21 research outputs found
A socio-ecological systems perspective on planning for informality
No full textPlanning for the informal seems paradoxical. But planning without considering the informal a part of the urban fabric is too precarious. In Delhi, the river Yamuna is polluted by thousands of kilometers of open-access nullahs (stormwater drains) being used to dispose waste. This includes waste from ~250 jhuggi jhopdi clusters or JJCs (slums) along these nullahs, and JJC evictions have occurred on grounds of “nuisance”–defined by aesthetic cues like open defecation and improper waste disposal, but intended to convey environmental impact. Taking nullah-adjacent JJCs as a social-ecological system (SES), I conduct a mixed methods study, demonstrating that environmental planning for the river is interwoven with lack of sanitation and waste disposal infrastructure in drain-adjacent JJCs, that necessitates planning for informality, and that decentralized community-managed infrastructure provision may be a socio-ecologically sustainable alternative to current strategies of service provision. In Chapter 1, a city and basin-scale spatial analysis of Delhi's plans for river remediation and sewerage and drainage infrastructure exposes the exclusion of nullah-adjacent JJCs in the most recent infrastructure and city plans. This can impact the city’s pipelines and treatment plants, unequipped to deal with sewage and fecal matter from ~1.54 million people in nullah-adjacent JJCs. In Chapter 2, nullah water quality and land cover analyses upstream and downstream of 10 JJCs reveals that nuisance actually occurs upstream of JJCs and can be correlated with the type of upstream land use (dairy, transit, industry, malls, residential). But the pervasiveness of an aesthetic governmentality in “world cities” like Delhi urges an ethnographic exploration of why waste becomes so visible in these spaces even though it is produced upstream, and so aversive that it compels middle-class Delhi to demand– and Delhi High Court to grant– evictions. In Chapter 3 then, I analyze interviews with 56 JJC residents, 14 municipal agency officials, and 9 NGOs. Aesthetic nuisance results from inadequacy, inaccessibility, infrequency and incompleteness of infrastructure, which in turn stems from regulatory overlap, wherein multiple regulatory agencies operate without clarity or coordination, causing waste to accumulate in slums and cycle from toilet to drain to public space. In Chapter 4, an institutional analysis using these interviews and 9 State and Central legislations and policies reveals how rules of service provision produce incentives that dictate the behavior of JJC residents, regulatory agencies, and NGOs, altogether producing the outcome of waste disposal in drains. Any institutional change then– and several are identified– will have to include changing problematic rules and norms. In the final chapter, this biophysical, spatial, and qualitative data is brought into the SES Framework to understand the social and ecological outcomes for a nullah-JJC SES, whose sustainability is crucial to sustain the higher order SESs. An SES with community-managed decentralized waste management has a higher density of information sharing and deliberation activity, higher investment (activities removing waste), and lower harvesting (waste disposal activity) than SESs without interventions. This multi-scalar, integrated analysis of social and ecological dynamics is crucial not only to understand the data deficient informal built environment better, but also to firmly establish the informal as indistinct from the formal city.Submission published under a 24 month embargo labeled 'Closed Access', the embargo will last until 2021-05-01The student, Shruti Syal, accepted the attached license on 2019-04-17 at 21:50.The student, Shruti Syal, submitted this Dissertation for approval on 2019-04-17 at 22:07.This Dissertation was approved for publication on 2019-04-18 at 15:45.DSpace SAF Submission Ingestion Package generated from Vireo submission #13730 on 2019-08-22 at 16:23:07Made available in DSpace on 2019-08-23T20:47:33Z (GMT). No. of bitstreams: 3
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Hospital Length of Stay Independently Predicts Mortality in Patients Emergently Admitted for Esophageal Hemorrhage: Sex, Frailty, and Age as Additional Mortality Factors
No full textINTRODUCTION: Upper gastrointestinal bleeding results in greater than $7.6 billion of in-hospital economic burden in the United States yearly. With a worldwide incidence between 40-100/100,000 individuals and a mortality rate of approximately 2-10%, upper gastrointestinal bleeding represents a major source of mortality and morbidity. The goal of this study was to describe mortality risk factors in patients emergently admitted with esophageal hemorrhage, the second most common etiology of upper gastrointestinal bleeding. MATERIALS AND METHODS: Patients emergently admitted with esophageal hemorrhage between 2005-2014 were evaluated using the National Inpatient Sample database. Patient characteristics, clinical outcomes, and therapeutic trends were obtained. Relationships between morality and all other variables were determined via univariable and multivariable logistic regression analyses. RESULTS: In total, 4,607 patients were included, of which 2,045 (44.4%) were adults, 2,562 (55.6%) were elderly, 2,761 (59.9%) were males, and 1,846 (40.1%) were females. The average age of adult and elderly patients were 50.1 and 78.7 years, respectively. The multivariable logistic regression analysis revealed, for every additional day of hospitalization, the odds of mortality for nonoperatively treated adult and elderly patients increased by 7.5% (p=\u3c0.001) and 6.6% (p=\u3c0.001), respectively. Every additional year of age was associated with a 5.4% (p=0.012) increase in mortality odds for nonoperatively managed adult patients. Frailty increased the odds of mortality by 31.1% (p=0.009) in nonoperatively treated elderly patients. Undergoing invasive diagnostic procedures in conservatively treated adults reduced mortality significantly (odds ratio=0.400, p=0.021). Frailty, age, and hospital length of stay demonstrated no significant association with mortality in surgically managed adult and elderly patients. CONCLUSION: Nonoperatively managed patients emergently admitted for esophageal hemorrhage with longer hospital length of stay and higher modified frailty index exhibited higher odds of mortality. Invasive diagnostic procedures were negatively correlated with mortality in nonoperatively treated adult patients. Age is only associated with higher mortality rates in adults, while elderly patients revealed no association between age and mortality
The nonequilibrium kinetics of reversible bimolecular reactions.
No full textThe master equation describing the rate of the bimolecular reaction A+BC&rlhar2;AB+C under steadystate conditions at the vibrational level of detail, is solved by a matrix technique. A computer program (MRBIM) has been written by the author to exploit the matrix technique as applied to the H + O 2 reaction. Reaction from levels v = 0 to 15 for O2 and from levels v = 0 to 9 for OH are considered for, while vibrational-translational (V -- T) energy transfer by O2, H, OH, O and He is considered as the mechanism for equilibration. The distortion to the fates of the reaction H+O2&rlhar2;OH+O caused by the non-equilibrium vibrational population distribution is investigated in detail. It is found that the ratio of forward and reverse fate coefficients, (kf/kr does not equal the equilibrium constant, Keq when the reaction proceeds far from equilibrium and this is because the individual rate coefficients are suppressed from their equilibrium values to different extents. We have applied information theory to the HBrv+Cl&rlhar2;HCl v'+Br reaction over a wide range of temperatures, and we have thus extracted an extensive set of state-to-state rate constants from scattered literature data. We also made use of microscopic-reversibility to obtain the exothermic state-to-state rates. Our values for the rate constants fit and extrapolate all existing data. Reaction from levels v' = 0 to 9 of HCl and levels v = 0 to 9 of HBr are considered, while vibrational- translational (V - T) energy transfer by HCl, HBr, Cl, Br, and Ar is considered. The measure of the nonequilibrium effect (kf/kr) / Keq is much more severe for reaction occuring far from equilibrium. The temperature dependence of the non-equilibrium factor is complex. An effort to solve the master equation analytically has resulted in closed form expressions for the rate law for reversible bimolecular reactions, as well as for the thermal rate coefficients, kf and kr, and for the ratio of kf/kr under highly reactive non-equilibrium conditions. They are in qualitative agreement with the exact numerical results, and under some conditions, also in quantitative agreement. Model calculations indicate that our analytical expressions improving on the kinetic mass action law, can be best used when reactivity is from v > 0, v' > 0, and when Keq ≈ 1. (Abstract shortened by UMI.
Robotic-Assisted Obturator Nerve Repair: A Technical Report
No full textBACKGROUND AND IMPORTANCE: Untreated obturator nerve injury may result in weakness in thigh adduction, decreased medial thigh sensation, and groin pain. A neurosurgeon may be consulted intraoperatively for repair. Although there are reports of obturator nerve injury and repair in the gynecologic surgery literature, there are few reports detailing the specific steps of nerve repair after partial transection and the underlying principles of nerve coaptation, especially in the robotic-assisted setting. CLINICAL PRESENTATION: A partial transection of the right obturator nerve was noted in a patient undergoing total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection using the da Vinci robot. Sutures were placed in the epineurium of the cut nerves to realign the fascicles. A porcine wrap was placed around the coaptation site and covered with fibrin glue. The right lower extremity was passively ranged to ensure no tension was present across the repair site. The patient had loss of right leg adduction after surgery, but she recovered full motor function 5 months after surgery with no numbness or pain. CONCLUSION: The current report describes a repair strategy for partial-thickness obturator nerve injury in the setting of a laparoscopic surgery. Working in a multidisciplinary fashion, the tenets of nerve repair may be applied to robotic-assisted cases of obturator nerve injury, resulting in neurologic recovery
Spatial price dynamics in the EU F&V sector: the cases of tomato and cauliflower
No full textThe paper explores the characteristics of spatial price dynamics for fresh vegetables. The analysis is carried out on selected EU prices for tomatoes and cauliflowers collected on some of the main production and consumption markets. It is based on the estimation of an time-varying threshold autoregressive econometric specification that is shown capable to underline the asymmetries in inter-Countries price transmission. The model shows that that horizontal price transmissions among net producer and net consumer markets is asymmetric and how such characteristic differs for markets closer to production areas or to consumption locations. This paper allowed to assess the average elapsing time for shocks to be transmitted among spatially separated markets, and, in particular, it shows the speed of transmission of price raises and price falls.price transmission, TVECM, vegetables
Spatial price dynamics in the EU F&V sector: the cases of tomato and cauliflower
No full textThe paper explores the characteristics of spatial price dynamics for fresh vegetables. The analysis is carried out on selected EU prices for tomatoes and cauliflowers collected on some of the main production and consumption markets. It is based on the estimation of an time-varying threshold autoregressive econometric specification that is shown capable to underline the asymmetries in inter-Countries price transmission. The model shows that that horizontal price transmissions among net producer and net consumer markets is asymmetric and how such characteristic differs for markets closer to production areas or to consumption locations. This paper allowed to assess the average elapsing time for shocks to be transmitted among spatially separated markets, and, in particular, it shows the speed of transmission of price raises and price falls.price transmission, TVECM, vegetables, Agribusiness, Agricultural and Food Policy, Community/Rural/Urban Development, Food Consumption/Nutrition/Food Safety, Labor and Human Capital,
IMPACT OF CHANGE ORDERS ON THE COST PERFORMANCE OF MASS TIMBER CONSTRUCTION PROJECTS
No full textThesis (M.S.)--Michigan State University. Construction Management - Master of Science, 2024One of the major barriers to the widespread adoption of mass timber as a material is lack of knowledge. This lack of knowledge further promotes issues like high production and construction costs. The construction industry in the United States has been reluctant to accept mass timber as a new technology owing to these higher initial costs. Consequently, the most critical factor affecting the selection of a construction material is its cost performance. A successful construction project is governed by its cost performance. Although, the cost performance of a project can be affected by cost overruns and change orders. These project costs can be optimized by reducing the time. Owing to its prefabricated nature, mass timber construction can cut down time. While change orders negatively affect the time of a project, there is a need to understand their impact on mass timber construction. This study analyzes the impact of change orders on the cost performance of mass timber construction projects. The expected deliverables are to quantify and understand the most common causes of change orders in mass timber projects. The researcher believes that this study is a steppingstone toward the widespread adoption of mass timber as a construction material. Project data was collected for 34 projects from General Contractors around the country. Pearson\u2019s correlation, descriptive statistics, and ANOVAs were used to analyze the data collected. This study observed the relationship between the mass timber scope and the mass timber change orders. Along with that the project delivery methods and their impact on the construction costs was studied. The author believes a more widespread adoption of mass timber is beneficial through project team integration and reduction of change order costs.Description based on online resource. Title from PDF t.p. (Michigan State University Fedora Repository, viewed ).Includes bibliographical references
Rejecting hybridity? : the 'native foreigner' in the novels of Meera Syal and Hanif Kureishi
No full textThis thesis was scanned from the print manuscript for digital preservation and is copyright the author.
Researchers can access this thesis by asking their local university, institution or public library to
make a request on their behalf. Monash staff and postgraduate students can use the link in the References field
Antibody drugs conjugates in small-cell lung cancer: present-day status and promises
No full textSmall-cell lung cancer (SCLC) accounts for 15% of lung cancers and is characterized by an aggressive disease course and historically poor prognosis. Although tumors in most patients respond to initial chemotherapy, relapse is nearly universal and treatment options remain limited. Antibody-drug conjugates (ADCs) have emerged as a novel therapeutic class with the potential to address this unmet need.
ClinicalTrials.gov, PubMed, and their associated references and press releases were queried for the search terms "antibody-drug -conjugates" and "SCLC." Only English-language sources were included.
Multiple ADCs targeting diverse antigens have been evaluated in relapsed or refractory SCLC. Topoisomerase I inhibitor payloads have generated the most consistent activity across delta-like protein 3, TROP2, B7-H3, and SEZ6 targets, while microtubule and pyrrolobenzodiazepine-based constructs have not demonstrated durable benefit. Despite encouraging response rates, progression-free survival has remained short, reflecting intrinsic resistance, antigen heterogeneity, and toxicity-related dose limitations.
While ADCs have generated encouraging response rates in SCLC, durability has remained limited. Future development will require optimization of payloads, linkers, and trial design to determine whether ADCs can achieve a sustained role in this disease.
© The Author(s) 2025. Published by Oxford University Press
Outcomes, Complications, and Dosing of Intrathecal Baclofen in the Treatment of Multiple Sclerosis: A Systematic Review
No full textOBJECTIVE The purpose of this systematic review was to evaluate empirical outcomes of studies in the literature that investigated effectiveness of intrathecal baclofen (ITB) in the treatment of multiple sclerosis (MS)–related spasticity (MSRS) based on various metrics. Since the first description of this route of baclofen delivery for MS patients by Penn and Kroin in 1984, numerous studies have contributed to the medical community’s knowledge of this treatment modality. The authors sought to add to the literature a systematic review of studies over the last 2 decades that elucidates the clinical impact of ITB in treating MSRS with the following endpoints: impact on patient-centered outcomes, such as spasticity reduction (primary), complications (secondary), and dosing (secondary). METHODS The authors queried three databases (PubMed, Scopus, and Cochrane Library) using the following search terms: (intrathecal baclofen) AND (multiple sclerosis). The set inclusion criteria were as follows: 1) original, full-text article; 2) written in the English language; 3) published between and including the years 2000 and 2023; 4) discussion of pre- and post-ITB pump implantation outcomes (e.g., reduction in spasticity and improved comfort) in MSRS patients with long-term ITB treatment; and 5) contained a minimum of 5 MS patients. Data on study type, patient demographics, follow-up periods, primary outcomes, and secondary outcomes were extracted from the included studies. RESULTS The authors’ search yielded 465 studies, of which 17 met inclusion criteria. Overall, they found evidence for the effectiveness of ITB in treating MSRS patients whose condition was refractory to oral medications, with significant reported changes in spasm frequency from pre- to postimplantation. They also found evidence supporting the positive impact of ITB on MSRS patients’ quality of life. Moreover, the authors found that most complications were surgical rather than pharmacological. In addition, the average 1-year dose of ITB (reported in 7 of the included studies) was 191.93 μg/ day, which is substantially lower than ITB doses reported in the literature for patients with central (non-MS) or spinal origins of spasticity at 1-year follow-up. CONCLUSIONS The evidence supports ITB as a clinically effective treatment for MSRS, particularly in patients in whom oral antispasmodics and physiotherapy have failed. This systematic review contributes a comprehensive synthesis of clinical benefits, complications, and dosing of ITB reported over the past 2 decades, which furthers an understanding of ITB’s clinical utility in practice
