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Contains fulltext : 247205.pdf (Publisher’s version ) (Open Access) The COVID Pandemic may affect fertility behaviour and intentions in many ways. Restrictions on service provision reduce access to family planning services and increase fertility in the short term. By contrast, the economic uncertainty brought about by the pandemic and its impact on mental health and well-being may reduce fertility. These various pathways have been explored in the context of high income countries such as the United States and Western Europe, but little is known about middle income countries. In this paper we asses the impact of the COVID pandemic on fertility intentions and behaviour in the Republic of Moldova, a middle income country in Eastern Europe, using the Generations and Gender Survey. This survey was conducted partially before and partially after the onset of the pandemic in 2020, allowing for detailed comparisons of individual circumstances. The results indicate that the pandemic reduced the used of intrauterine devices, and increased the use of male condoms, but with no overall decrease in contraceptive use. Conversely individuals interviewed after the onset of the pandemic were 34.5% less likely to be trying to conceive, although medium term fertility intentions were unchanged. Indicators therefore suggest that in the medium term fertility intentions may not be affected by the pandemic but restricted access to contraception requiring medical consultation and a decrease in short-term fertility intentions could disrupt short term family planning. 16 p.

The direct fluorescent antibody test (dFAT) using brain sample after opening the skull is the standard rabies diagnostic test in animal rabies. However, it is not feasible in many resource-limited settings. Lateral flow devices (LFD) combined with a simple sampling methodology is quicker, simpler, and less hazardous than the standard test and can be a useful tool. We conducted a prospective on-site study to evaluate the diagnostic accuracy of the LFD with the straw sampling method compared with that of the dFAT with the skull opening procedure for post-mortem canine rabies diagnosis. We collected 97 rabies-suspected animals between December 1, 2020 and March 31, 2021. Among the 97 samples, 53 and 50 cases were positive tests for dFAT and LFD, respectively. The sensitivity and specificity of LFD with straw sampling method were 94.3% (95% confidence interval [CI], 84.3–98.8%) and 100% (95% CI, 92.0–100%), respectively. The performance of LFD by the straw sampling method showed relatively high sensitivity and 100% specificity compared with that of dFAT performed on samples collected after opening the skull. This methodology can be beneficial and is a strong tool to overcome limited animal surveillance in remote areas. However, because of our limited sample size, more data using fresh samples on-site and the optimizations are urgently needed for the further implementation in endemic areas.

Urban traffic demand distribution is dynamic in both space and time. A thorough analysis of individuals’ travel patterns can effectively reflect the dynamics of a city. This study aims to develop an analytical framework to explore the spatiotemporal traffic demand and the characteristics of the community structure shaped by travel, which is analyzed empirically in New York City. It uses spatial statistics and graph-based approaches to quantify travel behaviors and generate previously unobtainable insights. Specifically, people primarily travel for commuting on weekdays and entertainment on weekends. On weekdays, people tend to arrive in the financial and commercial areas in the morning, and the functions of zones arrived in the evening are more diversified. While on weekends, people are more likely to arrive at parks and department stores during the daytime and theaters at night. These hotspots show positive spatial autocorrelation at a significance level of p = 0.001. In addition, the travel flow at different peak times form relatively stable community structures, we find interesting phenomena through the complex network theory: 1) Every community has a very small number of taxi zones (TZs) with a large number of passengers, and the weighted degree of TZs in the community follows power-law distribution; 2) As the importance of TZs increases, their interaction intensity within the community gradually increases, or increases and then decreases. In other words, the formation of a community is determined by the key TZs with numerous traffic demands, but these TZs may have limited connection with the community in which they are located. The proposed analytical framework and results provide practical insights for urban and transportation planning.

Car sharing has become a new mode of transport during the past two decades in the world. Its rapid growth in China has attracted a wide range of users and posed some problems. The main focus is on service efficiency and user satisfaction. To explore possible service enhancement and management intervention, this study aims at capturing the user characteristics according to different user types and scrutinizing their satisfaction with station-based one-way car sharing service. The study firstly illustrates descriptive statistics of user profile. This is followed by a study of user satisfaction influenced by user rates on staffs, the efficiency of rental process, vehicle situation, the use of credit card and their familiarity towards rental station. Furthermore, by clustering users according to the total travel time and distance during one rent, two different types of users are identified and defined as User Group A (UGA) and User Group B (UGB). To examine how fully do users utilize the shared cars, ANOVA was conducted implying family car ownership, total travel distance and main travel purpose have strong impact on total rental time for UGB, while for UGA, travel purpose and age have strong impact. Finally, ordinal logistic regression was introduced to find that for UGB, “shopping” is the main travel purpose with longer rental time, whereas for UGA, “out for business”, “shopping”, “visit friends” or “pick up others” are the main travel purposes with longer total travel time. Based on the findings, advices for operators on how to improve service quality and suggestions for government management strategy are discussed, respectively.

Background Cutaneous leishmaniasis (CL) is common in Ethiopia, mainly affecting impoverished populations in rural areas with poor access to health care. CL is routinely diagnosed using skin slit smear microscopy, which requires skilled staff and appropriately equipped laboratories. We evaluated the CL Detect Rapid Test (InBios, Washington, USA), which is supplied with a dental broach sampling device, as a diagnostic alternative which could be used in field settings. Methodology/Principal findings We evaluated the diagnostic accuracy of the CL Detect Rapid Test on skin slit and dental broach samples from suspected CL patients at the Leishmaniasis Research and Treatment Center in Gondar, Ethiopia. A combined reference test of microscopy and PCR on the skin slit sample was used, which was considered positive if one of the two tests was positive. We recruited 165 patients consecutively, of which 128 (77.6%) were confirmed as CL. All microscopy-positive results (n = 71) were also PCR-positive, and 57 patients were only positive for PCR. Sensitivity of the CL Detect Rapid Test on the skin slit was 31.3% (95% confidence interval (CI) 23.9–39.7), which was significantly higher (p = 0.010) than for the dental broach (22.7%, 95% CI 16.3–30.6). Sensitivity for both methods was significantly lower than for the routinely used microscopy, which had a sensitivity of 55.5% (IQR 46.8–63.8) compared to PCR as a reference. Conclusions/Significance The diagnostic accuracy of the CL Detect Rapid Test was low for skin slit and dental broach samples. Therefore, we do not recommend its use neither in hospital nor field settings. Trial registration This study is registered at ClinicalTrials.gov as NCT03837431., Author summary Cutaneous leishmaniasis (CL) is common in Ethiopia, and mainly affects rural areas with poor access to health care. CL is routinely diagnosed using microscopy on a skin slit sample, which requires skilled staff and appropriately equipped laboratories. We evaluated the diagnostic accuracy of the CL Detect Rapid Test as an alternative which could be used in field settings. In a population of 165 patients suspected to have CL, 78% was confirmed to have CL by PCR. We found that the CL Detect Rapid Test on the supplied dental broach had a sensitivity of only 23%; on a skin slit sample, the Rapid Test had a slightly higher sensitivity with 31%. The routine diagnostic test of microscopy on the skin slit had a significantly higher sensitivity with 56%. These findings show that the sensitivity of the CL Detect Rapid Test is low, and is much worse than that of the currently used diagnostic method. Therefore, we do not recommend it to be used for diagnosing CL in Ethiopia.

This study presents a methodology for using tracer indicators to measure the effects of disease-specific programs on national health systems. The methodology is then used to analyze the effects of Bangladesh’s Lymphatic Filariasis Elimination Program, a disease-specific program, on the health system. Using difference-in-differences models and secondary data from population-based household surveys, this study compares changes over time in the utilization rates of eight essential health services and incidences of catastrophic health expenditures between individuals and households, respectively, of lymphatic filariasis hyper-endemic districts (treatment districts) and of hypo- and non-endemic districts (control districts). Utilization of all health services increased from year 2000 to year 2014 for the entire population but more so for the population living in treatment districts. However, when the services were analyzed individually, the difference-in-differences between the two populations was insignificant. Disadvantaged populations (i.e., populations that lived in rural areas, belonged to lower wealth quintiles, or did not attend school) were less likely to access essential health services. After five years of program interventions, households in control districts had a lower incidence of catastrophic health expenditures at several thresholds measured using total household expenditures and total non-food expenditures as denominators. Using essential health service coverage rates as outcome measures, the Lymphatic Filariasis Elimination Program cannot be said to have strengthened or weakened the health system. We can also say that there is a positive association between the Lymphatic Filariasis Elimination Program’s interventions and lowered incidence of catastrophic health expenditures., Author summary Evidence to understand the interactions between disease specific programs and the health system is insufficient and largely based on opinion. This study presents a methodology for using tracer indicators to measure the effect of a disease-specific program, the Bangladesh Lymphatic Filariasis Elimination Program, on its health system. The Composite Coverage Index and incidence of catastrophic health expenditures are well-established tracer indicators for measuring the strength of a health system. In this study, they were calculated, before the program started in 2000 and after it ended in 2015, using data from Demographic and Health Surveys and Household Income and Expenditure Surveys, respectively. Using the Composite Coverage Index to measure the effects of the Lymphatic Filariasis Elimination Program revealed that it did not negatively or positively affect health service coverage rates. We can also say that there is a positive association between the program interventions and lowered incidence of catastrophic health expenditures.

The primary dengue virus vectors, Aedes aegypti and Aedes albopictus, are primarily daytime biting mosquitoes. The risk of infection is suspected to be considerable in urban parks due to visitor traffic. Despite the importance of vector control for reducing dengue transmission, little information is available on vector populations in urban parks. The present study characterized mosquito habitats and estimated vector densities in the major urban parks in Ho Chi Minh City, Vietnam and compared them with those in adjacent residential areas. The prevalences of habitats where Aedes larvae were found were 43% and 9% for the parks and residential areas, respectively. The difference was statistically significant (prevalence ratio [PR]: 5.00, 95% CI: 3.85–6.49). The prevalences of positive larval habitats were significantly greater in the parks for both species than the residential areas (PR: 1.52, 95% CI: 1.04–2.22 for A. aegypti, PR: 10.10, 95% CI: 7.23–14.12 for A. albopictus). Larvae of both species were positively associated with discarded containers and planters. Aedes albopictus larvae were negatively associated with indoor habitats, but positively associated with vegetation shade. The adult density of A. aegypti was significantly less in the parks compared with the residential areas (rate ratio [RR]; 0.09, 95% CI: 0.05–0.16), while the density of A. albopictus was significantly higher in the parks (RR: 9.99, 95% CI: 6.85–14.59). When the species were combined, the density was significantly higher in the parks (RR: 2.50, 95% CI: 1.92–3.25). The urban parks provide suitable environment for Aedes mosquitoes, and A. albopictus in particular. Virus vectors are abundant in the urban parks, and the current vector control programs need to have greater consideration of urban parks., PLoS neglected tropical diseases, 16(1), e0010119; 2022

Funder: biotechnology and biologic sciences research council, Funder: department for international development; funder-id: http://dx.doi.org/10.13039/501100000278, Funder: economic & social research council, Funder: medical research council, Background: Previous work has shown differential predominance of certain Mycobacterium tuberculosis (M. tb) lineages and sub-lineages among different human populations in diverse geographic regions of Ethiopia. Nevertheless, how strain diversity is evolving under the ongoing rapid socio-economic and environmental changes is poorly understood. The present study investigated factors associated with M. tb lineage predominance and rate of strain clustering within urban and peri-urban settings in Ethiopia. Methods: Pulmonary Tuberculosis (PTB) and Cervical tuberculous lymphadenitis (TBLN) patients who visited selected health facilities were recruited in the years of 2016 and 2017. A total of 258 M. tb isolates identified from 163 sputa and 95 fine-needle aspirates (FNA) were characterized by spoligotyping and compared with international M.tb spoligotyping patterns registered at the SITVIT2 databases. The molecular data were linked with clinical and demographic data of the patients for further statistical analysis. Results: From a total of 258 M. tb isolates, 84 distinct spoligotype patterns that included 58 known Shared International Type (SIT) patterns and 26 new or orphan patterns were identified. The majority of strains belonged to two major M. tb lineages, L3 (35.7%) and L4 (61.6%). The observed high percentage of isolates with shared patterns (n = 200/258) suggested a substantial rate of overall clustering (77.5%). After adjusting for the effect of geographical variations, clustering rate was significantly lower among individuals co-infected with HIV and other concomitant chronic disease. Compared to L4, the adjusted odds ratio and 95% confidence interval (AOR; 95% CI) indicated that infections with L3 M. tb strains were more likely to be associated with TBLN [3.47 (1.45, 8.29)] and TB-HIV co-infection [2.84 (1.61, 5.55)]. Conclusion: Despite the observed difference in strain diversity and geographical distribution of M. tb lineages, compared to earlier studies in Ethiopia, the overall rate of strain clustering suggests higher transmission and warrant more detailed investigations into the molecular epidemiology of TB and related factors.

BackgroundPhysical activity (PA) is associated with numerous health benefits among children and youth. However, few studies have examined how active transportation (AT) and device-based measures of PA vary within and between countries in sub-Saharan Africa.PurposeThis cross-sectional study sought to investigate the prevalence and correlates of AT and device-measured PA among children living in urban, peri-urban and rural areas in three African countries representing Eastern, Western and Southern regions of Africa.Methods3,205 participants (53.3% girls; 46.7% boys) aged 10–12 years were recruited in Kenya, Nigeria and Mozambique. Data were collected using a child questionnaire, a parent/guardian questionnaire and PiezoRx® pedometers. ANCOVA and binary logistic regression analyses were used to examine the correlates of AT and PA while controlling for gender, age, parent education and vehicle ownership.ResultsParticipants accumulated an average of 45.6±23.5 min/day of moderate-to-vigorous physical activity (MVPA) and 11,215±4,273 steps/day. Kenyan and Mozambican children were significantly more active than their Nigerian counterparts (pConclusionsMajority of children engaged in AT, but still failed to meet MVPA recommendations. Most correlates of AT and PA were country-specific, suggesting that strategies to encourage both behaviours should be informed by local evidence.

The location of primary public schools in urban areas of developing countries is the focus of this study. In such areas, new schools and modification of the current schools are required, and this process should be developed using rational and broad supporting tools for decision makers, such as optimization models. We propose a realistic coverage location model and a framework to analyze the location of schools. Our approach considers the existing schools and their resizing, the best locations of the new schools that may have different capacities, population coverage, walking distances and budget provisions for building and updating schools. As a case study, we assess the current primary school network in Ciudad Benito Juarez to provide managerial insights. Through the proposed framework, we analyze the current locations of schools and decisions to be made by considering future scenarios in different time periods. The proposed model is quite flexible and easy to adapt to new considerations, allowing it to be applied to regions in developing countries under similar conditions.

BackgroundAn increased risk of cancer death has been demonstrated for patients diagnosed with acute coronary syndrome (ACS). We are investigating possible geographic risk disparities.MethodsThis prospective study included 541 ACS patients who were admitted to hospitals and discharged alive in three provinces of Italy’s Veneto region. The patients were classified as residing in urban or rural areas in each province.ResultsWith 3 exceptions, all patients completed the 22-year follow-up or were followed until death. Urban (46%) and rural (54%) residents shared most of their baseline demographic and clinical characteristics. Pre-existing malignancy was noted in 15 patients, whereas 106 patients developed cancer during the follow-up period, which represented 6232 person-years. No difference in the cancer death risk was found between the urban and rural areas or between southern and northern provinces (hazard ratio [HR] 1.1; 95% confidence interval [CI] 0.7–1.7; p = 0.59 and HR 1.1; 95% CI 0.9–1.4; p = 0.29, respectively) according to the unadjusted Cox regression analysis. Geographic areas, however, showed a strong positive interaction, with risk increasing from the urban to rural areas from southern to northern provinces (HR 1.9; 95% CI 1.1–3.0; p = 0.01). The fully adjusted Cox regression and Fine-Gray competing risk regression models provided similar results. Interestingly, these results persisted, and even strengthened, after exclusion of the 22 patients who developed malignancy and survived to the end of follow-up. We did not observe an urban/rural difference in non-neoplastic death risk or a significant interaction between the geographic areas.ConclusionOur analysis reveals that the cancer death risk among unselected ACS patients in Italy’s Veneto region significantly differs by geography. The northern rural area has the highest risk. These results highlight the importance of implementing a preventive policy based on area-specific knowledge.

How to promote and improve the level of urban innovation cooperation is a major issue in China’s current high-quality economic development. Thus, enhancing innovation ability is essential to achieving high-quality economic growth under the "new normal". Based on the data of Chinese invention patents from 1985 to 2017, this paper analyzes the characteristics of China’s urban innovation cooperation network and the different roles of proximity by using social network analysis and exploratory spatial data analysis methods. The analysis results show that: (1) On the whole, the development of China’s urban innovation cooperation network is characterized by stages (initial development stage, rapid development stage, and gradual decline stage); The urban innovation cooperation network has strong connectivity and centripetal concentration but its imbalance needs to be further improved; The degree of urban participation has gradually increased, consolidating the stability of the network structure. (2) The centrality of urban innovation cooperation network has obvious characteristics of administrative center orientation, coastal areas orientation, and ‘strong east and weak west’; Beijing is the center and bridge of the network, and the network flattening characteristics are obvious; A hierarchical ‘core-edge’ structure is gradually formed for the urban innovation cooperation network, and the pyramid structure with Beijing standing at the top is being consolidated. (3) The geographical proximity presents a significant global spatial positive correlation, while the network proximity and pure network proximity have a more significant global spatial negative correlation; The local spatial autocorrelation of China’s urban innovation cooperation system based on network proximity is more obvious and identifiable than that based on the geographical proximity, which better reflects the new development model of "relationship economy".

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.

Background Tuberculosis (TB) has contributed to a significant disease burden and economic loss worldwide. Given no gold standard for diagnosis, early identification of TB infection has been challenging. This study aimed to comparatively investigate the prevalence of TB across diagnostic approaches (sputum AFB, sputum culture, sputum genetic test, and chest x-ray) and geographical areas of Indonesia. Methods Participant demographic variables and TB screening test results were obtained from the Tuberculosis Unit, Health Research and Development Agency, Ministry of Health (HRDA-MoH). The prevalence of pulmonary TB in populations aged 15 years and over was calculated using TB cases as a numerator and populations aged 15 years and over as a denominator. Variations across geographical areas and diagnostic approaches were expressed as prevalence and 95% confidence interval (CI). Results A total of 67,944 records were reviewed. Based on bacteriological evidence, the prevalence of TB per 100,000 in Indonesia was 759 (95% CI: 589.7–960.8) with variations across areas: 913 (95% CI 696.7–1,176.7; Sumatra), 593 (95% CI 447.2–770.6; Java-Bali), and 842 (95% CI 634.7–1,091.8; other islands). Also, the prevalence of TB varied across diagnostic approaches: 256.5 (sputum AFB), 545 (sputum culture), 752.2 (chest x-ray), and 894.9 (sputum genetic test). Based on sputum AFB, the TB prevalence varied from 216.6 (95% CI 146.5–286.8; Java-Bali), 259.9 (95% CI 184.2–335.6; other islands) to 307.4 (95% CI 208.3–406.5; Sumatra). Based on sputum culture, the TB prevalence ranged from 487.9 (95% CI 433.6–548.6; Java-Bali), 635.9 (95% CI 564.9–715.1; Sumatra), to 2,129.8 (95% CI 1,664.0–2,735.6; other islands). Based on chest x-ray, the TB prevalence varied from 152.1 (95% CI 147.9–156.3; Java-Bali), 159.2 (95% CI 154.1–164.3; Sumatra), to 864 (95% CI 809–921.4; other islands). Based on sputum genetic test, the TB prevalence ranged from 838.7 (95% CI 748.4–900.8; Java-Bali), 875 (95% CI 775.4–934.2; Sumatra), to 941.2 (95% CI 663.6–992.3; other islands). Conclusions The variation of TB prevalence across geographical regions could be confounded by the diagnostic approaches. Trial registration This study was approved by the Institutional Review Board of Chulalongkorn University (IRB No. 684/63).

Uncontrolled urban growth detracts from healthy urban development. Understanding urban development trends and predicting future urban spatial states is of great practical significance. In order to comprehensively analyze urbanization and its effect on vegetation cover, we extracted urban development trends from time series DMSP/OLS NTL and NDVI data from 2000 to 2015, using a linear model fitting method. Six urban development trend types were identified by clustering the linear model parameters. The identified trend types were found to accurately reflect the on-ground conditions and changes in the Jinan area. For example, a high-density, stable urban type was found in the city center while a stable dense vegetation type was found in the mountains to the south. The SLEUTH model was used for urban growth simulation under three scenarios built on the urban development analysis results. The simulation results project a gentle urban growth trend from 2015 to 2030, demonstrating the prospects for urban growth from the perspective of environmental protection and conservative urban development.

Farmland and migratory bird populations are in decline. The Common quail (Coturnix coturnix) provides an exception to this trend and its populations have remained stable over the last two decades. However, some basic facts regarding quail biology and ecology, such as the geographic distribution of age and sex classes during the summer, remain poorly understood. We analyzed 43,194 Spanish quail ringing records from 1961 to 2014 to assess the effects of geography and weather conditions on the probability that individuals will be ringed during the various stages of their annual cycle (arrival –spring migration-, stationary breeding period, departure –autumn migration- and winter) for the different quail age-sex classes over time. We found that spatial distribution of the age and sex classes can be explained by date, latitude, longitude, altitude, rainfall, and temperature. Our results suggest that date accounts for most of the variation in the distribution of quail age classes, followed by the weather variables, and then latitude, and altitude. Similarly, date also accounts for most of the variation in the distribution of the two sexes. These results could partially explain why this species has avoided population decline, since its ecological strategy is based on its temporal and spatial distribution combined with the segregation of age and sex groups. We hypothesize that the distribution of quail age and sex classes follows variations in weather and habitat suitability to exploit seasonal and geographic variations in resource availability. The migratory and nomadic movements of quail, combined with the occurrence of multiple breeding attempts within a single season, may also allow these birds to overcome the impacts of predators and anthropogenic environmental change. Conservation and management efforts should therefore take account of these age and sex related temporal and spatial patterns., This research article was supported by a grant by the Language Institute of the University of Lleida (2016 call). A.M. was supported by a Ramón y Cajal research contract by the Ministry of Economy and Competitiveness (RYC-2012-11867).

Background The COVID-19 pandemic led to mental health fallout in the US; yet research about mental health and COVID-19 primarily rely on samples that may overlook variance in regional mental health. Indeed, between-city comparisons of mental health decline in the US may provide further insight into how the pandemic is disproportionately affecting at-risk groups. Purpose This study leverages social media and COVID-19-city infection data to measure the longitudinal (January 22- July 31, 2020) mental health effects of the COVID-19 pandemic in 20 metropolitan areas. Methods We used longitudinal VADER sentiment analysis of Twitter timelines (January-July 2020) for cohorts in 20 metropolitan areas to examine mood changes over time. We then conducted simple and multivariate Ordinary Least Squares (OLS) regressions to examine the relationship between COVID-19 infection city data, population, population density, and city demographics on sentiment across those 20 cities. Results Longitudinal sentiment tracking showed mood declines over time. The univariate OLS regression highlighted a negative linear relationship between COVID-19 city data and online sentiment (β = -.017). Residing in predominantly white cities had a protective effect against COVID-19 driven negative mood (β = .0629, p < .001). Discussion Our results reveal that metropolitan areas with larger communities of color experienced a greater subjective well-being decline than predominantly white cities, which we attribute to clinical and socioeconomic correlates that place communities of color at greater risk of COVID-19. Conclusion The COVID-19 pandemic is a driver of declining US mood in 20 metropolitan cities. Other factors, including social unrest and local demographics, may compound and exacerbate mental health outlook in racially diverse cities.

Gridded population data is widely used to map fine scale population patterns and dynamics to understand associated human-environmental processes for global change research, disaster risk assessment and other domains. This study mapped gridded population across Germany using weighting layers from building density, building height (both from previous studies) and building type datasets, all created from freely available, temporally and globally consistent Copernicus Sentinel-1 and Sentinel-2 data. We first produced and validated a nation-wide dataset of predominant residential and non-residential building types. We then examined the impact of different weighting layers from density, type and height on top-down dasymetric mapping quality across scales. We finally performed a nation-wide bottom-up population estimate based on the three datasets. We found that integrating building types into dasymetric mapping is helpful at fine scale, as population is not redistributed to non-residential areas. Building density improved the overall quality of population estimates at all scales compared to using a binary building layer. Most importantly, we found that the combined use of density and height, i.e. volume, considerably increased mapping quality in general and with regard to regional discrepancy by largely eliminating systematic underestimation in dense agglomerations and overestimation in rural areas. We also found that building density, type and volume, together with living floor area per capita, are suitable to produce accurate large-area bottom-up population estimates. Publication Franz Schug, David Frantz, Sebastian van der Linden, Patrick Hostert (2021): Gridded population mapping for Germany based on building density, height and type from Earth Observation data using census disaggregation and bottom-up estimates, PLoS ONE 16(3): e0249044. https://doi.org/10.1371/journal.pone.0249044 Funding This research received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (MAT_STOCKS, grant agreement No 741950).

The global growth of electronic media usage among children has caused concerns regarding screen time (ST) impact on child development. No previous population-based studies have evaluated ST and child development in India. This study aimed to determine the burden of ST, associated sociodemographic factors, and its impact on domains of child development. A population-based cross-sectional study was conducted in the field practice area of rural and urban health centers in Tamil Nadu, India. A total of 718 children (396 rural and 322 urban) were selected, using a cluster random sampling method. ST estimates were obtained from parents/guardian after a 7-day observation period. The Communication DEALL Developmental Checklist was used to assess child development. The mean ST was 2.39 hours/day (95% confidence interval [CI]: 2.23–2.54), and the prevalence of excessive ST was 73% (95% CI: 69.2–76.8). Excessive ST was significantly associated with the mothers’ ST, screen usage at bedtime, birth order (in children < 2 years), and attending school (in children ≥ 2 years). Increased ST was significantly associated with developmental delay, in particular, in the domains of language acquisition and communication. In children aged ≥ 2 years, a delay in ≥ 3 domains was associated with ST (adjusted odds ratio [AOR] = 17.75, 95% CI: 5.04–62.49, p < 0.001), as was language delay (AOR = 52.92, 95% CI: 12.33–227.21, p < 0.001). In children aged < 2 years, a delay in ≥ 2 domains was associated with ST (AOR = 16.79, 95% CI: 2.26–124.4, p < 0.001), as was language delay (AOR = 20.93, 95% CI: 2.68–163.32, p < 0.01). A very high prevalence of excessive ST was identified, with a significant association with developmental delay in children. There is an urgent need to include education on ST limits at the primary healthcare level.

The accurate identification of urban functional areas is of great significance for optimizing urban spatial structure, rationally allocating spatial elements, and promoting the sustainable development of the city. This paper proposes a method to precisely identify urban functional areas by coupling Open Street Map (OSM) and Point of Interest (POI) data. It takes the central urban area of Hangzhou as a case study to analyze the spatial distribution characteristics of the functional areas. The results show that: (1) The central urban areas of Hangzhou are divided into 21 functional areas (6 single functional areas, 14 mixed functional areas and 1 comprehensive functional area). (2) The single functional areas and the mixed functional areas show the geographical distribution characteristics of the looping stratification, which means “Core-periphery” differentiation is obvious, and the comprehensive functional area is relatively scattered. (3) The mixed degree of regional function with ecological function and production function is low while comprehensive functional areas are usually associated with higher potential and vitality. (4) The identification results are in great agreement with the actual situation of Hangzhou central urban area, and the method is feasible. Therefore, this paper can provide a reference for urban development planning and management.

Objectives Traffic speed is important to public health as it is a major contributory factor to collision risk and casualty severity. 20mph (32km/h) speed limit interventions are an increasingly common approach to address this transport and health challenge, but a more developed evidence base is needed to understand their effects. This study describes the changes in traffic speed and traffic volume in the City of Edinburgh, pre- and 12 months post-implementation of phased city-wide 20mph speed limits from 2016–2018. Methods The City of Edinburgh Council collected speed and volume data across one full week (24 hours a day) pre- and post-20mph speed limits for 66 streets. The pre- and post-speed limit intervention data were compared using measures of central tendency, dispersion, and basic t-tests. The changes were assessed at different aggregations and evaluated for statistical significance (alpha = 0.05). A mixed effects model was used to model speed reduction, in the presence of key variables such as baseline traffic speed and time of day. Results City-wide, a statistically significant reduction in mean speed of 1.34mph (95% CI 0.95 to 1.72) was observed at 12 months post-implementation, representing a 5.7% reduction. Reductions in speed were observed throughout the day and across the week, and larger reductions in speed were observed on roads with higher initial speeds. Mean 7-day volume of traffic was found to be lower by 86 vehicles (95% CI: -112 to 286) representing a reduction of 2.4% across the city of Edinburgh (p = 0.39) but with the direction of effect uncertain. Conclusions The implementation of the city-wide 20mph speed limit intervention was associated with meaningful reductions in traffic speeds but not volume. The reduction observed in road traffic speed may act as a mechanism to lessen the frequency and severity of collisions and casualties, increase road safety, and improve liveability.

To evaluate actions taken to implement the Telecommunications Act of 1996, the primary goal of which was to foster competition in the industry, the FCC created a standardized form (Form 477) to collect information about broadband deployment and competition in local telephone service. These data represent the best publicly available record of broadband provision in the United States. Despite the potential benefits offered by this database, there are several nuances to these data related to shifting geographies and reporting requirements that uncorrected, prevent them from being used as an uninterrupted time series for longitudinal analyses. Given the analytical challenges associated with the FCC Form 477 data, the purpose of this paper is to present a solution to the fragmented nature of these data which prevents meaningful longitudinal analyses of the digital divide. Specifically, this paper develops and describes a procedure for producing an integrated broadband time series (BITS) for the last decade (2008–2018). This includes the procedures for using these data, their value to social and economic analysis, and their underlying limitations. The core contribution of this paper is the creation of data infrastructure for investigating the evolution of the digital divide.

Most insurance policies include a deductible, so that a part of the claim is paid by the insured. In order to get full coverage of the claim, the insured has two options: purchase a Zero Deductible Insurance Policy or purchase an insurance policy with deductible together with Refundable Deductible Insurance. The objective of this paper is to analyze these two options and compare the premium paid by each. We definedif(P) as the difference between the premiums paid. This function depends on the parameters of the deductible applied, and we focus our attention on the sign of this difference and the calculation of the optimal deductible, that is, the values of the parameters of the deductible that allow us to obtain the greatest reduction in the premium.

Urban seismology has gained scientific interest with the development of seismic ambient noise monitoring techniques and also for being a useful tool to connect society with the Earth sciences. The interpretation of the sources of seismic records generated by sporting events, traffic, or huge agglomerations arouses the population’s curiosity and opens up a range of possibilities for new applications of seismology, especially in the area of urban monitoring. In this contribution, we present the analysis of seismic records from a station in the city of Brasilia during unusual episodes of silencing and noisy periods. Usually, cultural noise is observed in high-fequency bands. We showed in our analysis that cultural noise can also be observed in the low-frequency band, when high-frequency signal is attenuated. As examples of noisy periods, we have that of the Soccer World Cup in Brazil in 2014, where changes in noise are related to celebrations of goals and the party held by FIFA in the city, and the political manifestations in the period of the Impeachment trial in 2016, which reached the concentration of about 300,000 protesters. The two most characteristic periods of seismic silence have been the quarantine due to the COVID-19 pandemic in 2020, and the trucker strike that occurred across the country in 2018, both drastically reducing the movement of people in the city., MS received support from the Generalitat de Catalunya (2017SGR1022) and Spanish Ministry of Science, Innovation and Universities (SANIMS project, no. RTI2018-095594-B-I00).MPR thanks CNPq for the research fellowship grant 30.7151/2018-2.

With increasing flood risk, evacuation has become an important research topic in urban flood management. Urban flood evacuation is a complex problem due to i) the complex interactions among several components within a city and ii) the need to consider multiple, often competing, dimensions/objectives in evacuation analysis. In this study, we focused on the interplay between two such objectives: efficiency and fairness. We captured the evacuation process in a conceptual agent-based model (ABM), which was analyzed under different hard infrastructure and institutional arrangement conditions, namely, various shelter capacity distributions as a hard infrastructure property and simultaneous/staged evacuation as an institutional arrangement. Efficiency was measured as the time it takes for a person to evacuate to safety. Fairness was defined by how equally residents suffered from floods, and the level of suffering depended on the perceived risk and evacuation time. Our findings suggested that efficiency is more sensitive to the shelter capacity distribution, while fairness changes more notably according to the evacuation priority assigned to the divided zones in staged evacuation. Simultaneous evacuation generally tended to be more efficient but unfairer than staged evacuation. The efficiency-fairness trade-off was captured by Pareto-optimal strategies, among which uniform capacity cases led to a higher efficiency while prioritizing high-risk residents increases fairness. Strategies balancing efficiency and fairness featured a uniform capacity and prioritized high-risk residents at an intermediate time delay. These findings more clearly exposed the interactions between different factors and could be adopted as benchmarks to inform more complicated evacuation ABMs.

As in other countries, short-term rentals for tourism services are growing rapidly in China’s tourist cities, which are mainly operated through Airbnb. This paper explores whether the spatial distribution of Airbnb in China’s rapid urbanization process exhibits characteristics, paths, and drivers that are different from those of cities in other countries. Airbnb is a model for the global sharing economy, but it is increasingly influenced by other functions and facilities in cities as it grows. In this paper, the zero-expansion negative binomial regression was used to study the factors affecting the spatial distribution of Airbnb in Nanjing, China. The results showed that the spatial distribution of Airbnb listings was correlated with the distribution of cultural attractions, universities, public transport accessibility, shopping centers, and business apartments. By analyzing the driving forces of Airbnb’s development in Nanjing, this paper found that a large number of business apartments developed in cities were essential providers of Airbnb listings, and affected its spatial distribution. The gap between short-term and long-term rentals was also correlated with the distribution of Airbnb. In addition, similar to the previous literature findings, the increase in the proportion of professional hosts changes the original intention of Airbnb for sharing and communication. Our empirical results applies to the current situation of Airbnb in Chinese cities, which is conducive to the government’s more intelligent management and effective promotion of the Airbnb market. Our findings also provide positive references for urban renewal policies and public participation methods in China.

The sustainable development of collection and delivery points and urban street network is an important consideration of logistic planners. Urban street networks have a significant impact on collection and delivery points’ location, but the spatial relationship between the centrality of urban street network and collection and delivery points has not been studied using spatial design network analysis. In a multiple centrality assessment model, we used point of interest and street network data to evaluate the location of two types of collection and delivery points and the centrality of streets in Nanjing city, based on four indicators: closeness, betweenness, severance, and efficiency. Then, kernel density estimation and spatial autocorrelation are used to study spatial patterns of distribution and centrality coupling effects of urban street network and collection and delivery points. The results show that the centrality of Nanjing streets has a big influence on the location of the collection and delivery points, and the directions of different types of centrality also vary. The location of the Cainiao Stations are largely related to closeness, followed by betweenness, severance, and efficiency. China Post Stations and street centrality have a weak correlation between efficiency and severance, but no correlation between closeness and betweenness. Our results can help logistics enterprises and urban planners to develop collection and delivery points’ network based on the urban street network.

In this paper, we seek to identify the existing conceptualisations and applications of social capital contained in the literature, as well as how these are used and combined across and within research fields. Our analytical approach presents a unique combination of topic models and bipartite blockmodelling, enabling us to analyse both the content and structures of a large collection of academic texts. In particular, this allows us to: (a) summarise the content in relation to a variety of topics; and (b) uncover the structure, with diverse text subsets engaging differently with these topics. Our analysis of all of the 11,975 articles on Web of Science that address ‘social capital’ demonstrates that these can be reduced to nine distinct topic clusters and six article clusters. Specifically, we identify the multifaceted nature of the social-capital metaphor and show that there are clear variations in how it is deployed in different bodies of literature. Finally, by mapping the diverse conceptualisations and applications of social capital in a network, we propose a tool for identifying future research opportunities for those interested in novel social-capital treatments in their field.

Introduction In 2017, the highest global maternal deaths occurred in sub-Saharan Africa (SSA). The WHO advocates that maternal deaths can be mitigated with the assistance of skilled birth attendants (SBAs) at childbirth. Women empowerment is also acknowledged as an enabling factor to women’s functionality and healthcare utilisation including use of SBAs’ services. Consequently, this study investigated the association between women empowerment and skilled birth attendance in SSA. Materials and methods This study involved the analysis of secondary data from the Demographic and Health Surveys of 29 countries conducted between January 1, 2010, and December 3, 2018. For this study, only women who had given birth in the five years prior to the surveys were included, which is 166,022. At 95% confidence interval, Binary Logistic Regression analyses were conducted and findings were presented as adjusted odds ratios (aORs). Results The overall prevalence of skilled birth attendance was 63.0%, with the lowest prevalence in Tanzania (13.8%) and highest in Rwanda (91.2%). Women who were empowered with high level of knowledge (aOR = 1.60, 95% CI = 1.51, 1.71), high decision-making power (aOR = 1.19, 95% CI = 1.15, 1.23), and low acceptance of wife beating had higher likelihood of skill birth attendance after adjusting for socio-demographic characteristics. Women from rural areas had lesser likelihood (OR = 0.53, 95% CI = 0.51–0.55) of skilled birth attendance compared to women from urban areas. Working women had a lesser likelihood of skilled birth attendance (OR = 0.91, 95% CI = 0.88–0.94) as compared to those not working. Women with secondary (OR = 2.13, 95% CI = 2.03–2.22), or higher education (OR = 4.40, 95% CI = 3.81–5.07), and women in the richest wealth status (OR = 3.50, 95% CI = 3.29–3.73) had higher likelihood of skilled birth attendance. Conclusion These findings accentuate that going forward, successful skilled birth attendant interventions are the ones that can prioritise the empowerment of women.

Income polarization is a pressing issue which is increasingly discussed by academics and policymakers. The present research examines income polarization in Canada’s eight largest Census Metropolitan Areas (CMAs) using data at the census-tract (CT) level between 1971 and 2016. Generally, there are significant decreasing trends in the middle-income population with simultaneously increasing trends in low-income groups. The high-income groups have been relatively stable with fewer significant increasing population trends. Using conventional mapping and cartograms, patterns of the spatial evolution of income inequality are illustrated. Every CMA examined contains an increasing trend of spatial fragmentation at the patch level within each CMA’s landscape mosaic. The results of a spatial autocorrelation analysis at the sub-patch, CT level, exhibit significant spatial clustering of high-income CTs as one process that dominates the increasingly fragmented landscape mosaic.

Small and Medium Enterprises (SMEs) are considered as the fundamental tool for economic growth, nevertheless, they face continuous financing challenges. SMEs are a major source for generating employment, creation of wealth and alleviating poverty from the rural regions in developing countries. Their access to finance is key to the expansion of this sector. The paper aims to discover the intervening role of “access of SMEs to finance” in the link between SME’s evolution and rural development, in the context of Pakistan. In total 338 entrepreneurs operating SMEs in rural areas completed a survey for the study. Through a multi-stage stratified random sampling technique, entrepreneurs were selected from three districts. Confirmatory factor analysis and structural equation modeling were used to test hypotheses. This study shows that SME’s evolution has a positive and optimistic influence on rural development. Further, the study also reveals that on SME’s progress a positive influence happens by the “access of SMEs to finance”. Particularly, the study finds that “access of SMEs to finance” significantly mediated the effect of SME’s evolution on rural development. The findings of this paper hold significant implications for both the research society and loan-issuing institutions and departments.

Visiting parks and gardens supports physical and mental health. We quantified access to public parks and gardens in urban areas of England and Wales, and the potential for park crowdedness during periods of high use. We combined data from the Office for National Statistics and Ordnance Survey to quantify (i) the number of parks within 500 and 1,000 metres of urban postcodes (i.e., availability), (ii) the distance of postcodes to the nearest park (i.e., accessibility), and (iii) per-capita space in each park for people living within 1,000m. We examined variability by city and share of flats. Around 25.4 million people (~87%) can access public parks or gardens within a ten-minute walk, while 3.8 million residents (~13%) live farther away; of these 21% are children and 13% are elderly. Areas with a higher share of flats on average are closer to a park but people living in these areas visit parks that are potentially overcrowded during periods of high use. Such disparity in urban areas of England and Wales becomes particularly evident during COVID-19 pandemic and lockdown when local parks, the only available out-of-home space option, hinder social distancing requirements. Cities aiming to facilitate social distancing while keeping public green spaces safe might require implementing measures such as dedicated park times for different age groups or entry allocation systems that, combined with smartphone apps or drones, can monitor and manage the total number of people using the park.

In low- and middle-income countries, poor autonomy prevents women from making financial decisions, which may impact their access to improved sanitation facilities. Inadequate access to improved sanitation disproportionately affects women’s and children’s health and wellbeing. Although socio-cultural factors are known contributors to gender inequity, social beliefs that potentially motivate or dissuade women from making sanitation-related household decisions are not well understood. These beliefs may vary across settlement types. To empower more women to make sanitation-related decisions, the relevant socio-cultural norms and underlying social beliefs need to be addressed. In this mixed methods study, we explored women’s role in sanitation-related decision making in three settlement types, urban slums, peri-urban, and rural communities in Bihar. Trained qualitative researchers conducted six focus group discussions with women of two age groups: 18–30 years old, and 45–65 years old to understand the norm-focused factors around women’s role in getting a toilet for their household. Using insights generated from these group discussions, we developed and conducted a theory-driven survey in 2528 randomly selected participants, to assess the social beliefs regarding women making toilet construction decisions in these communities. Overall, 45% of the respondents reported making joint decisions to build toilets that involved both men and women household members. More women exclusively led this decision-making process in peri-urban (26%) and rural areas (35%) compared to urban slums (12%). Social beliefs that men commonly led household decisions to build toilets were negatively associated with women’s participation in decision making in urban slums (adjusted prevalence ratio, aPR: 0.53, 95% CI: 0.42, 0.68). Qualitative insights highlighted normative expectations to take joint decisions with elders, especially in joint family settings. Surrounding norms that limited women’s physical mobility and access to peers undermined their confidence in making large financial decisions involved in toilet construction. Women were more likely to be involved in sanitation decisions in peri-urban and rural contexts. Women’s involvement in such decisions was perceived as widely acceptable. This highlights the opportunity to increase women’s participation in sanitation decision making, particularly in urban contexts. As more women get involved in decisions to build toilets, highlighting this norm may encourage gender-equitable engagement in sanitation-related decisions in low-resource settings.

Background Cervical cancer (CC) promotion and prevention (P&P) programmes’ challenge lies in guaranteeing that follow-up strategies have a real impact on reducing CC-related mortality rates. CC P&P programme compliance and coverage rates are relevant indicators for evaluating their success and good performance; however, such indicators’ frequency rates are considerably lower among women living in rural and border areas. This study was aimed at identifying factors associated with CC screening programme attendance for women living in Colombia’s Amazon region. Methods This study (qualitative and quantitative phases) was carried out between September 2015 and November 2016; women residing in the border towns of Leticia and Puerto Nariño participated in it. The first phase (qualitative) involved interviews and focus group discussions; this led to establishing factors related to CC P&P programme attendance which were used in the quantitative phase for designing a survey for determining the strength of association in a logistic regression model. The terms attendance and compliance were considered to apply to women who had followed the 1–1–3 scheme throughout their lives, i.e. a cytology examination every 3 years after receiving two consecutive negative annual cytology results. Results Inclusion criteria were met by 309 women (≥18-year-olds having an active sexual life, having resided in the target community for at least one year); 15.2% had suitable P&P programme follow-up. Screening programme attendance was positively associated with first intercourse after becoming 20 years-old (aOR: 3.87; 1.03–9.50 95%CI; p = 0.045), frequent contraceptive use (aOR: 3.11; 1.16–8.33 95%CI; p = 0.023), awareness of the age to participate in P&P programmes (aOR: 2.69; 1.08–6.68 95%CI; p = 0.032), awareness of cytology’s usefulness in identifying cervical abnormalities (aOR: 2.43; 1.02–5.77 95%CI; p = 0.043) and considering cytology important (aOR: 2.64; 1.12–6.19 95%CI; p = 0.025). Women living in rural areas had a lower probability (aOR 0.43: 0.24–0.79 95%CI; p = 0.006) of adhering to CC P&P programmes. Conclusions This study’s findings suggested the need for including novel strategies in screening programmes which will promote CC P&P activities going beyond hospital outpatient attendance to reach the most remote or widely scattered communities, having the same guarantees regarding access, opportunity and quality. Including education-related activities and stimulating the population’s awareness regarding knowledge about CC prevention could be one of the main tools for furthering the impact of attendance at and compliance with P&P programmes.

The Effective Reproduction Number Rt provides essential information for the management of an epidemic/pandemic. Projecting Rt into the future could further assist in the management process. This article proposes a methodology based on exposure scenarios to perform such a procedure. The method utilizes a compartmental model and its adequate parametrization; a way to determine suitable parameters for this model in México’s case is detailed. In conjunction with the compartmental model, the projection of Rt permits estimating unobserved variables, such as the size of the asymptomatic population, and projecting into the future other relevant variables, like the active hospitalizations, using scenarios. The uses of the proposed methodologies are exemplified by analyzing the pandemic in a Mexican state; the main quantities derived from the compartmental model, such as the active and total cases, are included in the analysis. This article also presents a national summary based on the methodologies to illustrate how these procedures could be further exploited. The supporting information includes an application of the proposed methods to a metropolitan area to show that it also works well at other demographic disaggregation levels. The procedures developed in this article shed light on how to develop an effective surveillance system when information is incomplete and can be applied in cases other than México’s.

Giant kelp populations that support productive and diverse coastal ecosystems at temperate and subpolar latitudes of both hemispheres are vulnerable to changing climate conditions as well as direct human impacts. Observations of giant kelp forests are spatially and temporally uneven, with disproportionate coverage in the northern hemisphere, despite the size and comparable density of southern hemisphere kelp forests. Satellite imagery enables the mapping of existing and historical giant kelp populations in understudied regions, but automating the detection of giant kelp using satellite imagery requires approaches that are robust to the optical complexity of the shallow, nearshore environment. We present and compare two approaches for automating the detection of giant kelp in satellite datasets: one based on crowd sourcing of satellite imagery classifications and another based on a decision tree paired with a spectral unmixing algorithm (automated using Google Earth Engine). Both approaches are applied to satellite imagery (Landsat) of the Falkland Islands or Islas Malvinas (FLK), an archipelago in the southern Atlantic Ocean that supports expansive giant kelp ecosystems. The performance of each method is evaluated by comparing the automated classifications with a subset of expert-annotated imagery (8 images spanning the majority of our continuous timeseries, cumulatively covering over 2,700 km of coastline, and including all relevant sensors). Using the remote sensing approaches evaluated herein, we present the first continuous timeseries of giant kelp observations in the FLK region using Landsat imagery spanning over three decades. We do not detect evidence of long-term change in the FLK region, although we observe a recent decline in total canopy area from 2017–2021. Using a nitrate model based on nearby ocean state measurements obtained from ships and incorporating satellite sea surface temperature products, we find that the area of giant kelp forests in the FLK region is positively correlated with the nitrate content observed during the prior year. Our results indicate that giant kelp classifications using citizen science are approximately consistent with classifications based on a state-of-the-art automated spectral approach. Despite differences in accuracy and sensitivity, both approaches find high interannual variability that impedes the detection of potential long-term changes in giant kelp canopy area, although recent canopy area declines are notable and should continue to be monitored carefully.

Background Though institutional delivery plays a significant role in maternal and child health, there is substantial evidence that the majority of rural women have lower health facility delivery than urban women. So, identifying the drivers of these disparities will help policy-makers and programmers with the reduction of maternal and child death. Methods The study used the data on a nationwide representative sample from the most recent rounds of the Demographic and Health Survey (DHS) of four East African countries. A Blinder-Oaxaca decomposition analysis and its extensions was conducted to see the urban-rural differences in institutional delivery into two components: one that is explained by residence difference in the level of the determinants (covariate effects), and the other components was explained by differences in the effect of the covariates on the outcome (coefficient effects). Results The findings showed that institutional delivery rates were 21.00% in Ethiopia, 62.61% in Kenya, 65.29% in Tanzania and 74.64% in Uganda. The urban-rural difference in institutional delivery was higher in the case of Ethiopia (61%), Kenya (32%) and Tanzania (30.3%), while the gap was relatively lower in the case of Uganda (19.2%). Findings of the Blinder-Oaxaca decomposition and its extension showed that the covariate effect was dominant in all study countries. The results were robust to the different decomposition weighting schemes. The frequency of antenatal care, wealth and parity inequality between urban and rural households explains most of the institutional delivery gap. Conclusions The urban-rural institutional delivery disparities were high in study countries. By identifying the underlying factors behind the urban-rural institutional birth disparities, the findings of this study help in designing effective intervention measures targeted at reducing residential inequalities and improving population health outcomes. Future interventions to encourage institutional deliveries to rural women of these countries should therefore emphasize increasing rural women’s income, access to health care facilities to increase the frequency of antenatal care utilization.

Continuous urban developments have resulted in increased demand for street furniture, one of which is street light columns. Artificial light at night (ALAN) pose significant impacts on insect diversity in urban and rural areas. The ALAN is a significant driver of decline in insect diversity. This study evaluated the impact of light intensity and sky quality at night on insect diversity in rural and urban areas of the Asir province, Saudi Arabia. Insect traps were installed in both areas during night. Light intensity of nearby road lamps was measured using light meter, while sky quality was measured using sky quality meter. Rural areas exhibited low light intensity (10.33 flux/f.candle) and good sky quality (18.80 magnitude/arcsec2). Urban areas exhibited intense light (89.33 flux/f.candle) and poor sky quality (15.49 magnitude/arcsec2). Higher insect diversity was recorded for rural areas where insects belonging to seven orders (i.e., Diptera, Lepidoptera, Hemiptera, Hymenoptera, Coleoptera, Neuroptera, and Dermaptera) were collected. However, insects of four orders (i.e., Diptera, Lepidoptera, Hemiptera, and Neuroptera) were found in urban areas indicating low diversity. Lepidopteran insects were frequently recorded from rural areas indicating they are attracted to artificial light. It is concluded that excessive ALAN and poor sky quality at night disrupt insect biodiversity. Therefore, ALAN and sky quality must be considered responsible for decline in insect biodiversity along with other known factors.

Background Peru is a Latin American country with a significant burden of hypertension that presents worrying rates of disparities in socioeconomic determinants. However, there is a lack of studies exploring the association between those determinants, hypertension and prehypertension in Peruvian population. Objective We aimed to assess the association betwgeen socioeconomic determinants, hypertension and prehypertension using a nationally representative survey of Peruvians. Methods We performed a cross-sectional analysis of the Peruvian Demographic and Health Survey (2018), which is a two-staged regional-level representative survey. We used data from 33,336 people aged 15 and older. The dependent variable was blood pressure classification (normal, prehypertension and hypertension) following the Seventh Report of the Joint National Committee (JNC-7) on hypertension management. Independent variables were socioeconomic: age, sex, marital status, wealth index, health insurance, education, region and area of residence. Due to the nature of the dependent variable (more than two categories), we opted to use the multinomial regression model, adjusting the effect of the multistage sample using the svy command. We tested interactions with the adjusted Wald test. Results The prevalence of prehypertension and hypertension was 33.68% and 19.77%, respectively. Awareness was higher in urban than in rural areas (9.61% vs. 8.31%, p = 0.008). Factors associated with a higher prevalence ratio of both prehypertension and hypertension were age (ratios rose with each age group), male sex (prehypertension aRPR 5.15, 95%CI 4.63–5.73; hypertension aRPR 3.85, 95% CI 3.37–4.40) and abdominal obesity (prehypertension aRPR 2.11, 95%CI 1.92–2.31; hypertension aRPR 3.04, 95% CI 2.69–3.43). Factors with a lower prevalence ratio of both diseases were secondary education (prehypertension aRPR 0.76, 95%CI 0.60–0.95; hypertension aRPR 0.75, 95% CI 0.58–0.97), higher education (prehypertension aRPR 0.78, 95%CI 0.61–0.99; hypertension aRPR 0.62, 95% CI 0.46–0.82), being married/cohabiting (prehypertension aRPR 0.87, 95%CI 0.79–0.95; hypertension aRPR 0.77, 95% CI 0.68–0.87), richest wealth index (only prehypertension aRPR 0.76, 95%CI 0.63–0.92) and living in cities different to Lima (rest of the Coastline, Highlands and Jungle). Having health insurance (only hypertension aRPR 1.26, 95%CI 1.03–1.53) and current drinking (only prehypertension aRPR 1.15, 95%CI 1.01–1.32) became significant factors in rural areas. Conclusions We evidenced socioeconomic disparities among people with hypertension and prehypertension. Better health policies on reducing the burden of risk factors are needed, besides, policy decision makers should focus on hypertension preventive strategies in Peru.

Earlier phylogenetic studies in the genusPinguicua(Lentibulariaceae) suggested that the species within a geographical region was rather monophyletic, although the sampling was limited or was restricted to specific regions. Those results conflicted with the floral morphology-based classification, which has been widely accepted to date. In the current study, one nuclear ribosomal DNA (internal transcribed spacer; ITS) and two regions of chloroplast DNA (matKandrpl32-trnL), from up to ca. 80% of the taxa in the genusPinguicula, covering all three subgenera, were sequenced to demonstrate the inconsistency and explore a possible evolutionary history of the genus. Some incongruence was observed between nuclear and chloroplast topologies and the results from each of the three DNA analyses conflicted with the morphology-based subgeneric divisions. Both the ITS tree and network, however, corresponded with the biogeographical patterns of the genus supported by life-forms (winter rosette or hibernaculum formation) and basic chromosome numbers (haploidy). The dormant strategy evolved in a specific geographical region is a phylogenetic constraint and a synapomorphic characteristic within a lineage. Therefore, the results denied the idea that the Mexican group, morphologically divided into the three subgenera, independently acquired winter rosette formations. Topological incongruence among the trees or reticulations, indicated by parallel edges in phylogenetic networks, implied that some taxa originated by introgressive hybridisation. Although there are exceptions, species within the same geographical region arose from a common ancestor. Therefore, the classification by the floral characteristics is rather unreliable. The results obtained from this study suggest that evolution within the genusPinguiculahas involved; 1) ancient expansions to geographical regions with gene flow and subsequent vicariance with genetic drift, 2) acquirement of a common dormant strategy within a specific lineage to adapt a local climate (i.e., synapomorphic characteristic), 3) recent speciation in a short time span linked to introgressive hybridisation or multiplying the ploidy level (i.e., divergence), and 4) parallel evolution in floral traits among lineages found in different geographical regions (i.e., convergence). As such, the floral morphology masks and obscures the phylogenetic relationships among species in the genus.

As cities expand, human mobility has become a central focus of urban planning and policy making to make cities more inclusive and sustainable. Initiatives such as the "15-minutes city" have been put in place to shift the attention from monocentric city configurations to polycentric structures, increasing the availability and diversity of local urban amenities. Ultimately they expect to increase local walkability and increase mobility within residential areas. While we know how urban amenities influence human mobility at the city level, little is known about spatial variations in this relationship. Here, we use mobile phone, census, and volunteered geographical data to measure geographic variations in the relationship between origin-destination flows and local urban accessibility in Barcelona. Using a Negative Binomial Geographically Weighted Regression model, we show that, globally, people tend to visit neighborhoods with better access to education and retail. Locally, these and other features change in sign and magnitude through the different neighborhoods of the city in ways that are not explained by administrative boundaries, and that provide deeper insights regarding urban characteristics such as rental prices. In conclusion, our work suggests that the qualities of a 15-minutes city can be measured at scale, delivering actionable insights on the polycentric structure of cities, and how people use and access this structure., Comment: 32 pages, 7 figures

This paper examines the impact of widespread adoption of information and communication technologies (ICT) on urban structure worldwide. Has it offset agglomeration benefits and led to more dispersed spatial structures, or has it strengthened urban externalities and thus resulted in more concentrated spatial structures? Theoretical and empirical studies on this question have produced contradictory findings. The present study recognizes that assumptions made earlier about the evolution of technological capabilities do not necessarily hold today. As cutting-edge digital technologies have matured considerably, a fresh look at this question is called for. The paper addresses this issue by means of several data sets using instrumental variable methods. One is the UN data on Urban Settlements with more than 300, 000 inhabitants. Estimation methods with these data show that increased adoption of ICT has resulted in national urban systems that are less uniform in terms of city sizes and are characterized by higher population concentrations in larger cities, when concentration is proxied the Pareto (Zipf) coefficient for national city size distributions. Two, is disaggregated data for the urban systems of the US, defined as Micropolitan and Metropolitan Areas, and for the UK, defined as Built-up Areas in England and Wales, respectively. These data allow for the impacts to be studied for cities smaller than those included in the cross-country data. Increased internet usage improved a city’s ranking in the US urban system. Similarly, increased download speed improves a built-up area’s ranking in England and Wales.

Objectives To determine differences among multi-race (MR) American Indian and Alaska Natives (AIAN), single race (SR) AIANs, and SR-Whites on multiple health outcomes. We tested the following hypotheses: MR-AIANs will have worse health outcomes than SR-AIANs; SR-AIANs will have worse health outcomes than SR-Whites; MR-AIANs will have worse health outcomes than SR-Whites. Methods Behavioral Risk Factor Surveillance System data were used to examine general health, risk behaviors, access to health care, and diagnosed chronic health conditions. Those identifying as SR-White, SR-AIAN, and MR-AIAN were included in multinomial logistic regression models. Results Compared to SR-AIANs, MR-AIANs had more activity limitations, a greater likelihood of experiencing cost as a barrier to health care and were more likely to be at increased risk and diagnosed with more chronic health conditions. Both SR and MR-AIANs have worse health than SR-Whites; MR-AIANs appear to be at increased risk for poor health. Conclusions The current study examined access to health care and nine chronic health conditions, neither of which have been considered in prior work. MR AIANs are at increased risk compared to SR groups. These observations beg for further inquire into the mechanisms underlying these differences including stress related to identify, access to care, and discrimination. Findings support the continued need to address health disparities among AIANs regardless of SR or MR identification.

BackgroundProtecting people from financial hardship and impoverishment due to health care costs is one of the fundamental purposes of the Mongolian health system. However, the inefficient, oversized hospital sector is considered one of the main shortcomings of the system. The aim of this study is to contribute to policy discussions by estimating the extent of catastrophic health expenditure and impoverishment due to inpatient care at secondary-level and tertiary-level public hospitals and private hospitals.MethodsData were derived from a nationally representative survey, the Household Socio-Economic Survey 2012, conducted by the National Statistical Office of Mongolia. A total of 12,685 households were involved in the study. "Catastrophic health expenditure" is defined as out-of-pocket payments for inpatient care that exceed a threshold of 40% of households' non-discretionary expenditure. The "impoverishment" effect of out-of-pocket payments for inpatient care was estimated as the difference between the poverty level before health care payments and the poverty level after these payments.ResultsAt the threshold of 40% of capacity to pay, 0.31%, 0.07%, and 0.02% of Mongolian households suffered financially as a result of their member(s) staying in tertiary-level and secondary-level public hospitals and private hospitals respectively. About 0.13% of the total Mongolian population was impoverished owing to out-of-pocket payments for inpatient care at tertiary-level hospitals. Out-of-pocket payments for inpatient care at secondary-level hospitals and private hospitals were responsible for 0.10% and 0.09% respectively of the total population being pushed into poverty.ConclusionsAlthough most inpatient care at public hospitals is covered by the social health insurance benefit package, patients who utilized inpatient care at tertiary-level public hospitals were more likely to push their households into financial hardship and poverty than the inpatients at private hospitals. Improving the hospital sector's efficiency and financial protection for inpatients would be a crucial means of attaining universal health coverage in Mongolia.

Background Opioid-related overdose deaths are the top accidental cause of death in the United States, and development of regional strategies to address this epidemic should begin with a better understanding of where and when overdoses are occurring. Methods and findings In this study, we relied on emergency medical services data to investigate the geographical and temporal patterns in opioid-suspected overdose incidents in one of the largest and most ethnically diverse metropolitan areas (Houston Texas). Using a cross sectional design and Bayesian spatiotemporal models, we identified zip code areas with excessive opioid-suspected incidents, and assessed how the incidence risks were associated with zip code level socioeconomic characteristics. Our analysis suggested that opioid-suspected overdose incidents were particularly high in multiple zip codes, primarily south and central within the city. Zip codes with high percentage of renters had higher overdose relative risk (RR = 1.03; 95% CI: [1.01, 1.04]), while crowded housing and larger proportion of white citizens had lower relative risks (RR = 0.9; 95% CI: [0.84, 0.96], RR = 0.97, 95% CI: [0.95, 0.99], respectively). Conclusions Our analysis illustrated the utility of Bayesian spatiotemporal models in assisting the development of targeted community strategies for local prevention and harm reduction efforts.

Inefficiency in urban land use is one of the problems caused by rapid urbanization. The UN Sustainable Development Goals (SDGs) indicator 11.3.1 is designed to test urban land use efficiency. This study employed geospatial and statistical data to compute land use efficiencies from 1990 to 2015 with five 5-year and ten 15-year intervals in Wukang, center of Deqing County, China. A flowchart was designed to extract the built-up lands from multiple data sources. The produced built-up lands were demonstrated to provide good accuracy by constructing an error matrix between the extracted and manually interpreted built-up lands as classified and reference images, respectively. By using the model provided by UN metadata to calculate SDG 11.3.1, the land use efficiencies from 1990 to 2015 were identified in Wukang. Our results indicate that the land use efficiency in Deqing County center is lower than the average of cities around the world, primarily because our in-situ study focused on a county center with larger rural regions than urban areas. Over the long term, urban land use becomes denser as the population grows, which will have a positive impact on the sustainability of urban development. This work is helpful for the local government to balance urban land consumption and population growth.

In recent years, China’s economic development has advanced by leaps and bounds, but the development of China’s rural logistics system is still at its primary stage. Some remote areas with inconvenient transportation are still in a state of serious lack or even blank, and due to the high cost of rural logistics delivery services, the rural logistics business of the enterprise also has a profit problem, which limits the development of rural logistics talent innovation to some extent. The purpose of this paper is to study a new influencing factor model of the Internet rural logistics talent innovation mechanism. This paper innovatively proposes countermeasures to improve the innovation of e-commerce practitioners in rural areas. Through research, the author finds that the innovation of rural e-commerce application talents in China is generally low. The key point of the solution lies in how to improve the level of innovation in rural e-commerce application talents. According to the status quo, identify the factors that hinder the innovation and improvement of rural e-commerce application talents. Combined with the great environment of the development of rural e-commerce industry in China, the paper proposes to improve the countermeasures for improving the innovation of rural e-commerce application talents. Improve the current situation of rural e-commerce application talents mediocrity and promote the innovation of rural e-commerce application talents. Fundamentally promote agricultural development and the building of a new socialist countryside. This paper adopts the literature research method based on fuzzy comprehensive evaluation method, system analysis method and the combination of questionnaire survey and interview. Through big data and information science methods for data processing, using a company’s Internet rural talent data set to simulate, the results It shows that with the method of this paper, the recognition rate reaches 98%, the speed increases obviously, and it is 20% faster than others.

Objective To estimate the prevalence and analyze the association between sociodemographic and behavioral variables with the use of prehospital care, hospitalization and sequelae and/or disability in victims of road traffic accidents victims in Brazil. Methods Data from the National Health Survey conducted in 2013 in Brazil were used. Data were collected through a direct household survey. The research sample consisted of 1,840 individuals who reported road traffic accidents in the previous 12 months. Poisson regression analysis was used to evaluate the factors associated with the use of prehospital care services, hospitalization, and the presence of sequelae and/or disability. Results The prevalence of road traffic accidents victims who received prehospital care was 13.0% (95% Confidence Interval [95% CI]: 10.3–16.3) and the factors associated with this outcome were: residing in the Northeast or North region of Brazil; residing in rural areas; and being a motorcycle occupant at the moment of the road traffic accident. The frequency of hospitalization was 7.7% (95% CI: 6.0–10.0) and the associated factors were: age between 40 and 59 years; being a motorcycle occupant or pedestrian and having received on-site care at the moment of the road traffic accident. The prevalence of sequelae and/or disability was 15.1% (95% CI: 12.5–18.2) and the associated factors were: age range between 30 and 39 years or 40 and 59 years; being a motorcycle occupant, being a pedestrian or belonging to other category of modes of transport and having received on-site care at the moment of the road traffic accident. Conclusion The study allowed to evaluate the factors associated with prehospital care, hospitalization and presence of sequelae and/or disability in the victims of road traffic accident and the results can guide the implementation of interventions that prioritize the population exposed to the highest risk of road traffic accident injuries and with less access to prehospital and hospital care services in Brazil.

Environmental challenges to natural resources have been attributed to human behavior and traditional agricultural production techniques. Natural resource degradation in agriculture has always been a prime concern in agro ecological research and sustainability analysis. There are many techniques for assessing environmental performance; one of which, ecological footprint (EF), assesses human pressure on the environment and natural resources. The main purpose of this study was calculation of ecological indices including biocapacity (BC) and EF of rural areas of Fars province of Iran. The study was accomplished using survey and structured interviews consisting of three main questionnaires in two different steps. Different agricultural stakeholders, including farmers (for the first step) as well as the policymakers, extension managers and authorities (for the second step) were interviewed. Based on multi-stage stratified random sampling, 50 villages and 423 farmers were selected. Face validity and reliability of the questionnaires were assessed by a panel of specialists as well as conducting a pilot study, respectively. The paradigmatic perspectives of agricultural policy makers and managers (22 individuals) were also analyzed using another specific questionnaire by Analytical Hierarchy Process (AHP). Findings revealed that most of the studied villages faced a critical environmental condition due to the results of ecological indicator which was calculated in the study. According to the four main components of human ecology (POET model) including Population, Organization, Environment and Technology, village groups that differed in terms of sustainability level also showed significantly differences due to population, social participation, use of green technologies and attitude towards diverse environmental management paradigms. The causal model also revealed that population, green technology, social participation and attitude toward frontier economics, which were in accordance with the elements of human ecology model, were the main factors affecting the ecological index. Finally, AHP results determined the dominant economic perspectives of agricultural authorities. A paradigm shift toward the comprehensive paradigm of eco-development plus consideration of the results of the ecological indicator calculation as the base of agricultural planning at the local level were recommended.

Background Geospatial datasets of population are becoming more common in models used for health policy. Publicly-available maps of human population make a consistent picture from inconsistent census data, and the techniques they use to impute data makes each population map unique. Each mapping model explains its methods, but it can be difficult to know which map is appropriate for which policy work. High quality census datasets, where available, are a unique opportunity to characterize maps by comparing them with truth. Methods We use census data from a bed-net mass-distribution campaign on Bioko Island, Equatorial Guinea, conducted by the Bioko Island Malaria Elimination Program as a gold standard to evaluate LandScan (LS), WorldPop Constrained (WP-C) and WorldPop Unconstrained (WP-U), Gridded Population of the World (GPW), and the High-Resolution Settlement Layer (HRSL). Each layer is compared to the gold-standard using statistical measures to evaluate distribution, error, and bias. We investigated how map choice affects burden estimates from a malaria prevalence model. Results Specific population layers were able to match the gold-standard distribution at different population densities. LandScan was able to most accurately capture highly urban distribution, HRSL and WP-C matched best at all other lower population densities. GPW and WP-U performed poorly everywhere. Correctly capturing empty pixels is key, and smaller pixel sizes (100 m vs 1 km) improve this. Normalizing areas based on known district populations increased performance. The use of differing population layers in a malaria model showed a disparity in results around transition points between endemicity levels. Discussion The metrics in this paper, some of them novel in this context, characterize how these population maps differ from the gold standard census and from each other. We show that the metrics help understand the performance of a population map within a malaria model. The closest match to the census data would combine LandScan within urban areas and the HRSL for rural areas. Researchers should prefer particular maps if health calculations have a strong dependency on knowing where people are not, or if it is important to categorize variation in density within a city.