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

Natural photosensitizers in photodynamic therapy: In vitro activity against monolayers and spheroids of human colorectal adenocarcinoma SW480 cells

Photodynamic Therapy (PDT), is a treatment option for cancer.It involves the photochemical interaction of light, photosensitizer (PS) and molecular oxygen to produce radical species as well as singlet oxygen which induce cell death. Anthraquinones (AQs) have been extensively studied with respect to their UV/Vis absorption characteristics and their photosensitizing properties in photodynamic reactions. We study the photoactivity of different natural AQs (Parietin, Soranjidiol and Rubiadin) in treating monolayers and multicellular tumor spheroids (MCTSs). Rubiadin and soranjidiol were isolated and purified from the stem and leaves of Heterophyllae pustulata, and PTN was from the liquen Teloschistes flavicans by using repeated combination of several chromatographic techniques. Monolayer and spheroids of human colorectal adenocarcinoma SW480 cells were incubated with different concentrations of the AQs and then irradiated at room temperature. 24 h post-PDT cell viability, nuclear morphology and type of cell death were analyzed. We observed that Soranjidiol and Rubiadin showed no significant difference in the photosensitizing ability on monoculture of colon cancer cells (LD80 at 50 μM and 10 J/cm2, for both AQs). Nevertheless, for Parietin (PTN) LD80 was achieved at (20 μM using the same light dose (10 J/cm2). The death mechanism induced post-PDT was necrosis by use of Soranjidol and Rubiadin and apoptosis by use of PTN. Furthermore, in MCTSs of 300 and 900 μm, the treatment PTN- PDT produces the greatest cytotoxic effect. The three AQs analyzed could be promising chemotherapeutic candidates as anticancer PDT agents.Fil: Cogno, Ingrid Sol. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas Fisicoquímicas y Naturales. Departamento de Biología Molecular; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; ArgentinaFil: Gilardi, Pamela Agustina. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas Fisicoquímicas y Naturales. Departamento de Biología Molecular; ArgentinaFil: Comini, Laura Raquel. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas; Argentina. Provincia de Córdoba. Ministerio de Ciencia y Técnica. Centro de Excelencia en Productos y Procesos de Córdoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; ArgentinaFil: Núñez Montoya, Susana Carolina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Cabrera, Jose Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Rivarola, Viviana Alicia. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas Fisicoquímicas y Naturales. Departamento de Biología Molecular; Argentin

An adaptive algorithm for restoring image corrupted by mixed noise

In this work, numerical results of a nonlinear switching system that presents bistable attractors subjected to stochastic modulation are shown. The system exhibits a dynamical modification of the bistable attractor, giving rise to an intermit behavior, which depends of modulation strength. The resulting attractor converge to an intermittent double-scroll, for low amplitude modulation, and a 9-scroll attractor for a higher applied noise amplitude. A Detrended Fluctuation Analysis (DFA) applied to the x state variable, shows a perturbations robustness region, since the increase of noise does not present changes. Due to the applied noise, the final obtained system has higher randomness, compared with the original one. The understanding of the dynamical behavior of multiscrolls systems is highly important for advancing technology in communications, as well in memory systems applications.</jats:p

A Systematic Investigation of Beam Losses and Position-Reconstruction Techniques Measured with a Novel oBLM at CLEAR

Optical Beam-Loss Monitors (oBLMs) allow for cost-efficient and spatially continuous measurements of beam losses at accelerator facilities. A standard oBLM consists of several tens of metres of optical fibre aligned parallel to a beamline, coupled to photosensors at either or both ends. Using the timing information from loss signals, the loss positions can be reconstructed. This paper presents a novel oBLM system recently deployed at the CERN Linear Electron Accelerator for Research (CLEAR). Multiple methods of extracting timing and position information from measured waveforms with silicon photomultipliers (SiPM) and photomultiplier tubes (PMT) are investigated. For this installation, the optimal approach is determined to be applying a constant fraction discrimination (CFD) on the upstream readout. The position resolution is found to be similar for the tested SiPM and PMT. This work has resulted in the development of a user interface to aid operations by visualising the beam losses and their positions in real time.</jats:p

Beyond Chaos in Fractional-Order Systems: Keen Insight in the Dynamic Effects

Fractional calculus (or arbitrary order calculus) refers to the integration and derivative operators of an order different than one and was developed in 1695. They have been widely used to study dynamical systems, especially chaotic systems, as the use of arbitrary-order operators broke the milestone of restricting autonomous continuous systems of order three to obtain chaotic behavior and triggered the study of fractional chaotic systems. In this paper, we study the chaotic behavior in fractional systems in more detail and characterize the geometric variations that the dynamics of the system undergo when using arbitrary-order operators by asking the following question: is the Lyapunov exponent sufficient to describe the dynamical variations in a chaotic system of fractional order? By quantifying the convex envelope generated by the 2D projection of the system into all its phase portraits, the changes in the area of the system, as well as the volume of the attractor, are characterized. The results are compared with standard metrics for the study of chaotic systems, such as the Kaplan&ndash;Yorke dimension and the fractal dimension, and we also evaluate the frequency fluctuations in the dynamical response. It is found that our methodology can better describe the changes occurring in the systems, while the traditional dimensions are limited to confirming chaotic behaviors; meanwhile, the frequency spectrum hardly changes. The results deepen the study of fractional-order chaotic systems, contribute to understanding the implications and effects observed in the dynamics of the systems, and provide a reference framework for decision-making when using arbitrary-order operators to model dynamical systems

Territorios y producción en el noreste de la Patagonia

El enfoque territorial del desarrollo constituye una novedad que se está consolidando en la construcción y orientación de las políticas públicas para las zonas rurales de la Argentina. Existe cierto consenso en la potencia de este abordaje para superar el diseño de políticas basadas en un Estado protagonista casi excluyente y con una mirada sectorial, que muestra señales de agotamiento por los dispares resultados alcanzados en la mejora de las condiciones económicas y sociales. La re formulación de estas políticas para enfocarlas en el territorio con nuevas articulaciones interinstitucionales y con amplia participación social, en un modelo de aprendizaje colectivo, constituye una nueva aproximación para enfrentar el problema de comunidades que deben elegir nuevos senderos de desarrollo. Por otro lado, esta mirada permite rescatar una vieja tradición basada en el esfuerzo privado que existió y existe en la Argentina, que tiene reconocidos méritos y una enorme importancia socio-productiva y económica. Estos emprendimientos son impulsados por lo general por pequeños y medianos empresarios o por organizaciones asociativas como cooperativas con gran compromiso social, que logran construir empresas en el sentido de acciones o tareas que demandan esfuerzo y trabajo, que muestran capacidad de sustentación y de mejora del colectivo social que las integran. La articulación público-privada para el desarrollo de nuevas instituciones que actúen como verdaderos nodos de redes socio-técnicas densas en las que circulan los conocimientos codificados o tácitos desarrollados por el saber hacer de los productores y empresarios, sumados a investigadores e innovadores de todo tipo y naturaleza, el aumento del potencial de captar alternativas de financiamiento de grupos organizados, el incremento de la capacidad de agregar y retener valor “in situ” creando nuevos productos, la capacidad de organizarse para administrar recursos críticos como el agua y la vegetación en zonas áridas y el incremento de la capacidad de negociación comercial, son algunos de los atributos que presenta este abordaje de lo territorial. Este libro presenta trabajos realizados en el marco del proyecto de investigación “Políticas Públicas y Aglomeraciones Productivas” (04/V091), del Centro Regional Zona Atlántica de la Universidad Nacional del Comahue, dirigido por el Mg. Pablo Ricardo Tagliani y codirigido por el Mg. Héctor M. Villegas Nigra.EEA Valle InferiorFil: Alder, Maite. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Valle Inferior; ArgentinaFil: Cariac, Germán E. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Valle Inferior; ArgentinaFil: Gallego, Juan José. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Valle Inferior; ArgentinaFil: Gallo, Silvia Laura. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Valle Inferior; ArgentinaFil: Fuente, Gastón E. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Valle Inferior; ArgentinaFil: Martin, Dario. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Valle Inferior; ArgentinaFil: Nuñez, Adrián Humberto. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Valle Inferior; ArgentinaFil: Viretto, Juan Pablo. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Valle Inferior; ArgentinaFil: Main, Carlos Alberto. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Valle Inferior; ArgentinaFil: Bouhier, Rodolfo Abel. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Valle Inferior; ArgentinaFil: Carusso, Gabriel. Universidad Nacional del Comahue; ArgentinaFil: Di Nardo, Yanina. Instituto de Desarrollo del Valle Inferior; ArgentinaFil: Garcia Vinent, Juan Carlos. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Valle Inferior; ArgentinaFil: Gilardi, María Elvira. Instituto de Desarrollo del Valle Inferior; ArgentinaFil: Giorgetti, Hugo. Provincia de Buenos Aires. Ministerio de Asuntos Agrarios. Chacra Experimental de Patagones; ArgentinaFil: Miñón, Daniel J. Universidad Nacional del Comahue; ArgentinaFil: Miñon, Daniel Pedro. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Valle Inferior; ArgentinaFil: Perlo, Alberto Mario. Profesional Asociado de INTA; ArgentinaFil: Rodriguez, Gustavo D. Provincia de Buenos Aires. Ministerio de Asuntos Agrarios. Chacra Experimental de Patagones; ArgentinaFil: Tamburo, Leticia Gabriela. Instituto Nacional de Tecnología Agropecuaria (INTA). Gerencia de Monitoreo y Evaluación; ArgentinaFil: Villegas Nigra, Mario. Universidad Nacional del Comahue; Argentin

Global research priorities to mitigate plastic pollution impacts on marine wildlife

Marine wildlife faces a growing number of threats across the globe, and the survival of many species and populations will be dependent on conservation action. One threat in particular that has emerged over the last 4 decades is the pollution of oceanic and coastal habitats with plastic debris. The increased occurrence of plastics in marine ecosystems mirrors the increased prevalence of plastics in society, and reflects the high durability and persistence of plastics in the environment. In an effort to guide future research and assist mitigation approaches to marine conservation, we have generated a list of 16 priority research questions based on the expert opinions of 26 researchers from around the world, whose research expertise spans several disciplines, and covers each of the world’s oceans and the taxa most at risk from plastic pollution. This paper highlights a growing concern related to threats posed to marine wildlife from microplastics and fragmented debris, the need for data at scales relevant to management, and the urgent need to develop interdisciplinary research and management partnerships to limit the release of plastics into the environment and curb the future impacts of plastic pollution