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. MethodsWe 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. FindingsWe 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•4...

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Divisions of the discussion.-The following discussion of project teaching will be divided into seven sections: I. Definition; II. Recent examples; III. Historical development; IV. Values; V. Limitations; VI. Technique; VII. Conclusions. I. DEFINITION OF PROJECT TEACHINGPupils planning practical activities.-The central element in project teaching is the planning by pupils of some practical activity, something to be done. Hence, a pupil-project is any unit of activity that makes the pupils responsible for such practical planning. It gives them practice in devising ways and means and in selecting and rejecting methods of achieving some definite practical end. This conception conforms with the dictionary definition of a project as "something of a practical nature thrown out for the consideration of its being done" and with the dictionary statement that "to project" means "to contrive, to devise, to scheme." Furthermore, it describes with considerable precision a specific kind of improved teaching that has become common in progressive experimental schools since 1900.2 I The word "practical" is here used as the opposite of "theoretical" according to the following definitions from Webster's Dictionary: "Practical. i. Of or pertaining to practice or action. 2. Capable of being turned to use or account; useful in distinction from ideal or theoretical; as practical chemistry." "Theoretical. Pertaining to theory; depending on, or confined to, theory or speculation; speculative; terminating in theory or speculation; not practical; as theoretical learning; theoretic sciences." 2 Perhaps the briefest definition of a project for our purposes would read as follows: A pupil-project is a unit of practical activity planned by the pupils. The author has revised the use of the term "project" in his General Methods of Teaching in Elementary Schools (Ginn & Co.) to conform to this more precise meaning and has added in the revised edition (1922) a brief chapter on project teaching along the lines of this article. 335 All use subject to University of Chicago Press Terms and Conditions (http://www.journals.uchicago.edu/t-and-c 336 THE ELEMENTARY SCHOOL JOURNAL II. RECENT EXAMPLES OF PROJECT TEACHING Historical construction projects. Variations in pupils' planning.-We may illustrate project teaching, as well as the pertinency of our definition, by three similar pictures of projects in medieval history. In these cases three different fifth-grade classes of the University of Chicago Elementary School all had the same practical problem of illustrating certain phases of medieval life; yet the outcomes varied greatly owing to the variations in the pupils' planning. The nature of the pupil-activities in developing such a project is suggested by the following description: The castle and fortified town shown in [Fig. I] were constructed out of cardboard by a fifth-grade class which was studying the Feudal Age in European history. The children had read the stories of King Arthur and other knights, as well as descriptions of life in town and castle....

Reviews of American civic-moral textbooks.-The following articles and reviews will put the reader in touch with the general progress in America in the publication of civic-moral textbooks. Many of the most recent books are reviewed.

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