Navigating the Green Transition During the Pandemic Equitably: A New Perspective on Technological Resilience Among Boston Neighborhoods Facing the Shock

Cities, public authorities, and private organizations respond to climate change with various green policies and strategies to enhance community resilience. However, these community-level transition processes are complex and require deliberate and collective planning. Under this context, the purpose of this study is to understand the energy actions taken at the local level, as well as to analyze the differences between the neighborhoods’ green energy transitions in terms of their socio-economic aspects, using a big data perspective. The paper is addressing the following question: what was the role that the pandemic played in accelerating or slowing Boston’s green investments, and to what extent do different racial and socioeconomic groups invest in green technologies during this period? The study aims to answer these research questions using the City of Boston as a case study to reveal different neighborhoods’ paths in achieving the transformation of city ecosystems towards green neutrality. Next, the theoretical framework builds the linkages among the city’s measures, climate actions proposed by the City of Boston, and their associated contexts and outcomes in shaping new policy and planning models for higher ‘green’ performance. Following the understanding of the actions, the neighborhoods’ socio-economic and building permit data were assessed to understand whether economic disparities exacerbated during the pandemic have affected neighborhoods’ performance in green transition. This method is applied in a comparative study of its 23 neighborhoods, using a dataset provided by Boston Area Research Initiative (BARI). Intriguingly, the paper’s findings show that racial differences within the city have no significant impact on tech-related expenditures. There is a clear negative correlation between poverty rate and investment, which indicates the reverse relationship between these socio-economic factors. The study concludes that city authorities will need to address the challenges of each community achieving green transition with more targeted programs based on its needs

A guide to best practice in faculty development for health professions schools: a qualitative analysis

BACKGROUND: This is a practice guide for the evaluation tool specifically created to objectively evaluate longitudinal faculty development programs (FDP) using the “5×2 -D backward planning faculty development model”. It was necessary to create this tool as existing evaluation methods are designed to evaluate linear faculty development models with a specific endpoint. This backward planning approach is a cyclical model without an endpoint, consisting of 5 dynamic steps that are flexible and interchangeable, therefore can be a base for an evaluation tool that is objective and takes into account all the domains of the FDP in contrast to the existing, traditional, linear evaluation tools which focus on individual aspects of the program. The developed tool will target evaluation of longitudinal faculty development programs regardless of how they were planned. METHODOLOGY: Deductive qualitative grounded theory approach was used. Evaluation questions were generated and tailored based on the 5 × 2-D model followed by 2 Delphi rounds to finalize them. Based on the finalized evaluation questions from the results of the Delphi rounds, two online focus group discussions (FGDs) were conducted to deduce the indicators, data sources and data collection method. RESULTS: Based on the suggested additions, the authors added 1 new question to domains B, with a total of 42 modifications, such as wording changes or discarding or merging questions. Some domains received no comments, therefore, were not included in round 2. For each evaluation question, authors generated indicators, data sources and data collection methods during the FGD. CONCLUSION: The methodology used to develop this tool takes into account expert opinions. Comprehensiveness of this tool makes it an ideal evaluation tool during self-evaluation or external quality assurance for longitudinal FDP. After its validation and testing, this practice guide can be used worldwide, along with the provided indicators which can be quantified and used to suit the local context. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-022-03208-x

Egyptian historical parks, authenticity vs. change in Cairo's cultural landscapes

As a historically intense country, Egypt's built environment has always been the focus of plentiful urban research. However, the natural component in the urban fabric of Egyptian cities has been undermined and understudied in between all the numerous ideas and data. In a historical city like Cairo, layers of history are illustrated in its parks and gardens. Left unearthed and neglected, these vital spaces are subject to negative change and decay under the pressure of land use demands, among various other challenges. Many of Cairo's parks and gardens date back to the 19th and 20th century, containing endless gestures from the cultural essence of this time era in their design. This paper discusses ten public parks and gardens in Cairo founded in the 19th and 20th centuries, and survive to our present day (whether completely or partially). Viewing the initial design and development of these parks in comparison with their current state is rather intriguing to investigate. These historical parks and gardens are worthy of identification for preservation. With resourceful and directed management, these spaces can dramatically change the view of Cairo as a suffocating dense urban tissue, to a more perforated and engaging urban experience for its community

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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Spatializing Social Networking Analysis to Capture Local Innovation Flows towards Inclusive Transition

The location of the local network of firms impacts, positively or negatively, their economic performance. The interactions between different sectors in a territory are still not easily observable. We test the complexity of the economic structure at a local level, given the availability of data at a very granular scale. This could greatly assist in observing sectors or/and locations that play a dominant role in the regional economy. Thus, in order to interpret the economic structure of a territory, we used cluster-based analysis. The analysis helps in evaluating the interconnections among sectors that constitute a cluster. A novel method of describing the territorial economic structure is presented by applying Social Network Analysis (SNA) within cluster-based analysis to characterize the importance of both location and economic interconnections. In this study, we focus on the industrial agglomerations in Calabria, Italy, to underpin the potential of the region’s industries by using social networking analysis metrics. This research put forward new interpretations of SNA metrics that describe regional economic compositions. Our findings reveal that territorial social networks are a potential instrument for understanding interactions in regional systems and economic clusters and might help in highlighting local industrial potentials. We believe that this study’s results could be considered as the initial steps for a pioneer data-driven place-based structural analysis model

From Deinstitutionalization to Community-Based Urban Development: Investigating Accessibility of Urban Systems in Calabria through Network Analytics

Community-based urban development is an inclusive approach for local service provision and management centered on the proactive partnerships between urban communities and local governments. Rooted in the deinstitutionalization of public services, the European Union and national policy effort is pushing towards the organization of community-based alternatives in response to the evolving needs of local communities. As the pandemic has shown, service accessibility has proven to be a key concern element that needs to be addressed to increase communities’ and cities’ resilience. In this direction, the paper aims to propose data-driven alternative approaches to assess urban systems’ accessibility and connectivity as an element of leveraging the resilience-oriented planning process and facilitating community-based development. The methodological approach focuses on the case of the Calabria region, where community-based alternatives for the provision of public services found difficulties to be operationalized through an integrated planning approach. The case study is explored by experimenting on the spatial connections of two purposefully selected clusters to assess the accessibility and connectivity of urban systems within the region through network analysis visualization tools: health and social-related services and transportation and logistics. The analytical approach outlines the accessibility level of urban systems in the region examined, proving its relevance in detecting social, economic, and environmental dynamics. This approach shows how using non-traditional data-driven perspectives can detect development dynamics—which affect local community’s needs—and their limitations in the organization of community-based development alternatives

Evaluation of cochlear and auditory brainstem functions in COVID-19 patients; a case control study

Abstract Background Many viral infections can cause hearing loss due to affection of cochlear hair cells or neurogenic pathway. Although, the damage secondary to viral infections is mainly cochlear affection; auditory brainstem can be affected as well. It was predicted that SARS-COV-2 infection can similarly affect the auditory system. This study aimed to detect affection in auditory system and if present investigate the possible site of lesion (up to the level of the brain stem) in relation to COVID-19 infection. Methods This is a case control study, where the study group constituted of thirty adults, diagnosed with COVID-19 at least 2 weeks prior to testing and up to 6 months, without previous auditory complaints pre-COVID-19 or other risk factors that could affect the auditory pathway. Fifteen adult participants that were age and gender matched to the study group with no previous history of covid-19 infection constituted the control group. Audiological evaluations done to all participants were pure-tone and speech audiometry, tympanometry, transient-evoked otoacoustic emission with and without contralateral suppression and auditory brainstem response measurements. Results The study group showed significantly worse pure tone thresholds at high frequencies 4 and 8 kHz (p 0.05). Conclusion COVID-19 had subtle effect on cochlear basal turn, and it is shown that the auditory efferent system may also be affected, while the auditory nerve and afferent brainstem pathways seems to be spared. Moreover, the absence of the symptoms of auditory dysfunction postcovid-19 does not guarantee normal auditory functions