Africa in Motion: Why the rush to build Grand Renaissance and Inga 3 Dams in Africa?

Abstract: It is worthwhile to search that what really drives the two large dam's construction rush in Africa? To understand what has changed since the beginning of the 21st Century. When former Ethiopian Prime Minister Meles Zenawi gave an interview following the signing of the Entebbe Agreement in 2010, he had said, "some people in Egypt have old-fashioned ideas based on the assumption that the Nile water belongs to Egypt." But, "the circumstances have changed and changed forever." When he stressed this extraordinary changing in his speech, multinational driving forces has been in use to paradigm shift to solve some international disputes since the beginning of the 21st Century. Prime Minister Meles Zenawi was a visionary leader who brought real benefits on the table to share with. As the years go by Zenawi's statement come true.But mostly no attention has been given to what was "old fashion" and what is the circumstances that have changed forever in his statement. Rapidly developed and constructed water projects showed that it is time to remember these words to analyse new security paradigm as well as new driving forces in some African transboundary river basins. Some examples can be taken as Grand Renaissance Dam in Ethiopia and Grand Inga Dam in DR Congo that will be addressed in this article. First one has already completed as percent %60 and second one construction will start in very soon. Africa urgently needs energy to lift its people out of poverty and pursue sustainable development. The Nile and Congo River offers enormous opportunities for doing this.In this article,we aimed to highlight additional drivers being effective to develope transboundary waters faster than late 20 th Century

Detecting seasonal cycle shift on streamflow over Turkey by using multivariate statistical methods

Climate change analysis includes the study of several types of variables such as temperature, precipitation, carbon emission, and streamflow. In this study, we focus on basin hydrology and, in particular, on streamflow values. They are geographic and climatologic indicators utilized in the study of basins. We analyze these values to better understand monthly and seasonal change over a 40-year period for all basins in Turkey. Our study differs from others by applying multivariate analysis into the streamflow data implementations rather than on trend, frequency, and/or distribution-based analysis. The characteristics of basins and climate change effects are visualized and examined with monthly data by using cluster analysis, multidimensional scaling, and gCLUTO (graphical Clustering Toolkit). As a result, we classify months as lowflow and high-flow periods. Multidimensional scaling proves that there is a clockwise movement of months from one decade to the next, which is the indicator of seasonal shift. Finally, the gCLUTO tool is utilized in a novel way in the hydrology field by revealing the seasonal change and visualizing the current changing structure of streamflow

Detecting seasonal cycle shift on streamflow over Turkey by using multivariate statistical methods

Climate change analysis includes the study of several types of variables such as temperature, precipitation, carbon emission, and streamflow. In this study, we focus on basin hydrology and, in particular, on streamflow values. They are geographic and climatologic indicators utilized in the study of basins. We analyze these values to better understand monthly and seasonal change over a 40-year period for all basins in Turkey. Our study differs from others by applying multivariate analysis into the streamflow data implementations rather than on trend, frequency, and/or distribution-based analysis. The characteristics of basins and climate change effects are visualized and examined with monthly data by using cluster analysis, multidimensional scaling, and gCLUTO (graphical Clustering Toolkit). As a result, we classify months as lowflow and high-flow periods. Multidimensional scaling proves that there is a clockwise movement of months from one decade to the next, which is the indicator of seasonal shift. Finally, the gCLUTO tool is utilized in a novel way in the hydrology field by revealing the seasonal change and visualizing the current changing structure of streamflow

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research