Prediction And Simulation Of Spatial Pattern For Urban Growth And Change In Land Use In Sana’a City, Yemen

In this study, Sana’a master plans were evaluated and analyzed to verify whether their implementations corresponded with the actual spatial urban development. The result shows that until the present time there is still lack of clear policy that controls and guides urban development. It also shows that about 40% of the growth occurred in unplanned areas, green areas and reserved land without suitable protection and regulations. GIS, remote sensing techniques and field survey were used to study the spatial pattern growth for the spontaneous areas in Sana’a city as well as the physical, socio-economic, and environmental conditions. There is no specific planning pattern was found in these settlements. Development has taken place randomly in unplanned areas, following the pattern of topography and concentrating along main roads. The study has successfully developed a model for locating suitable land for urban development in Sana’a by integrating GIS and Multi-criteria Analysis and Cellular Automata methods. The potential suitable lands were generated and the validation of the model was done by overlaying the generated suitability map on the potential land for residential development proposed by 1999 Sana’a master plan. The result shows the areas for future development proposed by the master plan corresponded well with the high to very high suitability zones except for illegal areas. The prediction and simulation of the urban growth and land use change were done successfully in GIS-based CA model which output “managed growth scenario”. Based on the land suitability assessment produced by the model, the demand for land for urban development during the period from 2004 to 2020 was then estimated using statistical tools. Then, the candidature of a cell by adopting again MCA method was evaluated. It provides dynamic transition rule for land use conversion at each time step of the simulation model based on the following factors used: land suitability, proximity to existing developed areas, proximity to prioritized land, and current land use. Variable calculation produces land use conversion probabilities for each cell. The rules are updated at each time step in order to reflect the land dynamics of the previous step. The result was validated through the process of running the model for the period from 1994 to 2003. The result gives an overall accuracy of 99.6%, producer’s accuracy of 83.3% and the user’s accuracy of 83.6%. In this study the SLEUTH model was also used to predict the urban growth and land use change. It was calibrated using 35-year time series dataset compiled from interpreted historical topographical maps, aerial photographs and satellite imageries for the entire study area to identify the parameters that influenced the urban growth in Sana’a city. Results from the calibration modes- coarse, fine, and final represented the top five scorings from thousands of iterations. The composite results of the optimum values for the diffusion, spread, slope and road gravity parameters show successive improvements in the parameters that control the behavior of the system. In the mechanism of self-modification rules, parameters averaging on the best results from the final calibration were used. The prediction mode of the SLEUTH model uses the best fit growth rule parameters from the calibration to begin the process of ‘‘growing’’ urban settlements, starting at the most recent urban data layer. The resulting forecast of future urban growth outputs a probability map where individual grid cells are being urbanized at some future date, assuming the same unique ‘‘urban growth signature’’ is still in effect as it was in the past. The final results of the model are annual layers map of future urban growth and land use change (2004–2020). Based on the analysis the comparison between GIS-based CA model and SLEUTH model carried out and the strong and weak points of them were highlighted. This study benefits decision makers and planners in carrying out future urban growth planning and it gives them the opportunity to know the advantages and consequences for each growth scenario in order to promote the continuity and sustainability of urban development in the Sana’a city

Manifestation of Remote Sensing Data in Modeling Urban Sprawl Using the SLEUTH Model and Brute Force Calibration: A Case Study of Sana`a City, Yemen.

Sana’a the metropolitan capital of Yemen, has experienced rapid spatial growth and uncontrolled development for decades. In the absence of a means to forecast and predict urban growth trends, planning and urban policy decisions have been found wanting. In this study the SLEUTH (Slope, landuse, exclusion, urban extent, transportation and hillshade) model which has been widely and successfully applied in developed countries, has been applied to predict the spatial urban sprawl pattern from 2004–2020 in Sana’a. This was to provide the necessary forecast for better planning and decision making. The model performed well as per the calibration coefficient values. The results showed that there will a 29 % increase in spatial urban sprawl growth during the modeling period. Growth of the sprawl will be mainly at the edges of the urban boundary, there will also be a wide area of scattered urban clusters. Factors that will have major influence on spatial expansion of the city will be diffusion, natural and internal growth, slope (that will hinder spread) and transportation (along which most of the urban sprawl will occur). The study also provides an insight into how the SLEUTH model performs in a poorly planned urban environment as compared to the planned and controlled environment where it has been applied

Modelling urban growth evolution and land-use changes using GIS based cellular automata and SLEUTH models: the case of Sana'a metropolitan city, Yemen.

An effective and efficient planning of an urban growth and land use changes and its impact on the environment requires information about growth trends and patterns amongst other important information. Over the years, many urban growth models have been developed and used in the developed countries for forecasting growth patterns. In the developing countries however, there exist a very few studies showing the application of these models and their performances. In this study two models such as cellular automata (CA) and the SLEUTH models are applied in a geographical information system (GIS) to simulate and predict the urban growth and land use change for the City of Sana’a (Yemen) for the period 2004–2020. GIS based maps were generated for the urban growth pattern of the city which was further analyzed using geo-statistical techniques. During the models calibration process, a total of 35 years of time series dataset such as historical topographical maps, aerial photographs and satellite imageries was used to identify the parameters that influenced the urban growth. The validation result showed an overall accuracy of 99.6 %; with the producer’s accuracy of 83.3 % and the user’s accuracy 83.6 %. The SLEUTH model used the best fit growth rule parameters during the calibration to forecasting future urban growth pattern and generated various probability maps in which the individual grid cells are urbanized assuming unique “urban growth signatures”. The models generated future urban growth pattern and land use changes from the period 2004–2020. Both models proved effective in forecasting growth pattern that will be useful in planning and decision making. In comparison, the CA model growth pattern showed high density development, in which growth edges were filled and clusters were merged together to form a compact built-up area wherein less agricultural lands were included. On the contrary, the SLEUTH model growth pattern showed more urban sprawl and low-density development that included substantial areas of agricultural lands

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

The PROVENT-C19 registry: A study protocol for international multicenter SIAARTI registry on the use of prone positioning in mechanically ventilated patients with COVID-19 ARDS

Background The worldwide use of prone position (PP) for invasively ventilated patients with COVID-19 is progressively increasing from the first pandemic wave in everyday clinical practice. Among the suggested treatments for the management of ARDS patients, PP was recommended in the Surviving Sepsis Campaign COVID-19 guidelines as an adjuvant therapy for improving ventilation. In patients with severe classical ARDS, some authors reported that early application of prolonged PP sessions significantly decreases 28-day and 90-day mortality. Methods and analysis Since January 2021, the COVID19 Veneto ICU Network research group has developed and implemented nationally and internationally the "PROVENT-C19 Registry", endorsed by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care. . .'(SIAARTI). The PROVENT-C19 Registry wishes to describe 1. The real clinical practice on the use of PP in COVID-19 patients during the pandemic at a National and International level; and 2. Potential baseline and clinical characteristics that identify subpopulations of invasively ventilated patients with COVID-19 that may improve daily from PP therapy. This web-based registry will provide relevant information on how the database research tools may improve our daily clinical practice. Conclusions This multicenter, prospective registry is the first to identify and characterize the role of PP on clinical outcome in COVID-19 patients. In recent years, data emerging from large registries have been increasingly used to provide real-world evidence on the effectiveness, quality, and safety of a clinical intervention. Indeed observation-based registries could be effective tools aimed at identifying specific clusters of patients within a large study population with widely heterogeneous clinical characteristics. Copyright

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

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

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