Key Protected Classification for Collaborative Learning

Large-scale datasets play a fundamental role in training deep learning models. However, dataset collection is difficult in domains that involve sensitive information. Collaborative learning techniques provide a privacy-preserving solution, by enabling training over a number of private datasets that are not shared by their owners. However, recently, it has been shown that the existing collaborative learning frameworks are vulnerable to an active adversary that runs a generative adversarial network (GAN) attack. In this work, we propose a novel classification model that is resilient against such attacks by design. More specifically, we introduce a key-based classification model and a principled training scheme that protects class scores by using class-specific private keys, which effectively hide the information necessary for a GAN attack. We additionally show how to utilize high dimensional keys to improve the robustness against attacks without increasing the model complexity. Our detailed experiments demonstrate the effectiveness of the proposed technique. Source code is available at https://github.com/mbsariyildiz/key-protected-classification.Comment: Accepted to Pattern Recognitio

Relationship between food insecurity and geriatric syndromes in older adults: A multicenter study in Turkey

Aims: In this study, the aim was to determine the prevalence of geriatric syndromes such as frailty, sarcopenia risk and malnutrition in older adults and to investigate the relationship between food insecurity, and frailty, risk of sarcopenia and malnutrition. Methods: The study was cross-sectional. It was conducted between February 2022 and June 2022 with 707 older adults. The data were collected through the face-to-face interview method with a questionnaire including the Descriptive Information Form, Household Food Insecurity Access Scale (HFIAS), Frail Scale, Sarcopenia Risk Screening Scale (SARC-F) and Mini Nutritional Assessment-Short Form (MNA-SF). Numbers, percentages, mean, standard deviation, Pearson chi-square test and binary logistic regression analysis were used in data analysis. Results: In the present sample, 30% of the participants experienced some degree of food insecurity. The prevalence of frailty, sarcopenia risk, and malnutrition in the participants was 15.3%, 19.5%, and 1.3%, respectively. We determined that food insecurity was not associated with pre-frailty/frailty and sarcopenia risk. After adjusment for potential counfounders moderate and severe food insecurity was associated with higher odds of malnutrition risk and malnutrition (AOR: 2.06, 95% CI: 1.21–3.51, p:0.007). Conclusion: While food insecurity is not associated with pre-frailty/frailty and sarcopenia risk, moderate and severe food insecurity is a modifiable risk factor for malnutrition risk and malnutrition. Thus, economic and social policies to eliminate food insecurity should be implemented, and efforts to prevent food insecurity should be planned through inter-sectoral cooperation

A qualified dry-type transformer under the combined seismic conditions

This article presents the design, seismic simulation, and seismic testing of a 2500 kVA 36 kV 7.7-ton dry-type transformer designed to withstand the rigorous IEEE693-2018 moderate-level seismic test involving dynamic forces in the range of 0-55 Hz and 0.5 g acceleration. The testing was conducted at IAGB Test Company in Munich, Germany, and we are pleased to report that the test was successfully completed. Remarkably, the transformer design eliminates the need for additional consoles or supports, achieving stability solely through the use of eight M24 fasteners for secure grounding. This innovative approach ensures the transformer’s resilience under seismic conditions, addressing critical considerations for power infrastructure in earthquake-prone regions. The results and implications of this seismic testing contribute valuable insights to the field of transformer design and seismic resilience

Complication of occurring after bariatric surgery: Micronutrient deficiencies: Traditional review

Obezite, modern dünyanın karşı karşıya olduğu ciddi bir sağlık sorunudur ve son yıllarda görülme sıklığı endişe verici düzeyde artmıştır. Tedavi seçenekleri arasında diyet ve egzersiz gibi yaşam tarzı değişiklikleri ile farmakolojik ve cerrahi prosedürler yer almaktadır. Bariyatrik cerrahi, ileri derecede obez ve komorbiditeleri olan hastalara uygulanan yöntemdir. Cerrahi prosedürler genellikle; besin alımını kısıtlayıcı, malabsorptif ve hem besin alımını kısıtlayıcı hem de malabsorptif prosedürlerin kombinasyonu olarak sınıflandırılmaktadır. Cerrahiden sonra hastalarda mikro besin ögesi eksiklikleri gibi bazı komplikasyonlar meydana gelebilmektedir. Bu eksikliklerin oluşma nedenleri arasında hastaya ve cerrahi yönteme bağlı değişkenler bulunmaktadır. Hastaya bağlı değişkenler arasından özellikle bireye ve yapılan cerrahi işleme özel oluşturulmuş, beslenme programına uymama ve önerilen besin desteklerini kullanmama ön plana çıkarken, ameliyata bağlı değişkenler ise besin alımını kısıtlayıcı ve malabsorptif olan prosedürlere göre değişiklik göstermektedir. Bariyatrik cerrahi sonrasında en çok görülen mikro besin ögesi eksiklikleri arasında; tiamin, B12 vitamini, folat, demir, D, A ve K vitaminleri, çinko ve bakır bulunmaktadır. Ayrıca preoperatif dönemde bu mikro besin ögelerinin eksikliklerinin olması, postoperatif dönemde daha ciddi komplikasyonları meydana getirmektedir. Bariyatrik cerrahi sonucu görülen bu eksikliklerin yönetiminde, hastaların yaşam boyu takip edilmesi en önemli basamağı oluşturmaktadır. Özellikle hastaların, cerrahi sonrası önerilen besin desteklerine bağlı kalmaları ve tıbbi beslenme tedavisine yüksek düzeyde uyum göstermeleri gerekmektedir. Ek olarak, besin desteklerinden bazılarının birbirinin emilimini etkilemesinden dolayı uygun doz ve zaman ayarlamaları doğru bir biçimde yapılmalıdır. Bu derleme yazının amacı, bariyatrik cerrahi hastalarında postoperatif dönemde görülen mikro besin ögesi eksikliklerini tanımlamak ve bu eksikliklerin oluşmasındaki nedenler ile bunların önlenmesi hakkında literatürde yer alan güncel bilgilerin sunulmasıdır.Obesity is a serious health problem facing the modern world, and its incidence has increased at an alarming rate in recent years. Treatment options include lifestyle changes such as diet and exercise and pharmacological and surgical procedures. Bariatric surgery is a method applied to patients with advanced obese and comorbidities. Surgical procedures are generally classified into restrictive, malabsorptive, or a combination of restrictive and malabsorptive elements. Some complications such as micronutrient deficiencies can occur in patients after surgery. Among the reasons for the occurrence of these deficiencies are variables depending on the patient and the surgical method. While among the patient-dependent variables came to the fore noncompliance with the nutrition program created specifically for the individual and the surgical procedure and not using the recommended dietary supplements, variables related to surgery differ according to procedures that restrictive and malabsorptive. Thiamine, vitamin B12, folate, iron, vitamins D, A, and K, zinc, and copper are the most common micronutrient deficiencies after bariatric surgery. Besides, have deficiencies of these micronutrients in the preoperative period occurs more serious complications in the postoperative period. Lifelong follow-up of patients is the most important step in the management of these deficiencies as a result of bariatric surgery. In particular, patients need to adhere to the recommended dietary supplements after surgery and to comply with medical nutrition therapy at a high level. Also, because some of these nutritional supplements interfere with each other's absorption, appropriate dosage and time adjustments must be made correctly. The purpose of this review is; to describe the micronutrient deficiencies observed in the postoperative period in bariatric surgery patients and to present the current information in the literature about the reasons for the occurrence of these deficiencies and their prevention

Comparison of posterior cranial fossa morphometric measurements in Chiari type I patients with and without syrinx cavity on magnetic resonance imaging

Purpose: To compare the posterior fossa measurements of Chiari type I malformation (CHM1) patients with and without syrinx and with a control group. Material and methods: The patients with syrinx were divided into 2 groupd according to syrinx width/cord width (S/C) ratios: group 1 – S/C ratio 50%. The length of the clivus, the AP length of the foramen magnum, the AP length of the posterior fossa, the perpendicular distance between the McRae line and (a) the splenium of corpus callosum, (b) the pons, and (c) the fastigium of the 160 patients and of the 160 control patients were statistically compared. In addition, the measurements of the patients with and without syrinx, according to the S/C ratio, were statistically compared. Results: Syrinx was present in 59 (36.8 %) of the 160 patients. The S/C ratio was 50% in 29 (49.1%) of them. All the measurements in the patient group, except of the AP length of the foramen magnum, were statistically significantly lower than in the control group (p = 0.001). There was no signif icant difference in the measurements of the patients with syrinx group 1 and the patients without syrinx, but the AP length of posterior fossa was statistically significantly lower in the patients with syrinx group 2 than the patients without syrinx (p = 0.03). Conclusion: The S/C ratio can be a guide to the underlying aetiology

The effect of N95 respirators on vital parameters, PETCO2, among healthcare providers at the pandemic clinics

Background Wearing face shields and masks, which used to have very limited public use before the COVID-19 outbreak, has been highly recommended by organizations, such as CDC and WHO, during this pandemic period. Aims The aim of this prospective study is to scrutinize the dynamic changes in vital parameters, change in end tidal CO2 (PETCO2) levels, the relationship of these changes with taking a break, and the subjective complaints caused by respiratory protection, while healthcare providers are performing their duties with the N95 mask. Methods The prospective cohort included 54 healthcare workers (doctors, nurses, paramedics) who worked in the respiratory unit of the emergency department (ED) and performed their duties by wearing valved N95 masks and face shields. The vital parameters and PETCO2 levels were measured at 0-4th-5th and 9th hours of the work-shift. Results Only the decrease in diastolic BP between 0 and 9 h was statistically significant (p = 0.038). Besides, mean arterial pressure (MAP) values indicated a significant decrease between 0-9 h and 5-9 h (p = 0.024 and p = 0.049, respectively). In terms of the vital parameters of the subjects working with and without breaks, only PETCO2 levels of those working uninterruptedly increased significantly at the 4th hour in comparison to the beginning-of-shift baseline levels (p = 0.003). Conclusion Although the decrease in systolic blood pressure (SBP) and MAP values is assumed to be caused by increased fatigue due to workload and work pace as well as increase in muscle activity, the increase in PETCO2 levels in the ED healthcare staff working with no breaks between 0 and 4 h should be noted in terms of PPE-induced hypoventilation

Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience

Background/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population.Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed.Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.Turkish Association for the Study of The Liver (TASL

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

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