The effects of ex-situ oil shale mining on groundwater resources in Siwaqa area, southern Jordan, using DRASTIC index and hydrochemical water assessment

Energy resources in addition to water resources are the most limited resources in Jordan, being one of the fourth poorest countries in water resources, and limitation of surface water resources put huge pressure on groundwater which is the main resource there. High expenses and the increasing prices of oil over all worlds increase the feasibility to mining the oil shale that exists in southern Jordan area, Siwaqa. This study took place to clarify the possible effects of mining and energy production activities on the water resources in that area. Groundwater vulnerability mapping was done for many areas all over the country, including this part. The initiative of this work is to determine the vulnerability under the conditions of removing the bedrock of the oil shale which is described as a con ning layer. Results that are obtained by this work conclude that the oil shale area becomes highly vulnerable to the human activities because of the existing geological structures while it is small and medium vulnerable in the elds in which there are no geological structures. In addition to the structural features and adding the possibility of the oil shale mining from the outcropped areas which will decrease the depth to water table and hence will affect the vulnerability values. Efectos en las fuentes de agua subterránea de la minería ex situ de esquistos bituminosos, en el área de Siwaqa, al sur de Jordania, a través del índice DRASTIC y la evaluación hidroquímica del agua ResumenLas fuentes de energía y agua son las más limitadas en Jordania, uno de los cuatro países más pobres en recursos hídricos; además, las limitadas fuentes super ciales hacen de las aguas subterráneas las más importantes. Las ganancias y el precio del petróleo, por su parte, incrementan la viabilidad de la minería de esquistos bituminosos en el sur de Jordania, en la región de Siwaqa. Este estudio se realiza con el  n de establecer los posibles efectos de las actividades de producción de energía y minería en las fuentes hídricas de la zona. Se elaboró un mapa de vulnerabilidad para las fuentes de agua subterránea en varias regiones del país, incluida el área de estudio. La iniciativa de este trabajo es determinar la vulnerabilidad si se remueve el lecho rocoso del esquisto bituminoso, que funciona como una capa de con namiento. Los resultados obtenidos evidencian que el esquisto bituminoso se torna bastante vulnerable a las actividades humanas debido a la presencia de estructuras geológicas, mientras que su vulnerabilidad es media o baja en aquellos lugares donde no hay estructuras geológicas. Además de los rasgos estructurales, existe la posibilidad de que la minería del esquisto bituminoso en las áreas de a oramiento podría descender hasta la capa freática y allí afectar los valores de vulnerabilidad

Understanding the impact of droughts in the Yarmouk Basin, Jordan: monitoring droughts through meteorological and hydrological drought indices

This article assesses drought status in the Yarmouk Basin (YB), in northern Jordan, using the Standardized Precipitation Index (SPI), the Standardized Water-Level Index (SWI), and the Percent Departure from Normal rainfall (PDNimd) during the years 1993–2014. The results showed that the YB suffers from frequent and irregular periods of drought as variations in drought intensity and frequency have been observed. The SPI results revealed that the highest drought magnitude of − 2.34 appeared at Nuaimeh rainfall station in 1991. This station has also experienced severe drought particularly in years 1995, 1999, 2005, and 2012 with SPI values ranging from − 1.51 to − 1.59. Some other rainfall stations such as Baqura, Ibbin, Khanasiri, Kharja, Mafraq police, Ramtha, Turra, and Umm Qais have also suffered several periods of drought mostly in 1993. The SWI results show the highest extreme drought events in 2001 in Souf well while other extreme drought periods were observed at Wadi Elyabis well in 1994 and at Mafraq well in 1995. As compared to SPI maps, our SWI maps reflect severe and extreme drought events in most years, negatively impacting the groundwater levels in the study area

Placemaking from Interstitial Spaces: Participatory planning and collaborative community design as strategies to revitalize a service alleyway in Montreal (Bishop/Mackay)

This project explores participatory planning and community design methodologies (i.e. pattern language design, placemaking, community planning charrettes, planning-in-situ, open planning and peer to peer urbanism) to revitalize a service alleyway in downtown Montreal. The objective of this project is to democratize planning and urban design practices and to engage ordinary citizens in the planning of their own spaces. After a series of visioning workshops, brainstorming sessions and a community planning charrette, this project incorporates inputs from stakeholders, students and ordinary citizens into a collaborative urban design project. The project proposes interventions such as a woonerf, a planning committee, a cubic/fractal scaffolding structure, art murals and wall projections (among others). With the objective of encouraging future adaptations and transformations, this project is published under a Creative Commons license. Adopt and adapt these ideas (but cite and acknowledge accordingly)

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 < 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

Stroke in the Arab World: A bibliometric analysis of research activity (2002–2016)

Background: The Arab world has an increasing prevalence of strokes, a leading cause of death in this part of the world. Aims: The aim of this article is to quantify the stroke research activity in the Arab countries over the past 15 years taking into consideration the population, GDP, and DALY of each country. Methods: A PubMed search was conducted to find stroke research articles published from the Arab countries between 2002 and 2016 (inclusive). Medical subject headings related to strokes and author origin/affiliation were used for this purpose. Results: The Arab world only produced 0.51% of all the stroke-related publications on PubMed even though the stroke-related DALY percentage in this region was greater than 2.88% during the period we studied. In general, the number of publications increased in the last few years. Somalia came first regarding the percentage of stroke to non-stroke publications released. Lebanon had the highest number of publications per GDP (in US Billion Dollars), Qatar had the highest number of publications per million persons (PPMP), while Saudi Arabia had the highest number of publications per 1% of stroke DALY. In addition, a strong positive correlation was found between the number of stroke publications and GDP; however, the correlation between the number of stroke publication and either population size or DALY was a weak positive one. Conclusions: A general increase in publications is noticed, but stroke research activity in the Arab world is still poor compared to other parts of the world. Keywords: Stroke, Bibliometric, Arab world, Population, GDP, DAL

A cross-sectional survey on community pharmacists readiness to fight COVID-19 in a developing country: knowledge, attitude, and practice in Lebanon

Abstract Background Lebanon, a developing Middle Eastern country, was hit by the COVID-19 pandemic that occurred amid a severe national economic crisis. Community pharmacists are responsible for dispensing appropriate medications and products in addition to counseling, informing and educating the public, and promoting disease prevention and infection control. Objective This study aimed to assess community pharmacists' knowledge, attitude, and practice towards the COVID-19 pandemic and evaluate behavior changes and safety measures. Methods An anonymous and standardized online questionnaire in English was disseminated via social media platforms to Lebanese community pharmacists. The questionnaire consisted of 95 items designed as Likert-scales and multiple-choice questions divided into four different sections: socio-demographic characteristics, knowledge-based, attitude-based, and pharmacy practice questions. Descriptive statistical analysis was used to summarize the demographic characteristics, and indices were created for knowledge, attitude, and practice by computing the correct answers for each section. Results A total of 310 questionnaires were completed. Around 61% have expressed their fear of getting infected with COVID-19 due to occupational exposure. The respondents were able to answer 80–90% of the knowledge-based questions of the survey. A more careful/anxious attitude, but not knowledge, was associated with overall better practice (p = 0.03). Also, respondents stated that they are dispensing protective equipment items such as masks (87%), gloves (60%), and sanitizers (77%) in small quantities due to limited availability. Conclusion Our findings revealed an adequate level of knowledge and good practice towards COVID-19 among Lebanese community pharmacists. Their fears of contracting the virus and compromising the safety of those around them are justified. However, their supply of protective equipment is limited

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