Summary Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov , NCT03471494 . Findings Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding National Institute for Health Research Global Health Research Unit.
In this study, the situation of waste management and zero waste applications in educational institutions was investigated in Turkey. For this purpose, the wastes collected and separated within the scope of zero waste and the wastes collected without separating them in trash cans were determined at certain periods and the total amount of waste generated per unit time and per person was calculated for an engineering faculty, vocational school, high school and primary school. A questionnaire study was conducted to determine the viewpoints of the students studying at the engineering faculty on zero waste management. According to the obtained data, the amount of waste collected in the faculty was calculated as 184 kg day -1 and only 27 kg day -1 of this amount is being recycled. Considering all types of waste in the whole schools, waste generation rates were found to be 17,6, 32,3, 93,7 and 113 g person -1 day -1 respectively for primary school, high school, vocational school, and engineering faculty. One of the important results obtained in the study is that the necessary training and awareness-raising activities in zero waste implementation are very important, and every stage from the reduction of the number of trash cans to the correct placement of zero waste sets requires detailed planning.
The purpose of this study is to analyze the process of school principal selection and appointment in Turkey and some other developed countries in a comparative way. The specific purpose is to make suggestions in order to improve the school principal selection process in Turkey by comparatively analyzing school principal selection process in Turkey and some developed countries. The focus is on the principal selection processes in the USA, Germany, and Finland, and it makes a comparison with the current situation implemented in Turkey. In most of the states in the USA, in order to be a principal, a certificate, a master's degree, and being an actual teacher are required. In the study methodology, official papers and documents have been analyzed in the context of research review in order to study the existing materials that do not require collecting through a data collection tool. These documents include related official reports, graduate thesis, articles, proceedings, National Education Councils conclusions, and legislative texts consisting of official regulations. The findings indicate that there are various selection methods used for this purpose. District Board of Education is in charge at selection procedures. In Germany, there is a variety of selection procedures among the states. The states' Education Ministries and administrators are in charge of selection and appointment of principals and modifications of selection procedures. The state exams and regular official performance assessments by superiors are decisive in the centralized selection process in most federal states. In Finland, a certificate and teaching qualification are required to be a principal. Interviews and tests are used in the selection procedures. Administrators and educational committee members are in charge of the highly decentralized selection process. There are some common and varied features in principal selection process between Turkey and the mentioned countries in the study. In Turkey, school principality is regarded as a secondary role to a teacher and the principal selection processes, procedures, and rules change very frequently in time.
In this study, compressibility, and conventional and ultra-high frequency induction sintering behaviors of 99.8% purity and 50-70 µm size range aluminum powders were investigated. In the compressibility studies, uniaxial-cold pressing method was used. Green samples were produced in the range of 50-275 MPa using different pressures. By measuring the apparent densities of the produced samples, the optimum compressibility pressure was determined as 200 MPa. Pure aluminum powder metal samples produced with this ideal pressing pressure were sintered in both classical and ultra-high frequency induction methods in the range of 500-600 o C. Sintering was performed as 40 min in the traditional method and 5 min in the ultra-high frequency induction sintering method. As a result of the tests carried out in this study, it was determined that pure aluminum samples were successfully sintered with a high frequency induction system in a shorter time than traditional sintering method.
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