Efficiency of Geospatial Technology and Multi-Criteria Decision Analysis for Groundwater Potential Mapping in a Semi-Arid Region

The increasing water demand in Egypt causes massive stress on groundwater resources. The high variability in the groundwater depth, aquifer properties, terrain characteristics, and shortage of rainfall make it necessary to identify the groundwater potentiality in semi-arid regions. This study used the possibilities of multi-criteria decision approaches (MCDA), geographical information system (GIS), and groundwater field data to delineate potential groundwater zones in the Tushka area, west of Lake Nasser, South Egypt. Furthermore, groundwater potentiality identification can help decision-makers better plan and manage the water resources in this promising area. Eight controlling factors were utilized to achieve the objective of the present work using multi-criteria decision analysis (MCDA) approaches, namely the analytical hierarchy process (AHP) and frequency ratio (FR) models. The controlling parameters were integrated with the geographic information system (GIS) to develop the zones of groundwater potentialities. The results revealed that high and moderate-potential zones cover approximately 61% and 52% of the total area in the AHP and FR models, respectively. A total of 44 groundwater production wells along with the well yield were collected and used to validate the models. The results were evaluated using the receiver operating characteristics (ROC) curve. The best-performing prediction rates achieved by AHP and FR were 83% and 81%, respectively. Finally, the obtained results indicated that the AHP model achieved better performance than the FR model

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Possible Factors Driving Groundwater Quality and Its Vulnerability to Land Use, Floods, and Droughts Using Hydrochemical Analysis and GIS Approaches

Land use and climate change always induce significant changes in various parameters of the hydrologic cycle (e.g., surface runoff, infiltration, evapotranspiration). The Wadi El-Assiuti downstream area in the Eastern Desert of Egypt is one of the most promising areas for development that is suffering from insufficient water availability and inadequate water quality for different purposes. The main goal of this research is to evaluate the changes in groundwater quality, land use, and climate in association with geology and flooding during three periods within the years 1997&ndash;2019 in the downstream portion of Wadi El-Assiuti in the Eastern Desert of Egypt, using spatiotemporal variation associated with groundwater hydrochemical analysis and GIS techniques. About 133 groundwater samples were collected to examine groundwater quality changes over time. Different groundwater quality indices were calculated, and the results show that TDS levels of groundwater in the study area ranged between 1080&ndash;2780 mg/L, 672&ndash;4564 mg/L, and 811&ndash;6084 mg/L, while SAR levels varied within 6.15&ndash;15.34, 1.83&ndash;28.87, and 1.43&ndash;30.57 for the years 1997, 2007, and 2019, respectively. Both RSBC and SSP values exhibited significantly increasing trends over time. KR values were within 1.36&ndash;4.06 in 1997, 0.58&ndash;14.09 in 2007, and 0.35&ndash;14.92 in 2019; MAR values were within 6.9&ndash;45.2 in 1997, 20.79&ndash;71.5 in 2007, and 17.71&ndash;75.81 in 2019; and PI values were within 60.16&ndash;83 in 1997, 45.56&ndash;101.03 in 2007, and 42.51&ndash;148.88 in 2019. Across the entire study area, ongoing land use changes increased from 1.1% in 1997 to 4.1% in 2019. Findings pointed to the significant contribution of the deep Nubian Sandstone Aquifer to the groundwater aquifer at Wadi El-Assiuti through fractures and deep faults. Given the climatic conditions from 1997&ndash;2019, these changes may have affected water quality in shallow aquifers, especially with increasing evaporation. Realizing the spatiotemporal variation of the aquifer recharge system, land use development, and climate change clearly would help in water resource management. This study revealed that flooding events, deep-seated geologic structures, and land use development associated with human activities have the highest impact on groundwater quality

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

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

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 percent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P &lt; 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P &lt; 0·001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P &lt; 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P &lt; 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P &lt; 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone