Conceptualisation and system design in the monitoring of urban form

Historically, humanity has congregated in certain places to benefit from a division of labour and scale economies. Yet, in this process, issues inevitably emerge surrounding urban form, understood as the physical configuration of the built environment. As settlements expand and technologies change, so do these inherent problems. Official responses are put in place to address them, thereby creating direct and indirect social costs and distorting pure market forces. Efficacious and transparent governance presumes accountability and some means of appraising these interventions. Thus, systems have been established worldwide to monitor physical changes in urban form against predetermined goals and objectives. Yet, many of these efforts have fallen short in terms of effectiveness, efficiency and equity and, whether acknowledged or not, they continue to do so. The research and policy focus should be upon the fundamentals – the conceptualization stage and design of such systems. In this article, diagnosis of common problems leads to six ameliorative strategies applicable in these early phases which could improve overall outcomes. Monitoring the physical features of the built environment is significant not only in terms of the logic and integrity of city planning but also for the welfare of urban populations. While equally important and challenging problems of implementation exist on the path to urban sustainability, they are left for another day

Anti-TNFα therapy for chronic inflammatory disease in kidney transplant recipients

Anti-tumor necrosis factor-α (TNFα) therapy has improved the prognosis of many chronic inflammatory diseases. It appears to be well-tolerated by liver-transplant patients. However, their use and their safety in kidney-transplant patients have yet to be determined. In this retrospective study, we identified 16 adult kidney-transplant patients aged 46.5 years (34–51.8) who received anti-TNFα therapy from 7 kidney transplantation centers. The indications for this treatment included: chronic inflammatory bowel disease (n = 8), inflammatory arthritis (n = 5), AA amyloidosis (n = 1), psoriasis (n = 1), and microscopic polyangiitis (n = 1). Anti-TNFα therapies resulted in a clinical response in 13/16 patients (81%). Estimated glomerular filtration rates (MDRD-4) were similar on day 0 and at 24 months (M24) after anti-TNFα treatment had been initiated (41 [12–55] and 40 [21–53] mL/min/1.73 m(2), respectively). Two allograft losses were observed. The 1st case was due to antibody-mediated rejection (M18), while the 2nd was the result of AA amyloidosis recurrence (M20). There were several complications: 8 patients (50%) developed 23 serious infections (18 bacterial, 4 viral, and 1 fungal) and 4 developed cancer. Five patients died (infection n = 2, cardiac AA amyloidosis n = 1, intraalveolar hemorrhage following microscopic polyangiitis n = 1, and acute respiratory distress syndrome n = 1). On univariate analysis, recipient age associated with death (P = 0.009) and infection development (P = 0.06). Using anti-TNFα therapies, remission can be achieved in chronic inflammatory diseases in kidney-transplant patients. However, concommitant anti-TNFα and immunosuppresive therapies must be used with caution due to the high risk of infection, particularly after the age of 50