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

Effect of surfactants on the displacement efficiency of Nubia crude oil

325-328<span style="font-size:11.0pt;line-height:115%; font-family:" calibri","sans-serif";mso-ascii-theme-font:minor-latin;mso-fareast-font-family:="" "times="" new="" roman";mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:="" minor-latin;mso-bidi-font-family:"times="" roman";mso-ansi-language:en-us;="" mso-fareast-language:en-us;mso-bidi-language:ar-sa"="">An experimental investigation has been carried out using surfactant solutions to displace Nubia crude oil (October field).The effect of surfactant concentration and slug size has been investigated. The effect of oil saturation at the start of surfactant injection is also studied. The results indicate that the oil <span style="font-size:11.0pt;line-height: 115%;font-family:" calibri","sans-serif";mso-ascii-theme-font:minor-latin;="" mso-fareast-font-family:"times="" new="" roman";mso-fareast-theme-font:minor-fareast;="" mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"times="" roman";="" mso-ansi-language:en-us;mso-fareast-language:en-us;mso-bidi-language:ar-sa"="">recovery factor increases with increasing the oil saturation at the start of surfactant injection. The maximum surfactant recover ability is obtained by a slug size of 10%of the pore volume with 5000ppm surfactant concentration. It is also found that the oil recovery factor obtained by a small slug size with a high surfactant concentration is higher than that resulted by a big slug size with a lower surfactant concentration.</span

Thresholds for Object-Oriented Measures

A practical application of object-oriented measures is to predict which classes are likely to contain a fault. This is contended to be meaningful because object-oriented measures are believed to be indicators of psychological complexity, and classes that are more complex are likely to be faulty Recently, a cognitive theory has been proposed suggesting that there are threshold effects for many object-oriented measures. This means that objectoriented classes are easy to understand as long as their complexity is below a threshold. Above that threshold their understandability decreases rapidly, leading to an increased probability of a fault. This occurs, according to the theory, due to an overflow of short-term human memory. If this theory is confirmed, then it would provide a mechanism that would explain the introduction of faults into objectoriented systems, and would also provide some practical guidance on how to design object-oriented programs. In this paper we empirically test this theory on two C++ telecommunications systems. We test for threshold effects in a subset of the Chidamber and Kemerer (CK) suite of measures. The dependent variable was the incidence of faults that lead to field failures. Our results indicate that there are no threshold effects for any of the measures studied. This means that there is no value for the studied CK measures where the fault-proneness changes from being steady to rapidly increasing. The results are consistent across the two systems. Therefore, we can provide no support to the posited cognitive theory

Synthesis and characterization of metal complexes of schiff bases derived diamines

268-269The synthesis and the characterization of so e solid complexes of the types [M(IDE)]n.H2O and [M(IDB ]n.H2O [where M = Co2+, Ni2+, Cu2+, Zn2+, Cd2+ and UO, n= 0-4, IDE = the anion of bis (indol-2-one-3-imino)-1, 2-diamino ethane, IDB = the anion of bis (indo -2-one3- imino)-1, 4-diaminobenzene] have been carried out on the basis of IR, NMR, electronic spectra and magnetic measurements