A novel hybrid MCDM approach to evaluate universities based on student perspective.

University rankings are an essential source of comparisons between universities according to specific combinations of criteria. International or national rankings have an increasing impact on higher education institutions, stakeholders, and their environments. Thereby, on behalf of effective decision-making, university-ranking efforts should be a process involving some conflicting criteria and uncertainties in a more sensitive manner. This study presents a detailed university evaluation procedure under certain service criteria via multi-criteria decision-making (MCDM) methodologies and provides an appropriate clustering of universities according to teaching and research factors. A hierarchical cluster-based Interval Valued Neutrosophic Analytic Hierarchy Process (IVN-AHP) integrated VIKOR methodology that includes two stages, clustering and ranking, is proposed for the university evaluation problem. The hierarchical clustering method is performed using teaching and research factors in the first stage. The second stage addresses the determination weights of service criteria through IVN-AHP and the ranking of universities by using VIKOR according to service criteria under determined clusters. This study, in which the proposed methodology is applied to Turkish universities, is the most comprehensive in terms of the number of universities evaluated and participating students. Furthermore, the integration of IVN-AHP and VIKOR to solve MCDM problems is presented for the first time. This study differs from other studies in terms of novelties both methodological-based and application based. Moreover, categorizing universities with similar characteristics into groups using cluster analysis and ranking them with the MCDM methodology provide a more realistic and effective interpretation of the results.

Neuromuscular effects of cisatracurium in morbidly obese patients.

Obesity is associated with significant changes in body composition and function that may alter the pharmacodynamics and pharmacokinetics of various drugs. In this study, we investigated the neuromuscular effects of cisatracurium in morbidly obese as compared to control group of normal body weight patients. In the morbidly obese group (n = 20), corrected weight was used to calculate the drug doses. In the control group (n = 20), the dose was calculated on ideal body weight (IBW). 0.15 mg/kg(-1) cisatracurium was administered as the neuromuscular blocker. Neuromuscular effects were recorded at T0 (onset time), T1 (appearance of first stimulus of TOF), T25 (25% recovery of T1) and T25-75 (time of T25 to T75, recovery time). T0 was determined as 177 +/- 23 s and 168 +/- 19 s in the morbidly obese, and control group, respectively. T25 was determined as 46 +/- 7 min and 56 +/- 8 min, in the morbidly obese and control group, respectively (p < 0.05). T25-75 was determined as 11 +/- 5 min and 14 +/- 6 min in the morbidly obese and control group, respectively (p < 0.05). Intubation conditions were determined as good in 13, excellent in 7 patients in the morbidly obese group, and as good in 4 and excellent in 16 patients in the control group (p < 0.05). As different neuromuscular effects of cisatracurium were detected, we conclude that ne uromuscular agents must be monitored in the morbidly obese patients.

The effects of pneumothorax on the respiratory mechanics during laparoscopic surgery.

Pneumothorax is rare but can be a severe complication of laparoscopic surgery. Diagnosis of pneumothorax in laparoscopy includes the sudden increase in end-tidal carbon dioxide (EtCO(2)) with a decrease in compliance and an abnormal increase in airway pressure. By these case reports, we recommend the simultaneous monitoring of airway pressures, dynamic compliance, and particularly, EtCO(2) for an immediate diagnosis and prompt treatment of pneumothorax.

Effects of sevoflurane, propofol and position changes on respiratory mechanics.

This study was designed to investigate the effects of propofol, sevoflurane and position changes on respiratory mechanics. Forty patients scheduled for thyroid surgery were divided randomly into two groups; those receiving sevoflurane (group S) (n=20), and those receiving TIVA propofol (group P) (n=22). Dynamic compliance (Cdyn), peak inspiratory pressure (PIP), and respiratory resistance (Rr) values were recorded with a VenTrak respiratory monitor (Novometrix Inc. USA) at three time instances. The first measurement was done immediately after the beginning of ventilation and before the inhalation agent was initiated (Induction). Second measurement was done after 5 minutes of thyroid position (Thyroid) (ventilation with 1 MAC sevoflurane concentration or propofol infusion at the rate of 6 mg/kg/h). The third measurement was performed 5 minutes after end of surgery in the supine position (Supine) Blood gases were measured at the three time instances. Respiratory mechanics did not change in the P group (51 +/- 13, 46 +/- 11, 48 +/- 10 mL/cmH2O) at Induction, Thyroid and Supine positions). In the S group, dynamic compliance measurements showed changes statistically significant in the supine position (52 +/- 6 mL/cmH2O)) when compared to Induction (47 +/- 9 mL/cmH2O) and Thyroid position (47 +/- 6 mL/cmH2O) measurements (p<0.05). When the groups were compared with each other, there was no significant difference whatsoever at all periods (p>0.05). His concluded that sevoflurane, propofol and position changes exhibit similar effects on respiratory mechanics and blood gases at described dose and concentration.

Influence of the patient positioning on respiratory mechanics during pneumoperitoneum.

The aim of this study was to evaluate the effect of patient positioning during laparoscopic cholecystectomy on respiratory mechanics and arterial blood gases. Thirty patients of ASA I were included. Ventilation was controlled mechanically. Tidal volume and ventilator frequency were kept unchanged throughout the operation. Intra-abdominal pressure was kept constant at 12 mmHg. Ventrak respiratory system was used for measuring respiratory mechanics. The airway resistance (Raw), the dynamic compliance (Cdyn), and the peak inspiratory pressure (PIP) were monitored. Measurements were made in five intervals: "a" after induction of general anesthesia, "b" after insufflation, "c" in the Trendelenburg position of 40 degree, "d" in the Fowler position of 40 degree, and "e" after desufflation. Samples of arterial blood gases were collected while the respiratory mechanics were being recorded. The mean arterial pressure (MAP) and heart rate (HR) were also monitored. In our study, during intervals "c" and "d", PCO2, was increased and pH decreased. With the initiation of insufflation, Cdyn, PIP, and Rawx, were altered (P < 0.05). The patient positioning had a significant effect on respiratory mechanics. After desufflation only Cdyn changed (P < 0.05). Although HR remained in normal limits, MAP increased during pneumoperitoneum (P < 0.05). We conclude that blood gas changes and respiratory mechanics were affected by the duration of pneumoperitoneum and patient positioning. The Fowler position had the least influence on respiratory mechanics.

The effects of pneumoperitoneum on respiratory mechanics during bariatric surgery.

BACKGROUND: The aim of this study was to investigate the influence of laparoscopic and conventional open surgery on respiratory mechanics, and blood gases, and to determine convenient techniques from the point of view of intraoperative respiratory mechanics, for bariatric surgery. METHOD: 40 morbidly obese patients were divided into 2 groups, patients undergoing laparoscopy Group 1, and patients undergoing conventional open surgery Group 2. Resistance of airway, dynamic compliance, and peak inspiratory pressure were measured. Measurement was performed in 4 periods: a) after anesthesia induction, b) after pneumoperitoneum in the Group 1 and after incision in the Group 2, c) after gastric band placement, d) and 5 min before extubation. Blood gases were recorded concomitantly. RESULTS: There was no significant difference between the 2 groups in values of blood gases and respiratory mechanics. CONCLUSION: In the morbidly obese, laparoscopic and open surgery did not cause a significant difference for respiratory mechanics when compared with each other.