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Your air pollution reduction benefit is based on a very poor
assumption of all new cyclists were former drivers (per Rabl and De
Nazelle) could be no more wrong than in NYC with the biggest public
transit system in the US, lowest per capita car ownership and miles driven
of any major city, and where over 56% of workers use public transit, and
over 10% walk. Even the estimated 30% who drive or cab to work are
unlikely to...
Your air pollution reduction benefit is based on a very poor
assumption of all new cyclists were former drivers (per Rabl and De
Nazelle) could be no more wrong than in NYC with the biggest public
transit system in the US, lowest per capita car ownership and miles driven
of any major city, and where over 56% of workers use public transit, and
over 10% walk. Even the estimated 30% who drive or cab to work are
unlikely to convert to bicycling given how they might be elderly/disabled,
choose not to even walk to public transit bus stops and subway stations,
or may drive cabs or delivery vehicles for work.
Unless you get accurate survey information of mode shifts from new
cyclists since bike lane institution, you have no basis to make your huge
claims of air pollution reduction, and thus can't claim even 25% of the
air quality benefit you do to non-riders. In Rabl and De Nazelle cyclists
suffer from greater exposure to air pollution in traffic than non-riders.
Rider positive benefit is limited to added exercise.
I hope you reconsider your assumptions and calculations to produce a
more accurate estimation of bike lane cost-effectiveness.
On 25 April 2015 Nepal witnessed a huge earthquake of 7.8 magnitude
claiming over 8000 lives and injuring more than 23,000[1].Those injured
incurred either crush injuries, fractures or head and spinal cord trauma.
WHO estimates,over 400 people have sustained spinal cord injuries owing to
earthquake.[2]. They have become either paralyzed or developed weakness of
limbs (paraparesis) extending from neck downward (quadriparesi...
On 25 April 2015 Nepal witnessed a huge earthquake of 7.8 magnitude
claiming over 8000 lives and injuring more than 23,000[1].Those injured
incurred either crush injuries, fractures or head and spinal cord trauma.
WHO estimates,over 400 people have sustained spinal cord injuries owing to
earthquake.[2]. They have become either paralyzed or developed weakness of
limbs (paraparesis) extending from neck downward (quadriparesis) or in
lower limbs (paraparesis) with bladder and bowel dysfunction.
While many sustained primary injuries due to earthquake, many others
sustained secondary injuries due to improper transportation of these
patients to health facilities. Much of the reachable health facilities
were damaged by earthquake and thus patients needing immediate spinal
support were further deteriorated by this situation. In addition, majority
of the health care providers involved in the search ,rescue and the
evacuation were unaware of the concept of correct immobilization, log roll
and transport technique. The use of the spinal board was hardly seen. This
resulted in the neurological and vertebral damage further worsening to
complete SCI(Spinal Cord Injuries).
Spinal cord injury has a devastating effect in a person's life ranging
from psychosocial impact to the different grades of disability. The
challenges posed by spinal cord injuries vary in wide spectrum,
particularly treatment of which demands clinician's technical expertise
and advanced surgical facilities. Even in an advanced technical facility,
treatment requires a concentrated effort and dedication of both the
clinicians and the patients. With the good medical, nursing and
physiotherapy most of the cases can be revived back to the normal.
In Nepal, the only rehabilitation center, situated in Kavre district has
received 150 patients with spinal injuries during the period of April to
August 2015.There might have been several other cases of spinal cord
injuries which might have been undocumented. Many undocumented cases might
have been either unable to reach health center particularly, spinal cord-
treating centres or might have given up hopes. This suggests the need of
spinal injury treatment centres and inadequacy of current level of health
facilities.
Incomplete quadriplegia has good recovery while complete have bad
prognosis. In Saga Spinal cord injury treatment center, among the treated
cases, no death has been reported so far, however, the complications like
Pressure sore has been reported in 16 patients. Impairment of autonomous
dysfunction such as Urinary Treatment Centre has been reported in 50
patients and DVT (Deep Venous Thrombosis) in 6 patients. Out of the total
150 cases managed in this spinal cord treatment center, 50% underwent
surgery for unstable fracture of spine while remaining were managed
conservatively.
In Nepal there are 20 spinal surgeons, 12 physiotherapists and 6
occupational therapists. These professionals are overburdened by current
level of work. This necessitates the immediate need of further technical
human resources.
References:
1. Nepal, G.o., Post Disaster Needs Assessment. 2015: Nepal.
2. WHO, WHO mobilizes funds for long-term spinal cord treatment after
Nepal earthquake. 2015: Nepal.
We read with interest the article named 'Prevention and treatment of
decompression sickness using training and in-water recompression among
fisherman divers in Vietnam' that was published in Injury Prevention 2016
February issue. We want to share our opinion about some parts of the
article, especially in three subjects.
It was mentioned that, the aim of the study was to investigate the
impact o...
We read with interest the article named 'Prevention and treatment of
decompression sickness using training and in-water recompression among
fisherman divers in Vietnam' that was published in Injury Prevention 2016
February issue. We want to share our opinion about some parts of the
article, especially in three subjects.
It was mentioned that, the aim of the study was to investigate the
impact of training programmes run over a period of 3 years, focusing on
preventing DCS by reducing unsafe diving practices and treating DCS by
means of IWR, in the last sentence of introduction. So we understood that
the main subject of the study is forcing fisherman divers to make safe
dives resulting in decrease in DCS and also to treat urgently with IWR if
disease occurs. Therefore this education only involves lowering DCS and
treating with IWR. But it is remarked as "Since implementing IWR training,
annual mortality and morbidity incidence rates due to neurological DCS
were reduced in our pilot sample" in second sentence of discussion. It was
understood from the article, prior to 2009, annual mortality due to diving
was estimated 4?1 cases per 1000 fisherman divers and annual incidence of
DCS was 8?2 cases. Between 2009 and 2012 fatality rate dropped 1 per 1000
divers and annual incidence of DCS dropped 2?1 per 1000 divers. However we
know it is unlikely to have a mortality rate of four cases in every eight
DCS cases before 2009 and also one fatal case within two cases of DCS
between 2009 and 2012. Many studies was reported before about this issue,
in one of them Xu et al. showed nine deaths of 5278 consecutive DCS cases
with a incidence of 0.17% in a decade (1). It seems suspicious that one in
a two cases DCS mortality rate as mentioned in the article. Probably the
mortality reasons must be other than DCS, e.g. drowning, nitrogen narcosis
and diving related accidents, before 2009 and also between 2009 and 2012
in these dive sites. We found it very challenging; two days 10 subjects
IWR training courses reduced annual mortality rates due to the DCS.
On the other hand, in the treatment of DCS, there appears three main
goals; [1] immediate reduction in bubble size, [2] to increase the washout
of inert gas and [3] to provide oxygen delivery to the tissues to restore
normal functions (2). If we put an order in terms of treatment efficacy;
standart recompression treatment in chamber (oxygen, 45-60 feet), IWR with
oxygen, breathing oxygen at surface, IWR with air at working depth
(fisherman divers' traditional IWR), IWR with air (Clipperton Protocol, 9
m.) had superiority each other, respectively in the treatment of DCS. It
is well known that, in the absence of a hyperbaric chamber treatment, IWR
with oxygen of course superior to breathing oxygen at surface in DCS.
Known risks of IWR are drowning, applying difficulties, hypothermia and
disability to transfer patient to chamber because of being underwater. It
has been shown that IWR with air at 9 meters has no significant benefit in
DCS; also authors mentioned in the article IWR with air is useless which
the fisherman divers used to do traditionally. Nevertheless authors
advised to divers apply IWR with air at nine meters, which is the last
choice in treatment of DCS but they did not mention exactly why divers
should follow this protocol. If it is done with oxygen it should be
helpful but not with air. According to our knowledge IWR with air should
not be performed, if it is to be done deep treatment protocols must be
chosen, not at shallow depth like nine meters (3).
The last point we want to take attention is that only eight of 24 DCS
patients have been treated with oxygen, the rest were treated with air.
Unfortunately the number of divers, which were treated with oxygen, is
very low. However, two of eight of these patients (%25) started with
oxygen but continued with air, because the cases were not able to breathe
from a second stage regulator. In our opinion, if the rate (%25) is really
in high ranges like this, there could be given educations about using
hoses without second stage regulator.
Declaration of conflicting interests:
The authors declared no conflicts of interest with respect to the
authorship and/or publication of this letter.
Funding:
No author or related institution has received any financial benefit for
this letter.
References
1. Xu W1, Liu W, Huang G, Zou Z, Cai Z, Xu W. Decompression illness:
clinical aspects of 5278 consecutive cases treated in a single hyperbaric
unit. PLoS One. 2012;7(11):e50079.
2. Diving and Subaquatic Medicine, Fifth Edition. Carl Edmonds, Michael
Bennett, John Lippmann, Simon Mitchell. 2015. p. 167
3. 6th ed. USA: U.S. Navy Diving Manual, 2008
Your air pollution reduction benefit is based on a very poor assumption of all new cyclists were former drivers (per Rabl and De Nazelle) could be no more wrong than in NYC with the biggest public transit system in the US, lowest per capita car ownership and miles driven of any major city, and where over 56% of workers use public transit, and over 10% walk. Even the estimated 30% who drive or cab to work are unlikely to...
On 25 April 2015 Nepal witnessed a huge earthquake of 7.8 magnitude claiming over 8000 lives and injuring more than 23,000[1].Those injured incurred either crush injuries, fractures or head and spinal cord trauma. WHO estimates,over 400 people have sustained spinal cord injuries owing to earthquake.[2]. They have become either paralyzed or developed weakness of limbs (paraparesis) extending from neck downward (quadriparesi...
Sir,
We read with interest the article named 'Prevention and treatment of decompression sickness using training and in-water recompression among fisherman divers in Vietnam' that was published in Injury Prevention 2016 February issue. We want to share our opinion about some parts of the article, especially in three subjects.
It was mentioned that, the aim of the study was to investigate the impact o...