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

An application of linear cryptanalysis method to des block cipher

1993 yılında Matsui tarafından bulunan lineer kriptoanaliz metodu, DES2e yapılan bilinen açık mesaj saldırısıdır. Bu metodun amacı verilen şifreleme algoritmasında lineer yaklaşımlar bulmaktır. Bu amaçla S-kutuları istatistiksel olarak analiz edilir, burada gözlenilen lineer özellik F-fonksiyonlarına taşınır. Sonunda açık mesaj, kapalı mesaj ve sabit anahtar bağlı basit olasılıklı bağıntı elde edilir. Bu metodla 26 altanahtar bitleri elde edilir. Diğer blok şifreleme algoritmalarına da uygulanabilir. Bu tezde lineer kriptoananliz metodunun DES blok şifreleme algoritmasına uygulanmasını çalıştık. Bunun için gerekli olan algoritmaları DES'e uyguladık. Anahtar Sözcükler: Bilinen açık mesaj saldırısı, DES, S-kutuları, lineer kriptoanaliz. Kasım, 2001 Şükran Aslan Linear cryptanalysis invented by Matsui in 1993 is an essentially known plaintext attack of DES cipher. The purpose of this method is to obtain a linear approximate expression of a given cipher algorithm. For this purpose this method analyzes S-box statistically, then extended local property of the S-boxes to the entire cipher structure through F-functions, and finally reach the simple probabilistic relations among plainttexts, ciphertexts and the fixed secret key. By this method we can find 26 subkey bits. This method is applicable for other block ciphers. In this thesis we study linear cryptanalysis method to DES block cipher for this purpose we implemented the algorithms and compare the results. Key Words: Known plaintext attack, DES, S-boxes, linear cryptanalysis. November, 2001 Şükra

Dîvan-ı Çâkerî (Dil özellikleri-Metin)

06.03.2018 tarihli ve 30352 sayılı Resmi Gazetede yayımlanan “Yükseköğretim Kanunu İle Bazı Kanun Ve Kanun Hükmünde Kararnamelerde Değişiklik Yapılması Hakkında Kanun” ile 18.06.2018 tarihli “Lisansüstü Tezlerin Elektronik Ortamda Toplanması, Düzenlenmesi ve Erişime Açılmasına İlişkin Yönerge” gereğince tam metin erişime açılmıştır.Dîvân-ı Çâkerî XV. yüzyıla ait Eski Anadolu Türkçesi özelliklerini gösteren birmetindir.Dîvân-ı Çâkerî'nin tek nüshası vardır. Bu nüsha İstanbul-SüleymaniyeKütüphanesi'nde Hacı Mahmud 3298 koduyla bulunmaktadır. İstinsah tarihi 1592-93'tür. Dîvân içinde iki kasîde, üç mesnevî ve yüz yirmi iki gazel bulunmaktadır. Birdîvânda olması gereken nazım biçimlerini içermemesi sebebiyle Dîvân-ı Çâkerî'ninmüretteb bir dîvân olduğunu söyleyemeyizBu çal?şma; Giriş, Dil Özellikleri ve Metin ana bölümlerinden oluşmaktad?r.Giriş bölümünde, metin ve müellifi hakk?nda bilgiler yer almaktad?r.Dil Özellikleri bölümünü, metnin imlas? ve ses olaylar? oluşturmaktad?r.Metin bölümü ise, metnin transkripsiyonu içermektedir.Bu bölümlerden elde edinilen bilgiler sonuç bölümünde s?ralanm?şt?r.Anahtar kelimeler: Dîvân-ı Çâkerî ,Dil Özellikleri, Ses Olayları, MetinDîvân-ı Çâkerî is a written work that shows the features of XV.th Century OldAnatolia Turkish.Dîvân-ı Çâkerî has only one copy.This copy is in İstanbul Sulaymaniye Library witha code :Haci Mahmud 3298.It was published in 1592-93. There are 2 qasidas,3poemmade up of rhymed couplets and 122 ottoman poet in Divan. We cannot saythat Dîvân-ı Çâkerî is a full collected poems as it doesn?t contain poem forms thatshould be in a collected poems.There is some information about this written work and its writer in the introductionpart.Its spelling rules and phonetic rules form The language Features.Also, Written Work Part contains its transcripton .The information that is gained from these parts is in order in the conclusion part.Keywords: Dîvân-ı Çâkerî, Language Characteristics, Phonetic Events, Text