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

Systematic Detection of Parallelism in Ordinary Programs

Thesis (Ph. D.--University of Rochester. Dept. of Computer Science, 1991. Simultaneously published in the Technical Report series.This dissertation discusses a general model for compilers that take imperative code written for sequential machines (ordinary code) and detect in that code the parallelism that is compatible with the semantics of the underlying programming language. This model is based on the idea of separating the concerns of parallelism detection and parallelism exploitation. This separation is made possible by having the detection component provide an explicit representation of the parallelism available in the original code. This explicitly parallel representation is based on a mathematical formalization of the notion of permissible execution sequences for a given mass of code. Having made that separation, one can discuss an organization for the parallelism detection component. This organization depends on (1) recognizing a hierarchical structure on a graph representation of the program; and (2) separately encoding parallelization conditions and effects. Opportunities for parallelization can then be discovered by traversing the hierarchical structure from the bottom up. During this traversal, progressively larger parts of the program are compared against the independently encoded conditions, and transformed when the conditions for a parallelizing transformation are satisfied

Benchmarking interno para el desempeno del servicio del mantenimiento en minas subterraneas para la Superintendencia Mantenimiento Mina, Division el teniente Codelco, Chile

146 p.Esta memoria fue desarrolla en las dependencias de la Superintendencia Mantenimiento Mina, de la División El Teniente, CODELCO CHILE. Más específicamente en la unidad de ingeniería de mantenimiento. La ingeniería del mantenimiento se encarga de proyectar, controlar y mejorar el mantenimiento dentro de la División. Con la idea de mejorar los estándares de desempeño, nace este estudio de benchmarking interno, comparando los resultados obtenidos en la gestión del mantenimiento, por medio de indicadores existentes dentro del mantenimiento a nivel corporativo, e identificando brechas y posibilidades de mejora. El benchmarking o estudio de referencia es una técnica de recolección de información acerca de prácticas competitivas. Se utiliza para buscar el mejor indicador y compararse con él para mejorar las prácticas o procesos del negocio, proveyendo a la administración de prácticas que deliberadamente den al cliente mayores valores. Esta memoria se desarrolló en tres grandes etapas, inherentes a cualquier proyecto: Planificación, Ejecución e implementación. En la Planificación, se reconocieron los servicios relevantes como el mantenimiento de los equipos LHD, Jumbos y Martillos y se formalizaron los indicadores para el estudio. En la etapa de ejecución se analizaron los datos encontrándose brechas de 24,21 US$/Hrs. En el costo unitario de mantenimiento de los equipos LHD TORO T007 y 3,27mantenimiento. En Jumbos de Reducción Secundaria las brechas encontradas fueron de 44,22US$/Hrs. Y 2,5% en el costo unitario de mantenimiento y el cumplimiento de las estrategias de mantenimiento respectivamente. En la etapa de Implementación se elaboraron propuestas que permiten disminuir las brechas de 24,01 a 10,02US$/Hrs. Para los equipos LHD TORO T007 y de 44,22 a 23 US$/Hrs. Para los equipos Jumbos de Reducción Secundaria. Lo relacionado con la implantación de los planes queda a disposición de la Superintendencia Mantenimiento Mina ya que escapa de los objetivos de esta memoria

Computer Science and Engineering Research Review 1991-1992

Table of Contents: Introduction / p. 5; The Rochester Checkers Player: Multi-Model Parallel Programming for Animate Vision / Brian D. Marsh, Christopher M. Brown, Thomas J. LeBlanc, Michael L. Scott, Timothy G. Becker, Prakash Ch. Das, Jonas Karlsson, Cesar A. Quiroz p. 7; A Novel Halftoning Technique; the Blue Noise Mask / Theophano Mitsa , Kevin J. Parker p. 16; Quasi-Injective Reductions / Lane A. Hemachandra, Edith Spaan p. 21; An Asynchronous Multiplier / Brenda Luderman, Alexander Albicki p. 24; An Overview of the TRAINS Project James F. Allen, Lenhart K. Schubert p. 29; Faculty p. 36; Publications p. 38; Doctoral and Master's Theses p. 46; Seminars p. 51; Grant and Industrial Support p. 52

Non-canonical function of IRE1 alpha determines mitochondria-associated endoplasmic reticulum composition to control calcium transfer and bioenergetics

Mitochondria-associated membranes (MAMs) are central microdomains that fine-tune bioenergetics by the local transfer of calcium from the endoplasmic reticulum to the mitochondrial matrix. Here, we report an unexpected function of the endoplasmic reticulum stress transducer IRE1α as a structural determinant of MAMs that controls mitochondrial calcium uptake. IRE1α deficiency resulted in marked alterations in mitochondrial physiology and energy metabolism under resting conditions. IRE1α determined the distribution of inositol-1,4,5-trisphosphate receptors at MAMs by operating as a scaffold. Using mutagenesis analysis, we separated the housekeeping activity of IRE1α at MAMs from its canonical role in the unfolded protein response. These observations were validated in vivo in the liver of IRE1α conditional knockout mice, revealing broad implications for cellular metabolism. Our results support an alternative function of IRE1α in orchestrating the communication between the endoplasmic reticulum and mitochondria to sustain bioenergetics.status: publishe

Odanacatib for the treatment of postmenopausal osteoporosis. results of the LOFT multicentre, randomised, double-blind, placebo-controlled trial and LOFT extension study

Background: Odanacatib, a cathepsin K inhibitor, reduces bone resorption while maintaining bone formation. Previous work has shown that odanacatib increases bone mineral density in postmenopausal women with low bone mass. We aimed to investigate the efficacy and safety of odanacatib to reduce fracture risk in postmenopausal women with osteoporosis. Methods: The Long-term Odanacatib Fracture Trial (LOFT) was a multicentre, randomised, double-blind, placebo-controlled, event-driven study at 388 outpatient clinics in 40 countries. Eligible participants were women aged at least 65 years who were postmenopausal for 5 years or more, with a femoral neck or total hip bone mineral density T-score between −2·5 and −4·0 if no previous radiographic vertebral fracture, or between −1·5 and −4·0 with a previous vertebral fracture. Women with a previous hip fracture, more than one vertebral fracture, or a T-score of less than −4·0 at the total hip or femoral neck were not eligible unless they were unable or unwilling to use approved osteoporosis treatment. Participants were randomly assigned (1:1) to either oral odanacatib (50 mg once per week) or matching placebo. Randomisation was done using an interactive voice recognition system after stratification for previous radiographic vertebral fracture, and treatment was masked to study participants, investigators and their staff, and sponsor personnel. If the study completed before 5 years of double-blind treatment, consenting participants could enrol in a double-blind extension study (LOFT Extension), continuing their original treatment assignment for up to 5 years from randomisation. Primary endpoints were incidence of vertebral fractures as assessed using radiographs collected at baseline, 6 and 12 months, yearly, and at final study visit in participants for whom evaluable radiograph images were available at baseline and at least one other timepoint, and hip and non-vertebral fractures adjudicated as being a result of osteoporosis as assessed by clinical history and radiograph. Safety was assessed in participants who received at least one dose of study drug. The adjudicated cardiovascular safety endpoints were a composite of cardiovascular death, myocardial infarction, or stroke, and new-onset atrial fibrillation or flutter. Individual cardiovascular endpoints and death were also assessed. LOFT and LOFT Extension are registered with ClinicalTrials.gov (number NCT00529373) and the European Clinical Trials Database (EudraCT number 2007-002693-66). Findings: Between Sept 14, 2007, and Nov 17, 2009, we randomly assigned 16 071 evaluable patients to treatment: 8043 to odanacatib and 8028 to placebo. After a median follow-up of 36·5 months (IQR 34·43–40·15) 4297 women assigned to odanacatib and 3960 assigned to placebo enrolled in LOFT Extension (total median follow-up 47·6 months, IQR 35·45–60·06). In LOFT, cumulative incidence of primary outcomes for odanacatib versus placebo were: radiographic vertebral fractures 3·7% (251/6770) versus 7·8% (542/6910), hazard ratio (HR) 0·46, 95% CI 0·40–0·53; hip fractures 0·8% (65/8043) versus 1·6% (125/8028), 0·53, 0·39–0·71; non-vertebral fractures 5·1% (412/8043) versus 6·7% (541/8028), 0·77, 0·68–0·87; all p&lt;0·0001. Combined results from LOFT plus LOFT Extension for cumulative incidence of primary outcomes for odanacatib versus placebo were: radiographic vertebral fractures 4·9% (341/6909) versus 9·6% (675/7011), HR 0·48, 95% CI 0·42–0·55; hip fractures 1·1% (86/8043) versus 2·0% (162/8028), 0·52, 0·40–0·67; non-vertebral fractures 6·4% (512/8043) versus 8·4% (675/8028), 0·74, 0·66–0·83; all p&lt;0·0001. In LOFT, the composite cardiovascular endpoint of cardiovascular death, myocardial infarction, or stroke occurred in 273 (3·4%) of 8043 patients in the odanacatib group versus 245 (3·1%) of 8028 in the placebo group (HR 1·12, 95% CI 0·95–1·34; p=0·18). New-onset atrial fibrillation or flutter occurred in 112 (1·4%) of 8043 patients in the odanacatib group versus 96 (1·2%) of 8028 in the placebo group (HR 1·18, 0·90–1·55; p=0·24). Odanacatib was associated with an increased risk of stroke (1·7% [136/8043] vs 1·3% [104/8028], HR 1·32, 1·02–1·70; p=0·034), but not myocardial infarction (0·7% [60/8043] vs 0·9% [74/8028], HR 0·82, 0·58–1·15; p=0·26). The HR for all-cause mortality was 1·13 (5·0% [401/8043] vs 4·4% [356/8028], 0·98–1·30; p=0·10). When data from LOFT Extension were included, the composite of cardiovascular death, myocardial infarction, or stroke occurred in significantly more patients in the odanacatib group than in the placebo group (401 [5·0%] of 8043 vs 343 [4·3%] of 8028, HR 1·17, 1·02–1·36; p=0·029, as did stroke (2·3% [187/8043] vs 1·7% [137/8028], HR 1·37, 1·10–1·71; p=0·0051). Interpretation: Odanacatib reduced the risk of fracture, but was associated with an increased risk of cardiovascular events, specifically stroke, in postmenopausal women with osteoporosis. Based on the overall balance between benefit and risk, the study's sponsor decided that they would no longer pursue development of odanacatib for treatment of osteoporosis. Funding: Merck Sharp &amp; Dohme Corp, a subsidiary of Merck &amp; Co, Inc, Kenilworth, NJ, USA