Browsing by Author "Kokturk N."

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    Epidemiology and distribution of interstitial lung diseases in Turkey
    (2014) Musellim B.; Okumus G.; Uzaslan E.; Akgün M.; Cetinkaya E.; Turan O.; Akkoclu A.; Hazar A.; Kokturk N.; Calisir H.C.; Sever F.; Kiter G.; Celik G.; Bilgin S.; Kurutepe M.; Uzun O.; Tabak L.; Ozdemir O.; Turker H.; Ogus C.; Kiral N.; Ozkan M.; Yalniz E.; Camsari G.; Dogan T.; Yilmaz U.; Cildag O.; Yildiz F.; Hanta I.; Oztuna F.; Arik D.; Goktalay T.; Kanmaz D.; Yilmaz V.; Altiay G.; Komurcuoglu B.; Ozkan G.; Erbaycu A.; Dogrul M.I.; Ongen G.; Tuncay E.; Dabak G.; Sakar A.; Bircan A.; Uzel I.; Kalpaklioglu F.; Gülbay B; Bulbul Y.; Gulbanu H.; Havlucu Y.; Ekici Z.; Zamani A.; Caglayan B.; Kayacan O.; Dursunoglu N.
    Introduction: There is very few data on the epidemiological features of interstitial lung diseases (ILD) in the literature. These studies on this subject suffer from limited number of patients. Objective: The goal of this study was to evaluate the epidemiological features of ILD in Turkey. Methods: Fifty-four investigators, 31 centres in 19 cities from six regions of Turkey, participated in the study. Two thousand two hundred forty-five newly diagnosed patients (51.8% females), led by Turkish Thoracic Society Clinical Problems Study Group, enrolled in this prospective study. Results: The mean age was 51.8±16.7 years. The mean age among males was 50.5±18.6 years and 53.0±14.6 years among females (P<0.001). 23.8% of the cases had ILD with known causes, while 39.4% were in granulomatous group, 23.7% were idiopathic, and 4.4% were in the unclassified group. Overall, histopathologically confirmed diagnosis rate was 40.4%. Sarcoidosis was the most common disease (37%), whereas cases with idiopathic pulmonary fibrosis (IPF) constituted 19,9% of patients. 53% of the sarcoidosis patients were females, and the ratio reaches to 75% under 50 years of age (for this group, IPF ratio is %3). In contrast, sarcoidosis and IPF ratios were equal in males (25%). Sarcoidosis was 8% in men over 50, while IPF was %45. Conclusion: The overall incidence of ILD in Turkey was computed to be 25.8/100000. © 2013 John Wiley & Sons Ltd.
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    Pneumococcal and influenza vaccination status of hospitalized adults with community acquired pneumonia and the effects of vaccination on clinical presentation
    (Taylor and Francis Inc., 2017) Demirdogen Cetinoglu E.; Uzaslan E.; Sayıner A.; Cilli A.; Kılınc O.; Sakar Coskun A.; Hazar A.; Kokturk N.; Filiz A.; Polatli M.; Tasbakan S.; Karaboğa B.; Kilic Ö.; Havlucu Y.; Tokgöz F.; Nazik S.
    Background: Previous reports have shown that vaccination rates of adult at-risk populations are low in Turkey. There are differing reports with regards to the effectiveness of the influenza and the pneumococcal polysaccharide vaccine (PPSV23) on the clinical outcomes of community acquired pneumonia (CAP). The purpose of this study was to analyze the influenza (FV) and pneumococcal vaccination (PV) status, the factors that influence the receipt of influenza/pneumococcal vaccine and the effects of prior vaccination on the clinical outcomes in adults hospitalized with CAP. Patients and Methods: Patients hospitalized with CAP between March 2009 and October 2013 and registered at the web-based Turkish Thoracic Society Pneumonia Database (TURCAP) were included in this multicentric, observational study. Of a total of 787 cases, data were analyzed for 466 patients for whom self-reported information on PV and FV was available. Results: In this adult population with CAP, the vaccination rate with both the pneumococcal and influenza vaccines was found to be 6%. Prior FV was found to be the sole variable that was associated with the receipt of PV [OR 17.8, 95% CI (25–75:8.56–37.01), p < 0.001]. Conversely, being vaccinated with PPSV23 was the only predictor of receipt of FV [OR 18.1, 95% CI (25–75:8.75–37.83), p < 0.001]. Compared to the unvaccinated cases, the chest radiograms of the vaccinated patients revealed less consolidation. The latter also reported fatigue, muscle pain and gastrointestinal symptoms less frequently. Although there was a trend for lower 30-day mortality and for lower rates of intensive care unit (ICU) admission, these did not reach statistical significance. A pneumonia severity index (PSI) score ≥ 90, CURB-65 score ≥3 and multilobar involvement, but not the vaccination status, were identified as independent determinants of ICU admission. Conclusions: This study showed that, among patients hospitalized with CAP, the FV and/or PV rates are low. Prior vaccination does not appear to significantly affect the clinical outcomes. © 2017 Taylor & Francis.
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    Prognosis of hospitalized patients with community-acquired pneumonia
    (Elsevier Doyma, 2018) Tokgoz Akyil F.; Yalcinsoy M.; Hazar A.; Cilli A.; Celenk B.; Kilic O.; Sayiner A.; Kokturk N.; Sakar Coskun A.; Filiz A.; Cakir Edis E.
    Introduction: The long-term prognosis of patients with community-acquired pneumonia (CAP) has attracted increasing interest in recent years. The objective of the present study is to investigate the short and long-term outcomes in hospitalized patients with CAP and to identify the predictive factors associated with mortality. Patients and methods: The study was designed as a retrospective, multicenter, observational study. Hospitalized patients with CAP, as recorded in the pneumonia database of the Turkish Thoracic Society between 2011 and 2013, were included. Short-term mortality was defined as 30-day mortality and long-term mortality was assessed from those who survived 30 days. Predictive factors for short- and long-term mortality were analyzed. Results: The study included 785 patients, 68% of whom were male and the mean age was 67 ± 16 (18–92). The median duration of follow-up was 61.2 ± 11.8 (37–90) months. Thirty-day mortality was 9.2% and the median survival of patients surviving 30 days was 62.8 ± 4.4 months. Multivariate analysis revealed that advanced age, the absence of fever, a higher Charlson comorbidity score, higher blood urea nitrogen (BUN)/albumin ratios and lower alanine aminotransferase (ALT) levels were all predictors of long-term mortality. Conclusion: Long-term mortality following hospitalization for CAP is high. Charlson score and lack of fever are potential indicators for decreased long-term survival. As novel parameters, baseline BUN/albumin ratios and ALT levels are significantly associated with late mortality. Further interventions and closer monitoring are necessary for such subgroups of patients. © 2017 Sociedade Portuguesa de Pneumologia
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    The effect of inhaled corticosteroids in the outcomes of community-acquired pneumonia: ICCAP study (TURKCAP Database)
    (Blackwell Publishing Ltd, 2020) Baha A.; Kokturk N.; Bahcecioglu S.N.; Yapar D.; Aksakal N.; Gündüz C.; Tasbakan S.; Sayiner A.; Coskun A.S.; Durmaz F.; Cilli A.; Celenk B.; Kılınc O.; Salman S.; Hazar A.; Tokgoz F.
    Objective: We aimed to investigate the effect of inhaled corticosteroids (ICS) in the outcomes of community-acquired pneumonia (CAP), as well as to determine if ICS usage is exist among the risk factors for mortality in those patients. Materials and Methods: In this retrospective cross-sectional multicentre study, 1069 hospitalised CAP patients were investigated using CAP Database of Turkish Thoracic Society (TURKCAP Database). The patients were divided into two groups, depending on their ICS use. The data were analysed by appropriate statistical methods. Results: 172 (75.8%) of the 227 patients who were on ICS had COPD and 37 (16.3%) had asthma. There were fewer patients with fever among ICS-users compared to non-ICS users (P = 0.013), and less muscle pain (P = 0.015) and fewer GIS symptoms (P = 0.022). No statistically significant difference was found between ICS use/ type of ICS and the duration of hospitalisation (P = 0.286). The multivariate regression analysis showed that patients using ICS had lower body temperature and, less crackles/bronchial sound. In the multivariate logistic regression model lung cancer (OR: 6.75), glucose (OR: 1.01) and CURB-65 (OR: 1.72) were significantly associated with mortality in the CAP patients. ICS usage were not found to be associated with mortality. Conclusion: The use of ICS by the patients with CAP admitted to the hospital is not independently related with any radiological pattern, hospitalisation duration and mortality. ICS usage may diminish fever response and may suppress the findings of crackles and/or bronchial sounds. This needs further confirmation. © 2020 John Wiley & Sons Ltd
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    The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients
    (W.B. Saunders Ltd, 2021) Kokturk N.; Babayigit C.; Kul S.; Duru Cetinkaya P.; Atis Nayci S.; Argun Baris S.; Karcioglu O.; Aysert P.; Irmak I.; Akbas Yuksel A.; Sekibag Y.; Baydar Toprak O.; Azak E.; Mulamahmutoglu S.; Cuhadaroglu C.; Demirel A.; Kerget B.; Baran Ketencioglu B.; Ozger H.S.; Ozkan G.; Ture Z.; Ergan B.; Avkan Oguz V.; Kilinc O.; Ercelik M.; Ulukavak Ciftci T.; Alici O.; Nurlu Temel E.; Ataoglu O.; Aydin A.; Cetiner Bahcetepe D.; Gullu Y.T.; Fakili F.; Deveci F.; Kose N.; Tor M.M.; Gunluoglu G.; Altin S.; Turgut T.; Tuna T.; Ozturk O.; Dikensoy O.; Yildiz Gulhan P.; Basyigit I.; Boyaci H.; Oguzulgen I.K.; Borekci S.; Gemicioglu B.; Bayraktar F.; Elbek O.; Hanta I.; Kuzu Okur H.; Sagcan G.; Uzun O.; Akgun M.; Altinisik G.; Dursun B.; Cakir Edis E.; Gulhan E.; Oner Eyuboglu F.; Gultekin O.; Havlucu Y.; Ozkan M.; Sakar Coskun A.; Sayiner A.; Kalyoncu A.F.; Itil O.; Bayram H.
    The COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5–5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6–23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored. © 2021 Elsevier Ltd
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    COVID-19: vaccination vs. hospitalization
    (Springer Science and Business Media Deutschland GmbH, 2022) Uzun O.; Akpolat T.; Varol A.; Turan S.; Bektas S.G.; Cetinkaya P.D.; Dursun M.; Bakan N.; Ketencioglu B.B.; Bayrak M.; Baris S.A.; Guner R.; Gunal O.; Nural S.; Deniz P.P.; Toprak O.B.; Ozkan G.; Gumus A.; Kerget F.; Ercelik M.; Ataoglu O.; Yuksel A.; Ates G.; Kutsoylu O.E.; Kose N.; Kizilirmak D.; Keskin S.; Gultekin O.; Coskun N.; Yilmaz E.S.; Uslu S.; Basyigit İ.; Ergan B.; Deveci F.; Yakar M.N.; Zuhur C.; Sagcan G.; Yuce Z.T.; Kuluozturk M.; Sezgin M.E.; Sezgin E.N.A.; Havlucu Y.; Cuhadaroglu C.; Kilinc O.; Boyaci H.; Altunay H.; Akti M.; Dursun Z.B.; Kalem A.K.; Isik S.A.; Akyildiz L.; Aykac N.; Almaz M.S.; Kokturk N.; Itil O.
    Objective: Vaccination is the most efficient way to control the coronavirus disease 2019 (COVID-19) pandemic, but vaccination rates remain below the target level in most countries. This multicenter study aimed to evaluate the vaccination status of hospitalized patients and compare two different booster vaccine protocols. Setting: Inoculation in Turkey began in mid-January 2021. Sinovac was the only available vaccine until April 2021, when BioNTech was added. At the beginning of July 2021, the government offered a third booster dose to healthcare workers and people aged > 50 years who had received the two doses of Sinovac. Of the participants who received a booster, most chose BioNTech as the third dose. Methods: We collected data from 25 hospitals in 16 cities. Patients hospitalized between August 1 and 10, 2021, were included and categorized into eight groups according to their vaccination status. Results: We identified 1401 patients, of which 529 (37.7%) were admitted to intensive care units. Nearly half (47.8%) of the patients were not vaccinated, and those with two doses of Sinovac formed the second largest group (32.9%). Hospitalizations were lower in the group which received 2 doses of Sinovac and a booster dose of BioNTech than in the group which received 3 doses of Sinovac. Conclusion: Effective vaccinations decreased COVID-19-related hospitalizations. The efficacy after two doses of Sinovac may decrease over time; however, it may be enhanced by adding a booster dose. Moreover, unvaccinated patients may be persuaded to undergo vaccination. © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
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    The association of antiviral drugs with COVID-19 morbidity: The retrospective analysis of a nationwide COVID-19 cohort
    (Frontiers Media S.A., 2022) Babayigit C.; Kokturk N.; Kul S.; Cetinkaya P.D.; Atis Nayci S.; Argun Baris S.; Karcioglu O.; Aysert P.; Irmak I.; Akbas Yuksel A.; Sekibag Y.; Baydar Toprak O.; Azak E.; Mulamahmutoglu S.; Cuhadaroglu C.; Demirel A.; Kerget B.; Baran Ketencioglu B.; Ozger H.S.; Ozkan G.; Ture Z.; Ergan B.; Avkan Oguz V.; Kilinc O.; Ercelik M.; Ulukavak Ciftci T.; Alici O.; Nurlu Temel E.; Ataoglu O.; Aydin A.; Cetiner Bahcetepe D.; Gullu Y.T.; Fakili F.; Deveci F.; Kose N.; Tor M.M.; Gunluoglu G.; Altin S.; Turgut T.; Tuna T.; Ozturk O.; Dikensoy O.; Yildiz Gulhan P.; Basyigit I.; Boyaci H.; Oguzulgen I.K.; Borekci S.; Gemicioglu B.; Bayraktar F.; Elbek O.; Hanta I.; Kuzu Okur H.; Sagcan G.; Uzun O.; Akgun M.; Altinisik G.; Dursun B.; Cakir Edis E.; Gulhan E.; Oner Eyuboglu F.; Gultekin O.; Havlucu Y.; Ozkan M.; Sakar Coskun A.; Sayiner A.; Kalyoncu A.F.; Itil O.; Bayram H.
    Background and objectives: Although several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity. Methods: Patients admitted to 26 different hospitals located in 16 different provinces between March 11–July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation. Results: We retrospectively evaluated 1,472 COVID-19 adult patients; 57.1% were men (mean age = 51.9 ± 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5–12) days. Favipiravir (n = 328), lopinavir/ritonavir (n = 55), and oseltamivir (n = 761) were administered as antiviral agents, and hydroxychloroquine (HCQ, n = 1,382) and azithromycin (n = 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (β [95% CI]: 4.71 [2.31–7.11]; p = 0.001), favipiravir (β [95% CI]: 3.55 [2.56–4.55]; p = 0.001) and HCQ (β [95% CI]: 0.84 [0.02–1.67]; p = 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR [95% CI]: 3.02 [1.70–5.35]; p = 0.001) and invasive mechanical ventilation requirement (OR [95% CI]: 2.94 [1.28–6.75]; p = 0.011). Conclusion: Our findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment. Copyright © 2022 Babayigit, Kokturk, Kul, Cetinkaya, Atis Nayci, Argun Baris, Karcioglu, Aysert, Irmak, Akbas Yuksel, Sekibag, Baydar Toprak, Azak, Mulamahmutoglu, Cuhadaroglu, Demirel, Kerget, Baran Ketencioglu, Ozger, Ozkan, Ture, Ergan, Avkan Oguz, Kilinc, Ercelik, Ulukavak Ciftci, Alici, Nurlu Temel, Ataoglu, Aydin, Cetiner Bahcetepe, Gullu, Fakili, Deveci, Kose, Tor, Gunluoglu, Altin, Turgut, Tuna, Ozturk, Dikensoy, Yildiz Gulhan, Basyigit, Boyaci, Oguzulgen, Borekci, Gemicioglu, Bayraktar, Elbek, Hanta, Kuzu Okur, Sagcan, Uzun, Akgun, Altinisik, Dursun, Cakir Edis, Gulhan, Oner Eyuboglu, Gultekin, Havlucu, Ozkan, Sakar Coskun, Sayiner, Kalyoncu, Itil and Bayram.
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    COVID-19: booster(s) vs. hospitalization and Intensive Care Unit admission
    (Verduci Editore s.r.l, 2023) Toprak O.B.; Akpolat T.; Uzun O.; Pinar Deniz P.; Kokturk N.; Varol A.; Guzel E.; Ercelik M.; Gultekin O.; Guner R.; Turan S.; Gökbulut Bektaş Ş.; Coskun N.; Bakan N.; Nuri Yakar M.; Eren Kutsoylu O.; Ergan B.; Argun Bariş S.; Başyiğit İ.; Boyaci H.; Çetinkaya F.; Çolak H.; Aykac N.; Baran Ketencioğlu B.; Türe Yüce Z.; Akkaya Isik S.; Serap Yilmaz E.; Karaoğlanoğlu S.; Berik Safci S.; Ozkan G.; Kose N.; Kizilirmak D.; Havlucu Y.; Nural S.; Kerget F.; Sunal Ö.; Yuksel A.; Bestepe Dursun Z.; Deveci F.; Kuluozturk M.; Ataoglu O.; Dursun M.; Keskin S.; Emin Sezgin M.; Aktepe Sezgin E.N.; Eser F.; Akyildiz L.; Selim Almaz M.; Kayaaslan B.; Hasanoğlu İ.; Bayrak M.; Gümüş A.; Sağcan G.; Cuhadaroglu C.; Kucuk H.; Onyilmaz T.; Mete B.; Kilinc O.; Oya Itil B.
    OBJECTIVE: As the pandemic continues, different vaccine protocols have been implemented to maintain the protection of vaccines and to provide protection against new variants. The aim of this study was to assess hospitalized patients' vaccination status and document the efficacy of boosters. PATIENTS AND METHODS: The patients that were hospitalized due to COVID-19 were enrolled from 28 hospitals in Turkey for five months from September 2021. 5,331 confirmed COVID-19 patients from collaborating centers were randomly enrolled to understand/estimate the distribution of vaccination status in hospitalized patients and to compare the efficacy of vaccination/booster protocols. RESULTS: 2,779 men and 2,552 women of which 2,408 (45.2%) were admitted to Intensive Care Units participated in this study. It was found that the highest risk reduction for all age groups was found in groups that received 4 doses. Four doses of vaccination for every 3.7 people under 50 years of age, for every 5.7 people in the 50-64 age group, and for every 4.3 people over 65 years of age will prevent 1 patient from being admitted to intensive care. Regardless of the type of vaccine, it was found that the risk of ICU hospitalization decreased in those who were vaccinated compared to those who were not vaccinated. Regardless of the type of vaccine, the ICU risk was found to decrease 1.25-fold in those who received 1 or 2 doses of vaccine, 1.18-fold in those who received 3 doses, and 3.26-fold in those who received 4 doses. CONCLUSIONS: The results suggested that the addition of a fourth dose is more effective in preventing intensive unit care even in disadvantaged. © 2023 Verduci Editore s.r.l. All rights reserved.
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    Attitudes toward and exposure to gender discrimination in work life by pulmonologists and thoracic surgeons: a questionnaire-based survey among Turkish thoracic society members
    (Frontiers Media SA, 2024) Ocakli B.; Yorgancioglu A.; Gungor S.; Topcu F.; Senol Y.Y.; Goktas B.; Kokturk N.; Tuncay E.; Gundogus B.; Altinoz H.; Yasin Y.; Ozmen I.; Duru S.; Yildirim E.O.; Sevim T.; Ozturk C.A.; Uzaslan E.
    Background: This study aimed to evaluate attitudes toward and exposure to gender discrimination in work life by chest diseases specialists and thoracic surgeons. Methods: A total of 275 members of Turkish Thoracic Society (TTS) were included on a voluntary basis in this online cross-sectional questionnaire-survey using an internal member-only social media platform of TTS. The questionnaire form elicited items on sociodemographic characteristics, occupational characteristics and gender discrimination in work life (general opinions, attitudes and exposure). Results: Female doctors (vs. males) were less likely to be a thoracic surgeon (13.8% vs. 34.5%, p < 0.05) and a professor of thoracic surgery (0.0% vs. 26.7% vs. p < 0.05), and more likely to consider housework as a considerable burden (89.8 vs. 73.6%, p = 0.02) and the significant role of discriminatory, negative and dissuasive attitudes of male physicians in their career choice (67.6 vs. 35.6%, p = 0.039). Male doctors were more likely to considered that men are more successful in specialties that require active physical strength (65.5 vs. 27.7%, p = 0.005) and those with very long working hours and heavy shifts (57.5 vs. 39.4%, p = 0.001). Female thoracic surgeons were more likely than males to consider that specialties with very long working hours and heavy shifts are more suitable for men (26.9 vs. 6.0%, p = 0.027) and men are given priority in academic career promotion (64.0 vs. 13.3%, p < 0.001). Younger (vs. older) females reported higher rate of exposure to gender discrimination (p = 0.041) and considerable impact of social roles on the specialty (p = 0.007), while female doctors working as a resident (33.8%) and a specialist (50.05%) indicated higher rate of exposure to gender discrimination during their career (p = 0.024). Conclusion: In conclusion, our findings revealed that exposure to gender discrimination in work life was more commonly expressed by female members of TTS, particularly in terms of burden of social roles, career advancement options and leadership positions, along with significant role of discriminatory, negative and dissuasive attitudes of male physicians in their career choice. Accordingly, women remain underrepresented in thoracic surgery, particularly in the academic rank of full professor and in leadership positions with inability to promote after a definite step in their careers. Copyright © 2024 Ocakli, Yorgancioglu, Gungor, Topcu, Senol, Goktas, Kokturk, Tuncay, Gundogus, Altinoz, Yasin, Ozmen, Duru, Yildirim, Sevim, Ozturk, Uzaslan and the Turkish Thoracic Society Women and Lung Diseases Working Group.