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

Hotel - Spa en Sot de Chera

El objetivo del proyecto es el beneficio de las cualidades inmediatas del entorno. Se tendrán en cuenta sobre todo aspectos fundamentales como las vistas, la orientación y la garantía de proyectar un espacio funcionalmente viable y de confort. El reto de plantear un hotel+spa en esta ubicación viene dado por varios factores: el manejo de la arquitectura en curvas de nivel, la explotación máxima de los valores arquitectónicos, tales como la relación con el pueblo, las vistas, el río y el paisaje, y la implantación de un edificio que no rompa con la el tejido. El primer paso es establecer las guías del proyecto, marcadas por los siguientes factores: se coge como base el Masterplan del taller efectuado en el curso 2015 2016. Este comprende adición de nuevas calles y cuidado del urbanismo, así como una interacción adecuada con lo ya existente; el programa funcional basado en una correcta y coherente relación con el terreno, la pendiente del mismo y el elemento verde. De manera que, simplificando el análisis del proyecto, el Hotel Spa se organiza en varios niveles de la siguiente manera: se toma como el nivel 0 el paseo adyacente al río. El proyecto se desarrolla entre el mismo, y una nueva calle del masterplan, detrás de los edificios de la calle Valencia. A medida que vamos ascendiendo en altura, un primer nivel lo formaría la planta de instalaciones y una de las dos plantas del restaurante. Un segundo nivel lo conformarían el spa, justo encima de la planta de instalaciones, el parking y la planta primera del restaurante, donde se encontraría la carga y descarga del mismo. Un tercer nivel esta formado por el paquete de administración y sala de conferencias. Un último nivel lo comprenden las habitaciones. La estructura del edificio es de hormigón armado y se utiliza como forjado la losa. El proyecto pretende tener como elemento clave la celosía y el elemento verde, ya que el spa esta organizado según una retícula que incorpora patios. La adaptación al terreno es muy importante, así como la transición de un edificio de grandes dimensiones a la arquitectura humana del pueblo. Se respetan dentro de lo que cabe los bancales y se recurre al mínimo movimiento de tierras. El acceso al hotel spa tiene dos recepciones respectivamente que se efectúan por la nueva calle, que va bajando en pendiente una planta hasta la salida del parking, donde se puede acceder al servicio de carga y descarga. De manera que de una punta del edificio a la otra hay una diferencia de una planta aproximadamente.Gavrila, BN. (2017). Hotel - Spa en Sot de Chera. http://hdl.handle.net/10251/111158TFG

MQL-Assisted Hard Turning of AISI D2 Steel with Corn Oil: Analysis of Surface Roughness, Tool Wear, and Manufacturing Costs

Precision hard turning (HT) gained more and more attention in the cutting industry in the last years due to continuous pressure of the global market for reducing costs, minimizing the environmental and health issues, and achieving a cleaner production. Therefore, dry cutting and minimal quantity lubrication (MQL) became widely used in manufacturing to meet the environmental issues with respect to harmful cutting fluids (CFs). Vegetable oils, in MQL machining, are a promising solutions to petroleum-based CFs; however, the effects and performance on surface roughness and tool wear in HT with ceramic inserts remain unclear. To address this limitation, hardened AIDI D2 steel and pure corn oil, rich in saturated and monounsaturated fatty acids, cheap and widely available, have been used to conduct dry and MQL experiments at different cutting speed and feeds. Results show that corn oil is suitable as cutting lubricant in HT, creating a strong anti-wear and anti-friction lubricating film which improves the roughness with 10–15% and tool life with 15–20%, therefore reducing costs. Best surface roughness values (Ra = 0.151 μm, Rz = 0.887 μm, Rpk = 0.261 μm) were obtained at 180 m/min and 0.1 mm/rev. The analysis of variance shows that corn oil has statistical significance on roughness, validating the results

Molecularly Imprinted Ligand-Free Nanogels for Recognizing Bee Venom-Originated Phospholipase A2 Enzyme

In this study, ligand-free nanogels (LFNGs) as potential antivenom mimics were developed with the aim of preventing hypersensitivity and other side effects following massive bee attacks. For this purpose, poly (ethylene glycol) diacrylate was chosen as a main synthetic biocompatible matrix to prepare the experimental LFNGs. The overall concept uses inverse mini-emulsion polymerization as the main route to deliver nanogel caps with complementary cavities for phospholipase A2 (PLA2) from bee venom, created artificially with the use of molecular imprinting (MI) technologies. The morphology and the hydrodynamic features of the nanogels were confirmed by transmission electron microscopy (TEM) and dynamic light scattering (DLS) analysis. The following rebinding experiments evidenced the specificity of molecularly imprinted LFNG for PLA2, with rebinding capacities up to 8-fold higher compared to the reference non-imprinted nanogel, while the in vitro binding assays of PLA2 from commercial bee venom indicated that such synthetic nanogels are able to recognize and retain the targeted PLA2 enzyme. The results were finally collaborated with in vitro cell-viability experiments and resulted in a strong belief that such LFNG may actually be used for future therapies against bee envenomation