Evaluation of flow, supply, and demand for noise reduction in urban area, Hamadan in Iran.

Noise pollution is one of the consequences of urbanization that can cause environmental disturbances in urban areas. Urban ecosystems provide noise reduction services through Urban Green infrastructures (UGIs). Many studies have been conducted to evaluate and model traffic noise, but none have addressed the flow, supply, and demand of noise reduction ecosystem services. The main purpose of this paper is to present a new methodology for estimating flow, supply, and demand for noise reduction in Hamadan city that has not been mentioned in any paper so far. UGIs were classified into six main categories: agricultural lands, gardens, parks, abandoned lands, single trees, and street trees. A total of 57 sampling stations for sound measurement were made in August 2018. The current map of noise pollution (flow) was created using the Kriging method. The amount of supply was measured up to a distance of 50 meters from the main roads based on two approaches (the distance effect and the sound barrier effect). To quantify the demand, the current sound intensity level in the noise-sensitive land uses was compared with standards. Zonal statistics was used for spatial analysis of supply-demand in the urban neighborhood as a working unit. Results showed that at distances of 5m, 10m, 15m, and 20m, the average noise reduction was found to be 1.61, 2.83, 3.92, and 5.33 dB, respectively. Sound barriers at distances of 5m and 10m resulted in an average sound reduction of 1.61 and 2.83 dB, respectively. Individual trees, strip trees, abandoned lands, parks, and gardens led to a decrease in traffic noise by 0.3, 1, 0.1, 3.5, and 4.5 dB, respectively. The clustering analysis revealed a significant spatial clustering of noise pollution in Hamedan. The results and new methodology of this research can be used in similar areas to estimate the supply and demand of noise reduction and also for decision-makers to take management actions to increase supply and meet the demand for noise reduction service.

A Multidisciplinary Approach to Penetrating Neck Trauma in a Patient with Self-Inflicted Gunshot Injuries to Zones 1-3 of the Neck.

Penetrating neck trauma comprises 5%-10% of all traumatic injuries in adults and carries up to a 10% mortality rate for those affected. Management of penetrating neck trauma can be challenging and often requires a multidisciplinary approach. A case of penetrating neck trauma via self-inflicted gunshot wound to zones 1-3 of the neck in an intoxicated, suicidal 60-year-old man is presented. Immediately after stabilization by the trauma surgery team, surgical reconstruction using a pectoralis major pedicled myocutaneous flap was completed by the plastic and reconstructive surgery team. The patient's hospital course was complicated by injury to the left phrenic nerve, oropharyngeal swallowing dysfunction, and left diaphragmatic dysfunction. The trauma team initiated prompt multidisciplinary responses to each of these complications as they arose by involving the plastic and reconstructive surgery, otolaryngology, gastroenterology, and speech language pathology teams. Early involvement of the physical medicine and rehabilitation, psychiatry, dietary, and pharmacy teams allowed for early optimization and monitoring of the patient's mobility, psychological, and nutritional statuses. The timely initiation of multidisciplinary care in this patient's case allowed for the patient to not only to survive a potentially fatal penetrating neck trauma, but to be discharged to a rehabilitation facility with an independent level of function. Given the complications due to severe penetrating neck trauma of zones 1-3 in this case, it is essential for early involvement of the appropriate subspecialty teams in order to achieve the best possible outcome for the patient.

Responses of surface water quality to future land cover and climate changes in the Neka River basin, Northern Iran.

The spatial and temporal dimensions of environmental impacts of climate and land cover changes are two significant factors altering hydrological processes. Studying the effects of these factors on water quality, provides important insight for water resource management and optimizing land planning given increasing water scarcity and water pollution. The impact of land cover and climate changes on surface water quality was assessed for the Neka River basin in Northern Iran. The widely used Soil and Water Assessment Tool (SWAT) was applied for pollutant modeling, and was calibrated using the Sequential Uncertainty Fitting (SUFI-2) algorithm. An ensemble of 17 CMIP5 climate models under two IPCC greenhouse gas emission scenarios were selected, and future land cover change (LCC) was modeled based on the evolution that occurred in the last decades. We simulated the impacts of climate change (CC) and LCC on sediment, nitrate, and phosphate for the 2035-2065 time slice. The annual loads of sediment, phosphate, and nitrate are projected to decrease under both CC scenarios based on the inter-model average, and generally follow a pattern similar to the change in river discharge. Nitrate concentrations show an increase across all seasons, while the sediment and phosphate concentrations increase in winter and autumn under CC conditions. Results indicate that pollutants are expected to increase under LCC alone, mainly due to the expansion of the cultivated areas. Overall, it seems CC has a greater impact than LCC on the variation of water quality variables in the Neka River basin. With a combined change in climate and land cover, the annual nitrate concentrations are expected to increase by + 19.7% and + 17.9%, under RCP 4.5 and RCP 8.5, respectively. The combined impacts of the CC and LCC caused a decline in the annual sediment and phosphate concentrations by -10.1% and -2.2% under RCP 4.5 and -9%, and -3.2% under RCP 8.5, respectively.

Facial Gunshot Wound: Mandibular Fracture With Internal Fixation and a Pectoralis Myocutaneous Flap Coverage.

Facial penetrating gunshot wounds (GSWs) are seen in an assault, suicide, and accidental injury. They often carry high mortality given the important anatomical structures located within the neck. The foundations of maxillofacial GSWs are rooted in data from military combat, specifically the last world war. This type of injury is complex for reconstructive surgery due to significant soft tissue and bone loss. Management of maxillofacial GSWs is often challenging and has trended from serial debridement, immediate reconstruction, local tissue flaps, and distant free flap transfers depending on bullet trajectory and wound intricacy. We present a case of a 51-year-old male with a 22-caliber GSW to the left side of his face. Hemodynamics were stable on arrival and history included alcohol use. A left mandibular wound measured approximately 8 cm in diameter with exposed bone. A small 0.5-1 cm wound was also present inferiorly. A maxillofacial CT scan was utilized, showing a left mandibular body fracture. The patient underwent exploration and debridement on the same day of injury. Open reduction with internal fixation of the left mandible fracture and Synthes 2.5 mm locking plate was done. Additionally, a left pectoralis major myocutaneous muscle flap was performed two days later. Regional pectoralis flap reconstruction of facial firearm injury is scarcely acknowledged in the literature. Due to the location of the wound, the functionality of the jaw can be maintained in addition to ample blood supply by performing mandibular fixation and pectoralis major myocutaneous flap.

Complex Wound Closure Following Mysterious and Vicious Animal Attack.

Animal attacks are a worrisome and dangerous entity that occur at high volumes and are evaluated frequently by ER physicians, primary care physicians, trauma teams, acute care surgeons, and plastic surgeons. The severity of animal attacks can range from a small insect sting to mauling by large animal, and even death. With animal attacks of high intensity, there is often significant scratching, tearing, shearing, with destruction of the skin, subcutaneous tissues, muscles, and bone. Serious attacks frequently lead to infection, sepsis, pain, loss of sensation or mobility, operative interventions, and amputations of affected limbs. We report herein the traumatic mauling of a woman by a reported unknown animal. Though the entity of animal attacks has been reported in the past, this case dictates presentation given the suspicious circumstances surrounding the attack, the involvement of her care requiring a multidisciplinary surgical approach via trauma surgery and plastic surgery, multiple extensive interventions, and the excellent take of the split thickness skin graft (STSG) after the use of a dermal regeneration template (DRT).

A new ecosystem-based land classification of Iran for conservation goals.

Land management and biodiversity protection are highly dependent on ecosystem classification. To identify the ecosystems, often ecologically homogenous areas are distinguished based on physical and biological features at various scales. These areas can also be considered as biodiversity surrogates for protection policies and planning. We classified the terrestrial areas of Iran into ecosystems using revised and updated layers of landform and climate as our two main criteria. Moreover, we applied a revised vegetation layer as the confirmatory criterion. At a scale of 1:1,000,000, we obtained a total of 119 homogenous ecological units, and based on the dominant vegetation types, we classified them into 21 terrestrial ecosystems at the national level. Of these ecosystems, 11 were dominated by vegetation, and the remaining 10 had sparse nondominant vegetation. Evaluation of the least and most frequent ecosystem patches and ranking of their size classes using landscape metrics provided an information basis for better land protection planning. We maintain that each ecosystem needs to be represented by a protected area and its size and distribution also helps us form a comprehensive and effective protection network in Iran. Graphical abstract.

Norwegian Scabies management after prolonged disease course: A case report.

INTRODUCTION: Scabies is a well - known, commonly recognized, and frequently diagnosed pathology especially in children, close quarters, living facilities, and immunocompromised patients. An accelerated severe infestation of traditional scabies with limited treatment options is known as the rare entity of Norwegian or Crusted Scabies. CASE PRESENTATION: We present the history, clinical manifestations, medical treatments and surgical interventions of a patient with Norwegian Scabies of his hands, which rendered them nonfunctional prior to intervention. The patient was initially misdiagnosed and underwent inappropriate treatments for several years prior to our assessment, and ultimately required surgical intervention that was therapeutic. DISCUSSION: Norwegian, or Crusted, Scabies is a severe infestation of S. scabiei in which the mite load is extreme in comparison to traditional scabies. This manifests as scaly plaques that are often misdiagnosed for other hyperkeratotic skin lesions. With this misdiagnosis, improper treatments are often recommended, and can even accelerate the manifestation. Traditional scabies therapies can be effective, however often due significant disease progression due to diagnostic delay, invasive measures, such as surgical debridement like presented here, are the only option. CONCLUSION: The patient presented in this case harbored a rare infection, known as Norwegian Scabies, for several years, with inappropriate medical therapy. Due to his prolonged inadequate treatments, his disease became so pronounced that the recommended medical treatments were no longer adequate, thus he required surgical debridements which ultimately allowed him to regain function in his hands.