Yemen: Cholera outbreak and the ongoing armed conflict

Yemen was affected by a major cholera epidemic in 2016, while a civil war, which has devastated the country since March 2015, has exacerbated the humanitarian situation. Cholera is a disease caused by the bacterium Vibrio cholera, thus this study aims to analyze the epidemiological features of the outbreak and explore the relation of the outbreak to the current armed conflict situation.&#x0D; The data were obtained from the national surveillance system in Yemen. This contains details of 15,074 cases registered as suspected cholera patients per governorate from week 39 to 52 in 2016. In addition to the data concerning cholera, other data on conflict-related injuries, and population movement (numbers of Internally Displaced Persons – IDPs – and number of displaced returnees) were used to assess the correlation using Spearman's rho analysis.&#x0D; The data analysis shows the intensity of the conflict as measured by the total casualties per governorate (conflict-related injuries and death) is significantly correlated with the number of cholera cases per governorate (r 0.483, P = 0.026). The analysis also shows a positive, but not significant correlation between cholera cases, and both the number of conflict internal displaced people (IDPs) (r 0.389, P = 0.081), and number of returnees (r = 432, P = 0.050).</jats:p

Topologically Consistent Models for Efficient Big Geo-Spatio-Temporal Data Distribution

Geo-spatio-temporal topology models are likely to become a key concept to check the consistency of 3D (spatial space) and 4D (spatial + temporal space) models for emerging GIS applications such as subsurface reservoir modelling or the simulation of energy and water supply of mega or smart cities. Furthermore, the data management for complex models consisting of big geo-spatial data is a challenge for GIS and geo-database research. General challenges, concepts, and techniques of big geo-spatial data management are presented. In this paper we introduce a sound mathematical approach for a topologically consistent geo-spatio-temporal model based on the concept of the incidence graph. We redesign DB4GeO, our service-based geo-spatio-temporal database architecture, on the way to the parallel management of massive geo-spatial data. Approaches for a new geo-spatio-temporal and object model of DB4GeO meeting the requirements of big geo-spatial data are discussed in detail. Finally, a conclusion and outlook on our future research are given on the way to support the processing of geo-analytics and -simulations in a parallel and distributed system environment

Two new marine species of Cocconeis (Bacillariophyceae) from the west coast of Sweden

This paper is part of a project of studying benthic diatom biodiversity on marine coastal regions of Sweden with focus on rare and less known species. Two new species of Cocconeis Ehrenb. are described from Vrångö, a small island in the west coast of Sweden. Both species were found as epiphytic on the green alga Ulva intestinalis L. Cocconeis magnoareolata Al-Handal, Riaux-Gob., R.Jahn & A.K.Wulff sp. nov. is a small species not exceeding 9 µm in length and characterized by having large subquadrangular areolae on the sternum valve. Cocconeis vrangoensis Al-Handal & Riaux-Gob. sp. nov. appears similar to some taxa of the ‘Cocconeis scutellum complex’, but differs by its stria density on both valves and variable features of the areola and valvocopula ultrastructure. Detailed descriptions based on light and electron microscopy examination, a comparison with closely related taxa, as well as a description of the habitat of both species are here presented

Risk factors associated with the recent cholera outbreak in Yemen: a case-control study

OBJECTIVES The cholera outbreak in Yemen has become the largest in the recent history of cholera records, having reached more than 1.4 million cases since it started in late 2016. This study aimed to identify risk factors for cholera in this outbreak. METHODS A case-control study was conducted in Aden in 2018 to investigate risk factors for cholera in this still-ongoing outbreak. In total, 59 cholera cases and 118 community controls were studied. RESULTS The following risk factors were associated with being a cholera case in the bivariate analysis: a history of travelling and having had visitors from outside Aden Province; eating outside the house; not washing fruit, vegetables, and khat (a local herbal stimulant) before consumption; using common-source water; and not using chlorine or soap in the household. In the multivariate analysis, not washing khat and the use of common-source water remained significant risk factors for being a cholera case. CONCLUSIONS Behavioural factors and unsafe water appear to be the major risk factors in the recent cholera outbreak in Yemen. In order to reduce the risk of cholera, hygiene practices for washing khat and vegetables and the use and accessibility of safe drinking water should be promoted at the community level

Humanising the craftmens: a review and roadmap of indigenous design appreciation through the GWKL experience

The spirit of KL - shaping city identity through Art and Culture. A critical analysis of “Gallery Weekend Kuala Lumpur” and its potential contribution in branding Kuala Lumpur. In this paper, the dynamics and driving factors of forming “city identity” will be reviewed and examined by applying theoretical frameworks of urban and cultural studies to Malaysia's capital Kuala Lumpur. A brief presentation of current research on city identity will show that besides infrastructure, media coverage and architectural landmarks, a vivid cultural sphere is an essential part in the internal and external perception and imagination of a city. As Kuala Lumpur is aiming in developing into a competitive global city, symbolising the general progress of Malaysia as a nation, efforts have been done in branding the city in economic and touristic terms. Reviewing these past attempts of shaping Kuala Lumpur’s identity, it will be argued that greater focus should be put on nurturing the cultural and artistic sphere in order to meet the various challenges the city itself, the nation in general and the world as a whole is facing. Furthermore, the cultural event “Gallery Weekend Kuala Lumpur” will be introduced, serving as an example for a newly establishing institution of Kuala Lumpur’s art scene. It will be questioned in how far this particular event bears the twofold potential of allowing firstly for a discourse among local creatives and citizens and secondly, of increasing the attention of the international Art world on Kuala Lumpur. Highlighting the local and international dynamics of Gallery Weekend Kuala Lumpur, it will be shown that it bears identity-establishing potential for the city of Kuala Lumpur and should develop accordingly. It will be concluded that artistic and cultural events of the like are to be supported by the economy and political actors as they are of economic, political and social need and benefit

Geospatial Data Management Research: Progress and Future Directions

Without geospatial data management, today´s challenges in big data applications such as earth observation, geographic information system/building information modeling (GIS/BIM) integration, and 3D/4D city planning cannot be solved. Furthermore, geospatial data management plays a connecting role between data acquisition, data modelling, data visualization, and data analysis. It enables the continuous availability of geospatial data and the replicability of geospatial data analysis. In the first part of this article, five milestones of geospatial data management research are presented that were achieved during the last decade. The first one reflects advancements in BIM/GIS integration at data, process, and application levels. The second milestone presents theoretical progress by introducing topology as a key concept of geospatial data management. In the third milestone, 3D/4D geospatial data management is described as a key concept for city modelling, including subsurface models. Progress in modelling and visualization of massive geospatial features on web platforms is the fourth milestone which includes discrete global grid systems as an alternative geospatial reference framework. The intensive use of geosensor data sources is the fifth milestone which opens the way to parallel data storage platforms supporting data analysis on geosensors. In the second part of this article, five future directions of geospatial data management research are presented that have the potential to become key research fields of geospatial data management in the next decade. Geo-data science will have the task to extract knowledge from unstructured and structured geospatial data and to bridge the gap between modern information technology concepts and the geo-related sciences. Topology is presented as a powerful and general concept to analyze GIS and BIM data structures and spatial relations that will be of great importance in emerging applications such as smart cities and digital twins. Data-streaming libraries and “in-situ” geo-computing on objects executed directly on the sensors will revolutionize geo-information science and bridge geo-computing with geospatial data management. Advanced geospatial data visualization on web platforms will enable the representation of dynamically changing geospatial features or moving objects’ trajectories. Finally, geospatial data management will support big geospatial data analysis, and graph databases are expected to experience a revival on top of parallel and distributed data stores supporting big geospatial data analysis

Effectiveness of adjuvant radiotherapy in patients with oropharyngeal and floor of mouth squamous cell carcinoma and concomitant histological verification of singular ipsilateral cervical lymph node metastasis (pN1-state) - A prospective multicenter randomized controlled clinical trial using a comprehensive cohort design

<p>Abstract</p> <p>Background</p> <p>Modern radiotherapy plays an important role in therapy of advanced head and neck carcinomas. However, no clinical studies have been published addressing the effectiveness of postoperative radiotherapy in patients with small tumor (pT1, pT2) and concomitant ipsilateral metastasis of a single lymph node (pN1), which would provide a basis for a general treatment recommendation.</p> <p>Methods/Design</p> <p>The present study is a non-blinded, prospective, multi-center randomized controlled trial (RCT). As the primary clinical endpoint, overall-survival in patients receiving postoperative radiation therapy vs. patients without adjuvant therapy following curative intended surgery is compared. The aim of the study is to enroll 560 adult males and females for 1:1 randomization to one of the two treatment arms (irradiation/no irradiation). Since patients with small tumor (T1/T2) but singular lymph node metastasis are rare and the amount of patients consenting to randomization is not predictable in advance, all patients rejecting randomization will be treated as preferred and enrolled in a prospective observational study (comprehensive cohort design) after giving informed consent. This observational part of the trial will be performed with maximum consistency to the treatment and observation protocol of the RCT. Because the impact of patient preference for a certain treatment option is not calculable, parallel design of RCT and observational study may provide a maximum of evidence and efficacy for evaluation of treatment outcome. Secondary clinical endpoints are as follows: incidence and time to tumor relapse (locoregional relapse, lymph node involvement and distant metastatic spread), Quality of life as reported by EORTC (QLQ-C30 with H&N 35 module), and time from operation to orofacial rehabilitation. All tumors represent a homogeneous clinical state and therefore additional investigation of protein expression levels within resection specimen may serve for establishment of surrogate parameters of patient outcome.</p> <p>Conclusion</p> <p>The inherent challenges of a rare clinical condition (pN1) and two substantially different therapy arms would limit the practicality of a classical randomized study. The concept of a Comprehensive Cohort Design combines the preference of a randomized study, with the option of careful data interpretation within an observational study.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: NCT00964977</p

Diphtheria outbreak in Yemen: the impact of conflict on a fragile health system

Background: War in Yemen started three years ago, and continues unabated with a steadily rising number of direct and indirect victims thus leaving the majority of Yemen’s population in dire need of humanitarian assistance. The conflict adversely affects basic socioeconomic and health conditions across the country. Methods: This study analyzed the recent ongoing diphtheria outbreak in Yemen and in particular, the health system’s failure to ensure immunization coverage and respond to this outbreak. Data from the weekly bulletins of the national electronic Disease Early Warning System’s (eDEWS) daily diphtheria reports and district immunization coverage were analyzed. The number of diphtheria cases and deaths, and immunization coverage (DPT) were reviewed by district including the degree to which a district was affected by conflict using a simple scoring system. A logistic regression and bivariate correlation were applied using the annual immunization coverage per district to determine if there was an association between diphtheria, immunization coverage and conflict. Results: The study results confirm the association between the increasing cases of diphtheria, immunization coverage and ongoing conflict. A total of 1294 probable cases of diphtheria were reported from 177 districts with an overall case fatality rate of 5.6%. Approximately 65% of the patients were children under 15 years, and 46% of the cases had never been vaccinated against diphtheria. The risk of an outbreak increased by 11-fold if the district was experiencing ongoing conflict p &lt; 0.05. In the presence of conflict (whether past or ongoing), the risk of an outbreak decreased by 0.98 if immunization coverage was high p &gt; 0.05. Conclusion: The conflict is continuously devastating the health system in Yemen with serious consequences on morbidity and mortality. Therefore, the humanitarian response should focus on strengthening health services including routine immunization procedures to avoid further outbreaks of life-threatening infectious diseases, such as diphtheria