Assessing the sustainability index of part-time and full-time hazelnut farms in Giresun and Ordu Province, Turkey.

The study's primary purposes were to assess the sustainability of hazelnut farms and explore the effects of part-time and full-time farming types on sustainability in hazelnut production in the Giresun and Ordu Province of Turkey. One hundred fifty-two hazelnut farms were selected using the stratified sampling method, and data were collected by using face-to-face questionnaires. Several steps were taken, including using factor analysis after standardizing the variables to determine their weights to calculate the composite hazelnut farms' sustainability index. The research findings showed that overall hazelnut sustainability scores of farms varied from 0.28 to 0.59, and the average score was 0.44 at sampled farms. The composite hazelnut sustainability index was at an unsatisfactory level. The social and economic sustainability index values of farms were equal, and they were higher than the environmental index value. The values were 0.50 and 0.30, respectively. The economic sustainability index score of full-time farms was higher than that of part-time farms, and part-time farms had higher environmental sustainability index scores than that of full-time farms. Social sustainability scores were not different in terms of farm type. It was recommended that when designing and regulating support policies, policy-makers should differentiate part-time and full-time farming. Training and extension programs must be planned to increase the level of knowledge of every willing farmer. To increase sustainability, specific policies are developed according to the farming type.

Heartmate II implantation with right coronary bypass grafting in ischemic cardiomyopathy with "fixed" pulmonary hypertension: treatment strategy to protect right ventricular function.

A 49-year-old male patient suffering from end-stage ischemic cardiomyopathy with a left ventricular ejection fraction below 15% was presented to redo coronary artery bypass grafting (CABG). Coronary angiogram demonstrated an occluded left anterior descending artery and occluded right coronary artery, perfused retrogradely from the circumflex artery. Since positron emission tomography did not demonstrate viable left ventricular myocardium except for the basis of the left ventricle, CABG was considered futile. Cardiac transplantation was contra-indicated due to pharmacologically unresponsive pulmonary artery hypertension. The patient successfully underwent left ventricular assist device implantation in combination with right coronary artery revascularization. The article reflects the regimen of right ventricular preservation in this patient.

Evaluating eco-efficiency and optimal levels of fertilizer use based on the social cost and social benefits in tea production.

The extensive use of synthetic fertilizers is increasing continuously to meet the growing demand of food worldwide. This excessive use of fertilizer not only pose a threat to the sustainability but also cause negative externalities in form of hidden social cost to the society The present study estimated social costs and benefits associated with excessive use of chemical fertilizers at tea farms and also evaluated eco-efficiency of tea growers in Rize Province of Turkey. Data envelopment analysis (DEA) was used in this study. Tea growers are 68% eco-efficient in the locality. They can reduce their average fertilizer use from 115.45 to 66.45 kg and labor from 9.88 to 8 days per decare. The overuse of fertilizers at tea farms emits 289.3 kg/hectare of greenhouse gases. Therefore, by applying the eco-efficient fertilizer target level, 1574.48 tons of gas emissions only in Rize Province and 23,997.57 tons in whole Turkey can be reduced. The cost of 1 kg gas emissions was calculated as 0.3316 TL. The optimal level of fertilizers (social costs = social benefits) was also similar to the target level. The fertilizer use efficiency analysis showed that the tea growers cannot only reduce their fertilizer quantity by 49.03 kg/decare without compromising the crop yield, but can also contribute to the healthy environment with a low level of greenhouse gas emissions. Tea growers should replace their older tea orchards with new ones in order to achieve social and eco-efficient levels as well as to maintain viable yield level.

Cardiac surgery and hematologic malignancies: a retrospective single-center analysis of 56 consecutive patients.

OBJECTIVE: Patients with a history of hematologic malignancies (HMs) are considered high-risk candidates for cardiac surgery. Increased perioperative rates of infections, thrombo-embolic complications, and bleeding disorders are reported. However, low patient numbers and lack of control groups limit all published studies. METHODS: A total of 56 patients with a history of HM underwent cardiac surgery. As many as 29 patients suffered from non-Hodgkin lymphoma, five from Hodgkin disease, and 12 from myeloproliferative disorders, one from acute lymphatic leukemia, and nine from monoclonal gammopathy. Surgery consisted of coronary artery bypass grafting, valvular surgery or combination procedures. HM patients were matched to 142 controls. Matching criteria applied consisted of sex, age, main diagnosis, and co-morbidities. RESULTS: In-hospital mortality was elevated in HM patients though not reaching significance (P = 0.7). HM patients demonstrated increased rates of vascular, pulmonary, infectious complications (P > 0.1), and transfusion requirements (P = 0.077). The long-term survival of HM patients was significantly impaired (P = 0.043). A history of irradiation or chemotherapy predisposed to postoperative respiratory insufficiency, acute renal failure, and an impaired long-term survival (P > 0.065). CONCLUSIONS: Cardiac surgery in patients with a history of a malignant hematologic disorder might achieve acceptable results. However, a higher complication and mortality rate have to be anticipated. Patients with hematologic disorders and a history of either irradiation or chemotherapy appear to be at an increased risk to develop postoperative end-organ failure.

Emergency computed tomography for aortic valve vegetation mimicking disruption.

A 47-year-old man presented with symptoms typical of infective endocarditis and history of streptococcal meningitis 8 months previously. Echocardiography showed a large aortic valve vegetation that was interpreted as disruption of the noncoronary cusp. This was ruled out by 64-slice cardiac computed tomography. Valve replacement was performed successfully.

The innominate vein as alternative venous access for complicated implantable cardioverter defibrillator revisions.

BACKGROUND: Venous complications of implantable cardioverter defibrillator (ICD) systems may cause significant problems when the need for system revision or upgrades arises. Such revisions require venous access close to the site of the previous ICD implantation. The internal and external jugular vein have disadvantages due to a long subcutaneous course crossing the clavicle and problems with lead extraction if infection occurs. METHODS: In seven patients with ICD revisions due to lead dysfunction (n = 4) and upgrade to a biventricular device (n = 2) and status after system removal due to infection with new device implantation (n = 1) conventional venous access could not be obtained. Intraoperative contrast venography demonstrated an occluded left subclavian and/or left innominate vein in all patients. In all patients, we gained venous access through puncture of the right innominate vein and tunneled the new lead subcutaneously to the ICD pocket on the left. RESULTS: No intraoperative complications were observed. All patients are followed in our ICD clinic. Mean follow-up is 16 +/- 4 months now. So far, no clinical or lead complications with this access have been observed. CONCLUSIONS: We have demonstrated that ICD lead placement through puncture of the right innominate vein is feasible. We propose the innominate vein as an alternative route for establishing venous access in patients requiring ICD revisions or upgrades who suffer from venous obstruction. ICD implanting physicians should acquaint themselves with the technique of right innominate vein puncture to use this vein as a bail-out strategy in patients with complicated venous access.