EXPLORING POTENTIALS OF LEFTOVER SPACES USING URBAN METAMORPHOSIS

In a dynamic world, the challenge behind reaching utopia is a result of the continuity of change and the metamorphosis. Metamorphosis, from the Greek meta signifying the change and morphe referring to the form, is a change and adaptation of the form or nature of something into a different one through time. However, when it comes to urban metamorphosis, it is a tension between the traditional living and the raise of technology through history, and this adaptation is affecting cities, buildings, identity, and environment. Urban metamorphosis of undeveloped non-organized cities had created urban and social fragmentation; unorganized cities are broken urban fabrics disconnected by bare lands. Therefore, this research aims to establish guidelines to metamorphic the leftover lands to create utopian spaces in the cities. To achieve this aim the study starts with a literature review including previous opinion in the field of study, and the case study analysis of the neighborhood of Bachoura in Beirut city; a disconnected neighborhood from Beirut central city. The urban fabric of this neighborhood needs to reconsider preserving the identity which goes back to 1960s, and to reconsidering the use of the urban leftover spaces in revitalizing the district. A holistic approach of urban integration among built and natural environment, changes the way people occupy a place and get attached to it

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

Summary 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 middleincome 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 lowincome 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 lowincome, 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

Residents’ Training in COVID-19 Pandemic Times: An Integrated Survey of Educational Process, Institutional Support, Anxiety and Depression by the Saudi Commission for Health Specialties (SCFHS)

In late December of 2019, the outbreak of coronavirus disease (COVID-19) was first reported in the city of Wuhan, the capital of Hubei province in China, and was declared a pandemic by the World Health Organization in March 2020. Globally, as of 8 July 2020, there have been 11,669,259 confirmed cases of COVID-19, including 539,906 deaths. In Saudi Arabia, the confirmed cases have already reached 223,327, with 161,096 patients confirmed to have recovered, and 2100 deaths. This study aims to determine the effect of the COVID-19 pandemic on the training programs of the Saudi Commission for Health Specialties (SCFHS) and assess trainees&rsquo; mental health status (i.e., anxiety and depression). Trainee evaluations on training programs were also sought in order to obtain insights for strategic planning necessary for curricular modifications or improvements to address the clinical learning needs of trainees during this pandemic. The main contribution of our work is an investigation of the incidence of depression and anxiety regarding COVID-19 within the community of residents and fellows. Furthermore, we elaborate on key responsive actions towards the enhancement of the mental health of trainees. Last but not least, we propose the Saudi Commission for Health Specialties (SCFHS) Model for Residents&rsquo; Mental Health Enhancement during the COVID-19 Pandemic, which consists of five integrative value layers for medical education and training, namely: the knowledge creation process and innovation; technological capabilities for personalized medicine and patient-centric healthcare with a social impact; innovative applications of technology-enhanced learning and web-based active learning approaches for medical training and education; residents&rsquo; wellbeing and the impact of COVID-19 in strategic layers. In our future work, we intend to enhance the proposed framework with studies on trainee satisfaction and the efficiency of different technology-enhanced learning platforms for medical education