Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials.

Funder: laura and john arnold foundationBACKGROUND: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care

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

El uso del microtargeting en las campa?as electorales: una aproximaci?n al caso de las elecciones del concejo municipal de Ibagu? en 2019.

102 p.Esta investigaci?n tuvo como objetivo analizar el proceso electoral en la ciudad de Ibagu? en 2019, para lo cual asumi? la microfocalizaci?n como herramienta de an?lisis de cuyo uso no se tiene un precedente claro en los en los procesos de participaci?n democr?tica a nivel local. El an?lisis diferenciado mediante la aplicaci?n de esta herramienta permiti? comprender los diferentes factores que convergen en dichos momentos electorales de manera directa. As? mismo, se busca ofrecer una visi?n mucho m?s amplia y clara de c?mo estos son analizados de la misma forma por los diferentes actores que convergen y permiten obtener informaci?n valiosa para determinar variables que muchas veces se pasan por alto en los estudios. Las redes sociales se han convertido en los ?ltimos a?os en una herramienta muy importante para el dise?o de las campa?as electorales, puesto que permiten a los candidatos difundir de manera masiva sus ideas y, al mismo tiempo, acercarse a una mayor cantidad de personas. De esta forma, las redes sociales han logrado transformarse en escenarios de debate pol?tico, donde existe un mayor grado de participaci?n por parte de los ciudadanos. Dada la importancia de aquellas, se ha desarrollado el microtargeting o la microfocalizaci?n como una herramienta para poder segmentar a?n m?s las poblaciones, con el objetivo de conocerlas mejor y lograr personalizar mensajes pol?ticos con el objetivo de captar m?s electores de acuerdo con sus caracter?sticas espec?ficas. Teniendo en cuenta este contexto, se analiz? el impacto del microtargeting en el dise?o de estrategias de comunicaci?n pol?tica y en los resultados electorales para las elecciones del concejo de Ibagu? en el a?o 2019. A partir de la aplicaci?n de una encuesta a los candidatos electos y la realizaci?n de algunas entrevistas a sus equipos de campa?a se evidenci? que, en la actualidad, el internet, las redes sociales y el microtargeting han marcado un cambio en el paradigma de la comunicaci?n pol?tica y la forma de hacer las campa?as pol?ticas. Por esta raz?n, aquellos candidatos que dise?aron sus campa?as pol?ticas estrat?gicamente a partir de estos medios y los m?todos de estratificaci?n lograron llegar al concejo. Palabras claves: microfocalizaci?n, microtargeting, electoral, participaci?n, elecciones y marketing.This research aimed to analyze the electoral process in the city of Ibagu? in 2019, for which it assumed microfocalization as an analysis tool whose use does not have a clear precedent in the processes of democratic participation at the local level. The differentiated analysis through the application of this tool allowed us to understand the different factors that converge directly at these electoral moments. Likewise, it seeks to offer a much broader and clearer vision of how these are analyzed in the same way by the different actors that converge and allow obtaining valuable information to determine variables that are often overlooked in studies. Social networks have become in recent years a very important tool for the design of electoral campaigns, since they allow candidates to massively disseminate their ideas and, at the same time, get closer to a greater number of people. In this way, social networks have managed to transform themselves into scenarios of political debate, where there is a greater degree of participation by citizens. Given their importance, microtargeting or microfocalization has been developed as a tool to further segment populations, with the aim of getting to know them better and personalizing political messages in order to attract more voters according to their specific characteristics. Taking this context into account, the impact of microtargeting on the design of political communication strategies and on the electoral results for the Ibagu? council elections in 2019 was analyzed. Conducting some interviews with their campaign teams showed that, at present, the internet, social networks and microtargeting have marked a change in the paradigm of political communication and the way of conducting political campaigns. For this reason, those candidates who strategically designed their political campaigns based on these means and stratification methods managed to reach the council. Keywords: microfocalizaci?n, microtargeting, electoral, participaci?n, elecciones y marketing

Importancia de la comprensi?n lectora en el proceso del aprendizaje en los estudiantes del grado primero de la sede Cora Grimaldo del municipio de Purificaci?n

100 p. Recurso Electr?nicoEl presente trabajo, ?importancia de la comprensi?n lectora en el proceso del aprendizaje en los estudiantes del grado primero de la sede Cora Grimaldo del municipio de Purificaci?n?, tiene como fin conocer las causas que hacen que los ni?os del grado primero de la instituci?n educativa Cora Grimaldo del municipio de Purificaci?n Tolima, presente dificultades en el proceso de comprensi?n lectora. Para la realizaci?n de esta investigaci?n se realiz? un trabajo de campo con los actores principales de la falencia encontrada, como fueron los estudiantes, docentes y se involucr? a algunos padres de familia. Se llevaron actividades pr?cticas y de observaci?n teniendo en cuenta que se utiliz? un m?todo cuantitativo dividido en una primera fase ?caracterizaci?n de los discursos que circulan y de las pr?cticas que se ejercen en la educaci?n de ni?os y ni?as menores de 7 a?os? y una segunda fase ?Los Sentidos Pedag?gicos De Los Proyectos De Intervenci?n?. Terminadas estas fases se da inicio a un proceso de intervenci?n con el micro proyecto pedag?gico de aula ?El Mundo M?gico de la Lectura?. Con ?l se pudo crear un m?todo de aprendizaje en la poblaci?n objeto de estudio en lo que hace referencia a la debilidad encontrada como lo fue crear un h?bito de lectura en estos infantes, buscando mejorar el nivel de lectura y comprensi?n de textos. Con base en teor?as de te?ricos expertos en estudiantes de este nivel. Palabras claves: Comprensi?n, Aprendizaje, Actores, Estudiantes, Docentes, Caracterizaci?n, Intervenci?n, te?rico.The present work, "importance of reading comprehension in the learning process in the students of the first grade", has as purpose to know the causes that make the children of the first degree of the educational institution Cora Grimaldo of the municipality of Purificaci?n Tolima, present difficulties in the process of reading comprehension. In order to carry out this research, a fieldwork was carried out with the main actors of the flaw found, such as the students; teachers and some parents were involved. Practical and observation activities were carried out taking into account that a quantitative method was used divided into a first phase "characterization of the circulating discourses and of the practices that are exercised in the education of children under 7 years of age" and a second phase "Pedagogical Senses of Intervention Projects". After these phases, an intervention process begins with the micro-pedagogical project of the classroom "El Mundo M?gico de la Lectura". With it, a method of learning could be created in the population under study in what refers to the weakness found as it was to create a habit of reading in these infants, seeking to improve the level of reading and comprehension of texts. Based on theories of expert theorists in students of this level. Keyworks: Understanding, Learning, Actors, Students, Teachers, Characterization, Intervention, theoretical