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 Effect of Storing Produced PV Power on the National Grid

The dramatic increase in renewable sources employment and the new trend to eliminate carbon emissions are the main reasons for using energy storage to overcome the fluctuation of Photovoltaic (PV) output. This paper aims to study the ability of PV solar system, to provide a significant fraction of utility systems energy demand in Jordan. MATLAB software was used to simulate algorithms in order to estimate the storage properties of Energy Capacity (EC), Power Capacity (PC), and Capacity Ratio (CR). These properties are mainly affected by the size of the PV system and the flexibility (ff) of the grid. The hourly generation data from the National Electric Power Company (NEPCO) were investigated to determine the most efficient way to feed PV-generated power into the grid. It was found that for flexibilities (ff) values of 0.7, 0.8, and 1, the No-Dump (ND) PV system, which is the largest PV system that could deliver all its annual production to the grid without any need of spillage of the PV system size were 566.3MW, 998.4MW and 1.6 GW respectively. Also, the relation between Energy Capacity of storage (EC) and Power Capacity (PC) was investigated, it was found that if storage installed with EC and PC equal to 24 GWh (almost 45% of average daily demand) and 3 GW (which is less than the peak hour demand) at ff=0.8, the penetration of PV energy will increase by 42% of annual demand compared with almost 10% without storage. Furthermore, if ff is increased to 1 in parallel to installing storage with energy capacity and power capacity equal to 52.7 GWh and 4.7GW, respectively, the PV penetration will increase to reach 68% of the annual demand compared to 16% without storage

How Students, in an Air Conditioning and Heating Course, Assess the Impact of the COVID-19 Pandemic on the ABET Student Learning Outcomes

The COVID-19 pandemic has forced almost all universities in the world to switch from face-to-face to an online teaching format. In response to this sudden transition, the Mechanical Engineering department at the Al-Zaytoonah University in Jordan had to adapt to this change within two weeks in mid-March 2020. In addition, the department had to comply with the strict ABET accreditation regulations, among which is the indirect assessment of each course by the students each semester. They judge to what degree ABET-mandated student learning outcomes (SO) are actually met in any course designated to deliver the outcomes. Another ABET accreditation regulation is direct assessment, which is conducted by the instructor and relies on an instructor’s own evaluation of tasks designated for certain student learning outcomes. The aim of this study is to determine if, during the COVID-19 pandemic, students’ assessments changed significantly, in accordance with the ABET mandate, by using statistical analyses of students’ responses on an online completed survey. An independent samples t-test was used to evaluate the statistical importance of the observed differences. The SO coverage rates were quite high during the pandemic, although, generally, somewhat lower than their pre-pandemic equivalents. In this study, the Air Conditioning and Heating (ACH) course was selected to compare direct and indirect student learning outcomes before and after the COVID-19 pandemic. Consequently, our findings revealed a positive effect on SO performance during the COVID-19 pandemic and due to e-learning teaching

Finned PV Natural Cooling Using Water-Based TiO₂ Nanofluid

The efficiency of PV (photovoltaic) modules is highly dependent on the operating temperature. The objective of this work is to enhance the performance of PV by passive cooling using aluminum fins that have been nanocoated (like those on an automobile radiator). A rise in the cell temperature of the module PV leads to a decrease in its performance. As a result, an effective cooling mechanism is required. In this work, the performance of the PV module has been improved using natural convection, which was achieved by placing three similar PV modules next to each other in order to test them simultaneously. The first panel will be the base panel and will be used for comparison purposes. An automotive radiator (with aluminum fins) was firmly fixed onto the rear of the other two PV modules, and the fins of the third PV panel had titanium oxide (TiO2) water-based nanofluid applied to them. The power produced by the PV modules, as well as their rear side temperatures, were recorded every 30 min over four months. A temperature reduction of 4.0 °C was attained when TiO2 water-based nanofluid was sprayed onto the panel’s finned rear side. This was followed by the scenario where the rear side was only finned, with a temperature drop of 1.0 °C. As a result of the temperature reduction, the percentage of power produced by the coated-finned PV and the finned PV increased by 5.8 and 1.5 percent, respectively. This caused an increase in PV efficiency of 1.1 percent for coated-finned panels and 0.4 percent for finned PV

How Students, in an Air Conditioning and Heating Course, Assess the Impact of the COVID-19 Pandemic on the ABET Student Learning Outcomes

The COVID-19 pandemic has forced almost all universities in the world to switch from face-to-face to an online teaching format. In response to this sudden transition, the Mechanical Engineering department at the Al-Zaytoonah University in Jordan had to adapt to this change within two weeks in mid-March 2020. In addition, the department had to comply with the strict ABET accreditation regulations, among which is the indirect assessment of each course by the students each semester. They judge to what degree ABET-mandated student learning outcomes (SO) are actually met in any course designated to deliver the outcomes. Another ABET accreditation regulation is direct assessment, which is conducted by the instructor and relies on an instructor’s own evaluation of tasks designated for certain student learning outcomes. The aim of this study is to determine if, during the COVID-19 pandemic, students’ assessments changed significantly, in accordance with the ABET mandate, by using statistical analyses of students’ responses on an online completed survey. An independent samples t-test was used to evaluate the statistical importance of the observed differences. The SO coverage rates were quite high during the pandemic, although, generally, somewhat lower than their pre-pandemic equivalents. In this study, the Air Conditioning and Heating (ACH) course was selected to compare direct and indirect student learning outcomes before and after the COVID-19 pandemic. Consequently, our findings revealed a positive effect on SO performance during the COVID-19 pandemic and due to e-learning teaching

Enhancing Photovoltaic Panel Performance through Hybrid Nanoparticle Cooling: A Study on Zinc Oxide and Aluminum Oxide Nanofluids

High operating temperatures, particularly under conditions of high solar irradiation have adverse effects on the performance of the photovoltaic (PV) panels. The efficiency of electricity generation decreases with an increase in operating temperature, and therefore, minimizing the operating temperature is essential. Thus, efficient cooling systems are of significant importance, particularly in areas with scorching heat during the day. Hybrid nanoparticles have been identified as one of the most effective methods in utilizing the concept of PV cooling because of their special characteristics that can help improve the efficiency of solar panels in the long run. These nanoparticles offer the best heat dissipation and convective heat transfer alongside better light trapping and stability and are relatively cheaper to produce, thus playing a central role in enhancing the cooling effectiveness in photovoltaic systems. In our view, depending on these combined forces, hybrid nanoparticles can enhance the general effectiveness, dependability, and efficacy of solar panels as a high-potential instrument for solar power extraction. This study sought to determine the most effective ZnO and Al₂O₃ Nanofluids concentrations in improving the performance of PV modules. Five PV modules were placed side by side. One of them was a reference sample; the other four were coated on the backside with a range of hybrid nanofluid concentrations. K-type thermocouples were used to monitor the hourly backside thermal profile of each module to ensure thermal integrity. Moreover, a data logger monitored the current and the voltage of each PV during the experiment. In general, the coated modules had significantly better results compared to the control. The best improvement in the generated output power was obtained when 0. 4% Al₂O₃ and 0.2% ZnO reached 28.4% and increased efficiency to 29.6%

The Effect of Nanomaterial Type on Water Disinfection Using Data Mining

Multiple linear regression and artificial neural network (ANN) models were utilized in this study to assess the type influence of nanomaterials on polluted water disinfection. This was accomplished by estimating E. coli (E.C) and the total coliform (TC) concentrations in contaminated water while nanoparticles were added at various concentrations as input variables, together with water temperature, PH, and turbidity. To achieve this objective, two approaches were implemented: data mining with two types of artificial neural networks (MLP and RBF), and multiple linear regression models (MLR). The simulation was conducted using SPSS software. Data mining was revealed after the estimated findings were checked against the measured data. It was found that MLP was the most promising model in the prediction of the TC and E.C concentration, s followed by the RBF and MLR models, respectively

Enhancement of Solar Water Disinfection Using Nanocatalysts

Solar water disinfection (SODIS) is a simple and low-cost method of increasing water quality. However, it takes about 6 hours of exposure to solar radiation. The elimination of harmful pathogenic germs from drinking water can be accelerated using a combination of sun disinfection and nanotechnology. In this study, a hybrid water purification technique using solar water disinfection, Titanium Oxide (TiO2), and natural mineral clays was investigated. TiO2, natural kaolin clay nanoparticles, and a mixture of TiO2 and natural clay were added to contaminated wastewater containers at different concentrations. After that, the containers were exposed to sun light for different time intervals. Samples were then collected from all tests to measure the total counts of Total Coliform and Escherichia coli (E. coli) using the IDEXX system. The results showed that the addition of TiO2 and natural kaolin clay to wastewater with solar water disinfection reduced the total count of the pathogenic microorganisms and decreased the time needed time for the disinfection process compared to using solar energy alone. The results also showed that the optimum concentration of the TiO2, which yielded the shortest purification time and lowest levels of pathogenic microorganisms, was 0.006 g/ml. In co ntrast, the most effective concentratio n of natural clay was 0.0015 g/ml. Moreover, the results showed that the optimum concentration of the mixture of TiO2 and natural clay, which speeds up the purification time an d lowest the level of pathogen ic microorganisms was 0.006 g/ml for TiO2 and 1.2 g/ml for the natural clay

Utilization of Desulfurized Heavy Liquid Fuel Blends in Domestic Boiler

One way to cut down the consumption of diesel fuel in domestic heating in Jordan is to blend it with shale oil, which may be extracted from oil shale. This leads to a cut down in the national fuel bill in Jordan. Unfortunately, shale oil contains significant amounts of sulfur as impurities and upon burning sulfur oxides are emitted causing a negative environmental impact, and hence desulfurization of such fuel blends is essential. This may be achieved by adding activated carbon to the fluids. The process of removing sulfur from shale oil is crucial for safeguarding the environment, human well-being, and equipment, as well as meeting regulatory requirements and creating superior-quality goods. In this study, a domestic boiler was utilized to evaluate the degree of desulfurization process of blends of diesel and shale oil fuels upon their burning in a domestic boiler, to achieve this, blends of both fuels were prepared with varying amounts of shale oil (10%, 20%, 30%, and 40%) and various amounts of activated carbon were added to the prepared mixtures of diesel fuel and shale oil. The assessment of performance included examining the environmental impact, specifically by analyzing exhaust gases to measure the concentration of Sulfur Oxide (SO2). It was found that an increase in the concentration of shale oil in the mixture led to an increase in the concentration of SO2. However, adding more activated carbon to the mixture from the fuels resulted in a decrease in the SO2 concentration. The lowest SO2 concentration was observed when 1g of activated carbon was added per liter of the fuel mixture at a 20% concentration of shale oil, and 0.6g of activated carbon per liter of the fuel mixture at a 40% concentration of oil shale

Utilization of Desulfurized Heavy Liquid Fuel Blends in Domestic Boiler

One way to cut down the consumption of diesel fuel in domestic heating in Jordan is to blend it with shale oil, which may be extracted from oil shale. This leads to a cut down in the national fuel bill in Jordan. Unfortunately, shale oil contains significant amounts of sulfur as impurities, and upon burning, sulfur oxides are emitted, causing a negative environmental impact, and hence desulfurization of such fuel blends is essential. This may be achieved by adding activated carbon to the fluids. The process of removing sulfur from shale oil is crucial for safeguarding the environment, human well-being, and equipment, as well as meeting regulatory requirements and creating superior-quality goods. In this study, a domestic boiler was utilized to evaluate the degree of desulfurization process of blends of diesel and shale oil fuels upon their burning in a domestic boiler. To achieve this, blends of both fuels were prepared with varying amounts of shale oil (10%, 20%, 30%, and 40%) and various amounts of activated carbon were added to the prepared mixtures of diesel fuel and shale oil. The assessment of performance included examining the environmental impact, specifically by analyzing exhaust gases to measure the concentration of Sulfur Oxide (SO2). It was found that an increase in the concentration of shale oil in the mixture led to an increase in the concentration of SO2. However, adding more activated carbon to the mixture from the fuels resulted in a decrease in the SO2 concentration. The lowest SO2 concentration was observed when 1g of activated carbon was added per liter of the fuel mixture at a 20% concentration of shale oil and 0.6g of activated carbon per liter of the fuel mixture at a 40% concentration of oil shale