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

The Relationship Between Sleep Disturbances and Perceived Injury Severity

There is growing evidence supporting the relationship between sleep disturbances and the development of post-traumatic stress disorder. Post-traumatic stress disorder is a psychological phenomenon that potentially affects those whom experience a severe traumatic event in his/her life. As a result, the traumatic event can trigger a fight-or-flight response that ultimately determines how the given situation is psychologically recovered. Depending on the individual, one recovers from these experiences in a variety of ways, both positively and negatively. Those who continue to experience negative psychological and/or physical instabilities may ultimately be diagnosed with post-traumatic stress disorder. It is hypothesized that individuals with sleep disturbances may therefor perceive a traumatic event as more severe on self-reported questionnaires. Thus, individuals with sleep disturbances may not only be at a higher risk of developing post-traumatic stress disorder, but receiving successful psychological treatment in regards to his/her experience of a traumatic event. This may be indicative of the success of future treatments to impede the development of post-traumatic stress disorder. Sleep disturbances were determined using the Pittsburg Sleep Quality Index among 52 individuals, and perceived trauma severity was determined from self-reported questionnaires. Given prior research, along with any correlation found in this study, further research may seek to explore if treatment of sleep disturbances in individuals with post-traumatic stress disorder (or suspected development of post-traumatic stress disorder) may lead to a greater degree of successful psychological trauma treatment. Treatment for post-traumatic stress disorder, upon data calculation, may hold ramifications for treatment design. Data collected for this hypothesis is in the process of being analyzed and concluded

Impaired H-Reflex Gain during Postural Loaded Locomotion in Individuals Post-Stroke

Successful execution of upright locomotion requires coordinated interaction between controllers for locomotion and posture. Our earlier research supported this model in the non-impaired and found impaired interaction in the post-stroke nervous system during locomotion. In this study, we sought to examine the role of the Ia afferent spinal loop, via the H-reflex response, under postural influence during a locomotor task. We tested the hypothesis that the ability to increase stretch reflex gain in response to postural loads during locomotion would be reduced post-stroke

Criteria for the definition of Pituitary Tumor Centers of Excellence (PTCOE): A Pituitary Society Statement

Introduction: With the goal of generate uniform criteria among centers dealing with pituitary tumors and to enhance patient care, the Pituitary Society decided to generate criteria for developing Pituitary Tumors Centers of Excellence (PTCOE). Methods: To develop that task, a group of ten experts served as a Task Force and through two years of iterative work an initial draft was elaborated. This draft was discussed, modified and finally approved by the Board of Directors of the Pituitary Society. Such document was presented and debated at a specific session of the Congress of the Pituitary Society, Orlando 2017, and suggestions were incorporated. Finally the document was distributed to a large group of global experts that introduced further modifications with final endorsement. Results: After five years of iterative work a document with the ideal criteria for a PTCOE is presented. Conclusions: Acknowledging that very few centers in the world, if any, likely fulfill the requirements here presented, the document may be a tool to guide improvements of care delivery to patients with pituitary disorders. All these criteria must be accommodated to the regulations and organization of Health of a given country

A Multi-Country Test of Brief Reappraisal Interventions on Emotions during the COVID-19 Pandemic

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 12 May 2020. The protocol, as accepted by the journal, can be found at https://doi.org/10.6084/m9.figshare.c.4878591.v1

The very forward CASTOR calorimeter of the CMS experiment

The physics motivation, detector design, triggers, calibration, alignment, simulation, and overall performance of the very forward CASTOR calorimeter of the CMS experiment are reviewed. The CASTOR Cherenkov sampling calorimeter is located very close to the LHC beam line, at a radial distance of about 1cm from the beam pipe, and at 14.4m from the CMS interaction point, covering the pseudorapidity range of -6.6 &lt; η &lt; -5.2. It was designed to withstand high ambient radiation and strong magnetic fields. The performance of the detector in measurements of forward energy density, jets, and processes characterized by rapidity gaps, is reviewed using data collected in proton and nuclear collisions at the LHC

The very forward CASTOR calorimeter of the CMS experiment

International audienceThe physics motivation, detector design, triggers, calibration, alignment, simulation, and overall performance of the very forward CASTOR calorimeter of the CMS experiment are reviewed. The CASTOR Cherenkov sampling calorimeter is located very close to the LHC beam line, at a radial distance of about 1 cm from the beam pipe, and at 14.4 m from the CMS interaction point, covering the pseudorapidity range of $-$6.6 $\lt\eta\lt$ $-$5.2. It was designed to withstand high ambient radiation and strong magnetic fields. The performance of the detector in measurements of forward energy density, jets, and processes characterized by rapidity gaps, is reviewed using data collected in proton and nuclear collisions at the LHC