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

Modal analysis of Kaplan turbine in Haditha hydropower plant using ANSYS and SolidWorks

Abstract In this study, numerical analysis is conducted to investigate the failure modes in Kaplan turbine. All necessary steps for Kaplan turbine failure analysis are presented in this work using the modal analysis computational approach. The modal behaver analysis is carried out on a model of an existing Kaplan turbine blade, which is based on the existing turbine used in Haditha hydropower plant in Iraq. This work investigates the modal behavior of the blade of interest, which aid in predicting structural damage initiation. The Kaplan turbine blade is designed using the commercial software ANSYS and SolidWorks. To simulate the blade in operation, the blade is fixed from one end, and all degrees of freedom are measured. Moreover, the turbine blade is moved and rotated to simulate multiple operational conditions. Both mode shapes and natural frequencies are predicted and analyzed using the two aforementioned commercial software and the numerical formula involving the arrest Lanczos method. It is clear from the results that the natural frequency of the specified mode shape does not match with the natural frequency of the runner blade. Hence, there is no failure due to resonance phenomenon in this specific Kaplan turbine. The future work must investigate other aspect of the failure modes in such turbine, such as unbalance dynamic loading. The Results obtained from this study will help study the different possibilities for detecting the failure of the Kaplan blade by examining the modal behavior of the blade.</jats:p

A survey on deep learning tools dealing with data scarcity: definitions, challenges, solutions, tips, and applications

Data scarcity is a major challenge when training deep learning (DL) models. DL demands a large amount of data to achieve exceptional performance. Unfortunately, many applications have small or inadequate data to train DL frameworks. Usually, manual labeling is needed to provide labeled data, which typically involves human annotators with a vast background of knowledge. This annotation process is costly, time-consuming, and error-prone. Usually, every DL framework is fed by a significant amount of labeled data to automatically learn representations. Ultimately, a larger amount of data would generate a better DL model and its performance is also application dependent. This issue is the main barrier for many applications dismissing the use of DL. Having sufficient data is the first step toward any successful and trustworthy DL application. This paper presents a holistic survey on state-of-the-art techniques to deal with training DL models to overcome three challenges including small, imbalanced datasets, and lack of generalization. This survey starts by listing the learning techniques. Next, the types of DL architectures are introduced. After that, state-of-the-art solutions to address the issue of lack of training data are listed, such as Transfer Learning (TL), Self-Supervised Learning (SSL), Generative Adversarial Networks (GANs), Model Architecture (MA), Physics-Informed Neural Network (PINN), and Deep Synthetic Minority Oversampling Technique (DeepSMOTE). Then, these solutions were followed by some related tips about data acquisition needed prior to training purposes, as well as recommendations for ensuring the trustworthiness of the training dataset. The survey ends with a list of applications that suffer from data scarcity, several alternatives are proposed in order to generate more data in each application including Electromagnetic Imaging (EMI), Civil Structural Health Monitoring, Medical imaging, Meteorology, Wireless Communications, Fluid Mechanics, Microelectromechanical system, and Cybersecurity. To the best of the authors’ knowledge, this is the first review that offers a comprehensive overview on strategies to tackle data scarcity in DL

Impact of fiber reinforcements on properties of geopolymer composites: A review

Conventional Portland cement-based composites are inherently weak under tensile stresses, due to its high brittleness quotient, and the problem gets further aggravated in geopolymer composites due to pozzolanic effect of precursors like fly ash, GGBFS, etc. Fiber reinforcement in conventional Portland cement concrete have been adopted, for quite some time, to remodel its character from brittle to ductile or quasi-ductile along with significant enhancement in mechanical as well as durability characteristics. With the global emphasis on partial or full replacement of Portland cement-based products in the construction industry and with the advent of "geopolymer" composite as potential replacement, efforts have been made to use fiber reinforcement in geopolymer composites to enhance its performance and service life. The development of fiber reinforced geopolymer composite (FRGC) being relatively new, the paper envisages to contribute to overall understanding and assessment of fiber utility in geopolymer materials. Against this background, a comprehensive database is developed based on past research work and pin-point research gaps for further study and analysis. Analytical assessment of past research reveals that FRGCs possess immense potential as a viable substitute for Portland cement-based composites with a scope for providing better mechanical, durability and structural performances, besides being more environmentally friendly. Further research is required to streamline its database, codes and practical design standards with different fibers, parameters and conditions