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

A Theoretical Study of the Hydration of Methane, from the Aqueous Solution to the sI Hydrate-Liquid Water-Gas Coexistence

Monte Carlo and molecular dynamics simulations were done with three recent water models TIP4P/2005 (Transferable Intermolecular Potential with 4 Points/2005), TIP4P/Ice (Transferable Intermolecular Potential with 4 Points/ Ice) and TIP4Q (Transferable Intermolecular Potential with 4 charges) combined with two models for methane: an all-atom one OPLS-AA (Optimal Parametrization for the Liquid State) and a united-atom one (UA); a correction for the C–O interaction was applied to the latter and used in a third set of simulations. The models were validated by comparison to experimental values of the free energy of hydration at 280, 300, 330 and 370 K, all under a pressure of 1 bar, and to the experimental radial distribution functions at 277, 283 and 291 K, under a pressure of 145 bar. Regardless of the combination rules used for σC,O, good agreement was found, except when the correction to the UA model was applied. Thus, further simulations of the sI hydrate were performed with the united-atom model to compare the thermal expansivity to the experiment. A final set of simulations was done with the UA methane model and the three water models, to study the sI hydrate-liquid water-gas coexistence at 80, 230 and 400 bar. The melting temperatures were compared to the experimental values. The results show the need to perform simulations with various different models to attain a reliable and robust molecular image of the systems of interest

Nivel de la integración de diseño en la estrategia competitiva en Pymes del tejido industrial; Ciudad Juárez, Chihuahua, México.

El diseño es un actor clave en la promoción de la innovación dentro de la empresa, ya que esta disciplina en sus tres áreas principales como, diseño de producto; diseño de comunicación y diseño de espacios, se vinculan en la investigación y desarrollo de nuevas modalidades de uso de productos (bien o servicio), desarrollo de nuevos métodos de comercialización o nuevos métodos organizativos, lo cual proyecta la estrategia competitiva de la empresa en el mercado (Viladas, 2008). Actualmente vivimos en un entorno globalizado, donde el de- sarrollo de productos o servicios han dado lugar a un incremento de competencia y segmentación de los mercados; esta competencia demanda que las empresas desarrollen diversas estrategias de posicionamiento. Este cambio en el mercado ha tenido como efecto que empresas actualmente lideres en su sector, integren el diseño como herramienta importante para obtener el éxito en el mercadoque compiten, de acuerdo con estudios realizados por la BCD (Centro de Diseño de Barcelona). Así mismo el presente estudio muestra los resultados de una investigación exploratoria sobre la integración del diseño en las PyMES del tejido industrial en Ciudad Juárez, en el cual se identifica el nivel en el que se encuentra el tejido antes mencionado en relación al modelo de Design Ladder “escalera de diseño”, el cual se utiliza para medir la madures e integración del diseño en la empresa, con el cual se puede identificar líneas de acción dentro de la estrategia de competitividad

Proyecto De Investigación Aplicada 1-IP21-201801

Curso de especialidad en la carrera de Ingeniería Civil EPE de carácter teórico práctico dirigido a los estudiantes del 10mo Ciclo que busca desarrollar las competencias generales de Razonamiento Cuantitativo nivel 3 Pensamiento Crítico nivel 3 Manejo de la Información nivel 3; además desarrolla las competencias específicas A B y K nivel 3 de ABET: Propone soluciones en Ingeniería Civil EPE aplicando principios de matemática ciencias computación e ingeniería; Concibe y conduce experimentos así como analiza e interpreta su resultado en el campo de la ingeniería civil.Utiliza las técnicas habilidades herramientas modernas de ingeniería necesarias en la práctica de la ingeniería civil.La asignatura es eminentemente práctica y tiene como objetivos fundamentales que los alumnos definan el tema de su proyecto profesional o de su tesis conozcan la estrategia de la UPC y de la Carrera para llevar a cabo una investigación académica dirigida a la elaboración de su Plan de Tesis y desarrollo de la primera parte de su trabajo de tesis o proyecto profesional.Se brindarán consultas y asesorías técnicas a los alumnos durante la realización del trabajo de tesis o proyecto profesional. Propiciando una familiarización con la elaboración de proyectos reales en los que aplique sus conocimientos y habilidades adquiridos durante sus estudios e incentiva el interés por la investigación y experimentación en las diferentes áreas de la carrera

Evidencia de una proteína de reserva vegetativa de 20 kDa en raíz de nogal (Carya illinoensis Koch) durante la etapa de letargo

An analysis of total soluble proteins and vegetative storage proteins (VSPs) in the tissues of pecan (Carya illinonensis Koch var. Western) trees in dormancy and production was carried out. Total soluble proteins were determined using the Bradford method, by means of electrophoresis in 15% polyacrylamide gel, to detect the VSPs present in the plant tissues. The results indicate that the branches and shoots of annual growth were the organs with the highest concentration of total soluble proteins in dormancy, while in production there was no significant difference in concentration between the different tissues studied. A 20-kDa polypeptide with characteristics of a VSP was detected in the root in the dormancy stage.Se realizó un análisis de proteínas totales solubles y de proteínas de reservas vegetativas (PRV), en tejidos de árboles de nogal (Carya illinonensis Koch var. Western) en letargo y producción. La determinación de proteínas totales solubles se realizó por el método de Bradford, por medio de electroforesis en gel de poliacrilamida al 15% para detectar las PRV presentes en los tejidos vegetales. Los resultados indican que las ramas y los brotes de crecimiento anual fueron los órganos con mayor concentración de proteínas totales solubles en letargo, mientras que en producción no se presentó diferencia significativa de concentración entre los diferentes tejidos estudiados. Se detectó un polipéptido de 20 kDa con características de una PRV en la raíz en la etapa de letargo

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data