would be useful, especially for individual designers/makers and noncommercial producers to increase productivity in a shorter timeframe. In this study, a medical face shield that is competitively lighter, relatively more ergonomic, easy to use, and can be assembled without extra components (such as elastic bands, softening materials, and clips) was designed. The face shield ...
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Therapeutic plasma exchange (TPE) is used to treat more than 60 diseases worldwide and has drawn growing interest. Little is known about the current situation of TPE activity in Turkey, so we developed a survey to obtain information about this timely topic. We collected data on TPE from 28 apheresis units throughout Turkey. We performed a total of 24,912 TPE procedures with 3203 patients over the past decade. Twenty years ago, the majority of procedures were performed for neurological and hematological disorders, and today, most TPE procedures are done for the same reasons. The only historical change has been an increase in TPE procedures in renal conditions. Currently, renal conditions were more frequently an indication for TPE than rheumatic conditions. Fresh frozen plasma was the most frequently used replacement fluid, followed by 5% albumin, used in 57.9% and 34.6% of procedures, respectively. The most frequently used anticoagulants in TPE were ACD-A and heparin/ACD-A, used with 1671 (52.2%) and 1164 (36.4%) patients, respectively. The frequency of adverse events (AEs) was 12.6%. The most common AEs were hypocalcemia-related symptoms, hypotension, and urticaria. We encountered no severe AEs that led to severe morbidity and mortality. Overall, more than two thirds of the patients showed improvement in the underlying disease. Here, we report on a nationwide survey on TPE activity in Turkey. We conclude that there has been a great increase in apheresis science, and the number of TPE procedures conducted in Turkey has increased steadily over time. Finally, we would like to point out that our past experiences and published international guidelines were the most important tools in gaining expertise regarding TPE. ; C1 [Korkmaz, Serdal] Univ Hlth Sci, Kayseri Training & Res Hosp, Dept Hematol, Kayseri, Turkey. ; [Medeni, Serife Solmaz] Univ Hlth Sci, Bozyaka Training & Res Hosp, Dept Hematol, Izmir, Turkey. ; [Demirkan, Fatih] Dokuz Eylul Univ, Dept Internal Med, Div Hematol, Fac Med,HCT Unit, Izmir, Turkey. ; [Besisik, Sevgi Kalayoglu; Dadin, Senem Altay] Istanbul Univ, Istanbul Fac Med, Dept Internal Med, Div Hematol, Istanbul, Turkey. ; [Cagliyan, Gulsum Akgun; Hacioglu, Sibel Kabukcu; Sari, Ismail] Pamukkale Univ, Dept Internal Med, Div Hematol, Denizli, Turkey. ; [Sahin, Deniz Goren] Istanbul Bilim Univ, Sch Med, Dept Hematol, Istanbul, Turkey. ; [Sahin, Deniz Goren; Arat, Mutlu] Sisli Florence Nightingale Hosp, Stem Cell Transplantat Unit, Istanbul, Turkey. ; [Dagdas, Simten; Ozet, Gulsum] Ankara Numune Training & Res Hosp, Dept Hematol, Ankara, Turkey. ; [Kutlu, Nermin; Akyol, Tulay Karaagac] Hacettepe Univ, Sch Med, Therapeut Apheresis Unit, Ankara, Turkey. ; [Ozcebe, Osman Ilhami] Hacettepe Univ, Sch Med, Dept Hematol, Ankara, Turkey. ; [Teke, Hava Uskudar] Eskisehir Osmangazi Univ, Sch Med, Dept Internal Med, Div Hematol, Eskisehir, Turkey. ; [Unal, Demet Kiper; Guner, Naile; Payzin, Bahriye] Izmir Katip Celebi Univ, Ataturk Training & Res Hosp, Dept Hematol, Izmir, Turkey. ; [Tombak, Anil] Mersin Univ, Fac Med, Dept Internal Med, Div Heamatol, Mersin, Turkey. ; [Celik, Halil] Mersin Univ, Fac Med, Dept Internal Med, Mersin, Turkey. ; [Bay, Ilker; Kiki, Ilhami] Ataturk Univ, Sch Med, Dept Internal Med, Div Hematol, Erzurum, Turkey. ; [Ozgur, Gokhan] Gulhane Training & Res Hosp, Hematol & HCT Clin, Ankara, Turkey. ; [Erkurt, Mehmet Ali; Kuku, Irfan] Inonu Univ, Fac Med, Dept Internal Med, Div Hematol, Malatya, Turkey. ; [Ozatli, Duzgun; Meletli, Ozgur] Ondokuz Mayis Univ, Fac Med, Dept Hematol, Samsun, Turkey. ; [Demircioglu, Sinan; Demir, Cengiz] Yuzuncu Yil Univ, Fac Med, Dept Internal Med, Div Hematol, Van, Turkey. ; [Kurtoglu, Erdal] Univ Hlth Sci, Antalya Training & Res Hosp, Dept Hematol, Antalya, Turkey. ; [Vural, Filiz; Tobu, Mahmut] Ege Univ, Fac Med, Dept Internal Med, Div Hematol, Izmir, Turkey. ; [Karakus, Abdullah; Ayyildiz, Orhan] Dicle Univ, Fac Med, Dept Internal Med, Div Hematol, Diyarbakir, Turkey. ; [Dal, Mehmet Sinan; Altuntas, Fevzi] Univ Hlth Sci, Ankara Oncol Training & Res Hosp, Dept Hematol, Ankara, Turkey. ; [Dal, Mehmet Sinan; Altuntas, Fevzi] Univ Hlth Sci, Ankara Oncol Training & Res Hosp, BMT Unit, Ankara, Turkey. ; [Ozturk, Berna Afacan; Albayrak, Murat] Univ Hlth Sci, Diskapi Yildirim Beyazit Training & Res Hosp, Hematol & HCT Clin, Ankara, Turkey. ; [Ocakci, Serkan] Med Pk Izmir Hosp, Dept Hematol, Izmir, Turkey. ; [Bolaman, Zahit; Cagirgan, Seckin] Adnan Menderes Univ, Fac Med, Dept Internal Med, Div Hematol, Aydin, Turkey. ; [Sonmez, Mehmet] Karadeniz Tech Univ, Fac Med, Dept Internal Med, Div Hematol, Trabzon, Turkey. ; [Karakus, Volkan] Mugla Sitki Kocman Univ, Dept Hematol, Training & Res Hosp, Mugla, Turkey. ; [Sevindik, Omur Gokmen] Firat Univ, Fac Med, Dept Internal Med, Div Hematol, Elazig, Turkey. ; [Berber, Ilhami] Malatya Training & Res Hosp, Div Hematol, Malatya, Turkey. ; [Dogu, Mehmet Hilmi] Istanbul Training & Res Hosp, Hematol Clin, Istanbul, Turkey. ; [Gulturk, Emine] Kartal Dr Lutfi Kirdar Training & Res Hosp, Dept Internal Med, Div Hematol, Istanbul, Turkey. ; [Ulas, Turgay] Near East Univ, Dept Internal Med, Div Hematol, Nicosia, Cyprus. ; [Altuntas, Fevzi] Yildirim Beyazit Univ, Fac Med, Dept Internal Med, Div Hematol, Ankara, Turkey.
BASE
Therapeutic plasma exchange (TPE) is used to treat more than 60 diseases worldwide and has drawn growing interest. Little is known about the current situation of TPE activity in Turkey, so we developed a survey to obtain information about this timely topic. We collected data on TPE from 28 apheresis units throughout Turkey. We performed a total of 24,912 TPE procedures with 3203 patients over the past decade. Twenty years ago, the majority of procedures were performed for neurological and hematological disorders, and today, most TPE procedures are done for the same reasons. The only historical change has been an increase in TPE procedures in renal conditions. Currently, renal conditions were more frequently an indication for TPE than rheumatic conditions. Fresh frozen plasma was the most frequently used replacement fluid, followed by 5% albumin, used in 57.9% and 34.6% of procedures, respectively. The most frequently used anticoagulants in TPE were ACD-A and heparin/ACD-A, used with 1671 (52.2%) and 1164 (36.4%) patients, respectively. The frequency of adverse events (AEs) was 12.6%. The most common AEs were hypocalcemia-related symptoms, hypotension, and urticaria. We encountered no severe AEs that led to severe morbidity and mortality. Overall, more than two thirds of the patients showed improvement in the underlying disease. Here, we report on a nationwide survey on TPE activity in Turkey. We conclude that there has been a great increase in apheresis science, and the number of TPE procedures conducted in Turkey has increased steadily over time. Finally, we would like to point out that our past experiences and published international guidelines were the most important tools in gaining expertise regarding TPE. ; C1 [Korkmaz, Serdal] Univ Hlth Sci, Kayseri Training & Res Hosp, Dept Hematol, Kayseri, Turkey. ; [Medeni, Serife Solmaz] Univ Hlth Sci, Bozyaka Training & Res Hosp, Dept Hematol, Izmir, Turkey. ; [Demirkan, Fatih] Dokuz Eylul Univ, Dept Internal Med, Div Hematol, Fac Med,HCT Unit, Izmir, Turkey. ; [Besisik, Sevgi Kalayoglu; Dadin, Senem Altay] Istanbul Univ, Istanbul Fac Med, Dept Internal Med, Div Hematol, Istanbul, Turkey. ; [Cagliyan, Gulsum Akgun; Hacioglu, Sibel Kabukcu; Sari, Ismail] Pamukkale Univ, Dept Internal Med, Div Hematol, Denizli, Turkey. ; [Sahin, Deniz Goren] Istanbul Bilim Univ, Sch Med, Dept Hematol, Istanbul, Turkey. ; [Sahin, Deniz Goren; Arat, Mutlu] Sisli Florence Nightingale Hosp, Stem Cell Transplantat Unit, Istanbul, Turkey. ; [Dagdas, Simten; Ozet, Gulsum] Ankara Numune Training & Res Hosp, Dept Hematol, Ankara, Turkey. ; [Kutlu, Nermin; Akyol, Tulay Karaagac] Hacettepe Univ, Sch Med, Therapeut Apheresis Unit, Ankara, Turkey. ; [Ozcebe, Osman Ilhami] Hacettepe Univ, Sch Med, Dept Hematol, Ankara, Turkey. ; [Teke, Hava Uskudar] Eskisehir Osmangazi Univ, Sch Med, Dept Internal Med, Div Hematol, Eskisehir, Turkey. ; [Unal, Demet Kiper; Guner, Naile; Payzin, Bahriye] Izmir Katip Celebi Univ, Ataturk Training & Res Hosp, Dept Hematol, Izmir, Turkey. ; [Tombak, Anil] Mersin Univ, Fac Med, Dept Internal Med, Div Heamatol, Mersin, Turkey. ; [Celik, Halil] Mersin Univ, Fac Med, Dept Internal Med, Mersin, Turkey. ; [Bay, Ilker; Kiki, Ilhami] Ataturk Univ, Sch Med, Dept Internal Med, Div Hematol, Erzurum, Turkey. ; [Ozgur, Gokhan] Gulhane Training & Res Hosp, Hematol & HCT Clin, Ankara, Turkey. ; [Erkurt, Mehmet Ali; Kuku, Irfan] Inonu Univ, Fac Med, Dept Internal Med, Div Hematol, Malatya, Turkey. ; [Ozatli, Duzgun; Meletli, Ozgur] Ondokuz Mayis Univ, Fac Med, Dept Hematol, Samsun, Turkey. ; [Demircioglu, Sinan; Demir, Cengiz] Yuzuncu Yil Univ, Fac Med, Dept Internal Med, Div Hematol, Van, Turkey. ; [Kurtoglu, Erdal] Univ Hlth Sci, Antalya Training & Res Hosp, Dept Hematol, Antalya, Turkey. ; [Vural, Filiz; Tobu, Mahmut] Ege Univ, Fac Med, Dept Internal Med, Div Hematol, Izmir, Turkey. ; [Karakus, Abdullah; Ayyildiz, Orhan] Dicle Univ, Fac Med, Dept Internal Med, Div Hematol, Diyarbakir, Turkey. ; [Dal, Mehmet Sinan; Altuntas, Fevzi] Univ Hlth Sci, Ankara Oncol Training & Res Hosp, Dept Hematol, Ankara, Turkey. ; [Dal, Mehmet Sinan; Altuntas, Fevzi] Univ Hlth Sci, Ankara Oncol Training & Res Hosp, BMT Unit, Ankara, Turkey. ; [Ozturk, Berna Afacan; Albayrak, Murat] Univ Hlth Sci, Diskapi Yildirim Beyazit Training & Res Hosp, Hematol & HCT Clin, Ankara, Turkey. ; [Ocakci, Serkan] Med Pk Izmir Hosp, Dept Hematol, Izmir, Turkey. ; [Bolaman, Zahit; Cagirgan, Seckin] Adnan Menderes Univ, Fac Med, Dept Internal Med, Div Hematol, Aydin, Turkey. ; [Sonmez, Mehmet] Karadeniz Tech Univ, Fac Med, Dept Internal Med, Div Hematol, Trabzon, Turkey. ; [Karakus, Volkan] Mugla Sitki Kocman Univ, Dept Hematol, Training & Res Hosp, Mugla, Turkey. ; [Sevindik, Omur Gokmen] Firat Univ, Fac Med, Dept Internal Med, Div Hematol, Elazig, Turkey. ; [Berber, Ilhami] Malatya Training & Res Hosp, Div Hematol, Malatya, Turkey. ; [Dogu, Mehmet Hilmi] Istanbul Training & Res Hosp, Hematol Clin, Istanbul, Turkey. ; [Gulturk, Emine] Kartal Dr Lutfi Kirdar Training & Res Hosp, Dept Internal Med, Div Hematol, Istanbul, Turkey. ; [Ulas, Turgay] Near East Univ, Dept Internal Med, Div Hematol, Nicosia, Cyprus. ; [Altuntas, Fevzi] Yildirim Beyazit Univ, Fac Med, Dept Internal Med, Div Hematol, Ankara, Turkey.
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Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
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Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
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