An application of the hybrid AHP-PROMETHEE approach to evaluate the severity of the factors influencing road accidents.

The evaluation of the severity of the factors influencing road accidents with a detailed severity distribution is critical to plan evidence-based road safety improvements and strategies. However, currently available studies use statistical and machine learning (ML) models to evaluate the severity of factors causing road accidents without a detailed severity distribution. Further, most of these available models require significant pre-data processing and have certain data-centric limitations. However, the multi criteria decision-making (MCDM) techniques have the potential to combine expert opinions for robust analysis without any pre-data processing calculations. Thus, this study uses a hybrid analytic hierarchy process (AHP) and the preference ranking organisation method for enrichment evaluation (PROMETHEE) approach to analyse the severity of factors and characteristics that influence road accidents within the Gujarat state, using injury types as criteria and minor road accident influencing factors as alternatives. These 82 minor factors have been further characterised into 18 characteristics and 4 major factors. Further, AHP integrated 40 expert inputs to determine criterion weights, while PROMETHEE ranked all minor variables. Then, after applying k-mean clustering, each ranked factor has been classified as very severe, moderately severe, or severe. The result clearly highlights that overspeeding, male gender, and clear weather conditions have been concluded to be the highly severe factors for Gujarat state. Thus, by providing a clear severity analysis and distribution of factors influencing road accidents, the proposed research may help government stakeholders, researchers, and politicians build severity-based road safety reforms and strategies with clarity.

Granulomatosis With Polyangiitis Complicated by Diffuse Alveolar Hemorrhage, Splenic Infarction and Stroke.

Granulomatosis with polyangiitis (GPA, formerly Wegener granulomatosis) is a type of small artery necrotizing vasculitis that presents with various organ manifestations and disease severity. The most commonly and severely affected organs include the nasopharynx, lungs, and kidneys. However, it can have atypical presentations and lead to misdiagnosis. Here we present a case report of a patient diagnosed with GPA complicated by diffuse alveolar hemorrhage (DAH), splenic infarctions, and stroke.

Severe Ketamine-Induced Uropathy Associated With Cholangiopathy Requiring Percutaneous Nephrostomy.

Ketamine-induced uropathy (KIU) is becoming more prevalent as ketamine abuse becomes widespread. Recently, a plethora of reports have highlighted the association between recreational ketamine abuse and its deleterious effects including uropathy and cholangiopathy. However, there are hardly any reports that demonstrate the management of severe KIU in young people. We report a case of an Asian female in her late 20's with a 10-year history of ketamine abuse who presented to the emergency department with sharp, epigastric pain for two weeks. An evaluation revealed acute kidney injury and transaminitis with bilirubinemia. CT scan showed bladder and ureteral wall thickening with hydroureteronephrosis. The patient underwent percutaneous bilateral nephrostomy tubes placement, improving urine output and with acute kidney injury resolution. Repeat renal/bladder US showed near complete resolution of bilateral hydronephrosis. This case documents one of the first few documented cases of severe ketamine-induced uropathy with cholangiopathy necessitating bilateral nephrostomies in the continental U.S.