Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Kitab bahdjal al nawazir bi-idjtinab al-kabaïr. Commentaire par Ahmad ibn Mohammad al-Safadi sur son traité des péchés mortels.

Bahdjat al-nawazir bi idjtinab al-kabaïrNumérisation effectuée à partir d'un document de substitution

Portable Biogas Digesters for Domestic Use in Jordanian Villages

Essential energy needs are not always met in poor and rural areas of developing counties; therefore, natural energy sources are necessary to mitigate this problem. Rural areas inhabitants utilize methane as a replacement for cooking gas to reduce their gas bill. Methane gas can be produced from a biogas digester; however, operating a large digester in a densely populated village in Jordan can be challenging due to inefficient village waste management systems. On the other hand, using a small-scale portable biogas digester to generate biogas could overcome these problems. In this work, three biogas digester feedstocks for a small portable biogas digester from natural sources available in Jordanian villages such as human and animal waste were designed and evaluated. The three feedstocks are food waste, human waste, and a mixture of human and food waste. The parameters tested were the digester size and the biogas production. The results showed that the best digester for portable application was that which digested a mixture of human and food waste; for a five-member family, this type of digester provided 115% of the family’s cooking gas requirements with a digester volume of 0.54 m3. This design, while applicable for a typical rural Jordanian family, can also be utilized globally

Data from: Children in the Syrian civil war: the familial, educational, and public health impact of ongoing violence

The Syrian civil war since 2011 has led to one of the most complex humanitarian emergencies in history. The objective of this study was to document the impact of the conflict on the familial, educational, and public health state of Syrian children. A cross-sectional observational study was conducted in May 2015. Health care workers visited families with a prospectively designed data sheet in 4 Northern Syrian governorates. The 1001 children included in this study originated from Aleppo (41%), Idleb (36%), Hamah (15%), and Lattakia (8%). The children’s median age was 6 years (range, 0-15 years; interquartile range, 3-11 years), and 61% were boys. Almost 20% of the children were internally displaced, and 5% had deceased or missing parents. Children lacked access to safe drinking water (15%), appropriate sanitation (23%), healthy nutrition (16%), and pediatric health care providers (64%). Vaccination was inadequate in 72%. More than half of school-aged children had no access to education. Children in Idleb and Lattakia were at greater risk of having unmet public health needs. Younger children were at greater risk of having an incomplete vaccination state. After 4 years of civil war in Syria, children have lost parents, live in substandard life quality circumstances, and are at risk for outbreaks because of worsening vaccination states and insufficient availability of health care providers

The health-related quality of life of Syrian refugee women in their reproductive age

Background Health-Related Quality of Life (HRQoL) for refugee women in reproductive age is highly affected by physical, political, psychosocial and environmental conditions in countries of asylum. HRQoL is enormously affected by the satisfaction of this vulnerable group with the physical, psychological, emotional and social care services provided in this critical time. Therefore, this study aimed toassess the HRQoL among Syrian refugee women of reproductive age living outside camps in Jordan. Methods A cross-sectional correlational study was conducted with a convenience sample of 523 Syrian refugee women in the host communities in Jordan.Health-related quality of life (HRQOL) was measured using the short-form 36 (SF-36) questionnaire. Results Significant negative correlations were found between SF-36 individual subscales score and the length of marriage, the number of children, parity and family income. The strongest correlations were between pain scale and length of marriage (r =  − .21), and between Energy/Fatigue and ‘number of children’ (r =  − .21). Conversely, antenatal care was positively correlated with physical, role emotional, pain, and general health. Physical functioning and general health were predicted significantly with less years of marriage, younger age at marriage, less violence and by higher family income. Conclusion This study suggests low HRQoL scores for women of reproductive age across all domains. Several factors such as years of marriage, age at marriage, the number of children, violence, antenatal care and family income affected the women’s general health. The provision of appropriate and accessible reproductive and maternal healthcare services in antenatal visits is critical for ensuring the immediate and long-term health and wellbeing of refugee women and their families

Al-Wafi bil-wafayat, dictionnaire biographique, complément du Wafayat al-aʿyan d'Ibn Khallikan, par Salah al-Din Khalil ibn Aïbek al-Safadi ; le premier et le second volumes.

Wafayat al-aʿyan fi anba abna al-zamanAl-Wafi bil-wafayatNumérisation effectuée à partir d'un document de substitution

Recueil.

Boustan al-ʿarifinAl-Fikh al-akbar fil-kalam li Abi HanifaKitab al-wasiyya li Abi HanifaTadj al-taradjim fi tabakat al-ayoummat al-hanafiyyaKitab al-wasiyya li Abi HanifaNumérisation effectuée à partir d'un document de substitution.Commentaire par Mohammad ibn Mahmoud ibn Ahmad sur le Kitab al-vasiyya d'Abou Hanifa (fol. 3 v°) ; extraits du Boustan d'Aboul Laïth al-Samarkandi, sur les révélations (fol. 16 r°) ; liste des juristes musulmans non indiqués dans Ibn Koutlouboukha (fol. 17 v°) ; Tadj al-taradjim fi tabakat al-ayoumma al-hanafiyya, biographies des jurisconsultes musulmans hanéfites, par Ibn Koutlouboukha (fol. 22 v°) ; traité par lequel Soyouti établit que la communauté musulmane doit durer plus de 1000 ans (fol. 42 v°) ; préface du dictionnaire biographique de Safadi (fol. 49 v°) ; le Kitab al-fikh al-akbar d'Abou Hanifa (fol. 79 v°), et opuscules de Rashid-i Vatvat (fol. 87 v°)