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

Technical performance of basalt fiber reinforced polymer BFRP confined RC driven piles new construction methodology

Pile foundations are often necessary to support large structures when the surface soil conditions are not strong enough to support the structure with shallow foundations. Pile foundation can be founded in dense sand layers at deeper, and also provide additional frictional support along their length to resist vertical loads. Load carrying capacity of Basalt FRP confined and unconfined piles were found out using the dynamic formulae and pile load test. Safe load carrying capacity of piles determined from piles load test was slightly higher than the dynamic formulae. The experimental result also shows that surface roughness of specimen is significantly changes the interface friction angle. The shear strength at the interface increases with the increase in surface roughness of the specimens. </jats:p

Evaluation of damage area on fibre epoxy composites using digital image processing

In this paper, fibre epoxy composite specimens are prepared by hand lay-up method with stacking sequences (04/±452)s. Five specimens are prepared with the same dimensions and named as S1, S2, S3, S4, and S5. These specimens are tested for impact analysis using a drop-weight apparatus (DWA-Ceast9350) at energy levels of 25, 30, and 35 J, followed by tensile testing using a universal testing machine (Dak9103). The damaged areas of the impacted specimens are examined by digital image processing, numerically simulated ABAQUS software, and scanning electron microscopy, followed by tensile strength results. The results of the experiment reveal that when the impact energy increases, the damage area increases, the tensile strength decreases, and the cracks formed during impact are shown in scanning electron microscope imaging. The homogeneity and isotropy of the composite are identified by the Feret ratio and circular shape factor. </jats:p

New construction methodology-geothermal cogeneration plant efficiency improvements for environmental and economic sustainability using waste heat recovery system

Power station is used in geothermal cogeneration or Combined Heat and Power (CHP) plant to generate electric power and heat from a single process simultaneously. Industrial CHP gains attention due to its sustainability and its nature of carbon footprint reduction. In this regard, CHP is more effective than generating steam or burning fuel on-site, and electricity is imported from the grid. CHP is a combined system which finds applications in several techniques and thermal and fuel systems, and these functionalities can be integrated into prevail-ing building structures. In CHP, the modifications are carried out with respect to the energy and user requirements. In heat recovery mecha-nism of CHP plant, several critical parameters are required. The present research work focuses on heat recovery analysis in geothermal co-generation (CHP) plant, in which the methods to lessen the generated secondary (waste) heat is emphasized by enhancing energy efficiency. Further it also includes passive and active strategies. The recent trends of direct electric conversion devices are more useful, and therefore can be introduced in industrial waste heat recovery applications, which are usually applied in CHP or geothermal cogeneration plants includ-ing paper mills and chemical processing and refinery systems, hotels, hospitals, industries and commercial structures, where constant heat and power requirements exist.  </jats:p

A Research on Strength of Concrete by Replacing Natural Sand with Granulated Blast Furnace Slag

There are numerous negative social and environmental effects of overuse of river sand for construction. To reduce this, various substitutes have been used such as quarry dust, demolished concrete waste, industrial waste such as copper slag, eco sand etc. GBFS (Granulated Blast Furnace Slag) is a slag obtained from the manufacture of iron in steel industries. This research aims to investigate the possibility of replacing Granulated Blast Furnace Slag (GBFS) as sand substitutes in concrete. In this research, natural sand was replaced by GBFS in various percentages (0%, 25%, 50%, 75% and 100%) with a constant water cement ratio of 0.45. Tests such as sieve analysis, specific gravity, fineness modulus and bulk density were done for fine aggregates and GBFS sample. Different mixed proportions for different percentage replacement of fine aggregates was obtained for M30 grade concrete as per IS 10262: 2009. The durability test was done for cubes of control mix and GBFS mix (0%, 25%, 50%, 75% and 100%). It was found the strength of concrete was improved due to the addition of GBFS as fine aggregates. Test results showed that the compressive strength of concrete increased with increase in percentage of GBFS up to 75%. Beyond 75%, there was a marginal decrease in strength of concrete.</jats:p