Building a food-resilient city through urban agriculture: The case of Ilorin, Nigeria

The rise in urban population, accompanied by growing poverty and hunger, has triggered debates on the relevance of urban agriculture in addressing the challenges of food insecurity in urban centres. This article examines the effects of urban planning practice on urban agriculture (UA) in Ilorin, Nigeria, and how it has contributed to improving the resilience of the city to food shock. Adopting a cross-sectional survey design, primary and secondary data were used. A structured questionnaire was used to obtain primary data from randomly selected urban farmers. Secondary data were obtained from the publications of the Central Bank of Nigeria, the National Bureau of Statistics, and the Food and Agricultural Organization. Data collected were analysed using descriptive statistical techniques. Respondents’ Agreement Index (RAI) was used to measure the variables influencing the performance of UA. Findings revealed that UA contributed 16.9% to meat/fish/egg requirements in the city; 4.5% to yam/cassava/potato requirements; 0.58% to vegetable requirements; 0.6% to fruit requirements, and 0.5% to grain requirements. RAI results indicated poor access to finance (0.93), limited land area (0.75), and lack of tenure security (0.44) as the dominant variables influencing the poor contribution of UA to food security. It is recommended that UA be integrated into urban planning and that more land for farming be provided

Climate change effects and livelihood-adaptation strategies by the urban poor in Ibadan, Nigeria

As with many developing countries, one of Nigeria’s major challenges to socio-economic development is climate change. This article examines the effects of climate change on the livelihood activities of the urban poor in Ibadan, Nigeria. Adopting a cross-sectional survey design, the research relied essentially on primary data. A structured questionnaire was used to obtain primary data from 481 purposively selected urban residents engaging in different livelihood activities. Data collected were analysed using descriptive and inferential statistical techniques. The Respondents’ Agreement Index was used to measure the respondents’ awareness of climate change and climate change adaptation strategies. Tobit Regression Model was used to analyse the factors influencing climate change adaptation strategies, while the effects of climate change on residents’ livelihood were measured using Multinomial Logistic Regression. Findings revealed that respondents were involved in diverse livelihood activities, ranging from trading to civil service. Long dry seasons, excessive heat, irregular rainfall patterns, and frequent floods make respondents aware of climate change. Low patronage by buyers, low productivity, and reduction in income were the major effects of climate change on livelihood activities. Diversifying income sources was the main adaptation strategy. Strengthening the physical planning system to build the city’s resilience and adaptive capacity to climate-related disasters was recommended

Effective Environmental Planning Management (EPM) as Panacea to Sustainable Urban Development

The rapid rate of urban growth in most developing countries of the world in recent times is alarming. Mass movement of people from rural areas to the urban centres, the consequence of the uncontrolled rapid urbanisation resulting to many un-conforming environmental challenges such as inadequate infrastructure, land, water and air pollution, poor environmental sanitation, poor and inadequate housing, urban degradation, sprawl and slums, urban violence, crime, robbery and prostitution as well as many other social vices that make the cities unsustainable. The resultant effects of all these are abysmal failure in the management of cities on the part of the governing authorities and other relevant stakeholders as well as unconducive and unwholesome condition of living of the people. This paper attempts to examine holistically the issue of environmental planning management (EPM) process development and management concept with a view for dynamic and interactive approach for various stakeholders as partners in achieving sustainable cities of our dream. The areas of discussion including conceptual and contextual issues, sustainable cities concept, good urban governance including literature review. The paper goes further to examine opportunities and challenges of built environment generally, the nature and context of environmental problems in particular, the role and duties of environmental planning and management (EPM) process in sustainable urban development. The paper further reviewed briefly the various levels of institutionalisation of EPM process with a typical case study of sustainable Ibadan project (SIP). The paper concludes with a list of recommendations to ensure effective and lasting solutions to cities problems through initiation of EPM process achievable in a sustainable manner

Efficacy and Safety of Carfilzomib-Lenalidomide-Dexamethasone (KRd) in Newly Diagnosed Multiple Myeloma: Pooled Analysis of 4 Single-Arm Studies

Introduction: Carfilzomib (K) is a second-generation proteasome inhibitor that is approved as a single agent and in combination with lenalidomide and dexamethasone (KRd) or dexamethasone alone for the treatment of patients with relapsed and/or refractory multiple myeloma (RRMM) (Siegel et al., Blood, 2012; Siegel et al., JCO, 2018; Dimopoulos et al., Lancet Oncol, 2017). While KRd is not approved for patients with newly diagnosed multiple myeloma (NDMM), the efficacy and safety of this regimen have been examined in several independent investigator-driven studies (Kazandjian et al., ASH 2018, Abstract 1957; Jakubowiak et al., ASCO 2013, Abstract 8543; Roussel et al., ASH 2016, Abstract 1142; Zimmerman et al., ASH 2016, Abstract 675). The four phase 1 and phase 2 studies (NCT01029054 [N=55], NCT01402284 [N=45], NCT01816971 [N=76], NCT02405364 [N=46]) have shown that KRd is safe and effective in NDMM. However, the studies were single-arm with relatively small numbers of enrolled patients. A pooled analysis of individual patient data would provide an overall assessment of clinical outcomes for KRd, allowing further assessment of the efficacy and safety of KRd in NDMM. Methods: Patient-level data from four single-arm phase 1 and phase 2 studies of KRd in NDMM were combined (3 in the U.S. and one in France); three of the four studies were multicenter studies. Patients were treated in 28-day cycles of KRd: carfilzomib (most received 20/36 mg/m2, days 1, 2, 8, 9, 15, and 16), lenalidomide (25 mg/day, days 1‒21), and dexamethasone (20‒40 mg/week). The primary endpoint was to estimate the rate of very good partial response or better (≥VGPR). The secondary endpoints included assessments of overall response rate (ORR), the rate of complete response or better (≥CR), median progression-free survival (mPFS), landmark PFS, and safety. Response rate analyses were based on best overall response for stringent CR, CR, VGPR, or partial response (PR) that were reported in each study. The patients were separated into two cohorts: those who received stem cell transplant (SCT) (NCT01816971 and NCT02405364) and those who did not (NCT01029054 and NCT01402284). Results: The first cohort of patients from the SCT studies included 122 patients (table). The average age for this cohort was 57.1 years, and 63% were male. The percentages of patients with ISS stages I, II, and III were 46%, 37%, and 11%, respectively. High-risk cytogenetics were observed in 25% of patients (table). The pooled proportion of patients who had ≥VGPR was 93% (95% CI: 89%, 98%), while the pooled ≥CR rate was 79% (95% CI: 72%, 86%). All patients had at least a partial response or better. The 1- and 2-year PFS rates were 95% (95% CI: 89%, 98%) and 88% (95% CI: 80%, 93%), respectively. The limited patient follow-up beyond 2 years did not allow estimation of mPFS. 109 patients (89%) reported at least one grade 3 or 4 treatment-emergent adverse event (TEAE). Selected grade 3 or 4 TEAEs of interest were acute renal failure (2%), cardiac failure (2%), and hypertension (2%) (table). The second cohort of patients from the non-SCT studies included 99 patients (table). The average age for this cohort was 60.9 years, and 67% were male. The percentages of patients with ISS stages I, II, and III were 44%, 39%, and 16%, respectively. High-risk cytogenetics were observed in 35% of patients (table). The pooled proportion of patients who had ≥VGPR was 90% (95% CI: 84%, 96%). The pooled ORR was of 98% (95% CI: 95%, >99%), while the pooled ≥CR rate of 71% (95% CI: 62%, 80%). The 1- and 2-year PFS rates were 96% (95% CI: 90%, 98%) and 85% (95% CI: 76%, 90%), respectively. The limited patient follow-up beyond 2 years did not allow estimation of mPFS. 91 patients (92%) reported at least one grade 3 or 4 TEAE. Selected grade 3 or 4 TEAEs of interest were peripheral neuropathy (1%), acute renal failure (4%), cardiac failure (3%), and hypertension (5%) (table). Additionally, the results of the individual studies are consistent in efficacy and safety. Conclusion: The results of this study demonstrate deep and sustained responses, highlighting KRd as an effective and tolerable treatment option for patients with NDMM in both the transplant and non-transplant settings. The promising results presented here should be evaluated against standard of care regimens. Disclosures Landgren: Adaptive: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Sanofi: Membership on an entity's Board of Directors or advisory committees; Karyopharm: Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Merck: Other: IDMC; Theradex: Other: IDMC; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Roussel:Celgene Corporation: Consultancy, Other: travel fees, lecture fees, Research Funding; Janssen: Honoraria, Other: travel fees, lecture fees, Research Funding; Amgen: Other: travel fees, lecture fees, Research Funding; takeda: Other: travel fees, lecture fees, Research Funding. Anderson:Statistics Collaborative, Inc.: Employment. Kervin:Statistics Collaborative, Inc.: Employment. Iskander:Amgen Inc.: Employment, Other: stockholder of Amgen. Mezzi:Amgen Inc.: Employment, Other: stockholder of Amgen. Welliver:Amgen Inc.: Employment, Other: stockholder of Amgen. Yusuf:Amgen Inc.: Employment, Other: stockholder of Amgen. Jakubowiak:Adaptive Biotechnologies: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; KaryoPharm Therapeutics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Millennium: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; SkyLineDx: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Juno: Consultancy, Honoraria; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; GSK: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees

Carfilzomib, dexamethasone, and daratumumab versus carfilzomib and dexamethasone for patients with relapsed or refractory multiple myeloma (CANDOR): updated outcomes from a randomised, multicentre, open-label, phase 3 study

Despite recent advances in therapeutic options, there remains an unmet need for treating patients with relapsed or refractory multiple myeloma, especially in those previously exposed or refractory to lenalidomide. This updated efficacy and safety analysis from the phase 3 CANDOR study compared carfilzomib, daratumumab, and dexamethasone (KdD) with carfilzomib and dexamethasone (Kd) in patients with relapsed or refractory multiple myeloma. In this updated analysis of the randomised, multicentre, open-label, phase 3 CANDOR study, patients (aged ≥18 years) with relapsed or refractory multiple myeloma, at least a partial response to between one and three previous therapies, and Eastern Cooperative Oncology Group performance status of 0-2, were recruited from 102 medical centres globally and randomly assigned (2:1) by interactive voice or web response software to receive KdD or Kd. Participants were stratified by disease stage, previous proteasome inhibitor or anti-CD38 antibody exposure, and number of previous therapies. All patients received intravenous infusions of carfilzomib twice per week at 56 mg/m (20 mg/m on days 1 and 2 during cycle 1) on days 1, 2, 8, 9, 15, and 16 of each 28-day cycle. Daratumumab (8 mg/kg) was administered intravenously on days 1 and 2 of cycle 1 and at 16 mg/kg weekly for the remaining doses of the first two cycles, then every 2 weeks for four cycles (cycles 3-6), and every 4 weeks thereafter. Patients received 40 mg dexamethasone weekly (20 mg for patients >75 years old). This analysis was a preplanned interim analysis for overall survival; however, at the time of data cutoff, overall survival data were not mature. The primary endpoint was progression-free survival. Here, we provide updated progression-free survival data, assessed centrally by Onyx Response Computer Algorithm in the intention-to-treat population, with 11 months additional follow-up. Adverse events were assessed in the safety population, which included all participants who received at least one dose of trial treatment. CANDOR is registered with ClinicalTrials.gov, NCT03158688, and is active but not recruiting. Between June 13, 2017, and June 25, 2018, 466 patients were enrolled, of whom 312 received KdD and 154 received Kd. At data cutoff (June 15, 2020), median follow-up was 27·8 months (IQR 25·6-29·5) for KdD and 27·0 months (13·2-28·6) for Kd. Median progression-free survival was 28·6 months (95% CI 22·7-not estimable [NE]) in the KdD group and 15·2 months (11·1-19·9) in the Kd group (hazard ratio 0·59 [95% CI 0·45-0·78], log-rank p<0·0001). Treatment-emergent adverse events in the safety population were consistent with the primary analysis. Grade 3 or worse treatment-emergent adverse events occurred in 268 (87%) patients in the KdD group and 116 (76%) in the Kd group; most commonly thrombocytopenia (76 [25%] vs 25 [16%], respectively), hypertension (65 [21%] vs 23 [15%]), pneumonia (54 [18%] vs 14 [9%]), and anaemia (53 [17%] vs 23 [15%]). Serious adverse events occurred in 194 (63%) patients with KdD and 76 (50%) with Kd. Adverse events leading to death occurred in 27 (9%) patients in the KdD group and seven (5%) in the Kd group; most commonly septic shock (five [2%] vs one (1%]) and pneumonia (four [1%] vs none). No new treatment-related deaths have occurred since the primary analysis. A clear, maintained progression-free survival benefit of KdD over Kd with longer follow-up was confirmed, making KdD an emerging standard-of-care for patients with relapsed or refractory multiple myeloma. Amgen and Janssen

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

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

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