Mining-induced displacement and resettlement: the case of rutile mining communities in Sierra Leone

This study examines mining-induced displacement and resettlement (MIDR) in rutile mining communities in Sierra Leone, drawing from mining and resettlement literature and utilizing political ecology and the impoverishment risk and reconstruction (IRR) model. Data for this paper was primarily obtained from semistructured interviews of sixty participants in Kanga and Madina Villages in Bonthe District, Sierra Leone in May and December 2016. The interviews were recorded, transcribed, and thematically analyzed. The findings of this study show that the execution of MIDR has primarily contributed to sustained social and economic impoverishment rather than improved the socioeconomic condition of resettled communities. Sustained impoverishment included loss of land-based resources with an adverse impact on the local livelihoods, joblessness and marginalization of the affected persons with reference to compensation for lost property. Such outcomes have reinforced unequal power relations over the processes surrounding involuntary displacement and the resettlement of displaced communities, to the disadvantage of relocated communities. Nevertheless, close examination of the resettlement effect on local actors revealed that chiefs, who are the traditional leaders, derived substantial socioeconomic benefits during resettlement, unlike women and youths who faced social and economic impoverishment. This study calls for the inclusion and active involvement of landowners in determining the modality for compensation for lost trees and crops, which may include a new policy wherein affected persons will receive an annual payment for economic trees until the rehabilitation of mined-out areas. It also underscores the need to formulate legislation that ensures the provision of alternative livelihoods for relocated persons, which would potentially enhance the reconstruction of affected communities

Livelihood impacts of iron ore mining-induced land change in Sierra Leone: A time series analysis

This study explores the role of industrial iron ore mining on land change and local livelihoods in the Tonkolili mineral rich region of northeastern Sierra Leone. The study integrates time series of land use and land cover (LULC), statistical modeling, and qualitative analytical framework to provide a comprehensive assessment of livelihood response to iron ore mining induced land change over an 8-year period (2010–2018). Results of the study demonstrated that the establishment of industrial iron ore mines in 2011 resulted in gradual urban land expansion (average of 7.5%) and exponential population growth (600%) in search of employment through 2018. Due to the inability of the iron ore mining companies to absorb the excess influx of labor, residents resorted to alternative livelihood activities of which artisanal gold mining became prominent. Growth in industrial iron ore mining footprint reduced farming livelihood (- 48%) within the mining concession area, generated several lakes and ponds which polluted fertile swamplands outside the mining area with negative implications for farming, the dominant livelihood activity in the study area. Between 2011 and 2018, the iron ore mining industry directly provided jobs for some people and enhanced livelihoods in its ancillary industries. Notwithstanding, the negative livelihood impacts of iron ore mining on agricultural productivity and forest products was far higher than the positive impacts. •Iron ore mining caused livelihood shift from farming to artisanal gold mining.•Iron ore mining indirectly constricted forest product livelihood.•Iron ore mining footprint is mostly determined by global consumption.•Timeseries analysis reveals nuanced spatiotemporal impacts of iron ore mining on livelihood

Sociospatial geographies of civil war in Sierra Leone and the new global diamond order: is the Kimberley process the panacea?

We examine the relationship between diamonds and conflict, and performance of the Kimberley Process Certification Scheme (KPCS) in combating ‘conflict diamonds’ using Sierra Leone as a case study and theory on the social production of scale. A ‘glocalization’ process produced lawless spaces and economic opportunities for rebels to circumvent national controls through subregional networks and to access global capital to fund conflict, while KPCS arrangements stemmed conflict diamonds by restoring state regulation and transparency. We contend that the KPCS and its scaling were initially more about protecting economic interests of major diamond companies and trading countries than about ‘ethical diamonds’. The KPCS externalized costs to national governments and poor alluvial-diamond-producing countries relative to industry players; hence the discordance between near elimination of conflict diamonds globally and relative failure in these countries. Findings suggest an approach differentiated by country circumstances, and broadening the KPCS from conflict to illicit and development diamonds.

Global Survey of Outcomes of Neurocritical Care Patients: Analysis of the PRINCE Study Part 2

BACKGROUND: Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the Point PRevalence In Neurocritical CarE (PRINCE) study, a prospective, cross-sectional, observational study. METHODS: We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and in-hospital mortality. We present descriptive statistics to summarize data from the case report form. We tested differences between geographically grouped data using parametric and nonparametric testing as appropriate. We used a multivariable logistic regression model to evaluate factors associated with in-hospital mortality. RESULTS: We analyzed data from 1545 patients admitted to 147 participating sites from 31 countries of which most were from North America (69%, N = 1063). Globally, there was variability in patient characteristics, admission diagnosis, ICU treatment team and resource allocation, and in-hospital mortality. Seventy-three percent of the participating centers were academic, and the most common admitting diagnosis was subarachnoid hemorrhage (13%). The majority of patients were male (59%), a half of whom had at least two comorbidities, and median Glasgow Coma Scale (GCS) of 13. Factors associated with in-hospital mortality included age (OR 1.03; 95% CI, 1.02 to 1.04); lower GCS (OR 1.20; 95% CI, 1.14 to 1.16 for every point reduction in GCS); pupillary reactivity (OR 1.8; 95% CI, 1.09 to 3.23 for bilateral unreactive pupils); admission source (emergency room versus direct admission [OR 2.2; 95% CI, 1.3 to 3.75]; admission from a general ward versus direct admission [OR 5.85; 95% CI, 2.75 to 12.45; and admission from another ICU versus direct admission [OR 3.34; 95% CI, 1.27 to 8.8]); and the absence of a dedicated neurocritical care unit (NCCU) (OR 1.7; 95% CI, 1.04 to 2.47). CONCLUSION: PRINCE is the first study to evaluate care patterns of neurocritical patients worldwide. The data suggest that there is a wide variability in clinical care resources and patient characteristics. Neurological severity of illness and the absence of a dedicated NCCU are independent predictors of in-patient mortality.status: publishe

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally