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

Dust concentration and awareness of safety and health among orthopaedic clinic staffs in Hospital Kuala Lumpur, Malaysia

Abstract Objective: The study was carried out to determine the concentration of total dust from the orthopaedic casting materials exposed to personnel and working area. The determination of knowledge, attitude, and practices (KAP) regarding occupational safety and health (OSH) aspects also conducted. Increase dust concentration above the permissible limit (PEL) would decrease the health status among the staffs. Methods: This cross-sectional study was conducted at the orthopaedic clinic public hospital in Kuala Lumpur, Malaysia. Determination of total dust concentration was using a NIOSH Manual of Analytical Method (NMAM 0501) for 8 hours and a direct reading for 10 minutes. A set of questionnaires assessing the level of KAP related to OSH at the orthopaedic clinic was distributed. Results: The results of total dust concentration in the casting room are 3.402 ± 0.003 mg/m3 from area sampling and for the personal air sampling is 5.573 ± 0.040 mg/m3 which are below than 15 mg/m3 PEL. Percentage of KAP level of OSH in the orthopaedic clinic indicates knowledge (96.75%), attitude (83.7%) and practices (82.85%) respectively. However, this study found that the level of knowledge related to OSH at the orthopaedic clinic had significant relationships (p &lt;0.05) with age, job titles and area of workplaces, while OSH attitudes in orthopaedic clinics had significant relationships (p &lt;0.05) with job titles, use of personal protective equipment (PPE). Level of practice of OSH at orthopaedic clinics, there was significant relationship (p &lt;0.05) with age, job titles and use of PPE. Conclusion: The risk to total dust concentration exposure in this study are relatively low, however, some literature suggested duration of exposure-response even though in the low concentration can be a predisposing factor toward to health occupational illnesses. Medical health surveillance should be implemented in every 6 months to monitor staff’s health status.</jats:p

Dielectric properties of epoxy/POSS and PE/POSS systems

In many applications in electronic power, and high-voltage engineering, there is a need to improve the electrical properties of existing insulation systems and/or to develop novel insulation materials with properties more suitable with the changing requirements, particularly in the electrotechnical area. During the last few decades, a considerable attention has been given to the possible use of polymeric nanocomposites systems, usually a nonconductive polymer containing nanometric inorganic fillers, as a replacement to the neat polymers offering better electrical and thermal properties. There is almost, nowadays, a consensus among the scientific community that such property enhancements can only be achieved when the nano-fillers present a reasonably good size dispersion and spatial distribution within the host polymer. However, due to nano-fillers’ strong tendency to agglomerate and their generally poor compatibility with commonly used polymers, to reach optimal dispersions has been found challenging in most cases. In order to improve the polymer/particles’ compatibility and therefore to avoid agglomeration and poor-dispersion problems, polyhedral oligomeric silsesquioxanes (POSS) appear to be a filler of choice since they are by nature nanoscaled molecules bearing built-in functionalities which can be selected according to the chemical nature of the host polymer. This chapter summarizes the investigations that were reported so far on the electrical properties of epoxy/POSS, PE/POSS, and PP/POSS systems. The general conclusion is that in the case of polyolefin/POSS composites, nanoscale dispersion was found to be hard to reach despite the selection alkyl-type POSS and the dielectric properties were not found to be strongly improved while in the case of epoxy/POSS systems, the selection of appropriate POSS compounds and a carefully chosen resin/additive/hardener ratio allow nanoscale dispersion accompanied with noticeable improvements of the dielectric properties

Smart, Eco-Sustainable and Human-Centered Product Development Processes: 21st Century Manufacturing Industries

he development of new and valuable products, from conceptual design to production, is to date supported by advanced methodologies based on ICT tools allowing many controls and checks before proceeding to heavy spending investment decisions. The increasing use ICT allow highlighting product design process and solutions able to improve people’s quality of life. Key product development principles based on human-centered approaches and eco-sustainability concepts prove to be the main factors affecting both the products’ users as well as the product manufacturing staff. This paper outlines product’s development approaches state of the art, foreseeing at the same time possible research trajectories to define manufacturing industry future scenario based on more sustainable economical, environmental and social design choices