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

Ege sahil kuşağında yeşil alana uygun olabilecek bazı buğdaygillerin değişik morfolojik özellikleri ile büyüme formlerı üzerinde bir araştırma

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.ABSTRACT AN INVESTIGATION ON THE GROWING HABITS AND VARIOUS MORPHOLOGICAL CHARACTERISTICS OF SOME TURFGRASSES ADAPTED TO AEGEAN COASTAL BELT CANÖZER, Sibel M.Sc. Thesis in Field Crops Department Supervisor : Prof. Dr. Rıza AVCIOGLU March 1997, 31 pages Pecularities of two Festuca arundinacea cultivars and Agrostis tenuis and Zoysia japonica under the Mediterranean Climatic conditions were examined in this study conducted in the experimental fields of Ege University Agriculture Faculty Field Crops Department in 1994. For this purpose, commence of tillering and shooting stages, growing habits, leaf structures, plant heights, tiller numbers and turfgrass qualities of above mentioned grasses were tested. Results indicated that Festuca arundinacea cultivars were suitable for problematic areas whereas Agrostis tenuis were proper to shady areas under intensive cultivation measures. Zoysia japonica with a successful establishment of plant cover should be searched in more detail because of slow growing habit. Keywords: Tall fescue, Festuca arundinacea, Japanese lawngrass, Zoysia japonica, fine bent, Agrostis tenuis, Turfs.İİ KISA ÖZET EGE SAHİL KUŞAĞINDA YEŞİL ALANA UYGUN OLABİLECEK BAZI BUĞDAYGİLLERİN DEĞİŞİK MORFOLOJİK ÖZELLİKLERİ İLE BÜYÜME FORMLARI ÜZERİNDE BİR ARAŞTIRMA CANÖZER, Sibel Yüksek Lisans Tezi, Tarla Bitkileri Bölümü Tez Yöneticisi : Prof. Dr. Rıza AVCIOGLU Mart 1997,31 sayfa Ege Üniversitesi Ziraat Fakültesi Tarla Bitkileri Bölümü deneme tarlalarında, 1994 yılında yürütülen bu araştırmada Festuca arundinacea' nm iki çeşidi ile Agrostis tenuis ve Zoysia japonica' mn Akdeniz İklim koşullarındaki özellikleri incelenmiştir. Bu amaçla anılan bitkilerin kardeşlenme ve sapa kalkma tarihleri, büyüme formları, yaprak yapılan, bitki boylan ve kardeş sayılan ile yeşil alana uygunluklan ele alınmıştır. Sonuçlar Festuca arundinacea çeşitlerinin problemli alanlara, Agrostis tenuis" in yoğun bakım koşullarında gölgelik alanlara uygun olduğunu göstermiştir. İyi bir örtü oluşturan ancak yavaş gelişen Zoysia japonica'nın daha detaylı araştırılması gerekmektedir

Enraizamento de estacas semilenhosas de oliveira sob efeito de diferentes épocas, substratos e concentrações de ácido indolbutírico Rootings of semi-woody cuttings of olive tree under effects of collection time, substrate, and concentrations of indol-3-butiric acid (IBA)

Com o objetivo de avaliar o enraizamento de estacas semilenhosas de oliveira (Olea europaea L.), sob efeito de diferentes épocas, substratos e concentrações de ácido indolbutírico (AIB), foram conduzidos na Fazenda Experimental da EPAMIG em Maria da Fé, MG, dois experimentos, sob condições de casa-de-vegetação rústica. As estacas foram coletadas da cultivar Ascolano 315, e os experimentos instalados nos meses de fevereiro de 2000 (09/02) e abril de 2000 (27/04). O delineamento experimental utilizado foi o de blocos casualizados em esquema fatorial 4 x 4, compreendendo, respectivamente, quatro substratos: areia, vermiculita, areia/terra 1/1(v/v) e terra, e quatro concentrações: 0, 1.000, 3.000 e 5.000 mg.L-1 de AIB, com quatro repetições. Pelos resultados, observa-se que é possível o enraizamento de estacas dessa espécie em instalações rústicas, obtendo-se 48,44% de enraizamento no substrato areia/terra 1:1(v/v) e 44,28% quando utilizou-se o tratamento com AIB na concentração de 3.000 mg.L-1 de estacas coletadas em fevereiro 2000.<br>Aiming to evaluate the rooting of semi-woody cuttings of olive tree (Olea europaea L.) under effect of combinations of different times, substrates, and concentrations of indol-3-butiric acid (IBA), two experiments, under greenhouse conditions, were carried out on the EPAMIG experimental farm at Maria da Fé, State of Minas Gerais, Brazil. The cuttings were collected from the cultivar 'Ascolano 315', on the same day of the experiment installation, March 2nd, 2000 and April 27th, 2000. The experimental design used in the two experiments was randomized blocks in 4 × 4 factorial scheme with four substrates (sand, vermiculite, sand/earth 1/1, and earth) and four concentrations of IBA (0, 1000, 3000, and 5000 mg L-1), with four replicates. The results indicate rooting of this species is possible in rustic facilities, obtaining 48% of rooting for the substrate sand/earth 1:1 (v/v, and 44% when treated with IBA at the concentration of 3000 mg L-1, for cuttings collected on February 9th, 2000