The United States is famous for its grid layouts, and the logical, easy-to-remember addresses they generate. But in the vast majority of new settlements all over the world streets twist and turn and end in cul-de-sacs
of South Ashland Avenue and West County Line Road, in Will County, Illinois, is a picture of classic midwestern rural America. Ashland Avenue, at that point, is barely wider than a lane. On one side is a vast corn field; on the other, a few ranch houses, each set on at least an acre of land and hidden behind hedges. Farther up the road a bright red combine harvester works its way through the fields.
Thanks to the rise of digital mapping, the relative orderliness of different street systems can now be calculated. Geoff Boeing of the University of Southern California created a measure of city “entropy”, looking at how consistent the direction of streets in over 100 major cities worldwide is, as well as how continuously they run through any given city without interruption. A measure of zero suggests a city with absolutely no consistent street direction.
But the grid kept coming back. In the Spanish colonies, the Law of the Indies decreed that new cities should be planned on grids, though as in Europe, with large squares at the centre for churches. Streets laid out along the squares would then block the wind, which would otherwise “cause much inconvenience” to the religious festivals and the like that were expected to be held in the plaza.
And grids are easy to navigate. In London cab drivers have to spend up to four years learning the street network before they can get around without a map. Chicago or New York taxi drivers can achieve much the same thing in a day. Pedestrians can walk in a fairly direct route anywhere they need to go, without worrying about dead ends or impassable barriers between roads.
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Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States’ dataObjectives Chiropractic spinal manipulative therapy (CSMT) and lumbar discectomy are both used for lumbar disc herniation (LDH) and lumbosacral radiculopathy (LSR); however, limited research has examined the relationship between these therapies. We hypothesised that adults receiving CSMT for newly diagnosed LDH or LSR would have reduced odds of lumbar discectomy over 1-year and 2-year follow-up compared with those receiving other care. Design Retrospective cohort study. Setting 101 million patient US health records network (TriNetX), queried on 24 October 2022, yielding data from 2012 query. Participants Adults age 18–49 with newly diagnosed LDH/LSR (first date of diagnosis) were included. Exclusions were prior lumbar surgery, absolute indications for surgery, trauma, spondylolisthesis and scoliosis. Propensity score matching controlled for variables associated with the likelihood of discectomy (eg, demographics, medications). Interventions Patients were divided into cohorts according to receipt of CSMT. Primary and secondary outcome measures ORs for lumbar discectomy; calculated by dividing odds in the CSMT cohort by odds in the cohort receiving other care. Results After matching, there were 5785 patients per cohort (mean age 36.9±8.2). The ORs (95% CI) for discectomy were significantly reduced in the CSMT cohort compared with the cohort receiving other care over 1-year (0.69 (0.52 to 0.90), p=0.006) and 2-year follow-up (0.77 (0.60 to 0.99), p=0.040). E-value sensitivity analysis estimated the strength in terms of risk ratio an unmeasured confounding variable would need to account for study results, yielding point estimates for each follow-up (1 year: 2.26; 2 years: 1.92), which no variables in the literature reached. Conclusions Our findings suggest receiving CSMT compared with other care for newly diagnosed LDH/LSR is associated with significantly reduced odds of discectomy over 2-year follow-up. Given socioeconomic variables were unavailable and an observationa
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