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

Analysing Associations between the Actual, Ideal and Maximum Willingness to Commute Time, as well as Satisfaction with Commuting: A Case Study of Jounieh, Lebanon

Many studies have been conducted worldwide to study travel behavior, specifically commuting times. Nevertheless, few or none have been conducted in the Middle East and North Africa region. The main objective of this paper is to understand the relationship between the actual, ideal and maximum willingness to commute times, and satisfaction with commuting in the city of Jounieh, Lebanon. Socio-economic and land use factors were included to investigate whether they influence commuting times. The average commuting time of the sample is 48.2 minutes, longer than their ideal commute time by about 20 minutes, while their maximum willingness to commute time is 53.46 minutes. The sample was neither satisfied nor dissatisfied with their commutes. After performing multivariate Ordinary Least Squares model, and fixing the socio-economic and land use variables, the model proved that the actual and ideal commuting times as well as the actual and maximum commuting times are positively correlated, but the actual commuting time and satisfaction are negatively correlated. A univariate Ordinary Least Square model was performed to determine the correlation between ideal and maximum commuting times; they are highly positively correlated. Finally, the average commuting times and satisfaction were compared for some categories. Women spend almost 13% less time commuting than men, yet they have lower level of satisfaction. Lebanese commuters are also shown to commute more than non-Lebanese ones by approximately 22%. University level commuters commute about 36% more than non-university level people, while unemployed and employed respondents commute for the same time

The implementation of lean manufacturing in the furniture industry: a review and analysis on the motives, barriers, challenges, and the applications

Although research on the adoption of lean manufacturing in the furniture industry in emerging economies is slowly progressing, its implementation has been emphasized by researchers and practitioners. Research on this scope is therefore limited, particularly when compared to the vast amount of scholarly studies contributed to successful implementation of lean in the developed countries. To support the narrow body of knowledge on this under-researched scope, this paper presents the current shortfalls of implementing the lean manufacturing in terms of motives, barriers, challenges, and applications. To address these issues, a methodological approach was implemented in two tiers. Firstly, a comprehensive review of state-of-the-art literature on the issues was performed followed by an analytic approach using a survey on 148 companies in Malaysia to finalize the research. Upon validation of the analyses, the results revealed that most of the lean companies agreed that the reasons for lean implementation are to increase efficiency, to clean up and organize the workplace, and to increase utilization of space. Non-lean companies believe that issues related to knowledge are the reasons for not undertaking lean implementation. However, lean companies believe that the obstacles are more about employee-related issues including lack of labor resources, lack of implementation know-how, and employee resistance to change. Lean companies also face challenges in the form of technical knowledge, training, and financial resources during the early phase of lean implementation. In addition, only three applications – 5S, employee training, and quality control – were found to be useable in the Malaysian wood and furniture industry. These findings present a critical view of the current shortfalls of lean implementation in the wood and furniture industry throughout Malaysia and other emerging economies

Pathways of lean manufacturing in wood and furniture industries: a bibliometric and systematic review

As wood and furniture industries have little knowledge of the implementation of lean manufacturing particularly in emerging economies, the purpose of this study is to analytically and systematically review the literature in this context. To this end, a multi-method approach was implemented in two ways. Firstly, a bibliometric method was performed to analyse the scientific literature and examine all general papers on lean manufacturing in the Scopus database—2879 articles published in leading journals from 1991 to 2019 were accordingly identified and analysed. Secondly, a methodological approach was employed to systematically review all papers focusing on the topic of lean manufacturing in the wood and furniture industries. After fine-tuning, 36 articles were considered to classify the research findings into three sections: (1) growth of research interest, (2) motives and application of lean practices, and (3) lean implementation status, organizational context, barriers, and challenges. The findings revealed that lean has gradually evolved over the years, but not for the wood and furniture industries. The vast amount of scholarly studies has contributed to successful lean implementation in developed countries. Moreover, the existing literature on lean in the context of wood and furniture industries have insufficient evidence levels, and their findings have not yet been widely accepted. Interestingly, the first publication on lean implementation in the wood and furniture industries was recorded in 2003, accordingly revealing that the lean concept is new for practitioners. The present study offers a valuable insight into the development of a lean implementation framework specifically for the wood and furniture industries and is the first attempt to examining the industry-level variable which can lead to new theoretical insight

An SEM approach for the barrier analysis in lean implementation in manufacturing industries

This paper investigates the barriers that hinder the implementation of lean manufacturing in wood and furniture industries as the adoption of this philosophy in such industries is not prom-ising especially in emerging economies. To this end, a comprehensive review of the literature was performed to identify the barriers and develop a conceptual model. Next, structural equation modeling is employed to examine the model using the collected data from 131 wood and furniture com-panies. The findings revealed a synergetic effect between three key factors—culture and human attitude, knowledge, and resources—which play a crucial role in implementing lean. The analyses indicated the reasons of companies refused or not ready to implement lean on knowledge and culture and human attitudinal issues, particularly in companies that have limited resources. It is be-lieved that resource issues are an obstacle to lean implementation, but not as important as knowledge and culture and human attitudinal issues. Sufficient knowledge is needed to deploy lean practices as well as changes in culture and human attitude. Investigating the relationships between these three key barriers is a contribution that this study intends to become a forward step for promoting lean manufacturing among under-studied industries. This paper also proposes that through adopting the activities for lean implementation, small and medium enterprises can experience and quantify the positive impacts of lean practices. Government agencies, universities, and professional bodies can support such enterprises in this transition through targeted interventions that address the barriers presented