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

Weeds were caused porblem in the wheat fields and their densities in Niğde province

Bu çalışma, Niğde ili buğday ekim alanlarında bulunan yabancı otların türlerini ve yoğunluklarını belirlemek için yapılmıştır. Bu amaçla, 2003 yılı Mayıs ve Haziran ayında Niğde (Merkez), Altunhisar, Bor, Ulukışla, Çamardı ve Çiftlik' de toplam 229 örnekleme yaparak türler ve yoğunlukları belirtilen ilçelere göre belirlenmiştir. Niğde ili ve ilçelerinde 2003 yılı Vejetasyon döneminde buğday ekim alanlarında yapılan sürveyler sonucunda; 1 tohumsuz, 12 tek çenekli (monokotiledon) ve 80 çift çenekli (dikotiledon) olmak üzere 26 familyaya ait 93 yabancı ot türü saptanmıştır. İl genelinde en önemli yabancı otlar sırasıyla; Convolvulus arvensis L. (tarla sarmaşığı), Boreava orientalis Jaub et Spach. (sarıot), Centaura solstitialis subsp. solstitialis L. (güneş dikeni), Avena fatua L. (yabani yulaf), Sinapis arvensis L. (yabani hardal), Polygonum aviculare L. (çoban değneği), Alopecunts myosııroides Huds. (tilki kuyruğu), Euphorbia helioscopia L. (güneş sütleğeni), Consolida orientalis (Gay.) Schröd (tarla hezaranı) ve Vida sativa L. (yabani fiğ)'nın yoğun (m2 de ortalama 1-10 arası) olduğu saptanmıştır.This study was carried out to determine densities and species of weeds on wheat fields, in Niğde province. For this aim the species and their densities were determined according to county by during an observation on total 229 wheat fields were surveyed on May and July-2003 year, in Niğde (Centre, Altunhisar, Bor, Ulukışla, &Ccedil;amardı, and &Ccedil;iftlik). Based on the result of survey carried out during the vegetation period of 2003 on wheat fields in Niğde province and counties 93 weed species belonging to 26 families, 1 cryptogamae, 12 tnonocotyledonous and 80 dicotyledonous were identified. Important weed species (avarege 1-10 betwwen in m ) in Niğde are C. arvensis (field bindweed), B. orientalis (yellow weed), C. solstitialis var. solstitialis (corn flower), A. fatua (commor wild oat), S. arvensis (wild mustard), P. aviculare (door weed), A. myosuroides (blacl grass), E. helioscopia (sun spurge), C. orientalis (oriental larkspur), and V. sativa (mauss vetch) respectively

A Model Predictive Control Framework for Hybrid Dynamical Systems⁎

This paper presents a model predictive control (MPC) algorithm that asymptotically stabilizes a compact set of interest for a given hybrid dynamical system. The considered class of systems are described by a general model, which identifies the dynamics by the combination of constrained differential and difference equations. The model allows for trajectories that exhibit multiple jumps at the same time instant, or portray Zeno behavior. At every optimization time, the proposed algorithm minimizes a cost functional weighting the state and the input during both the continuous and discrete phases, and at the terminal time via a terminal cost, without discretizing the continuous dynamics. To account for the structure of time domains defining solution pairs, the minimization is performed in a manner akin to free end-time optimal control. When the terminal cost is a control Lyapunov function on the terminal constraint set, recursive feasibility and asymptotic stability of the proposed algorithm can be guaranteed. A sample-and-hold control system and a bouncing ball model are two examples reported to demonstrate the applicability and effectiveness of the proposed approach

Age and growth of Capoeta pestai (Actinopterygii: Cypriniformes: Cyprinidae) in a small river entering Lake Eğirdir, Turkey

Background. Capoeta pestai (Pietschmann, 1933) is commercially important fish species in Turkey. The knowledge of the biology of this species is very scarce. This species has a ‘critically endangered’ status on the IUCN Red List. The objective of this study was to determine the age and growth rates of C. pestai, and to evaluate whether otolith morphometrics could be used as an age predictor. Materials and methods. Fish were collected from a small river entering Lake Eğirdir between January and December 2012. Fish samples were obtained from shallow parts of the river (30–40 cm depth) seasonally in a single station by using an electrofishing devise. Results. Annual growth increments were counted on the otoliths of 154 specimens, ranging from 6.2 to 26.8 cm total lengths. Estimated ages ranged from 0+ to 7+ years old. The von Bertalanffy growth curve was fitted to the age/total length data as follows: L∞ = 47.83 cm (TL), K = 0.081, t0 = –1.840, for females; L∞ = 41.25 cm (TL), K = 0.086, t0 = –1.99 for males; L∞ = 52.45 cm (TL), K = 0.067, t0 = –1.84 for all specimens. No significant differences in morphometric measures (length, width, and mass) were found between left and right otoliths (paired t-test, P > 0.05). Otolith length and width showed significant linear relations with the total length while otolith mass represented by power model. Conclusion. This study provides the first information on age, growth and otolith morphometric parameters of C. pestai. In addition, otolith morphometric measurements could possibly be used in future as an age predictor for C. pestai

Association between smoking and cognitive impairment in multiple sclerosis

Muhammed Emin &Ouml;zcan,1 Bahri İnce,2 Ayhan Bing&ouml;l,3 Simge Ert&uuml;rk,3 Meri&ccedil; Adil Altın&ouml;z,4 Hasan H&uuml;seyin Karadeli,1 Abdulkadir Ko&ccedil;er,5 Talip Asil1 1Deparment of Neurology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey; 2Department of&nbsp;Psychiatry, Bakirk&ouml;y Research and Training Hospital for Psychiatry, Istanbul, Turkey; 3Mayis Psychology Center, Istanbul, Turkey; 4Department of Molecular Biology and&nbsp;Genetics, Hali&ccedil; University, Istanbul, Turkey; 5Department of&nbsp;Neurology, Medical Faculty, İstanbul Medeniyet University, G&ouml;ztepe, Istanbul, Turkey Purpose: Although smoking is known to cause various symptoms in multiple sclerosis (MS) patients, there have been no reports regarding the relationship between smoking and cognitive impairment in MS. Studying the effects of cigarette smoking in MS patients is imperative as there is a high prevalence of cognitive impairment in MS patients. In this study we examined the potentially deleterious effects of heavy smoking on mentation of patients with MS. Patients and methods: MS patients receiving care at the Neurology Clinic at Bezmialem Vakif University, between the ages of 18&ndash;65 years who have at least graduated elementary school were included in the study. The Brief Repeatable Battery of Neuropsychological Tests (BRB-N) is a commonly used method to assess cognitive function in MS patients and was utilized in our study. Patients that smoked for at least 10 pack-years were considered heavy smokers.Results: All the patients were stratified into two groups: heavy smokers (n=20) and nonsmokers (n=24). For heavy smokers, their cognitive functioning was more impaired than that of nonsmokers (P=0.04,&nbsp;&chi;2=4.227). For patients with cognitive impairment, 78.9% of the Paced Auditory Serial Addition Test and 63.2% of the Symbol Digit Modalities Test scores were found to be lower.Conclusion: Previous reports have suggested that smoking increases the frequency of relapse among individuals with relapsing-remitting MS and accelerates disease progression in patients with progressive MS. According to the results of our study, heavy smokers had increased cognitive impairment when compared to nonsmokers. Extensive studies are necessary to further elucidate the relationship between smoking and cognitive impairment in MS patients. Keywords: cigarette, BRB-N, nicotine, cognition, tobacco, mentation, memor