An Urban environment analysis system based on an integrated land- use and transport model

During last several decades the world population continued to grow at an exponential rate, supported mainly by the improved health care facilities all over the world. But most of this growth was confined to relatively fewer number of urban centres. This trend was more obvious in the metropolitan areas of developing countries, where already high natural population increases were backed by increasing migration from rural areas. These intolerably high population growths, however, were not paralleled by the infrastructure provision, and the inevitable outcome was the numerous land-use, transport and environment related problems. The magnitude and the complexity of urban problems in metropolitan areas of developing countries reveal the extent to which these sectors of the metropolis are interrelated. The interrelationships between these sectors are so significant that the roots of the problems in one sector lie in the other sectors as well, and hence should be handled with an integrated approach. Unfortunately, the current institutional set up or the practice of urban planning does not facilitate policy formulation and implementation with such integrated approach. One of the pre-requisites for this much-needed co-ordinated institutional set up and policy planning and implementation practice is an analysis tool that covers all these sectors and the interrelationships among them. An analysis system for integrated policies of land-use, transport and the environment has the objective of providing such an analysis tool. This research focuses mainly on the development of an urban environment analysis system based on an integrated land-use and transport model. This study deals especially with developing metropolises, and those in the Southeast Asia in particular. The objectives of the study are; understanding the present situation and issues of the developing metropolitan areas; the theoretical development of an integrated land-use and transport model; the development of an estimation system of land-use and the environment; and development of a personal computer based analysis system for integrated policies of land-use, transport and the environment. In the beginning, investigation is made on the present situations of developing metropolises with regard to land-use, transport and the environment, in an attempt to understand the issues and their interrelationships, and to decide on the kind of integration between land-use, transport and the environment that best suits the urban areas under discussion. The ways of modelling interactions between land-use and transport are formed considering the dynamics of land-use change and trip characteristics. Land-use and transport interaction is represented in two ways in the contemporary urban models; interaction type where land-use and transport are represented hierarchically connected separate modules, and integrated type where land-use and transport are represented in an organically connected single model framework. The two kinds of integration are discussed and compared. Some urban environmental issues pertinent to the developing metropolises, which have some significance at finer spatial levels than the whole metropolis, are identified and discussed in detail. Most of these issues can be identified as externalities of land-use and transport. The environmental estimation is therefore based on the land-use and transport forecast from the integrated land use and transport model. The interaction between transport and the environment have been the subject of many researches and at present there are many good environment estimation models to forecast transport externalities. But little research has been conducted on the environmental impacts of land-use. Although the environmental impacts of transport are very important, impacts of land-use, such as solid waste and waste water problem, are not at all insignificant, especially in developing metropolises. In the development of the environment estimation system here, interactions between land-use and the environment are discussed. Because the environment estimation model is intended to be used together with an integrated land-use and transport model (which itself is based on an improved version of the RURBAN (Random Utility Rent-Bidding ANalysis) land-use model), it is considered to be necessary to use predicted land-use and transport conditions as inputs, and environment qualities that form explanatory variables for land-use forecast as some of the outputs. In the development of the estimation system of urban land-use and the environment, environmental impacts of land-use are classified into those depend on the change of land-cover and those depend on the intensity of land-use activities. Land cover dependent environmental impacts can be estimated if the land-cover change is known., whereas for other impacts the land-use activity intensity should be known. The basic assumption behind the land cover and emission estimation is that both the land cover and the emission rate of pollutants are related to the land price of the area, which is an output from the land-use model. Land price is used here to represent the intensity of urban activities taking place in a given zone. Out of the zone characteristics predicted by the land-use simulation model, land price represents the intensity of activities most. Since the environmental estimation system is developed to be used together with a land-use simulation model, land price is selected as an index of activity intensity. Land cover does not mean the land-use of an area but the 'spatial composition of land according to the land cover types, such as vegetation, water bodies or built-up areas, as defined in the remote-sensing information'. Whereas emission rates are defined as 'the amount of pollutant emission in a given time from a unit of locator group'. The relationships that relate land cover compositions and emission rates with the land price are developed empirically using base year data of sampled zones. The empirical relationships developed using sampled data are used to forecast the land cover compositions and emission rates of a zone with a known land price. Land cover and emission rates for the forecast year, are used together with land use activity data, derived from the locator composition, and other topographic data, in the environmental simulation model to estimate environmental indicators for different zones. An empirical study is carried out to investigate to what extent is valid the assumption that the emission rates, which represent the intensity of activities in a zone, are related to the land price. Ward-wise solid waste emission data during 1987 and 1990 in the city of Yokohama for residential land-use agree with the assumption. The emission rates and the land price are related with correlation coefficient (R2) of between 0.32 and 0.57. These low correlations are, however, found to be due to the high land prices in two of the wards, which actually have more relationship with the Tokyo metropolis than with Yokohama. The exclusion of these two wards increase the correlation coefficient to 0.95. However, it is found that the per capita pollutant emission relates better with the land price, than the pollutant emission per household, in the case of residential land-use. Example emission equations are derived to estimate solid waste generation from the residential land-use. Another empirical study is carried out to examine the relationship between the land cover composition and the land price. Aerial photographic information and land prices of 1990 in the City of Yokohama are used. Land blocks with varying land prices and belong to different land-uses are used in the analysis. Land cover types are identified visually from the aerial photographs. These land cover compositions correlate with the land price, with correlation coefficients (R2) varying between 0.5 and 0.8. An example set of share curves, which represent the relationships between land price and the composition of land covers, are developed using the data, for different land-use categories. A personal computer based analysis system for integrated policies of land-use, transport and the environment is developed based on the integrated land-use and transport model and the urban environment analysis system mentioned above. The latter part of the study discusses the development of this analysis system on MS-Windows 3.1 environment using Visual BASIC 3.0 as the user interface and FORTRAN language for simulation programs. A brief explanation about the basic features, the facilities available, and the kind of visual output presentation available in the system is also given

Pediatric firearm injury trends in the United States: A national trauma data bank (NTDB) analysis.

AIM OF STUDY: Firearm injuries are the second leading cause of injury-related death in the USA in children less than 18. We compared overall and intent-specific firearm hospitalizations across age group and race to understand recent trends. METHODS: A retrospective cohort of 20,083 children from the national trauma data bank involved in incidences of firearm discharges from 2013 to 2017 was divided by race, discharge intent, gun type, and four age groups: infants (ages 0-2), toddlers (3-6), children (7-12), and adolescents (13-18). Discharge intent and gun type were determined by ICD-9-CM and ICD-10-CM External Causes of Injury codes. Injury severity score (ISS), hospital discharge disposition, and length of stay (LOS) were used as predictors for morbidity and mortality. RESULTS: From 2013 to 2017, there were on an average 4016 firearm injuries reported to the NTDB (n = 20,083). 71% (n = 14,313) of the incidents were assaults. Victims who identified as African American and Caucasian made up 60% (n = 11,890) and 26% (n = 5162) of the total victims, respectively, and were predominantly male (86%, n = 17,202). Victims who identified as Caucasian made up 70% of suicides (n = 819), while African Americans made up 70% of assaults (n = 9733). 87% (n = 17,525) of the patient population were adolescents. The number of accidental firearm discharges compared to firearm assaults was greater for toddlers, while the opposite was true for infants, children, and adolescents. Average LOS by age group varied each year, though children had the highest total average LOS. Average ISS was highest for infants and adolescents (11.5 and 10.4) and American Indians and Caucasians (10.1 and 11.1). Overall mortality rate was 6% (n = 1220) and had no significant differences between years. Mortality rate was highest for infants (7%, n = 25). CONCLUSIONS: Adolescent males and African Americans were disproportionately affected by overall and assault-specific firearm discharges. Firearm injury prevention legislation is critical to prevent these injures

Meckel′s diverticulum and ectopic epithelium: Evaluation of a complex relationship

Introduction: Meckel′s diverticulum is the most common congenital anomaly of the gastrointestinal tract. Currently, for any incidentally discovered Meckel′s diverticulum, the management approach is based on weighing the statistical odds of future complications against the risks of a diverticulectomy. Materials and Methods: The temporal relationship between age at Meckel′s diverticulectomy and the presence of ectopic epithelium was evaluated in our series. A meta-analysis of all reported recent literature on this condition was subsequently performed to evaluate the strength of the relationship between ectopic epithelium and symptomatic Meckel′s diverticulum. Results: There was a paucity of ectopic epithelium in Meckel′s diverticulectomy specimens in infants operated on at less than 1 year of age. Having two or more ectopic epithelia in a diverticulum does not appear to carry an additive risk for complications. The meta-analysis confirmed that ectopic epithelium was the most significant factor that influenced surgical intervention in all series of Meckel′s diverticulum. Conclusion: The relationship between ectopic epithelium and the development of symptomatic Meckel′s diverticulum is complex. Further understanding of the development of ectopic rests in the diverticulum will facilitate elucidating the pathophysiology in symptomatic cases

Congenital mesenteric defect: Description of a rare cause of distal intestinal obstruction in a neonate

AbstractINTRODUCTIONInternal hernias are a rare cause of bowel obstruction in the neonate and present with bilious vomiting. Newborns may be at risk of loss of significant length of bowel if this rare condition is not considered in the differential diagnosis of bilious emesis.PRESENTATION OF CASEWe report a case of a twin with an internal hernia through a defect in the ileal mesentery who presented with neonatal bowel obstruction. The patient had a microcolon on the contrast enema suggesting that the likely etiology was an intra-uterine event most likely a vascular accident that prevented satisfactory meconium passage into the colon.discussionAn internal hernia is rarely considered in the differential diagnosis of distal bowel obstruction in a neonate with a microcolon. Congenital trans-mesenteric hernias constitute only 5–10% of internal hernias. True diagnosis of trans-mesenteric hernias is difficult due to lack of specific radiology or laboratory findings to confirm the suspicion.conclusionWhen clinical and radiological findings are not classical, rare possibilities such as an internal hernia must be considered in the differential diagnosis, to avoid catastrophic bowel loss

Pediatric Nonaccidental Trauma: Experience at a Level 1 Trauma Center

Introduction. Pediatric nonaccidental trauma (NAT) is difficult to diagnose. Several isolated injuries in NAT could happen in the setting of accidental trauma (AT), and having a high index of suspicion is important to correctly identify abuse. NAT has a significant mortality rate if the sentinel event is not adequately diagnosed, and the infant is not separated from the perpetrator. Level 1 pediatric trauma centers (PTC) see a significant number of NAT. We evaluated the injury patterns of NAT admissions at our level 1 PTC. Methods. Retrospective analysis of all cases of NAT for children under the age of two admitted at an ACS level 1 pediatric trauma center between the years of 2016 and 2018. Charts were queried for demographic data, injury patterns, mortality, and disposition. Correlation between disposition status and injury patterns was performed. The Fisher Exact test and student t-test were used to study the significance of differences in categorical and continuous data, respectively. Results. 32/91 (35%) trauma patients under the age of two years were diagnosed as NAT in the three-year study period. 21/32 (39%) male and 11/26 (42%) female admissions were confirmed NAT (p=NS). 20 were under 1 year of age, and 12 were aged between 1 and 2 years (p=NS). 13 (41%) were Caucasian, 6 (19%) were Hispanic/Latino, 11 (34%) were Black, and 2(6%) were of unknown ethnicity (p=NS). Facial, torso, lower extremity, retinal, and internal organ injury were significantly more common with NAT. Medicaid coverage was noted in 31/32 (97%) NAT patients. 20/32 (62.5%) patients were legally displaced as a result of the NAT. Conclusion. 1/3rd of all admissions at a pediatric level 1 trauma center were identified as NAT. A high index of suspicion is necessary to not miss NAT, as injury patterns are variable. Nearly 1/3rd of all victims go back to the same environment where they sustained NAT increasing their susceptibility to future NAT

Predictive Factors of Mortality in Pediatric Pleuropulmonary Blastoma: A Surveillance Epidemiology and End Results Database Analysis

Purpose: Pleuropulmonary blastoma (PPB) is a rare malignancy associated with mutations in the DICER1 gene. Early-stage disease (PPB type I) mimics cystic lung malformations and develops in infants <1 year of age, and PPB type II and III arises in older children. The objective of this study was to analyze predictive factors of mortality in pediatric patients aged 0–19 years diagnosed with PPB between 2000 and 2019 in the USA. Methods: A retrospective analysis of pediatric patients (0–19 years) in the Surveillance Epidemiology and End Results database was conducted from 2000 to 2019 with a diagnosis of PPB using International Classification of Disease for Oncology, third edition code 8973/3 and rare tumor code 45. Demographics, incidence, staging, treatment, and mortality were extracted. A mortality risk predictive equation was developed using logistic regression. Statistical analysis was conducted through Microsoft Excel Analysis ToolPak and Solver. Results: There were a total of 71 new cases of PPB during the study period, with 16 (22%) deaths. The demographic analysis demonstrated that 40/71 (56.3%) patients were female, 57/71 (80.3%) were White, and 64/71 (90.1%) resided in metropolitan areas. Regression analysis demonstrated a statistically significant correlation between mortality and stage (P = 0.029), need for chemotherapy (P = 0.047), and female sex (P = 0.019). There was no significant correlation between mortality and need for radiation, race, or age at diagnosis. Multiple logistic regression analysis generated a predictive equation of mortality dependent on the stage of PPB, need for chemotherapy, and sex. This equation has an 82% accuracy, 81% sensitivity, and an 18% false positive rate. Conclusion: PPB is a rare disease. Distinguishing PPB from benign cystic lung malformations in infancy is important to avoid progression to Type II and III PPB. Advanced stages of PPB have a greater need for systemic chemotherapy and radiation with a poor prognosis

Antimicrobial and antifungal efficacy of Spilanthes acmella as an intracanal medicament in comparison to calcium hydroxide: An in vitro study

Background: Repeated endodontic failures are due to pathogens like Enterococcus faecalis and Candida albicans which are resistant to the common intracanal medicaments like calcium hydroxide (Ca[OH] 2 ). Aims: To determine the role of commonly used folk medicine, Spilanthes acmella (SPA) against root canal pathogens like E. faecalis, C. albicans, Staphylococcus aureus, Streptococcus sp, and to compare its efficacy with Ca(OH) 2 , a popularly used intracanal medicament. Materials and Methods: Bacterial strains of S. aureus, Streptococcus sp., E. faecalis, and fungal strains of C.albicans were tested against different concentrations of SPA and Ca(OH) 2 . Seven days old cultures of test organisms were seeded onto agar plates and uniformly spread with a spreader. Five to six wells (8 mm) were made on agar plate to which different concentrations of the test solutions were added. The inoculated plates were kept in an incubator at 37°C for 48 h and inhibition zones were measured. Statistical Analysis: Results of SPA were compared with results of Ca(OH) 2 statistically using Mann-Whitney U test. Results: A significant zone of inhibition was obtained with SPA and was found to increase as the concentration increased for C. albicans. SPA showed a significant zone of inhibition at 2-5% and 10% whereas Ca(OH) 2 showed a zone of inhibition only at 10% for E. faecalis. SPA showed a zone of inhibition only at 10%, whereas, Ca(OH) 2 showed a significant zone of inhibition at 5% and 10% for S. aureus and Streptococcus sp., respectively. Conclusion: SPA possesses remarkable antibacterial and antifungal activity against common root canal pathogens which are responsible for repeated endodontic failures such as E. faecalis and C. albicans when compared with medicaments like Ca(OH) 2