Spatial planning, urban land management, and political architecture In the conflict areas

Theories pertaining to spatial planning and sustainable development have magnificently grown during the second half of the past century and still witness increased rate of attention concerning the manifold aspects encapsulated by their subjects. However, both of these themes still remain underestimated and require further investigation and even augmentation when exploring areas of ‘political turbulences’ or ‘unbalanced powers’; in other words, regions of ‘conflict areas’. The development process in the conflict areas seems to depend ultimately on the scale and magnitude of power between the different contested groups, i.e. the ‘dominant group’ and the ‘weaker group’; where sustainability becomes very vulnerable, and if exists, belongs to the dominant group neglecting the weaker one, and even in many cases, exploiting the resources and opportunities of the weaker for the advantage of the dominant, resulting therefore, more marginalizing and social degradation. Hence, new arguments pertaining to sustainability in the conflict areas conclude that sustainable development in these areas can be considered as a ‘terminology game’ which does not resolve the older growth debate, but disguises it. Spatial planning in the conflict areas may shape fast-changing or dynamic spatial policies accompanied with irreversible physical layouts that create in many cases multi-dimensional challenges for inhabitants. Especially, for the indigenous residents when considered for one reason or another ‘a group of minority’. Therefore, clarifying the relationship between spatial planning, power and politics is a prominent issue in this doctoral research. Understanding this relation reveals the range of influence of politics upon planning objectives and role. Accordingly, it is a marvelous question to know if planning is an organic reflection of politics or not; as well as, to explore whether spatial planning, in the conflict areas, is used to mitigate or intensify conflict. Based upon theoretical framework, this doctoral research presents comprehensive set of interrelationships between the main parameters affecting the development process in the conflict areas, namely (space, politics, power and planning); these are interestingly elaborated and conceptualized by the researcher within referenced spatial context; i.e. Jerusalem (the case study). Moreover, the direct and implicit role and impacts of these relations were examined. The examination through logical framework (theory – analysis – conception) of the aforementioned parameters (in conflict areas) reveals a maze of dynamic interrelationships which outstandingly guide the development for the benefit of the dominant group. This doctorate research provides critical review for the role of planning whether it acts as ‘progressive’ or ‘regressive’ agent of change, especially in the conflict areas with unbalanced powers. In Jerusalem, it has been shown that power and politics are the major planning drivers which set out the development pattern and objectives. Consequently, the spatial and social profiles of Jerusalem have been changing very fast producing new norms of urban fabrics and geographical extents, which all together, constitute manifold challenges to the ‘indigenous’ Palestinian residents

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