Editorial: Cities and Sustainable Development

In this special issue of Belgeo we brought together several articles on Cities and Sustainable Development. Two contributions focus on specific urban case studies. In her article «The Social Sustainability of Multicultural Cities: a neighbourhood affair?», Annick Germain uses the case of the city of Montréal (Canada) to argue that social and cultural diversity should be at the centre of our attention if we think about sustainable development in an urban context. Using the findings of two of ..

Editorial: Cities and Sustainable Development

In this special issue of Belgeo we brought together several articles on Cities and Sustainable Development. Two contributions focus on specific urban case studies. In her article «The Social Sustainability of Multicultural Cities: a neighbourhood affair?», Annick Germain uses the case of the city of Montréal (Canada) to argue that social and cultural diversity should be at the centre of our attention if we think about sustainable development in an urban context. Using the findings of two of ..

Urban studies of Belgian geographers at the turn of the millennium

An overview is presented of urban research produced by Belgian geographers in the last five years. The paper highlights contributions on the position of Brussels in the European urban network, on urban hierarchy in Belgium, on the dynamics of Belgian city regions, on the socio-spatial structure of European and Belgian cities, on the regeneration of city centres and on urban sustainable development. Several publications deal with the increasing social polarization in cities and the existence of deprived neighbourhoods. A lot of research has been done on the multicultural character of Belgian cities and the relation between residential patterns of foreigners and the structure of the housing market.In deze bijdrage wordt een overzicht gegeven van stedelijk onderzoek van de laatste vijf jaar van Belgische geografen. De auteurs bespreken onderzoek over de positie van Brussel in het Europese stedennetwerk, de hiërarchie van steden in België, de dynamiek van de Belgische stadsgewesten, de interne structuur van Europese en Belgische steden, de regeneratie van stadscentra en over duurzame stedelijke ontwikkeling. Verschillende publicaties handelen over de toenemende sociale polarizatie in steden en over het voorkomen van achtergestelde buurten. Er werd veel onderzoek verricht over het multicultureel karakter van Belgische steden en over het verband tussen de ruimtelijke patronen van vreemdelingen en de structuur van de woningmarkt

Brussels, a sustainable city

Observations As a reminder: Sustainable defines that which meets the current generations’ needs without jeopardising the possibilities for future generations to meet their own needs (that is to say, without exceeding resource renewal rates). More simply put, that which is capable of continuing is sustainable. A layout inherited from the modernist era The zoning of the city’s territory Brussels has been marked by monofunctionalism over the past few decades. This applies to both its central nei..

Brussel, duurzame stad

Vaststellingen Duurzame ontwikkeling is een ontwikkeling waarbij de huidige wereldbevolking in haar behoeften voorziet zonder de komende generaties te beperken om in hun behoeften te voorzien (namelijk zonder het vermogen om de rijkdommen te vernieuwen aan te tasten). Eenvoudiger gesteld: duurzaam is wat kan blijven bestaan… Stedenbouwkunde: een erfenis uit het modernistische tijdperk De indeling van het Brussels grondgebied De laatste decennia werd Brussel gekenmerkt door monofunctionalisme,..

Quality indicators for patients with traumatic brain injury in European intensive care units

Background: The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measur

Machine learning algorithms performed no better than regression models for prognostication in traumatic brain injury

Objective: We aimed to explore the added value of common machine learning (ML) algorithms for prediction of outcome for moderate and severe traumatic brain injury. Study Design and Setting: We performed logistic regression (LR), lasso regression, and ridge regression with key baseline predictors in the IMPACT-II database (15 studies, n = 11,022). ML algorithms included support vector machines, random forests, gradient boosting machines, and artificial neural networks and were trained using the same predictors. To assess generalizability of predictions, we performed internal, internal-external, and external validation on the recent CENTER-TBI study (patients with Glasgow Coma Scale <13, n = 1,554). Both calibration (calibration slope/intercept) and discrimination (area under the curve) was quantified. Results: In the IMPACT-II database, 3,332/11,022 (30%) died and 5,233(48%) had unfavorable outcome (Glasgow Outcome Scale less than 4). In the CENTER-TBI study, 348/1,554(29%) died and 651(54%) had unfavorable outcome. Discrimination and calibration varied widely between the studies and less so between the studied algorithms. The mean area under the curve was 0.82 for mortality and 0.77 for unfavorable outcomes in the CENTER-TBI study. Conclusion: ML algorithms may not outperform traditional regression approaches in a low-dimensional setting for outcome prediction after moderate or severe traumatic brain injury. Similar to regression-based prediction models, ML algorithms should be rigorously validated to ensure applicability to new populations

Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study.

INTRODUCTION: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. METHODS: We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. RESULTS: All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers. CONCLUSION: Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches

Quality indicators for patients with traumatic brain injury in European intensive care units: a CENTER-TBI study

Abstract: Background: The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement. Methods: Our analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in the CENTER-TBI study. Indicator scores were calculated as percentage adherence for structure and process indicators and as event rates or median scores for outcome indicators. Feasibility was quantified by the completeness of the variables. Discriminability was determined by the between-centre variation, estimated with a random effect regression model adjusted for case-mix severity and quantified by the median odds ratio (MOR). Statistical uncertainty of outcome indicators was determined by the median number of events per centre, using a cut-off of 10. Results: A total of 26/42 indicators could be calculated from the CENTER-TBI database. Most quality indicators proved feasible to obtain with more than 70% completeness. Sub-optimal adherence was found for most quality indicators, ranging from 26 to 93% and 20 to 99% for structure and process indicators. Significant (p < 0.001) between-centre variation was found in seven process and five outcome indicators with MORs ranging from 1.51 to 4.14. Statistical uncertainty of outcome indicators was generally high; five out of seven had less than 10 events per centre. Conclusions: Overall, nine structures, five processes, but none of the outcome indicators showed potential for quality improvement purposes for TBI patients in the ICU. Future research should focus on implementation efforts and continuous reevaluation of quality indicators. Trial registration: The core study was registered with ClinicalTrials.gov, number NCT02210221, registered on August 06, 2014, with Resource Identification Portal (RRID: SCR_015582)