Exile and nostalgia in Arabic and Hebrew poetry of al-Andalus (Muslim Spain).

The purpose of this study is to examine the notions of "exile" (qhurba) and "nostalgia" (al-hanin ila al-Watan) in Arabic and Hebrew poetry in al-Andalus (Muslim Spain). Although this theme has been examined individually in both Arabic and Hebrew literatures, to the best of my knowledge no detailed comparative analysis has previously been undertaken. Therefore, this study sets out to compare and contrast the two literatures and cultures arising out of their co-existence in al-Andalus in the middle ages. The main characteristics of the Arabic poetry of this period are to a large extent the product of the political and social upheavals that took place in al-Andalus. Some of the cities which for many years represented the bastions of Islamic civilization were falling into the hands of the invading Christian army. This gave rise to a stream of poetry that reflects the feelings of exile and nostalgia suffered by those poets who were driven away from their native land. This Arabic poetry had a substantial influence on the literary works of the Jewish poets who were reared within the cultural circles of the Arabic courts. As a consequence the Hebrew poetry they composed, in many respects, bore the stamp of the Arabic poetry in form and content. This thesis is divided into three major parts organized as follows: the first part deals with the themes of exile and nostalgia in Arabic poetry in al-Andalus. It contains three chapters: chapter one begins with a study of the origins of the themes of exile and nostalgia in the Arabic poetic tradition. Chapter two focuses on the nostalgia and lament poetry in al-Andalus describing the characteristics of each period through examining specimens of Andalusian poems. Chapter three is devoted to a study of the poetic product of Ibn Hamdis, the Sicilian (d.1133) and discusses how the themes of exile and nostalgia became the framework of both his life and his poetry. The second part of the thesis parallels the first part in that it deals with the Hebrew poetry in al-Andalus. It consists of three chapters: chapter one investigates the origins of the concept of the homeland in the Biblical sources. Chapter two discusses the form and the structural scheme of the Hebrew poetry in al-Andalus and the influence of the Arabic poetry on the Hebrew poetic works. Chapter three is devoted to a study of the poetry of the Jewish poet, Judah ha-Levi (d.1140) and his nostalgic expressions for Zion. The third part is a comparative literary study of two specimen poems of Ibn Hamdis and ha-Levi. The aim of this study is to develop methods for an analysis of the motifs and internal structure of these two poems. The linguistic analysis is focussed mainly on the levels of phonology, morphology and syntax, while the traditional analysis is focussed primarily on the content and imagery

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background 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

Energy Management Strategy for Optimal Sizing and Siting of PVDG-BES Systems under Fixed and Intermittent Load Consumption Profile

Advances in PV technology have given rise to the increasing integration of PV-based distributed generation (PVDG) systems into distribution systems to mitigate the dependence on one power source and alleviate the global warming caused by traditional power plants. However, high power output coming from intermittent PVDG can create reverse power flow, which can cause an increase in system power losses and a distortion in the voltage profile. Therefore, the appropriate placement and sizing of a PVDG coupled with an energy storage system (ESS) to stock power during off-peak hours and to inject it during peak hours are necessary. Within this context, a new methodology based on an optimal power flow management strategy for the optimal allocation and sizing of PVDG systems coupled with battery energy storage (PVDG-BES) systems is proposed in this paper. To do this, this problem is formulated as an optimization problem where total real power losses are considered as the objective function. Thereafter, a new optimization technique combining a genetic algorithm with various chaotic maps is used to find the optimal PVDG-BES placement and size. To test the robustness and applicability of the proposed methodology, various benchmark functions and the IEEE 14-bus distribution network under fixed and intermittent load profiles are used. The simulation results prove that obtaining the optimal size and placement of the PVDG-BES system based on an optimal energy management strategy (EMS) presents better performance in terms of power losses reduction and voltage profile amelioration. In fact, the total system losses are reduced by 20.14% when EMS is applied compared with the case before integrating PVDG-BES

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 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

Linking surface hydrodynamics to planktonic ecosystem: the case study of the ichthyoplanktonic assemblages in the Central Mediterranean Sea

Oceanographic processes play a key role in influencing the structure of the marine planktonic ecosystems. Taking advantage of the quasi-simulta-neous collection of a large ichthyoplanktonic dataset in different regions of the Central Mediterranean Sea (Italian/Maltese, Tunisian and Libyan waters), this study aimed at the identification of the main environ-mental drivers that control the structure of the larval fish assemblages. Spatial distribution and taxa com-position were related to physical forcings (geostrophic currents and wind stress) and environmental condi-tions (bottom depth, temperature, salinity, chlorophyll-a concentration). ANOSIM and SIMPER identified contribution of fish taxa to the average Bray–Curtis dissimilarity among regions. In Italian and Libyan waters, two assemblages (neritic and oceanic) were identified, while a mixed assemblage characterized only some stations. Two neritic and one oceanic assemblages were discriminated in Tunisian waters. Random Forest classification model high-lighted the essential role of the bathymetry, while Lagrangian simulations evidenced the action of the hydrodynamics in mixing neritic and oceanic assem-blages in the Italian/Maltese and partially in Libyan waters. These findings highlighted the importance of the multidisciplinary approach and shed light on the potential value of the ichthyoplanktonic surveys for the assessment of the state of the marine ecosystem and the conservation of the fishery resources

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