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

Study of perceptions of digital commerce and sales of the MYPES of clothing confections of the Gamarra emporium, 2021

El objetivo principal del presente trabajo de investigación fue comprender las percepciones sobre el comercio digital y las ventas de las MYPES de confecciones de prendas de vestir del emporio de Gamarra, 2021, considerando, como primera categoría, el comercio digital, con las subcategorías (i) seguridad de los procesos, (ii) distribución de productos, (iii) segmentación de mercado; y como segunda categoría, las ventas, cuyas subcategorías son (i) publicidad online, (ii) promoción de venta y (iii) venta personal. La metodología utiliza un enfoque cualitativo de estudio de caso. La recolección de información se realizó mediante fichas de observación y entrevistas semiestructuradas, las cuales fueron validadas por cuatro expertos antes de la aplicación de los instrumentos con especialistas: cinco dueños de empresas, tres gerentes, tres especialistas, tres clientes fidelizados y tres académicos expertos en marketing. Los resultados del trabajo de campo se procesaron con el software Atlas Ti. Se identificaron 71 códigos entre el comercio digital y ventas, y se halló que los clientes, antes de comprar un producto, están informados y valoran la flexibilidad en una negociación. Además, estos consideran que aumentarán su uso del comercio digital y descartan a empresas que no tienen presencia en los medios virtuales. La conclusión principal del estudio es la percepción de los encuestados de que el comercio digital es de gran importancia, porque permite aumentar las ventas, y que la seguridad de los procesos es clave. Asimismo, que toda venta, ya sea una venta personal, publicidad online y promoción de venta, si no ofrece seguridad en los procesos, ocasionará la pérdida de la confianza del cliente para realizar la compra.The main objective of this research work was to understand the perceptions of digital commerce and sales of MYPES of garments from the Gamarra emporium, 2021, considering, as the first category, digital commerce, with the subcategories (i ) process safety, (ii) product distribution, (iii) market segmentation; and as a second category, sales, whose subcategories are (i) online advertising, (ii) sales promotion and (iii) personal selling. The methodology uses a qualitative case study approach. The collection of information was carried out through observation sheets and semi-structured interviews, which were validated by four experts before the application of the instruments with specialists: five business owners, three managers, three specialists, three loyal customers and three academic experts in marketing. The results of the field work were processed with the Atlas Ti software. 71 codes between digital commerce and sales were identified, and it was found that customers, before buying a product, are informed and value flexibility in a negotiation. In addition, they consider that they will exclude their use of digital commerce and will rule out companies that do not have a presence in virtual media. The main conclusion of the study is the perception of those surveyed that digital commerce is of great importance, because it allows sales to be increased, and that process security is key. Likewise, that any sale, whether it is a personal sale, online advertising and sales promotion, if it does not offer security in the processes, will cause the loss of the client's confidence to make the purchase.Tesi

Boutique Be Free

This thesis is a business idea that is conformed by students of the Business Administration career, it was born in the classroom, after knowing each other and while we were talking with the members of the team we asked ourselves that in Peru there are few stores selling cosmetic by catalog that offer their products in real time, where one can experience the texture and colors of the various products to sell, leaving the traditional and betting on the new fashion trends, improving their own style with the desire to see and feel good. Many women have the need to acquire cosmetic products, but the main problem they have is the lack of availability of these products and the lack of knowledge of their correct use. The objective of this thesis is the sale of cosmetic products for women from four of the best brands of sale by catalog, complementing it with a personalized advice service in techniques of makeup and skin care, taking customers a good shopping experience , relaxing, solving their doubts and taking a good learning home that is easy to apply in daily life, we will also have a history of each client since their first visit, so our beauty professionals will quickly know what is what more benefits to each client and what promotions to provide, achieving better services in their image and personal care adviceTrabajo de investigaciónEsta tesis es una idea de negocios que está conformado por estudiantes de la carrera de Administración de Empresas, nace en el salón de clase, después de conocernos y mientras conversábamos con los integrantes del equipo nos preguntábamos que en el Perú hay pocas tiendas de venta de cosmético por catalogo que ofrezcan sus productos en tiempo real, donde uno pueda experimentar la textura y los colores de los diversos productos a vender , saliendo de lo tradicional y apostando por las nuevas tendencias de modas, mejorando su estilo propio con el deseo de verse y sentirse bien. Muchas mujeres tiene la necesidad de adquirir productos cosméticos, pero el principal problema que tienen es la falta de disponibilidad de estos productos y el desconocimiento del correcto uso de los mismos. El objetivo de esta tesis es la venta de los productos cosméticos para mujeres de cuatro de las mejores marcas de venta por catalogo, complementándolo con un servicio de asesoría personalizado en técnicas de maquillaje y cuidado de la piel, llevándose las clientas una buena experiencia de compra, relajándose, resolviendo sus dudas y adquiriendo un buen aprendizaje a casa que se le haga fácil aplicarlo en la vida diario, contaremos además, con un historial de cada cliente desde su primera visita, así nuestros profesionales de la belleza sabrán rápidamente que es lo que mas le beneficia a cada clienta y que promociones brindarle, logrando un mejor servicios en su asesoría de imagen y cuidado personal