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Abstract Do cities have a collective identity? The latest advancements in generative artificial intelligence (AI) models have enabled the creation of realistic representations learned from vast amounts of data. In this study, we test the potential of generative AI as the source of textual and visual information in capturing the place identity of cities assessed by filtered descriptions and images. We asked questions on the place identity of 64 global cities to two generative AI models, ChatGPT and DALL·E2. Furthermore, given the ethical concerns surrounding the trustworthiness of generative AI, we examined whether the results were consistent with real urban settings. In particular, we measured similarity between text and image outputs with Wikipedia data and images searched from Google, respectively, and compared across cases to identify how unique the generated outputs were for each city. Our results indicate that generative models have the potential to capture the salient characteristics of cities that make them distinguishable. This study is among the first attempts to explore the capabilities of generative AI in simulating the built environment in regard to place-specific meanings. It contributes to urban design and geography literature by fostering research opportunities with generative AI and discussing potential limitations for future studies.

Objectives Data breaches are a financial and operational threat to hospitals. In this study, we examine the association between a data breach and information technology capital and labor investment. Methods In this retrospective cohort study, we used American Hospital Association data from 2017 to 2019 and an unbalanced panel of hospitals with 6751 unique hospital-year observations. The breached group had 482 hospital-years, and the control group had 6269 hospital-years. We estimated the association between data breaches, information technology capital, and labor investment using the average treatment effect with propensity-score matching. Results From 2017 to 2019, hospitals experienced more hacking and information technology incidents but fewer thefts and losses. We found that hospital data breaches were associated with a 66% increase in employed information technology staff and a 57% increase in outsourced information technology staff. Breaches were not associated with information technology operating expenses and information technology capital expenses. Conclusion Higher information technology labor investment due to the remediation of data breaches is an added cost to the healthcare system. Hospitals and policymakers should consider initiatives to improve cybersecurity and protect patient data.

How does ChatGPT introduce transport problems and solutions in North America? By analyzing ChatGPT's answers to four prompts related to transport issues and solutions in the United States and Canada, our results reveal that ChatGPT's answers generally align well with transport researchers' expectations. However, ChatGPT's capability may be limited in providing trustworthy or sound solutions because of the potential issues (e.g., geographic biases, inaccuracy) in its training data. ChatGPT might be a decent starting point for discussing transport issues and solutions, but one should be aware of its limitations.

Objectives Many small-sized healthcare institutions play a critical role in communities by preventing infectious diseases. This study examines how they have been impacted by the global COVID-19 pandemic compared with large hospitals.Design This study adopted a retrospective study design looking back at the healthcare utilisation of medical facilities according to size after the COVID-19 pandemic. The dependent variable was change in the number of outpatient health insurance claims before and after onset of the COVID-19 pandemic. The independent variable was an observation time point of the year 2020 compared with 2019.Setting and participants The study was conducted in Korea having a competitive medical provision environment under the national health insurance system. The units of analysis are hospitals and clinics: tertiary hospitals (42), general hospitals (293), small hospitals (1272) and medical clinics (27 049). This study analysed all the health insurance claim data from 1 January 2019 to 31 December 2020.Results Compared with 2019, in 2020, there were significant decreases in the number of claims (−14.9%), particularly in small hospitals (−16.8%) and clinics (−16.3%), with smaller decreases in general hospitals (−8.9%) and tertiary hospitals (−5.3%). The reduction in healthcare utilisation increased as the size of institutions decreased. The magnitude of decrease was significantly greatest in small hospitals (absolute risk (AR): 0.8317, 0.7758 to 0.8915, p

Recently, in Winnipeg, the implementation of new bus rapid transit (BRT) system in the middle of the COVID-19 pandemic has raised many concerns, challenging the rationale behind the untimely release. However, the new BRT service can benefit low-income, socio-economically vulnerable, and transit captive passengers who must travel to essential services and work opportunities during the pandemic. This study evaluates whether the new BRT system has positive impacts on accessibility to such essential services during the pandemic. Isochrones with different time budgets as well as times of a day are generated based on high-resolution public transit network via the General Transit Feed Specification (GTFS) data and used for evaluating accessibility benefits before and after the BRT construction. The new BRT service in Winnipeg demonstrates varying accessibility impacts across different parts of the BRT corridor. Areas near dedicated lane-section show a significant increase, whereas areas near non-dedicated lane sections show a decrease in accessibility. Nevertheless, across the whole BRT corridor, the new BRT service presents an overall increase in accessibility to essential services. This demonstrates the positive accessibility benefits of the new BRT service to residents seeking essential services during the COVID-19 pandemic. A decrease in accessibility along some parts suggests the necessity of using local transit improvement strategies (e.g., dedicated lanes) to improve service speed when planning BRT services within urban areas.

With the rapid growth of aging populations in South Korea, it is important to assess spatial accessibility to healthcare resources as older adults may need frequent visits to hospitals. Healthcare spatial accessibility is measured based on available resources (e.g., physicians, beds, services), demands (e.g., population), and travel costs (e.g., distance or time). In this study, we employed an Enhanced Two-Step Floating Catchment Area (E2SFCA) method to measure the spatial accessibility to primary care for older populations (i.e., aged 65 and older) in major cities in South Korea, including Seoul, Busan, Daegu, Incheon, Gwangju, Daejeon, and Ulsan. We found that the aging population in Seoul, the capital and biggest city in South Korea, has relatively better accessibility than those living in other cities. We also discovered a negative relationship between accessibility to primary care and the aging index (i.e., population over 65 years old/population less than 15 years old); the regions with a higher ratio of older populations have lower accessibility to primary care. The results suggested that more primary care services (perhaps via mobile vans) are needed in regions predominantly with older people to improve their healthcare access.

Abstract This study aimed to investigate the impact of health information technology (IT) on the Case Mix Index (CMI). This study was a retrospective cohort study using hospital financial data from the Office of Statewide Health Planning and Development (OSHPD) in California. A total of 309 unique hospitals were included in the study for 7 years, from 2009 to 2015, resulting in 2,135 hospital observations. The effects of health information technology (IT) on the Case Mix Index (CMI) was evaluated using dynamic panel data analysis to control endogeneity issues. This study found that more health IT adoption could lead to a lower CMI by improving coding systems. Policy makers, researchers, and healthcare providers must be cautious when interpreting the effect of health IT on the CMI. To encourage the adoption of health IT, the cost savings and reimbursement reductions resulting from health IT adoption should be compared. If any profit loss occurs (i.e., the cost savings is less than reimbursement reduction), more incentives should be provided to healthcare providers.

A variety of engineered nanoparticles, including lipid nanoparticles, polymer nanoparticles, gold nanoparticles, and biomimetic nanoparticles, have been studied as delivery vehicles for biomedical applications. When assessing the efficacy of a nanoparticle-based delivery system, in vitro testing with a model delivery system is crucial because it allows for real-time, in situ quantitative transport analysis, which is often difficult with in vivo animal models. The advent of tissue engineering has offered methods to create experimental models that can closely mimic the 3D microenvironment in the human body.This review paper overviews the types of nanoparticle vehicles, their application areas, and the design strategies to improve delivery efficiency, followed by the uses of engineered microtissues and methods of analysis. In particular, this review highlights studies on multicellular spheroids and other 3D tissue engineering approaches for cancer drug development. The use of bio-engineered tissues can potentially provide low-cost, high-throughput, and quantitative experimental platforms for the development of nanoparticle-based delivery systems.

Bioimaging in the second near‐infrared (NIR‐II) window can help to obtain high‐resolution images and a high penetration depth. This study proposes an Au/Si bilayer plasmonic nanodisk (Au/Si ND) that has a resonance wavelength in the NIR‐II window caused by Si ND stacking on top of the Au ND with a resonance wavelength in the first near‐infrared window; the Si ND has a high refractive index. Au/Si NDs are physically synthesized using nanoimprint lithography and vacuum deposition. Optical coherence tomography (OCT) imaging is performed using synthesized Au/Si NDs as OCT contrast agents in the NIR‐II window. Due to the 2D circular shape and its remarkable response to random incident light, the Au/Si NDs exhibit approximately 250‐fold greater OCT signal intensity than do commercial 1D Au nanorods, as well as fourfold greater penetration depth and improved OCT image contrast.

This study examined the urban structure of colonial Seoul in the 1930s, the capital city of Korea under the rule of the Japanese empire, by adopting quantitative geographical methods. We utilized a job accessibility index to operationalize the urban structure. We also used geographic information science (GIScience) analysis tools to digitize neighborhood-level sociodemographic and parcel-level business location information from historical materials. The results illustrated several findings that were not revealed by previous studies based on qualitative approaches. First, transit-based job accessibility (13.392) is significantly higher (p < 0.001) than walk-based job accessibility (10.575). Second, there is a Γ-shaped area with higher job accessibility, including the central part of colonial Seoul. Third, Japanese-dominant neighborhoods had significantly (p < 0.001) higher transit-based (27.156) job accessibility than Korean-dominant neighborhoods (9.319). Fourth, transit-based job accessibility is not significantly correlated with the unemployment rate overall. Although colonial Seoul was the seventh-largest city of the Japanese empire, few practical planning actions were taken to resolve urban issues, unlike the other large cities in mainland Japan.

The spatial directionality of Millennials' migration has been underexplored. This study utilizes local spatial network autocorrelation to identify migration clusters of Millennials in a metropolitan area. The result found that Millennials migrate within an urban core and move to newer districts in surrounding areas. We found spatially distinct migration clusters by age group, possibly reflecting different motives through life stages. The analysis demonstrated that this method is effective for detecting migration clusters and for comparing subsets.

BackgroundData breaches are an inevitable risk to hospitals operating with information technology. The financial costs associated with data breaches are also growing. The costs associated with a data breach may divert resources away from patient care, thus negatively affecting hospital productivity. ObjectiveAfter a data breach, the resulting regulatory enforcement and remediation are a shock to a hospital’s patient care delivery. Exploiting this shock, this study aimed to investigate the association between hospital data breaches and productivity by using a generalized difference-in-differences model with multiple prebreach and postbreach periods. MethodsThe study analyzed the hospital financial data of the California Office of Statewide Health Planning and Development from 2012 to 2016. The study sample was an unbalanced panel of hospitals with 2610 unique hospital-year observations, including general acute care hospitals. California hospital data were merged with breach data published by the US Department of Health and Human Services. The dependent variable was hospital productivity measured as value added. The difference-in-differences model was estimated using fixed effects regression. ResultsHospital productivity did not significantly differ from the baseline for 3 years after a breach. Data breaches were not significantly associated with a reduction in hospital productivity. Before a breach, the productivity of hospitals that experienced a data breach maintained a parallel trend with control hospitals. ConclusionsHospital productivity was resilient against the shocks from a data breach. Nonetheless, data breaches continue to threaten hospitals; therefore, health care workers should be trained in cybersecurity to mitigate disruptions.

Transportation is a key element to understanding the socio-spatial structure of colonial cities and the lives of individuals living under colonial governance. This study investigates the disparity in transit-based travel time between colonial rulers (Japanese) and subjects (Koreans) in Colonial Seoul (*Keijo*) in 1936 using modern GIS and open-source transport analysis tools. Findings suggest a significant disparity in travel time to a major urban facility (i.e., City Hall) between the two population groups of the largest colonial city in the Korean peninsula.

ObjectivesAn Opioid Treatment Desert is an area with limited accessibility to medication-assisted treatment and recovery facilities for Opioid Use Disorder. We explored the concept of Opioid Treatment Deserts including racial differences in potential spatial accessibility and applied it to one Midwestern urban county using high resolution spatiotemporal data.MethodsWe obtained individual-level data from one Emergency Medical Services (EMS) agency (Columbus Fire Department) in Franklin County, Ohio. Opioid overdose events were based on EMS runs where naloxone was administered from 1/1/2013 to 12/31/2017. Potential spatial accessibility was measured as the time (in minutes) it would take an individual, who may decide to seek treatment after an opioid overdose, to travel from where they had the overdose event, which was a proxy measure of their residential location, to the nearest opioid use disorder (OUD) treatment provider that provided medically-assisted treatment (MAT). We estimated accessibility measures overall, by race and by four types of treatment providers (any type of MAT for OUD, Buprenorphine, Methadone, or Naltrexone). Areas were classified as an Opioid Treatment Desert if the estimate travel time to treatment provider (any type of MAT for OUD) was greater than a given threshold. We performed sensitivity analysis using a range of threshold values based on multiple modes of transportation (car and public transit) and using only EMS runs to home/residential location types.ResultsA total of 6,929 geocoded opioid overdose events based on data from EMS agencies were used in the final analysis. Most events occurred among 26-35 years old (34%), identified as White adults (56%) and male (62%). Median travel times and interquartile range (IQR) to closest treatment provider by car and public transit was 2 minutes (IQR: 3 minutes) and 17 minutes (IQR: 17 minutes), respectively. Several neighborhoods in the study area had limited accessibility to OUD treatment facilities and were classified as Opioid Treatment Deserts. Travel time by public transit for most treatment provider types and by car for Methadone-based treatment was significantly different between individuals who were identified as Black adults and White adults based on their race.ConclusionsDisparities in access to opioid treatment exist at the sub-county level in specific neighborhoods and across racial groups in Columbus, Ohio and can be quantified and visualized using local public safety data (e.g., EMS runs). Identification of Opioid Treatment Deserts can aid multiple stakeholders better plan and allocate resources for more equitable access to MAT for OUD and, therefore, reduce the burden of the opioid epidemic while making better use of real-time public safety data to address a public health epidemic that has turned into a public safety crisis.

This paper compares the speeding patterns before and after the COVID-19 pandemic in three major cities in Ohio, USA: Columbus, Cincinnati, and Cleveland. Using high-resolution and real-time INRIX traffic data, we find evidence of increased speeding in all three cities. In particular, we observe an increase in the spatial extent of speeding as well as in the average level of speeding. We also find the mean differences in speeding before and after the COVID-19 outbreak are statistically significant within the study areas.

Social mixing is one of the key objectives of the housing policy in OECD countries. The Low-Income Housing Tax Credit (LIHTC) program, the largest affordable housing construction program in the US since 1986, has recently set creating mixed-income communities as one of the standards. As a project-based program, LIHTC developments are likely to influence residential mobility; however, little is known about its empirical effects. This study investigated whether new LIHTC projects are effective at attracting heterogeneous income groups to LIHTC neighborhoods, thereby contributing to creating mixed-income communities. Using unique individual-level household movement data combined with origin–destination neighborhood characteristics, we developed zero-inflated negative binomial (ZINB) models to analyze the LIHTC’s impact on residential mobility patterns in Franklin County, Ohio, US, from 2011 to 2015. The results suggest that the LIHTC attracts low-income households while deterring higher-income families, and therefore the program is not proved to be effective at creating mixed-income neighborhoods.

Aims: This study aimed to explore the impacts of neighborhood-level socioeconomic contexts on the therapeutic and preventative dental quality outcome of children under 16 years. Materials and Methods: Anonymized billing data of 842 patients reporting to a university children’s dental over three years (March 2017–2020) met the inclusion criteria. Their access to care (OEV-CH-A), topical fluoride application (TFL-CH-A) and dental treatment burden (TRT-CH-A) were determined by dental quality alliance (DQA) criteria. The three oral health variables were aggregated at the neighborhood level and analyzed with Canadian census data. Their partial postal code (FSA) was chosen as a neighborhood spatial unit and maps were created to visualize neighborhood-level differences. Results: The individual-level regression models showed significant negative associations between OEV-CH-A (p = 0.027) and TFL-CH-A (p = 0.001) and the cost of dental care. While there was no significant association between neighborhood-level sociodemographic variables and OEV-CH-A, TRT-CH-A showed a significant negative association at the neighborhood level with median household income and significant positive association with percentage of non-official first language (English or French) speakers. Conclusion: Initial analysis suggests differences exist in dental outcomes according to neighborhood-level sociodemographic variables, even when access to dental care is similar.

ObjectivesHealth information technology (IT) can assist healthcare providers in ordering medication and adhering to guidelines while improving communication among providers and the quality of care. However, the relationship between health IT and Case Mix Index (CMI) has not been thoroughly investigated; therefore, this study aimed to clarify this relationship.MethodsTo examine the effect of health IT on CMI, a generalized estimation equation (GEE) was applied to two years of California hospital data.ResultsWe found that IT was positively associated with CMI, indicating that increased IT adoption could lead to a higher CMI or billing though DRG up-coding. This implies that hospitals' revenue could increase around $40,000 by increasing IT investment by 10%.ConclusionsThe positive association between IT and CMI implies that IT adoption itself could lead to higher patient billings. Generally, a higher CMI in a hospital indicates that the hospital provides expensive services with higher coding and therefore receives more money from patients. Therefore, measures to prevent upcoding through IT systems should be implemented.

Nanotechnology platforms, such as nanoparticles, liposomes, dendrimers, and micelles have been studied extensively for various drug deliveries, to treat or prevent diseases by modulating physiological or pathological processes. The delivery drug molecules range from traditional small molecules to recently developed biologics, such as proteins, peptides, and nucleic acids. Among them, proteins have shown a series of advantages and potential in various therapeutic applications, such as introducing therapeutic proteins due to genetic defects, or used as nanocarriers for anticancer agents to decelerate tumor growth or control metastasis. This review discusses the existing nanoparticle delivery systems, introducing design strategies, advantages of using each system, and possible limitations. Moreover, we will examine the intracellular delivery of different protein therapeutics, such as antibodies, antigens, and gene editing proteins into the host cells to achieve anticancer effects and cancer vaccines. Finally, we explore the current applications of protein delivery in anticancer treatments.

ObjectivesDisparities in healthcare among minority groups can result in disparate treatments for similar severities of symptoms, unequal access to medical care, and a wide deviation in health outcomes. Such racial disparities may be reduced via use of an Electronic Medical Record (EMR) system. However, there has been little research investigating the impact of EMR systems on the disparities in health outcomes among minority groups.MethodsThis study examined the impact of EMR systems on the following four outcomes of black patients: length of stay, inpatient mortality rate, 30-day mortality rate, and 30-day readmission rate, using patient and hospital data from the Medicare Provider Analysis and Review and the Healthcare Information and Management Systems Society between 2000 and 2007. The difference-in-difference research method was employed with a generalized linear model to examine the association of EMR adoption on health outcomes for minority patients while controlling for patient and hospital characteristics.ResultsWe examined the association between EMR adoption and the outcomes of minority patients, specifically black patients. However, after controlling for patient and hospital characteristics we could not find any significant changes in the four health outcomes of minority patients before and after EMR implementation.ConclusionsEMR systems have been reported to support better coordinated care, thus encouraging appropriate treatment for minority patients by removing potential sources of bias from providers. Also, EMR systems may improve the quality of care provided to patients via increased responsiveness to care processes that are required to be more time-sensitive and through improved communication. However, we did not find any significant benefit for minority groups after EMR adoption.

ObjectivesThe widespread adoption of health information technology (IT) will help contain health care costs by decreasing inefficiencies in healthcare delivery. Theoretically, health IT could lower hospitals' malpractice insurance premiums (MIPs) and improve the quality of care by reducing the number and size of malpractice. This study examines the relationship between health IT investment and MIP using California hospital data from 2006 to 2007.MethodsTo examine the effect of hospital IT on malpractice insurance expense, a generalized estimating equation (GEE) was employed.ResultsIt was found that health IT investment was not negatively associated with MIP. Health IT was reported to reduce medical error and improve efficiency. Thus, it may reduce malpractice claims from patients, which will reduce malpractice insurance expenses for hospitals. However, health IT adoption could lead to increases in MIPs. For example, we expect increases in MIPs of about 1.2% and 1.5%, respectively, when health IT and labor increase by 10%.ConclusionsThis study examined the effect of health IT investment on MIPs controlling other hospital and market, and volume characteristics. Against our expectation, we found that health IT investment was not negatively associated with MIP. There may be some possible reasons that the real effect of health IT on MIPs was not observed; barriers including communication problems among health ITs, shorter sample period, lower IT investment, and lack of a quality of care measure as a moderating variable.

ObjectivesThe objective of this paper is to investigate the factors affecting adoption of an Electronic Medical Record (EMR) system in small Korean hospitals.MethodsThis study used survey data on adoption of EMR systems; data included that from various hospital organizational structures. The survey was conducted from April 10 to August 3, 2009. The response rate was 33.5% and the total number of small general hospitals was 144. Data were analyzed using the generalized estimating equation method to adjust for environmental clustering effects.ResultsThe adoption rate of EMR systems was 40.2% for all responding small hospitals. The study results indicate that IT infrastructure (OR, 1.48; 95% CI, 1.23 to 1.80) and organic hospital structure (OR, 1.86; 95% CI, 1.07 to 3.23) rather than mechanistic hospital structure or the number of hospitals within a county (OR, 1.08; 95% CI, 1.01 to 1.17) were critical factors for EMR adoption after controlling for various hospital covariates.ConclusionsThis study found that several managerial features of hospitals and one environmental factor were related to the adoption of EMR systems in small Korean hospitals. Considering that health information technology produces many positive health outcomes and that an 'adoption gap' regarding information technology exists in small clinical settings, healthcare policy makers should understand which organizational and environmental factors affect adoption of EMR systems and take action to financially support small hospitals during this transition.

To achieve sensitive plasmonic biosensors, it is essential to develop an efficient method for concentrating analytes in hot spots, as well as to develop plasmonic nanostructures for concentrating light. In this study, target analytes were delivered to the surface of double-bent Au strip arrays by a multiple dip-coating method; they were self-aligned in the valleys between neighboring Au strips by capillary forces. As the valleys not only accommodate target analytes but also host strong electromagnetic fields due to the interaction between adjacent strips, sensitive measurement of target analytes was possible by monitoring changes in the wavelength of a localized surface plasmon resonance. Using the proposed plasmonic sensor and target delivery method, the adsorption and saturation of polystyrene beads 100 nm in size on the sensor surface were monitored by the shift of the resonance wavelength. In addition, the pH-dependent stability of exosomes accumulated on the sensor surface was successfully monitored by changing the pH from 7.4 to 4.0.

ObjectivesThis study investigate the effect of health information technology (IT) expenditure on individual patient-level cost using California Office of Statewide Health Planning and Development (OSHPD) data obtained from 2000 to 2007.MethodsWe used a traditional cost function and applied hospital fixed effect and clustered error within hospitals.ResultsWe found that a quadratic function of IT expenditure best fit the data. The quadratic function in IT expenditure predicts a decrease in cost of up to US$1,550 of IT labor per bed, US$27,909 of IT capital per bed, and US$28,695 of all IT expenditure per bed. Moreover, we found that IT expenditure reduced costs more quickly in medical conditions than surgical diseases.ConclusionsInterest in health IT is increasing more than ever before. Many studies examined the effect of health IT on hospital level cost. However, there have been few studies to examine the relationship between health IT expenditure and individual patient-level cost. We found that IT expenditure was associated with patient cost. In particular, we found a quadratic relationship between IT expenditure and patient-level cost. In other word, patient-level cost is non-linearly (or a polynomial of second-order degree) related to IT expenditure.

ObjectivesThe objective of this study was to create a new measure for clinical information technology (IT) adoption as a proxy variable of clinical IT use.MethodsHealthcare Information and Management Systems Society (HIMSS) data for 2004 were used. The 18 clinical IT applications were analyzed across 3,637 acute care hospitals in the United States. After factor analysis was conducted, the clinical IT adoption score was created and evaluated.ResultsBasic clinical IT systems, such as laboratory, order communication/results, pharmacy, radiology, and surgery information systems had different adoption patterns from advanced IT systems, such as cardiology, radio picture archiving, and communication, as well as computerized practitioner order-entry. This clinical IT score varied across hospital characteristics.ConclusionsDifferent IT applications have different adoption patterns. In creating a measure of IT use among various IT components in hospitals, the characteristics of each type of system should be reflected. Aggregated IT adoption should be used to explain technology acquisition and utilization in hospitals.