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

Precision measurement of CP\it{CP} violation in the penguin-mediated decay Bs0→ϕϕB_s^{0}\rightarrow\phi\phi

A flavor-tagged time-dependent angular analysis of the decay $B_s^{0}\rightarrow\phi\phi$ is performed using $pp$ collision data collected by the LHCb experiment at % at $\sqrt{s}=13$ TeV, the center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 6 fb^{-1}. The $\it{CP}$-violating phase and direct $\it{CP}$-violation parameter are measured to be $\phi_{s\bar{s}s} = -0.042 \pm 0.075 \pm 0.009$ rad and $|\lambda|=1.004\pm 0.030 \pm 0.009$, respectively, assuming the same values for all polarization states of the $\phi\phi$ system. In these results, the first uncertainties are statistical and the second systematic. These parameters are also determined separately for each polarization state, showing no evidence for polarization dependence. The results are combined with previous LHCb measurements using $pp$ collisions at center-of-mass energies of 7 and 8 TeV, yielding $\phi_{s\bar{s}s} = -0.074 \pm 0.069$ rad and $|lambda|=1.009 \pm 0.030$. This is the most precise study of time-dependent $\it{CP}$ violation in a penguin-dominated $B$ meson decay. The results are consistent with $\it{CP}$ symmetry and with the Standard Model predictions.Comment: All figures and tables, along with any supplementary material and additional information, are available at https://cern.ch/lhcbproject/Publications/p/LHCb-PAPER-2023-001.html (LHCb public pages

Precision measurement of CP violation in the penguin-mediated decay Bs0→ϕϕ

A flavor-tagged time-dependent angular analysis of the decay B 0 s → ϕ ϕ is performed using p p collision data collected by the LHCb experiment at the center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 6     fb − 1 . The C P -violating phase and direct C P -violation parameter are measured to be ϕ s ¯ s s s = − 0.042 ± 0.075 ± 0.009     rad and | λ | = 1.004 ± 0.030 ± 0.009 , respectively, assuming the same values for all polarization states of the ϕ ϕ system. In these results, the first uncertainties are statistical and the second systematic. These parameters are also determined separately for each polarization state, showing no evidence for polarization dependence. The results are combined with previous LHCb measurements using p p collisions at center-of-mass energies of 7 and 8 TeV, yielding ϕ s ¯ s s s = − 0.074 ± 0.069     rad and | λ | = 1.009 ± 0.030 . This is the most precise study of time-dependent C P violation in a penguin-dominated B meson decay. The results are consistent with C P symmetry and with the standard model predictions

Eucalyptus microfungi known from culture. 3. Eucasphaeria and Sympoventuria genera nova, and new species of Furcaspora, Harknessia, Heteroconium and Phacidiella

Members of the genus Eucalyptus represent a substrate richly colonized by numerous undescribed fungal species. Several species and genera of ascomycetes were collected from leaves or from leaf litter of this host genus in Australia and South Africa in the present study. New genera include Eucasphaeria capensis and Sympoventuria capensis (ascomycetes), genera et spp. nov. New species include Furcaspora eucalypti, Harknessia ipereniae, H. gibbosa, Heteroconium kleinziensis and Phacidiella eucalypti

Pre-hospital videoconferencing telemedicine: are we there yet?

Aims  Pre-Hospital telemedicine has the potential to save lives. This study examined the challenges in the development of a mobile audio-visual telemedicine platform for the pre-hospital telemedicine component of the European Commission funded LiveCity project.  Methods  Open source software and off-the-shelf hardware elements were used to build a wearable field unit for the paramedic to communicate from the scene of an emergency via live video with the Emergency Department hub over a Third Generation (3G)/High Speed Packet Access (HSPA) network.  Results  Videoconferencing from the scene was compromised in all but one of thirty-four telemedical consultations. Significant challenges in software and hardware suitability, durability, and reliability were identified. The 3G network was unable to provide for an uninterrupted high-quality mobile video link between the paramedic and the Emergency Department.  Discussion  Improvements in hardware and software design with bespoke telemedicine equipment appropriate to the pre-hospital environment as well as investment in fourth (4G) and fifth generation (5G) networks with more extensive coverage will be required to further enable the widespread adoption of optimal telemedicine in pre-hospital care.</p