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Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
\n\n\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"8778",leadTitle:null,fullTitle:"Self-Assembly of Nanostructures and Patchy Nanoparticles",title:"Self-Assembly of Nanostructures and Patchy Nanoparticles",subtitle:null,reviewType:"peer-reviewed",abstract:"Top-down approaches are currently the main contributor of fabricating microelectronic devices. However, the prohibitive cost of numerous technological steps in these approaches is the main obstacle to further progress. Furthermore, a large number of applications necessitate fabrication of complex and ultra-small devices that cannot be made using these approaches. New approaches based on natural self-assembly of matter need to be developed to allow for fabrication of micro and nanoelectronic devices. Self-assembly of nanostructures is a dynamic field, which explores physics of these structures and new ways to fabricate them. However, the major problem is how to control the properties of the nanostructures resulting from low dimensionality. This book presents recent advances made to address this problem, and fabricate nanostructures using self-assembly.",isbn:"978-1-78984-742-0",printIsbn:"978-1-78923-960-7",pdfIsbn:"978-1-78984-743-7",doi:"10.5772/intechopen.80196",price:100,priceEur:109,priceUsd:129,slug:"self-assembly-of-nanostructures-and-patchy-nanoparticles",numberOfPages:100,isOpenForSubmission:!1,isInWos:1,isInBkci:!1,hash:"8a6a5ad75592f8e3921048e4f300caa5",bookSignature:"Shafigh Mehraeen",publishedDate:"November 4th 2020",coverURL:"https://cdn.intechopen.com/books/images_new/8778.jpg",numberOfDownloads:2826,numberOfWosCitations:2,numberOfCrossrefCitations:2,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:4,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:8,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"June 28th 2019",dateEndSecondStepPublish:"December 30th 2019",dateEndThirdStepPublish:"February 28th 2020",dateEndFourthStepPublish:"May 18th 2020",dateEndFifthStepPublish:"July 17th 2020",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"280108",title:"Associate Prof.",name:"Shafigh",middleName:null,surname:"Mehraeen",slug:"shafigh-mehraeen",fullName:"Shafigh Mehraeen",profilePictureURL:"https://mts.intechopen.com/storage/users/280108/images/system/280108.jfif",biography:"Shafigh Mehraeen is an Assistant Professor at the University of Illinois at Chicago. He received his M.Sc. and Ph.D. in Mechanical Engineering, both from Stanford University under the supervision of Andrew Spakowitz. For his Ph.D., he studied the impact of molecular elasticity on the behavior of semi-flexible polymers and protein self-assembly. As a postdoctoral scholar, he studied the impact of active layer morphology on bimolecular recombination losses in organic photovoltaics, and transition state theory under the supervision of Jean-Luc Bredas at Georgia Institute of Technology, and Jianshu Cao at MIT, respectively. He has published three books, more than 30 scientific papers, and served as a reviewer for major scientific journals. His current research focuses on applying molecular simulations, atomistic modeling, and density functional theory to address directed self-assembly of nanoparticles on templated surfaces, photochemistry of organic solar cells, and polymer and electrocatalyst design using machine learning and artificial intelligence.",institutionString:"University of Illinois at Chicago",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"University of Illinois at Chicago",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"208",title:"Material Science",slug:"nanotechnology-and-nanomaterials-material-science"}],chapters:[{id:"73502",title:"Introductory Chapter: Self-Assembly of Nanostructures",doi:"10.5772/intechopen.94014",slug:"introductory-chapter-self-assembly-of-nanostructures",totalDownloads:394,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Shafigh Mehraeen",downloadPdfUrl:"/chapter/pdf-download/73502",previewPdfUrl:"/chapter/pdf-preview/73502",authors:[{id:"280108",title:"Associate Prof.",name:"Shafigh",surname:"Mehraeen",slug:"shafigh-mehraeen",fullName:"Shafigh Mehraeen"}],corrections:null},{id:"69617",title:"Self-Assembly of Nanoparticles Decorated by Liquid Crystalline Groups: Computer Simulations",doi:"10.5772/intechopen.89682",slug:"self-assembly-of-nanoparticles-decorated-by-liquid-crystalline-groups-computer-simulations",totalDownloads:575,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"We present the results of the computer simulations for the self-assembly of decorated nanoparticles. The models are rather generic and comprise a central core and a shell of ligands containing terminal liquid crystalline group, including the case of the azobenzene chromophores. The simulations are performed using the coarse-grained molecular dynamics with the effective soft-core interparticle interaction potentials obtained from the atomistic simulations. The discussion is centred around the set of the self-assembled morphologies in a melt of 100–200 of such decorated nanoparticles obtained upon the change of the temperature, surface density of ligands, the type of the terminal group attachment, as well as the prediction of the possibility of photo-assisted self-assembly of the nanoparticles decorated by the azobenzene chromophores.",signatures:"Jaroslav Ilnytskyi",downloadPdfUrl:"/chapter/pdf-download/69617",previewPdfUrl:"/chapter/pdf-preview/69617",authors:[{id:"310418",title:"Dr.",name:"Jaroslav",surname:"Ilnytskyi",slug:"jaroslav-ilnytskyi",fullName:"Jaroslav Ilnytskyi"}],corrections:null},{id:"72421",title:"Self-Assembly of GeMn Nanocolumns in GeMn Thin Films",doi:"10.5772/intechopen.92709",slug:"self-assembly-of-gemn-nanocolumns-in-gemn-thin-films",totalDownloads:637,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This chapter presents the results of growing GeMn nanocolumns on Ge(001) substrates by means of molecular beam epitaxy (MBE). The samples have been prepared by co-depositing Ge and Mn at growth temperature of 130°C and Mn at concentration of ~6% to ensure the reproduction of GeMn nanocolumns. Based on the observation of changes in reflection high-energy electron diffraction (RHEED) patterns during nanocolumn growth, surface signals of GeMn nanocolumn formation have been identified. Structural analysis using transmission electron microscopy (TEM) show the self-assembled nanocolumns with core-shell structure extend through the whole thickness of the GeMn layer. Most of nanocolumns are oriented perpendicular to the interface along the growth direction. The nanocolumn size has been determined to be about 5–8 nm in diameter and a maximum height of 80 nm. A phenomenological model has been proposed to explain the driving force for self-assembly and growth mechanisms of GeMn nanocolumns. The in-plane or lateral Mn diffusion/segregation is driven by a low solubility of Mn in Ge while the driving force of Mn vertical segregation is induced by the surfactant effect along the [001] direction.",signatures:"Thi Giang Le",downloadPdfUrl:"/chapter/pdf-download/72421",previewPdfUrl:"/chapter/pdf-preview/72421",authors:[{id:"317675",title:"Ph.D.",name:"Thi Giang",surname:"Le",slug:"thi-giang-le",fullName:"Thi Giang Le"}],corrections:null},{id:"73046",title:"Patchy Nanoparticle Synthesis and Self-Assembly",doi:"10.5772/intechopen.93374",slug:"patchy-nanoparticle-synthesis-and-self-assembly",totalDownloads:625,totalCrossrefCites:1,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Biological building blocks (i.e., proteins) are encoded with the information of target structure into the chemical and morphological patches, guiding their assembly into the levels of functional structures that are crucial for living organisms. Learning from nature, researchers have been attracted to the artificial analogues, “patchy particles,” which have controlled geometries of patches that serve as directional bonding sites. However, unlike the abundant studies of micron-scale patchy particles, which demonstrated complex assembly structures and unique behaviors attributed to the patches, research on patchy nanoparticles (NPs) has remained challenging. In the present chapter, we discuss the recent understandings on patchy NP design and synthesis strategies, and physical principles of their assembly behaviors, which are the main factors to program patchy NP self-assembly into target structures that cannot be achieved by conventional non-patched NPs. We further summarize the self-assembly of patchy NPs under external fields, in simulation, and in kinetically controlled assembly pathways, to show the structural richness patchy NPs bring. The patchy NP assembly is novel by their structures as well as the multicomponent features, and thus exhibits unique optical, chemical, and mechanical properties, potentially aiding applications in catalysts, photonic crystals, and metamaterials as well as fundamental nanoscience.",signatures:"Ahyoung Kim, Lehan Yao, Falon Kalutantirige, Shan Zhou and Qian Chen",downloadPdfUrl:"/chapter/pdf-download/73046",previewPdfUrl:"/chapter/pdf-preview/73046",authors:[{id:"321288",title:"Dr.",name:"Qian",surname:"Chen",slug:"qian-chen",fullName:"Qian Chen"},{id:"324422",title:"Ms.",name:"Ahyoung",surname:"Kim",slug:"ahyoung-kim",fullName:"Ahyoung Kim"},{id:"324423",title:"Mr.",name:"Lehan",surname:"Yao",slug:"lehan-yao",fullName:"Lehan Yao"},{id:"324425",title:"Ms.",name:"Falon",surname:"Kalutantirige",slug:"falon-kalutantirige",fullName:"Falon Kalutantirige"},{id:"324426",title:"Dr.",name:"Shan",surname:"Zhou",slug:"shan-zhou",fullName:"Shan Zhou"}],corrections:null},{id:"72551",title:"Self-Assembled Copper Polypyridyl Supramolecular Metallopolymer Achieving Enhanced Anticancer Efficacy",doi:"10.5772/intechopen.92708",slug:"self-assembled-copper-polypyridyl-supramolecular-metallopolymer-achieving-enhanced-anticancer-effica",totalDownloads:595,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Metallopolymers, a combination of organic polymers and metal center, contain metal atoms in repeating monomers can change its dynamic and thermodynamic properties through the directionality of coordination bonds and chemical tailoring of ligands. In the past decade, self-assembled functional supramolecular metallopolymers have aroused a surge of research interest, and have demonstrated application potential in cancer therapy. In this chapter, we have summarized the progress in the rational design of biological application of different metallopolymers. Especially, a copper polypyridyl complex was found be able to self-assemble into a supramolecular metallopolymer driven by the intermolecular interactions, which could enhance the uptake in cancer cells through endocytosis, thus effectively inhibit tumor growth in vivo without damage to the major organs. This study may provide a good example to use self-assembled metallopolymer to achieve enhanced anticancer efficacy.",signatures:"Zushuang Xiong, Lanhai Lai and Tianfeng Chen",downloadPdfUrl:"/chapter/pdf-download/72551",previewPdfUrl:"/chapter/pdf-preview/72551",authors:[{id:"317382",title:"Dr.",name:"Tianfeng",surname:"Chen",slug:"tianfeng-chen",fullName:"Tianfeng Chen"},{id:"317383",title:"MSc.",name:"Zusuang",surname:"Xiong",slug:"zusuang-xiong",fullName:"Zusuang Xiong"},{id:"321953",title:"Dr.",name:"Lanhai",surname:"Lai",slug:"lanhai-lai",fullName:"Lanhai Lai"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"6408",title:"Novel Nanomaterials",subtitle:"Synthesis and Applications",isOpenForSubmission:!1,hash:"f3585d338d78e4d31c200d9991b03692",slug:"novel-nanomaterials-synthesis-and-applications",bookSignature:"George Z. Kyzas and Athanasios C. 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\r\n\tMedical devices and pharmaceutical agents must undergo rigorous testing to determine their biocompatibility when they have contact with the body, regardless of their mechanical, physical, and chemical properties. All new drugs and medical devices must undergo biocompatibility tests of cytotoxicity, sensitization, intradermal irritation, acute systemic toxicity, and a series of tests before entering a clinical environment to ensure safe and effective use for humans.
\r\n\tCell viability is defined as the number of healthy cells in a sample and proliferation of cells is a vital indicator for understanding the mechanisms inaction of certain genes, proteins, and pathways involved in cell survival or death after exposure to toxic agents. The methods used to determine viability are also common for the detection of cell proliferation. A cell viability assay is performed based on the ratio of live and dead cells. This assay is based on an analysis of cell viability in cell culture for evaluating in vitro drug effects in cell-mediated cytotoxicity assays for monitoring cell proliferation. Various methods are involved in performing a cell viability assay, including the dilution method, surface viable count, roll tube technique, nalidixic acid method, fluorogenic dye assay, and the Trypan Blue Cell Viability Assay. The cell viability assays can determine the effect of drug candidates on cells and be used to optimize the cell culture conditions. The parameters that define cell viability can be as diverse as the redox potential of the cell population, the integrity of cell membranes, or the activity of cellular enzymes.
\r\n\tCytotoxicity is the degree to which a substance can cause damage to a cell. Cytotoxicity assays measure the ability of cytotoxic compounds to cause cell damage or cell death. Cytotoxicity assays are widely used in fundamental research and drug discovery to screen libraries for toxic compounds. The cell cytotoxicity and proliferation assays are mainly used for drug screening to detect whether the test molecules have effects on cell proliferation or display direct cytotoxic effects. In a cell-based assay, it is important to know how many viable cells are remaining at the end of the experiment. There are a variety of assay methods based on various cell functions such as enzyme activity, cell membrane permeability, cell adherence, ATP production, co-enzyme production, and nucleotide uptake activity. These methods could be classified in to different categories: (I) dye exclusion methods such as trypan blue dye exclusion assay, (II) methods based on metabolic activity, (III) ATP assay, (IV) sulforhodamine B assay, (V) protease viability marker assay, (VI) clonogenic cell survival assay, (VII) DNA synthesis cell proliferation assays and (V) Raman micro-spectroscopy.
\r\n\tMedical devices have been widely used in various clinical disciplines and these devices have direct contact with the tissues and cells of the body, they should have good physical and chemical properties as well as good biocompatibility. Biocompatibility testing assesses the compatibility of medical devices with a biological system. It studies the interaction between the device and the various types of living tissues and cells exposed to the device when it comes into contact with patients.
\r\n\t
\r\n\tThe book will cover original studies, reviews, all aspects of Cell Viability and Cytotoxicity assays, methods, Biocompatibility of studies of biomedical devices, and related topics.
For developing countries to reach the level of developed countries and to catch the level to compete with them, more than one condition must be met. The most important of these conditions is the industrialization strategies that developing countries will implement. With the decisions of January 24, 1980, which were a turning point in terms of redesigning the Turkish economy, the export-based industrialization strategy was started to be implemented by targeting export-based growth instead of the import substitution strategy implemented since the 1960s, and some institutions were created to eliminate the problems that will be encountered at the implementation stage of these decisions ([1], p. 22).
To increase the competitiveness of exporters in foreign markets, Turkish Exim bank provides export financing in Turkey with credit, guarantee and insurance programs under international rules and principles ([2], p. 180).
In developing countries, Exim bank loans are provided by organizations that support the Central Bank of the Republic of Turkey (CBRT) and non-profit exports. Commercial banks, private equity export credit insurance companies and factoring companies are the only organizations that support finance, as the main purpose is profit.
In developed countries, the necessary financing for exports is usually provided by the commercial banking system. Export financing organizations, on the other hand, support the export sector and banks with insurance and guarantee programs, only performs the function of providing a risk-free environment.
Imports are the value of foreign goods and services bought by a country’s households, firms, government agencies, and other organizations in a given period.
Exports are goods and services that are produced in one country and sold to buyers in another. Exports, along with imports, make up international trade.
Eximbank loans are lines of credit made available by Export Credit Bank of Turkey (Exim bank) to enhance exports. This credit is made available during the pre-export stage against a written pledge by the exporter to export Turkish-origin goods and services as stipulated by Exim bank. It provides a price advantage over other export loans offered by banks.
In the Literature view, a summary of information was given about research that examines the relationship between exports, financial development and economic growth in Turkey in the context of causality.
Dodaro [3], examined the relationship between economic growth and exports with the Granger Causality test by using variables between 1967 and 1986 periods. The study found a one-sided causal relationship from economic growth to exports.
Bahmani and Domac [4] examined the relationship between economic growth and exports, with the Co-Integration test by using variables between 1923 and 1990 periods. As a result of the research, it is found that there is a decidedly causal relationship between economic growth and exports.
Tuncer [5], examined the causal relationship between exports, imports, investments and Gross domestic product (GDP) with the method Toda and Yamamoto by using variables between 1980Q1 and 2000Q3 periods. As a result of the study, a one-sided causality relationship has been found from economic growth to exports.
Şimşek [6], tested the export-based growth hypothesis with Error Correction Model, Co-Integration Test and Causality tests by using variables between 1960 and 2002 periods. As a result of the study, the one-sided causality relationship has been found from economic growth to exports.
Erdogan [7], examined the relationship between economic growth and exports, with Co-Integration and Causality tests by using variables between 1923 and 2004 periods. As a result of the study, the long-term double-sided causal relationship between economic growth and exports was found at the level of 10% significance.
Taştan [8], examined the interaction and causal relationships between export, industrial production and import variables, with Co-Integration and Causality tests by using variables between 1985Q1 and 2009Q3 periods. As a result of the study, a one-sided causality relationship has been found from economic growth to exports.
Tıraşoglu [9], examined whether the export-based growth hypothesis is valid in Turkey or not, with Co-Integration and Causality tests by using variables between 1998Q1–2011Q3 periods. As a result of the study, there is a long-term one-sided causal relationship between exports and economic growth.
Korkmaz [10], examined the relationship between economic growth and exports, with Co-Integration and Causality tests by using variables between 1998: Q1–2013:Q3 periods. As a result of the study, a one-sided causality relationship has been found from exports to economic growth.
Pentecost and Kar [11], examined the relationship between economic growth and exports, with Co-Integration and Causality tests by using variables between 1963 and 1995 periods. As a result of the research, there is a one-sided causal relationship from economic growth to financial development.
Al-Yousif [12], studied the causal relationship between financial development and economic growth for 30 developing countries, with both Time Series and Panel Data Analysis tests, by using variables between 1970 and 1999 periods. As a result of the study, there is a double-sided relationship between economic growth and financial development.
Ceylan and Durkaya [13], examined the causal relationship between domestic credit volume and economic growth, by taking advantage of Gross domestic product (GDP) and total loans that private banks use domestically by using variables between 1998 and 2008 periods. As a result of the research, there is a one-sided causality relationship from economic growth to loans.
In this study, the data set used were between 2003 and 2019 periods. The source of the data used in the study was taken from the Central Bank of the Republic of Turkey (TCMB) and the official website of the bank Exim bank. This data was created with three different variables which are listed in Table 1. All analyses and tests were performed on these variables by using the EViews11 program.
Variable | Code |
---|---|
Import | Central Bank of the Republic of Turkey, Balance Of Payments Analytical Presentation (6.manual), A.2 |
Export | Central Bank of the Republic of Turkey, Balance Of Payments Analytical Presentation (6.manual), A.1 |
Exim bank loans | https://www.eximbank.gov.tr |
Data set.
To obtain econometrically significant relationships between series in time series analysis, it is essential that the analyzed series must be stationary. Unit root tests are usually used to test whether the series has a stationary structure or not. The most commonly used of these tests is the unit root test performed by Dickey-Fuller [14], which assumes that the error term is independent and uniformly distributed. If a time series is stationary, its variance, average, and covariance (with various delays) are the same, no matter when it is measured ([15], p. 757).
Let
The relationship between this period value of Series
If ρ = 1 or γ = 0 is found in this equation, there is a unit root problem. If ρ = 1, the relationship will be as in Eq. (8):
This means that the impact of the shock that the series was subjected in the previous period remains in the system as it was. If ρ < 1, it means that the initial effect of shocks in the past continues and that this effect will disappear over time.
The main regression patterns used in the Dickey-Fuller test are:
Eq. (9), shows a structure with no fixed term and no trend effect. Eq. (10) shows a structure with a fixed term and no trend term, and Eq. (11) shows a structure with a fixed term and no trend effect.
In case of correlation between error terms, the extended Dickey-Fuller (ADF) unit root test was developed again by Augmented Dickey-Fuller [16] by including the delayed values of the dependent variable in the model. The proposed models for this test are shown in the following equations:
Eq. (12) shows the structure in which there is no fixed term and no trend effect. Eq. (13) shows the structure in which there is only a fixed term, and Eq. (14) shows the structure in which both the fixed term and the trend effect are observed.
The stationary test is first performed at the level value. If stationary is not achieved in the level value, the first difference of the
In Eqs. (4) and (7), the
If the ADF test statistic value is more negative than the MacKinnon [17] critical values at various significance levels, it is decided that there is a unit root in the series; in other words, the series are not stationary. In this study, the stability of the series was analyzed using the extended Dickey-Fuller (ADF) unit Root Test.
As we can see in Table 2, Import variables were found stationary in the intercept model in the first difference I(1), Export variables were found stationary in non-intercept and trendless model in the first difference I(1); while Eximbank loans variables were found stationary in intercept model in the second difference I(2).
Variables | Test for unit root in | Include in test equation | Lag Length | ADF |
---|---|---|---|---|
Import | I(1) | Intercept | p = 0 | −4.061237 |
Export | I(1) | None | p = 0 | −3.196258 |
Eximbank loans | I(2) | Intercept | p = 1 | −4.417361 |
ADF unit root test.
To test whether non-stationary series converge to equilibrium over a long period, the cointegration test examines whether there is a long-term relationship between the series or not. But since this test does not provide information about the direction of the relationship, causality tests are used to determine the direction of the relationship. There are two Tests in Johansen’s cointegration analysis. These are trace and max.
Trace hypothesis test H0: r ≤ r0, H1: r ≥ r0 + 1.
Max hypothesis test H0: r = r0, H1: r = r0 + 1.
If r = 0 there is not cointegration vector.
The series were analyzed using the Johansen cointegration test and the results were shown in Table 3. In Table 3, the r = 0 hypothesis, shows that there is no cointegration relationship between the variables; the r ≥ 1 hypothesis, is an alternative hypothesis which shows that there is at least one cointegration relationship; the r ≥ 2 hypothesis is an alternative hypothesis that shows that there are at least two cointegration relations:
Hypothesis | Trace statistic | Max-Eigen statistic | |||
---|---|---|---|---|---|
H0 | H1 | Statistic | Critical value | Statistic | Critical value |
r = 0 | r ≥ 0 | 76.02502 | 29.79707 | 66.68893 | 21.13162 |
r = 1 | r ≥ 2 | 9.336092 | 15.49471 | 8.804522 | 14.26460 |
Johansen cointegration test results.
According to the Johansen test output, both the Trace test statistic value and the Maximum Eigen test statistic value were greater than the table critical value of 5%. Therefore, the zero hypothesis of r = 0 can be rejected for both test values. In other words, Export, Gross domestic product (GDP), and Loan variables are cointegrated.
The Granger causality test examines the relationship between series based on estimating past and present values. According to Granger, if past information about
Accurate determination of the number of lag lengths in the Granger causality test is very important for the application to give healthy results, because this test is sensitive to the number of lag lengths. To find the appropriate lag length numbers for the Granger causality test, the Vector autoregression (VAR) model is estimated. Here a generic VAR model is estimated primarily to determine the appropriate number of lag length. Then, the number of lag length, will be determined by Akaike information criteria and by the LM test.
For the VAR model, the appropriate lag length was obtained by LogL (Log-We), LR (sequential modified LR test statistic), FPE (Final prediction error), AIC (Akaike information criterion), SC (Schwarz information criterion) and HQ (Hannan-Quinn information criterion) criteria. The model with the largest LogL and LR values and the smallest FPE, AIC, SC and HQ values were selected to determine the appropriate lag length criteria.
As seen from Table 4, Sequentially modified LR test statistic (LR); Final prediction error (FPE), Akaike information criterion (AIC),Schwarz information criterion (SC) and Hannan-Quinn information criterion (HQ) appropriate lag length as 1. According to this information, the lag length will be 1.
Lag | LogL | LR | FPE | AİC | SC | HQ |
---|---|---|---|---|---|---|
0 | −853.9328 | 0 | 6.65e+42 | 107.1166 | 107.2615 | 107.1240 |
1 | −820.4059 | 50.29035* | 3.20e+41* | 104.0507* | 104.6302* | 104.0804* |
2 | −816.0730 | 4.874522 | 6.71e+41 | 104.6341 | 105.6481 | 104.6861 |
Determination of appropriate lag length.
Values shows that the appropriate number of lag lengths according to the relevant criterion.
In Figure 1 it is presented the Var(1) model which provides the stationary condition:
Stationarity analysis.
Since the auto-regressive characteristic roots are all in the unit circle,the model VAR(1) which is used in the study, provided the stationary condition. Subsequently, appropriate delay numbers for the Granger causality test were performed by autocorrelation LM tests, it was determined that there was no autocorrelation and the series was stationary.
The series were analyzed using the Granger causality test, as we can see from Table 5; there is no causal relationship between Eximbank to Export variables (ρ = 0.2485 > 0.05), Import to Export variables (ρ =0.1140 > 0.05), Export and Eximbank variables(ρ = 0.3826 > 0.05), Import to Eximbank variables(ρ = 0.0839 > 0.05), Eximbank to Import(ρ =0.98035 > 0.05), Export to Import(ρ =0.8944 > 05).
H0 Hypothesis | Chi-sq. | Probability | Result |
---|---|---|---|
Eximbank→Export | 1.331500 | 0.2485 | Rejected |
Import→Export | 2.497195 | 0.1140 | Rejected |
Export→Exim bank | 0.762369 | 0.3826 | Rejected |
Import→Eximbank | 2.986957 | 0.0839 | Rejected |
Eximbank→Import | 0.000609 | 0.9803 | Rejected |
Export→Import | 0.017613 | 0.8944 | Rejected |
Granger causality test results.
According to the results which are shown in Table 5, it was determined that there is no causal relationship between Eximbank loans, Import and Export variables at 1 and 5% significance levels.
To decipher the causal relationship between import, export and Eximbank loan variables in the Turkish economy, three different variables were used in the study. All variables used in the study are time series, because they depend on time, so the stationarity of the variables was tested by the ADF test. As a result of the test, stationarity was achieved by taking first-order differences in import and export variables and second-order differences in eximbank loans variables. To test whether non-stationary series converge to equilibrium over a long period or not, the series were analyzed by using the Johansen cointegration test and the results revealed that Export, GDP, and Loan variables were cointegrated. Then the series were analyzed using the Granger causality test, and according to the results, it was determined that there was no causal relationship between Eximbank loans, Import and Export variables at 1 and 5% significance levels.
When we look at the literature review, a summary of information was given about research that examines the relationship between exports, financial development and economic growth in Turkey in the context of causality. From the study of Ceylan and Durkaya [13], there was found one-sided causality relationship from economic growth to loans. From the study of Dodaro [3], Bahmani and Domac [4], Tuncer [5], Şimşek [6] and Taştan [8] it was found a causal relationship from economic growth to exports. Erdogan [7] found causality relationship between economic growth and exports at the level of 10% significance. Tıraşoğlu [9] and Korkmaz [10], found a causal relationship between export and economic growth. Pentecost, Kar [11] and Al-Yousif [12] found causal relationships from economic growth to financial development. But in this study, it was determined that there were no causal relationship between Eximbank loans, Import and Export variables at 1 and 5% significance levels.
Turkey’s export target in 2023, is to set at 500 billion USD. Looking at the export figures at the end of 2015, Turkey must increase exports by an average of 16.5% each year to reach the 2023 target. To achieve this increase, it is necessary to ensure the high growth of the economy, accelerate R&D investments, diversify exports, reach new markets, and provide the necessary regulations and facilities for exporting companies to compete with exporters in other countries.
Eximbank loans provide a price advantage over other export loans offered by banks. It has a strong financial structure. Because of this financial structure, it supports exports at a high rate. To achieve the export potential that the country has, also in international markets, it should implement new and effective credit/insurance programs under international treaties and the restrictions of the institutions to which it is affiliated.
Cesarean is a commonly performed obstetric surgery and in the recent times its number is constantly increasing. Standard technique for abdominal wall closure should be practiced considering the need to provide good support, prevent infections, sinus formation, and incision pain and scar dehiscence. There are multiple sutures and suturing techniques practiced worldwide for the closure of abdominal layers following cesarean section.
The history of sutures begins more than 2,000 years ago. Surgical and suture techniques evolved in the late 1800s with the development of sterilization procedures. It has been said that the scar is the “autograph of a surgeon”. Every surgeon wants cosmetically acceptable scars along with optimal healing.
An ideal suture material should be cheap, sterile, non-electrolytic, non-allergenic, with adequate tensile strength, good handling characteristics, should not induce tissue reaction or cut through tissue.
A good suturing technique should ideally eliminate the dead space and minimize tension that causes wound separation. It involves correct wound placement with respect to relaxed tension lines. Consideration should focus on factors, such as systemic diseases and selection of ideal suture material that influence the outcome. The surgical technique used to close a given wound depends on the force and direction of tensions on the wound, the thickness of the tissues to be opposed and anatomic considerations.
The physiology of wound healing has 3 phases: inflammation, proliferation, and remodeling. Various factors like cytokines, cellular mediators are involved in the healing process.
Phase I: Inflammation (Onset of injury to day 4–6): The first phase of wound healing is characterized by hypoxic, ischemic environment with macrophages, neutrophils and platelet. Collagen, platelet, thrombin, fibronectin and fibrin with complements form a blood clot which has 3 major functions
Expresses cellular mediators
Serves as reservoir to amplify cellular signaling
Provides support and communication matrix for arriving inflammatory cells
Phase II: Proliferation (Days 4–14): It is marked by rapid construction of new tissue. Macrophages emit nitrous oxide thus dilating the vessels to accommodate influx of new cells. Granulation begins to form at this phase. Fibroblast which are recruited from the surrounding normal tissue starts synthesizing and depositing collagen.
Phase III: Maturation and remodeling (1 week- 1 year): The final stage of wound healing is characterized by evolution of matrix into ordered collagen complex. At one week, the wound has about 3 percent of its final strength, 30 percent of final strength at 3 weeks and ultimately achieves 80 percent of its final strength at 3 months and beyond. However wound will never regain the strength of an uninjured tissue.
A scarred uterus carries long term consequences. Thus, the technique and the suture material used are crucial for the uterine scar healing. But strong evidence regarding optimal techniques is scarce [1]. There are multiple techniques and suture materials used for closure of uterus during cesarean section.
Usually intraperitoneal repair of the uterus is undertaken. RCOG [2] and Cochrane review [3] on exteriorization of the uterus for repair of the uterine incision does not recommend routine exteriorization of the uterus as it is associated with more pain and does not improve operative outcomes such as hemorrhage and infection. However, a RCT conducted by Isabela Cristina et al., showed that number of sutures required is lower and the surgical time is shorter with extra-abdominal repair, although moderate and severe pain at 6 hours is less frequent with in situ uterine repair [4]. A meta-analysis in 2015 also showed that uterine repair by exteriorization may reduce blood loss and the associated decrease in hemoglobin, but did not find any difference between the two techniques with respect to intraoperative nausea, vomiting, or pain [5].
Uterine closure can be done either in a single layer or by double layer and both interlocking and unlocked suturing techniques have been used. Methods concerning closure of the uterine incision need to be considered with regards to benefit and potential harm in order to offer the best available surgical care to women undergoing cesarean section.
Blumenfeld in a study with 127 women opines that single layer closure is associated with 7 fold increase in the risk of developing bladder adhesions compared to double layer closure but there was no difference in the outcome of other pelvic or abdominal adhesions thus favoring double layer closure [6].
Glavind in a similar study, using 2D TVS (Transvaginal sonography), assessed for the residual myometrial thickness, scar defect, depth, width and length in 68 women with single layer and 81 women with double layer closure. Study concluded that double layer closure improves the quality of the scar with significantly higher myometrial thickness and shorter scar defect. He also favors double layer closure for better long term outcomes [7].
A Cochrane review based on 19 studies on single versus double layer closure of the uterus, found that there was no statistically significant differences for the primary outcome, febrile morbidity, although the meta-analysis suggested single layer closure was associated with a reduction in mean blood loss [8]. RCOG recommends that, except within research content, the uterine incision should be sutured within two layers [2]. A meta-analysis of 9 RCTs including 3969 women, showed that single layer closure and double layer closure are associated with similar incidence of cesarean scar defects, uterine dehiscence, uterine rupture in subsequent pregnancies [9].
Single layer closure and double layer closure carry the same risk of uterine rupture in subsequent pregnancy. However a LOCKED single layer closure is associated with an increase of uterine rupture compared to double layer closure. They demonstrated that the double-layer uterine closure with a first unlocked layer that excludes the decidua, compared with locked single-layer closure that includes the decidua, is associated with a greater residual myometrial thickness (RMT) and healing ratio, which suggests that this technique is associated with better healing of the uterine scar (Figure 1) [10].
Locked versus unlocked suturing techniques.
However Jun Woo Han in his study on impact of uterine closure on residual myometrial thickness after cesarean section disagrees with the Roberge study. He believes the main causative factor of the RMT is the coaptation ratio of incised myometrium (BX/A0B; Figure 2A). When a single layer with a locking suture is used to penetrate the full thickness of myometrium and the decidua, the 2 points of A0 and A0’ barely join each other, even after the absorption of suture materials (Figure 2B–D), because the uterus that delivered the baby is a dynamically contracting, globular, and muscular organ. Moreover, the presence and length of the uncoaptated portion (X-A0) are the predominant factors that influence the different degree of RMT. Therefore, the surgeon should aim to minimize the length of the line “D0-D1” and not exclude the decidua itself. This would minimize the potential adverse effect that is associated with the inversion of the decidua (such as adenomyosis) or influence RMT and prevent the postoperative endometrial defect of exposure of the myometrium to the endometrial cavity [11].
Cut plane of uterine incision site when closing with single layer locking suture that penetrates the full thickness of myometrium and includes the decidua.
Including full thickness of the uterine wall may bring decidua into the scar. Decidual inclusion results in defective uterine healing in 78% of cases. When deciduas was excluded from the suture, all cases resulted in perfect healing [12].
Isthmocele is a uterine scar defect as a result of poor healing of uterine incision. It results in menstrual spotting, dysmenorrhea, dyspareunia, chronic pelvic pain, with an increased risk of scar pregnancy, placentation abnormalities and development of uterine rupture in future pregnancies. Uterine closure technique is considered to be the most important factor associated with isthmocele formation. A study to demonstrate the factors associated with isthmocele concluded that uterine closure using the FFNN (Far far near near technique) continuous unlocked double layer technique is beneficial in terms of providing protection from isthmocele formation and ensuring sufficient RMT [13].
The uterine incision is closed using an absorbable suture of number 0 or number 1. The commonly used suture materials are chromic catgut and polyglactin. Chromic catgut, being a natural suture material, has comparatively marked tissue reactivity, inconsistent tensile strength retention and reabsorption.
Plain catgut is a natural suture material derived from the submucosa of sheep intestine or the serosa of cattle intestine. Chromic catgut is a modification of plain catgut that is tanned with chromic salts to improve strength and delay dissolution. Catgut is absorbed by phagocytosis, and is associated with a marked tissue inflammation that can be detrimental to healing. Conversely, tissue inflammation may lead to a more rapid breakdown of catgut. Plain gut has a median survival time of 4 days in the oral cavity, whereas chromic gut retains its strength for 2 to 3 weeks. In moist environments such as the oral cavity, the strength of gut is reduced by 20–30%.Gut is a stiff material that must be moistened in alcohol, and forms knots that can be irritating to the oral tissues. Infection rates may increase with the use of gut. The advent of synthetic materials preferable to gut, with less tissue reactivity and more predictable resorption, has almost made catgut obsolete [14].
Polyglactin 910 is a absorbable, braided, multifilament, coated synthetic suture. It is a heteropolymer consisting of 90% of glycolideand 10% of lactide and is degraded by hydrolysis. It is available with an antibiotic impregnation with triclosan. The residual tensile strength of a polyglactin 910 suture is consistently greater than that of polyglycolic acid suture and is absorbed more rapidly. Absorption starts at 40 days, and completes by day 70 with no remains by day 90. It retains 75% of its tensile strength at 2 weeks and 50% at 3 weeks. It elicits less tissue reactions and promote faster wound healing with good strength [15].
But, chromic gut has an excellent historical record in obstetrics and the knotted tensile strength of 0 chromic gut is adequate to withstand the disruptive forces on the repaired hysterotomy [16].
PGA is a synthetic, braided polymer. When compared with chromic catgut, PGA is less reactive and is experimentally better able to resist infection from contaminating bacteria. PGA has excellent knot security and maintains at least 50% of its tensile strength for 25 days. The main drawback of PGA is that it has a high friction coefficient and “binds and snags” when wet. It is for the same reason that some experience is required to pass this material properly through tissues and to “seat” the throws during knotting. There is a modified PGA (dexon plus) which is coated with poloxamer 188, an agent that significantly reduces the friction and drag through the tissues. Although handling has become easier with this modification, more throws (four to six) are required to prevent knot slippage than for plain PGA (three to four). The main uses of PGA are for closures of superficial fascia (subcutaneous tissue) in wounds and ligature of small blood vessels for effective hemostasis [17].
A study to assess different suturing techniques and different materials (catgut plain, Dexon and Vicryl) on healing of uterine incision in Cesarean section (CS) concluded that the best uterine scar was seen after using one layer interrupted Vicryl and Dexon suture and the worst healing results were obtained after two-row interrupted and continuous sutures using catgut [18]. As compared to catgut, use of synthetic sutures were associated with thicker myometrium in subsequent delivery. Increased inflammation in natural absorbable suture may lead to increase in fibrosis and impaired healing rendering difficulty in subsequent pregnancies and delivery [19].
The CORONIS trial on the cesarean section surgical techniques compared the chromic catgut and polyglactin-910 for uterine closure. There were no statistically significant differences noted in the primary outcome, which was the composite of death, maternal infectious morbidity, further operative procedures, or blood transfusion (>1 unit) up to the 6 weeks follow up visit [20]. A 3 year follow up study was done to the CORONIS trial and there was no evidence of a difference in the main comparisons for adverse pregnancy outcomes in subsequent pregnancy, such as uterine rupture [21].
Thus, it can be concluded that both chromic catgut and polyglactin-910 of number 0 or 1 can be safely used for the uterine repair during cesarean section, though polyglactin has been used more often in the recent times.
The B-Lynch surgical technique is used for the management of massive postpartum hemorrhage (PPH) secondary to uterine atony with failed conservative management. Long term study demonstrated, the B-Lynch surgical technique is safe, effective and free of short- and long-term complication [22].
A large Mayo needle with absorbable suture is used to enter the uterine cavity from below the uterine incision and exit just above the incision. The suture is looped over the fundus, then enters and exits the uterine cavity posteriorly, forms a second loop over the fundus and finally enters just above and exits just below the uterine incision The suture should be pulled very tight at this point and tied anteriorly (Figure 3).
B lynch suture.
It is performed to control bleeding in atonic postpartum hemorrhage post vaginal delivery and rarely after uterine incision closure in cesarean delivery. Two loops are formed over the fundus and tied after applying compression (Figure 4).
Hayman suture.
A needle transfixes the uterus from anterior to posterior(point 1) and then from posterior to anterior (point 2), the same is done again at points 3 and 4 to approximate the uterine walls in a square manner. Usually 4 to 5 sutures are required Figure 5a and b.
Cho square suture.
Several studies are conducted to assess the ideal suture and size for uterine compression sutures but they have concluded no variations in outcome with type of suture used but it was observed that uterine preservation rate was significantly higher in cases with size 2 suture than in those with size 1 suture [23].
Placement of compression sutures that transverse the uterine cavity postpartum for PPH may be associated with a significant risk of uterine synechiae. Risk of synechiae following uterine compression sutures in the management of major postpartum hemorrhage [24].
The closure of peritoneum and the approximation the rectus muscle at cesarean section has always been debatable. The promoters of practicing peritoneal closure argue that this leads to less adhesion formation and comparative ease during a repeat cesarean section, but it also has an added disadvantage of prolonging the operative time and increased need for maternal analgesia. As far as peritoneal closure is concerned, visceral peritoneum is generally not closed as bladder adhesion is increased [25]. A review of 21 trials comparing closure versus non closure of the peritoneum showed that there was a reduction in operative time and the evidence on adhesion formation was limited and inconsistent [26]. RCOG too recommends that neither the visceral nor the parietal peritoneum should be sutured at cesarean section because this reduces operating time and the need for postoperative analgesia and improves maternal satisfaction [2]. Rectus muscle reapproximation increases immediate postoperative pain without difference in operative time, surgical complications, or maternal satisfaction but, closure of the rectus muscles at cesarean delivery was found to reduce adhesions.
If peritoneal closure and rectus muscle approximation is done in cases with diastasis recti abdominis, use absorbable sutures such as chromic catgut and polyglactin-910. A new modified undermined suture technique for rectus muscle, which gives increased post-operative satisfaction, has been tried, using Z suture method with absorbable 1/0 suture material [27].
Different techniques and suture materials are used in cesarean section for closure of the rectus sheath. Few general principles are to be followed while closing the abdominal wall to achieve good healing and reduce complications. All sutures used to close the musculofascial wall must be tied with enough tension to approximate the edges of the incision. If greater tension is applied, the tissue will become ischemic and necrosis will develop. The sutures should be placed at least 1 to 1.5 cm from the wound edge. In patients at increased risk of wound disruption, sutures should be placed 2 cm from the edge [28].
The commonly used technique is to put continuous sutures without any locking. Continuous suture when used in one layer avoids high tension on suture and does not compress the wound edges. This prevents devascularization of the sheath and formation of a good quality collagen, i.e., type I [29]. Running sutures have the advantage of speed, since knots need only be tied at two or three points. Interrupted and figure-of-eight sutures can be used for reinforcing in thin rectus sheath and has an advantage, of not coming apart if insecurely tied.
Rectus sheath closure is routinely performed with non-absorbable or delayed absorbable sutures. It is generally accepted that non-absorbable sutures cause less tissue reaction and are more resistant to infection than the absorbable sutures. However, these sutures are associated with higher incidence of buttonhole hernias and sinus formation leading to increased wound pain. Care should be taken while tying the knots to avoid slippage. The commonly used suture materials for rectus sheath closure are polyglactin-910 number 1 and polypropylene number 1. Cochrane review found no studies examining different suture techniques or material for rectus sheath closure.
Suturing of the subcutaneous tissue has always been debated. Level one evidence says that suture closure of the subcutaneous fat at the time of CS reduces the risk of wound disruption in women with a subcutaneous tissue larger than two centimeters. Doing so will not only reduce collection in this space but also decrease wound tension. Though studies do show that it does not affect long-term cosmetic outcome [30].
A basic need of skin closure is good approximation. Apart from cosmetically good scars it is also necessary that the skin closure technique should be technically easy, acceptable, speedy and economical. Good tissue union and cosmetically acceptable scars are vital for ideal surgical practice.
Technique of skin closure in a cesarean section can be continuous subcuticular stitch, interrupted mattress stitch, staples or adhesive compounds.
With a plethora of skin closure materials currently available, choosing a solution that combines excellent and rapid cosmetic results with practicality and cost-effectiveness can be difficult, if not tricky. Suture materials currently available are natural, synthetic, absorbable, or non-absorbable, single filament or braided.
Mattress sutures have an advantage of occluding dead space and keeping the skin edges everted without tension. This is useful especially in older women where skin tends to get inverted.
The disadvantage with this type of suture is that there can be difficulty in approximation and prominent suture marks as sutures tend to be removed later.
To overcome the disadvantage of traditional interrupted mattress suture, Hohenleutner et al., described the intradermal buried vertical mattress suture [31]. This suture technique is safe, easy and fast to perform, everts skin edges and achieves good cosmetic results without leaving suture marks.
Subcuticular suture was first described by Halsted [32]. It is a cosmetic stitch, more difficult, but a good choice especially in younger women whose skin is soft and supple, hence making approximation easy. It is preferable to use absorbable suture for this stitch as the ends are also buried and suture removal is not required.
Though subcuticular stitch has better patient compliance than mattress stitch, the post-operative scar assessment at 6 weeks have yielded similar results in both.
Staples are attractive because of the speed of application.
An RCT study of staples with subcuticular stitch by Figueroa D showed that surgical staples were significantly associated with a higher incidence wound disruptions among those randomized to staples. This observation persisted when the outcome is restricted to disruptions >1 cm in length or > 0.5 cm in depth and typically led to additional scheduled clinic follow-up visits [33].
Another RCT by Madsen AM, comparing absorbable subcuticular staples with suture showed that wound complications, and cosmesis were similar [34]. So if one wants to use staples for closure then the absorbable one would be preferred, as metal staples though faster, has more wound morbidity.
There are many advantages of tissue adhesives over suturing and other methods of wound closure, such as a lower infection rate, less operating room time, good cosmetic results, lower costs, ease of use, immediate wound sealing, faster return to work, elimination of needle-stick injuries and eliminating the need for post-operative suture removal [35]. An RCT by Daykan Y, says that skin closure with glue or synthetic subcuticular suture have similar outcomes with respect to surgical site infection and wound disruptions [36]. The commonly used adhesive is octyl-2-cyanoacrylat.
Various techniques and suture materials for closure of uterus and the abdominal wall following cesarean section have been described. Many studies and meta-analysis have been done to compare different methods with varying results. It is best left to the decision of the operating surgeon and the institutional protocols to decide about the technique of closure and the suture material to be used.
Authors declare no conflict of interest.
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