The Changes in the urban roles of the public spaces and its impact on the future plans of Great cities centers

The Great cities center all over the world have common features in its structure, Such as The Historic district that represent the oldest part of the city, the Central Business district "CBD", the Main of public transportation networks, and many other urban components. Those mentioned urban components including Public spaces, such as the Central Parks, Main squares and pedestrians Plazas which represent the Social Activities of a great city center do not exist as the same as in the rest of the city. at the same time they have urban roles within the urban structure of the great cities center. Not only the traditional Urban role but also the new roles that appaiers according to the global changes (political, social, economical, environmental issues) in the 21 century . This paper aims to determine the new urban roles of the public spaces in the great cities center and its impact on future plans, to be applied in the developing plans. Not only on Cairo city center but also on the other world's Great cities.Our Methedology based on analyzing the structure of the Greater Cairo city center, focusing on the distributing, classification of the Public spaces and its urban characteristics. And Using the SWOT analysis to evaluate the existing Public spaces in the Greater Cairo center and its urban performance related to the new social activities.The study found that there are many urban problems about the Public spaces in Cairo city center affect its performance.Cairo center suffers from shortage of the Public spaces, considering that most of its squares designed as automobiles squares, such as the famous square of "El-Tahrir". KEY WORDS: Urban roles, Public spaces, Great Cities, Future plans

Cities' Identity Through Architecture and Art

Intended to be a guide for academics, scholars, and interested leaders, this book was designed to critically assess issues related to architectural identity, the city as a scene, the city as an organism, the city as a subject, and the planning or rather approaching of one. A pressing issue for many researchers in the field, the book discusses the negative repercussions resulting from globalization. Studies have indicated that globalization, despite all the positive effects, has resulted in a loss of identity within a city. As a city develops over time, its identity is evolving as well and may even be lost due to rapid and constant changes it is subjected to. Discussed as well are examples and tendencies in dealing with urban identities as well as the transformation of cities and urban cultures mentioned in terms of form, identity, and art. This book is a combination of innovative research submitted to a conference on Cities’ Identity Through Architecture and Arts (CITAA) whereas scholars from all over the world gather in one venue to discuss cultural, historical, and economic issues of the city. Thus, the book offers a collective and global solution that is applicable on a universal level. The research presented in this book was conducted by authors, or rather participants of the conference from, three different continents of the world and organized by IEREK. It was a distinct opportunity for them to share their thoughts with leading scholars and professionals in the field of Architecture, Arts, and Planning. The research and materials in this book are directed at those who are actively engaged in the decision-making processes and to a heterogeneous audience who has an interest to critically examine all the new literature available in the field. A special word of thanks should be made to the editors of this book and to all the authors and co-authors of the chapters who collectively provided the academic community with unique and increasingly valuable literature

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

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

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

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)

Planning for Climate Change, Why does it Matter? (From Phenomenon to Integrative Action Plan)

AbstractClimate change was appeared as a phenomenon since the early 19th Century, and since then non serious international commitment was conducted to reduce its rapid impacts, however after 1980th many countries made extreme efforts to document and understand climate change complex impacts and how to deal with it, but those efforts marked by successes and failures within a very uneven pace. Nowadays many (developed) countries adopted the idea of planning the city for climate change (In-spite of inherent limitations to predictive capacity and uncertainty) that guarantee providing the city not only with the necessary Actions and precautions that insure the city resiliency and inhabitants’ safety, but also contribute to quality of life to have liveable cities.However, many of developing countries have another point of view in considering this issue, as they don’t take climate change issue into consideration while planning for its local/national development Agenda, despite most of them are expose to natural disasters/Hazards (such as tsunamis, floods, flash floods or excessive increase in temperature), depending on the Reaction strategy and short-term Adaptation plans to confront such disasters or at least minimize their impacts. As they believe that even if they accept to conduct climate change action plan; it may represent extreme financial burden on its Local/National budget or it may affect the NGOs/international fund for development.This paper aims to reveal this conflict by explain the climate change paradigm and how/why it transformed from just a phenomenon to Action plan. Followed by identifying the climate change planning cycle and how to make climate change action plan and the challenges that the developing countries faces in planning for climate change and how we could support their initiatives

Comparative analysis of the efficiency of air source heat pumps in different climatic areas of Iran

To address the problems caused by fossil energy usage it is important to make a transition to renewable sources of energy, in particular in the residential area. Heating systems such as air source heat pumps that gather heat energy from the ambient air are useful alternatives. However, whether or not such technical solutions are actually used depends on individual decisions. In the current paper the economic aspect for heating is analysed for different regions of Iran and for different pricing strategies for electricity and gas. This is done based on numerical simulations over a year based on temperature data, for domestic heating based on a heat pump in comparison to gas-based heatin