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

Structural change and economic development : an analysis of the Industrial-Space (2000 - 2018)

Tese (doutorado)—Universidade de Brasília, Departamento de Economia, Brasília, 2018.Esse trabalho possui como objetivo analisar a importância das variáveis densidade industrial e Professional Business Services (PBS) para diversas economias, uma vez que elas capturam a capacidade que os países possuem em produzir bens de alto valor agregado e diferenciação de produtos. As duas hipóteses da presente tese são: 1) A densidade industrial e o PBS são positivamente correlacionadas com o PIB per capita, para qualquer que seja o nível de desenvolvimento do país; 2) Países com menor valor de densidade industrial e de PBS são menos desenvolvidos econômica e tecnologicamente do que os países que possuem alto valor dessas variáveis. Em primeiro lugar, no capítulo 1, essa tese realiza uma análise teórica sobre mudança estrutural e desenvolvimento econômico, apresentando também o espaço indústria, que é um espaço ilustrativo cujo objetivo é apresentar a trajetória de desenvolvimento industrial dos países. Uma vez explicada a importância do espaço indústria, sobretudo para o setor de serviços, no capítulo 2 é realizada uma análise descritiva das variáveis que compõem o espaço indústria e a importância destas para o desenvolvimento econômico. Por último, já no capítulo 3 é efetuado um exercício econométrico, utilizando os dados do espaço indústria, com o objetivo de verificar a correlação existente entre as variáveis independentes frente ao PIB per capita dos países contidos na amostra. Para isso, são utilizados cinco regressões: uma regressão quantílica, um mínimos quadrados ordinários e três painéis de efeito fixo. Todos os resultados obtidos mostraram que o PBS e a densidade industrial são positivamente correlacionadas com o PIB per capita dos países.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).Largely motivated by the fact the variables Industrial Density and Professional Business Services (PBS) capture the capacity of countries to produce differentiated goods of high added value, the goal of this work is to empirically investigate the importance of those two variables to several economies. We perform the test of two hypotheses. First, whatever the level of development of a given country, Industrial Density and PBS are positively correlated with per capita GDP. Second, countries with lower industrial density and lower PBS are economically and technologically less developed than countries with higher values of those variables. This thesis is organized as follows. In chapter 1 we give a theoretical account of structural change and economic development, and at the same time present an illustrative space, called the industrial space, depicting the path of industrial development of different countries. After explaining the importance of the industrial-space, especially for the service sector, in chapter 2 we describe the variables that make up the industrialspace, and also their importance for economic development. Finally, using data from the industrial-space, in chapter 3 we perform an econometric exercise in order to verify the correlation between the independent variables and per capita GDP of the sampled countries. To that end three econometric models were used: quantile regression, ordinary least squares, and fixed effect panel. Our results show that PBS and Industrial Density are positively correlated with per capita GDP of those countries

REPRIMARIZAÇÃO E DESINDUSTRIALIZAÇÃO: OS IMPACTOS DA LEI KANDIR E DO COMÉRCIO COM A CHINA NO COMPLEXO SOJA

This article aims at analyzing the exportation agenda of the soybean complex and its changes with the advent of the Kandir Law and the participation of China, under the hypothesis that these events can generate negative externalities for Brazilian economy in terms of reprimarization of the country’s exportation agenda. For this, we analyzed the production and trade data of the soybean complex in Brazil and in the world, and researched the factors that influence the commercialization of these products. As a result, there was a decrease in the exports of products with higher added value, such as oil and bran, and a significant increase in the export of in natura soybean. The Kandir Law, China’s trade profile and the use of tariff scale practices contributed for such an occurrence

Influence of Exchange Variation and Demand Conditions in the Determination of IPCA in Brazil (1999 -2011)

Abstract: The objective of this paper is analyzing the exchange rate pass-through in Brazil and the importance of demand pressures on prices in the period after the implementation of the inflation-targeting regime. The methodology used was the Vector Error Correction Model (VECM), between the periods January 1999 to May 2011. The results show a high degree of inertia in both periods. Furthermore, show that neglecting the inertia, the exchange was the main determinant of price variation in the first period, while in the second period the main causes of inflationary pressures were demand pressures

Tax Reform in Brazil: a Public Choice Theory approach

This article aims to analyze tax reform necessity and the barriers to the implementation of tax reform at the light of public choice theory. The research identifies the arguments that provides the explanation for the tax reform does not occur in Brazil. The question that the article searches to answer is: what are the justifications for the Brazil not have done tax reform? The literature review addresses the failures of government, public choice theory and the theory of optimal taxation. The evidence and studies show that there are reasons to think about a tax system more consistent with the Brazilian reality, indicating the existence of "government failures" that may be the probable cause of impairment of the tax reform

Global patterns and drivers of ecosystem functioning in rivers and riparian zones

Abstract River ecosystems receive and process vast quantities of terrestrial organic carbon, the fate of which depends strongly on microbial activity. Variation in and controls of processing rates, however, are poorly characterized at the global scale. In response, we used a peer-sourced research network and a highly standardized carbon processing assay to conduct a global-scale field experiment in greater than 1000 river and riparian sites. We found that Earth’s biomes have distinct carbon processing signatures. Slow processing is evident across latitudes, whereas rapid rates are restricted to lower latitudes. Both the mean rate and variability decline with latitude, suggesting temperature constraints toward the poles and greater roles for other environmental drivers (e.g., nutrient loading) toward the equator. These results and data set the stage for unprecedented “next-generation biomonitoring” by establishing baselines to help quantify environmental impacts to the functioning of ecosystems at a global scale

Long-term efficacy and safety of eculizumab in Japanese patients with generalized myasthenia gravis: A subgroup analysis of the REGAIN open-label extension study

The terminal complement inhibitor eculizumab was shown to improve myasthenia gravis-related symptoms in the 26-week, phase 3, randomized, double-blind, placebo-controlled REGAIN study (NCT01997229). In this 52-week sub-analysis of the open-label extension of REGAIN (NCT02301624), eculizumab's efficacy and safety were assessed in 11 Japanese and 88 Caucasian patients with anti-acetylcholine receptor antibody-positive refractory generalized myasthenia gravis. For patients who had received placebo during REGAIN, treatment with open-label eculizumab resulted in generally similar outcomes in the Japanese and Caucasian populations. Rapid improvements were maintained for 52 weeks, assessed by change in score from open-label extension baseline to week 52 (mean [standard error]) using the following scales (in Japanese and Caucasian patients, respectively): Myasthenia Gravis Activities of Daily Living (−2.4 [1.34] and − 3.3 [0.65]); Quantitative Myasthenia Gravis (−2.9 [1.98] and − 4.3 [0.79]); Myasthenia Gravis Composite (−4.5 [2.63] and − 4.9 [1.19]); and Myasthenia Gravis Quality of Life 15-item questionnaire (−8.6 [5.68] and − 6.5 [1.93]). Overall, the safety of eculizumab was consistent with its known safety profile. In this interim sub-analysis, the efficacy and safety of eculizumab in Japanese and Caucasian patients were generally similar, and consistent with the overall REGAIN population

Long-term safety and efficacy of eculizumab in generalized myasthenia gravis

Introduction: Eculizumab is effective and well tolerated in patients with antiacetylcholine receptor antibody-positive refractory generalized myasthenia gravis (gMG; REGAIN; NCT01997229). We report an interim analysis of an open-label extension of REGAIN, evaluating eculizumab's long-term safety and efficacy. Methods: Eculizumab (1,200 mg every 2 weeks for 22.7 months [median]) was administered to 117 patients. Results: The safety profile of eculizumab was consistent with REGAIN; no cases of meningococcal infection were reported during the interim analysis period. Myasthenia gravis exacerbation rate was reduced by 75% from the year before REGAIN (P < 0.0001). Improvements with eculizumab in activities of daily living, muscle strength, functional ability, and quality of life in REGAIN were maintained through 3 years; 56% of patients achieved minimal manifestations or pharmacological remission. Patients who had received placebo during REGAIN experienced rapid and sustained improvements during open-label eculizumab (P < 0.0001). Discussion: These findings provide evidence for the long-term safety and sustained efficacy of eculizumab for refractory gMG. Muscle Nerve 2019

Correction to: Eculizumab improves fatigue in refractory generalized myasthenia gravis (Quality of Life Research, (2019), 28, 8, (2247-2254), 10.1007/s11136-019-02148-2)

The article “Eculizumab improves fatigue in refractory generalized myasthenia gravis”, written by “Henning Andersen, Renato Mantegazza, Jing Jing Wang, Fanny O’Brien, Kaushik Patra, James F. Howard Jr. and The REGAIN Study Group” was originally published electronically on the publisher’s internet portal (currently SpringerLink) on 23 March 2019 without open access