Cohort profile: LifeLines DEEP, a prospective, general population cohort study in the northern Netherlands:Study design and baseline characteristics

Purpose There is a critical need for population-based prospective cohort studies because they follow individuals before the onset of disease, allowing for studies that can identify biomarkers and disease-modifying effects, and thereby contributing to systems epidemiology. Participants This paper describes the design and baseline characteristics of an intensively examined subpopulation of the LifeLines cohort in the Netherlands. In this unique subcohort, LifeLines DEEP, we included 1539 participants aged 18 years and older. Findings to date We collected additional blood (n=1387), exhaled air (n=1425) and faecal samples (n=1248), and elicited responses to gastrointestinal health questionnaires (n=1176) for analysis of the genome, epigenome, transcriptome, microbiome, metabolome and other biological levels. Here, we provide an overview of the different data layers in LifeLines DEEP and present baseline characteristics of the study population including food intake and quality of life. We also describe how the LifeLines DEEP cohort allows for the detailed investigation of genetic, genomic and metabolic variation for a wide range of phenotypic outcomes. Finally, we examine the determinants of gastrointestinal health, an area of particular interest to us that can be addressed by LifeLines DEEP. Future plans We have established a cohort of which multiple data levels allow for the integrative analysis of populations for translation of this information into biomarkers for disease, and which will offer new insights into disease mechanisms and prevention

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

TVII - Taller de Integración - AR324 - 202101

Descripción: El curso TVII Taller de Integración es un curso perteneciente al séptimo nivel de los talleres de diseño arquitectónico que constituyen la columna vertebral de la carrera. en el que el estudiante Desarrollará propuestas arquitectónicas en las que las consideraciones específicas que fueron materia principal de los anteriores talleres estén satisfactoriamente atendidas. En los niveles precedentes, cada taller ha tenido un tema de inflexión (explicitado en el propio nombre del taller) Introducción al diseño de la Arquitectura, Arquitectura y Arte, Arquitectura y Entorno, Arquitectura y Función, Arquitectura y Medio Ambiente y Arquitectura y Construcción) En este nivel se pretende hacer que el estudiante adquiera una experiencia en la que aplique de manera integral los 06 temas anteriores en un proyecto arquitectónico. Este curso permite comprender la importancia que tiene cada una de las inflexiones en el Proceso de Diseño. En este nivel se trabajan proyectos con mayor envergadura y complejidad como Edificaciones Hospitalarias, Edificios Híbridos, Teatros de gran escala, entre otros. El curso de taller se basa en la búsqueda y ensayo de una metodología de diseño, mediante la rigurosidad y compromiso, que le permite al estudiante transitar por los distintos niveles de un método y acercarse al logro de los objetivos. Propósito: El curso Taller VII ¿Taller de integración tiene como propósito que el estudiante trabaje y desarrolle las herramientas necesarias para su desenvolvimiento en el campo profesional. En él se concientiza, refuerza y consolida en el estudiante, la importancia de las ideas detrás de un proyecto arquitectónico, una arquitectura pensada y no arbitraria, la importancia del desarrollo de un buen lenguaje, en el caso de la arquitectura, planos profesionales bien dibujados y expresados, imágenes en 03 dimensiones, esquemas. Por ello, se puede afirmar que los temas a trabajar son una excusa para desarrollar estas habilidades que finalmente aseguran el logro del nivel de las competencias. La asignatura contribuye al desarrollo de la competencia general Pensamiento innovador y la competencia específica de la carrera: Diseño Fundamentado que corresponde a los criterios NAAB : PC2, PC3, PC8, PC5, SC3, SC5 , ambas en el nivel de logro A2. Tiene como pre requisito la asignatura de AR313 Taller VI - Arquitectura y Construcció