The impact of Gaza fishing harbour on the Mediterranean coast of Gaza

The Mediterranean coast of Gaza strip, which is covered about 40 km in length, is rich by coastal resources. The development that occurred along the coastal lines has led to the host of problems such as increased erosion, siltation, loss of coastal resources and the destruction of the fragile marine habitats. In order to conserve the depleting coastal resources, the changes due to development and associated activities must be monitored. Studying the temporal pattern of shoreline change is considered one of the most effective means of monitoring the cumulative effects of different activities. An attempt was made to study the impact of Gaza harbour on shoreline displacement along 6 km. This paper was intended to detect changes of coastal area in Gaza city to provide future database in coastal management studies. The analysis was carried out using image processing technique (ERDAS) and Geographical Information System platform. The variation during 38 years in the shoreline along the Gaza coast was determined by analyzing MSS, TM and ETM Landsat images from 1972 to 2010. The analyses identified the erosion and accretion patterns along the coast. The shoreline was advanced south of the Gaza fishing harbor, where the wave-induced littoral transport was halted by southern breakwater and the annual beach growth rate was 15,900 m 2. On the downdrift side of the harbor, the shoreline was retreating and beaches erode at an annual rate of-14,000 m 2. This study was emphasized that the coastal band is considered as a critical area, it is therefore necessary to monitor coastal zone changes because of the importance of environmental

The Impact of Gaza Fishing Harbour on the Mediterranean Coast of Gaza

The Mediterranean coast of Gaza strip, which is covered about 40 km in length, is rich by coastal resources. The development that occurred along the coastal lines has led to the host of problems such as increased erosion, siltation, loss of coastal resources and the destruction of the fragile marine habitats. In order to conserve the depleting coastal resources, the changes due to development and associated activities must be monitored. Studying the temporal pattern of shoreline change is considered one of the most effective means of monitoring the cumulative effects of different activities. An attempt was made to study the impact of Gaza harbour on shoreline displacement along 6 km. This paper was intended to detect changes of coastal area in Gaza city to provide future database in coastal management studies. The analysis was carried out using image processing technique (ERDAS) and Geographical Information System platform. The variation during 38 years in the shoreline along the Gaza coast was determined by analyzing MSS, TM and ETM Landsat images from 1972 to 2010. The analyses identified the erosion and accretion patterns along the coast. The shoreline was advanced south of the Gaza fishing harbor, where the wave-induced littoral transport was halted by southern breakwater and the annual beach growth rate was 15,900 m2. On the downdrift side of the harbor, the shoreline was retreating and beaches erode at an annual rate of -14,000 m2. This study was emphasized that the coastal band is considered as a critical area, it is therefore necessary to monitor coastal zone changes because of the importance of environmental parameter and human disturbance. In particular, the projections of future shoreline erosion and accretion rates are considered important for long-term planning and environmental assessment for a variety of projects, including the construction and tourism facilities

Mitigation Measures for Gaza Coastal Erosion

Coastal erosion is an ongoing hazard affecting Gaza beach, but is worsening due to a wide range of human activities such as the construction of Gaza fishing harbor in 1994-1998. The net annual alongshore sediment transport is about 190×103 m3, but can vary significantly depending on the severity of winter storms. According to the observed wave heights and directions, the net waves are cross-shore, therefore vast quantities of sediments may transfer to deep sea. The main objective of this study is to mitigate the erosion problem of Gaza coast. Change detection analysis was used to compute the spatial and temporal change of Gaza shoreline between 1972 and 2010. The results show negative rates in general, which means that the erosion was the predominant process. Gaza fishing harbor caused a serious damage to the Beach Camp shoreline. Consequently, several mitigation measures were considered in this study, which are: relocation of Gaza fishing harbor to offshore, groins, detached breakwaters, wide-crested submerged breakwaters and beach nourishment. Several numerical model tests associated with coastal structures are conducted to investigate the influence on morphodynamics. The results show that the relocation of the harbor is the best alternative to stop trapping of the sediments. If for any reason the relocation was not carried out, the wide-crested submerged breakwater alternative is an effective structure for preventing sandy beach erosion. The artificial reef type of submerged breakwaters with beach nourishment is recommended for Gaza beach, because it is an environmentally friendly and improving the ecosystem of marine life

Injection Drug Use Is a Risk Factor for HCV Infection in Urban Egypt

OBJECTIVE: To identify current risk factors for hepatitis C virus (HCV) transmission in Greater Cairo. DESIGN AND SETTING: A 1:1 matched case-control study was conducted comparing incident acute symptomatic hepatitis C patients in two "fever" hospitals of Greater Cairo with two control groups: household members of the cases and acute hepatitis A patients diagnosed at the same hospitals. Controls were matched on the same age and sex to cases and were all anti-HCV antibody negative. Iatrogenic, community and household exposures to HCV in the one to six months before symptoms onset for cases, and date of interview for controls, were exhaustively assessed. RESULTS: From 2002 to 2007, 94 definite acute symptomatic HCV cases and 188 controls were enrolled in the study. In multivariate analysis, intravenous injections (OR = 5.0; 95% CI = 1.2-20.2), medical stitches (OR = 4.2; 95% CI = 1.6-11.3), injection drug use (IDU) (OR = 7.9; 95% CI = 1.4-43.5), recent marriage (OR = 3.3; 95% CI = 1.1-9.9) and illiteracy (OR = 3.9; 95% CI = 1.8-8.5) were independently associated with an increased HCV risk. CONCLUSION: In urban Cairo, invasive health care procedures remain a source of HCV transmission and IDU is an emerging risk factor. Strict application of standard precautions during health care is a priority. Implementation of comprehensive infection prevention programs for IDU should be considered

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

إجراءات التخفيف من التآكل الساحلي لغزة

Coastal erosion is an ongoing hazard affecting Gaza beach, but is worsening due to a wide range of human activities such as the construction of Gaza fishing harbor in 1994-1998. The net annual alongshore sediment transport is about 190×103 m3, but can vary significantly depending on the severity of winter storms. According to the observed wave heights and directions, the net waves are cross-shore, therefore vast quantities of sediments may transfer to deep sea. The main objective of this study is to mitigate the erosion problem of Gaza coast. Change detection analysis was used to compute the spatial and temporal change of Gaza shoreline between 1972 and 2010. The results show negative rates in general, which means that the erosion was the predominant process. Gaza fishing harbor caused a serious damage to the Beach Camp shoreline. Consequently, several mitigation measures were considered in this study, which are: relocation of Gaza fishing harbor to offshore, groins, detached breakwaters, wide-crested submerged breakwaters and beach nourishment. Several numerical model tests associated with coastal structures are conducted to investigate the influence on morphodynamics. The results show that the relocation of the harbor is the best alternative to stop trapping of the sediments. If for any reason the relocation was not carried out, the wide-crested submerged breakwater alternative is an effective structure for preventing sandy beach erosion. The artificial reef type of submerged breakwaters with beach nourishment is recommended for Gaza beach, because it is an environmentally friendly and improving the ecosystem of marine life.Coastal erosion is an ongoing hazard affecting Gaza beach, but is worsening due to a wide range of human activities such as the construction of Gaza fishing harbor in 1994-1998. The net annual alongshore sediment transport is about 190×103 m3, but can vary significantly depending on the severity of winter storms. According to the observed wave heights and directions, the net waves are cross-shore, therefore vast quantities of sediments may transfer to deep sea. The main objective of this study is to mitigate the erosion problem of Gaza coast. Change detection analysis was used to compute the spatial and temporal change of Gaza shoreline between 1972 and 2010. The results show negative rates in general, which means that the erosion was the predominant process. Gaza fishing harbor caused a serious damage to the Beach Camp shoreline. Consequently, several mitigation measures were considered in this study, which are: relocation of Gaza fishing harbor to offshore, groins, detached breakwaters, wide-crested submerged breakwaters and beach nourishment. Several numerical model tests associated with coastal structures are conducted to investigate the influence on morphodynamics. The results show that the relocation of the harbor is the best alternative to stop trapping of the sediments. If for any reason the relocation was not carried out, the wide-crested submerged breakwater alternative is an effective structure for preventing sandy beach erosion. The artificial reef type of submerged breakwaters with beach nourishment is recommended for Gaza beach, because it is an environmentally friendly and improving the ecosystem of marine life