5 research outputs found
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
Advanced computer vision-based human computer interaction for entertainment and software development
In this thesis we propose novel methods for 3D interaction on 3D environments. The
evaluation of these methods was performed based on three interaction environments:
3D interaction using portable multi-touch devices, 3D hand gesture data
manipulation using 3D database representation and 3D multi-threaded programing
using hand gesture interaction. The three experiments provided qualitative and
quantitative information to evaluate the features of the presented interfaces.
The first experiment, based on the use on the use of portable multi-touch devices,
aimed to evaluate the use of 3D movements to interact under a 3D environment.
Also, the possibility of generate collaborative interaction under 3D interfacing
(simulating a 3D multi-touch table top environment) was evaluated.
The second experiment consisted on 3D touchless data manipulation, removing the
intermediate device (portable multi-touch) and providing hand gesture data
interaction using the Kinect device. Furthermore, this evaluation was conducted over
a 3D cube database model, based on the concepts of multidimensional databases and
graphic databases.
The third experiment intended to evaluate the possibility of software generation
using a 3D interaction environment, following a similar model of interaction from
the second experiment, but providing a better two handed interaction. The
environment aimed multi-threaded programing under a 3D interface.
The three experiments provided valuable data about users’ interaction and
preference, which were tested with users of different ages and levels of knowledge.
The research process and results are summarized in this research work
Performance issues of gesture based communication systems
Abstract- Gesture based communication is relatively adopted in areas like medicine, sports, inventory etc. Human factors are involved in the algorithms to determine the nature of the gesture and the computer tool translating it should be an autodidactic tool. Traditional systems use touch screens of any touch points to communicate with the system either via a control panel or following a user journey. Gesture communication varies with the traditional in the sense that human communication is transferred to technical form of algorithms for a system to decipher them. There are few issues relating to the performance such gesture communication systems namely accuracy, transfer of human knowledge to computer and various other observations needs to be addressed. A case study in the form of a simple experiment relating to a basic two handed gesture and human interaction in a 3D database is analyzed in this paper