200 research outputs found
A theropod trackway providing evidence of a pathological foot from the exceptional locality of Las Hoyas (upper Barremian, Serranía de Cuenca, Spain)
We describe a trackway (LH-Mg-10-16) occurring in laminated carbonated limestones of the Las Hoyas locality, Serranía de Cuenca, Spain. It is unmistakably a large theropod dinosaur trackway encompassing two unusual aspects, namely, wide-steps, and a set of equally deformed left footprints (with a dislocated digit). The layer also preserves other vertebrate trails (fish Undichna) and different impressions in the sediment. To address these complex settings, we devised a multidisciplinary approach, including the ichnological and taphonomical descriptions, characterisation of the rock lithofacies using thin-sections, 3D structured-light digitalisation with a high precision of 200-400 μm, and a geometric morphometric comparison with a large sample of bipedal dinosaur trackways. Sedimentary analyses showed that the trackway was produced in a humid, benthonic microbial mat, the consistency and plasticity of which enabled the preservation of the details of the movement of the animal. The results of the geometric analysis indicate that the 'wide-steps' of the trackway is not unusual compared to other trackways, providing evidence that it was made by a single individual with an estimated hip height approximately 2 m. Analogous pathologies in extant archosaurs that yield the combination of wide steps and deformed digits in the same trackway were considered. All results mutually support the hypothesis that a large theropod dinosaur, with a pathological foot, generated the trackway as it crossed an area of shallow water while slowly walking towards the main water source, thus stepping steadily over the benthonic mat over which multiple fish were swimming
Kwapa: Gente del río. Estrategias transmedia de impacto social
PAP Alter Código produce materiales de interacción audiovisual que se organizan en un universo transmedia, trabaja con personas de todas las edades, su meta es difundir representaciones no estigmatizantes de grupos socialmente desfavorecidos, además de compartir esta visión a todo aquel que colabore en el proyecto.
En la temporada de verano 2023, el equipo Alter CÓDIGO continuó con el desarrollo del videojuego “A la orilla del río”, para ello la organización del trabajo se dividió en múltiples áreas tanto como comunitarias como digitales para dar una mayor profundidad al producto. Los avances más significativos van desde una versión más actualizada del guion, storyboards, una primera
animación, un demo, este último de lo que sería el gameplay, y un minijuego. Asimismo, se muestra la vinculación comunitaria e impacto social que se logró con el desarrollo de los talleres de intervención fotográfica con niños acerca de su territorio. Paralelamente se aborda la creación de redes sociales y página web para la difusión del proyecto por fuera del PAP.
En los dos meses de trabajo se cumplieron con los ideales del Proyecto de Aplicación Profesional y se logró una difusión transmedia. A pesar de que el proyecto aún no llega a su finalización, los avances y el alcance superaron las metas que se otorgaron al inicio de la temporada.ITESO, A.C
The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients
Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation
VIII Encuentro de Docentes e Investigadores en Historia del Diseño, la Arquitectura y la Ciudad
Acta de congresoLa conmemoración de los cien años de la Reforma Universitaria de 1918 se presentó como una ocasión propicia para debatir el rol de la historia, la teoría y la crítica en la formación y en la práctica profesional de diseñadores, arquitectos y urbanistas.
En ese marco el VIII Encuentro de Docentes e Investigadores en Historia del Diseño, la Arquitectura y la Ciudad constituyó un espacio de intercambio y reflexión cuya realización ha sido posible gracias a la colaboración entre Facultades de Arquitectura, Urbanismo y Diseño de la Universidad Nacional y la Facultad de Arquitectura de la Universidad Católica de Córdoba, contando además con la activa participación de mayoría de las Facultades, Centros e Institutos de Historia de la Arquitectura del país y la región.
Orientado en su convocatoria tanto a docentes como a estudiantes de Arquitectura y Diseño Industrial de todos los niveles de la FAUD-UNC promovió el debate de ideas a partir de experiencias concretas en instancias tales como mesas temáticas de carácter interdisciplinario, que adoptaron la modalidad de presentación de ponencias, entre otras actividades.
En el ámbito de VIII Encuentro, desarrollado en la sede Ciudad Universitaria de Córdoba, se desplegaron numerosas posiciones sobre la enseñanza, la investigación y la formación en historia, teoría y crítica del diseño, la arquitectura y la ciudad; sumándose el aporte realizado a través de sus respectivas conferencias de Ana Clarisa Agüero, Bibiana Cicutti, Fernando Aliata y Alberto Petrina. El conjunto de ponencias que se publican en este Repositorio de la UNC son el resultado de dos intensas jornadas de exposiciones, cuyos contenidos han posibilitado actualizar viejos dilemas y promover nuevos debates.
El evento recibió el apoyo de las autoridades de la FAUD-UNC, en especial de la Secretaría de Investigación y de la Biblioteca de nuestra casa, como así también de la Facultad de Arquitectura de la UCC; va para todos ellos un especial agradecimiento
The Helicobacter pylori Genome Project : insights into H. pylori population structure from analysis of a worldwide collection of complete genomes
Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics
A search for pulsars around Sgr A* in the first Event Horizon Telescope data set
In 2017 the Event Horizon Telescope (EHT) observed the supermassive black hole at the center of the Milky Way,
Sagittarius A* (Sgr A*), at a frequency of 228.1 GHz (λ = 1.3 mm). The fundamental physics tests that even a
single pulsar orbiting Sgr A* would enable motivate searching for pulsars in EHT data sets. The high observing
frequency means that pulsars—which typically exhibit steep emission spectra—are expected to be very faint.
However, it also negates pulse scattering, an effect that could hinder pulsar detections in the Galactic center.
Additionally, magnetars or a secondary inverse Compton emission could be stronger at millimeter wavelengths
than at lower frequencies. We present a search for pulsars close to Sgr A* using the data from the three most
sensitive stations in the EHT 2017 campaign: the Atacama Large Millimeter/submillimeter Array, the Large
Millimeter Telescope, and the IRAM 30 m Telescope. We apply three detection methods based on Fourier-domain
analysis, the fast folding algorithm, and single-pulse searches targeting both pulsars and burst-like transient
emission. We use the simultaneity of the observations to confirm potential candidates. No new pulsars or
significant bursts were found. Being the first pulsar search ever carried out at such high radio frequencies, we detail
our analysis methods and give a detailed estimation of the sensitivity of the search. We conclude that the EHT 2017
observations are only sensitive to a small fraction (2.2%) of the pulsars that may exist close to Sgr A*, motivating
further searches for fainter pulsars in the region.ACKNOWLEDGEMENTS : We are grateful to the anonymous referee for the review and
providing suggestions that improved the manuscript. We thank the
staff at the participating observatories and correlator centers that
made possible the EHT 2017 observations. P.T. thanks Pablo
Mellado and William Robertson for their support through several
stages of the data reduction in the IRAM servers. R.P.E. is funded by the Chinese Academy of Sciences President’s International
Fellowship Initiative, grant No. 2021FSM0004. S.M.R. is a
CIFAR Fellow and is supported by the NSF Physics Frontiers
Center awards 1430284 and 2020265. This work was supported
by the European Research Council Synergy Grant “Black-
HoleCam: Imaging the Event Horizon of Black Holes” (grant
610058). This paper makes use of the following ALMA data:
ADS/JAO.ALMA#2016.1.01404.V. ALMA is a partnership of
the European Southern Observatory (ESO; Europe, representing its
member states), NSF, and National Institutes of Natural Sciences
of Japan, together with National Research Council (Canada),
Ministry of Science and Technology (MOST; Taiwan), Academia
Sinica Institute of Astronomy and Astrophysics (ASIAA; Taiwan),
and Korea Astronomy and Space Science Institute (KASI;
Republic of Korea), in cooperation with the Republic of Chile.
The Joint ALMA Observatory is operated by ESO, Associated
Universities, Inc. (AUI)/NRAO, and the National Astronomical
Observatory of Japan (NAOJ). The National Radio Astronomy
Observatory is a facility of the National Science Foundation
operated under cooperative agreement by Associated Universities,
Inc. The LMT is a project operated by the Instituto Nacional de
Astrófisica, Óptica, y Electrónica (Mexico) and the University of
Massachusetts at Amherst (USA). This work is partly based on
observations carried out with the IRAM 30m Telescope under
project No. 084-17. The IRAM 30m Telescope on Pico Veleta,
Spain is operated by IRAM and supported by CNRS (Centre
National de la Recherche Scientifique, France), MPG (Max-
Planck-Gesellschaft, Germany), and IGN (Instituto Geográfico
Nacional, Spain). This research has made use of NASA’s
Astrophysics Data System Bibliographic Services. Part of this
research was carried out at the Jet Propulsion Laboratory,
California Institute of Technology, under a contract with the
National Aeronautics and Space Administration. The Event
Horizon Telescope Collaboration thanks the following organizations
and programs: the Academia Sinica; the Academy of Finland
(projects 274477, 284495, 312496, and 315721); the Agencia
Nacional de Investigación y Desarrollo (ANID), Chile via
NCN19_058 (TITANs) and Fondecyt 1221421, the Alexander
von Humboldt Stiftung; an Alfred P. Sloan Research Fellowship;
Allegro, the European ALMA Regional Centre node in the
Netherlands, the NL astronomy research network NOVA and the
astronomy institutes of the University of Amsterdam, Leiden
University and Radboud University; the ALMA North America
Development Fund; the Astrophysics and High Energy Physics
program by MCIN (with funding from European Union
NextGenerationEU, PRTR-C17I1); the Black Hole Initiative,
which is funded by grants from the John Templeton Foundation
and the Gordon and Betty Moore Foundation (although the
opinions expressed in this work are those of the author(s) and do
not necessarily reflect the views of these Foundations); theBrinson
Foundation; Chandra DD7-18089X and TM6-17006X; the China
Scholarship Council; the China Postdoctoral Science Foundation
fellowships (2020M671266, 2022M712084); Consejo Nacional de
Ciencia y Tecnología (CONACYT, Mexico, projects U0004-
246083, U0004-259839, F0003-272050, M0037-279006, F0003-
281692, 104497, 275201, and 263356); the Consejería de
Economía, Conocimiento, Empresas y Universidad of the Junta
de Andalucía (grant P18-FR-1769), the Consejo Superior de
Investigaciones Científicas (grant 2019AEP112); the Delaney
Family via the Delaney Family John A. Wheeler Chair at
Perimeter Institute; Dirección General de Asuntos del Personal
Académico-Universidad Nacional Autónoma de México
(DGAPA-UNAM, projects IN112417 and IN112820); the Dutch
Organization for Scientific Research (NWO) for VICI award (grant
639.043.513), grant OCENW.KLEIN.113 and the Dutch black
hole Consortium (with project No. NWA 1292.19.202) of the
research program the National Science Agenda; the Dutch National
Supercomputers, Cartesius and Snellius (NWO grant 2021.013);
the EACOA Fellowship awarded by the East Asia Core
Observatories Association, which consists of the Academia Sinica
Institute of Astronomy and Astrophysics, the National Astronomical
Observatory of Japan, Center for Astronomical Mega-Science,
Chinese Academy of Sciences, and the Korea Astronomy and
Space Science Institute; the European Union Horizon 2020
research and innovation program under grant agreements RadioNet
(No 730562) and M2FINDERS (No 101018682); the Horizon
ERC Grants 2021 program under grant agreement No. 101040021;
the Generalitat Valenciana (grants APOSTD/2018/177 and
ASFAE/2022/018) and GenT Program (project CIDEGENT/
2018/021); MICINN Research Project PID2019-108995GB-C22;
the European Research Council for advanced grant “JETSET:
Launching, propagation and emission of relativistic jets from
binary mergers and across mass scales” (grant No. 884631); the
Institute for Advanced Study; the Istituto Nazionale di Fisica
Nucleare (INFN) sezione di Napoli, iniziative specifiche TEONGRAV;
the International Max Planck Research School for
Astronomy and Astrophysics at the Universities of Bonn and
Cologne; DFG research grant “Jet physics on horizon scales and
beyond” (grant No. FR 4069/2-1); Joint Columbia/Flatiron
Postdoctoral Fellowship, research at the Flatiron Institute is
supported by the Simons Foundation; the Japan Ministry of
Education, Culture, Sports, Science and Technology (MEXT;
grant JPMXP1020200109); the Japan Society for the Promotion of
Science (JSPS) Grant-in-Aid for JSPS Research Fellowship
(JP17J08829); the Joint Institute for Computational Fundamental
Science, Japan; the Key Research Program of Frontier Sciences,
Chinese Academy of Sciences (CAS, grants QYZDJ-SSWSLH057,
QYZDJSSW-SYS008, ZDBS-LY-SLH011); the Leverhulme
Trust Early Career Research Fellowship; the Max-Planck-
Gesellschaft (MPG); the Max Planck Partner Group of the MPG
and the CAS; the MEXT/JSPS KAKENHI (grants 18KK0090,
JP21H01137, JP18H03721, JP18K13594, 18K03709,
JP19K14761, 18H01245, 25120007); the Malaysian Fundamental
Research Grant Scheme (FRGS) FRGS/1/2019/STG02/UM/
02/6; the MIT International Science and Technology Initiatives
(MISTI) Funds; the Ministry of Science and Technology (MOST)
of Taiwan (103-2119-M-001-010-MY2, 105-2112-M-001-025-
MY3, 105-2119-M-001-042, 106-2112-M-001-011, 106-2119-M-
001-013, 106-2119-M-001-027, 106-2923-M-001-005, 107-2119-
M-001-017, 107-2119-M-001-020, 107-2119-M-001-041, 107-
2119-M-110-005, 107-2923-M-001-009, 108-2112-M-001-048,
108-2112-M-001-051, 108-2923-M-001-002, 109-2112-M-001-
025, 109-2124-M-001-005, 109-2923-M-001-001, 110-2112-M-
003-007-MY2, 110-2112-M-001-033, 110-2124-M-001-007, and
110-2923-M-001-001); the Ministry of Education (MoE) of
Taiwan Yushan Young Scholar Program; the Physics Division,
National Center for Theoretical Sciences of Taiwan; the National
Aeronautics and Space Administration (NASA, Fermi Guest
Investigator grant 80NSSC20K1567, NASA Astrophysics Theory
Program grant 80NSSC20K0527, NASA NuSTAR award
80NSSC20K0645); NASA Hubble Fellowship grants HST-HF2-
51431.001-A, HST-HF2-51482.001-A awarded by the Space
Telescope Science Institute, which is operated by the
Association of Universities for Research in Astronomy, Inc., for NASA, under contract NAS5-26555; the National Institute of
Natural Sciences (NINS) of Japan; the National Key Research and
Development Program of China (grant 2016YFA0400704,
2017YFA0402703, 2016YFA0400702); the National Science
Foundation (NSF, grants AST-0096454, AST-0352953, AST-
0521233, AST-0705062, AST-0905844, AST-0922984, AST-
1126433, AST-1140030, DGE-1144085, AST-1207704, AST-
1207730, AST-1207752, MRI-1228509, OPP-1248097, AST-
1310896, AST-1440254, AST-1555365, AST-1614868, AST-
1615796, AST-1715061, AST-1716327, AST-1716536, OISE-
1743747, AST-1816420, AST-1935980, AST-2034306); NSF
Astronomy and Astrophysics Postdoctoral Fellowship (AST-
1903847); the Natural Science Foundation of China (grants
11650110427, 10625314, 11721303, 11725312, 11873028,
11933007, 11991052, 11991053, 12192220, 12192223); the
Natural Sciences and Engineering Research Council of Canada
(NSERC, including a Discovery Grant and the NSERC Alexander
Graham Bell Canada Graduate Scholarships-Doctoral Program);
the National Youth Thousand Talents Program of China; the
National Research Foundation of Korea (the Global PhD
Fellowship Grant: grants NRF-2015H1A2A1033752, the Korea
Research Fellowship Program: NRF-2015H1D3A1066561, Brain
Pool Program: 2019H1D3A1A01102564, Basic Research
Support Grant 2019R1F1A1059721, 2021R1A6A3A01086420,
2022R1C1C1005255); Netherlands Research School for Astronomy
(NOVA) Virtual Institute of Accretion (VIA) postdoctoral
fellowships; Onsala Space Observatory (OSO) national infrastructure,
for the provisioning of its facilities/observational support
(OSO receives funding through the Swedish Research Council
under grant 2017-00648); the Perimeter Institute for Theoretical
Physics (research at Perimeter Institute is supported by the
Government of Canada through the Department of Innovation,
Science and Economic Development and by the Province of
Ontario through the Ministry of Research, Innovation and
Science); the Princeton Gravity Initiative; the Spanish Ministerio
de Ciencia e Innovación (grants PGC2018-098915-B-C21,
AYA2016-80889-P, PID2019-108995GB-C21, and PID2020-
117404GB-C21); the University of Pretoria for financial aid in
the provision of the new Cluster Server nodes and SuperMicro
(USA) for an SEEDING grant approved toward these nodes in
2020; the Shanghai Pilot Program for Basic Research, Chinese
Academy of Science, Shanghai Branch (JCYJ-SHFY-2021-013);
the State Agency for Research of the Spanish MCIU through the
“Center of Excellence Severo Ochoa” award for the Instituto de
Astrofísica de Andalucía (SEV-2017-0709); the Spinoza Prize SPI
78-409; the South African Research Chairs Initiative, through the
South African Radio Astronomy Observatory (SARAO, grant ID
77948), which is a facility of the National Research Foundation
(NRF), an agency of the Department of Science and Innovation
(DSI) of South Africa; the Toray Science Foundation; the Swedish
Research Council (VR); the US Department of Energy (USDOE)
through the Los Alamos National Laboratory (operated by Triad
National Security, LLC, for the National Nuclear Security
Administration of the USDOE (contract 89233218CNA000001);
and the YCAA Prize Postdoctoral Fellowship. This research used
resources of the Oak Ridge Leadership Computing Facility at the
Oak Ridge National Laboratory, which is supported by the Office
of Science of the U.S. Department of Energy under contract No.
DE-AC05-00OR22725. We also thank the Center for Computational
Astrophysics, National Astronomical Observatory of Japan.
The computing cluster of Shanghai VLBI correlator supported by
the Special Fund for Astronomy from the Ministry of Finance in
China is acknowledged. This work was partially supported by
FAPESP (Fundação de Amparo á Pesquisa do Estado de São
Paulo) under grant 2021/01183-8. APEX is a collaboration
between the Max-Planck-Institut für Radioastronomie (Germany),
ESO, and the Onsala Space Observatory (Sweden). The SMT is
operated by the Arizona Radio Observatory, a part of the Steward
Observatory of the University of Arizona, with financial support of
operations from the State of Arizona and financial support for
instrumentation development from the NSF. Support for SPT
participation in the EHT is provided by the National Science
Foundation through award OPP-1852617 to the University of
Chicago. Partial support is also provided by the Kavli Institute of
Cosmological Physics at the University of Chicago. The SPT
hydrogen maser was provided on loan from the GLT, courtesy of
ASIAA. The SMA is a joint project between the SAO and ASIAA
and is funded by the Smithsonian Institution and the Academia
Sinica. The JCMT is operated by the East Asian Observatory on
behalf of the NAOJ, ASIAA, and KASI, as well as the Ministry of
Finance of China, Chinese Academy of Sciences, and the
National Key Research and Development Program (No.
2017YFA0402700) of China and Natural Science Foundation of
China grant 11873028. Additional funding support for the JCMT
is provided by the Science and Technologies Facility Council
(UK) and participating universities in the UK and Canada. We
acknowledge the significance that Maunakea, where the SMA and
JCMT EHT stations are located, has for the indigenous Hawaiian people. The EHTC has received generous donations of FPGA
chips from Xilinx Inc., under the Xilinx University Program. The
EHTC has benefited from technology shared under an open-source
license by the Collaboration for Astronomy Signal Processing and
Electronics Research (CASPER). The EHT project is grateful to
T4Science and Microsemi for their assistance with Hydrogen
Masers. We gratefully acknowledge the support provided by the
extended staff of the ALMA, both from the inception of the
ALMA Phasing Project through the observational campaigns of
2017 and 2018. We would like to thank A. Deller and W. Brisken
for EHT-specific support with the use of DiFX.
FACILITIES: ALMA, LMT, IRAM:30m.
SOFTWARE : MPIvdif2psrfits, PRESTO (Ransom 2011),
RIPTIDE (Morello et al. 2020), NUMPY (Harris et al. 2020),
SCIPY (Virtanen et al. 2020), MATPLOTLIB (Hunter 2007),
TEMPO (Nice et al. 2015), SIGPYPROC (Lorimer 2011).https://iopscience.iop.org/journal/0004-637Xam2024PhysicsNon
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
- …