Search results for: road injury

Authors: Hyojung Shin, Munhee Kweon

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Non-suicide Self Injuri (NSSI) can be defined as the act of an individual who does not intend to die directly and intentionally damaging his or her body tissues. According to a study conducted by the Korean Ministry of Education in 2018, the NSSI is widely spreading among teenagers, with 7.9 percent of all middle school students and 6.4 percent of high school students reporting experience in NSSI. As such, it is understood that the first time of the NSSI is in adolescence. However, the NSSI may not start and stop at a certain time, but may last longer. However, despite the widespread prevalence of NSSI among teenagers, little is known about the process and maintenance of NSSI college students on a continuous development basis. Korea's NSSI research trends are mainly focused on individual internal vulnerabilities (high levels of painful emotions/awareness, lack of pain tolerance) and interpersonal vulnerabilities (poor communication skills and social problem solving), and little studies have been done on individuals' unique characteristics and environmental factors such as substrate or environmental vulnerability factors. In particular, environmental factors are associated with the occurrence of NSSI by acting as a vulnerability factor that can interfere with the emotional control of individuals, whereas individual factors play a more direct role by contributing to the maintenance of NSSI, so it is more important to consider this for personal environmental involvement in NSSI. This study focused on the Fight-Flight-Freeze System as a factor in the defensive avoidance system of Reward Sensitivity in individual factors. Also, Environmental factors include the level of expressed emotion in family. Wedig and Nock (2007) said that if parents with a self-critical cognitive style take the form of criticizing their children, the experience of NSSI increases. The high level of parental criticism is related to the increasing frequency of NSSI acts as well as to serious levels of NSSI. If the normal coping mechanism fails to control emotions, people want to overcome emotional difficulties even through NSSI, and emotional disturbances experienced by individuals within an unsupported social relationship increase vulnerability to NSSI. Based on these theories, this study is to find ways to prevent NSSI and intervene in counseling effectively by verifying the differences between the characteristics experienced NSSI persons and non-experienced NSSI persons. Therefore, the purpose of this research was to examine the relationship of Fight-Flight-Freeze System (FFFS), level of expressed emotion in family and emotion regulation difficulties, comparing those who experienced Non-Suicidal Self-Injury (NSSI) with those who did not experienced Non-Suicidal Self-Injury (NSSI). The data were collected from university students in Seoul Korea and Gyeonggi-do province. 99 subjects were experienced student of NSSI, while 375 were non- experienced student of NSSI. The results of this study are as follows. First, the result of t-test indicated that NSSI attempters showed a significant difference in fight-flight-freeze system, level of expressed emotion and emotion regulation difficulties, compared with non-attempters. Second, fight-flight-freeze system, level of expressed emotion in family and emotion regulation difficulties of NSSI attempters showed a significant difference in correlation. The correlation was significant only freeze system of fight-flight-freeze system, Level of expressed emotion in family and emotion regulation difficulties. Third, freeze system and level of expressed emotion in family predicted emotion regulation difficulties of NSSI attempters. Fight-freeze system and level of expressed emotion in family predicted emotion regulation difficulties of non-NSSI attempters. Lastly, Practical implications for counselors and limitations of this study are discussed.

Keywords: fight-flight-freeze system, level of expressed emotion in family, emotion regulation difficulty, non-suicidal self injury

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Authors: Arman Kishan, Mark Haft, Steve Li, Duc Nguyen, Dawn Laporte

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Objective: Patients with Type 2 diabetes (T2DM) often face higher postoperative complication rates. Limited data exist on outcomes in T2DM patients undergoing carpal tunnel release (CTR). This study aims to compare complication rates between endoscopic CTR (ECTR) and open CTR (OCTR) in patients with T2DM. Methods: This was a retrospective cohort study using the TriNetX database of 56741 patients with T2DM undergoing ECTR (N= 14,949) or OCTR (N= 41,792). Demographic data, medical comorbidities, and complication rates were analyzed. We used multivariable analysis to identify differences in postoperative complication rates between the two treatment methods in patients with T2DM. Results: Patients with T2DM undergoing ECTR had a significantly lower incidence of 90-day wound infection (p < 0.001), 90-day wound dehiscence (p < 0.001), and nerve injury (p < 0.001) when compared to patients who underwent OCTR. After matching, there was a significantly higher number of T2DM patients undergoing ECTR who had peripheral vascular disease (p = 0.045) and hypertension (p = 0.020) when compared to the OCTR group. These patients also had a lower incidence of fluid and electrolyte disorders (p = 0.002) and chronic blood loss anemia (p = 0.025). Conclusion: ECTR presents a superior choice for T2DM patients undergoing CTR, yielding significantly lower rates of wound infection, wound dehiscence, and nerve injury within 90 days post-surgery—reducing the risk by 31%, 48%, and 59%, respectively. These findings support the adoption of ECTR as the preferred method in this patient population, potentially leading to improved postoperative outcomes.

Keywords: endoscopic treatment of carpal tunnel syndrome, open treatment of carpal tunnel syndrome, carpal tunnel syndrome, postoperative complications in patients with diabetes mellitus

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Authors: Basavaraj Kabade, K. T. Nagaraja, Swathi Ramanathan, A. Veeraragavan, P. S. Reashma

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Deteriorating quality of the pedestrian environment and the increasing risk of pedestrian crashes are major concerns for most of the cities in India. The recent shift in the priority to motorized transport and the abating condition of existing pedestrian facilities can be considered as prime reasons for the increasing pedestrian related crashes in India. Bengaluru City – the IT capital hub of the nation is not much different from this. The increase in number of pedestrian crashes in Bengaluru reflects the same. To resolve this issue and to ensure safe, sustainable and pedestrian friendly sidewalks, Govt. of Karnataka, India has implemented newfangled pedestrian sidewalks popularized programme named Tender S.U.R.E. (Specifications for Urban Road Execution) projects. Tender SURE adopts unique urban street design guidelines where the pedestrians are given prime preference. The present study presents an assessment of the quality and performance of the pedestrian side walk and the walkability index of the newly built pedestrian friendly sidewalks. Various physical and environmental factors affecting pedestrian safety are identified and studied in detail. The pedestrian mobility is quantified through Pedestrian Level of Service (PLoS) and the pedestrian walking comfort is measured by calculating the Walkability Index (WI). It is observed that the new initiatives taken in reference to improving pedestrian safety have succeeded in Bengaluru by attaining a level of Service of ‘A’ and with a good WI score.

Keywords: pedestrian safety, pedestrian level of service (PLoS), Right of Way (RoW), Tender S.U.R.E (Specifications for Urban Road Execution), walkability index (WI), walkway facilities

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Authors: Nurten Akgun, Dilum Dissanayake, Neil Thorpe, Margaret C. Bell

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Cycling has gained a great attention with comparable speeds, low cost, health benefits and reducing the impact on the environment. The main challenge associated with cycling is the provision of safety for the people choosing to cycle as their main means of transport. From the road safety point of view, cyclists are considered as vulnerable road users because they are at higher risk of serious casualty in the urban network but more specifically at roundabouts. This research addresses the development of an enhanced mathematical model by including a broad spectrum of casualty related variables. These variables were geometric design measures (approach number of lanes and entry path radius), speed limit, meteorological condition variables (light, weather, road surface) and socio-demographic characteristics (age and gender), as well as contributory factors. Contributory factors included driver’s behavior related variables such as failed to look properly, sudden braking, a vehicle passing too close to a cyclist, junction overshot, failed to judge other person’s path, restart moving off at the junction, poor turn or manoeuvre and disobeyed give-way. Tyne and Wear in the UK were selected as a case study area. The cyclist casualty data was obtained from UK STATS19 National dataset. The reference categories for the regression model were set to slight and serious cyclist casualties. Therefore, binary logistic regression was applied. Binary logistic regression analysis showed that approach number of lanes was statistically significant at the 95% level of confidence. A higher number of approach lanes increased the probability of severity of cyclist casualty occurrence. In addition, sudden braking statistically significantly increased the cyclist casualty severity at the 95% level of confidence. The result concluded that cyclist casualty severity was highly related to approach a number of lanes and sudden braking. Further research should be carried out an in-depth analysis to explore connectivity of sudden braking and approach number of lanes in order to investigate the driver’s behavior at approach locations. The output of this research will inform investment in measure to improve the safety of cyclists at roundabouts.

Keywords: binary logistic regression, casualty severity, cyclist safety, roundabout

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Authors: Maria Pavlova

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In our days, it is possible to put the camera on different vehicles like quadcopter, train, airplane and etc. The camera also can be the input sensor in many different systems. That means the object recognition like non separate part of monitoring control can be key part of the most intelligent systems. The aim of this paper is to focus of the object recognition process during vehicles movement. During the vehicle’s movement the camera takes pictures from the environment without storage in Data Base. In case the camera detects a special object (for example human or animal), the system saves the picture and sends it to the work station in real time. This functionality will be very useful in emergency or security situations where is necessary to find a specific object. In another application, the camera can be mounted on crossroad where do not have many people and if one or more persons come on the road, the traffic lights became the green and they can cross the road. In this papers is presented the system has solved the aforementioned problems. It is presented architecture of the object recognition system includes the camera, Raspberry platform, GPS system, neural network, software and Data Base. The camera in the system takes the pictures. The object recognition is done in real time using the OpenCV library and Raspberry microcontroller. An additional feature of this library is the ability to display the GPS coordinates of the captured objects position. The results from this processes will be sent to remote station. So, in this case, we can know the location of the specific object. By neural network, we can learn the module to solve the problems using incoming data and to be part in bigger intelligent system. The present paper focuses on the design and integration of the image recognition like a part of smart systems.

Keywords: camera, object recognition, OpenCV, Raspberry

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Authors: Ahmed O. Apampa, Yinusa A. Jimoh

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The potential economic viability and environmental benefits of using a biomass waste, such as corn cob ash (CCA) as pozzolan in stabilizing soils for road pavement construction in a sub-tropical region was investigated. Corn cob was obtained from Maya in South West Nigeria and processed to ash of characteristics similar to Class C Fly Ash pozzolan as specified in ASTM C618-12. This was then blended with ordinary Portland cement in the CCA:OPC ratios of 1:1, 1:2 and 2:1. Each of these blends was then mixed with lateritic soil of ASHTO classification A-2-6(3) in varying percentages from 0 – 7.5% at 1.5% intervals. The soil-CCA-Cement mixtures were thereafter tested for geotechnical index properties including the BS Proctor Compaction, California Bearing Ratio (CBR) and the Unconfined Compression Strength Test. The tests were repeated for soil-cement mix without any CCA blending. The cost of the binder inputs and optimal blends of CCA:OPC in the stabilized soil were thereafter analyzed by developing algorithms that relate the experimental data on strength parameters (Unconfined Compression Strength, UCS and California Bearing Ratio, CBR) with the bivariate independent variables CCA and OPC content, using Matlab R2011b. An optimization problem was then set up minimizing the cost of chemical stabilization of laterite with CCA and OPC, subject to the constraints of minimum strength specifications. The Evolutionary Engine as well as the Generalized Reduced Gradient option of the Solver of MS Excel 2010 were used separately on the cells to obtain the optimal blend of CCA:OPC. The optimal blend attaining the required strength of 1800 kN/m2 was determined for the 1:2 CCA:OPC as 5.4% mix (OPC content 3.6%) compared with 4.2% for the OPC only option; and as 6.2% mix for the 1:1 blend (OPC content 3%). The 2:1 blend did not attain the required strength, though over a 100% gain in UCS value was obtained over the control sample with 0% binder. Upon the fact that 0.97 tonne of CO2 is released for every tonne of cement used (OEE, 2001), the reduced OPC requirement to attain the same result indicates the possibility of reducing the net CO2 contribution of the construction industry to the environment ranging from 14 – 28.5% if CCA:OPC blends are widely used in soil stabilization, going by the results of this study. The paper concludes by recommending that Nigeria and other developing countries in the sub-tropics with abundant stock of biomass waste should look in the direction of intensifying the use of biomass waste as fuel and the derived ash for the production of pozzolans for road-works, thereby reducing overall green house gas emissions and in compliance with the objectives of the United Nations Framework on Climate Change.

Keywords: corn cob ash, biomass waste, lateritic soil, unconfined compression strength, CO2 emission

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Authors: Cristina Domínguez, Steven N. Cuadra

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Aims: The aims of this study are: 1) to describe the occurrence and estimate the risk of suffering injuries of any kind, especially work-related injuries, in rural children working in agricultural activities and in urban children working on the street 2) to explore factors that might be associated with the occurrence of work-related injuries among child workers such as gender, school attendance, and performance of household chore. Method: We performed a crossectional study among working children in agricultural activities (120) and on the street (108) and in non-working referents (140) in 2019. We investigated self-reported injuries during the last 12 months, with focus on work-related injuries. Incidence rate, rate ratios, and 95% CI were calculated by Poisson regression. Results: Agricultural workers have a higher incidence of work-related injuries (2.1 per 1000 person-days) than children working on the street (1.8 per 1000 person-days). However, when considering girl’s unpaid work at home, girls had higher occurrence. Girls had a 30% increase on the risk of suffering work related injuries compared to boys. Performing household chore and attending school were the major predictors of injury occurrence. Discussion: Our data suggest If such partial and full-time girl’s housework is taken into account, there would be little or no variation between the sexes with regard to injuries occurrence, and the incidence rate of work related injuries among girls could even exceed that of boys A greater understanding of the interaction of factors related to how child workers spend their time, and its impact on children’s health, is needed in order to identify feasible and appropriate strategies to reduce the negative effect of work on children when elimination of child labor is not reachable in the short term. Clearly, gender aspects on child labor may allow for more effective targeting of prevention efforts.

Keywords: injuries, child labor, agricultural work, gender

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Authors: Maninder Singh

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The Chandigarh city is under the strain of exponential growth of car density across various neighborhood. The consumerist nature of society today is to be blamed for this menace because everyone wants to own and ride a car. Car manufacturers are busy selling two or more cars per household. The Regional Transport Offices are busy issuing as many licenses to new vehicles as they can in order to generate revenue in the form of Road Tax. The car traffic in the neighborhoods of Chandigarh has reached a tipping point. There needs to be a more empirical and sustainable model of cars per household, which should be based on specific parameters of livable neighborhoods. Sector 22 in Chandigarh is one of the first residential sectors to be established in the city. There is scope to think, reflect, and work out a method to know how many cars we need to sell our citizens before we lose the argument to traffic problems, parking problems, and road rage. This is where the true challenge of a planner or a designer of the city lies. Currently, in Chandigarh city, there are no clear visible answers to this problem. The way forward is to look at spatial mapping, planning, and design of car parking units to address the problem, rather than suggesting extreme measures of banning cars (short-term) or promoting plans for citywide transport (very long-term). This is a chance to resolve the problem with a pragmatic approach from a citizen’s perspective, instead of an orthodox development planner’s methodology. Since citizens are at the center of how the problem is to be addressed, acceptable solutions are more likely to emerge from the car and traffic problem as defined by the citizens. Thus, the idea and its implementation would be interesting in comparison to the known academic methodologies. The novel and innovative process would lead to a more acceptable and sustainable approach to the issue of number of car parks in the neighborhood of Chandigarh city.

Keywords: cars, Chandigarh, neighborhood, sustainable living, walkability

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Authors: Hatharasinghe Liyanage Saneetha Chathaurika, Shreenika De Silva Weliange

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Background and Significance of the Study: Natural and human-induced disasters have become more common due to rapid development and climate change. Therefore hospitalization due to injuries has increased in the midst of advancement in medicine. Prehospital trauma care is critical in reducing morbidity and mortality following injury. Army soldiers are one of the first responder categories after a major disaster causing injury. Thus, basic life support measures taken by trained lay first responders is life-saving, it is important to build up their capacities by updating their knowledge and practices while cultivating positive attitudes toward it. Objective: To describe knowledge, attitudes and practices on prehospital trauma care among army soldiers in Matara District. Methodology: A descriptive cross sectional study was carried out among army soldiers in Matara district. The whole population was studied belonging to the above group during the study period. Self-administered questionnaire was used as the study instrument. Cross tabulations were done to identify the possible associations using chi square statistics. Knowledge and practices were categorized in to two groups as “Poor” and “Good” taking 50% as the cut off. Results: The study population consists of 266 participants (response rate 97.79%).The overall level of knowledge on prehospital trauma care is poor (78.6%) while knowledge on golden hour of trauma (77.1%), triage system (74.4%), cardio pulmonary resuscitation (92.5%) and transportation of patients with spinal cord injury (69.2%) was markedly poor. Good knowledge is significantly associated with advance age, higher income and higher level of education whereas it has no significant association with work duration. More than 80% of them had positive attitudes on most aspects of prehospital trauma care while majority thinks it is good to have knowledge on this topic and they would have performed better in disaster situations if they were trained on pre-hospital trauma care. With regard to the practice, majority (62.8%) is included in the group of poor level of practice. They lack practice on first-aid, cardiopulmonary resuscitation and safe transportation of the patients. Moreover, they had less opportunity to participate in drills/simulation programs done on disaster events. Good practice is significantly associated with advance age and higher level of education but not associated with level of income and working duration of army soldiers. Highly significant association was observed between the level of knowledge and level of practice on prehospital trauma care of army soldiers. It is observed that higher the knowledge practices become better. Conclusion: A higher proportion of army soldiers had poor knowledge and practice on prehospital trauma care while majority had positive attitudes regarding it. Majority lacks knowledge and practice in first-aid and cardiopulmonary resuscitation. Due to significant association observed between knowledge and practice it can be recommended to include a training session on prehospital trauma care in the basic military curriculum which will enhance the ability to act as first responders effectively. Further research is needed in this area of prehospital trauma care to enhance the qualitative outcome.

Keywords: disaster, prehospital trauma care, first responders, army soldiers

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Authors: Won Young Choi, Kwan Kyu Park

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Recently, the road depression happening in the urban area is different from the cause of the sink hole and the generation mechanism occurring in the limestone area. The main cause of sinkholes occurring in the city center is the loss of soil due to the damage of old underground buried materials and groundwater discharge due to large underground excavation works. The method of detecting the sinkhole in the urban area is mostly using the Ground Penetration Radar (GPR). However, it is challenging to implement compact system and detecting watery state since it is based on electromagnetic waves. Although many ultrasonic underground detection studies have been conducted, near-ground detection (several tens of cm to several meters) has been developed for bulk systems using geophones as a receiver. The goal of this work is to fabricate a miniaturized sinkhole detecting system based on low-cost ultrasonic transducers of 40 kHz resonant frequency with high transmission pressure and receiving sensitivity. Motived by biomedical ultrasonic imaging methods, we detect air layers below the ground such as asphalt through the pulse-echo method. To improve image quality using multi-channel, linear array system is implemented, and image is acquired by classical synthetic aperture imaging method. We present the successful feasibility test of multi-channel sinkhole detector based on ultrasonic transducer. In this work, we presented and analyzed image results which are imaged by single channel pulse-echo imaging, synthetic aperture imaging.

Keywords: road depression, sinkhole, synthetic aperture imaging, ultrasonic transducer

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Authors: Nadeem Akhtar, An Ran, Cornelius B. Pratt

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China’s President Xi' vision of Belt and Road Initiative, an infrastructural project of development and connectivity, is attracting international students to Chinese universities, with Pakistan and India among the top-10 countries of origin of those students (Ministry of Education China, 2018). An additional factor in international students’ interest in Chinese universities is their improving global rankings of Chinese universities. Against that backdrop, this study addresses two overarching questions: (a) What factors explain South Asian students’ study-away experiences, particularly in their multicultural environments? and (b) What role do new media play in their adaptation to that environment? This study is guided by Stephen’s (2011) theoretical model, which suggests that social networks influence immigrants’ interactions with host and home culture. The present study used a structured questionnaire distributed through both WeChat and other online platforms to international students studying in Chinese universities. Preliminary results are threefold: (a) that the frequency of use of social media is a predictor of the level of adjustment of the students to their multicultural environment; (b) that social engagement with their international-student peers is a moderating factor in their experiential outcomes; and (c) length of stay in Chinese universities, surprisingly, was not a predictor of adaptation. A major implication of these findings is that, even though social media tend to be criticized for contributing to anomie and to diminishing social capital among youths and millennials, they can be poignant tools for cultural adaptation, particularly among international students in China. It remains to be seen if such outcomes occur among international students in other countries or world regions.

Keywords: adaptation, China's Belt and Road Initiative, international students, social media

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Authors: Christian Kapuku, Seung-Young Kho

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An accurate representation of the transportation system serving the region is one of the important aspects of transportation modeling. Such representation often requires developing an abstract model of the system elements, which also requires important amount of data, surveys and time. However, in some cases such as in developing countries, data deficiencies, time and budget constraints do not always allow such accurate representation, leaving opportunities to assumptions that may negatively affect the quality of the analysis. With the emergence of Internet open source data especially in the mapping technologies as well as the advances in Geography Information System, opportunities to tackle these issues have raised. Therefore, the objective of this paper is to demonstrate such application through a practical case of the development of the transportation network for the city of Kinshasa. The GIS geo-referencing was used to construct the digitized map of Transportation Analysis Zones using available scanned images. Centroids were then dynamically placed at the center of activities using an activities density map. Next, the road network with its characteristics was built using OpenStreet data and other official road inventory data by intersecting their layers and cleaning up unnecessary links such as residential streets. The accuracy of the final network was then checked, comparing it with satellite images from Google and Bing. For the validation, the final network was exported into Emme3 to check for potential network coding issues. Results show a high accuracy between the built network and satellite images, which can mostly be attributed to the use of open source data.

Keywords: geographic information system (GIS), network construction, transportation database, open source data

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Authors: Gehan ElAkabawy

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Background: Diabetes mellitus causes severe deteriorations of almost all the organs and systems of the body, as well as significant damage to the oral cavity. The oral changes are mainly related to salivary glands dysfunction characterized by hyposalivation and xerostomia, which significantly reduce diabetic patients’ quality of life. Human dental pulp stem cells represent a promising source for cell-based therapies, owing to their easy, minimally invasive surgical access, and high proliferative capacity. It was reported that the trophic support mediated by dental pulp stem cells can rescue the functional and structural alterations of damaged salivary glands. However, potential differentiation and paracrine effects of human dental pulp stem cells in diabetic-induced parotid gland damage have not been previously investigated. Our study aimed to investigate the therapeutic effects of intravenous transplantation of human dental pulp stem cells (hDPSCs) on parotid gland injury in a rat model of streptozotocin (STZ)-induced type 1 diabetes. Methods: Thirty Sprague-Dawley male rats were randomly categorised into three groups: control, diabetic (STZ), and transplanted (STZ+hDPSCs). hDPSCs or vehicle was injected into the tail vein 7 days after STZ injection. The fasting blood glucose levels were monitored weekly. A glucose tolerance test was performed, and the parotid gland weight, salivary flow rate, oxidative stress indices, parotid gland histology, and caspase-3, vascular endothelial growth factor (VEGF), and proliferating cell nuclear antigen (PCNA) expression in parotid tissues were assessed 28 days post-transplantation. Results: Transplantation of hDPSCs downregulated blood glucose, improved the salivary flow rate, and reduced oxidative stress. The cells migrated to, survived, and differentiated into acinar, ductal, and myoepithelial cells in the STZ-injured parotid gland. Moreover, they downregulated the expression of caspase-3 and upregulated the expression of VEGF and PCNA, likely exerting pro-angiogenetic and antiapoptotic effects and promoting endogenous regeneration. In addition, the transplanted cells enhanced the parotid nitric oxide (NO) -tetrahydrobiopterin (BH4) pathway. Conclusions: Our results show that hDPSCs can migrate to and survive within the STZ-injured parotid gland, where they prevent its functional and morphological damage by restoring normal glucose levels, differentiating into parotid cell populations, and stimulating paracrine-mediated regeneration. Thus, hDPSCs may have therapeutic potential in the treatment of diabetes-induced parotid gland injury.

Keywords: dental pulp stem cells, diabetes, streptozotocin, parotid gland

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Authors: Vittorio Astarita, Giuseppe Guido, Vincenzo Pasquale Giofre, Alessandro Vitale

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Traffic microsimulation has been used extensively to evaluate consequences of different traffic planning and control policies in terms of travel time delays, queues, pollutant emissions, and every other common measured performance while at the same time traffic safety has not been considered in common traffic microsimulation packages as a measure of performance for different traffic scenarios. Vehicle conflict techniques that were introduced at intersections in the early traffic researches carried out at the General Motor laboratory in the USA and in the Swedish traffic conflict manual have been applied to vehicles trajectories simulated in microscopic traffic simulators. The concept is that microsimulation can be used as a base for calculating the number of conflicts that will define the safety level of a traffic scenario. This allows engineers to identify unsafe road traffic maneuvers and helps in finding the right countermeasures that can improve safety. Unfortunately, most commonly used indicators do not consider conflicts between single vehicles and roadside obstacles and barriers. A great number of vehicle crashes take place with roadside objects or obstacles. Only some recent proposed indicators have been trying to address this issue. This paper introduces a new procedure based on the simulation of potential crash events for the evaluation of safety levels in microsimulation traffic scenarios, which takes into account also potential crashes with roadside objects and barriers. The procedure can be used to define new conflict indicators. The proposed simulation procedure generates with the random perturbation of vehicle trajectories a set of potential crashes which can be evaluated accurately in terms of DeltaV, the energy of the impact, and/or expected number of injuries or casualties. The procedure can also be applied to real trajectories giving birth to new surrogate safety performance indicators, which can be considered as “simulation-based”. The methodology and a specific safety performance indicator are described and applied to a simulated test traffic scenario. Results indicate that the procedure is able to evaluate safety levels both at the intersection level and in the presence of roadside obstacles. The procedure produces results that are expressed in the same unity of measure for both vehicle to vehicle and vehicle to roadside object conflicts. The total energy for a square meter of all generated crash can be used and is shown on the map, for the test network, after the application of a threshold to evidence the most dangerous points. Without any detailed calibration of the microsimulation model and without any calibration of the parameters of the procedure (standard values have been used), it is possible to identify dangerous points. A preliminary sensitivity analysis has shown that results are not dependent on the different energy thresholds and different parameters of the procedure. This paper introduces a specific new procedure and the implementation in the form of a software package that is able to assess road safety, also considering potential conflicts with roadside objects. Some of the principles that are at the base of this specific model are discussed. The procedure can be applied on common microsimulation packages once vehicle trajectories and the positions of roadside barriers and obstacles are known. The procedure has many calibration parameters and research efforts will have to be devoted to make confrontations with real crash data in order to obtain the best parameters that have the potential of giving an accurate evaluation of the risk of any traffic scenario.

Keywords: road safety, traffic, traffic safety, traffic simulation

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Authors: Abraham O. Olaniyi, Oluyemi Oke, Atilade Otunla

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The structural performance of bridges decreases progressively throughout their service life due to many contributing factors (fatigue, carbonation, fire incidents etc.). Around the world, numerous bridges have attained their estimated service life and many have approached this limit. The structural integrity assessment of the burnt composite bridge located at CH57+450, Koita village along Abuja-Abaji-Lokoja road, Nigeria, is presented as a case study and shall be forthwith referred to as the 'Koita bridge' in this paper. From the technical evaluation, the residual compressive strength of the concrete piers was found to be below 16.0 N/mm2. This value is very low compared to the expected design value of 30.0 N/mm2. The pier capping beam at pier location 1 has a very low residual compressive strength. The cover to the reinforcement of certain capping beams has an outline of reinforcement which signifies poor concrete cover and the mean compressive strength is also less than 20.0 N/mm2. The steel girder indicated black colouration as a result of the fire incident without any significant structural defect like buckling or warping of the steel section. This paper reviews the structural integrity assessment and repair methodology of the Koita bridge; a composite bridge damaged by fire, highlighting the various challenges of limited obtainable guidance documents about the bridge. The objectives are to increase the understanding of processes and versatile equipment required to test and assess a fire-damaged bridge in order to improve the quality of structural appraisal and rehabilitation; thus, eliminating the prejudice associated with current visual inspection techniques.

Keywords: assessment, bridge, rehabilitation, sustainability

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Authors: Venencia Albert, Arulselvi Subramanian, Hara Prasad Pati, Asok K. Mukhophadhyay

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Acute traumatic coagulopathy in an endogenous dysregulation of the intrinsic coagulation system in response to the injury, associated with three-fold risk of poor outcome, and is more amenable to corrective interventions, subsequent to early identification and management. Multiple definitions for stratification of the patients' risk for early acute coagulopathy have been proposed, with considerable variations in the defining criteria, including several trauma-scoring systems based on prehospital data. We aimed to develop a clinically relevant definition for acute coagulopathy of trauma based on conventional coagulation assays and to assess its efficacy in comparison to recently established prehospital prediction models. Methodology: Retrospective data of all trauma patients (n = 490) presented to our level I trauma center, in 2014, was extracted. Receiver operating characteristic curve analysis was done to establish cut-offs for conventional coagulation assays for identification of patients with acute traumatic coagulopathy was done. Prospectively data of (n = 100) adult trauma patients was collected and cohort was stratified by the established definition and classified as "coagulopathic" or "non-coagulopathic" and correlated with the Prediction of acute coagulopathy of trauma score and Trauma-Induced Coagulopathy Clinical Score for identifying trauma coagulopathy and subsequent risk for mortality. Results: Data of 490 trauma patients (average age 31.85±9.04; 86.7% males) was extracted. 53.3% had head injury, 26.6% had fractures, 7.5% had chest and abdominal injury. Acute traumatic coagulopathy was defined as international normalized ratio ≥ 1.19; prothrombin time ≥ 15.5 s; activated partial thromboplastin time ≥ 29 s. Of the 100 adult trauma patients (average age 36.5±14.2; 94% males), 63% had early coagulopathy based on our conventional coagulation assay definition. Overall prediction of acute coagulopathy of trauma score was 118.7±58.5 and trauma-induced coagulopathy clinical score was 3(0-8). Both the scores were higher in coagulopathic than non-coagulopathic patients (prediction of acute coagulopathy of trauma score 123.2±8.3 vs. 110.9±6.8, p-value = 0.31; trauma-induced coagulopathy clinical score 4(3-8) vs. 3(0-8), p-value = 0.89), but not statistically significant. Overall mortality was 41%. Mortality rate was significantly higher in coagulopathic than non-coagulopathic patients (75.5% vs. 54.2%, p-value = 0.04). High prediction of acute coagulopathy of trauma score also significantly associated with mortality (134.2±9.95 vs. 107.8±6.82, p-value = 0.02), whereas trauma-induced coagulopathy clinical score did not vary be survivors and non-survivors. Conclusion: Early coagulopathy was seen in 63% of trauma patients, which was significantly associated with mortality. Acute traumatic coagulopathy defined by conventional coagulation assays (international normalized ratio ≥ 1.19; prothrombin time ≥ 15.5 s; activated partial thromboplastin time ≥ 29 s) demonstrated good ability to identify coagulopathy and subsequent mortality, in comparison to the prehospital parameter-based scoring systems. Prediction of acute coagulopathy of trauma score may be more suited for predicting mortality rather than early coagulopathy. In emergency trauma situations, where immediate corrective measures need to be taken, complex multivariable scoring algorithms may cause delay, whereas coagulation parameters and conventional coagulation tests will give highly specific results.

Keywords: trauma, coagulopathy, prediction, model

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Authors: J. J. Lloyd, J. S. Phillips

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Background: HIV/AIDS has made a huge impact on human development and sexual reproductive habits in this century in the world and especially in sub-Saharan Africa. It has only recently been acknowledged that HIV/AIDS has an equal if not greater effect on or threat to people with disabilities. Survivors of traumatic spinal cord injury (SCI) with resultant disability are incorrectly believed to be sexually inactive, unlikely to use drugs or alcohol and at less risk of violence or rape than their non-disabled peers. This group can thus be described as economically, educationally and socially disadvantaged, which in itself, suggest that they are a high-risk group for HIV infection. Objectives: Thus, the overall objective of this study was to assess the factors that exacerbate the risk and vulnerability of individuals with spinal cord injuries to HIV infection in order to develop a more effective HIV intervention. Methodology: This paper reports on the cross-sectional data gathered from individuals with a traumatic spinal cord injury in 4 conveniently selected provinces in South Africa. Data was collected by means of self-administered questionnaires. The questionnaire consisted of various sections requesting for information on Demographics; HIV-Knowledge (HIV- KQ-18); Sexual behaviours; sexual communication, and negotiation skills and Self-efficacy to refuse sex. Results: The majority of the study sample was males (72.7%) with a mean age of 34.6 years. The majority reported lifetime sexual intercourse (92.4%) but only 31.8% reported condom use with last sexual intercourse. Low level of HIV knowledge, and being male were the strongest predictor of risky sexual behaviours in this sample. Conclusion: Significant numbers of individuals with spinal cord injuries are thus engaging in risky sexual behaviours pointing to a need to strengthen comprehensive sexual health education to increase access to HIV testing, promote safe sex and condom use among this group.

Keywords: Human Immunodeficiency Virus (HIV), individuals with spinal cord injuries, risky sexual behaviours, HIV risk factors, sub-saharan Africa

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Authors: Rideci Farias, Haroldo Paranhos

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The present work deals with the use of drainage geo-composite as a deep drainage and geogrid element to reinforce the base of the body of the landfill destined to the road pavement on geological faults in the stretch of the TO-342 Highway, between the cities of Miracema and Miranorte, in the State of Tocantins / TO, Brazil, which for many years was the main link between TO-010 and BR-153, after the city of Palmas, also in the state of Tocantins / TO, Brazil. For this application, geotechnical and geological studies were carried out by means of SPT percussion drilling, drilling and rotary drilling, to understand the problem, identifying the type of faults, filling material and the definition of the water table. According to the geological and geotechnical studies carried out, the area where the route was defined, passes through a zone of longitudinal fault to the runway, with strong breaking / fracturing, with presence of voids, intense alteration and with advanced argilization of the rock and with the filling up parts of the faults by organic and compressible soils leachate from other horizons. This geology presents as a geotechnical aggravating agent a medium of high hydraulic load and very low resistance to penetration. For more than 20 years, the region presented constant excessive deformations in the upper layers of the pavement, which after routine services of regularization, reconformation, re-compaction of the layers and application of the asphalt coating. The faults were quickly propagated to the surface of the asphalt pavement, generating a longitudinal shear, forming steps (unevenness), close to 40 cm, causing numerous accidents and discomfort to the drivers, since the geometric positioning was in a horizontal curve. Several projects were presented to the region's highway department to solve the problem. Due to the need for partial closure of the runway, the short time for execution, the use of geosynthetics was proposed and the most adequate solution for the problem was taken into account the movement of existing geological faults and the position of the water level in relation to several Layers of pavement and failure. In order to avoid any flow of water in the body of the landfill and in the filling material of the faults, a drainage curtain solution was used, carried out at 4.0 meters depth, with drainage geo-composite and as reinforcement element and inhibitor of the possible A geogrid of 200 kN / m of resistance was inserted at the base of the reconstituted landfill. Recent evaluations, after 13 years of application of the solution, show the efficiency of the technique used, supported by the geotechnical studies carried out in the area.

Keywords: geosynthetics, geocomposite, geogrid, road, recovery, geological failure

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Authors: Toufic Sarieddine

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The current debate on the hegemonic impact of China’s Belt and Road Initiative (BRI) is of two opposing strands: Resilient and absolute US hegemony on the one hand and various models of multipolar hegemony such as bifurcation on the other. Bifurcation theories illustrate an unprecedented division of hegemonic functions between China and the US, whereby Beijing becomes the world’s economic hegemon, leaving Washington the world’s military hegemon and security guarantor. While consensus points to China being the main driver of unipolarity’s rupturing, the debate among bifurcationists is on the location of the first rupture. In this regard, the Middle East and North Africa (MENA) region has seen increasing Chinese foreign direct investment in recent years while that to other regions has declined, ranking it second in 2018 as part of the financing for the Maritime Silk Road Initiative (MSRI). China has also become the top trade partner of 11 states in the MENA region, as well as its top source of machine imports, surpassing the US and achieving an overall trade surplus almost double that of Washington’s. These are among other features outlined in world-systems analysis (WSA) literature which correspond with the emergence of a new hegemon. WSA is further utilized to gauge other facets of China’s increasing involvement in MENA and assess whether bifurcation is unfolding therein. These features of hegemony include the adoption of China’s modi operandi, economic dominance in production, trade, and finance, military capacity, cultural hegemony in ideology, education, and language, and the promotion of a general interest around which to rally potential peripheries (MENA states in this case). China’s modi operandi has seen some adoption with regards to support against the United Nations Convention on the Law of the Sea, oil bonds denominated in the yuan, and financial institutions such as the Shanghai Gold Exchange enjoying increasing Arab patronage. However, recent elections in Qatar, as well as liberal reforms in Saudi Arabia, demonstrate Washington’s stronger normative influence. Meanwhile, Washington’s economic dominance is challenged by China’s sizable machine exports, increasing overall imports, and widening trade surplus, but retains some clout via dominant arms and transport exports, as well as free-trade deals across the region. Militarily, Washington bests Beijing’s arms exports, has a dominant and well-established presence in the region, and successfully blocked Beijing’s attempt to penetrate through the UAE. Culturally, Beijing enjoys higher favorability in Arab public opinion, and its broadcast networks have found some resonance with Arab audiences. In education, the West remains MENA students’ preferred destination. Further, while Mandarin has become increasingly available in schools across MENA, its usage and availability still lag far behind English. Finally, Beijing’s general interest in infrastructure provision and prioritizing economic development over social justice and democracy provides an avenue for increased incorporation between Beijing and the MENA region. The overall analysis shows solid progress towards bifurcation in MENA.

Keywords: belt and road initiative, hegemony, Middle East and North Africa, world-systems analysis

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Authors: Eric Mwenda, Shadrack Ngene

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Human-wildlife conflicts (HWCs) are the main threat to conservation in Africa. This is because wildlife needs overlap with those of humans. In Kenya, about 70% of wildlife occurs outside protected areas. As a result, wildlife and human range overlap, causing HWCs. The HWCs in Kenya occur in the drylands adjacent to protected areas. The top five counties with the highest incidences of HWC are Taita Taveta, Narok, Lamu, Kajiado, and Laikipia. The common wildlife species responsible for HWCs are elephants, buffaloes, hyenas, hippos, leopards, baboons, monkeys, snakes, and crocodiles. To ensure individuals affected by the conflicts are compensated, Kenya has developed a model of HWC compensation claims data collection and payment. We collected data on HWC from all eight Kenya Wildlife Service (KWS) Conservation Areas from 2009 to 2019. Additional data was collected from stakeholders' consultative workshops held in the Conservation Areas and a literature review regarding payment of injuries and ongoing insurance schemes being practiced in areas. This was followed by the description of the claims administration process and calculation of the pricing of the compensation claims. We further developed a digital platform for data capture and processing of all reported conflict cases and payments. Our product recognized four categories of HWC (i.e., human death and injury, property damage, crop destruction, and livestock predation). Personal bodily injury and human death were provided based on the Continental Scale of Benefits. We proposed a maximum of Kenya Shillings (KES) 3,000,000 for death. Medical, pharmaceutical, and hospital expenses were capped at a maximum of KES 150,000, as well as funeral costs at KES 50,000. Pain and suffering were proposed to be paid for 12 months at the rate of KES 13,500 per month. Crop damage was to be based on farm input costs at a maximum of KES 150,000 per claim. Livestock predation leading to death was based on Tropical Livestock Unit (TLU), which is equivalent to KES 30,000, whick includes Cattle (1 TLU = KES 30,000), Camel (1.4 TLU = KES 42,000), Goat (0.15 TLU = 4,500), Sheep (0.15 TLU = 4,500), and Donkey (0.5 TLU = KES 15,000). Property destruction (buildings, outside structures and harvested crops) was capped at KES 150,000 per any one claim. We conclude that it is possible to use an administrator to collect data on HWC compensation claims and make payments using technology. The success of the new approach will depend on a piloting program. We recommended that a pilot scheme be initiated for eight months in Taita Taveta, Kajiado, Baringo, Laikipia, Narok, and Meru Counties. This will test the claims administration process as well as harmonize data collection methods. The results of this pilot will be crucial in adjusting the scheme before country-wide roll out.

Keywords: human-wildlife conflicts, compensation, human death and injury, crop destruction, predation, property destruction

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Authors: Abdulwhab Alotaibi, Abdullah Alzahrani, Ziyad Bokhari, Abdulelah Alghamdi

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First described in 1975 by Dr. Miller, Medical dressings are uncommon but possible cause of hand digital ischemia due the tourniquet-like effect. The incident of this complication has been reported across wide range of age-groups, yet it seems like that the pediatric population are specifically vulnerable. Multiple dressing types were reported to have caused ischemic injury, such as elastic wrap, tubular gauze, and self-adherent dressings. We present a case of medical dressing induced digital ischemia in patient with Congenital insensitivity to pain and anhidrosis (CIPA), which further challenge the discovery of the condition. An 8-year-old girl known case of CIPA. Brought by her mother to the ER after nail bed injury, which she managed by application of elastic wrap that was left for 24 hours. When the mother found out she immediately removed the elastic band, and noticed the fingertip was black and cold with tense bullae. The color then changed later when she arrived to the ER to dark purple with bluish discoloration on the tip. On examination there was well demarcated tense bullae on the distal right fifth finger. Neurovascular intact, pulse oximetry on distal digit 100%, capillary refill time was delayed. She was seen under Plastic surgery and conservative management recommended, and patient was discharged with safety netting. Two days later the patient came as follow-up visit at which her condition demonstrated significant improvement, the bullae has since ruptured leaving behind sloughed skin, capillary refill and pulse oximetry were both within normal limits, sensory function couldn’t be assessed but her motor function and ROM were normal, topical bacitracin and bandage dressings were applied for the eroded skin. Patient was scheduled for a follow-up in 2 weeks. Preventatively it’s advisable to avoid the commonly implicated dressings such as elastic, tubular gauze or self-adherent wraps in hand or digital injuries when possible, but in cases where the use of these dressings is of necessity the appropriate precautions must be taken, Dr. Makarewich proposed the following 5 measures to help minimize the incidence of the injury: 1-Unwrapping 12 inches of the dressing before rolling the injured finger. 2-Wrapping from distal to proximal with minimal tension to avoid vascular embarrassment. 3-The use of 5-25 inch to overlap the entire wrap. 4-Maintaining light pressure over the wrap to allow adherence of the dressing. 5-Minimization of the number of layers used to wrap the affected digit. Also assessing the capillary refill after the application can help in determining the patency of the supplying blood vessels. It’s also important to selectively determine if the patient is a candidate for conservative management, as tailored approach can help in maximizing the positive outcomes for our patients.

Keywords: congenital insensitivity to pain, digital ischemia, medical dressing, conservative management

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Authors: Gamal Seliem, Hassan Seliem

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Aswan area is one of the important areas in Egypt and because it encompasses the vital engineering structure of the High dam, so it has been selected for the present study. The study of the crustal deformation and gravity associated with earthquake activity in the High Dam area of great importance for the safety of the High Dam and its economic resources. This paper deals with using micro-gravity, precise leveling and GPS data for geophysical and geodetically studies. For carrying out the detailed gravity survey in the area, were established for studying the subsurface structures. To study the recent vertical movements, a profile of 10 km length joins the High Dam and Aswan old dam were established along the road connecting the two dams. This profile consists of 35 GPS/leveling stations extending along the two sides of the road and on the High Dam body. Precise leveling was carried out with GPS and repeated micro-gravity survey in the same time. GPS network consisting of nine stations was established for studying the recent crustal movements. Many campaigns from December 2001 to December 2014 were performed for collecting the gravity, leveling and GPS data. The main aim of this work is to study the structural features and the behavior of the area, as depicted from repeated micro-gravity, precise leveling and GPS measurements. The present work focuses on the analysis of the gravity, leveling and GPS data. The gravity results of the present study investigate and analyze the subsurface geologic structures and reveal to there be minor structures; features and anomalies are taking W-E and N-S directions. The geodetic results indicated lower rates of the vertical and horizontal displacements and strain values. This may be related to the stability of the area.

Keywords: repeated micro-gravity changes, precise leveling, GPS data, Aswan High Dam

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Authors: Vivian A. Galindo, Maria C. Galvis, Jaime R. Obando, Alvaro Guarin

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In Colombia, most of the roads of the national tertiary road network are unpaved roads with granular rolling surface. These are very important ways of guaranteeing the mobility of people, products, and inputs from the agricultural sector from the most remote areas to urban centers; however, it has not paid much attention to the search for alternatives to avoid the occurrence of deteriorations that occur shortly after its commissioning. In recent years, geosynthetics have been used satisfactorily to reinforce unpaved roads on soft soils, with geotextiles and geogrids being the most widely used. The interaction of the geogrid and the aggregate minimizes the lateral movement of the aggregate particles and increases the load capacity of the material, which leads to a better distribution of the vertical stresses, consequently reducing the vertical deformations in the subgrade. Taking into account the above, the research aimed at the mechanical behavior of the granular material, used in unpaved roads with and without the presence of geogrids, from the development of laboratory tests through the loaded wheel tester (LWT). For comparison purposes, the reinforced conditions and traffic conditions to which this type of material can be accessed in practice were simulated. In total four types of geogrids, were tested with granular material; this means that five test sets, the reinforced material and the non-reinforced control sample were evaluated. The results of the numbers of load cycles and depth rutting supported by each test body showed the influence of the properties of the reinforcement on the mechanical behavior of the assembly and the significant increases in the number of load cycles of the reinforced specimens in relation to those without reinforcement.

Keywords: geosynthetics, load wheel tester LWT, tertiary roads, unpaved road, vertical deformation

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Authors: Teresa Wanjiru Mbatia

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On 7th June 2011, the government Minister of Roads in Kenya announced the proposed construction of a major highway known as a southern bypass to run on the northern border of the Nairobi National Park. The following day on 8th June 2011, the chairperson of the Friends of Nairobi National Park (FONNAP) posted a protest statement on their website, with the heading, ‘Nairobi Park is Not a cake’ alerting its members and conservation groups, with the aim of getting support to the campaign against the government’s intention to hive off a section of the park for road construction. This was the first and earliest statement that led to a series of other events that culminated in conservationists and some other members of the public campaign against the government’s plan to hive off sections of the park to build road and railway infrastructure in or around the park. Together with other non-state actors, mostly non-governmental organisations in conservation/environment and tourism businesses, FoNNAP issued a series of other statements on social, print and electronic media to battle against road and railway construction. This paper examined the strategies, outcomes and interests of actors involved in opposing/proposing the development of transport infrastructure in and around the Nairobi National Park. Specifically, the objectives were to analyse the: (1) Arguments put forward by the eco-warriors to protest infrastructure development; (2) Background and interests of the eco-warriors; (3) Needs/interests and opinions of ordinary common citizens on transport infrastructural development, particularly in and around the urban nature reserve and (4) Final outcomes of the eco-politics surrounding infrastructure development in and around Nairobi National Park. The methodological approach used was environmental history and the social construction of nature. The study collected combined qualitative data using four main approaches, the grounded theory approach, narratives, case studies and a phenomenological approach. The information collected was analysed using critical discourse analysis. The major findings of the study were that under the guise of “public participation,” influential non-state actors have the capacity to perpetuate social-spatial inequalities in the form of curtailing the majority from accessing common public goods. A case in point in this study is how the efforts of powerful conservationists, environmentalists, and tourism businesspersons managed to stall the construction of much-needed road and railway infrastructure severally through litigations in lengthy environmental court processes involving injunctions and stop orders to the government bodies in charge. Moreover, powerful non-state actors were found to have formed informal and sometimes formal coalitions with politicians with selfish interests, which serves to deepen the exclusionary practices and the common good. The study concludes that mostly composed of certain types of elites (NGOs, business communities, politicians and privileged social-cultural groups), non-state actors have used participatory policies to advance their own interests at the expense of the majority whom they claim to represent. These practices are traced to the historically unjust social, political, and economic forces involved in the production of space in Nairobi.

Keywords: eco-politics, exclusion, infrastructure, Nairobi national park, non-state actors, protests

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Authors: Rabbya Ashrafi, Mohammad Tarikul Islam , Al-Amin Bhuiyan, Aminur Rahman

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Injury is the leading killer of children in Bangladesh. Anchal (community crèche) is an effective intervention to prevent injuries among children under 5. Through the SoLiD project, 1,600 Anchals are in place in three sub-districts in Bangladesh. The objectives of the Anchal are to provide supervision and early childhood development stimulations (ECD) to the children. A locally trained caregiver supervises 20-25 children, 9 to 59 months old, from 9 a.m. to 1 p.m., six days a week. Although it was found effective, during its implementation phase several challenges were noticed. To identify challenges and means to overcome those to improve the Anchal activities. In-depth interviews were conducted with Anchal caregivers, their supervisors, and trainers. Focus group discussions were conducted with the mothers of the Anchal children. The study was conducted in the Manohardi sub-district in November 2015. Decay of knowledge and skills after 2-3 months of training, lack of formal certification and inappropriate selection of women as Anchal caregivers, and enrollment of small children (less than 12 months) were the important challenges. The reluctance of parents to send children to the Anchal at the proper time, failure to engage children in various ECD activities, ineffective conduction of parents and community leaders meeting by the Anchal caregivers, insufficient accommodation, and poor supply of logistics for children were also the important challenges. The suggestion for improvement was to recruit caregivers as per standard criteria, provide them refreshers training at three months intervals, train them on effective conduction of parents and community leaders meetings, provide a formal certificate, and ensure regular supply of logistics. The identified challenges are needed to be addressed by utilizing the suggestions obtained from the IDIs and FGDs to make the Anchal intervention more effective in preventing childhood injuries.

Keywords: comunity crech, earlychildhood development, measures for improvement, childhood injury

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Authors: Naad-E-Ali Sulehria

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Pakistan and china have stepped in a new phase of strengthening fraternity as the dream of economic corridor once discerned by both countries is going to take a pragmatic shape. Pak-China economic corridor an under construction program is termed to be an emerging dynamic of 21st century that anticipates a nexus between Asian continent and Indian Ocean by extending its functions to adjoining East, South, Central and Western Asian regions. The $45.6 billion worth heavily invested megaprojects by China are meant to revive energy sector and building economic infrastructure in Pakistan. Evidently, these projects are a part of ‘southern extension’ of Silk Road economic belt which is going to draw out prominent incentives for both countries particularly bolstering China to acquire influential dominance over the regional trade and beyond. In pursuit to adhere, by these progressive plans both countries have began working on their respective assignments. This article discusses the economical development programs under China’s peripheral diplomacy regarding its region-specific-approach to accumulate trade of Persian Gulf and access the landlocked Central Asian states through Pakistan in a sublimate context to break US encirclement of Asia. Pakistan’s utmost preference to utilize its strategic channel as a trade hub to become an emerging economy and surpass its arch-rival India for strategic concerns is contemplated accordingly. The needs and feasibility of the economic gateway and the dividends it can provide in the contemporary scenario are examined carefully and analysis is drawn upon the future prospects of the Pakistan-China Economic corridor once completed.

Keywords: pak-china economic corridor (PCEC), central asian republic states (CARs), new silk road economic belt, gawadar

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Authors: Ticijana Prijon, Branko Ermenc

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Background: Blunt aortic trauma (BAT) includes various morphological changes that occur during deceleration, acceleration and/or body compression in traffic accidents. The various forms of BAT, from limited laceration of the intima to complete transection of the aorta, depends on the force acting on the vessel wall and the tolerance of the aorta to injury. The force depends on the change in velocity, the dynamics of the accident and of the seating position in the car. Tolerance to aortic injury depends on the anatomy, histological structure and pathomorphological alterations due to aging or disease of the aortic wall.An overview of the literature and medical documentation reveals that different terms are used to describe certain forms of BAT, which can lead to misinterpretation of findings or diagnoses. We therefore, propose a classification that would enable uniform systematic screening of all forms of BAT. We have classified BAT into three morphologycal types: TYPE I (intramural), TYPE II (transmural) and TYPE III (multiple) aortic ruptures with appropriate subtypes. Methods: All car accident casualties examined at the Institute of Forensic Medicine from 2001 to 2009 were included in this retrospective study. Autopsy reports were used to determine the occurrence of each morphological type of BAT in deceased drivers, front seat passengers and other passengers in cars and to define the morphology of BAT in relation to the accident dynamics and the age of the fatalities. Results: A total of 391 fatalities in car accidents were included in the study. TYPE I, TYPE II and TYPE III BAT were observed in 10,9%, 55,6% and 33,5%, respectively. The incidence of BAT in drivers, front seat and other passengers was 36,7%, 43,1% and 28,6%, respectively. In frontal collisions, the incidence of BAT was 32,7%, in lateral collisions 54,2%, and in other traffic accidents 29,3%. The average age of fatalities with BAT was 42,8 years and of those without BAT 39,1 years. Conclusion: Identification and early recognition of the risk factors of BAT following a traffic accident is crucial for successful treatment of patients with BAT. Front seat passengers over 50 years of age who have been injured in a lateral collision are the most at risk of BAT.

Keywords: aorta, blunt trauma, car accidents, morphology, risk factors

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Authors: Ramin Zargarbashi, Hamid Rabie, Behnam Panjavi, Hooman Kamran, Seyedarad Mosalamiaghili, Zohre Erfani, Seyed Peyman Mirghaderi, Maryam Salimi

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Background: Posterior shoulder dislocation is one of the disabling complications of brachial plexus birth injury (BPBI), and various treatment options, including capsule and surrounding muscles release for open reduction, humeral derotational osteotomy, and tendon transfers, have been recommended to manage it. In the present study, we aimed to determine the clinical outcome of open reduction with soft tissue release, tendon transfer, and glenoid osteotomy inpatients with BPBI and posterior shoulder dislocation or subluxation. Methods: From 2018 to 2020, 33 patients that underwent open reduction, glenoid osteotomy, and tendon transfer were included. The glenohumeral deformity was classified according to the Waters radiographic classification. Functional assessment was performed using the Mallet grading system before and at least two years after the surgery. Results: The patients were monitored for 26.88± 5.47 months. Their average age was 27.5±14 months. Significant improvement was seen in the overall Mallet score (from 13.5 to 18.91 points) and its segments, including hand to mouth, hand to the neck, global abduction, global external rotation, abduction degree, and external rotation degree. Hand-to-back score and the presence of trumpet sign were significantly decreased in the post-operation phase (all p values<0.001). The above-mentioned variables significantly changed for both infantile and non-infantile dislocations. Conclusion: Our study demonstrated that open reduction along with glenoid osteotomy improves retroversion, and muscle strengthening with different muscle transfers is an effective technique for BPBI.

Keywords: birth injuries, nerve injury, brachial plexus birth palsy, Erb palsy, tendon transfer

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Authors: Saowapa Phaithayawat

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The purposes of this study are 1) to study the over 20-year attempt of Mahakan fort community to negotiate with Bangkok Metropolitan Administration (BMA) to remain in their residential area belonging to the state, and 2) to apply the new social and cultural dimension between the state and the community as an alternative for local participation in keeping their residential area. This is a qualitative research, and the findings reveal that the community claimed their ancestors’ right as owners of this piece of land for over 200 years. The community, therefore, requested to take part in the preservation of land, culture and local intellect and the area management in terms of being a learning resource on the cultural road in Rattanakosin Island. However, BMA imposed the law concerning the community area relocation in Rattanakosin Island. The result of law enforcement led to the failure of the area relocation, and the hard hit on physical structure of the area including the overall deterioration of the cultural road renovated in the year 1982, the 200 years’ celebration of Bangkok. The enforcement of law by the state required the move of the community, and the landscape improvement based on the capital city plan. However, this enforcement resulted in the unending conflicts between the community and the state, and the solution of this problem was unclear. At the same time the community has spent a long time opposing the state’s action, and preparing themselves by administrating the community behind Mahakan fortress with community administrative committee under the suggestion of external organization by registering all community members, providing funds for community administration. At the meantime the state lacked the continuation of the enforcement due to political problem and BMA’s administration problem. It is, therefore, suggested that an alternative solution to this problem lie at the negotiation between the state and the community with the purpose of the collaboration between the two to develop the area under the protective law of each side.

Keywords: Pom-Mahakan community, reduction of conflicts, social area disclosure, residential area

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Authors: Sameer Masood, Lucas Chartier

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Head injuries are a commonly encountered presentation in emergency departments (ED) and the Choosing Wisely Canada (CWC) campaign was released in June 2015 in an attempt to decrease imaging utilization for patients with minor head injuries. The impact of the CWC campaign on imaging utilization for head injuries has not been explored in the ED setting. In our study, we describe the characteristics of patients with head injuries presenting to a tertiary care academic ED and the impact of the CWC campaign on CT head utilization. This retrospective cohort study used linked databases from the province of Ontario, Canada to assess emergency department visits with a primary diagnosis of head injury made between June 1, 2014 and Aug 31, 2016 at the University Health Network in Toronto, Canada. We examined the number of visits during the study period, the proportion of patients that had a CT head performed before and after the release of the CWC campaign, as well as mode of arrival, and disposition. There were 4,322 qualifying visits at our site during the study period. The median presenting age was 44.12 years (IQR 27.83,67.45), the median GCS was 15 (IQR 15,15) and the majority of patients presenting had intermediate acuity (CTAS 3). Overall, 43.17% of patients arrived via ambulance, 49.24 % of patients received a CT head and 10.46% of patients were admitted. Compared to patients presenting before the CWC campaign release, there was no significant difference in the rate of CT heads after the CWC (50.41% vs 47.68%, P = 0.07). There were also no significant differences between the two groups in mode of arrival (ambulance vs ambulatory) (42.94% vs 43.48%, P = 0.72) or admission rates (9.85% vs 11.26%, P = 0.15). However, more patients belonged to the high acuity groups (CTAS 1 or 2) in the post CWC campaign release group (12.98% vs 8.11% P <0.001). Visits for head injuries make up a significant proportion of total ED visits and approximately half of these patients receive CT imaging in the ED. The CWC campaign did not seem to impact imaging utilization for head injuries in the 14 months following its launch. Further efforts, including local quality improvement initiatives, are likely needed to increase adherence to its recommendation and reduce imaging utilization for head injuries.

Keywords: choosing wisely, emergency department, head injury, quality improvement

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