Autonomous Vehicles for All?

The traditional build-and-expand approach is not a viable solution to keep roadway traffic rolling safely, so technological solutions, such as Autonomous Vehicles (AVs), are favored. AVs have considerable potential to increase the carrying capacity of roads, ameliorate the chore of driving, improve safety, provide mobility for those who cannot drive, and help the environment. However, they also raise concerns over whether they are socially responsible, accounting for issues such as fairness, equity, and transparency. Regulatory bodies have focused on AV safety, cybersecurity, privacy, and legal liability issues, but have failed to adequately address social responsibility. Thus, existing AV developers do not have to embed social responsibility factors in their proprietary technology. Adverse bias may therefore occur in the development and deployment of AV technology. For instance, an artificial intelligence-based pedestrian detection application used in an AV may, in limited lighting conditions, be biased to detect pedestrians who belong to a particular racial demographic more efficiently compared to pedestrians from other racial demographics. Also, AV technologies tend to be costly, with a unique hardware and software setup which may be beyond the reach of lower-income people. In addition, data generated by AVs about their users may be misused by third parties such as corporations, criminals, or even foreign governments. AVs promise to dramatically impact labor markets, as many jobs that involve driving will be made redundant. We argue that the academic institutions, industry, and government agencies overseeing AV development and deployment must act proactively to ensure that AVs serve all and do not increase the digital divide in our society

Structural Assessment of the 13th Century Great Mosque and Hospital of Divrigi: A World Heritage Listed Structure

The Great Mosque and Hospital of Divrigi is located in the central eastern part of Turkey, in Divrigi, Sivas. The historical facility consists of a monumental mosque and a two-story hospital, which are adjacent to each other. The structure dates back to 13th century Mengujekids period and has been listed by the UNESCO as a World Heritage since 1985. Great Mosque and Hospital of Divrigi is particularly notable for its monumental stone portals that are decorated with three-dimensional ornaments carved from stone. The structural system of the monument consists of multi-leaf stone masonry walls and stone piers that support the roof structure which consists of stone and brick arches and vaults. The structure is located about 90 km away from the North Anatolian Fault Line, that has been causing several destructive earthquakes. Consequently, the structure is prone to destructive seismic activities. In this study, after a brief introduction on the structural system and current condition of the structure, the structural performance of the Great Mosque and Hospital of Divrigi is investigated through site observations and structural analyses. For this purpose, linear and nonlinear 3D finite element models of the structure are developed and the structure is examined under the effects of vertical loads and seismic actions. In the light of the analyses results, recommendations for potential interventions are outlined for further preservation of the structure

Effect of curing time on selected properties of soil stabilized with fly ash, marble dust and waste sand for road sub-base materials

The properties of sub-base filling materials in highway construction are essential, as they can determine the performance of the road in service. Normally, the existing materials are removed and replaced with new materials that have adequate load-bearing capacity. Rising environmental concern and new environmental legislations have made construction professionals consider other methods. These methods include stabilizing the existing materials with other additives to improve their performance. Additives can be waste materials generated by different industries. In this work, the existing excavated soil is stabilized with waste materials. The wastes consisted of fly ash, marble dust and waste sand. The percentage addition of waste materials was 5%, 10%, 15% and 20% (by mass) of the existing soil. The soil/waste specimens were cured for 1, 7, 28, 56, 90 and 112 days before testing. Testing included the dry unit weight and unconfined compressive strength ( qu) as well as X-ray diffraction analysis and scanning electron microscopy observation. Also, the California Bearing Ratio values were obtained and are reported in this investigation. The results showed that the qu values increased with the increase in waste materials content. Also, there is tendency for the dry unit weight to increase with the increase in waste materials

The global impact of the COVID-19 pandemic on the management and course of chronic urticaria

Introduction: The COVID-19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. Aim: To understand how CU patients are affected by the COVID-19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID-19. Materials and Methods: Our cross-sectional, international, questionnaire-based, multicenter UCARE COVID-CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences. Results: The COVID-19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID-19 patient care, which negatively impacted on the care of urticaria patients. The rate of face-to-face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID-19, but COVID-19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID-19. Conclusions: The COVID-19 pandemic brings major changes and challenges for CU patients and their physicians. The long-term consequences of these changes, especially the increased use of remote consultations, require careful evaluation

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

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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 middle-income 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 low-income 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 low-income, 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