Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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 middle-income 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 low-income 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 low-income, 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

ICAR: endoscopic skull‐base surgery

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and mechanical properties in the tetragonal rutile phase

Structural and mechanical properties in rutile (tetragonal) phases of SnO2 and TiO2 are investigated by performing first-principle density functional theory (DFT) calculations. Generalized Gradient Approximation (GGA) potentials of electronic exchange and correlation part parameterized by Perdew-Burke-Ernzerhof (PBE) are used. Second order elastic stiffness constants, bulk modulus, First derivative of bulk modulus, and pressure behavior of these mechanical properties are studied up to pressure of 10 GPa. Structural properties and elastic constants of SnO2 and TiO2 calculated in this study are compatible with experimental and other available theoretical studies. Electronic band gap energies of these semiconductors are also calculated. As expected, the calculated values by standard DFT calculations are underestimated in comparison to experimental values. (C) 2014 Elsevier Ltd. All rights reserved

O2-AT-SNO2; PHONONS

The structural properties of SnO2 polymorphs in the sequential order of observed phases in experiments are determined by the density functional theory (DFT) calculations based on local density approximation (LDA) of ultra soft pseudo potentials (US-PPs). Phonon dispersion relations are calculated by the lattice dynamics calculations. Shifts in the infrared (IR) active optical modes due to polarization (LO/TO splitting) are also calculated. Moreover, softening of B-1g mode at the rutile-CaCl2 second-order ferroelastic phase transition is confirmed. Thermal properties, such as temperature behavior of bulk modulus and thermal expansion in the rutile phase are obtained by employing quasiharmonic approximation (QHA). They are in good agreement with the available experimental results. Dynamic stabilities of SnO2 polymorphs except for the rutile phase are checked for the first time by using phonon dispersions. The rutile, CaCl2, pyrite, ZrO2 and cotunnite type structures have shown thermodynamical stability. The cause of alpha-PbO2 phase showing nearly stability is discussed in the light of experimental studies. However, the fluorite type structure is definitely instable even at different pressures. It may not be one of SnO2 polymorphs. (C) 2015 Elsevier B.V. All rights reserved

Nurse scheduling via answer set programming

The Nurse Scheduling problem (NSP) is a combinatorial problem that consists of assigning nurses to shifts according to given practical constraints. In previous years, several approaches have been proposed to solve different variants of the NSP. In this paper, an ASP encoding for one of these variants is presented, whose requirements have been provided by an Italian hospital. We also design a second encoding for the computation of \ue2\u80\u9coptimal\ue2\u80\u9d schedules. Finally, an experimental analysis has been conducted on real data provided by the Italian hospital using both encodings. Results are very positive: the state-of-the-art ASP system clingo is able to compute one year schedules in few minutes, and it scales well even when more than one hundred nurses are considered