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The regional networking strategy is widely implemented in China as a normative policy aimed at fostering cohesion and enhancing competitiveness. However, the empirical basis for this strategy remains relatively weak due to limitations in measurement methods and data availability. This paper establishes the urban networks by the enterprise investment data, and then accurately measures the network's external effects of each city by the method of MGWR model. The results show that: (1) Regional networking plays a significant role in urban development, although it is not the dominant factor. (2) The benefits of network connections may vary depending on the location and level of cities. (3) The major cities assume a pivotal role in the urban network. Based upon the aforementioned research conclusions, this paper presents strategic measures to enhance the network's external impacts, aiming to offer insights for other regions in formulating regional development strategies and establishing regional urban networks. [ABSTRACT FROM AUTHOR]

This paper utilizes an improved undesirable output DEA model to measure the eco-efficiency of cities in five major urban agglomerations in China during 2006–2020. It employs the Theil Index and Geodetector to investigate the spatial-temporal distribution differentiation characteristics and driving factors of urban eco-efficiency. The main findings are as follows. Firstly, the eco-efficiency of all urban agglomerations showed a fluctuating upward trend, but the eco-efficiency performance of different urban agglomerations in China shows a stratification characteristic. Specifically, the Pearl River Delta urban agglomeration consistently ranks first in China, while the mean values of the Yangtze River Delta urban agglomeration, Beijing-Tianjin-Hebei urban agglomeration, and Chengdu-Chongqing urban agglomeration are lower than the national average. Secondly, the overall differences in the urban eco-efficiency of all sample cities show a consistently fluctuating downward trend. The factor that affects the level differences of eco-efficiency in different cities is the intra-regional differences. Last but not least, the top three factors affecting the spatial distribution difference of urban eco-efficiency in the whole sample are environmental pollution control investments, innovation level, and environmental infrastructure investments. In the end, this paper proposes that reducing the intra-regional differences is the primary task to achieve the coordinated improvement of urban eco-efficiency in urban agglomerations, and then puts forward some policy suggestions to improve eco-efficiency for the five major urban agglomerations. [ABSTRACT FROM AUTHOR]

Background: Malawi has one of the highest incidence and mortality rates of cervical cancer in the world. Despite a national strategic plan and the roll-out of VIA and screen-and-treat services, cervical cancer screening coverage in Malawi remains far below the national target.Using a nationally representative sample of women enumerated in the Malawi Population-based Impact Assessment (MPHIA) survey we estimated the prevalence and spatial distribution of self-reported cervical cancer screening as a proxy for uptake in Malawi. Methods: MPHIA was a nationally representative household survey in Malawi, targeting adults aged 15 and above, that employed a cross-sectional, two-stage, cluster design. The primary aim of MPHIA was to assess the regional prevalence of viral load suppression and the progress towards achieving the UNAIDS 95-95-95 goals among adults aged 15 and above. The survey was carried out between January 2020 and April 2021. Prevalence of self-reported cervical cancer screening by different characteristics was estimated accounting for the survey design using the Taylor series approach. We used univariable and multivariable logistic regression approaches to examine associations between the prevalence of cervical cancer screening and demographic characteristics. Findings: A total of 13,067 adult (15 years and older) female individuals were surveyed during the MPHIA 2020 to 2021 survey, corresponding to a weighted total of 5,604,578. The prevalence of self-reported cervical cancer screening was 16.5% (95% CI 15.5–18.0%), with women living with HIV having a higher prevalence of 37.8% (95% CI 34.8–40.9) compared to 14.0% (95% CI 13.0–15.0) in HIV negative women. The highest prevalence of screening was reported in the Southwest zone (SWZ) (24.1%, 95% CI 21.3–26.9) and in major cities of Blantyre (25.9%, 95% CI 22.9–29.0), and Lilongwe (19.6%, 95% CI 18.0–21.3). Higher self-reported screening was observed in women who resided in urban regions ((22.7%; 95% CI 21.4–24.0) versus women who resided in rural areas (15.2%; 95% CI 14.0–16.8). Cervical cancer screening was strongly associated with being HIV positive (aOR 2.83; 95% CI 2.29–3.50), ever having been pregnant (aOR 1.93; 95% CI 1.19–3.14), attaining higher education level than secondary education (aOR 2.74; 95% CI 1.67–4.52) and being in the highest wealth quintile (aOR 2.86; 95% CI 2.01–4.08). Interpretation: The coverage of cervical cancer screening in Malawi remains low and unequal by region and wealth/education class. Current screening efforts are largely being focussed on women accessing HIV services. There is need for deliberate interventions to upscale cervical cancer screening in both HIV negative women and women living with HIV. [ABSTRACT FROM AUTHOR]

Using publicly available data, this paper investigates the diffusion of COVID-19 across neighborhoods in two major cities, London and New York. We link neighborhood demographics to incidence, and we investigate patterns of change over time in conjunction with changing policy responses to the pandemic. By comparing and contrasting these two cities, we are able to exploit surveillance and policy differences, demonstrating how each contributes information to the other. We conclude that better coordination can be translated into improved health policy. [ABSTRACT FROM AUTHOR]

Transforming resource-based cities into sustainable economic development is a great challenge for policy-makers in many countries. However, the economic-centered evaluation system tends to breed the undesirable view of "GDP only" or "brown growth" in the previous case studies which is inconsistent with the long-run and sustainable development of resource-based cities. To fill in this research gap, this paper takes Jilin province in northeast China as a case study to explore urban development problems faced by major resource-based cities during resource depletion. This research constructs a stratified indicator system and conducts an in-depth analysis of the features and spatial effects of urban decline. For this analysis, this paper jointly uses the methods of entropy-weighted TOPSIS, analytic hierarchical process (AHP), and spatial effect model based on a database from 2000 to 2019. The findings of this study show that the current transformation of resource-based cities in Jilin province is generally ineffective and difficult to maintain long-run and sustainable development due to its historical reasons and industrial development background. According to the results, the resource-based cities in Jilin province show an unstable development because of factors such as barriers to the physical renewal of resources, rigid industrial structure, insufficient backup resources, and institutional and policy constraints. Also, the transformation of these cities into sustainable economic development is still facing demographic, social, and ecological difficulties. [ABSTRACT FROM AUTHOR]

The study evaluates the resistance and susceptibility of adult female Anopheles gambiae s. l., Aedes aegypti and Culex quinquefasciatus mosquitoes sourced within Osogbo metropolis, Osun State, Nigeria to four groups of insecticides [Permethrin, Deltamethrin, Pirimiphos-methyl and DDT (Dichlorodiphenyltrichloroethane)] and the distribution of their larval habitat within the metropolis. Mosquito larvae of the three genera were collected during the wet season and reared to adult stage in the laboratory. Emerged adult female mosquitoes were exposed to insecticide impregnated papers of the four insecticide groups for 60mins using WHO kits to determine the knock down rate (kdr). Thereafter, they were transferred into holding tubes and left for 24hrs to assess their resistance and susceptibility according to the WHO protocol. Four types of larval habitats were identified (tires, ground pools, gutters and plastic containers). Anopheles gambiae s. l. showed the highest resistance to Permethrin (49%) (p = 0.04, p<0.05) while the highest susceptibility was recorded with Pirimiphos-methyl (69%) with the lowest against Permethrin (16%) (P = 0.002; p<0.05). The highest resistance of A. aegypti was against OC-Control (45%) (p = 0.031; p<0.05). Permethrin had the highest susceptibility (60%) against A. aegypti while OC-control had the lowest (11%) (p = 0.005; p< 0.05). Culex quinquefasciatus had a lower resistance to OC-control (38%) as compared with Aedes aegypti (45%). However, it was least susceptible to Pirimiphos-methyl (52%) and DDT (17%) respectively (p = 0.013; p<0.05). The susceptibility of A. gambiae s. l. and C. quinquefasciatus to Pirimiphos-methyl and A. aegypti to Permethrin is an indication of the possibility of success if employed for vector control of A. gambiae s. l., C. quinquefasciatus and A. aegypti respectively. This could be through their inclusion as active ingredients in insecticide treated nets (ITNs) and indoor residual spray (IRS) with a view to abating malaria and other life-threatening mosquito-borne diseases constituting global public health scourge. [ABSTRACT FROM AUTHOR]

Climate / weather factors are important factors for tourists to choose tourist destinations. With the public's attention to the influence of haze, air quality will have a profound impact on the development of tourism in tourist destinations. Based on the Epsilon-based Measure (EBM) super-efficiency model and Global Malmquist–Luenberger index analysis method, this paper aims to study the tourism development efficiency of 58 major cities in China from 2001 to 2016 and analyse the total factor productivity in the development of urban tourism and the changing driving factors in consideration of the undesirable output of haze characterised by PM2.5 emission concentration. The study findings show that the overall efficiency of tourism development of 58 cities is not high in 2001–2016, but the tourism development efficiency of all cities is increasing year by year. Under the constraint of haze, the efficiency of urban tourism development is not directly proportional to the degree of urban development. The overall redundancy rate of each input index is slightly high, and the redundancy of PM2.5 emission concentration has a considerable effect on the efficiency of urban tourism development. The overall change trend in total factor productivity in the development of urban tourism is improved, mainly due to the improvement of technological progress factors. On this basis, the corresponding policy implications are concluded according to high-efficiency and high-quality development of tourism in 58 major cities. [ABSTRACT FROM AUTHOR]

Background: Evidence globally indicates that female adolescents face numerous sexual and reproductive health (SRH) risks. Utilization of sexual reproductive health services among adolescents is of global health importance and plays a crucial role in adolescent sexual reproductive health outcomes and their quality of life. Aim: The current study explored sexual reproductive health service utilization concerns among female adolescents in the Tema Metropolis in Southern Ghana using the Anderson and Newman Behavioural model of Health Service Utilization as a guiding framework. Methods: The study utilized a qualitative exploratory descriptive design. Purposive sampling was used to recruit female adolescents. In-depth face-to-face interviews were conducted using a semi-structured interview guide. In all, 12 interviews were conducted. Each interview lasted between 45 and 60 minutes. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic content analysis. Thematic analysis was guided by the constructs of the Anderson and Newman Behavioural model of health service utilization. Results: Utilization of sexual reproductive health services among female adolescents is low in the Tema metropolis. Factors such as unprotected non-consensual sexual activity or an unwanted pregnancy sometimes triggered the use of these services. Barriers to utilization identified include lack of awareness on sexual reproductive health services, unreliable sources of SRH information, underestimation of the severity of sexual reproductive health problems faced, unmet expectations and poor experiences with service providers. Conclusion: The current study identified poor utilization of sexual reproductive health services among female adolescents within the Tema metropolis of Ghana. There is the need to increase the number of adolescent health corners, increase awareness about SRH services among adolescents, improve parent-child SRH communication and provide adequate training for healthcare providers to improve provider attitude towards adolescent SRH service delivery in order to increase utilization of sexual reproductive health services among female adolescents in the Metropolis. [ABSTRACT FROM AUTHOR]

Little is known of the relationship between exposure to the smallest particles of air pollution and socio-demographic characteristics. This paper explores linkages between ultrafine particle (UFP) concentrations and indicators of both race/ethnicity and socioeconomic status in Boston, Massachusetts, USA. We used estimates of UFP based on a highly-resolved land-use regression model of concentrations. In multivariate linear regression models census block groups with high proportions of Asians were associated with higher levels of UFP in comparison to block groups with majority White or other minority groups. Lower UFP concentrations were associated with higher homeownership (indicating higher SES) and with higher female head of household (indicating lower socioeconomic status). One explanation for the results include the proximity of specific groups to traffic corridors that are the main sources of UFP in Boston. Additional studies, especially at higher geographic resolution, are needed in Boston and other major cities to better characterize UFP concentrations by sociodemographic factors. [ABSTRACT FROM AUTHOR]

As the COVID-19 pandemic moved beyond the initial heavily impacted and urbanized Northeast region of the United States, hotspots of cases in other urban areas ensued across the country in early 2020. In South Carolina, the spatial and temporal patterns were different, initially concentrating in small towns within metro counties, then diffusing to centralized urban areas and rural areas. When mitigation restrictions were relaxed, hotspots reappeared in the major cities. This paper examines the county-scale spatial and temporal patterns of confirmed cases of COVID-19 for South Carolina from March 1st—September 5th, 2020. We first describe the initial diffusion of the new confirmed cases per week across the state, which remained under 2,000 cases until Memorial Day weekend (epi week 23) then dramatically increased, peaking in mid-July (epi week 29), and slowly declining thereafter. Second, we found significant differences in cases and deaths between urban and rural counties, partially related to the timing of the number of confirmed cases and deaths and the implementation of state and local mitigations. Third, we found that the case rates and mortality rates positively correlated with pre-existing social vulnerability. There was also a negative correlation between mortality rates and county resilience patterns, as expected, suggesting that counties with higher levels of inherent resilience had fewer deaths per 100,000 population. [ABSTRACT FROM AUTHOR]

As the capital and one of the metropolises in China, Beijing has met with a number of serious so-called "urban diseases" in the process of rapid urbanization such as blind expansion of urban areas, explosion of population and the increase of urban heat island effect. To treat these "urban diseases" and make the metropolis develop healthful and sustainable in Beijing in the future, the spatial characteristics of metropolis developments in Beijing are explored in this paper. The urban built-up areas in Beijing are extracted using the DMSP-OLS nighttime light data from 1992 to 2013. The characteristics of the urban developments of Beijing are studied, including spatial and temporal scales of urban developments, urban barycenter of Beijing and its transfer trajectory, variations of urban spatial forms and the differences of urban internal developments. The results have shown that the built-up areas had been increasing and circling extending from the central urban areas to the outer spaces in the last 21 years. The built-up area had expanded by 878km2 in 1992–2013, and the built-up area in 2013 had expanded to three times comparing to that of 1992. The expanding area of the built-up area in the northeast is the largest. The expansion of the urban had mainly occurred in 1996–2007, and the expanded area had accounted for 92% of the total research period. During the whole research period, the urban barycenter of Beijing had moved 5000.71 meters towards Northeast 28° of its original place from Dongcheng District to Chaoyang District. The development level of each municipal district had been increasing year by year, and the development differences among the municipal districts had been gradually reduced; the spatial forms of Beijing had been alternately changed between extensive and intensive expansion. The results of this study can help to plan urban land use and people migration of Beijing. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of TB in pediatric population poses several challenges. A novel initiative was implemented in several major cities of India aimed at providing upfront access to free-of-cost Xpert MTB/RIF to presumptive pediatric TB cases. This paper aims to describe the experience of implementing this large initiative and assess feasibility of the intervention in high TB burden settings. Methods: Data were drawn from the pediatric TB project implemented in 10 major cities of India between April 2014 and March 2018. In each city, providers, both public and private, were engaged and linked with a high throughput Xpert MTB/RIF lab (established in that city) through rapid specimen transportation and electronic reporting system. Rates and proportions were estimated to describe the characteristics of this cohort. Results: Of the total 94,415 presumptive pediatric TB cases tested in the project, 6,270 were diagnosed positive for MTB (6.6%) on Xpert MTB/RIF (vs 2% on smear microscopy). Among MTB positives, 545 cases were rifampicin resistant (8.7%). The median duration between collection of specimens and reporting of results was 0 days (same day) and >89% cases were initiated on treatment. Approximately 50% of the specimens tested were non-sputum. The number of providers/facilities engaged under the project increased >10-fold (from 124 in Q2'14 to 1416 in Q1'18). Conclusion: This project, which was one of the largest initiatives globally among pediatric population, demonstrated the feasibility of sustaining rapid and upfront access to free-of-cost Xpert MTB/RIF testing. The project underscores the efficiency of this rapid diagnostic assay in tackling several challenges in pediatric TB diagnosis, identifies opportunities for further interventions as well as brings to light scope for effective engagement with healthcare providers. The findings have facilitated a policy decision by National TB Programme mandating the use of Xpert MTB/RIF as a primary diagnostic tool for TB diagnosis in children, which is being scaled-up. [ABSTRACT FROM AUTHOR]

Cities are major drivers of environmental change at all scales and are especially at risk from the ensuing effects, which include poor air quality, flooding and heat waves. Typically, these issues are studied on a city-by-city basis owing to the spatial complexity of built landscapes, local topography and emission patterns. However, to ensure knowledge sharing and to integrate local-scale processes with regional and global scale modelling initiatives, there is a pressing need for a world-wide database on cities that is suited for environmental studies. In this paper we present a European database that has a particular focus on characterising urbanised landscapes. It has been derived using tools and techniques developed as part of the World Urban Database and Access Portal Tools (WUDAPT) project, which has the goal of acquiring and disseminating climate-relevant information on cities worldwide. The European map is the first major step toward creating a global database on cities that can be integrated with existing topographic and natural land-cover databases to support modelling initiatives. [ABSTRACT FROM AUTHOR]

Understanding the evolution of rural landscapes in metropolises during rapid urbanization is crucial for formulating policies to protect the rural ecological environment. In this study, remote sensing and geographical information system data, as well as applied landscape index analysis, are used to examine the spatiotemporal evolution of rural landscape patterns in the Beijing-Tianjin region of China, which has experienced rapid urbanization. The relationships between land use/land cover changes and changes in rural landscape patterns are explored. The results revealed significant spatial differences in the rural landscapes in the Beijing-Tianjin region; farmland and forestland were the main types of landscapes, creating a "mountain-field-sea" natural landscape pattern. The conversion of rural landscapes in the Beijing-Tianjin region involved mainly the conversion of farmland to urban areas, with few exchanges between other landscape types. The urban areas in the Beijing-Tianjin region increased by 3% per decade; farmland decreased at the same rate. Additionally, the rural landscape patterns in the Beijing-Tianjin region were dominated by fragmentation, dispersion, and heterogeneity and moved from complex to regular. Water bodies displayed the most fragmented natural landscape; their number of patches increased by 36%, though their network characteristics were maintained. Forestland was the most concentrated natural landscape. In this study, theoretical support and a scientific reference for the optimization of rural landscape patterns and the improvement in rural living environments in rapidly urbanizing areas are provided. [ABSTRACT FROM AUTHOR]

An in-depth study of the mechanisms governing the generation, evolution, and regulation of differences in tourism economics holds significant value for the rational utilization of tourism resources and the promotion of synergistic tourism economic development. This study utilizes mathematical statistical analysis and GIS spatial analysis to construct a single indicator measure and a comprehensive indicator measure to analyze tourism-related data in the research area from 2004 to 2019. The main factors influencing the spatial and temporal differences in the tourism economy are analyzed using two methods, namely, multiple linear regression and geodetector. The temporal evolution, overall differences and differences within each city group fluctuate downwards, while the differences between groups fluctuate upwards. Domestic tourism economic differences contribute to over 90% of the overall tourism economic differences. Spatial divergence, the proportion of the tourism economy accounted for by spatial differences is obvious, the comprehensive level of the tourism economy can be divided into five levels. The dominant factors in the formation of the pattern of spatial and temporal differences in the tourism economy are the conditions of tourism resources based on class-A tourist attractions and the level of tourism industry and services based on star hotels and travel agencies. This study addresses the regional imbalance of tourism economic development in city clusters and with the intent of promoting balanced and high-quality development of regional tourism economies. [ABSTRACT FROM AUTHOR]

Background: Spatial analysis at different levels can help understand spatial variation of human immunodeficiency virus (HIV) infection, disease drivers, and targeted interventions. Combining spatial analysis and the evaluation of the determinants of the HIV burden in Southern African countries is essential for a better understanding of the disease dynamics in high-burden settings. Methods: The study countries were selected based on the availability of demographic and health surveys (DHS) and corresponding geographic coordinates. We used multivariable regression to evaluate the determinants of HIV burden and assessed the presence and nature of HIV spatial autocorrelation in six Southern African countries. Results: The overall prevalence of HIV for each country varied between 11.3% in Zambia and 22.4% in South Africa. The HIV prevalence rate was higher among female respondents in all six countries. There were reductions in prevalence estimates in most countries yearly from 2011 to 2020. The hotspot cluster findings show that the major cities in each country are the key sites of high HIV burden. Compared with female respondents, the odds of being HIV positive were lesser among the male respondents. The probability of HIV infection was higher among those who had sexually transmitted infections (STI) in the last 12 months, divorced and widowed individuals, and women aged 25 years and older. Conclusions: Our research findings show that analysis of survey data could provide reasonable estimates of the wide-ranging spatial structure of the HIV epidemic in Southern African countries. Key determinants such as individuals who are divorced, middle-aged women, and people who recently treated STIs, should be the focus of HIV prevention and control interventions. The spatial distribution of high-burden areas for HIV in the selected countries was more pronounced in the major cities. Interventions should also be focused on locations identified as hotspot clusters. [ABSTRACT FROM AUTHOR]

ASPirin in Reducing Events in the Elderly (ASPREE), a placebo-controlled prevention trial of low dose aspirin, provided the opportunity to establish a biospecimen biobank from initially healthy persons aged 70+ years for future research. The ASPREE Healthy Ageing Biobank (ASPREE Biobank) collected, processed and stored blood and urine samples at -80degC or under nitrogen vapour at two timepoints, three years apart, from a willing subset of Australian ASPREE participants. Written informed consent included separate opt-in questions for biomarker and genetic testing. Fractionated blood and urine were aliquoted into multiple low-volume, barcoded cryotubes for frozen storage within 4 hours of collection. Specially designed and outfitted mobile laboratories provided opportunities for participation by people in regional and rural areas. Detailed, high quality demographic, physiological and clinical data were collected annually through the ASPREE trial. 12,219 participants contributed blood/urine at the first timepoint, 10,617 of these older adults provided 3-year follow-up samples, and an additional 1,712 provided saliva for DNA. The mean participant age was 74 years, 54% were female and 46% lived outside major cities. Despite geographical and logistical challenges, nearly 100% of blood/urine specimens were processed and frozen within 4 hours of collection into >1.4 million aliquots. After a median of 4.7 years, major clinical events among ASPREE Biobank participants included 332 with dementia, 613 with cardiovascular disease events, 1259 with cancer, 357 with major bleeds and 615 had died. The ASPREE Biobank houses and curates a large number of biospecimens collected prior to the clinical manifestations of major disease, and 3-year follow-up samples, all linked to high quality, extensive phenotypic information. This provides the opportunity to identify or validate diagnostic, prognostic and predictive biomarkers, and potentially study biological effectors, of ageing-related diseases or maintenance of older-age good health. [ABSTRACT FROM AUTHOR]

Background: The home-based vaccination card is an important health record for determining vaccination status of children during surveys, particularly in low- and middle-income countries. However, there are limited evidence on the factors that influence its retention in Ghana. We assessed the predictors of vaccination card retention in Tamale Metropolis, Ghana. Methods: We conducted a cross-sectional study from 21st December 2022 to 10th January 2023 among children aged 0–59 months in the Tamale Metropolis. Multi-stage sampling was used to select caregivers of children aged 0–59 months for enrolment in the study. Data were collected using validated questionnaire through face-to-face interviews of caregivers. A vaccination card was retained if it was presented for physical inspection by research assistants. The factors that influence vaccination card retention were determined in a multivariate logistic regression analysis at p<0.05. Results: A total of 1,532 eligible children were enrolled in this study. Vaccination card retention was 91.5%. Negative predictors of card retention included: being resident in the Nyohini (AOR = 0.28; 95% CI = 0.15–0.50) and Tamale Central (AOR = 0.51; 95% CI = 0.29–0.90) sub-Metro areas and being caregivers of children aged 24–59 months (AOR = 0.39; 95% CI = 0.22–0.68). On the other hand, paying for the vaccination card (AOR = 5.14; 95% CI = 2.95–8.95) was a positive predictor of vaccination card retention. Conclusion: In this study, vaccination card retention among children aged 0–59 months was higher than national estimates. Vaccination card retention was mainly influenced by sub-Metro area, age of child and mode of acquisition of the card such as out-of-pocket payment. There is need to design and deliver tailored messages including the importance of vaccination card retention to caregivers of children based on geographic context. Additionally, the policy on sale of vaccination cards should be revised to allow for cost sharing to enhance its retention. [ABSTRACT FROM AUTHOR]

Infertility is a complex and often sensitive issue with far-reaching psycho-social ramifications for couples and their families. This study therefore seeks to delve into the psycho-social burden of infertility in Cape Coast, a major city in Ghana. Specifically, we explored the impact of infertility on the psychological and social health of infertile couples receiving fertility treatment. It also delves into the strategies they adopt to cope with their conditions. The study employs a qualitative approach to inquiry using phenomenology as a study design to explore the experiences of the study participants. In-depth interviews were conducted using interview guides, voice recorded and transcribed verbatim. Both inductive and deductive/framework coding techniques were used to code the data leading to the generation of themes and sub-themes. The results show that most of the study participants dealing with infertility faced psychological burdens from different sources including their families, society and themselves. These burdens take a toll on their mental health, pushing them into a state of desperation and depression. It was, however, revealed that infertile couples are able to cope with the help of their family, spouses and the church. Curiously, some of them opt for withdrawal from social events as a coping mechanism. Infertility exerts an enormous negative psycho-social impact on affected couples, especially women. The family and society serve as the main sources of stressors for infertile couples. Therefore, programmes that are aimed at fertility treatment should deliberately consider addressing the psychosocial burden of infertility through education targeting actors, especially interpersonal-level actors. [ABSTRACT FROM AUTHOR]

The construction of the Iron Age Mediterranean chronology began in the Levant based on historical evidence and has been additionally supported in recent decades by means of radiocarbon analysis, although with variable precision and ratification. It is only in recent years that new evidence in the Aegean and the western Mediterranean has opened discussion towards its further acceptance as an authoritative i.e. highly reliable, and widely applicable historiographic network. Altogether, the Mediterranean Iron Age chronology has only undergone minor changes during the last hundred years. The Phoenician metropolis of Sidon in southern Lebanon now provides a new, large and robust dataset obtained through a combination of archaeological and 14C-radiometric analysis of materials from stratified contexts that allow their statistical assessment. The appearance of substantial amounts of pottery of Greek, Cypriot and Egyptian origin together with Phoenician local wares in a long stratigraphy is a benefit for the synchronisation of regional pottery styles and allows wider geographic correlation of relative chronological systems. The close association of the archaeological data with a long series of AMS-14C-dates on short-lived samples provides new evidence for the absolute dating of many of the regional pottery styles that are represented in the stratigraphy of Sidon, and contributes towards a considerable improvement of the Mediterranean chronology. [ABSTRACT FROM AUTHOR]

Background: Corona Virus Disease of 2019 (COVID-19) emerged in 2019 and caused widespread disruption to many facets of life, including healthcare. Healthcare workers, particularly nurses, became the front-line fighters against the pandemic, making it imperative to comply with recommended safety protocols. However, many nurses were infected by the virus in the Tamale Metropolis, raising concerns regarding their level of adherence to the safety protocols. This study assessed the predictors of knowledge and adherence to COVID-19 safety protocols among nurses at selected health facilities in the Tamale Metropolis of northern Ghana. Methods: A facility based cross-sectional study design was adopted and 339 nurses from six (6) public health facilities in the Tamale Metropolis were recruited for the study using questionnaires. The questionnaires were transformed into Google Forms for respondents to answer online via WhatsApp or email. The data were exported from the Google spreadsheet into SPSS and analyzed using descriptive and inferential statistics. Results: Of the 339 participants, 60.2% were classified as having adequate knowledge while only 9.1% demonstrated high adherence to COVID-19 safety protocols. Knowledge of COVID-19 was predicted by source of information, and marital status, whereas health facility types predicted level of adherence. The odds of having adequate knowledge were higher among unmarried nurses (AOR = 1.94; 95% CI: 1.16–3.25; p = 0.012) and nurses using social media (AOR = 1.80; 95%CI 1.02–3.18; p = 0.042) compared to their counterparts. Meanwhile, primary health care nurses (AOR = 0.24; 95% CI = 0.12–0.50; p<0.001) and secondary health care nurses (AOR = 0.52; 95% CI = 0.31–0.88; P = 0.016) had reduced odds of exhibiting higher adherence compared to nurses from tertiary-level facility. Conclusion: In this study, we found that knowledge was high but adherence to COVID-19 safety protocols was low. We suggest that facility managers should enforce compliance of their staff to the safety protocols to prevent spread of the virus within healthcare settings. [ABSTRACT FROM AUTHOR]

In Australia, telehealth is not new, with several telehealth specialist services being available for those living in rural and remote communities. However, prior to the COVID-19 pandemic, telehealth was not routinely available for primary care or urban specialist appointments. There has been an increased focus in the use of telehealth within primary care, and particularly general practice, but overall, there has been limited research to date to guide telehealth best-practice based on consumer experiences and preferences within these settings. We aimed to capture the consumer experience of telehealth during the COVID-19 pandemic, through a novel Kitchen Table Discussion (KTD) method. This increases access to a broader community consumer cohort, with consumer hosts leading discussions in a safe environment. The KTDs were conducted in May 2021, with 10 community members each hosting a group of up to 10 participants. A total of 90 participants took part from across Australia, with the majority living in major cities, although a significant proportion lived in inner and outer regional areas of Australia, or had experience living in rural, regional or remote areas. Seventy percent of participants reported using telehealth in the past. Data were analysed sequentially using thematic analysis and identified key themes: modality, convenience, access, wait time, existing relationship, communication, connectivity, cost, and privacy. Overall, the future of telehealth looks hopeful from the perspective of the consumer, but significant improvements are required to improve consumer engagement and experience. It is evident that 'one size does not fit all', with results suggesting consumers value the availability of telehealth and having choice and flexibility to use telehealth when appropriate, but do not want to see telehealth replacing face-to-face delivery. Participants tended to agree that telehealth was not a preferred method when physical examination was required but would suit certain points of the patient journey. [ABSTRACT FROM AUTHOR]

To examine which factors affect the performance of technology business incubators in China, the present study proposes an entrepreneurial ecosystem framework with four key areas, i.e., people, technology, capital, and infrastructure. We then assess this framework using a three-year panel data set of 857 national-level technology business incubators in 33 major cities from 28 provinces in China, from 2015 to 2017. We utilize factor analysis to downsize dozens of characteristics of these technology business incubators into seven factors related to the four proposed areas. Panel regression model results show that four of the seven factors related to three areas of the entrepreneurial ecosystem, namely people, technology, and capital areas, have statistically significant associations with an incubator's performance when applied to the overall national data set. Further, seven factors related to all four areas have various statistically significant associations with an incubator's performance in five major regional data set. In particular, a technology related factor has a consistently statistically significant association with the performance of the incubator in both national model and the five regional models, as we expected. [ABSTRACT FROM AUTHOR]

Background: Australia has a universal healthcare system, yet organisation and delivery of primary healthcare (PHC) services varies across local areas. Understanding the nature and extent of this variation is essential to improve quality of care and health equity, but this has been hampered by a lack of suitable measures across the breadth of effective PHC systems. Using a suite of measures constructed at the area-level, this study explored their application in assessing area-level variation in PHC organisation and delivery. Methods: Routinely collected data from New South Wales, Australia were used to construct 13 small area-level measures of PHC service organisation and delivery that best approximated access (availability, affordability, accommodation) comprehensiveness and coordination. Regression analyses and pairwise Pearson's correlations were used to examine variation by area, and by remoteness and area disadvantage. Results: PHC service delivery varied geographically at the small-area level–within cities and more remote locations. Areas in major cities were more accessible (all measures), while in remote areas, services were more comprehensive and coordinated. In disadvantaged areas of major cities, there were fewer GPs (most disadvantaged quintile 0.9[SD 0.1] vs least 1.0[SD 0.2]), services were more affordable (97.4%[1.6] bulk-billed vs 75.7[11.3]), a greater proportion were after-hours (10.3%[3.0] vs 6.2[2.9]) and for chronic disease care (28%[3.4] vs 17.6[8.0]) but fewer for preventive care (50.7%[3.8] had cervical screening vs 62.5[4.9]). Patterns were similar in regional locations, other than disadvantaged areas had less after-hours care (1.3%[0.7] vs 6.1%[3.9]). Measures were positively correlated, except GP supply and affordability in major cities (-0.41, p <.01). Implications: Application of constructed measures revealed inequity in PHC service delivery amenable to policy intervention. Initiatives should consider the maldistribution of GPs not only by remoteness but also by area disadvantage. Avenues for improvement in disadvantaged areas include preventative care across all regions and after-hours care in regional locations. [ABSTRACT FROM AUTHOR]

The equity of transport accessibility is a prerequisite for sustainable development targets, especially in the ecologically fragile area of the Tibetan Plateau (also known as the Qinghai-Tibet Plateau). The relationship between transportation supply and social demand has become a key element of socioeconomic development and environmental protection in agricultural and pastoral areas. Based on data from transportation networks, permanent populations and the economy, this study uses a network analysis model, the coefficient of variation and the Gini coefficient to construct an index of social demand in townships and analyse the equity of transport accessibility on the Tibetan Plateau between 1980 and 2017; the principle of geographic distribution and the spatial relationship between transport accessibility and social demand at the township scale are also discussed. This study finds the following: the development of transportation has improved accessibility on the Tibetan Plateau, creating a highly accessible region with important cities as the nodes and major traffic arteries as the axes; both the coefficient of variation of transport accessibility and the Gini coefficient have increased slightly; and the equity of transport accessibility among townships on the Tibetan Plateau has exhibited a downward trend. Further, the social demand index is doubling every ten years, the spatial distribution has regional characteristics, and a decrease in permanent populations is the main reason for declining social demand index scores among townships. Townships with the lowest and highest social demand index scores for transportation development enjoy greater transportation benefits; there is a significant spatial relationship between social demand and location conditions (potential accessibility); the aggregation of social demand and accessibility types follows specific geographical distribution principles; and the Mangya-Gongshan Line delineates the distribution characteristics of township clusters with low social demand and low accessibility. [ABSTRACT FROM AUTHOR]

Background: Whilst evidence of use of face masks in reducing COVID-19 cases is increasing, the impact of mandatory use across a large population has been difficult to assess. Introduction of mandatory mask use on July 22, 2020 during a resurgence of COVID-19 in Melbourne, Australia created a situation that facilitated an assessment of the impact of the policy on the epidemic growth rate as its introduction occurred in the absence of other changes to restrictions. Methods and findings: Exponential epidemic growth or decay rates in daily COVID-19 diagnoses were estimated using a non-weighted linear regression of the natural logarithm of the daily cases against time, using a linear spline model with one knot (lspline package in R v 3.6.3). The model's two linear segments pivot around the hinge day, on which the mask policy began to take effect, 8 days following the introduction of the policy. We used two forms of data to assess change in mask usage: images of people wearing masks in public places obtained from a major media outlet and population-based survey data. Potential confounding factors (including daily COVID-19 tests, number of COVID-19 cases among population subsets affected differentially by the mask policy–e.g., healthcare workers) were examined for their impact on the results. Daily cases fitted an exponential growth in the first log-linear segment (k = +0.042, s.e. = 0.007), and fitted an exponential decay in the second (k = -0.023, s.e. = 0.017) log-linear segment. Over a range of reported serial intervals for SARS-CoV-2 infection, these growth rates correspond to a 22–33% reduction in an effective reproduction ratio before and after mandatory mask use. Analysis of images of people in public spaces showed mask usage rose from approximately 43% to 97%. Analysis of survey data found that on the third day before policy introduction, 44% of participants reported "often" or "always" wearing a mask; on the fourth day after, 100% reported "always" doing so. No potentially confounding factors were associated with the observed change in growth rates. Conclusions: The mandatory mask use policy substantially increased public use of masks and was associated with a significant decline in new COVID-19 cases after introduction of the policy. This study strongly supports the use of masks for controlling epidemics in the broader community. [ABSTRACT FROM AUTHOR]

As of mid-August 2020, Brazil was the country with the second-highest number of cases and deaths by the COVID-19 pandemic, but with large regional and social differences. In this study, using data from the Brazilian Ministry of Health, we analyze the spatial patterns of infection and mortality from Covid-19 across small areas of Brazil. We apply spatial autoregressive Bayesian models and estimate the risks of infection and mortality, taking into account age, sex composition of the population and other variables that describe the health situation of the spatial units. We also perform a decomposition analysis to study how age composition impacts the differences in mortality and infection rates across regions. Our results indicate that death and infections are spatially distributed, forming clusters and hotspots, especially in the Northern Amazon, Northeast coast and Southeast of the country. The high mortality risk in the Southeast part of the country, where the major cities are located, can be explained by the high proportion of the elderly in the population. In the less developed areas of the North and Northeast, there are high rates of infection among young adults, people of lower socioeconomic status, and people without access to health care, resulting in more deaths. [ABSTRACT FROM AUTHOR]

This study assesses the dollar benefit of a neighborhood approach intervention on disaster risk reduction in small-sized, densely populated, and hazard-prone informal settlements across Latin American and Caribbean countries. We use a life satisfaction approach that assigns a dollar value to gains in wellbeing associated with the neighborhood approach intervention. Our primary data was a survey to a sample of 349 beneficiaries from small towns in Haiti, Guatemala, and Jamaica, and in major cities' surrounded areas of Peru, Colombia, and Honduras. Out of 14 interventions, we found that community empowerment, physical works in public spaces and urban gardens/food approaches produced a gain of USD1,038 to USD1,241 to individual beneficiaries. Our study suggests a large benefit associated with the neighborhood approach intervention. It also shows that the life satisfaction approach is a promising method for the valuation of non-market and public goods, especially for countries where data on hazards and risks is not available to help monetize risk reductions. [ABSTRACT FROM AUTHOR]

In February 2020, the Novel Coronavirus (COVID-19) was raging in Wuhan, China and quickly spreading to the rest of the world. This period was fraught with uncertainty for those in the affected areas. The present investigation examined the role of two potential coping resources during this stressful period of uncertainty: flow and mindfulness. Participants in Wuhan and other major cities affected by COVID-19 (N = 5115) completed an online survey assessing subjective experiences of flow, mindfulness, and well-being. Longer quarantine was associated with poorer well-being; flow and mindfulness were associated with better well-being on some measures. However, flow—but not mindfulness—moderated the link between quarantine length and well-being, such that people who experienced high levels flow showed little or no association between quarantine length and poorer well-being. These findings suggest that experiencing flow (typically by engaging in flow-inducing activities) may be a particularly effective way to protect against potentially deleterious effects of a period of quarantine. [ABSTRACT FROM AUTHOR]

Introduction: Poor mental and sleep health negatively affects work performance, turnover intention, and information retention. We examined the impact of waiting job in upscale restaurants on the sleep health of waiters. Materials and methods: This was a descriptive study which collected cross-sectional data from waiters of upscale restaurants, using PSQI and DASS-21 questionnaires. Descriptive and inferential statistics comprising mean, frequency, percentage, chi-square, and logistic regression were adopted in presenting the results. Results: Sleep quality was poor among 74% of the waiters. The predictors of sleep quality were sex (p = 0.002), role at restaurant (p = 0.004), non-prescription drug use (p<0.001), depression (p<0.001), anxiety (p<0.001), and stress (p<0.001). The prevalence of anxiety, depression, and stress among the waiters was 52.3%, 38.3%, and 34.4% respectively. Stationed (AOR = 4.72, 95%CI = 1.7–812.53, p = 0.002) and supervising (AOR = 3.08, 95%CI = 1.25–7.57, p = 0.014) waiters were more likely to have good sleep quality than headwaiters. Waiters who had depression, anxiety, and stress were, however, 8% (AOR = 0.92, 95%CI = 0.46–1.85, p = 0.819), 28% (AOR = 0.72, 95%CI = 0.38–1.36, p = 0.315), and 49% (AOR = 0.51, 95%CI = 0.24–1.07, p = 0.073) less likely to have a good sleep quality than those who respectively did not have depression, anxiety, and stress. Conclusions: Sleep quality was poor among most of the waiters. If this persists, Ghana may not be able to meet the Sustainable Development Goal 3.4 target of promoting mental health and wellbeing. To improve sleep quality and accelerate progress towards achievement of the SDG target, there should be increased collaboration among stakeholders in the health and hospitality industries to develop innovative interventions to reduce poor sleep quality among workers. [ABSTRACT FROM AUTHOR]

Access to toilets and latrines represents both a development indicator and a significant factor in child mortality and physical development. The lack of latrines in rural India therefore constitutes a major global health challenge. Given the urban-rural gap in latrine ownership across India, I investigated how family ties to major cities, which extend beyond the local community affected by neighbors' defecation practices, shaped latrine ownership in rural India. Using the national Rural Economic & Demographic Survey 2006 (n = 7,949), I analyzed the geographies of family ties, types of exchange and rural latrine ownership. Receiving family visits from major cities increased the likelihood of having a latrine (33% higher odds). The relationship between family visitors from major cities and rural latrine ownership was stronger for wealthier households (.031 increase in average marginal effect of urban visitors for a.5 standard deviation increase in household assets at the mean). Material support from family also increased the likelihood of latrine ownership (7.8% higher odds for each additional $200USD) suggesting that family members not living in major cities may still contribute necessary resources. The importance of personalized connections beyond the village, particularly to major cities, suggests that linking geographically disparate sanitation interventions may produce synergies. [ABSTRACT FROM AUTHOR]

Background: Pre-payment and risk pooling schemes, central to the idea of universal health coverage, should protect households from catastrophic health expenditure and impoverishment; particularly when emergency care is required. Inadequate financial protection consequent on surgical emergencies occurs despite the existence of risk-pooling schemes. This study documented the experiences and coping strategies of slum and non-slum dwellers in a southwestern metropolis of Nigeria who had undergone emergency surgery. Methods: In-depth interviews were conducted with 31 participants (13 slums dwellers, 18 non-slum dwellers) who had recently paid for emergency surgical care in Ibadan. Patients who had experienced catastrophic health expenditure from the use of emergency surgical care were identified and people who paid for the care were purposively selected for the interviews. Using an in-depth interview guide, information on the experiences and overall coping strategies during and after the hospitalization was collected. Data were analyzed inductively using the thematic approach. Results: The mean age of the 31 participants (consisting of 7 men and 24 women) was 31 ± 5.6years. Apathy to savings limited the preparation for unplanned healthcare needs. Choice of hospital was determined by word of mouth, perceptions of good quality or prompt care and availability of staff. Social networks were relied on widely as a coping mechanism before and during the admission. Patients that were unable to pay experienced poor and humiliating treatment (in severe cases, incarceration). Inability to afford care was exacerbated by double billing and extraneous charges. It was opined that health care should be more affordable for all and that the current National Health Insurance Scheme, that was operating sub-optimally, should be strengthened appropriately for all to benefit. Conclusion: The study highlights households' poor attitude to health-related savings and pre-payment into a social solidarity fund to cover the costs of emergency surgical care. It also highlights the factors influencing costs of emergency surgical care and the role of social networks in mitigating the high costs of care. Improving financial protection from emergency surgical care would entail promoting a positive attitude to health-related savings, social solidarity and extending the benefits of social health insurance. [ABSTRACT FROM AUTHOR]

Bird-building collisions are the largest source of avian collision mortality in North America. Despite a growing literature on bird-building collisions, little research has been conducted in downtown areas of major cities, and no studies have included stadiums, which can be extremely large, often have extensive glass surfaces and lighting, and therefore may cause many bird collisions. Further, few studies have assessed the role of nighttime lighting in increasing collisions, despite the often-cited importance of this factor, or considered collision correlates for different seasons and bird species. We conducted bird collision monitoring over four migration seasons at 21 buildings, including a large multi-use stadium, in downtown Minneapolis, Minnesota, USA. We used a rigorous survey methodology to quantify among-building variation in collisions and assess how building features (e.g., glass area, lighting, vegetation) influence total collision fatalities, fatalities for separate seasons and species, and numbers of species colliding. Four buildings, including the stadium, caused a high proportion of all collisions and drove positive effects of glass area and amount of surrounding vegetation on most collision variables. Excluding these buildings from analyses resulted in slightly different collision predictors, suggesting that factors leading some buildings to cause high numbers of collisions are not the exact same factors causing variation among more typical buildings. We also found variation in collision correlates between spring and fall migration and among bird species, that factors influencing collision fatalities also influence numbers of species colliding, and that the proportion, and potentially area, of glass lighted at night are associated with collisions. Thus, reducing bird collisions at large buildings, including stadiums, should be achievable by reducing glass area (or treating existing glass), reducing light emission at night, and prioritizing mitigation efforts for glass surfaces near vegetated areas and/or avoiding use of vegetation near glass. [ABSTRACT FROM AUTHOR]

Objective: To identity differences between a general access index (Accessibility/ Remoteness Index of Australia; ARIA+) and a specific acute and aftercare cardiac services access index (Cardiac ARIA). Research design and methods: Exploratory descriptive design. ARIA+ (2011) and Cardiac ARIA (2010) were compared using cross-tabulations (chi-square test for independence) and map visualisations. All Australian locations with ARIA+ and Cardiac ARIA values were included in the analysis (n = 20,223). The unit of analysis was Australian locations. Results: Of the 20,223 locations, 2757 (14% of total) had the highest level of acute cardiac access coupled with the highest level of general access. There were 1029 locations with the poorest access (5% of total). Approximately two thirds of locations in Australia were classed as having the highest level of cardiac aftercare. Locations in Major Cities, Inner Regional Australia, and Outer Regional Australia accounted for approximately 98% of this category. There were significant associations between ARIA+ and Cardiac ARIA acute (χ2 = 25250.73, df = 28, p<0.001, Cramer’s V = 0.559, p<0.001) and Cardiac ARIA aftercare (χ2 = 17204.38, df = 16, Cramer’s V = 0.461, p<0.001). Conclusions: Although there were significant associations between the indices, ARIA+ and Cardiac ARIA are not interchangeable. Systematic differences were apparent which can be attributed largely to the underlying specificity of the Cardiac ARIA (a time critical index that uses distance to the service of interest) compared to general accessibility quantified by the ARIA+ model (an index that uses distance to population centre). It is where the differences are located geographically that have a tangible impact upon the communities in these locations–i.e. peri-urban areas of the major capital cities, and around the more remote regional centres. There is a strong case for specific access models to be developed and updated to assist with efficient deployment of resources and targeted service provision. The reasoning behind the differences highlighted will be generalisable to any comparison between general and service-specific access models. [ABSTRACT FROM AUTHOR]

Background: There are few quantitative studies on palliative care provision to Indigenous Australians, a population known to experience distinctive barriers to quality healthcare and to have poorer health outcomes than other Australians. Objectives: To investigate equity of specialist palliative care service provision through characterising and comparing Indigenous and non-Indigenous patients at entry to care. Methods: Using data (01/01/2010–30/06/2015) from all services participating in the multi-jurisdictional Palliative Care Outcomes Collaboration, Indigenous and non-Indigenous patients entering palliative care were compared on proportions vis-à-vis those expected from national statutory datasets, demographic characteristics, and entry-to-care status across fourteen ‘problem’ domains (e.g., pain, functional impairment) after matching by age, sex, and specific diagnosis. Results: Of 140,267 patients, 1,465 (1.0%, much lower than expected from statutory data) were Indigenous, 133,987 (95.5%) non-Indigenous, and 4,905 (3.5%) had a missing identifier. The proportion of patients with a missing identifier diminished markedly over the study period, without a corresponding increase in the proportion identified as Indigenous. Indigenous compared with non-Indigenous patients were younger (mean 62.8 versus 73.0 years, p<0.001), a higher proportion were female (51.5% versus 46.3%; p<0.001) or resided outside major cities (44.2% versus 21.5%, p<0.001). Across all domains, Indigenous compared with matched non-Indigenous patients had lower or equal risk of status requiring prompt intervention. Conclusions: Indigenous patients (especially those residing outside major cities) are substantially under-represented in care by services participating in the nationwide specialist palliative care Collaboration, likely reflecting widespread access barriers. However, the similarity of status indicators among Indigenous and non-Indigenous patients at entry to care suggests that Indigenous patients who are able to access these services do not disproportionately experience clinically important impediments to care initiation. [ABSTRACT FROM AUTHOR]

Background: Outreach and promotion programs are essential to ensuring uptake of new public health interventions and guidelines. We assessed the costs and operation dynamics of outreach and promotion efforts for up front Xpert MTB/RIF (Xpert) testing for pediatric presumptive tuberculosis (TB) patients in four major Indian cities. Methods: Xpert test costs were assessed as weighted average per-test costs based on the daily workload dynamics matched by test volume specific Xpert unit cost at each study site. Costs of outreach programs to recruit health providers to refer pediatric patients for Xpert testing were assessed as cost per referral for each quarter based on total program costs and referral data. All costs were assessed in the health service provider’s perspective and expressed in 2015 USD. Results: Weighted average per-test costs ranged from $14.71 to $17.81 at the four laboratories assessed. Differences between laboratories were associated with unused testing capacity and/or frequencies of overtime work to cope with increasing demand and same-day testing requirements. Outreach activities generated between 825 and 2,065 Xpert testing referrals on average each quarter across the four study sites, translating into $0.63 to $2.55 per patient referred. Overall outreach costs per referral decreased with time, stabilizing at an average cost of $1.10, and demonstrated a clear association with increased referrals. Conclusions: Xpert test and outreach program costs within and across study sites were mainly driven by the dynamics of Xpert testing demand resulting from the combined outreach activities. However, these increases in demand required considerable overtime work resulting in additional costs and operational challenges at the study laboratories. Therefore, careful laboratory operational adjustment should be evaluated at target areas in parallel to the anticipated demand from the Xpert referral outreach program scale-up in other Indian regions. [ABSTRACT FROM AUTHOR]

Air pollution is well-known as a major risk to public health, causing various diseases including pulmonary and cardiovascular diseases. As social concern increases, the amount of air pollution data is increasing rapidly. The purpose of this study is to statistically characterize dependence between major cities in China based on a measure of directional dependence estimated from PM2.5 measurements. As a measure of the directional dependence, we propose the so-called copula directional dependence (CDD) using beta regression models. An advantage of the CDD is that it does not rely on strict assumptions of specific probability distributions or linearity. We used hourly PM2.5 measurement data collected at four major cities in China: Beijing, Chengdu, Guangzhou, and Shanghai, from 2013 to 2017. After accounting for autocorrelation in the PM2.5 time series via nonlinear autoregressive models, CDDs between the four cities were estimated to produce directed network structures of statistical dependence. In addition, a statistical method was proposed to test the directionality of dependence between each pair of cities. From the PM2.5 data, we could discover that Chengdu and Guangzhou are the most closely related cities and that the directionality between them has changed once during 2013 to 2017, which implies a major economic or environmental change in these Chinese regions. [ABSTRACT FROM AUTHOR]

The topsoil around Beijing metropolis, China, is experiencing impacts of rapid urbanization, intensive farming, and extensive industrial emissions. We analyzed the concentrations of Cu, Ni, Pb, Zn, Cd, and Cr from 87 topsoil samples in the pre-rainy season and 115 samples in the post-rainy season. These samples were attributed to nine land use types: forest, grass, shrub, orchard, wheat, cotton, spring maize, summer maize, and mixed farmland. The pollution index (PI) of heavy metals was calculated from the measured and background concentrations. The ecological risk index (RI) was assessed based on the PI values and toxic-response parameters. The results showed that the mean PI values of Pb, Cr, and Cd were > 1 while those of Cu, Ni, and Zn were < 1. All the samples had low ecological risk for Cu, Ni, Pb, Zn, and Cr while only 15.35% of samples had low ecological risk for Cd. Atmospheric transport rather than land use factors best explained the seasonal variations in heavy metal concentrations and the impact of atmospheric transport on heavy metal concentrations varied according to the heavy metal types. The concentrations of Cu, Cd, and Cr decreased from the pre- to post-rainy season, while those of Ni, Pb, and Zn increased during this period. Future research should be focused on the underlying atmospheric processes that lead to these spatial and seasonal variations in heavy metals. The policymaking on environmental management should pay close attention to potential ecological risks of Cd as well as identifying the transport pathways of different heavy metals. [ABSTRACT FROM AUTHOR]

Background: This study aimed to estimate coverage and identify factors associated to vaccination against influenza in the elderly population. Methods: The study design was cross-sectional and population based. Data was collected in 2010 by the Health, Well-Being and Aging Study. Sample consisted of 1,341 community-dwelling elderly, in São Paulo, Brazil. Association between vaccination and covariates was evaluated by means of prevalence ratios estimated by Poisson regression models. Results: Self-reported vaccination coverage was 74.2% (95% confidence interval: 71.3–76.9). Remaining physically active and having had recent interaction with health services, mainly with public units of healthcare, were the main incentives to increase vaccination coverage among the elderly; whereas lower age, living alone and absent interaction with health services were the main constraints to influenza vaccination at the community level. These covariates had already been reported to influence influenza vaccination of elders in previous years. Conclusion: Previous knowledge already available on the main constraints to influenza vaccination has not allowed to remove them. Influenza campaigns should be strengthened to increase vaccination coverage, especially in the group more reticent to vaccination. Instructing healthcare providers to recommend vaccine uptake is an important piece of this puzzle. [ABSTRACT FROM AUTHOR]

This study explores the effects that the weather has on people's everyday activity patterns. Temperature, rainfall, and wind speed were used as weather parameters. People's daily activity patterns were inferred, such as place visited, the time this took place, the duration of the visit, based on the GPS location traces of their mobile phones overlaid upon Yellow Pages information. Our analysis of 31,855 mobile phone users allowed us to infer that people were more likely to stay longer at eateries or food outlets, and (to a lesser degree) at retail or shopping areas when the weather is very cold or when conditions are calm (non-windy). When compared to people's regular activity patterns, certain weather conditions affected people's movements and activities noticeably at different times of the day. On cold days, people's activities were found to be more diverse especially after 10AM, showing greatest variations between 2PM and 6PM. A similar trend is observed between 10AM and midnight on rainy days, with people's activities found to be most diverse on days with heaviest rainfalls or on days when the wind speed was stronger than 4 km/h, especially between 10AM–1AM. Finally, we observed that different geographical areas of a large metropolis were impacted differently by the weather. Using data of urban infrastructure to characterize areas, we found strong correlations between weather conditions upon people's accessibility to trains. This study sheds new light on the influence of weather conditions on human behavior, in particular the choice of daily activities and how mobile phone data can be used to investigate the influence of environmental factors on urban dynamics. [ABSTRACT FROM AUTHOR]

We present a small integrative model of human cardiovascular physiology. The model is population-based; rather than using best fit parameter values, we used a variant of the Metropolis algorithm to produce distributions for the parameters most associated with model sensitivity. The population is built by sampling from these distributions to create the model coefficients. The resulting models were then subjected to a hemorrhage. The population was separated into those that lost less than 15 mmHg arterial pressure (compensators), and those that lost more (decompensators). The populations were parametrically analyzed to determine baseline conditions correlating with compensation and decompensation. Analysis included single variable correlation, graphical time series analysis, and support vector machine (SVM) classification. Most variables were seen to correlate with propensity for circulatory collapse, but not sufficiently to effect reasonable classification by any single variable. Time series analysis indicated a single significant measure, the stressed blood volume, as predicting collapse in situ, but measurement of this quantity is clinically impossible. SVM uncovered a collection of variables and parameters that, when taken together, provided useful rubrics for classification. Due to the probabilistic origins of the method, multiple classifications were attempted, resulting in an average of 3.5 variables necessary to construct classification. The most common variables used were systemic compliance, baseline baroreceptor signal strength and total peripheral resistance, providing predictive ability exceeding 90%. The methods presented are suitable for use in any deterministic mathematical model. [ABSTRACT FROM AUTHOR]