Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reading Statuses of Social Studies and Turkish Language Teacher candidates (their attention, habits and levels of using reading strategies)

Okuma, yaşam boyu öğrenmenin geçekleştirilmesi için gerekli olan bir edinimdir. Bireyler okuma becerilerini kullanabildikleri ve okuduklarını anlayıp eleştirebildikleri oranda demokratik toplumsal sistem içerisinde yer edinebilirler. Model niteliğindeki öğretmen adaylarının, böylesine önemli bir kazanıma ne oranda sahip oldukları, öğretmen adayları tarafından okuma stratejilerinin ne oranda kullanıldığı cevaplanması gereken önemli sorulardır. Bu çalışma, bu sorulara cevap bulmak amacıyla Ahi Evran Üniversitesi Eğitim Fakültesinde gerçekleştirilmiştir. Araştırmada Türkçe ve Sosyal Bilgiler Öğretmenliği Bölümlerinden 577 öğrenciye anket uygulanmıştır. Araştırmanın bulgularına göre Türkçe öğretmeni adaylarının okuma sıklıkları sosyal bilgiler öğretmeni adaylarına göre yüksek çıksa da genelde öğretmen adaylarının okuma sıklıkları düşük oranda gerçekleşmiştir. Gün içerisinde kitle iletişim araçlarına ayrılan sürenin okumaya ayrılan süreyi olumsuz yönde etkilediği belirlenmiştir. Kütüphane kullanma alışkanlığının zayıf olduğu, kütüphanelerin ders çalışmak, gazete-dergi okumak için kullanıldığı belirlenmiştir. Ayrıca kız öğrencilerin okuma sıklıkları ve okuma stratejilerinin kullanımı bakımından erkeklere oranla daha üst düzeyde oldukları da çalışmanın bulguları arasındadır. Araştırmada okuma sıklıkları ile okuma stratejilerinin kullanımı arasında olumlu yönde bir ilişki bulunmuştur.Reading is an acquisition necessary for realising life-long learning. In addition, the more an individual is able to use reading skills and criticise what s/he reads, the more s/he participates in a democratic social system. To what extent the teacher candidates who are qualified as models bear these important merits and to what extent they use reading skills are two important questions that need to be answered. Aiming at answering these questions, this research has been conducted in the Education Faculty of Ahi Evran University. In the research, a questionnaire has been administered to 577 students from the departments of Turkish Language and Social Studies Teaching. According to the findings, although reading frequencies of Turkish Language teacher candidates are higher than those of Social Studies teacher candidates, the reading frequency of teacher candidates in general was found to be low. It has been observed that the daily time allocated for mass media negatively affects the time allocated for reading. It has also been observed that the habit of using libraries is poor and libraries are mostly used for studying and reading newspapers & magazines In addition, it is among the findings that female students are superior to male students in terms of their reading frequencies and levels of using reading strategies. Finally, a positive correlation has been found between the reading frequency and the level of using reading strategies

Differences in teachers' perceptions of school quality

Bu arastırma; ögretmenlerin kaliteli okul kavramı ile ilgili algılarının belirlenmesi amacıyla gerçeklestirilmistir. Bu amaçla, çalısmada betimsel tarama yöntemi kullanılmıs ve bu çalısma 2008-2009 egitim ögretim yılında Kırsehir il merkezindeki ilkögretim ve ortaögretim okullarında çalısan ögretmenlerle yürütülmüstür. Arastırmada arastırmacı tarafından gelistirilen anket formu ölçme aracı olarak kullanılmıstır. 52 maddeden olusan Anketin Cronbach Alpha iç güvenirlik katsayısı .96 olarak hesaplanmıstır. Ögretmenlerin görüslerinin belirlenmesinde frekans (f), yüzde (%), aritmetik ortalama ( X ) ve standart sapma (ss) degerleri kullanılarak bulgular kısmı olusturulmustur. Ayrıca ögretmenlerin anket maddelerine verdikleri yanıtların yorumlanmasında besli degerlendirme ölçegi kullanılmıstır. Arastırma bulguları sonucunda, ögretmenlerin okul kalitesini algılamalarında cinsiyetin ve kıdemin etkili olmadıgı görülmektedir. Ancak ögretmenlerin çalıstıkları kurumlara göre kalite algılarında anlamlı farklılıgın oldugu tespit edilmistir. Ayrıca, ortaögretimde çalısan ögretmenler ile ilkögretimde çalısan ögretmenler arasında“belirginlik ve paylasımcılık”, “yüksek standartlar”, “okul liderligi, “iletisim ve is birligi”, “müfredat, egitim ve degerlendirme”, “ögrenme ortamı”, “veli ve okul çevresinin katılımı”, okul kalite nitelikleri açısından ilkögretimde çalısanlar lehine anlamlı bir farklılık görülmüstür.The purpose of this study is to determine the perceptions of teachers about school quality. In this study descriptive survey model has been used among teachers who have been working in primary Schools in Kırsehir, 2008-2009 teaching year. The questionnaire having been formed by researcher has been used as measure tool. Questionnaire which consists of 52items is found that Cronbach Alpha is.96. The part of Findings has been formed by using frequency ,percentage, mean and standard deviations . Also 5 scale likert type has been used in construing teachers‘ responses to questionnaire items. According to the research findings; it is understood that neither gender nor seniority has effected the perceptions of teachers about school quality. But significant difference has been found in teachers‘ perceptions of school quality according to the schools where teachers wor

Reading Statuses of Social Studies and Turkish Language Teacher Candidates (Their Attention, Habits and Levels of Using Reading Strategies) Sosyal Bilgiler ve Türkçe Öğretmeni Adaylarının Okuma Durumları: (İlgi, Alışkanlık ve Okuma Stratejilerini Kullanım Düzeyleri)

Reading is an acquisition necessary for realising life-long learning. In addition, the more an individual is able to use reading skills and criticise what s/he reads, the more s/he participates in a democratic social system. To what extent the teacher candidates who are qualified as models bear these important merits and to what extent they use reading skills are two important questions that need to be answered. Aiming at answering these questions, this research has been conducted in the Education Faculty of Ahi Evran University. In the research, a questionnaire has been administered to 577 students from the departments of Turkish Language and Social Studies Teaching. According to the findings, although reading frequencies of Turkish Language teacher candidates are higher than those of Social Studies teacher candidates, the reading frequency of teacher candidates in general was found to be low. It has been observed that the daily time allocated for mass media negatively affects the time allocated for reading. It has also been observed that the habit of using libraries is poor and libraries are mostly used for studying and reading newspapers and magazines In addition, it is among the findings that female students are superior to male students in terms of their reading frequencies and levels of using reading strategies. Finally, a positive correlation has been found between the reading frequency and the level of using reading strategies. Okuma, yaşam boyu öğrenmenin geçekleştirilmesi için gerekli olan bir edinimdir. Bireyler okuma becerilerini kullanabildikleri ve okuduklarını anlayıp eleştirebildikleri oranda demokratik toplumsal sistem içerisinde yer edinebilirler. Model niteliğindeki öğretmen adaylarının, böylesine önemli bir kazanıma ne oranda sahip oldukları, öğretmen adayları tarafından okuma stratejilerinin ne oranda kullanıldığı cevaplanması gereken önemli sorulardır. Bu çalışma, bu sorulara cevap bulmak amacıyla Ahi Evran Üniversitesi Eğitim Fakültesinde gerçekleştirilmiştir. Araştırmada Türkçe ve Sosyal Bilgiler Öğretmenliği Bölümlerinden 577 öğrenciye anket uygulanmıştır. Araştırmanın bulgularına göre Türkçe öğretmeni adaylarının okuma sıklıkları sosyal bilgiler öğretmeni adaylarına göre yüksek çıksa da genelde öğretmen adaylarının okuma sıklıkları düşük oranda gerçekleşmiştir. Gün içerisinde kitle iletişim araçlarına ayrılan sürenin okumaya ayrılan süreyi olumsuz yönde etkilediği belirlenmiştir. Kütüphane kullanma alışkanlığının zayıf olduğu, kütüphanelerin ders çalışmak, gazete-dergi okumak için kullanıldığı belirlenmiştir. Ayrıca kız öğrencilerin okuma sıklıkları ve okuma stratejilerinin kullanımı bakımından erkeklere oranla daha üst düzeyde oldukları da çalışmanın bulguları arasındadır. Araştırmada okuma sıklıkları ile okuma stratejilerinin kullanımı arasında olumlu yönde bir ilişki bulunmuştur

Selçuk-Pamucak sulak alanının sınıflandırılması üzerine bir araştırma

Due to their biological diversity and functionalities, wetlands are ecosystems which have increasingly been significant in this century of facing water shortage. Such ecosystems show variations of their characteristics. In this study, a classification of Sel;ccedil;uk-Pamucak wetlands of ;quot;B class;quot; quality was made in order to prepare an inventory which could be used in management plans.Sulakalanlar biyolojik çeşitlilikleri ve fonksiyonları ile; su sıkıntısının yaşandığı yüzyılımızda önemi daha da kavranan ayrıcalıklı bir ekosistemdir. Bu ekosistem kendi içerisinde karakteristikleri bakımından çeşitliliğe sahip olup, farklılıklar göstermektedir. Bu çalışma kapsamında ,Selçuk-Pamucak sulak, alanının, bu alana yönelik yapılacak yönetim planlarına envanter oluşturulması amacıyla sınıflandırılması yapılmıştır

Protective Effects of Hydrogen-Rich Saline on Experimental Intestinal Volvulus in Rats

Background Intestinal volvulus can cause morbidity and mortality. Surgical reduction, on the other hand, could result in ischemia-reperfusion (I/R) injury. Hydrogen rich saline solution (HRSS neutralizes free radicals in the body. This study aimed to investigate the effects of HRSS in I/R injury in experimental intestinal volvulus in rats. Methods Thirty rats were randomly allocated into 5 groups. All procedures were done under general anesthesia and sterile conditions in each animal. Five ml/kg of saline and HRSS were administered intraperitoneally (ip) in Sham (Group 1) and HRSS (Group 2) groups, respectively. Groups 3, 4, and 5 constituted the study groups in which volvulus was created in a 5-cm- long ileal segment 2 cm proximal to the ileocecal valve. After 2 hours the volvuli were reduced and following 2 hours of reperfusion, these segments were removed. In volvulus-I/R group (Group 3) no additional procedure was done. HRSS was administered shortly before reperfusion (reduction of the volvulus) in Treatment I (Group 4) and 1 h before experimental volvulus in Treatment II (Group 5) groups. Blood and intestinal tissue samples were obtained from all rats at the 4th hour. Both tissue and blood total oxidant (TOS) and antioxidant status (TAS) levels were determined and tissue histomorphologies were studied. Oxidative stress indices (TOS ÷ TAS) (OSI) were calculated. Results Tissue TOS and OSI levels and histomorphological injury scores were statistically lower in treatment groups than I/R group, whereas blood TOS and OSI levels were similar between the groups. Conclusions This study provides biochemical and histomorphological evidence that HRSS prevents intestinal damage in I/R injury caused by volvulus