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

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

Identification par méthode inverse des propriétés optiques d’un milieu diffusant: Application à l’impact du brouillard sur la perception artificielle

National audienceutilisés dans différents domaines d’application (avionique, véhicules routiers intelligents, etc.). Le Cerema, au travers de sa plateforme PAVIN Brouillard-Pluie, mène des évaluations de ces capteurs dans des conditionscontrôlées de brouillard [3]. Dans une perspective de disposer d’un jumeau numérique de la plateforme, ilest nécessaire de développer des modélisations robustes de propagation des ondes électromagnétiques dans lebrouillard.La propagation est régie par les phénomènes de diffusion et d’absorption des photons au contact des gouttelettesde brouillard. La distribution N des tailles de ces gouttes est un paramètre clé des modèles de propagation.Nous proposons d’exposer une méthodologie pour identifier cette distribution en inversant l’équation de transfertradiatif à partir de mesures expérimentales

Identification of fog Particle Size Distributions by inverting the radiative transfer equation

International audienceDegraded meteorological conditions, including fog, limit the performance of optical sensors used in various fields of application (avionics, intelligent road vehicles, etc.). Cerema, the French research and expertise center under the supervision of the Ecological Transition Ministry, conducts evaluations of these sensors under artificial and controlled fog conditions in the dedicated PAVIN Fog&Rain platform. &#160;In order to perform a digital twin of the platform, it is necessary to develop robust modeling of the propagation of electromagnetic waves in fog. Propagation is governed by the phenomena of scattering and absorption of photons in contact with fog droplets. The fog Droplet Size Distribution (DSD) is a key parameter of the propagation models.In the present work, we investigate the DSD identification from spectral radiation measurements by inverting the stationary radiative transfer equation (RTE). This distribution together with Lorenz-Mie scattering theory allow to compute the optical properties (scattering coefficient, absorption coefficient, and phase function). First, we prove the well-posedness of the underlying inverse problem, then we perform some numerical experiments using synthetic data. The numerical results suggest that the method allows to identify the DSD.We present some numerical results obtained by using various models describingthe particle size distribution (e.g. Shettle and Fenn models) and some experimental distribution measured in the Cerema platform. Afterwards, the identification of the DSDs is carried out using the radiative transfer equation with the collision term (multiple scattering) and by performing direct scattering and backscattering measurements. The robustness of the reconstruction was studied numerically by introducing several noise levels to the measurements

Identification of fog Particle Size Distribution by a radiative transfer equation inversion

We investigate the identification problem of the fog Droplet Size Distribution (DSD) by an inverse method of the 1D radiative transfer equation thanks to spectral radiation measurements in the range 350 nm-2500 nm. This distribution together with Lorenz-Mie scattering theory allow to compute the optical properties (scattering coefficient, absorption coefficient, and phase function). We prove the well-posedness of the underlying inverse problem then we perform some numerical experiments using synthetic data. The numerical results suggest that the method allows to identify the DSD with different modellings of the radiative transfer (Beer-Lambert, isotropic and anisotropic collision operator)

Proving the effectiveness of negotiation protocols KQML in multi-agent systems using event-B

Multi-Agents Systems (MAS) provide a good basis to build complex systems and in MAS a negotiation is a key form of interaction that enables agents to arrive at a final agreement. We present an event-B based approach to reasoning about a negotiation protocols in multi-agent systems (MAS), Key features of Event-B are the use of set theory as a modeling notation and it is a formal method that can be used in the development of reactive distributed systems and we propose using the Rodin modeling tool for Event-B that integrates modeling and proving. © Springer International Publishing AG 2017.Ministry of Education, Youth and Sports of the Czech Republic within the National Sustainability Programme [LO1303 (MSMT-7778/2014)]; European Regional Development Fund under the project CEBIA-Tech [CZ.1.05/2.1.00/03.0089]; IGA (Internal Grant Agency) of Thomas Bata University in Zlin [IGA/CebiaTech/2017/007

Cultural Differences and the Understanding of Informed Consent

This project examines the delivery of informed consent in the medical field across cultures, with specific attention to potential barriers from linguistic differences in Worcester, Massachusetts. On the basis of qualitative interviews with medical professionals such as interpreters, doctors, and others, we investigated the accommodations and approaches to addressing such differences using interpretative analysis approaches. Our results emphasize distinctions in views of consent with patients of cultural difference, the significance of interpreters within the consent process, and the importance of trust within doctor-patient relationships

Distributed data mining systems: Techniques, approaches and algorithms

Nowadays, we are living in the midst of a data explosion and seeing a massive growth in databases so with the wide availability of huge amounts of data; necessarily we are become in need for turning this data into useful information and knowledge, where Data mining uncovers interesting patterns and relationships hidden in a large volume of raw data and big data is a new term used to identify the datasets that are of large size and have grater complexity. The knowledge gained from data can be used for applications such as market analysis, customer retention and production control. Data mining is a massive computing task that deals with huge amount of stored data in a centralized or distributed system to extract useful information or knowledge. In this paper, we will discuss Distributed Data Mining systems, approaches, Techniques and algorithms to deal with distributed data to discover knowledge from distributed data in an effective and efficient way. © 2018 The Authors, published by EDP Sciences.Ministry of Education, Youth and Sports of the Czech Republic within the National Sustainability Programme [LO1303 (MSMT-7778/2014)]; European Regional Development Fund under the project CEBIA-Tech [CZ.1.05/2.1.00/03.0089]; IGA (Internal Grant Agency) of Tomas Bata University in Zlin [IGA/CebiaTech/2017/007

Improved adaptive fault tolerance model for increasing reliability in cloud computing using Event-B

Cloud computing provide services to many users at the same time by providing virtual resources via internet, General example of cloud services is Google apps, provided by Google. In most of cloud applications, processing is done on remote cloud computing nodes. So, there are more chances of errors, due to the undetermined latency and lose control over remote nodes, so it is very important apply the techniques for fault tolerance in cloud computing. In this paper, a fault tolerance in real time cloud computing is proposed. In our model, the system tolerates the faults and makes the decision on the basis of reliability of the processing nodes. And we will present an event-B as formal method that can be used in the development of reactive distributed systems and we propose using the Rodin modeling tool for Event-B that integrates modeling and proving. © 2019, Springer International Publishing AG, part of Springer Nature.MSMT-7778/2014, MŠMT, Ministerstvo Školství, Mládeže a Tělovýchovy; LO1303, MŠMT, Ministerstvo Školství, Mládeže a Tělovýchovy; IGA/CebiaTech/2017/ 007, FEDER, European Regional Development Fund; CZ.1.05/2.1.00/03.0089, FEDER, European Regional Development Fun