Rethinking tourism conflict potential within and between groups using participatory mapping

Tourism on small tropical islands in the Global South is a balancing act between development to improve local livelihoods and the conservation of fragile coastal and coral ecosystems. The objective of our study is to develop a series of new spatial metrics to support sustainable development through assessing the direction and magnitude of tourism development support and conflict between groups. We surveyed 317 individuals out of an estimated total population of 3300 using public participation GIS (PPGIS) on Tioman Island, Malaysia. Here we present a first example of how nuances in conflict can be articulated spatially across different levels of attitude toward tourism development within and between different segments of the population. Our results suggest that treating a population as homogeneous risks missing place specific development conflicts between segments of the population and locations of agreement where development can be managed sustainably with the support of the community.Peer reviewe

Increasing mine waste will induce land cover change that results in ecological degradation and human displacement

Highlights Mining-induced displacement is a severely under researched social policy problem. Through global data sources and historic remote sensing we analyze this problem. The main output of most mining activity is hazardous waste. We confirm waste as the principal source of human displacement globally in mining. Resources to fuel urbanisation and energy transition targets will drive increases in waste

Transforming food systems in Maritime Southeast Asia and Pacific Small Island Developing States to support food security and sustainable healthy diets

Food is one of the basic necessities for human life. Nutritious food is essential for human health and helps oneself live up to our best potential as productive members of society. In spite of this, 3 billion people are estimated to have limited access to nutrient-rich food, and there are 768 million undernourished people in the globe today. There are still concerns with food systems and food security, despite the fast economic transformation of low-and middle-income nations in Maritime Southeast Asia and Oceania over the past 10 years. These issues include dwindling agricultural land, deforestation, ineffective food supply networks, environmental degradation, changing and unhealthy diets, non-communicable diseases, disappearing cultural legacy, and ineffective policies. These problems are exacerbated by climate change, natural hazards, and pandemic shocks. This review explores the perspectives of food systems that relates to all the elements and activities in transforming agri-food industry. In this paper, we discuss the challenges and solutions to transforming food systems in this region to achieve a sustainable and healthy diet for all, with the perspective of bringing the region closer toward the UN sustainable development goals. This paper is an outcome of the deliberations that took place during the Food Security in Small Islands and Developing States workshop in 2020. It also includes insights from subsequent expert group sessions that focused on the following topics: Agriculture and Food Systems; Nutrition, Health, and Culture; Innovations and Digitalization in Food Systems; as well as Policies Coordination and Future Shocks

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Characterising socio-environmental mining impacts using GIS and remote sensing:a case study in Didipio, Philippines

Mining results in significant land cover changes, directly and indirectly affecting local communities and the natural landscape via complex, interrelated and often long-lasting impacts. With the impending increase in demand for mineral resources, the need for robust analyses and clear reporting of data on the local and regional changes is considered essential for mining companies to effectively detect, track, sustainably manage and mitigate impacts. Remote sensing and GIS methods hold the potential to assist and improve conventional social science approaches; they provide the means to spatially capture and triangulate data from the dynamic mining landscape to study past and ongoing socio-environmental impacts. This thesis aims to investigate the use of spatially explicit GIS and Remote Sensing methods for assessing the social and environmental impacts of mining. To achieve this, the chapters (1) extensively reviewed prior studies that integrated GIS and remote sensing with social science methodologies to evaluate socio-economic and environmental mining impacts, (2) compile recommendations on how the integration of GIS, Remote Sensing, and Social Science can be enhanced for future research on the socio-economic and environmental implications of mining, and (3) characterise the land cover changes in a mining landscape in Didipio, Philippines, and its concurrent impacts on socio-environmental land uses. Chapter 1 of this thesis introduces the importance of this research and its relevance to present societal concerns. The aim and scope of the thesis are also outlined here. Chapter 2 comprehensively examines past research efforts by providing a systematic review of how GIS and remote sensing approaches have been integrated with social science approaches to assess socio-economic and environmental impacts of mining on local communities. We found that the integration of GIS and remote sensing applications with social science methods is a functional step and often the only means to spatially capture and coherently assess the various and complex dimensions of mining impacts. Overall, more research is still needed to improve interdisciplinary data capture and analysis, particularly to analyse less tangible socio-economic impacts. Concerted efforts must also be made to improve data availability, quality, geographic categorisation, consistency, validation, and transparency to achieve a more spatially integrated evaluation of socio-economic mining impacts.Multidimensional approaches involving interdisciplinary methods and coordinated efforts from all stakeholders are required to effectively capture and coherently analyse the various data types needed for a full understanding of mining impacts. In Chapter 3, land use and land cover changes in a Philippines mining landscape are classified and the concurrent impacts of mining on socio-environmental land uses were evaluated. This case study demonstrated how a range of recent and novel methods can be used to map socio-environmental mining landscapes. A time series of classified land use and land cover (LULC) maps was created using composites of multispectral Landsat images, vegetation indices and a Digital Elevation Model (DEM). Landsat historical imagery was used to successfully characterize coarse-scale high-level land covers via supervised Random Forest classification in Google Earth Engine (GEE). Web-based mapping by local experts was then used within selected zones of importance to characterise key fine thematic resolution land use categories; such fine resolution is beyond what is possible using only Landsat. Overall, the time series accurately estimated LULC change, and revealed significant temporal trends useful for studying socio-environmental indicators. The methods developed and their limitations were critically evaluated and potential ways to improve the workflow in terms of the quality and efficiency of data acquisition are proposed. This thesis is concluded in Chapter 4, which synthesizes the contributions made in this study. Recommendations and challenges anticipated for future research towards the goal of a more spatially integrated assessment of socio-economic mining impacts are outlined. Given the upcoming growth in demand, socioeconomic and environmental mining consequences must be handled in a multidimensional manner that involves interdisciplinary methods and coordinated efforts from all stakeholders. This research reinforces the potential that GIS and Remote Sensing holds to facilitate and optimise conventional socio-environmental impact assessments. The novel approach of stakeholder engagement via participatory GIS can be further enhanced to support successful socio-spatial data integration, inclusive analysis, and comprehensive planning throughout the mine life cycle to bring us a step closer in securing a sustainable future for mining

Characterising socio-environmental mining impacts using GIS and remote sensing:a case study in Didipio, Philippines

Mining results in significant land cover changes, directly and indirectly affecting local communities and the natural landscape via complex, interrelated and often long-lasting impacts. With the impending increase in demand for mineral resources, the need for robust analyses and clear reporting of data on the local and regional changes is considered essential for mining companies to effectively detect, track, sustainably manage and mitigate impacts. Remote sensing and GIS methods hold the potential to assist and improve conventional social science approaches; they provide the means to spatially capture and triangulate data from the dynamic mining landscape to study past and ongoing socio-environmental impacts. This thesis aims to investigate the use of spatially explicit GIS and Remote Sensing methods for assessing the social and environmental impacts of mining. To achieve this, the chapters (1) extensively reviewed prior studies that integrated GIS and remote sensing with social science methodologies to evaluate socio-economic and environmental mining impacts, (2) compile recommendations on how the integration of GIS, Remote Sensing, and Social Science can be enhanced for future research on the socio-economic and environmental implications of mining, and (3) characterise the land cover changes in a mining landscape in Didipio, Philippines, and its concurrent impacts on socio-environmental land uses. Chapter 1 of this thesis introduces the importance of this research and its relevance to present societal concerns. The aim and scope of the thesis are also outlined here. Chapter 2 comprehensively examines past research efforts by providing a systematic review of how GIS and remote sensing approaches have been integrated with social science approaches to assess socio-economic and environmental impacts of mining on local communities. We found that the integration of GIS and remote sensing applications with social science methods is a functional step and often the only means to spatially capture and coherently assess the various and complex dimensions of mining impacts. Overall, more research is still needed to improve interdisciplinary data capture and analysis, particularly to analyse less tangible socio-economic impacts. Concerted efforts must also be made to improve data availability, quality, geographic categorisation, consistency, validation, and transparency to achieve a more spatially integrated evaluation of socio-economic mining impacts.Multidimensional approaches involving interdisciplinary methods and coordinated efforts from all stakeholders are required to effectively capture and coherently analyse the various data types needed for a full understanding of mining impacts. In Chapter 3, land use and land cover changes in a Philippines mining landscape are classified and the concurrent impacts of mining on socio-environmental land uses were evaluated. This case study demonstrated how a range of recent and novel methods can be used to map socio-environmental mining landscapes. A time series of classified land use and land cover (LULC) maps was created using composites of multispectral Landsat images, vegetation indices and a Digital Elevation Model (DEM). Landsat historical imagery was used to successfully characterize coarse-scale high-level land covers via supervised Random Forest classification in Google Earth Engine (GEE). Web-based mapping by local experts was then used within selected zones of importance to characterise key fine thematic resolution land use categories; such fine resolution is beyond what is possible using only Landsat. Overall, the time series accurately estimated LULC change, and revealed significant temporal trends useful for studying socio-environmental indicators. The methods developed and their limitations were critically evaluated and potential ways to improve the workflow in terms of the quality and efficiency of data acquisition are proposed. This thesis is concluded in Chapter 4, which synthesizes the contributions made in this study. Recommendations and challenges anticipated for future research towards the goal of a more spatially integrated assessment of socio-economic mining impacts are outlined. Given the upcoming growth in demand, socioeconomic and environmental mining consequences must be handled in a multidimensional manner that involves interdisciplinary methods and coordinated efforts from all stakeholders. This research reinforces the potential that GIS and Remote Sensing holds to facilitate and optimise conventional socio-environmental impact assessments. The novel approach of stakeholder engagement via participatory GIS can be further enhanced to support successful socio-spatial data integration, inclusive analysis, and comprehensive planning throughout the mine life cycle to bring us a step closer in securing a sustainable future for mining

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe