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

Regla versus discreción en la política fiscal

El presente trabajo formula y evalúa una regla fiscal del 1% del PIB sobre el balance estructural del gobierno de Bolivia para un período retrospectivo (desde 1990 al 2014) y un prospectivo (2016 al 2018), a través de metodologías propuestas por el FMI y la OCDE, en el contexto de una economía guiada por la discrecionalidad y ciclicidad de sus finanzas públicas. Los resultados visibilizan el debate que existe en la teoría económica sobre regla y discreción en las finanzas públicas de un país. Si bien existe un consenso sustancial en la macroeconomía moderna sobre las ventajas de las reglas fiscales ante decisiones discrecionales, sus ventajas no son las mismas si se implementaría en un período de bajo crecimiento económico

Amphora production and the territory of Malaka/Malaka between the 6th and 1st centuries BC. New data from the excavations in the pottery production area of Juan XXIII Avenue

Entre los años 2009 y 2011 se excavaron en la zona de la actual Avenida Juan XXIII de Málaga restos de instalaciones artesanales ubicadas en la periferia de la ciudad antigua, entre los estuarios de los ríos Guadalmedina y Guadalhorce. Los trabajos han permitido documentar una secuencia de ocupación que describe un poblamiento de este sector iniciado probablemente hacia el siglo VI a. C. y que, entre los siglos II-I a. C., fue escenario de la ubicación de un taller alfarero cuya actividad parece prolongarse hasta más allá del Principado. Los abundantes materiales documentados permiten plantear una síntesis sobre la evolución de la producción anfórica malacitana desde una perspectiva tipológica y económica. El trabajo pretende por tanto sistematizar esta novedosa información, establecer una comparación con otros modelos productivos re-gionales (como el de Gadir/Gades) y medir la influencia de los repertorios itálicos en la conformación de las series anfóricas locales de época romano-republicana.Between 2009 and 2011 the remains of several workshops were excavated in the area of the current Juan XXIII Avenue in Malaga, in the rural belt of the ancient city, between the estuaries of the rivers Guadalmedina and Guadalhorce. The fieldwork revealed an unexpected archaeological sequence that suggests that the first Phoenician settlement in this sector probably was established during the 6th century BC. Also, that throughout the 2nd and 1st centuries BC the place was reused for artisanal activities as part of a pottery workshop, that would have been in function further than Augustus era. The study of the abundant materials unearthed makes possible to sketch a first synthesis of the evolution of the transport amphorae production of Malaka from a typological and economic perspective. The work therefore aims to systematize this fresh data, establish a comparison with other regional pottery production models (such as that of Gadir/Gades) and evaluate the influence of the Italic repertoires on the formation of the local amphorae series of the Roman-Republican period.Junta de Andalucía. Consejería de Economía y Conocimiento US-1266376Ministerio de Ciencia e Innovación PID2020-114482GB-I0

Income redistribution in Latin America: A microsimulation approach

We analyse the effect of taxes and benefits on income distribution of six Latin American countries: Argentina, Bolivia, Colombia, Ecuador, Uruguay, and Venezuela. Our analysis makes use of tax-benefit microsimulation models based on harmonized household representative survey data and developed within the structure of EUROMOD. The analysis focuses on the relative importance of tax-benefit instruments across countries and on the effect of taxes and benefits on poverty and inequality. The selected countries represent a wide range of cases in terms of the redistributive role of the tax-benefit system with Uruguay providing a large degree of redistribution, whereas the Bolivian system has a very modest role. We further exploit the advantages of our models and perform a simulation exercise whereby the most progressive income tax system of our set of countries is applied to the rest and assess its effect on inequality and revenue. Our paper represents the first study making use of microsimulation techniques to assess the redistributive role of tax-benefit systems in the region in a comparable manner, and highlights the advantages offered by microsimulation models to evaluate the effect of policy reforms aiming to improve social protection in the region

The role of tax-benefit systems in protecting household incomes in Latin America during the COVID-19 pandemic

The COVID-19 pandemic drastically affected household incomes around the world. In developed economies, pre-pandemic tax-benefit policies and emergency transfers mitigated to a large extent the negative income shock. However, less is known about the effect of government intervention on household incomes in developing countries. The aim of this paper is to assess in a comparative way the role of tax-benefit policies in protecting household incomes during the pandemic in seven Latin American countries: Argentina, Bolivia, Colombia, Ecuador, Mexico, Peru, and Uruguay. Departing from previous studies, we assess the effects both of expanded social assistance programmes and of automatic stabilizers (i.e. pre-pandemic taxes and benefits). We find an important cushioning effect of emergency policies at the bottom of the pre-pandemic income distribution, whereas automatic stabilizers are mostly present at the top of the distribution as a result of reduced social insurance and tax payments during the pandemic

Energy efficiency limits in Photo-CREC-Air photocatalytic reactors

Efficiencies in photocatalytic reactors for air treatment have to be established on the basis of Quantum Yields (QY) and Photochemical Thermodynamic Efficiency Factors (PTEFs) using rigorous methods. This involves the evaluation of absorbed photons on the TiO2 using macroscopic balances. These balances have to account for the incident, the reflected and the transmitted radiation. Moreover, hydroxyl radical formation enthalpy is required for PTEF calculations. This proposed methodology is illustrated in the present study using a spray immobilized photocatalyst in a Photo-CREC-Air unit. The operation of this unit with acetaldehyde model compounds provides high and promising maximum QYs of 124%. These experimentally measured QYs are close to the 133% QY anti cipated theoretical limit. Regarding maximum PTEFs, they were 24%, for acetaldehyde, showing a high degree of photonic energy utilization. Results obtained also allow one to establish the energy required for reacting hydroxyl radical formation, key species for converting organic molecules in photocatalysis. These energy demands affect photoconversion rates and efficiency factors, as observed for acetone and acetaldehyde. Results obtained also demonstrate the special value of experimentally established macroscopic balances. Macroscopic balances allow decoupling photocatalyst efficiency and photoreactor efficiency. This approach is critical to clarify key engineering issues for scaling up photocatalytic reactors

Miradas sobre la economía social y solidaria en América Latina

Insignias notorias de la gran tradición de los pensamientos de la emancipación, los conceptos de revolución y de democracia pudieron pensarse en América Latina, durante los tres primeros lustros de este siglo, en sus diversas y auspiciosas combinaciones. En ese clima de ideas, tan distinto del actual, se puso en marcha años atrás el Programa Regional Democracias en Revolución & Revoluciones en Democracia, cuyos grandes motivos no hay ninguna razón para abandonar y cuyo capítulo argentino se complace en presentar sus resultados por medio de esta serie de libros colectivos. Una cuestión latente en los capítulos de este libro es si se dan o pueden generarse las condiciones para pasar de intentos microeconómicos y políticas públicas coyunturales a la constitución de sujetos sociales y políticos, capaces de imaginar y realizar formas económicas que no solo afirmen la capacidad de autogestión de los trabajadores asociados y mejoren las vidas cotidianas de individuos y grupos particulares, sino que contribuyan a transformar las estructuras que los marginan y subordinan. Destacados autores de Argentina, Brasil, Ecuador, México, Perú y Venezuela problematizan en este volumen los fundamentos, conceptos y prácticas de la economía social y solidaria. Las propuestas de Economía Social y Solidaria han ido ganando un espacio en el discurso de lo alternativo y posible en el campo económico. Sin embargo, su implementación demanda mostrar ejemplos concretos que alcanzaron escala y sustentabilidad. La presentación, en este libro, de cinco experiencias significativas por su alcance y calidad contribuye en este sentido