MIDDIS: Arquitectura de referencia para la interacción de servicios basados en SOA e IMS

The current trend in telecommunications is oriented to a search of a convergence of fixed and mobile networks, and therefore networks designed would be more complex. Also there are new challenges in the service networking and integration field across multiple networks, technologies and business areas, which involve there is a need to interoperate the Information Technologies (IT) and Telecommunication services. Therefore to contribute by solving these challenges but given the current lack of a fully adequate converged telecommunications environment –both traditional and new services–, this paper presents a reference architecture to enable and deliver quickly new converged services to the IT and telecommunications worlds, through SOA-IMS-based services interaction. Implemented in a SLEE, the middleware essential feature is that IMS uses SOA to integrate its own software components with external components, and thus it is achieved the IMS and Web services facilities combination to present a rich set of both services.En telecomunicaciones la tendencia actual está dirigida hacia una búsqueda de la convergencia de redes fijas y móviles, y por lo tanto, las redes que se diseñan son más complejas. Así mismo, se presentan nuevos retos en el campo de la interconexión e integración de servicios a través de múltiples redes, tecnologías y áreas de negocio, lo cual hace imprescindible interoperar los servicios de las Tecnologías de Información (Information Technologies, IT ), con los de telecomunicaciones. Para aportar en la solución de estos retos y debido además, a la ausencia de un entorno de telecomunicaciones convergente y completamente adecuado para la prestación de servicios tradicionales y nuevos, en este artículo se presenta una arquitectura de referencia que permite la habilitación y entrega rápida de servicios convergentes para el mundo IT y el mundo de las Telecomunicaciones, con la mediación en la interacción de servicios basados en la Arquitectura Orientada a Servicios (Service Oriented Architecture, SOA), y el Subsistema Multimedia IP (IP Multimedia Subsystem, IMS ). La característica esencial del middleware, implementado en un Entorno de Ejecución de Lógica de Servicio (Service Logic Execution Environment, SLEE), consiste en que IMS utiliza a SOA para integrar sus propios elementos software con componentes externos y de esta manera, se logra la combinación de las facilidades de la Web y de IMS para exponer un conjunto de servicios enriquecidos para ambos mundos

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

Lógica de mediación para la interacción de servicios basados en SOA e IMS

A partir de la necesidad de proporcionarle a los proveedores de servicios una facilidad software que combine el mundo SIP/IMS de las Telecomunicaciones y el mundo SOA de las IT, para el desarrollo, despliegue y la prestación rápida y eficiente de servicios convergentes SOA/IMS, tanto para redes existentes como futuras, en este trabajo se propone una Lógica de Mediación, denominada MIDDIS, para tratar de hacer simple la complejidad de las Telecomunicaciones para el mundo de las IT, y con ello agilizar el desarrollo de cualquier tipo de servicio en el nuevo entorno de convergencia

MIDDIS: arquitectura de referencia para la interacción de servicios basados en SOA e IMS

the current trend in telecommunications is oriented to a search of a convergence of fixed and mobile networks, and therefore networks designed would be more complex. Also there are new challenges in the service networking and integration field across multiple networks, technologies and business areas, which involve there is a need to interoperate the information technologies (it) and telecommunication services. therefore to contribute by solving these challenges but given the current lack of a fully adequate converged telecommunications environment -both traditional and new services-, this paper presents a reference architecture to enable and deliver quickly new converged services to the it and telecommunications worlds, through sOa-ims-based services interaction. implemented in a slee, the middleware essential feature is that ims uses sOa to integrate its own software components with external components, and thus it is achieved the ims and Web services facilities combination to present a rich set of both services.En telecomunicaciones la tendencia actual está dirigida hacia una búsqueda de la convergencia de redes fijas y móviles, y por lo tanto, las redes que se diseñan son más complejas. Así mismo, se presentan nuevos retos en el campo de la interconexión e integración de servicios a través de múltiples redes, tecnologías y áreas de negocio, lo cual hace imprescindible interoperar los servicios de las Tecnologías de Información (Information Technologies, IT ), con los de telecomunicaciones. Para aportar en la solución de estos retos y debido además, a la ausencia de un entorno de telecomunicaciones convergente y completamente adecuado para la prestación de servicios tradicionales y nuevos, en este artículo se presenta una arquitectura de referencia que permite la habilitación y entrega rápida de servicios convergentes para el mundo IT y el mundo de las Telecomunicaciones, con la mediación en la interacción de servicios basados en la Arquitectura Orientada a Servicios (Service Oriented Architecture, SOA), y el Subsistema Multimedia IP (IP Multimedia Subsystem, IMS ). La característica esencial del middleware, implementado en un Entorno de Ejecución de Lógica de Servicio (Service Logic Execution Environment, SLEE), consiste en que IMS utiliza a SOA para integrar sus propios elementos software con componentes externos y de esta manera, se logra la combinación de las facilidades de la Web y de IMS para exponer un conjunto de servicios enriquecidos para ambos mundos

MIDDIS: Arquitectura de referencia para la interacción de servicios basados en SOA e IMS

The current trend in telecommunications is oriented to a search of a convergence of fixed and mobile networks, and therefore networks designed would be more complex. Also there are new challenges in the service networking and integration field across multiple networks, technologies and business areas, which involve there is a need to interoperate the Information Technologies (IT) and Telecommunication services. Therefore to contribute by solving these challenges but given the current lack of a fully adequate converged telecommunications environment –both traditional and new services–, this paper presents a reference architecture to enable and deliver quickly new converged services to the IT and telecommunications worlds, through SOA-IMS-based services interaction. Implemented in a SLEE, the middleware essential feature is that IMS uses SOA to integrate its own software components with external components, and thus it is achieved the IMS and Web services facilities combination to present a rich set of both services.En telecomunicaciones la tendencia actual está dirigida hacia una búsqueda de la convergencia de redes fijas y móviles, y por lo tanto, las redes que se diseñan son más complejas. Así mismo, se presentan nuevos retos en el campo de la interconexión e integración de servicios a través de múltiples redes, tecnologías y áreas de negocio, lo cual hace imprescindible interoperar los servicios de las Tecnologías de Información (Information Technologies, IT ), con los de telecomunicaciones. Para aportar en la solución de estos retos y debido además, a la ausencia de un entorno de telecomunicaciones convergente y completamente adecuado para la prestación de servicios tradicionales y nuevos, en este artículo se presenta una arquitectura de referencia que permite la habilitación y entrega rápida de servicios convergentes para el mundo IT y el mundo de las Telecomunicaciones, con la mediación en la interacción de servicios basados en la Arquitectura Orientada a Servicios (Service Oriented Architecture, SOA), y el Subsistema Multimedia IP (IP Multimedia Subsystem, IMS ). La característica esencial del middleware, implementado en un Entorno de Ejecución de Lógica de Servicio (Service Logic Execution Environment, SLEE), consiste en que IMS utiliza a SOA para integrar sus propios elementos software con componentes externos y de esta manera, se logra la combinación de las facilidades de la Web y de IMS para exponer un conjunto de servicios enriquecidos para ambos mundos

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care