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

Students’ Voices in Online Learning During a Pandemic

After the school districts’ decision to close schools and move to online learning environments to complete the 2029-2020 school year, many districts in Florida surveyed stakeholders. The selected school district collected data from parents at the end of the year and during the summer break. The voices of the students, the direct audience, target, and beneficiaries of the education system, were not included in the data collection instrument. Curious about what those voices had to say, the researcher conducted a three-part questionnaire to explore students’ perceptions of their online learning experience. A purposeful sample of convenience for the study consisted of 12 participants; 8 high school students and 4 middle school students who attended five public schools in different areas of a school district in the east of Florida. All three parts of the survey included questions to explore participants’ likes and dislikes, feelings and concerns, wishes regarding online learning, and changes in their lives due to the COVID 19 pandemic and to online education. The third part of the survey included questions that asked participants what they would change regarding their online classes, learning activities, and evaluations. The purpose of this presentation is to share the results of this qualitative study and to open a discussion regarding emerging students’ cognitive and emotional needs during prolonged crises

Digital Footprints, Privacy, and Security: I Know What You Did Last Summer!

The International Society for Technology in Education (ISTE) standards address the need for students to develop strong technology literacy skills due to the evolving role of technology in the global society. Therefore, educators must “Model and promote management of personal data and digital identity and protect student data privacy” (ISTE Standards for Education, 2017, para. 3). With the recent revelations of the breaches involving social media applications, concerns regarding digital footprints, privacy, and security have evolved for both educators and their students. As distance education expands, educators frequently use applications to engage students. This usage generates digital footprints, which are like physical footprints rendered unique to their owners (Dennen, 2015). Before generating digital footprints, users should be aware of privacy policies to protect personal information and how it is used (McDermott, 2018). These conditions are usually presented as written terms of agreement followed by a box to check/submit if giving consent. Security involves how companies protect information users agree to share, so when something is hacked both security and privacy are compromised. Therefore, evaluation of popular educational apps must become a priority for educators and several tools are available from school boards, universities, special interest groups, and state/ federal government agencies. Panelists in this roundtable will share the concepts of active digital footprints, passive digital footprints, privacy, and security; then participants will be given the opportunity to actively discuss their concerns. Panelists will also share tools for evaluating apps, and participants will be able to evaluate apps of their choice. By developing a greater understanding of the most frequently used apps in education, educators can venture higher in technology integration

Λc+\Lambda^+_c production in pppp and in pp-Pb collisions at sNN\sqrt {s_{NN}}=5.02 TeV

International audienceThe production cross section of prompt $\mathrm{\Lambda_{c}^{+}}$ charm baryons was measured with the ALICE detector at the LHC at midrapidity in proton-proton (pp) and proton-lead (p-Pb) collisions at a centre-of-mass energy per nucleon pair of $\sqrt{s_\mathrm{NN}} = 5.02$ TeV. The $\mathrm{\Lambda_{c}^{+}}$ and $\rm {\overline{\Lambda}{}_c^-}$ baryons were reconstructed in the hadronic decay channels $\rm \Lambda_{c}^{+} \rightarrow p K^{-}\pi^{+}$ and $\rm \Lambda_{c}^{+}\to p K^{0}_{S}$ and respective charge conjugates. The measured differential cross sections as a function of transverse momentum ($p_{\rm T}$) and the $p_{\rm T}$-integrated $\mathrm{\Lambda_{c}^{+}}$ production cross section in pp and in p-Pb collisions are presented. The $\mathrm{\Lambda_{c}^{+}}$ nuclear modification factor ($R_\mathrm{pPb}$), calculated from the cross sections in pp and in p-Pb collisions, is presented and compared with the $R_\mathrm{pPb}$ of D mesons. The $\mathrm {\Lambda_{c}^{+}}/\mathrm {D^0}$ ratio is also presented and compared with the light-flavour baryon-to-meson ratios p$/\pi$ and $\Lambda /\mathrm {K^0_S}$, and measurements from other LHC experiments. The results are compared to predictions from model calculations and Monte Carlo event generators

Global polarization of Λ and Λ hyperons in Pb-Pb collisions at √ s N N = 2.76 and 5.02 TeV

The global polarization of Λ and Λ hyperons is measured for Pb-Pb collisions at √sNN = 2.76 and 5.02 TeV recorded with the ALICE at the Large Hadron Collider (LHC). The results are reported differentially as a function of collision centrality and hyperon’s transverse momentum (pT ) for the range of centrality 5–50%, 0.5 < pT < 5 GeV/c, and rapidity |y| < 0.5. The hyperon global polarization averaged for Pb-Pb collisions at √sNN = 2.76 and 5.02 TeV is found to be consistent with zero, ⟨PH⟩(%)≈0.01±0.06(stat.)±0.03(syst.) in the collision centrality range 15–50%, where the largest signal is expected. The results are compatible with expectations based on an extrapolation from measurements at lower collision energies at the Relativistic Heavy Ion Collider, hydrodynamical model calculations, and empirical estimates based on collision energy dependence of directed flow, all of which predict the global polarization values at LHC energies of the order of 0.01%

Charged-particle multiplicity fluctuations in Pb–Pb collisions at √ sNN = 2.76 TeV

Measurements of event-by-event fluctuations of charged-particle multiplicities in Pb–Pb collisionsat √sNN = 2.76 TeV using the ALICE detector at the CERN Large Hadron Collider (LHC) are presented in the pseudorapidity range |η| < 0.8 and transverse momentum 0.2 < pT < 2.0 GeV/c. The amplitude of the fluctuations is expressed in terms of the variance normalized by the mean of the multiplicity distribution. The η and pT dependences of the fluctuations and their evolution with respect to collision centrality are investigated. The multiplicity fluctuations tend to decrease from peripheral to central collisions. The results are compared to those obtained from HIJING and AMPT Monte Carlo event generators as well as to experimental data at lower collision energies. Additionally, the measured multiplicity fluctuations are discussed in the context of the isothermal compressibility of the high-density strongly-interacting system formed in central Pb–Pb collisions

First measurements of N-subjettiness in central Pb–Pb collisions at √ sNN = 2.76 TeV

The ALICE Collaboration reports the first fully-corrected measurements of the N-subjettiness observable for track-based jets in heavy-ion collisions. This study is performed using data recorded in pp and Pb–Pb collisions at centre-of-mass energies of √s = 7 TeV and √ sNN = 2.76 TeV, respectively. In particular the ratio of 2-subjettiness to 1-subjettiness, τ2/τ1, which is sensitive to the rate of two-pronged jet substructure, is presented. Energy loss of jets traversing the strongly interacting medium in heavy-ion collisions is expected to change the rate of two-pronged substructure relative to vacuum. The results are presented for jets with a resolution parameter of R = 0.4 and charged jet transverse momentum of 40 ≤ pT,jet ≤ 60 GeV/c, which constitute a larger jet resolution and lower jet transverse momentum interval than previous measurements in heavy-ion collisions. This has been achieved by utilising a semi-inclusive hadron-jet coincidence technique to suppress the larger jet combinatorial background in this kinematic region. No significant modification of the τ2/τ1 observable for track-based jets in Pb–Pb collisions is observed relative to vacuum PYTHIA6 and PYTHIA8 references at the same collision energy. The measurements of τ2/τ1, together with the splitting aperture angle ∆R, are also performed in pp collisions at √s = 7 TeV for inclusive jets. These results are compared with PYTHIA calculations at √s = 7 TeV, in order to validate the model as a vacuum reference for the Pb–Pb centre-of-mass energy. The PYTHIA references for τ2/τ1 are shifted to larger values compared to the measurement in pp collisions. This hints at a reduction in the rate of two-pronged jets in Pb–Pb collisions compared to pp collisions