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

Is Carbon Neutrality Attainable with Financial Sector Expansion in Various Economies? An Intrinsic Analysis of Economic Activity on CO₂ Emissions

The severe effects of climate change and its anticipated negative influence on the future of the globe has prompted more research into the attainment of carbon neutrality. While carbon neutrality is a paramount issue, human socio-economic well-being which is mostly influenced by economic activities cannot be overlooked. This study investigates the effect of financial sector activities on CO2 emission in five economic sectors and three economic bodies. The financial sector variables utilized are derived from the undertakings of institutions such as banks, stock exchanges, and insurance companies. Using a sample of 39 countries between 1989 and 2018, this paper provides a global perspective of the profound impact financial sector activities have in different economies on CO2 emission reduction. The feasible generalized least squares (FGLS) regression model, as well as the random and fixed effects model with regards to Durbin–Wu–Hausman, are used to analyze the data. The generalized method of moments (GMM) is also adopted as the robustness method. Our findings show that for emerging economies, all major activities of the financial sector aggravated CO2 emission levels in all major CO2 emitting economic sectors. The developing and developed economies also show a similar trend. In the emerging economies, virtually all activities carried out by the financial sector have a significant negative impact on CO2 emissions at the 1% or 5% significance level, thereby hampering CO2 emission mitigation efforts. However, increased long-term bank lending to non-major economic sectors is found to alleviate CO2 emissions in developing economies. This is also the situation with increased numbers of import insurance. Meanwhile, CO2 emissions are found to decrease with increased net portfolio investments and numbers of insurance on exports. These findings not only imply that financial sector activities play a fundamental role in CO2 emission mitigation but also serve as a reminder for financial policymakers that the decisions they make have an inevitable impact on the attainment of carbon neutrality in their economies

Impact of Banking and Financial Systems on Environmental Sustainability: An Overarching Study of Developing, Emerging, and Developed Economies

In recent years, the developed, emerging, and developing economies have prioritized environmental sustainability attainment. In an attempt to offer some potential policy choices towards the achievement of sustainable development, this paper shifts emphasis from the popularly discussed economic development and carbon emissions nexus. Instead, we examine the impact of the banking and financial system&rsquo;s activities on carbon emissions for a sample of 45 countries. These are comprised of developed, emerging, and developing countries between 1990 and 2017. To fill the gap in the literature, the nexus is examined in seven different phases. This study exposes robust and reliable empirical results with the use of Feasible General Least Squares, random effects with regards to the Durbin&ndash;Wu&ndash;Hausman test, and Difference General Method of Moments panel data estimation models. Our findings indicate that the increase of domestic credit to the private sector and commercial bank lending consistently contributes towards aggravated carbon emissions in all economic types. Additionally, increased deposit rates in developing economies, increased lending rates in developed economies, and increased deposit rates in emerging economies contribute towards the overall reduction of carbon emissions. The decrease in lending to high GHG emitting members of the private sector by financial institutions in all economies is recommended based on the results of this study

COVID-19 Identification from Low-Quality Computed Tomography Using a Modified Enhanced Super-Resolution Generative Adversarial Network Plus and Siamese Capsule Network

Computed Tomography has become a vital screening method for the detection of coronavirus 2019 (COVID-19). With the high mortality rate and overload for domain experts, radiologists, and clinicians, there is a need for the application of a computerized diagnostic technique. To this effect, we have taken into consideration improving the performance of COVID-19 identification by tackling the issue of low quality and resolution of computed tomography images by introducing our method. We have reported about a technique named the modified enhanced super resolution generative adversarial network for a better high resolution of computed tomography images. Furthermore, in contrast to the fashion of increasing network depth and complexity to beef up imaging performance, we incorporated a Siamese capsule network that extracts distinct features for COVID-19 identification.The qualitative and quantitative results establish that the proposed model is effective, accurate, and robust for COVID-19 screening. We demonstrate the proposed model for COVID-19 identification on a publicly available dataset COVID-CT, which contains 349 COVID-19 and 463 non-COVID-19 computed tomography images. The proposed method achieves an accuracy of 97.92%, sensitivity of 98.85%, specificity of 97.21%, AUC of 98.03%, precision of 98.44%, and F1 score of 97.52%. Our approach obtained state-of-the-art performance, according to experimental results, which is helpful for COVID-19 screening. This new conceptual framework is proposed to play an influential task in the issue facing COVID-19 and related ailments, with the availability of few datasets