DEVELOPING ‘URBAN JUNGLE’ AS AN INTEGRATED MODEL OF SURVIVAL: Learning from Nature in War Zones

ConCave Ph.D. Symposium 2020: Divergence in Architectural Research, March 5-6, 2020, Georgia Institute of Technology, Atlanta, GA.This paper explores the relationship between conflict in the urban environment and natural systems of resiliency found in forests and jungles. Studying the different accounts of inhabitants of cities under siege during the Syrian Civil war, indicates that various sustainable practices were implemented within the built environment that helped inhabitants survive the devastating process. The innovative, circular economy allowed the inhabitants to survive their plight and lessened the intended effects of the destructive sieges. Drawing parallels with how forests and jungles utilize different natural systems, such as mycorrhizal networks, to increase resiliency, many lessons are inferred about sustainable resource management and efficient allocation in the face of different threats. The “Urban Jungle” is thus synthesized as a model that attempts to augment and maximize the practices inhabitants had devised through mimicking the model found in the natural jungle. Applying this model to conflict zones allows the evolution of survival tactics into a form of insurgent resilience, with wider socio-political ramifications on the survivability of the inhabitants, their political will, the effectiveness of the conflict, and sieges as a political tool

Decentralizing power : building peace through architecture in the Middle East

This paper argues that applying contextually conscious, and sustainable design principles in Middle urban environments has far-reaching social, cultural and environmental implications that could help diffuse and mitigate future conflicts and increase survivability for inhabitants. Initially, an extensive study of the role of cultural perception through the eyes of colonialism and orientalism on the conflicts and architecture of the Middle Eastern region, particularly its legacy on identity, and architecture indicates the fact that due to this legacy, modern conflicts in the Middle East tend to be recurring, identity based and related to resource inequity. These findings inform the idea that architecture has a duty to adapt and deal with the complicated problems that face the populace and play a role in an attempt to alleviate them. Modern residential and commercial building design and construction in the Middle East region had failed to react accordingly to these various dangers as proven by the immense recurring conflicts and levels of destruction and suffering present in various modern-day Middle Eastern urban battlegrounds. By studying the experience of people inhabiting these urban zones, and their relationship to the government and its effect on resource and energy, a framework of architectural intervention dubbed “Peace Building Architectural Intervention” that incorporates political, cultural, and energy contexts is theorized that is a vital tool to protect people in conflict-prone areas by helping diffuse these conflicts, aid them by giving them energy and resource dependence, power transparency and cultural expressionSustainable Desig

Prophylactic use of laxative for constipation in critically ill patients

<b>Background</b> : This study was designed to evaluate the use of laxative prophylaxis for constipation in intensive care unit (ICU) and the impact of early versus late bowel movement on patient&#x2032;s outcome. <b>Methods</b> : The study was a prospective, randomized controlled trial in critically ill ventilated adult patients, who were expected to stay on ventilator for &gt;72 h. Control group did not receive any intervention for bowel movement for the first 72 h, whereas interventional group received prophylactic dose of lactulose 20 cc enterally every 12 h for the first 72 h. The parameters measured during the study were admission diagnosis, age, gender, comorbid conditions, admission Simplified Acute Physiologic Score (SAPS II), sedative and narcotic agents with doses and duration, timing and tolerance of nutrition, daily assessment of bowel movement, total use of prokinetic, doses of suppositories, and enema for first bowel movement, total number of days on ventilator, weaning failures, extubation or tracheostomy, ICU length of stay, and death or discharge. <b>Results</b> : A total of 100 patients were enrolled, 50 patients in each control and interventional group. Mean age was 38.8 years, and both groups had male predominance. Mean SAPS II score for both was 35. Mean dose of Fentanyl (323.8 &#177; 108.89 mcg/h in control and 345.83 &#177; 94.43 mcg/h in interventional group) and mean dose of Midazolam (11.1 &#177; 4.04 mg/h in control and 12.4 &#177; 3.19 mg/h in interventional group). There were only two (4&#x0025;) patients in control, while nine (18&#x0025;) patients in interventional group who had bowel movement in &lt;72 h (<i>P</i> &lt; 0.05). Mean ventilator days were 16.19, and 17.36 days in control and interventional groups, respectively. Subgroup analysis showed that the patients who moved bowel in &lt;5 days in both groups had mean ventilator days of 18.5, whereas it was 15.88 days for the patients who moved bowel after 5 days in both groups (<i>P</i>&lt; 0.05). Mean ICU days for control was 21.15 &#177; 10.44 and 20.77 &#177; 8.33 days for interventional group. Forty-eight (96&#x0025;) patients in each group were discharged from the ICU. Two (4&#x0025;) patients died in ICU in each group. <b>Conclusions</b> : Laxative prophylaxis can be used successfully to prevent constipation in ICU patients. Late bowel movement &gt;5 days is associated with less ventilator days, compared to early &lt;5 days bowel movement

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Standards for structured reporting of dual-energy X-ray absorptiometry scans: best practice recommendations by the Pan Arab Osteoporosis Society

Abstract Background Dual-energy X-ray absorptiometry (DXA) is an important diagnostic test for bone mass status. The aim of this work was to set the standards for structured reporting of DXA measurements in adults within the context of fracture and fall risk assessment. Results Two rounds of Delphi were completed. The first Delphi round had a 68% response rate, while round two had a 100% response rate. After round 2, a total of 28 items were obtained, which were classified into three domains. The percentage of people who agreed with the recommendations (ranks 9–7) ranged from 76.5 to 100%. The wording of all 19 clinical standards determined by the scientific committee was agreed upon (i.e., 75% of respondents strongly agreed or agreed). Conclusion The DXA scan report is an independent document that contains sufficient information to enable optimal osteoporosis management advised by an experienced healthcare professional. Setting up quality standards for DXA scans not only supports healthcare professionals reporting/interpreting bone densitometry but also meets the parameters outlined in national as well as international guidelines or recommendations for the optimal management of osteoporosis and subsequent prevention of low trauma fractures