The Millennium Development Goals have ended and the Sustainable Development Goals have begun, marking a shift in the global health landscape. The frame of reference has changed from a focus on 8 development priorities to an expansive set of 17 interrelated goals intended to improve the well-being of all people. In this time of change, several groups, including the Lancet Commission on Global Surgery, have brought a critical problem to the fore: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The magnitude of this problem and the world's new focus on strengthening health systems mandate reimagined roles for and renewed commitments from high income country actors in global surgery. To discuss the way forward, on 6 May 2015, the Commission held its North American launch event in Boston, Massachusetts. Panels of experts outlined the current state of knowledge and agreed on the roles of surgical colleges and academic medical centres; trainees and training programmes; academia; global health funders; the biomedical devices industry, and news media and advocacy organisations in building sustainable, resilient surgical systems. This paper summarises these discussions and serves as a consensus statement providing practical advice to these groups. It traces a common policy agenda between major actors and provides a roadmap for maximising benefit to surgical patients worldwide. To close the access gap by 2030, individuals and organisations must work collectively, interprofessionally and globally. High income country actors must abandon colonial narratives and work alongside low and middle income country partners to build the surgical systems of the future.

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Permeable interlocking concrete pavement (PICP) is a type of permeable pavement system that uses the joint spaces between pavers to drain water from the surface into an aggregate base and subbase layer below. Because of its ability to rapidly drain surface water, PICP has the potential to reduce the amount of ice formed on the surface during winter conditions compared with traditional impervious pavements. As a result, PICP may reduce the amount of road salt needed for de-icing paved surfaces and may also reduce the risk of pedestrian slipping and vehicle skidding throughout the winter. This study evaluates the performance of an outdoor PICP and asphalt test pad over two winter seasons in Vaughan, Ontario, Canada, by assessing differences in surface conditions, surface friction, and surface temperatures. The results of this study indicate that PICP provides equivalent or higher levels of safety compared with asphalt when treated with de-icing products at medium (0.049 kg/m2) or low (0.024 kg/m2) application rates. Re-freezing of melted snow and ice after sunset was observed on the asphalt surface creating black ice, but not on the PICP cells. Consequently, compared with asphalt pavements, PICP surfaces will require use of less de-icer and will have lower risk of slips and falls for pedestrians, and lower risk of skidding for vehicles throughout the winter.

The urban development in Truro, Nova Scotia is situated on the floodplain of the Salmon River near its outlet to the Cobequid Bay. Extreme water levels in the Salmon River estuary and its tributaries overtop the dyke system that protects the area from high tides, resulting in widespread flooding of roads, residences, schools, senior homes, offices, commercial areas, industrial facilities and agricultural land. These high water levels are a result of the complex interactions between large river flows, the highest tides in the world, mudflat sedimentation and ice jamming. This paper presents the details of the extensive hydrodynamic modeling that was carried out for the Salmon River estuary and its tributaries as part of a comprehensive flood risk study using the latest in 1D, 2D and 3D modeling software. An integrated 1D-2D PCSWMM model was used to simulate the hydrology and the dynamic interaction between river and tidal flows, dyke breaching and urban floodplain hydraulics; MIKE21 and MIKE3 models were used to simulate the tidal ingress and amplification between the Bay of Fundy and Salmon River estuary as well as sedimentation rates in the estuary; and a HEC-RAS model was used to simulate ice jamming. Together these models were used to quantify the flood extents of the Salmon River estuary and its tributaries and to evaluate the impacts of over 40 potential flood mitigation solutions.

Numerous hydraulic modeling studies carried out since the 1970s have demonstrated that the impact of flow detention is reduced as the flow is routed through the downstream watershed. Since stormwater management ponds delay and prolong peak flows, the downstream watershed receives increased runoff volumes and sustained peak flow rates from the ponds that can combine with other watershed drainage to increase downstream peak flows. This study uses continuous simulation modeling in PCSWMM to analyse the impacts of stormwater management ponds located throughout the Sawmill River watershed in Dartmouth, Nova Scotia on downstream peak flows near the watershed outlet at Sullivan's Pond. The effectiveness of the upstream ponds to maintain peak flows at Sullivan's Pond was analysed for all 903 historical rainfall events within a 61 y simulation period that had a 1 in 2 month probability of occurrence or greater, providing results for a full range of rainfall frequencies, rainfall amounts, rainfall durations and initial flow conditions. Pond effectiveness was evaluated for multiple model scenarios, which included varying the maximum overland flow lengths, the hydraulic conductivities of the soils, pond locations and development conditions. Overall, the study confirmed that the effectiveness of upstream ponds is reduced towards the watershed outlet, demonstrating the need for stormwater management practices that preserve runoff volumes and timing characteristics in addition to peak flows.