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

Rutas para emprender: de las ideas al modelo de negocio: Área: Emprendimiento

En este MI-Book, se presentan algunas teorías fundamentales para contribuir al desarrollo de la cultura emprededora, como justificación para acompañar y potenciar procesos creativos e innovadores, capaces de generar productividad y desarrollo a partir de la generación de ideas de negocio sostenible. Con este objetivo, la presente obra lo llevará por diferentes etapas que constituyen la ruta del emprendedor, en las cuales podrá identificar oportunidades de negocio, validar la aceptación de sus productos por parte de los clientes, generar prototipos, encontrar las mejores estrategias de marketing digital para emprendedores y desarrollar modelos de negocios mediante las estrategias Lean Canvas y Businnes Model Canvas.&nbsp; &nbsp

Jóvenes investigadores

Ser joven en el siglo XXI, aparte de nuevas miradas para construir mundos, ofrece la oportunidad de encontrar múltiples caminos para realizarse como ser humano. Una de ellas dentro de un contexto de dificultades y desesperanzas provocadas en el marco del conflictivo contexto que vivimos está en la bonita tarea de ser Joven Investigador/a, que consiste en la calidad asumida por quien cumple las condiciones de haber terminado una carrera universitaria, pertenecer a un grupo de investigación y tener hasta 26 años de edad, y estar vinculado con una beca, a costa bien de la universidad o en cofinanciación con Colciencias. Su compromiso es desarrollar durante un año, que puede ser prorrogable, actividades de formación y trabajo como investigador/a. El/la joven responde a unas tareas que incluyen la elaboración de un artículo publicable, el cual se convertirá en la puerta de entrada al mundo de la ciencia. Con el ánimo de poner en evidencia lo que hacen los jóvenes se presenta el primer volumen de esta colección, que representa un texto colectivo resultado del pensar-hacer de algunos de los jóvenes investigadores/as adscritos a los grupos de investigación de la UPTC. La construcción de este volumen implica que se crearon unas condiciones de confianza y reconocimiento institucional a la labor de los jóvenes quienes representan una de las más significativas fortalezas en el proceso de formación investigadora y de ejecución de la investigación. El trabajo de los jóvenes contribuye a aumentar y perfeccionar la capacidad tanto teórica como práctica de los grupos, a la vez que aporta nuevas dinámicas e iniciativas de realización de proyectos, de temas y de modos de vinculación con comunidades y grupos sociales. Para la universidad los jóvenes investigadores/as constituyen un colectivo de creación, transformación y producción de conocimiento. De dicho colectivo, como equipo de trabajo en el interior de los grupos, se espera, ante todo, que profundice su formación de segunda fase, posterior a la de semilleros de investigación, que es el momento inicial para adentrarse en el reconocimiento del sentido, del significado y de los modos de investigación. La formación investigadora del/la joven involucra las potencialidades de resolución de problemas metodológicos y conceptuales de un campo temático que lo habilita para formularse interrogantes, le potencia sus capacidades para enfrentar los ya construidos y avanzar en la interpretación de éstos apoyados en teorías específicas

Patients with Crohn's disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications' rate

BACKGROUNDRight hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn's disease (CD) and malignant ones like colon cancer (CC).AIMTo investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODSThis is a sub-group analysis of the European Society of Coloproctology's prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission.RESULTSThree hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P &lt; 0.01), had lower American Society of Anesthesiology score (ASA) grade (P &lt; 0.01) and less comorbidity (P &lt; 0.01), but were more likely to be current smokers (P &lt; 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P &lt; 0.01) and frequently underwent ileocecal resection (P &lt; 0.01) with higher rate of de-functioning/primary stoma construction (P &lt; 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P &lt; 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSIONPatients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complication's rate was not different between the two groups

XVII International Congress of Control Electronics and Telecommunications: "Advanced Science, Technology and Innovation to move towards a new socio-technical system: Sustainable Social Transformation"

Contenido: Approach to the diagnostic of cesarean birth using bio-inspired models. ; Design of a tool in a virtual reality environment to manipulate anatomical models. ; The effect of COVID-19 restrictions on the electricity price forecasting models. ; Depression prevention through artificial intelligence. ; State of the art in Prototypes as complements to the learning of the Colombian Sign Language (LSC). ; A computational proposal for gene expression deterministic analysis in associated disorders to depression and anxiety. ; Evaluation of postural stability from the predictability of the measurement of the center of pressure. ; Psychophysiological Analysis of Sound Stimuli.; Delphi method for the identification of relevant variables in the development of low-power photovoltaic solar projects. ; Socioeconomic impact of a refrigerator powered by a photovoltaic system in La Guajira. ; Energy Efficiency: characteristics that allow the reduction of greenhouse gases in. ; Possibilities for the implementation of a bioreactor from organic waste. ; Energy Potential with Small Hydroelectric Power Plants in Non- interconnected Zones of Colombia. ; Energy Potential in Photovoltaic Solar Solutions in Non-Interconnected Areas of Colombia. ; Photovoltaic system, towards the energy transition from home. ; Blockchain model to increase the transparency of public sector processes. ; Intelligent agricultural irrigation prescription system based on sensor networks and crop modeling. ; Design and implementation of a digital modulation classification system using intelligent algorithms. ; A mobile application proposal to minimize intermediation during agricultural process distribution of products in supply chain. ; Accompanying strategy for the social appropriation of new technologies in vulnerable agricultural communities: case in communities producing Gulupas fruits (Passiflora edulis Sims). ; Predictive model of transparency as an indicator of Public Policies. ; Smart system for recognition of ripening level in blackberry fruits. ; Project-based learning as an alternative methodology for technological education in electronics. ; Design and construction of an automated system for N. ; Four bar mechanisms (FBM) and their Software-Based applications: a reviewFT aquaponic culture of Red Carp and Crespa Lettuce. ; Intelligent search implementation for the construction of states of the art: a python application. ; Indoor and Outdoor propagation models on 5G environments: state of the art. ;The electronic detection of offenders (DOO) in the District Secretary of mobility of Bogotá: a step forward in the configuration of the concept of digital citizenship in Colombia. ; Monitoring through ICT of Mobility: technological collaborative feature to incorporate IoT in a Smart City. ; Characterization model of asphalt mixtures using digital image processing. ; Review: identification of diseases and/or pests in fruit trees through image processing techniques and artificial intelligence. ; VRS applicated to Nasa Yuwe language. ; Application of Pix2Pix for edge reconstruction in images. ; Brushless DC Motor Control System for Active Myoelectric Prosthesis. ; Implementation of a Water Conductivity Measuring System. ; 2 DOF robot programmed with MatLab® (guide and Peter Corke) and Arduino uno for writing alphabetical characters. ; Simulator of the behavior of the center of mass in a quadruped robot. ; Biomimetic prototype for flapping movement of batsContent: Contenido: Approach to the diagnostic of cesarean birth using bio-inspired models. ; Design of a tool in a virtual reality environment to manipulate anatomical models. ; The effect of COVID-19 restrictions on the electricity price forecasting models. ; Depression prevention through artificial intelligence. ; State of the art in Prototypes as complements to the learning of the Colombian Sign Language (LSC). ; A computational proposal for gene expression deterministic analysis in associated disorders to depression and anxiety. ; Evaluation of postural stability from the predictability of the measurement of the center of pressure. ; Psychophysiological Analysis of Sound Stimuli.; Delphi method for the identification of relevant variables in the development of low-power photovoltaic solar projects. ; Socioeconomic impact of a refrigerator powered by a photovoltaic system in La Guajira. ; Energy Efficiency: characteristics that allow the reduction of greenhouse gases in. ; Possibilities for the implementation of a bioreactor from organic waste. ; Energy Potential with Small Hydroelectric Power Plants in Non- interconnected Zones of Colombia. ; Energy Potential in Photovoltaic Solar Solutions in Non-Interconnected Areas of Colombia. ; Photovoltaic system, towards the energy transition from home. ; Blockchain model to increase the transparency of public sector processes. ; Intelligent agricultural irrigation prescription system based on sensor networks and crop modeling. ; Design and implementation of a digital modulation classification system using intelligent algorithms. ; A mobile application proposal to minimize intermediation during agricultural process distribution of products in supply chain. ; Accompanying strategy for the social appropriation of new technologies in vulnerable agricultural communities: case in communities producing Gulupas fruits (Passiflora edulis Sims). ; Predictive model of transparency as an indicator of Public Policies. ; Smart system for recognition of ripening level in blackberry fruits. ; Project-based learning as an alternative methodology for technological education in electronics. ; Design and construction of an automated system for N. ; Four bar mechanisms (FBM) and their Software-Based applications: a reviewFT aquaponic culture of Red Carp and Crespa Lettuce. ; Intelligent search implementation for the construction of states of the art: a python application. ; Indoor and Outdoor propagation models on 5G environments: state of the art. ;The electronic detection of offenders (DOO) in the District Secretary of mobility of Bogotá: a step forward in the configuration of the concept of digital citizenship in Colombia. ; Monitoring through ICT of Mobility: technological collaborative feature to incorporate IoT in a Smart City. ; Characterization model of asphalt mixtures using digital image processing. ; Review: identification of diseases and/or pests in fruit trees through image processing techniques and artificial intelligence. ; VRS applicated to Nasa Yuwe language. ; Application of Pix2Pix for edge reconstruction in images. ; Brushless DC Motor Control System for Active Myoelectric Prosthesis. ; Implementation of a Water Conductivity Measuring System. ; 2 DOF robot programmed with MatLab® (guide and Peter Corke) and Arduino uno for writing alphabetical characters. ; Simulator of the behavior of the center of mass in a quadruped robot. ; Biomimetic prototype for flapping movement of bat

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

The impact of stapling technique and surgeon specialism on anastomotic failure after right?sided colorectal resection: an international multicentre, prospective audit

Aim There is little evidence to support choice of technique and configuration for stapled anastomoses after right hemicolectomy and ileocaecal resection. This study aimed to determine the relationship between stapling technique and anastomotic failure. Method Any unit performing gastrointestinal surgery was invited to contribute data on consecutive adult patients undergoing right hemicolectomy or ileocolic resection to this prospective, observational, international, multicentre study. Patients undergoing stapled, side?to?side ileocolic anastomoses were identified and multilevel, multivariable logistic regression analyses were performed to explore factors associated with anastomotic leak. Results One thousand three hundred and forty?seven patients were included from 200 centres in 32 countries. The overall anastomotic leak rate was 8.3%. Upon multivariate analysis there was no difference in leak rate with use of a cutting stapler for apical closure compared with a noncutting stapler (8.4% vs 8.0%, OR 0.91, 95% CI 0.54–1.53, P = 0.72). Oversewing of the apical staple line, whether in the cutting group (7.9% vs 9.7%, OR 0.87, 95% CI 0.52–1.46, P = 0.60) or noncutting group (8.9% vs 5.7%, OR 1.40, 95% CI 0.46–4.23, P = 0.55) also conferred no benefit in terms of reducing leak rates. Surgeons reporting to be general surgeons had a significantly higher leak rate than those reporting to be colorectal surgeons (12.1% vs 7.3%, OR 1.65, 95% CI 1.04–2.64, P = 0.04). Conclusion This study did not identify any difference in anastomotic leak rates according to the type of stapling device used to close the apical aspect. In addition, oversewing of the anastomotic staple lines appears to confer no benefit in terms of reducing leak rates. Although general surgeons operated on patients with more high?risk characteristics than colorectal surgeons, a higher leak rate for general surgeons which remained after risk adjustment needs further exploration

Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit

Aim: The anastomosis technique used following right-sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn). Method: This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a 2-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30\ua0days of surgery, determined using a prespecified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random-effect variable. Results: This study included 3208 patients, of whom 78.4% (n\ua0=\ua02515) underwent surgery for malignancy and 11.7% (n\ua0=\ua0375) underwent surgery for Crohn's disease. An anastomosis was performed in 94.8% (n\ua0=\ua03041) of patients, which was handsewn in 38.9% (n\ua0=\ua01183) and stapled in 61.1% (n\ua0=\ua01858). Patients undergoing handsewn anastomosis were more likely to be emergency admissions (20.5% handsewn vs 12.9% stapled) and to undergo open surgery (54.7% handsewn vs 36.6% stapled). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (P\ua0=\ua00.3). After adjustment for cofactors, the odds of a leak were higher for stapled anastomosis (adjusted OR\ua0=\ua01.43; 95% CI: 1.04\u20131.95; P\ua0=\ua00.03). Conclusion: Despite being used in lower-risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled anastomosis is safe

The relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit.

BACKGROUND: Anastomosis technique following right sided colonic resection is widely variable and may affect patient outcomes. This study aimed to assess the association between leak and anastomosis technique (stapled versus handsewn) METHODS: This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a two-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30 days of surgery, using a pre-specified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random effect variable. RESULTS: This study included 3208 patients, of whom 78.4% (n=2515) underwent surgery for malignancy and 11.7% (n=375) for Crohn's disease. An anastomosis was performed in 94.8% (n=3041) of patients, which was handsewn in 38.9% (n=1183) and stapled in 61.1% (n=1858) cases. Patients undergoing handsewn anastomosis were more likely to be emergency admissions (20.5% handsewn versus 12.9% stapled) and to undergo open surgery (54.7% versus 36.6%). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (p=0.3). After adjustment for cofactors, the odds of a leak were higher for stapled anastomosis (adjusted odds ratio 1.43, 95% confidence interval 1.04-1.95, p=0.03). DISCUSSION: Despite being used in lower risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled anastomosis is safe. This article is protected by copyright. All rights reserve