Star architecture projects: The assessment of spatial economic effects by means of a spatial incidence analysis

Following the inauguration of the Guggenheim Museum Bilbao, designed by the star architect Frank Gehry, numerous cities have developed star architecture projects that try to emulate the 'Bilbao Effect' in the hope of triggering positive impacts for tourism and socio-economic development. However, as many projects do not achieve the set goals, their role as catalysts for urban development is debatable. We argue that the temporal and spatial economic dimension of the effects of star architecture projects - which are hardly discussed in existing literature - is crucial to assess the contribution of such projects for urban regeneration. The Kunsthaus Graz in Austria serves as a case study where we apply and modify the approach of the 'spatial incidence analysis' to assess the socioeconomic and intertemporal effects of a publicly funded, star architecture project. The spatial incidence analysis is closely related to the cost-benefit analysis, but takes into consideration wider aspects of the spatial distribution and intertemporal development of three dimensions of effects: payment flows, goods and services, and utility. We identify the following key findings by applying a combination of quantitative and qualitative methods: the operation of the Kunsthaus Graz provides an inflow of purchasing power for the municipality of Graz; the Kunsthaus Graz has positive, long-term effects in the fields of tourism marketing, civic pride and identification, creative industries and urban regeneration; the effects of the Kunsthaus Graz are spatially concentrated in the municipality of Graz.Nach der Eröffnung des vom Stararchitekten Frank Gehry entworfenen Guggenheim-Museums Bilbao haben zahlreiche Städte versucht, den 'Bilbao-Effekt' zu wiederholen in der Hoffnung, mit Stararchitekturprojekten eine positive Wirkung auf den Tourismus und die sozioökonomische Entwicklung auszulösen. Viele Projekte erreichten die mit ihnen verbundenen Ziele aber nicht. Ihre Rolle als Katalysator für die Stadtentwicklung wird daher in Frage gestellt. Wir argumentieren, dass die zeitliche und räumlich-ökonomische Dimension der Effekte von Stararchitekturprojekten - die in der Literatur bisher kaum diskutiert wurden - entscheidend ist, um den Beitrag solcher Projekte für die Stadtentwicklung zu beurteilen. Wir zeigen am Beispiel des Kunsthauses Graz in Österreich, wie man die Methode der räumlichen Inzidenzanalyse zur Bewertung der sozioökonomischen und intertemporalen Effekte eines Stararchitekturprojekts, das mit öffentlichen Geldern gefördert wurde, anpassen und nutzen kann. Die räumliche Inzidenzanalyse ist einer Kosten-Nutzen-Analyse ähnlich, berücksichtigt jedoch die räumlichen und zeitlichen Verteilungseffekte dreier zusammenhängender Dimensionen: Zahlungsströme, Güter und Dienstleistungen, Nutzen. Durch eine Kombination von quantitativen und qualitativen Analysen gewinnen wir folgende Erkenntnisse: Der Betrieb des Kunsthauses Graz sorgt für einen Kaufkraftzufluss der Gemeinde Graz, es zeigt positive, langfristige Effekte in den Bereichen Tourismusmarketing, Bürgerstolz und -identifikation, Kreativwirtschaft und Stadterneuerung. Zudem konzentrieren sich die Wirkungen des Kunsthauses Graz räumlich auf die Gemeinde Graz

A screen for downstream effectors of Neurogenin2 in the embryonic neocortex

Neurogenin (Ngn) 1 and Ngn2 encode basic-helix-loop-helix transcription factors expressed in the developing neocortex. Like other proneural genes, Ngns participate in the specification of neural fates and neuronal identities, but downstream effectors remain poorly defined. We set out to identify Ngn2 effectors in the cortex using a subtractive hybridization screen and identified several regionally expressed genes that were misregulated in Ngn2 and Ngn1; Ngn2 mutants. Included were genes down-regulated in germinal zone progenitors (e.g., Nlgn1, Unc5H4, and Dcc) and in postmitotic neurons in the cortical plate (e.g., Bhlhb5 and NFIB) and subplate (e.g., Mef2c, srGAP3, and protocadherin 9). Further analysis revealed that Ngn2 mutant subplate neurons were misspecified and that thalamocortical afferents (TCAs) that normally target this layer instead inappropriately projected towards the germinal zone. Strikingly, EphA5 and Sema3c, which encode repulsive guidance cues, were down-regulated in the Ngn2 and Ngn1; Ngn2 mutant germinal zones, providing a possible molecular basis for axonal targeting defects. Thus, we identified several new components of the differentiation cascade(s) activated downstream of Ngn1 and Ngn2 and provided novel insights into a new developmental process controlled by these proneural genes. Further analysis of the genes isolated in our screen should provide a fertile basis for understanding the molecular mechanisms underlying corticogenesis

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

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

Building a transitional care checklist in rheumatology: A Delphi-like survey

tObjectives: To design a transitional care checklist to be used by and facilitate the work of health pro-fessionals in providing transitional care for children with a chronic rheumatologic disease and theirfamilies.Methods: A Delphi-like study among an international expert panel was carried out in four steps: (1)a working group of 6 specialists established a draft; (2) a web-survey among a panel of internationalexperts evaluated it; (3) a 2-day consensus conference with an expert panel discussed items not reachingagreement; (4) a web-survey among the panel of international experts with the list of reformulated items.Results: The first draft of the checklist included 38 items in 3 phases of transition and 5 age groups.Thirty-three international experts evaluated the checklist reaching ≥ 80% agreement for 26 items and≤ 80% for 12. The consensus conference of 12 experts discussed and redefined the 12 items. Twenty-five international experts filled out the web-survey and all items reached a minimum of 80% agreementexcept one. The final checklist was reached.Conclusions: This Delphi-like study defined what themes should be included and at what age they needto be addressed with patients with a chronic rheumatology disease and their families during transition.This checklist reached a strong international and interdisciplinary consensus while examining transitionin a broad way. It should now be spread widely to health professionals to be used by all those who carefor adolescents aged ≥ 12 years at times of transition. It could be transposed to most chronic conditions.Recommendations for further research are given

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe