Challenges and opportunities in the design and construction of a GIS-based emission inventory infrastructure for the Niger Delta region of Nigeria

© 2017, Springer-Verlag Berlin Heidelberg. Environmental monitoring in middle- and low-income countries is hampered by many factors which include enactment and enforcement of legislations; deficiencies in environmental data reporting and documentation; inconsistent, incomplete and unverifiable data; a lack of access to data; and technical expertise. This paper describes the processes undertaken and the major challenges encountered in the construction of the first Niger Delta Emission Inventory (NDEI) for criteria air pollutants and CO2 released from the anthropogenic activities in the region. This study focused on using publicly available government and research data. The NDEI has been designed to provide a Geographic Information System-based component of an air quality and carbon management framework. The NDEI infrastructure was designed and constructed at 1-, 10- and 20-km grid resolutions for point, line and area sources using industry standard processes and emission factors derived from activities similar to those in the Niger Delta. Due to inadequate, incomplete, potentially inaccurate and unavailable data, the infrastructure was populated with data based on a series of best possible assumptions for key emission sources. This produces outputs with variable levels of certainty, which also highlights the critical challenges in the estimation of emissions from a developing country. However, the infrastructure is functional and has the ability to produce spatially resolved emission estimates

Improving accountability for equitable health and well-being in urban informal spaces: Moving from dominant to transformative approaches

This article critically reviews the literature on urban informality, inequity, health, well-being and accountability to identify key conceptual, methodological and empirical gaps in academic and policy discourses. We argue that critical attention to power dynamics is often a key missing element in these discourses and make the case for explicit attention to the operation of power throughout conceptualization, design and conduct of research in this space. We argue that: (a) urban informality reflects the exercise of power to confer and withhold advantage; (b) the dominant biomedical model of health poorly links embodied experiences and structural contexts; (c) existing models of accountability are inadequate in unequal, pluralistic governance and provision environments. We trace four conceptual and empirical directions for transformative approaches to power relations in urban health equity research

The philosophy of religion /

Mode of access: Internet

A randomised tRial of Expedited transfer to a cardiac arrest centre for non-ST elevation ventricular fibrillation out-of-hospital cardiac arrest: The ARREST pilot randomised trial

Wide variation exists in inter-hospital survival from out-of-hospital cardiac arrest (OHCA). Regionalisation of care into cardiac arrest centres (CAC)may improve this. We report a pilot randomised trial of expedited transfer to a CAC following OHCA without ST-elevation.The objective was to assess the feasibility of performing a large-scale randomised controlled trial. Adult witnessed ventricular fibrillation OHCA of presumed cardiac cause were randomised 1:1 to either: 1) treatment: comprising expedited transfer to a CAC for goal-directed therapy including access to immediate reperfusion, or 2) control: comprising current standard of care involving delivery to the geographically closest hospital. The feasibility of randomisation, protocol adherence and data collection of the primary (30-day all-cause mortality) and secondary (cerebral performance category (CPC)) and in-hospital major cardiovascular and cerebrovascular events (MACCE)) clinical outcome measures were assessed. Between November 2014 and April 2016, 118 cases were screened, of which 63 patients (53%) met eligibility criteria and 40 of the 63 patients (63%) were randomised. There were no protocol deviations in the treatment arm. Data collection of primary and secondary outcomes was achieved in 83%. There was no difference in baseline characteristicsbetween the groups: 30-day mortality (Intervention 9/18, 50% vs. Control 6/15, 40%; P = 0.73), CPC 1/2 (Intervention: 9/18, 50% vs. Control 7/14, 50%; P > 0.99) or MACCE (Intervention: 9/18, 50% vs. Control 6/15, 40%; P = 0.73). These findings support the feasibility and acceptability of conducting a large-scale randomised controlled trial of expedited transfer to CAC following OHCA to address a remaining uncertainty in post-arrest care

Percutaneous device closure of paravalvular leak

Background: Paravalvular leak (PVL) occurs in 5% to 17% of patients following surgical valve replacement. Percutaneous device closure represents an alternative to repeat surgery. Methods: All UK and Ireland centers undertaking percutaneous PVL closure submitted data to the UK PVL Registry. Data were analyzed for association with death and major adverse cardiovascular events (MACE) at follow-up. Results: Three hundred eight PVL closure procedures were attempted in 259 patients in 20 centers (2004-2015). Patient age was 67±13 years; 28% were female. The main indications for closure were heart failure (80%) and hemolysis (16%). Devices were successfully implanted in 91% of patients, via radial (7%), femoral arterial (52%), femoral venous (33%), and apical (7%) approaches. Nineteen percent of patients required repeat procedures. The target valve was mitral (44%), aortic (48%), both (2%), pulmonic (0.4%), or transcatheter aortic valve replacement (5%). Preprocedural leak was severe (61%), moderate (34%), or mild (5.7%) and was multiple in 37%. PVL improved postprocedure (