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

Adsorption of Phenol from Aqueous Solution on a Low-Cost Activated Carbon Produced from Tea Industry Waste: Equilibrium, Kinetic, and Thermodynamic Study

The ability of activated carbon which was produced by chemical activation using zinc chloride from tea industry wastes (TIWAC) to adsorb phenol molecules from aqueous solution was tested by equilibrium, kinetic, and thermodynamic parameters. Phenol adsorption on TIWAC took place with a high yield at pH values in the range 4 to 8. The optimum contact period was observed as 4.0 h and from the adsorption graphs plotted as a function of time; it was established that phenol adsorption on TIWAC conformed more to a pseudosecond-order kinetic model. Additionally, it was determined that the adsorption rate is controlled by intraparticle diffusion as well as film diffusion. It was established that phenol adsorption on TIWAC can be better defined by the Langmuir adsorption model and its adsorption capacity was 142.9 mg.g(-1) from the linear Langmuir equation. Temperature had an adverse effect on adsorption yield, and hence, the adsorption process was exothermic in our case. Moreover, increasing electrolyte concentration in the medium has a positive effect on adsorption yield. From the data obtained, it was concluded that the removal of phenol from aqueous solution by TIWAC produced from tea industry wastes with a very low cost took place with an extremely high performance

Tea-industry waste activated carbon, as a novel adsorbent, for separation, preconcentration and speciation of chromium

Activated carbon was produced from tea-industry wastes (TIWAC) and employed as a low cost and effective solid phase material for the separation, preconcentration and speciation of chromium species without using a complexing agent, prior to determination by flame atomic absorption spectrometry (FAAS). The characterization of TIWAC was performed by utilizing several techniques such as Fourier Transform Infrared (FTIR) Spectroscopy, Scanning Electron Microscopy (SEM), and elemental analysis. The adsorption experiments were conducted in a batch adsorption technique. Under the experimental conditions, Cr(VI) adsorption amount was nearly equal to zero, however the adsorption percentage of Cr(III) was in the range of 95-100%. Therefore total chromium was determined after the reduction of Cr(VI) to Cr(III) and Cr(VI) was calculated by subtracting Cr(III) concentration from total chromium concentration. The suitable conditions for adsorption and speciation processes were evaluated in terms of pH, eluent type and volume, TIWAC concentration, adsorption and desorption contact time, etc. Adsorption capacity of TIWAC was found to be 61.0 mg g(-1). The detection limit for Cr(III) was found to be 0.27 mu g L(-1) and the preconcentration factor was 50 for 200 mL of sample volume. The procedure was applied to the determination and speciation of chromium in stream, tap and sea water. Also, the proposed method was applied to total chromium preconcentration in microwave digested tobacco and dried eggplant samples with satisfactory results. The method was validated by analyzing certified reference materials (CRM-TMDW-500 Drinking Water and CRM-SA-C Sandy Soil C) and the results were in good agreement with the certified values. (C) 2011 Elsevier B.V. All rights reserved

Adsorption of Cd(II) Ions onto Activated Carbon Prepared from Hazelnut Husks

In this study, a batch adsorption of Cd(II) ions onto activated carbon (AC) produced from hazelnut husks were investigated. The factors controlling the adsorption process such as initial pH, agitation time, dosage and initial concentration have been examined. The AC was showed a high affinity to Cd(II) ions at pH values between 5.0 and 7.0. The equilibrium time was found to be 300 minutes. Cd(II) adsorption equilibrium was analyzed with both Langmuir and Freundlich isotherm equations and it was found that Langmuir equations fitted well with the experimental data. Maximum Cd(II) adsorption capacity of AC was calculated to be 20.9mgg(-1). Cd(II) adsorption kinetics described well with the pseudo second order model. The activated carbon prepared from hazelnut husks is efficient sorbent material for the removal of Cd(II) ions from aqueous solutions

Solid-phase extraction of trace Ni(II) ions on ethylenediamine-silica material synthesized by sol-gel method

A solid-phase extraction method using ethylenediamine-silica (EDA-SIL) material for the determination of Ni(II) ions at trace level by flame atomic absorption spectrometry (FAAS) was presented in this study. EDA-SIL was synthesized with 3-(2-aminoethylamino) propyltrimethoxysilane (EDA-silane) and tetraethyl orthosilicate by sol-gel technique performing acidic hydrolysis and basic gelation procedure. EDA-SIL was characterized by FT-IR and C, H, and N elemental analysis. Solid-phase extraction of Ni(II) ions was carried out using mini column filled with EDA-SIL. The important variables governing the recovery of Ni(II) including pH, flow rate, eluent type, eluent volume, and matrix ions were studied. At the optimum preconcentration conditions, the recovery of Ni(II) was found to be 100 +/- 3% at 95% confidence level. The detection limit of Ni(II) was calculated based on the three times of standard deviation of blanks and found to be 0.32 ng mL(-1) using a preconcentration factor of 50. The developed method was validated using certified water samples (Ontario Lake water, NWTMDA-54.4) and applied to synthetic sea water samples for the determination of Ni concentration by FAAS

Altın, palladyum ve bakırın modifiye silika jel ile zenginleştime şartlarının araştırılması

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır.Organ nakli, organ tahsis politikası, web tabnlı uygulama, geniş alan bilgisayar ağları, simülasyon modelleme. Organ nakli, insan vücudunda meydana gelen ve geleneksel medikal yöntemlerle tedavi edilemeyen hastalıkların tedavisinde kullanılan bir yöntemdir. Bugün bu yöntemle, son dönem organ yetmezliği nedeniyle hayatlarının sonuna gelmiş hastalar yeniden sağlıklarına kavuşturulmakta ve bu hastaların yaşam süreleri ve kaliteleri arttırılmaktadır. Organ nakli, birbirine bağlı birden fazla operasyonu içerir. Bu operasyonlar sırası ile vericiden organın alınması, alınan organın değerlendirilmesi, değerlendirilmesi yapılan organ için uygun hastanın tespit edilesi, gereken durumlarda organın veya hastanın nakil merkezine transferi, organın hastaya nakli ve nakil sonrası hastanın izlenmesi şeklindedir. Bugün bütün Dünya ülkelerinde olduğu gibi ülkemizde de organ naklinin tedavide yöntem olarak kullanılması sırasında iki önemli sorunla karşılaşılmaktadır. Bu sorunlardan birincisi, tedavi için organ nakli bekleyen hastalar için yeterli organ kaynağının temin edilememesidir. İkinci sorun ise, oldukça kıt olan bu kaynağın nakil bekleyen hastalara adaletli bir şekilde dağıtımının sağlanamamasıdır. Ülkemizde değişik zamanlarda organ bağışı ve nakli ile ilgili yasal düzenlemeler yapılmış ancak bu güne kadar organ bağışlarının ve naklinin koordinasyonu için başarılı bir sistem oluşturulamamıştır. Türkiye'de organ bağışlarının ve naklinin koordinasyonu için başarılı bir sitem oluşturulamaması, her gün tedavi için organ bekleyen hasta sayısındaki artışa karşılık yapılabilen nakil sayısının düşük kalmasına ve hastaların organ nakli beklerken hayatlarını kaybetmelerine neden olmaktadır. Bu sorunun çözümü, kadavra organ kaynaklarının etkin kullanılmasına bağlıdır. Kadavra organ kaynaklarının etkin kullanılabilmesi için de organ kaynağı merkezleri ile organ nakil merkezleri arasında güçlü bir koordinasyona ihtiyaç vardır. Bu çalışmada, organ kaynağı merkezleri ile organ nakil merkezleri arasında koordinasyonun sağlanması amacıyla bir sistem önerilmiştir. Ayrıca, bağışlanan bir organın en kısa sürede, en uygun şekilde değerlendirilebilmesi için bu sistem içerisinde yer alan organizasyonlar bir bilgisayar ağı altında toplanmış, organ nakli operasyonları ile ilgili bir veritabanı dizayn edilmiş ve bölge koordinasyon merkezleri ile organ nakil merkezlerindeki kullanıcılar için web tabanlı bir uygulama geliştirilmiştir. Bunlara ilave olarak, bilim kurulları tarafından geliştirilen organ tahsis politikalarının uygulamaya başlanmasından önce değerlendirmesini sağlayacak bir simülasyon modeli geliştirilmiştir. Bu çalışmanın sonucunda şu sonuçlara ulaşılmıştır: Organ bağışı ve nakli ile ilgili güçlü sistemler oluşturan ülkeler her geçen gün milyon nüfus başına yapılan organ nakli sayılarını arttırmaktadırlar. Ülkemizde de organ bağışı ve naklinin koordinasyonu için başarılı bir sistem oluşturulması halinde bir yılda yapılan nakil sayısı bugüne göre artacak ve tedavi için organ nakli bekleyen hastaların bekleme listelerinde ölüm oranları düşecektir.DISIGN OF TURKISH ORGAN TRANSPLANTATION NETWORK AND SIMULATION MODEL Key words: Organ transplantation, organ allocation policy, web base applications, wide area computer network, simulation model. Organ transplantation is a treatment of illnesses, which can not be treated with traditional methods. With this treatment, many patients who come to the end of their life as a result of organ insufficiency, are got back their health, quality of life and life span. Organ transplantation is required multi linked-operations. They are; in order, removing an organ from the donor, evaluation the organ, to find appropriate patient for the organ, bringing patient or organ to transplantation centre, making transplantation operation and monitoring the patient. Today in many countries and Turkey, there are two main problems to use of organ transplantation as a treatment. One of the problems, there is no enough donor resource for the waiting patients. The second problem, this limited source is not distributed equitably to the waiting patients. In Turkey, the organ donations and transplantation relating laws were prepared, but until this time a system could not establishment for the co-ordination of the donations and the transplantation centres. Although the waiting list of the organ transplantation is increased day by day, the number of the transplantation operations are low, because of that some patients may loose their life during the waiting for organ transplantation. To solve this problem depends on active using of the cadaver organ sources. To active use of donor sources, it needs better co-ordinations between the organ resource with the transplantation centres

Column solid phase extraction of copper and nickel on triethylenetetramine bonded silica gel for their atomic absorption spectrometric determination

A procedure for the preconcentration of Cu(II) and Ni(II) is proposed using a minicolumn filled with silica gel modified by triethylenetetramine. The retained analytes on the modified silica gel were eluted with hydrochloric acid solution. The metal ions in the eluate were determined by flame atomic absorption spectrometry. The effect of various factors, such as pH of the sample solution, sample volume, flow rate of the sample solution, type of eluent, and matrix content of the sample solution, on preconcentration were examined to obtain optimum conditions. The recoveries for Cu(II) and Ni(II) ions under optimum preconcentration conditions were 98.3 +/- 1.3 and 99.2 +/- 1.4% at 95% confidence level, respectively. The analytical detection limits of Ni and Cu were found to be 0.22 and 0.36 mu g L-1, respectively. The proposed method was applied to the determination copper and nickel in river and synthetic sea water

FAAS Determination of Au and Pd After Selective Preconcentration on Ethylenediamine Silica Material Prepared By the Sol-Gel Method

The recoveries for Au(111) and Pd(II) ions under optimum preconcentration conditions were 99 +/- 2 and 98 +/- 2% at the 95% confidence level, respectively. The analytical detection limits of Au and Pd were 0.20 and 0.21 mu g L-1, respectively. The presented method was validated by the analysis of certified reference platinum ore (SARM7B). The obtained results agreed with the certified values