ABSTRACT
Most coastal cities have been experiencing unprecedented urbanization-induced flood risk, climatic events, and haphazard anthropogenic activities, jeopardizing residents' lives and building environments. Despite mounting flood-related studies, analyzing the correlation between the spatiotemporal dynamics of Built-up Expansion patterns (BE) and flood risk remains unknown and holds divergent perspectives. In this context, the coastal city of Alexandria, Egypt, characterized by multiple urban patterns and experiencing heavy rainfall annually, was selected as a testbed. Our method defined the spatiotemporal rates of BE from 1995 to 2023, quantified flood risk spatially, and finally investigated the correlation between BE and flood risk through spatial and statistical analysis. Our results show the built-up area occupied 30.32 % of the total city area till 2023, and the infilling pattern dominated the BE growth by 45.21 % of the total built-up area, followed by leapfrogging and edge expansion by 33.25 % and 21.55 %, respectively. The unplanned-infilling pattern is predominantly highly correlated with the flood-vulnerable peaks (correlation coefficient (rk) = 0.975, p-value < 0.05) and lowers dramatically towards planned-infilling regions with flood protections. Meanwhile, a spatial mismatch exists between high-risk peaks and leapfrogging and edge expansion (rk = 0.118 and 0.662, respectively, with a p-value < 0.01), indicating that controlling the built-up amount is inadequate for mitigating flood risk. Porosity-based urban configuration and spatial distribution of built-up patches in harmony with nature-based solutions are recommended for shaping flood-resilient and effective urban planning.
ABSTRACT
Major depressive disorder (MDD) is a prevalent and disabling condition, and many patients do not respond to available treatments. Deep transcranial magnetic stimulation (dTMS) is a new technology allowing non-surgical stimulation of relatively deep brain areas. This is the first double-blind randomized controlled multicenter study evaluating the efficacy and safety of dTMS in MDD. We recruited 212 MDD outpatients, aged 22-68 years, who had either failed one to four antidepressant trials or not tolerated at least two antidepressant treatments during the current episode. They were randomly assigned to monotherapy with active or sham dTMS. Twenty sessions of dTMS (18 Hz over the prefrontal cortex) were applied during 4 weeks acutely, and then biweekly for 12 weeks. Primary and secondary efficacy endpoints were the change in the Hamilton Depression Rating Scale (HDRS-21) score and response/remission rates at week 5, respectively. dTMS induced a 6.39 point improvement in HDRS-21 scores, while a 3.28 point improvement was observed in the sham group (p=0.008), resulting in a 0.76 effect size. Response and remission rates were higher in the dTMS than in the sham group (response: 38.4 vs. 21.4%, p=0.013; remission: 32.6 vs. 14.6%, p=0.005). These differences between active and sham treatment were stable during the 12-week maintenance phase. dTMS was associated with few and minor side effects apart from one seizure in a patient where a protocol violation occurred. These results suggest that dTMS constitutes a novel intervention in MDD, which is efficacious and safe in patients not responding to antidepressant medications, and whose effect remains stable over 3 months of maintenance treatment.
