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

Caracterización de los sistemas de captación de agua de los cantones de Hojancha y Nicoya, en Guanacaste, Costa Rica

Capítulo 2 del libro digital: Clima, agua y producción sostenible: Aportes desde la acción académica CEMEDE - HIDROCECEn esta investigación se caracterizaron los sistemas de captación de agua en los cantones de Hojancha y Nicoya, en Guanacaste, Costa Rica. Específicamente, se documentaron las razones que incentivaron a los agricultores a construir estos sistemas. Adicionalmente, se analizó la percepción de los agricultores acerca del estado actual del funcionamiento de estos sistemas, así como, de los beneficios obtenidos durante los meses de aridez estacional. La información fue obtenida por medio de visitas a las fincas, registrando la ubicación espacial de los sistemas, tomando fotografías del estado actual de la infraestructura de los sistemas. Además, se utilizaron encuestas que fueron aplicadas en finca, a los once dueños de sistemas de captación de agua. El diseño colaborativo de la metodología, así como el trabajo de campo, la transcripción de las encuestas y el análisis de la información fue realizada por los estudiantes y académicos de la Universidad Nacional (UNA). Los productores encuestados establecieron que el principal beneficio de los sistemas de captación es que pueden proporcionar el agua necesaria para desarrollar actividades agropecuarias durante la aridez estacional (seis meses). Esta es la temporada más difícil para el desarrollo de la ganadería y la agricultura en estos cantones. Los sistemas de captación de agua les permiten adaptarse a los problemas de escasez hídrica que se han agravado en los últimos diez años. A partir del análisis de los resultados, se identificaron oportunidades para mejorar el diseño técnico de los sistemas, así como, la necesidad de continuar investigando, a fin de, evaluar la eficiencia de la tecnología y las implicaciones de implementar los sistemas de captación de agua, para solventar la disponibilidad hídrica en la región.Centro Mesoamericano de Desarrollo Sostenible del Trópico Seco (CEMEDE-UNA)Universidad Nacional, Costa RicaUniversidad Nacional, Sede Regional Chorotega, Costa RicaCentro Mesoamericano de Desarrollo Sostenible del Trópico Seco (CEMEDE-UNA

Skewness and kurtosis of mean transverse momentum fluctuations at the LHC energies

International audienceThe first measurements of skewness and kurtosis of mean transverse momentum ($\langle p_\mathrm{T}\rangle$) fluctuations are reported in Pb$-$Pb collisions at $\sqrt{s_\mathrm{NN}}$ = 5.02 TeV, Xe$-$Xe collisions at $\sqrt{s_\mathrm{NN}}$$=$ 5.44 TeV and pp collisions at $\sqrt{s} = 5.02$ TeV using the ALICE detector. The measurements are carried out as a function of system size $\langle \mathrm{d}N_\mathrm{ch}/\mathrm{d}\eta\rangle_{|\eta|<0.5}^{1/3}$, using charged particles with transverse momentum ($p_\mathrm{T}$) and pseudorapidity ($\eta$), in the range $0.2 < p_\mathrm{T} < 3.0$ GeV/$c$ and $|\eta| < 0.8$, respectively. In Pb$-$Pb and Xe$-$Xe collisions, positive skewness is observed in the fluctuations of $\langle p_\mathrm{T}\rangle$ for all centralities, which is significantly larger than what would be expected in the scenario of independent particle emission. This positive skewness is considered a crucial consequence of the hydrodynamic evolution of the hot and dense nuclear matter created in heavy-ion collisions. Furthermore, similar observations of positive skewness for minimum bias pp collisions are also reported here. Kurtosis of $\langle p_\mathrm{T}\rangle$ fluctuations is found to be in good agreement with the kurtosis of Gaussian distribution, for most central Pb$-$Pb collisions. Hydrodynamic model calculations with MUSIC using Monte Carlo Glauber initial conditions are able to explain the measurements of both skewness and kurtosis qualitatively from semicentral to central collisions in Pb--Pb system. Color reconnection mechanism in PYTHIA8 model seems to play a pivotal role in capturing the qualitative behavior of the same measurements in pp collisions

Photoproduction of K+^{+}K−^{-} pairs in ultra-peripheral collisions

International audienceK$^{+}$K$^{-}$ pairs may be produced in photonuclear collisions, either from the decays of photoproduced $\phi (1020)$ mesons, or directly as non-resonant K$^{+}$K$^{-}$ pairs. Measurements of K$^{+}$K$^{-}$ photoproduction probe the couplings between the $\phi (1020)$ and charged kaons with photons and nuclear targets. We present the first measurement of coherent photoproduction of K$^{+}$K$^{-}$ pairs on lead ions in ultra-peripheral collisions using the ALICE detector, including the first investigation of direct K$^{+}$K$^{-}$ production. There is significant K$^{+}$K$^{-}$ production at low transverse momentum, consistent with coherent photoproduction on lead targets. In the mass range $1.1 < M_{\rm{KK}} < 1.4$ GeV/$c^2$ above the $\phi (1020)$ resonance, for rapidity $|y_{\rm{KK}}|<0.8$ and $p_{\rm T,KK} < 0.1$ GeV/$c$, the measured coherent photoproduction cross section is $\mathrm{d}\sigma/\mathrm{d}y$ = 3.37 $\pm\ 0.61$ (stat.) $\pm\ 0.15$ (syst.) mb. The centre-of-mass energy per nucleon of the photon-nucleus (Pb) system $W_{\gamma \mathrm{Pb, n}}$ ranges from 33 to 188 GeV, far higher than previous measurements on heavy-nucleus targets. The cross section is larger than expected for $\phi (1020)$ photoproduction alone. The mass spectrum is fit to a cocktail consisting of $\phi (1020)$ decays, direct K$^{+}$K$^{-}$ photoproduction, and interference between the two. The confidence regions for the amplitude and relative phase angle for direct K$^{+}$K$^{-}$ photoproduction are presented

Photoproduction of K+^{+}K−^{-} pairs in ultra-peripheral collisions

International audienceK$^{+}$K$^{-}$ pairs may be produced in photonuclear collisions, either from the decays of photoproduced $\phi (1020)$ mesons, or directly as non-resonant K$^{+}$K$^{-}$ pairs. Measurements of K$^{+}$K$^{-}$ photoproduction probe the couplings between the $\phi (1020)$ and charged kaons with photons and nuclear targets. We present the first measurement of coherent photoproduction of K$^{+}$K$^{-}$ pairs on lead ions in ultra-peripheral collisions using the ALICE detector, including the first investigation of direct K$^{+}$K$^{-}$ production. There is significant K$^{+}$K$^{-}$ production at low transverse momentum, consistent with coherent photoproduction on lead targets. In the mass range $1.1 < M_{\rm{KK}} < 1.4$ GeV/$c^2$ above the $\phi (1020)$ resonance, for rapidity $|y_{\rm{KK}}|<0.8$ and $p_{\rm T,KK} < 0.1$ GeV/$c$, the measured coherent photoproduction cross section is $\mathrm{d}\sigma/\mathrm{d}y$ = 3.37 $\pm\ 0.61$ (stat.) $\pm\ 0.15$ (syst.) mb. The centre-of-mass energy per nucleon of the photon-nucleus (Pb) system $W_{\gamma \mathrm{Pb, n}}$ ranges from 33 to 188 GeV, far higher than previous measurements on heavy-nucleus targets. The cross section is larger than expected for $\phi (1020)$ photoproduction alone. The mass spectrum is fit to a cocktail consisting of $\phi (1020)$ decays, direct K$^{+}$K$^{-}$ photoproduction, and interference between the two. The confidence regions for the amplitude and relative phase angle for direct K$^{+}$K$^{-}$ photoproduction are presented

Charged-particle production as a function of the relative transverse activity classifier in pp, p−-Pb, and Pb−-Pb collisions at the LHC

International audienceMeasurements of charged-particle production in pp, p$-$Pb, and Pb$-$Pb collisions in the toward, away, and transverse regions with the ALICE detector are discussed. These regions are defined event-by-event relative to the azimuthal direction of the charged trigger particle, which is the reconstructed particle with the largest transverse momentum ($p_{\mathrm{T}}^{\rm trig}$) in the range $8<p_{\mathrm{T}}^{\rm trig}<15$ GeV$/c$. The toward and away regions contain the primary and recoil jets, respectively; both regions are accompanied by the underlying event (UE). In contrast, the transverse region perpendicular to the direction of the trigger particle is dominated by the so-called UE dynamics, and includes also contributions from initial- and final-state radiation. The relative transverse activity classifier, $R_{\mathrm{T}}=N_{\mathrm{ch}}^{\mathrm{T}}/\langle N_{\mathrm{ch}}^{\mathrm{T}}\rangle$, is used to group events according to their UE activity, where $N_{\mathrm{ch}}^{\mathrm{T}}$ is the charged-particle multiplicity per event in the transverse region and $\langle N_{\mathrm{ch}}^{\mathrm{T}}\rangle$ is the mean value over the whole analysed sample. The energy dependence of the $R_{\mathrm{T}}$ distributions in pp collisions at $\sqrt{s}=2.76$, 5.02, 7, and 13 TeV is reported, exploring the Koba-Nielsen-Olesen (KNO) scaling properties of the multiplicity distributions. The first measurements of charged-particle $p_{\rm T}$ spectra as a function of $R_{\mathrm{T}}$ in the three azimuthal regions in pp, p$-$Pb, and Pb$-$Pb collisions at $\sqrt{s_{\rm NN}}=5.02$ TeV are also reported. Data are compared with predictions obtained from the event generators PYTHIA 8 and EPOS LHC. This set of measurements is expected to contribute to the understanding of the origin of collective-like effects in small collision systems (pp and p$-$Pb)

Multiplicity dependence of charged-particle intra-jet properties in pp collisions at s\sqrt{s} = 13 TeV

International audienceThe first measurement of the multiplicity dependence of intra-jet properties of leading charged-particle jets in proton-proton (pp) collisions is reported. The mean charged-particle multiplicity and jet fragmentation distributions are measured in minimum-bias and high-multiplicity pp collisions at $\sqrt{s}$ = 13 TeV using the ALICE detector. Jets are reconstructed from charged particles produced in the midrapidity region ($|\eta| < 0.9$) using the sequential recombination anti-$k_{\rm T}$ algorithm with jet resolution parameters $R$ = 0.2, 0.3, and 0.4 for the transverse momentum ($p_{\rm T}$) interval 5$-$110 GeV/$c$. High-multiplicity events are selected by the forward V0 scintillator detectors. The mean charged-particle multiplicity inside the leading jet cone rises monotonically with increasing jet $p_{\rm T}$ in qualitative agreement with previous measurements at lower energies. The distributions of jet fragmentation functions $z^{\rm ch}$ and $\xi^{\rm ch}$ are measured for different jet-$p_{\rm T}$ intervals. Jet-$p_{\rm T}$ independent fragmentation of leading jets is observed for wider jets except at high- and low-$z^{\rm ch}$. The observed "hump-backed plateau" structure in the $\xi^{\rm ch}$ distribution indicates suppression of low-$p_{\rm T}$ particles. In high-multiplicity events, an enhancement of the fragmentation probability of low-$z^{\rm ch}$ particles accompanied by a suppression of high-$z^{\rm ch}$ particles is observed compared to minimum-bias events. This behavior becomes more prominent for low-$p_{\rm T}$ jets with larger jet radius. The results are compared with predictions of QCD-inspired event generators, PYTHIA 8 with Monash 2013 tune and EPOS LHC. It is found that PYTHIA 8 qualitatively reproduces the jet modification in high-multiplicity events except at high jet $p_{\rm T}$. These measurements provide important constraints to models of jet fragmentation

Search for jet quenching effects in high-multiplicity pp collisions at s\sqrt{s} = 13 TeV via di-jet acoplanarity

International audienceThe ALICE Collaboration reports a search for jet quenching effects in high-multiplicity (HM) proton$-$proton collisions at $\sqrt{s}$ = 13 TeV, using the semi-inclusive azimuthal-difference distribution $\Delta\varphi$ of charged-particle jets recoiling from a high transverse momentum (high-$p_{\mathrm{T,trig}}$) trigger hadron. Jet quenching may broaden the $\Delta\varphi$ distribution measured in HM events compared to that in minimum bias (MB) events. The measurement employs a $p_{\mathrm{T,trig}}$-differential observable for data-driven suppression of the contribution of multiple partonic interactions, which is the dominant background. While azimuthal broadening is indeed observed in HM compared to MB events, similar broadening for HM events is observed for simulations based on the PYTHIA 8 Monte Carlo generator, which does not incorporate jet quenching. We elucidate the origin of the broadening by comparing biases induced by HM selection in the data and simulations, and discuss its implications for the study of jet quenching in small collision systems

Charged-particle production as a function of the relative transverse activity classifier in pp, p–Pb, and Pb–Pb collisions at the LHC

Measurements of charged-particle production in pp, p−Pb, and Pb−Pb collisions in the toward, away, and transverse regions with the ALICE detector are discussed. These regions are defined event-by-event relative to the azimuthal direction of the charged trigger particle, which is the reconstructed particle with the largest transverse momentum (ptrigT) in the range 8<ptrigT<15 GeV/c. The toward and away regions contain the primary and recoil jets, respectively; both regions are accompanied by the underlying event (UE). In contrast, the transverse region perpendicular to the direction of the trigger particle is dominated by the so-called UE dynamics, and includes also contributions from initial- and final-state radiation. The relative transverse activity classifier, RT=NTch/⟨NTch⟩, is used to group events according to their UE activity, where NTch is the charged-particle multiplicity per event in the transverse region and ⟨NTch⟩ is the mean value over the whole analysed sample. The energy dependence of the RT distributions in pp collisions at s√=2.76, 5.02, 7, and 13 TeV is reported, exploring the Koba-Nielsen-Olesen (KNO) scaling properties of the multiplicity distributions. The first measurements of charged-particle pT spectra as a function of RT in the three azimuthal regions in pp, p−Pb, and Pb−Pb collisions at sNN−−−√=5.02 TeV are also reported. Data are compared with predictions obtained from the event generators PYTHIA 8 and EPOS LHC. This set of measurements is expected to contribute to the understanding of the origin of collective-like effects in small collision systems (pp and p−Pb)

Exclusive four pion photoproduction in ultraperipheral Pb-Pb collisions at sNN=5.02\sqrt{s_{\rm NN}} = 5.02 TeV

International audienceThe intense photon fluxes from relativistic nuclei provide an opportunity to study photonuclear interactions in ultraperipheral collisions. The measurement of coherently photoproduced $\pi^+\pi^-\pi^+\pi^-$ final states in ultraperipheral Pb-Pb collisions at $\sqrt{s_{\mathrm{NN}}}=5.02$ TeV is presented for the first time. The cross section, d$\sigma$/d$y$, times the branching ratio ($\rho\rightarrow \pi^+ \pi^+ \pi^- \pi^-$) is found to be $47.8\pm2.3~\rm{(stat.)}\pm7.7~\rm{(syst.)}$ mb in the rapidity interval $|y| < 0.5$. The invariant mass distribution is not well described with a single Breit-Wigner resonance. The production of two interfering resonances, $\rho(1450)$ and $\rho(1700)$, provides a good description of the data. The values of the masses ($m$) and widths ($\Gamma$) of the resonances extracted from the fit are $m_{1}=1385\pm14~\rm{(stat.)}\pm3~\rm{(syst.)}$ MeV/$c^2$, $\Gamma_{1}=431\pm36~\rm{(stat.)}\pm82~\rm{(syst.)}$ MeV/$c^2$, $m_{2}=1663\pm13~\rm{(stat.)}\pm22~\rm{(syst.)}$ MeV/$c^2$ and $\Gamma_{2}=357 \pm31~\rm{(stat.)}\pm49~\rm{(syst.)}$ MeV/$c^2$, respectively. The measured cross sections times the branching ratios are compared to recent theoretical predictions