Time series subsidence evaluation using NSBAS InSAR: a case study of twin megacities (Rawalpindi and Islamabad) in Pakistan

Ground deformation associated with natural and anthropogenic activities can be damaging for infrastructure and can cause enormous economic loss, particularly in developing countries which lack measuring instruments. Remote sensing techniques like interferometric synthetic aperture radar (InSAR) can thus play an important role in investigating deformation and mitigating geohazards. Rawalpindi and Islamabad are twin cities in Pakistan with a population of approximately 5.4 million, along with important government and private entities of national and international interest. In this study, we evaluate rapid paced subsidence in this area using a modified small baseline subset technique with Sentinel-1A imagery acquired between 2015 and 2022. Our results show that approximately 50 mm/year subsidence occurs in the older city of Rawalpindi, the most populated zone. We observed that subsidence in the area is controlled by the buried splays of the Main Boundary Thrust, one of the most destructive active faults in the recent past. We suggest that such rapid subsidence is most probably due to aggressive subsurface water extraction. It has been found that, despite provision of alternate water supplies by the district government, a very alarming number of tube wells are being operated in the area to extract ground water. Over 2017–2021, field data showed that near-surface aquifers up to 50–60 m deep are exhausted, and most of the tube wells are currently extracting water from depths of approximately 150–160 m. The dropping water level is proportional to the increasing number of tube wells. Lying downstream of tributaries originating from the Margalla and Murree hills, this area has a good monsoon season, and its topography supports recharge of the aquifers. However, rapid subsidence indicates a deficit between water extraction and recharge, partly due to the limitations inherent in shale and the low porosity near the surface lithology exposed in the area. Other factors amplifying the impacts are fast urbanization, uncontrolled population growth, and non-cultivation of precipitation in the area

Geotechnical aspects of alluvial soils at different depths under sodium chloride action in Najran region, Saudi Arabia: Field supported by laboratory tests

The current research study is aimed at studying the impact of sodium chloride on the performance of semi-arid soils in the Najran area of Saudi Arabia. Experimental work has been undertaken to investigate how adding salt to the semi-arid soil collected in the Najran area affects the boundaries of Atterberg, compaction characteristics, California bearing ratio, and shear strength. All testing was conducted on soil samples from different zones of the Najran area at varying depths of 1.5, 3, and 4.5 m along the soil profiles. The soil samples were analyzed individually and then compared with the same soil samples mixed with NaCl at different percentages of 5, 10, and 20% by weight of the dry soil. Using advanced techniques, such as the scanning electron microscope, energy dispersive x-ray analysis, and X-ray diffraction analysis, the stabilization process was examined. The findings revealed that NaCl significantly impacts the geotechnical characteristics of semi-arid soils. The maximum dry density increased from 1.995, 1.93, and 1.96 to 2.02, 1.99, and 2.03 g/cm3, and the optimal water content decreased from 9.47, 13.7, and 11.29 to 7.01, 9.58%, and 8.09% with 20% NaCl added at various depths, respectively. Shear resistance parameters were improved by adding 20% NaCl, where the soil cohesion increased from 0.1333, 0.0872, and 0.0533 to 0.1843, 0.1034, and 0.0372 kg/cm2, and the angle of internal friction increased from 24°, 25.5°, and 29° to 27.8°, 30°, and 33°, respectively. The liquid and plastic limits and, in turn, the plasticity index reduced as the added percentage of NaCl increased. Furthermore, the California bearing ratio percentages significantly increased and reached more than 50%. As a result, it is established that NaCl is an excellent stabilizer, especially at 20% concentration, and might be used as a sub-base substance in highway construction

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

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

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

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

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Boosting-based ensemble machine learning models for predicting unconfined compressive strength of geopolymer stabilized clayey soil

The present research employs new boosting-based ensemble machine learning models i.e., gradient boosting (GB) and adaptive boosting (AdaBoost) to predict the unconfined compressive strength (UCS) of geopolymer stabilized clayey soil. The GB and AdaBoost models were developed and validated using 270 clayey soil samples stabilized with geopolymer, with ground-granulated blast-furnace slag and fly ash as source materials and sodium hydroxide solution as alkali activator. The database was randomly divided into training (80%) and testing (20%) sets for model development and validation. Several performance metrics, including coefficient of determination (R2), mean absolute error (MAE), root mean square error (RMSE), and mean squared error (MSE), were utilized to assess the accuracy and reliability of the developed models. The statistical results of this research showed that the GB and AdaBoost are reliable models based on the obtained values of R2 (= 0.980, 0.975), MAE (= 0.585, 0.655), RMSE (= 0.969, 1.088), and MSE (= 0.940, 1.185) for the testing dataset, respectively compared to the widely used artificial neural network, random forest, extreme gradient boosting, multivariable regression, and multi-gen genetic programming based models. Furthermore, the sensitivity analysis result shows that ground-granulated blast-furnace slag content was the key parameter affecting the UCS.Validerad;2024;Nivå 2;2024-02-16 (joosat);Funder: Najran University (NU/NRP/SERC/12/12);Full text license: CC BY</p

Time series subsidence evaluation using NSBAS InSAR: a case study of twin megacities (Rawalpindi and Islamabad) in Pakistan

Ground deformation associated with natural and anthropogenic activities can be damaging for infrastructure and can cause enormous economic loss, particularly in developing countries which lack measuring instruments. Remote sensing techniques like interferometric synthetic aperture radar (InSAR) can thus play an important role in investigating deformation and mitigating geohazards. Rawalpindi and Islamabad are twin cities in Pakistan with a population of approximately 5.4 million, along with important government and private entities of national and international interest. In this study, we evaluate rapid paced subsidence in this area using a modified small baseline subset technique with Sentinel-1A imagery acquired between 2015 and 2022. Our results show that approximately 50 mm/year subsidence occurs in the older city of Rawalpindi, the most populated zone. We observed that subsidence in the area is controlled by the buried splays of the Main Boundary Thrust, one of the most destructive active faults in the recent past. We suggest that such rapid subsidence is most probably due to aggressive subsurface water extraction. It has been found that, despite provision of alternate water supplies by the district government, a very alarming number of tube wells are being operated in the area to extract ground water. Over 2017–2021, field data showed that near-surface aquifers up to 50–60 m deep are exhausted, and most of the tube wells are currently extracting water from depths of approximately 150–160 m. The dropping water level is proportional to the increasing number of tube wells. Lying downstream of tributaries originating from the Margalla and Murree hills, this area has a good monsoon season, and its topography supports recharge of the aquifers. However, rapid subsidence indicates a deficit between water extraction and recharge, partly due to the limitations inherent in shale and the low porosity near the surface lithology exposed in the area. Other factors amplifying the impacts are fast urbanization, uncontrolled population growth, and non-cultivation of precipitation in the area.Validerad;2024;Nivå 2;2024-03-22 (joosat);Funder: Science and Engineering research Center at Najran University (NU/RCP/SERC/12/2);Full text license: CC BY</p