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

Evaluation of Global Solar Irradiance Estimates from GL1.2 Satellite-Based Model over Brazil Using an Extended Radiometric Network

The GL (GLobal radiation) physical model was developed to compute global solar irradiance at ground level from (VIS) visible channel imagery of geostationary satellites. Currently, its version 1.2 (GL1.2) runs at Brazilian Center for Weather Forecast and Climate Studies/National Institute for Space Research (CPTEC/INPE) based on GOES-East VIS imagery. This study presents an extensive validation of GL1.2 global solar irradiance estimates using ground-based measurements from 409 stations belonging to the Brazilian National Institute of Meteorology (INMET) over Brazil for the year 2016. The INMET reasonably dense network allows characterizing the spatial distribution of GL1.2 data uncertainties. It is found that the GL1.2 estimates have a tendency to overestimate the ground data, but the magnitude varies according to region. On a daily basis, the best performances are observed for the Northeast, Southeast, and South regions, with a mean bias error (MBE) between 2.5 and 4.9 W m&minus;2 (1.2% and 2.1%) and a root mean square error (RMSE) between 21.1 and 26.7 W m&minus;2 (10.8% and 11.8%). However, larger differences occur in the North and Midwest regions, with MBE between 12.7 and 23.5 W m&minus;2 (5.9% and 11.7%) and RMSE between 27 and 33.4 W m&minus;2 (12.7% and 16.7%). These errors are most likely due to the simplified assumptions adopted by the GL1.2 algorithm for clear sky reflectance (Rmin) and aerosols as well as the uncertainty of the water vapor data. Further improvements in determining these parameters are needed. Additionally, the results also indicate that the GL1.2 operational product can help to improve the quality control of radiometric data from a large network, such as INMET\u27s. Overall, the GL1.2 data are suitable for use in various regional applications

Índice Ultravioleta em Maceió, al: Análise Preliminar

The goal of this work was to evaluate the UV index daily variationin Maceió, Alagoas. Sensors were used in the solar ultraviolet radiationspectrum with spectral range of 290-390nm and overall (300-1100nm)installed at 2m above the surface. Measurements were taken on days 11to 15 of July, 2009. The highest values were observed in the IUV timenext to midday, and high to very high. Until 9 a.m. and after 15 p. m.localtime, the index was between low to moderate. The duration in hours ofIUV considered high by the World Health Organization wasapproximately 4 hours.Este trabalho teve como objetivo avaliar a variação diária doíndice ultravioleta em Maceió, Alagoas. Foram utilizados sensores deradiação solar no espectro ultravioleta com faixa espectral de 290-390 nme global (300-1100nm) instalados a 2m acima da superfície. As medidasforam realizadas nos dias 11 a 15 de julho de 2009. Os maiores valoresdo IUV, entre alto e muito alto, foram observados em horários próximosao meio-dia. Até as 9 h e após as 15 h, horário local, o índice esteveentre baixo e moderado. A duração diária, em horas de IUV consideradoelevado pela Organização Mundial de Saúde, foi aproximadamente 4horas

Crescimento e fotossíntese de cana-de-açúcar em função de variáveis biométricas e meteorológicas Growth and photosynthesis of sugarcane based on biometric and meteorological variables

O crescimento da cana-de-açúcar pode ser obtido por modelos biofísicos em que a fotossíntese bruta (FB) é obtida em função da radiação solar. O objetivo do trabalho é avaliar variedades de canas-de-açúcar em regime irrigado em relação à radiação fotossinteticamente ativa interceptada (RFAINT) e a estimativa da FB acumulada. Para isto, conduziu-se um estudo na Universidade Federal de Alagoas, entre 2008 e 2009, com variedades de cana RB. Foram realizadas medidas biométricas, variáveis de produção e dos elementos meteorológicos. A irradiância fotossintética (RFA) interceptada foi obtida pela diferença entre RFA e RFA transmitida (RFAT). A RFAT foi determinada pela Lei de Beer. Na estimativa da FB diária usou-se uma integração numérica, com uma abordagem trapezoidal. As variáveis de produção tiveram correlações com a RFAINT acumulada e com a FB acumulada durante o ciclo. A média da irradiação solar global diária do período chuvoso da região (maio - agosto) foi igual a 14,9 MJ m-2. A variedade RB92579 teve os maiores variáveis de produção, como também maiores RFA interceptada e FB acumuladas no ciclo, devido à sua maior capacidade de rebrotação e conversão de energia em fotoassimilados.<br>Sugarcane growth can be obtained by biophysical models in which gross photosynthesis (GP) is obtained as a function of solar radiation. This work aims to evaluate sugarcane varieties under irrigation in relation to intercepted photosynthetic active radiation (PARint) and the estimated accumulative GP. To achieve that, a study was conducted at the Federal University of Alagoas during 2008 and 2009, with RB sugarcane varieties. Biometric measurements, production variables and meteorological elements were made. The intercepted photosynthetic irradiance (PAR) was obtained by the difference between PAR and transmitted PAR (PART), which was determined by Beer's Law. The daily GP was estimated numerically by the trapezoidal approach. The production variables had correlations with accumulated PARint and accumulated GP during the crop cycle. The average global solar radiation in the region for rainy season (May-August) was 14.9 MJ m-2. The variety RB92579 had the highest production variables as well as higher intercepted PAR and accumulated GP in the cycle due to its greater capacity for regrowth and energy conversion in photoassimilate