Walkability, by J.D. Meyer

Let’s explore walkability—a key concept in urban studies/planning. Does your city have enough sidewalks—especially downtown? Downtown Tyler, Texas has a commendable Walk Score of 72, but the overall city only scores 35. https://www.walkscore.com/TX/Tyler  I’ve lived in four Tyler neighborhoods; walkability scores range from 24 to 66. Midtown/Hospital District is the best (66), and Hollytree in South Tyler is the worst (24).. Suburban sprawl is based on the domination of cars, and that leads to more traffic and air pollution. Can you easily walk to nearby bus stops?

The only time I really love the term—conservative—is when it’s preceded by the adjective: “fiscal.” I’m not the kind of liberal who would claim a need for concrete sidewalks on both sides of virtually all streets—unless it’s downtown. As long as one side of a major street has a paved sidewalk, your walking experience will be adequate. Moreover, flat land could get away with a trimmed dirt path through the grass. Not just a bus rider, I have considerable experience walking in Tyler—mainly in Midtown (66), Downtown (72), North Tyler (49 & 55), and Southeast Tyler (31).

Sidewalks could be downright dangerous if the land is slanted at a 45 degree angle! Hopefully, the pedestrian would have crossed the street by that time. On the other hand, a hilly path like across the street from Shiloh Road Learning Center could be a hazardous walk without paving or a trail. I recall a sidewalk in Midtown that was dangerously broken, and it could have been improved with some asphalt. Furthermore, bus ridership can improve with good sidewalks on the way to the bus stops.

Let’s hope my observation as a bus rider/pedestrian helps in our development of walkability. Check out this most walkable cities article with a map (at least a 100K population). http://www.governing.com/topics/urban/gov-most-walkable-cities.html

 

 

Alternatives to the Environmental & Economic Damage by the Border Wall Joffre (J.D.) Meyer @bohemiotx

“This Twitter moment offers alternatives (technology & more) to the environmental & economic destruction–including ecotourism–by the proposed border wall. Executive Order 12898 (1994) is Environmental Justice in Minority & Low Income Populations.”

1. Environmental & Ecotourism Impact of the Proposed Border Wall by @bohemiotx https://soapboxie.com/social-issues/Environmental-Ecotourism-Impact-of-the-Proposed-Border-Wall … #environment #SouthTX #ecotourism #EconomicJustice

2. Environmental & Ecotourism Impact of the Proposed Border Wall, Part Two: Smart Walls with Technology, by J.D. Meyer https://bohemiotx.wordpress.com/2019/03/20/environmental-ecotourism-impact-of-the-proposed-border-wall-part-two-smart-walls-with-technology-by-j-d-meyer/ … via @bohemiotx #Technology #BorderWall #Environment #Texas

3. Republican Congressman: Trump’s Border Crisis Is a ‘Myth’ https://www.rollingstone.com/politics/politics-features/will-hurd-border-wall-myth-781204/ … via @RollingStone #NorthernTriangle #LiDAR #NoBorderWall #SmartWall #ambassadors

4. Marines commandant protests US border deployments, wall https://news.yahoo.com/marines-commandant-protests-us-border-deployments-wall-232037037.html?soc_src=hl-viewer&soc_trk=tw … via @YahooNews #military #NoBorderWall

5. The Texas-Mexico Border Wall Comes with a Dangerous, Costly Side Effect: Flooding https://www.texasobserver.org/the-texas-mexico-border-wall-comes-with-a-dangerous-costly-side-effect-flooding … #BorderWall #floods #environment

6. Forget Trump’s Border Wall. Let’s Build F.D.R.’s International Park. https://nyti.ms/2JcYIl1 #BigBend #environment #Texas

7. New alternative to Trump’s wall would create jobs, renewable energy, and increase border security [solar, wind, natural gas and desalination facilities along the entirety of the border]. #GreenEnergy #Border #economics https://bigthink.com/politics-current-affairs/build-the-energy-wall?fbclid=IwAR3ed6Ai1UhYyC7Kz0Xt8mOeJrnBNsWMIhxwKo-3uR5t0LoacuoH2eYj1GQ

8. Future Energy, Water, Industry and Education Park (FEWIEP) https://www.purdue.edu/newsroom/releases/2019/Q1/USMexico-Border-Proposal_WHITEPAPER-2019.pdf … #FEWIEP #environment #RenewableEnergy

Replying to @amyklobuchar @keithellison
9. Could Executive Order 12898–Environmental Justice in Minority & Low Income Populations (1994) help in the fight against the #BorderWall? #ecotourism #SouthTX

10. Christina McNearney @tmcnearney1 • Mar 16
We stand strong as one progressive movement against our president’s anti-immigrant, anti-environment agenda. #NoBorderWall https://addup.sierraclub.org/campaigns/stand-with-immigrants–border-communities-for-environmental–social-justice-no-beds-no-boots-no?promoid=7010Z0000027Wv5QAE&utm_medium=recruit&utm_source=twitter&utm_campaign=addup&tc=false

SOL18: Report on TX SILC Transportation Works Summit to ETHNN Transportation Cmte, Part 1 by JD Meyer

I attended the 2nd annual Transportation Works Summit in Waco, TX “Collaboration & Connectivity” on Thursday, January 25 through Friday, January 26th in Waco. Last year’s conference was in Austin, and the theme was “Identifying & Removing Barriers through Innovation.” Major topics included city transit, paratransit, Uber and Lyft, violation of parking for the handicapped, and sidewalk concerns. If there was less dependence on cars, there would be increased efficiency and safety because there would be fewer cars on the road.

The first speakers were from the Texas A&M Transportation Institute. Their topic was “Emerging Issues & Advances in Accessible Transportation.” Low-vision people can be helped through Smart Cane Assistive Navigation (SCAN). Pathway Solutions for wheelchairs examines sidewalk conditions and curb cuts. Carnegie Mellon developed smart phones with traffic signals.
Houston METRO has 12 routes with 2400 stops and aspires to have 9600 stops. Plus, they’re being funded by Google! Houston also has a paratransit feeder service pilot program. It serves an area within a ¾ mile area around fixed routes, as well as beyond the required area. Capital Metro of Austin’s grant application, Transit Cooperative Research Program (TCRP IDEA), integrates transit and pedestrian planning. The technology is Open Source, so anyone can use it. San Antonio has a bunch of bond initiatives, including sidewalks.

The speaker hoped that someday sidewalks would be viewed as important as roads. Later we heard from Brian East, that sidewalks built after 1-27-92 must have curb ramps. Brian East works for Disability Rights Texas.
As for other states, Massachusetts Bay Transportation Authority has a paratransit agreement with Uber and Lyft. Washington Metro Area has an on-demand paratransit that’s partly subsidized and allows service animals. Some places are experimenting with autonomous vehicles; that means they can drive themselves without a driver. Texas A&M has low-speed autonomous vehicles that are golf cart look-alikes for its giant campus. Automated Vehicle proving grounds are in seven Texas cities: Arlington, Austin, Bryan-College Station, Corpus Christi, Huston, and San Antonio.

Wheelchair passengers riding planes is a concern as a staggering 98% of them don’t travel by plane. However, more children would survive a plane wreck than a car wreck. Qstraint is the leader of wheelchair tie down services, and it’s passed a 20G crash test—doubled in eight years! Wheelchair test criteria examines if the rider would be thrown out of a plane, fall over on its side, be ripped away from the floor, and if the straps were adequate. Partnerships have developed between airlines, plane manufacturers, wheelchair manufacturers, and universities. Recall that Collaboration & Connectivity was the theme of the 2018 transportation summit.

At the Lunch Panel, we found out that Texas is a leader in accessible buildings. There have been efforts to move into rural areas with Uber and Lyft because the drivers would have their own vehicles. Public transport is stronger when cities are bigger. It’s expensive for transit to run paratransit.

Upon hearing that paratransit can be hampered by a lack of funds, when I returned to Tyler, I proposed that we look for the for-profit businesses that would have a vested interest in paratransit and get a tax deduction for donations! “Eds and Meds” place like East Texas Medical Center (ETMC) and UT Health-NE are the most obvious. But how about banks? Tyler has a bunch, and it could be really good public relations. Then a lawyer friend suggested looking for businesses that have a large percentage of employees using Tyler Transit as possible donors.

“Asthma-COPD Overlap Syndrome (ACOS),” Footnotes & a Commentary from a Patient (6th Edition), by J.D. Meyer

 

“Asthma-COPD Overlap Syndrome (ACOS): A diagnostic challenge,” was a Top 100 WebxMD article for 2015. http://onlinelibrary.wiley.com/doi/10.1111/resp.12653/full It caught my attention because I’ve had this condition for ten years; however, I never heard the two described as a unit in this manner! Three symptoms stood out on my first reading: increased sputum, more dyspnea (breathlessness), but better response to inhaled corticosteroids. At once, I told all my local health connections about ACOS. This article was written by three doctors in the Far East: Vietnam, Korea, and Japan. “Tho, N. V., Park, H. Y. and Nakano, Y. (2015), Asthma–COPD overlap syndrome (ACOS): A diagnostic challenge. Respirology. doi: 10.1111/resp.12653.”

Furthermore, a Google search for ACOS yielded nothing unless I entered the complete term. So the breakthroughs didn’t happen around here—adding to this disabled Developmental English/Writing—ESOL teacher’s sense of urgency!

Definition of Terms

I printed this article and started highlighting and making notes. Fortunately for me, many of these technical terms corresponded to familiar brand names for my many ACOS drugs. Symbicort is a Long-Acting Beta2-Agonist (LABA) and an Inhaled Corticosteroid (ICS). A LABA is a long-term brochodilator while an ICS decreases inflammation. Rinse your mouth with water after each use, and don’t swallow the water; spit it out. I was switched back to Advair (another LABA +ICS drug), which has bee my usual inhaled corticosteroid. Both drugs are used for asthma &COPD. A Muscarinic Antagonist is also a bronchodilator, such as tiotropium (Spiriva) and aclidinium.

Spiriva, an inhaled capsule, is used for COPD, including emphysema and chronic bronchitis. Later, I was switched to Montelukast, the pill version of Singulair.

There is only one PDE4 inhibitor—Daliresp (roflumilast), and it works against excess bronchitis and phlegm. Daliresp decreases the number of exacerbations in severe COPD, and it’s not a bronchodilator. Daliresp decreases lung inflammation and prevents COPD flare-ups. Don’t use Symbicort, Spiriva, or Daliresp for an acute attack.

For an acute attack, use your “inhaler,” such as ProAir and Proventil; they’re examples of Short-Acting Beta2-Agonists (SABA); both are albuterol. Proair will open the airways and prevent a bronchospasm. You could go for your nebulizer for an acute attack, especially a bad attack. Our albuterol vials for the nebulizer could be called an”extra-strength” SABA. Iprat-Albut (Albuterol & Ipratropium) are two bronchodilators for the COPD patients’ nebulizer. For two decades, I was on pure Albuterol for my nebulizer. Now my inhaler is Combivent–a stronger ipratropium-albuterol inhaler.

Atopic is an allergic reaction, often hereditary. Atopy is a feature of ACOS and associated with a higher prevalence of chronic cough and sputum production, according to Tho, Park, and Nakano. Eosinophilic airway inflammation means there’s a higher than average number of white blood cells. It can be detected in mucus if it’s tissue eosinophilia. Tho, Park, and Nakano note that ACOS patients have higher sputum eosinophil counts than those with COPD alone, but sputum count profiles may change over time. Blood eosinophilia is over 500 in a microliter of blood. I found these definitions at Medicine Net and the Mayo Clinic websites too.  Much of the drug definitions came from the pharmacy’s medicine sheets themselves.

Economic Burden & Disability

Tho, Park, & Nakano note that the percentage of ACOS patients visiting the ER or admitted to hospitals is significantly higher than COPD alone in South Korea. A United States Medicaid population reports that ACOS patients have a higher rate of utilizing any service versus asthma or COPD alone. Moreover, the average annual medical cost for an ACOS patient in the US is $14, 914–much higher than asthma, $2307 or COPD,  $4879. ACOS is common in the elderly. It features more dyspnea (breathlessness), wheezing, and more frequent exacerbations. The respiratory quality of life and amount of physical activity for those with COPD alone.

Addendum to Tho, Park, & Nakano

Using my peak flow meter to check my forced exhale volume (FEV) always has been one of my strong points in managing my ACOS. I check my peak flow meter before I go for a walk, and if I’m under my usual low moderate level of impairment, I head for the albuterol nebulizer. Check my article https://www.newscastic.com/news/forced-exhale-volume-fev-lung-disease-your-peak-flow-meter-1155949/ The “whole story” includes a link to an About.com article on Pulmonary Function tests, by Deborah Leader, RN, COPD Expert.

Returning to the Tho, Park, and Nakano article, we see that a staggering 49% of smokers develop chronic bronchitis and 24% get emphysema or COPD. “Smoker’s cough” is worst upon arising. Dyspnea increases as the disease worsens. Quit smoking or else!

Guaifenesin (Mucinex) has been one of my favorite OTC medicines for years because it’s an expectorant. You can find a cheaper generic version in the dollar store too. Warn the doctor if you smoke, or have asthma or emphysema. It thins the mucus, so it’s less sticky and easier to cough up, according to www.drugs.com/mucinex.html  Take guaifenesin when you have a cold, bronchitis, flu, or allergies–whatever got your chest full of phlegm. Still drink plenty of fluids. www.webmd.com/drugs/2/drug-63818/mucinex-oral/details I’ve been told by my doctor to take a larger than average dose of guaifenesin during an ACOS attack.

I also take an over-the-counter allergy pill, for I’m allergic to Bermuda and Johnson grass. My choice is non-drowsy Loratadine Tablets, an antihistamine that’s another find at Family Dollar. Loratadine is a generic form of Claritin.

Beware of drinks with carbon dioxide (CO2) also, such as beer and soda. http://respiratorytherapycave.blogspot.com/2008/06/asthmacopders-should-avoid-pop-beer.html The ability to exhale carbon dioxide is vastly impaired for the bad lung crowd. “The normal human body breathes to eliminate CO2, producing 200 cc./minute. However, one can of soda has up to 1000 cc. of dissolved CO2. Most is absorbed by into the blood stream by the intestines.” This can lead to more dyspnea (breathlessness) in those with lung disease. Furthermore, beer can cause dehydration too–another cause of dyspnea. Maybe gas pills help; time will tell.

On the other hand, if you like alcoholic drinks and wish to be more careful, then try red wine. First of all, you won’t have to worry about bubbles. Red wine increases antioxidant status and decreases oxidative stress in circulation, mainly because of glutathione (GSH). The “French Paradox” is explained by their love of red wine lessening coronary heart disease despite a fatty diet. https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-6-27

In closing, there’s a rich amount of literature on asthma, bronchitis, and COPD. Learn to manage your illness before you continue to deteriorate, and get a pulmonologist if you don’t have one already.

Frequent Tyler, TX Bus Rider Survey: Answers for a Northside Resident—

Crescent DR & N. Confederate AV.

1. Which bus lines are closest to you?

2. Where are they?

3. Where are the “least distant” bus stops of different lines?

4. Is Bergfeld Shopping Center the closest Yellow Line stop for you?

5. Is the Downtown Transit Depot the closest place for you to access ….
A. Blue North
B. Green North
C. Purple South

6. Where are your favorite bus stops used by three lines, aside from the two hubs.

7. Where would you like to see a bike rack?
1. Two Green South, Blue North, Red South.

2. One Green South is at MLK and Englewood, near the grounds of the now-gone Emmett J. Scott HS. The other Green South is at the Labor Ready on West Gentry . Blue North is at the BBQ place on the NE corner of W. Gentry and Glenwood. Red South is at Palace and Nutbush near an elementary school.

3. Red, Green, & Blue are the only bus lines in North Tyler.

4. The Bergfeld Shopping Center is the closest Yellow Line stop.

5. The Downtown Transit Depot is the closest place to access Purple South.

6. I don’t know of any bus stops serviced by more than one line in North Tyler, let alone three.

7. Downtown at Oakwood AV, W. Gentry & Palace area near Neighborhood Services and D&N, a leading store-restaurant-gas station, & Bergfeld Shopping Center (the 2nd hub).