Large Metropolitan Regions Research Articles

A matter of measurement? Segregation and all-cause mortality in Sweden’s three metropolitan regions

Abstract Background Residential segregation can be operationalized and measured in many ways, along distinct dimensions. There are multiple mechanisms through which segregation and health mutually affect each other. Consequently, contextual health effects of segregation may vary depending on how segregation is measured. Methods We used longitudinal Swedish register data to compare associations between local measures of residential segregation (migrant density, migrant isolation, and the mutual information index) and all-cause mortality among the adult migrant and native-born populations in Sweden’s three largest metropolitan regions between 2004-2016. Results Among migrants, modest positive mortality gradients were observed across measures of migrant density and isolation, where a higher level of segregation was associated with higher risks of all-cause mortality (Q5 RR ranged from 1.08-1.20 across cities and measures). However, these effects were largely attenuated by individual-level socioeconomic factors, and reversed when further controlling for neighborhood economic deprivation (Q5 RR ranged from 0.74-0.87). Among the native-born, a positive gradient for mortality was found (Q5 RR ranged from 1.31-1.45), although this was reduced when accounting for neighborhood deprivation (Q5 RR ranged from 1.01 -1.11). For both migrants and the native-born, the mutual information index showed no clear association with mortality, although a mortality advantage is observed for migrants in the most segregated areas after individual and neighborhood level adjustments (Q5 RR ranged from 0.73-0.86). Conclusions Our findings show that the manner in which residential segregation is conceptualized and operationalized alters associations with health. However, individual and other contextual level confounders are important determinants which influences the patterns. Much of the negative health effects of residential segregation can be perceived through the lack of economic opportunities. Key messages • Associations between segregation and all-cause mortality depends on how segregation is conceptualized and measured. • The mortality disadvantage observed in local areas with high migrant density may be attributed to the lack of economic opportunities in the neighborhood.

Urban Patterns from Space: A Remote Sensing Based Comparison Between France and Germany

AbstractThis article presents two novel methods on how to derive and visualise settlement patterns from space: a non-parametric approach called multi-scale homogeneity and a parametric, unsupervised approach known as hierarchical multi-scale clustering that models the urban clusters with the help of Gaussian bell curves. The main advantage of remote sensing based acquisition and fully automated evaluation methods is their consistency over large coverages. The Global Urban Footprint-Density (GUF-DenS) indicating the degree of impervious surfaces worldwide serves as database. The geographical focus lies on the neighbouring central-European countries France and Germany. Assuming that the centralist and federal administrative systems resulting from the individual history show a certain impact on the urban patterns, both countries are first examined separately, then together as union. The numerical comparison proofs the expected differences: the settlement pattern of the capital Paris as the largest metropolitan region in France is dominating, whereas several economic clusters of more of less similar size like Rhine–Ruhr and Rhine–Main characterise the German urban landscape. The most interesting and unexpected findings are located along the border, where neighbouring urban ellipses overlay in the separate processing and form transnational clusters when processed as union. One can interpret that the national border does not play a role in the urban development (any longer). The temporal change of the settlement patterns as effect of the regional planning strategies or the opening of the inner-European border cannot be derived from the mono-temporal GUF-DenS and thus, will be subject to future studies.

Rural transformation and sustainable livelihood approaches under regional environmental policies: Evidence from two villages in the Yangtze River Delta metropolitan region, China

AbstractHasty and often uncontrolled urbanization and industrialization in metropolitan regions have pressured fragile rural ecosystems and large‐scale rural livelihoods in China. Through in‐depth observation and face‐to‐face interviews with key insiders in the villages of China's largest metropolitan region, the Yangtze River Delta, findings show that environmental policies in this region have profoundly influenced the local institutional processes and rural transformation. Through the lens of a modified sustainable livelihoods approach (MSLA), two institutional processes in formulating livelihoods strategies have stood out from case villages—state sponsorship exemplified by Yu village and grassroots entrepreneurship exemplified by Daxi village—and achieved sustainable livelihood outcomes in both collective level and household level. In particular, state‐sponsored development in Yu village was strongly supported by local leadership and trust between local cadres and villagers. In contrast, grassroots entrepreneurial development in Daxi village emphasized rural entrepreneurs' self‐learning and self‐governance capacities. As such, we argue that making sustainable livelihood strategies is not a unidirectional process like top‐down or bottom‐up, albeit multifaceted alternatives intertwined with dynamic institutional processes for collectives and households in rural areas. Ultimately, we call for more vivid and in‐depth case studies to nuance regional geography and its contextual attributes in further sustainable livelihood research in rural areas.

SARS-CoV-2 Pandemic in a Small-Sized Municipality in Ceará State, Brazil: Temporal and Spatial Evolution.

Data on the temporal and spatial evolution of SARS-CoV-2 and local control measures and their effects on morbidity and mortality patterns in rural Brazil are scarce. We analyzed the data from case notification systems, epidemiological investigation reports, and municipal decrees in Itapajé, a small municipality in Ceará State in northeast Brazil. For spatial and spatio-temporal analyses, cases and deaths were mapped. There were a total of 3020 cases of COVID-19, recorded between April 2020 and December 2021; 135 (4.5%) died. The cumulative incidence and mortality rates were 5650.3 cases and 252.6 deaths per 100,000 people, respectively. The index case of SARS-CoV-2 in Itapajé was diagnosed in March 2020. The first peak of cases and deaths occurred in May 2020. The second wave peaked in May 2021, with the highest number of deaths in March 2021. According to the spatial analysis, the highest density of cases and deaths occurred in the central urban areas. In these areas, there were also the clusters of highest risk according to the spatio-temporal analyses. The municipal government issued 69 decrees on restriction measures, surveillance, and the maintenance of social isolation as a response to the pandemic. The spread of the SARS-CoV-2 pandemic in Itapajé mirrored the dynamics in large metropolitan regions, going from central neighborhoods of low socio-economic status to the wealthier peripheries.

INFLUENCING CONSUMER PREFERENCE AND SATISFACTION TOWARDS BUYING BEHAVIOUR OF KITCHEN APPLIANCE PRODUCTS IN KRISHNAKIRI DISTRICT

Every business in India, particularly in the country's largest cities, is attempting to survive on its platform as best it can under the current circumstances in order to reach the target number of prospective clients. The world economy will inevitably shift, and liberalisation is essential to our nation. With its extensive and excellent product line, the premier multinational company has joined the Indian market and is already playing a significant role. We understand that our "Customer is the King" and that the Indian market is expanding with a superior product line in electronic home appliances as compared to the global market. Customers are sufficiently aware and sound to make the best choices when it comes to purchasing the chosen brand of home appliances in order to meet the necessary objective. Without home appliances, a contemporary house is incomplete, particularly in large cities and metropolitan regions. In large metropolises, electronic home appliances are seen as a boon as they significantly reduce the amount of time needed for the majority of domestic household chores. Thus, the researchers took into consideration their study on the purchasing habits of consumers in Krishnagar District, Tamil Nadu, with regard to electronics and household appliances. Products related to home appliances such as air coolers, refrigerators, washers, microwaves, and televisions are included in this study. 253 respondents in Krishnagar were chosen for this study using an expedient sampling technique. This study employed a demographic research design, using a questionnaire as a means of gathering data from participants. Additionally, data segmentation will be used in the study. The conclusion reached was that while price, quality, offer, and appliance features empowered the consumer to purchase the appliance, demographic characteristics also influenced the consumer's decision to purchase.

Exploring the changes in the interrelation between public transit mode share and accessibility across income groups in major Canadian cities in the post-pandemic era

The COVID-19 pandemic has impacted the travel behaviour of urban residents in an unprecedented manner, especially public transit (PT) users. PT has experienced a decline in ridership around the world early in the pandemic and has been struggling to rebound again to the pre-pandemic levels, whereas other modes have reached their pre-pandemic levels. PT agencies have been trying to attract users back through service improvements and other policies; nevertheless, the impacts of policies that were effective prior to the pandemic are not guaranteed in the post-pandemic world due to the lasting effects of the pandemic on travel behaviour. This study compares the changes in the impacts of accessibility, the ease of reaching destinations, to jobs by PT on commute mode share pre- and post-pandemic (2016 and 2021) with an equity lens in the three largest metropolitan regions in Canada: Toronto, Montreal, and Vancouver. Results show that planning for accessibility is still an impactful tool to increase PT mode share in the post-pandemic era, yet the magnitude of the impact has declined by almost 50% in Toronto and Montreal and 30% in Vancouver for low-income groups. In the post-pandemic era, the impact of accessibility on PT mode share remains higher for the low-income compared to other-income groups, which is similar to the pre-pandemic times. Understanding the changing effects of accessibility, a major land use and transport planning tool, on travel behaviour is important as PT agencies are developing strategies to restore pre-pandemic levels of ridership and increase it to reach their sustainability goals.

Socio-economic and spatial inequalities in animal sources of iron-rich foods consumption among children 6-23 months old in Ethiopia: A decomposition analysis.

Iron deficiency anaemia is the most common type of anaemia in young children which can lead to long-term health consequences such as reduced immunity, impaired cognitive development, and school performance. As children experience rapid growth, they require a greater supply of iron from iron-rich foods to support their development. In addition to the low consumption of iron-rich foods in low- and lower-middle-income countries, there are also regional and socio-economic disparities. This study aimed to assess contributing factors of wealth-related inequality and geographic variations in animal sources of iron-rich food consumption among children aged 6-23 months in Ethiopia. We used data from the Ethiopian Mini Demographic and Health Surveys (EMDHS) 2019, a national survey conducted using stratified sampling techniques. A total of 1,461 children of age 6-23 months were included in the study. Iron-rich animal sources of food consumption were regarded when parents/caregivers reported that a child took at least one of the four food items identified as iron-rich food: 1) eggs, 2) meat (beef, lamb, goat, or chicken), 3) fresh or dried fish or shellfish, and 4) organs meat such as heart or liver. Concentration indices and curves were used to assess wealth-related inequalities. A Wagstaff decomposition analysis was applied to identify the contributing factors for wealth-related inequality of iron-rich animal source foods consumption. We estimated the elasticity of wealth-related inequality for a percentage change in socioeconomic variables. A spatial analysis was then used to map the significant cluster areas of iron-rich animal source food consumption among children in Ethiopia. The proportion of children who were given iron-rich animal-source foods in Ethiopia is 24.2% (95% CI: 22.1%, 26.5%), with figures ranging from 0.3% in Dire Dawa to 37.8% in the Oromia region. Children in poor households disproportionately consume less iron-rich animal-source foods than those in wealthy households, leading to a pro-rich wealth concentration index (C) = 0.25 (95% CI: 0.12, 0.37). The decomposition model explained approximately 70% of the estimated socio-economic inequality. About 21% of the wealth-related inequalities in iron-rich animal source food consumption in children can be explained by having primary or above education status of women. Mother's antenatal care (ANC) visits (14.6%), living in the large central and metropolitan regions (12%), household wealth index (10%), and being in the older age group (12-23 months) (2.4%) also contribute to the wealth-related inequalities. Regions such as Afar, Eastern parts of Amhara, and Somali were geographic clusters with low iron-rich animal source food consumption. There is a low level of iron-rich animal source food consumption among children, and it is disproportionately concentrated in the rich households (pro-rich distribution) in Ethiopia. Maternal educational status, having ANC visits, children being in the older age group (12-23 months), and living in large central and metropolitan regions were significant contributors to these wealth-related inequalities in iron-rich animal source foods consumption. Certain parts of Ethiopia such as, Afar, Eastern parts of Amhara, and Somali should be considered priority areas for nutritional interventions to increase children's iron-rich animal source foods consumption.

PINK TAX: Why do women pay more than men for the same services? An exploratory study in the five largest metropolitan regions in Brazil

Resumo Evidências sobre a prática de preços mais elevados em produtos e serviços voltados ao público feminino, conhecida como pink tax, são observadas em diversos países no mundo. No Brasil, a literatura existente sobre o tema ainda é extremamente incipiente, além de focar sobretudo nos preços de produtos. Em primeiro lugar, o artigo faz uma revisão da literatura internacional e brasileira acerca do tema da pink tax. Na sequência, apresentamos os nossos próprios resultados de pesquisa. Investigamos a existência da pink tax nos serviços de lavanderia e salões de beleza das cinco maiores regiões metropolitanas do Brasil. O artigo também discute a relação entre gênero e espaço econômico, a natureza econômica da pink tax do ponto de vista da economia tradicional e o consumo feminino frente alguns estereótipos atribuídos às mulheres na contemporaneidade.

Assessment of water quality based on statistical analysis of physical-chemical, biomonitoring and land use data: Manso River supply reservoir

Preserving the quality of surface water has become increasingly difficult due to the intensification of human activities in watersheds. This study assessed the water quality of the Manso River reservoir, which supplies water to Brazil's third largest metropolitan region. The integration of >10,000 secondary data, comprising physico-chemical parameters, metals and microbiological indicators, together with biomonitoring and land use and occupation data, were analyzed by using statistical tools, the Water Quality Index (WQI) and the Trophic State Index (TSI). The results showed higher concentrations for solids and metals (Fe and Mn) characteristic of local geochemistry and also related to the mining activity in the region. Parameters associated with organic pollution, such as total phosphorus and Escherichia coli, were also elevated, probably due to contamination by untreated or insufficiently treated domestic sewage. The water at the tributary watercourses presented worse quality, predominantly medium WQI, compared with the stations inside the reservoir (predominantly good WQI). The TSI indicated a predominance of ultra-oligotrophic conditions for stations located in the lotic environment and mesotrophic conditions for those located in the lentic environment. In general, the same pattern was observed for the occurrence of the phytoplankton and zooplankton classes, indicating the relationship between the degree of trophy and the composition of these groups. In quantitative terms, for phytoplankton, the Euchlorophyceae and Cyanophyceae classes stood out, mainly in the rainy period (summer), whereas for zooplankton, the Crustacea and Monogonta classes were dominant. Regarding land use and occupation in the reservoir sub-basin, the positive impact of the surrounding forest cover was observed. It was also identified the effect of seasonality on the quality of aquatic environments. The integrated evaluation of the results proved to be efficient in assessing the environmental conditions of the reservoir and the tributaries, providing information for better management of these water resources.

Architectures of discretion: Autohoteles and the fortified enclaves of Guatemala city

Autohoteles in Guatemala City are mid-market, pay-by-the-hour hotels designed for sexual encounters. Folding quietly into the landscape of Central America’s largest metropolitan region, these establishments provide middle-class Guatemalans with the opportunity to evade (even if only for an afternoon) the very regimes of surveillance that they have come to expect from fortified enclaves. Autohoteles have walls but no windows, guards but no guest books, and security booths but no surveillance cameras. They are one of the few places where the middle-class in Guatemala City pay not to be watched. Set against the increasing panopticism of everyday life in Central America, this essay engages the autohoteles of Guatemala City to understand an architectural form that minimizes rather than maximizes visibility, for the sake of discretion rather than discipline. It argues that these buildings evidence an intimate and necessary imbrication between the ‘inside’ and ‘outside’ of fortified enclaves.

Persistence of an external shock to domestic tourism demand

ABSTRACT This study investigates two aspects of how an external shock in the guise of the Covid-19 pandemic affects domestic tourism demand: (1) If the impact varies across regions and over time or (2) whether a permanent change (hysteresis) occurs anywhere. By doing so, a presumptive change in domestic tourism demand during three summers is quantified based on timely official data for all Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) and Estonia, encompassing a total of 76 NUTS3 regions. These regions are divided into five groups from large metropolitan to remote. Tourism demand is approximated by the number of domestic overnight stays in accommodation establishments in the summer months 2016–2022. Dynamic panel data estimations, including household consumption and hotel price index, reveal that all non-metropolitan regions experience a strong increase in domestic tourism flows in the first summer of the pandemic compared with the three years preceding 2020. In contrast, the largest metropolitan areas encounter a substantial decline. The surge in demand for non-metropolitan areas continues in 2021, while the large metropolitan regions return to their pre-pandemic level. After this, demand no longer deviates from its pre-2020 pattern across regions, confirming that the effects are temporary.

WEAP Model Based Evaluation of Future Scenarios and Strategies for Sustainable Water Management in the Chennai Basin, India

Abstract The gap between water supply and demand is increasing in several urban clusters of the world. This study uses the water evaluation and planning model to assess the water supply and demand dynamics in one of the large metropolitan regions of the Chennai hydrological basin. The primary water supply sources, including reservoirs, groundwater, inter-basin transfer, and desalination plants, were integrated into the model to simulate the current and future water demand and supply scenario. Three rainfall scenarios (excess, normal, and deficit) were utilized to assess their impacts on water supply. The study highlights the increase in unmet demand for normal and deficit rainfall scenarios. In response, various mitigation options were explored, including increasing groundwater recharge, reservoir capacity enhancement, water treatment plant expansion, additional storage, and utilization of water stored in rock quarries. The findings provide valuable insights for policymakers and stakeholders to develop sustainable water management strategies in the Chennai Basin.

Mixed Land Use as an Intrinsic Feature of Sprawl: A Short-Term Analysis of Settlement Growth and Population Distribution Using European Urban Atlas

This study investigates the land-use/population mix over time as the base to derive an indicator of urban sprawl. Land-use individual patches (provided by Urban Atlas, hereafter UA, with a detailed spatial geometry at 1:10,000 scale) were associated with the total (resident) population based on official statistics (census enumeration districts and other public data sources), providing a comprehensive mapping of the spatial distribution of population density by land-use class in a representative case study for the Mediterranean region (metropolitan Athens, Greece). Data analysis adopted a mix of statistical techniques, such as descriptive statistics, non-parametric curve interpolation (smoothing splines), and exploratory multivariate statistics, namely hierarchical clustering, non-metric multi-dimensional scaling and confirmative factor analysis. The results of this study indicate a non-linear gradient of density decline from downtown (dominated by compact settlements) to peripheral locations (dominated by natural land). Population density in agricultural land was locally high and increasing over time; this result suggests how mixed land use may be the base of intense sprawl in large metropolitan regions. The methodology implemented in this study can be generalized over the whole sample of European cities included in Urban Atlas, providing a semi-automatic assessment of exurban development and population re-distribution over larger metropolitan regions.

Exploring the Effects of Municipal Land and Building Policies on Apartment Size in New Residential Construction in Sweden

New residential construction in many countries with rapid urban growth is often interrelated with smaller housing units being built. Sweden is not an exception. It is of interest to investigate the driving forces behind this tendency. Our presumption is that municipal land price policies and building permit regulations might play a certain role in this process. Contrary to previous studies that focus on the number of new dwelling units in housing construction, our purpose is to analyze the average size of new housing units and the factors that affect it on an aggregate level. We apply seemingly unrelated regressions for analysis of the average apartment size in new residential construction in the three largest metropolitan regions in Sweden as a function of the changes in population, apartment rent and prices, mortgage interest rates, land prices, and building permits per capita as a proxy for regulation. The unbalanced panel dataset includes the period between 1998 and 2017 and covers both the rental and the housing cooperative sectors. The analysis demonstrates that land prices and building policies along with market fundamentals are the underlying factors that affect the average size of an apartment in new residential construction in Sweden.

The prevalence and determinant factors of substance use among the youth in Ethiopia: A multilevel analysis of Ethiopian Demographic and Health Survey.

In Ethiopia, the youth are more exposed to substances such as alcohol, Khat, and tobacco than other populations. Despite the seriousness of the situation, low- and middle-income nations, particularly Ethiopia, have intervention gaps. Service providers must be made more aware of relevant evidence to combat these problems. This research focused on finding out how common substance abuse is among teenagers and the factors that influence it. The 2016 Ethiopian Demographic and Health Survey data were used for secondary data analysis. This survey includes all young people aged 15 to 24 years. The total sample size was 10,594 people. Due to the hierarchical nature of the survey data, a multilevel logistic regression model was employed to uncover the individual- and community-level characteristics related to substances. In Ethiopia, the overall current prevalence of occasional or daily substance use 30 days prior to the survey was 46.74%. Of the participants, 36.34, 12.56, and 0.95% were drinking alcohol, chewing Khat, and smoking cigarettes/any tobacco products, respectively. Male sex, 20-24 years of age, exposure to media, having a job, and living in large central and metropolitan regions were the factors associated with the problem. According to the 2016 EDHS, substance use among young people is widespread in Ethiopia. To lower the prevalence of substance use among youth, policymakers must increase the implementation of official rules, such as restricting alcohol, Khat, and tobacco product marketing to minors, prohibiting smoking in public places, and banning mass-media alcohol advertising. Specific interventions targeting at-risk populations, such as youth, are mainly required in prominent central and metropolitan locations.

Urban air mobility (UAM) in the metropolitan region of São Paulo: Potential and threats

Purpose: The increase in congestion and pollution in large cities combined with the innovation of air transport technology (drones and vertical takeoff and electric propulsion vehicles – eVTOL) and with the advances in autonomous technology have stimulated this research on the potential of Urban Air Mobility – UAM as an alternative to improve mobility conditions in urban centers. In this research, the evaluation of the UAM's potential was carried out with a focus on the metropolitan region of São Paulo (RMSP), the largest metropolitan region in Brazil, with about 22 million inhabitants, and one of the ten most populous metropolitan regions in the world.Design/methodology/approach: In addition to evaluating challenges such as vehicle certification, infrastructure and ATM, an assessment of public acceptance of UAM (based on a survey) was carried out. The survey identified the perceptions of potential customers regarding the gains of the air mobility alternative, as well as the restrictions and fears in relation to the UAM. The opinion poll was carried out along the same lines as the work carried in Europe, allowing the comparison of results between the two markets.Findings: The main results highlighted the identification of the biggest problems for the implementation of UAM services in the metropolitan region of São Paulo, as well as the expectations and restrictions of customers, which will be important subsidies for the development of public policies to improve conditions mobility in the region.Originality/value: UAM is a new, disruptive mobility technology that can improve travel conditions in highly congested urban centers, such as the RMSP. The success of this new technology depends on understanding the challenges and opportunities, but mainly on the perception and expectations of potential customers.

A tale of a shrinking City? Exploring the complex interplay of socio-demographic dynamics in the recent development of Attica, Greece

Mixing peculiar socioeconomic conditions and demographic contexts, urban decline in Mediterranean Europe was less extensively documented than in other regions of the continent. Urbanization without industrialization or, more frequently, a ‘late and light’ industrialization prevented a specific interpretation of metropolitan dynamics in Mediterranean basin according with the paradigm of ‘industrial shrinkage’. For the first time in the recent history, the great recession was a factor leading to metropolitan decline in Southern Europe and, after more than one decade, its outcomes can be investigated considering sufficiently long time series of demographic indicators that assess natural population growth and migration rates. Benefiting from quantitative information derived from official statistics, the present study describes medium- and short-term demographic transformations in a large metropolitan region (Attica, Greece) in response to the great recession. After an uninterrupted growth lasting more than one century, the last decade (2010–2019) has provided a dynamic representation of regional population decline based on the interplay of long-term factors (aging, low fertility) and concomitant short-term disturbances (counter-urbanization and crisis-driven emigration). By delineating the most relevant socio-demographic mechanisms at the base of recent urban decline, our study contributes to (re)formulate short-term development scenarios in large metropolitan regions, shedding further light on crisis-driven shrinkage in Southern Europe. • Urban decline in Mediterranean Europe was poorly documented up to now. • The 2007 recession was a leading factor of metropolitan decline in Southern Europe. • Demographic indicators were used to test shrinkage in a representative Mediterranean city. • Both long-term and short-term factors were important drivers of shrinkage dynamics. • Our study contributes to (re)formulate short-term development scenarios in large cities.

Epidemiology and Predictors of 30-Day Readmission in CAR-T Cell Therapy Recipients

The novel cellular immunotherapy using chimeric antigen receptor (CAR) T cells has transformed the management of several previously incurable hematologic malignancies. Since the first CAR-T cell product was approved by the Food and Drug Administration in 2017, five additional products have been approved for various hematologic malignancies. Although there is now more experience with outpatient administration, CAR-T therapy was initially delivered in an inpatient setting. The unique complications of cytokine release syndrome (CRS) and neurologic side effects (commonly known as immune effector cell-associated neurotoxicity syndrome [ICANS]), along with a higher risk for infection, increase the risk for hospital readmission. Given the recent approval of CAR-T therapy, large-scale epidemiologic data are lacking. The present study aimed to characterize the epidemiology of hospitalizations, readmissions, and factors associated with all-cause 30-day readmission post CAR-T therapy. This retrospective cohort study used the Nationwide Readmissions Database from 2017 to 2019 to identify hospitalizations for CAR-T therapy administration. A descriptive analysis was performed after categorizing these hospitalizations as non-Hodgkin lymphoma, multiple myeloma, or leukemia. The readmission rate was calculated, and etiologies of readmission were identified. A Cox proportional hazards model was used to elucidate factors associated with 30-day readmission. We also estimated the healthcare utilization related to readmissions, including total hospital charges and length of stay. The 2,964 CAR-T therapy-related admissions included 2,176 with a diagnosis of non-Hodgkin lymphoma, 344 with multiple myeloma, and 445 with leukemia. The median length of stay was 15 days. Most CAR-T therapy recipients were male (63.4%), admitted to a teaching hospital (99.2%); 49.3% had private insurance, and 33.2% belonged to the highest-income communities. CAR-T therapy was administered mostly in privately owned (89.5%) large-sized hospitals (74.4%) in large metropolitan regions (91.4%). Median total hospital charges were highest for non-Hodgkin lymphoma, followed by leukemia and multiple myeloma ($945,645 versus $265,034 versus $184,194; P < .001). All-cause mortality during index hospitalization was highest for leukemia at 8.6%, followed by 3.6% for non-Hodgkin lymphoma and 1.4% for multiple myeloma (P < .001). The 30-day all-cause readmission rate was 23.6%, and the median time to readmission was 7 days. The readmission rate was highest for leukemia, followed by non-Hodgkin lymphoma and multiple myeloma (34.2% versus 22.8% versus 15.7%; P < .001). Readmission incurred an additional median total hospital charge of $64,561. During readmission, median length of stay was 5 days, and in-hospital mortality was 4.9%. Top etiologies for readmission were cancer or treatment-related (22%), sepsis or infection (18%), neurologic events (15%), neutropenia or pancytopenia (11%), and fever, hypotension, or hypoxia (8%). On multivariable analysis, non-Hodgkin lymphoma and leukemia (compared with multiple myeloma), transfer to a facility at discharge, chronic renal disease, cerebrovascular disease, and noninvasive ventilation were associated with higher odds of readmission. In contrast, admission to a teaching hospital predicted lower odds of readmission. Almost a quarter of CAR-T therapy recipients are readmitted within the first 30 days resulting in additional economic burden and substantial healthcare utilization.

Bus Rapid Transit: An Overview

Bus Rapid Transit (BRT) is growing in popularity throughout the world. The reasons for this phenomenon include its passenger and developer attractiveness, its high performance and quality, and its ability to be built quickly, incrementally, and economically. BRT also provides sufficient transport capacity to meet demands in many corridors, even in the largest metropolitan regions. In the United States, the development of BRT projects has been spurred by the Federal Transit Administration’s (FTA) BRT initiative. These projects have been undertaken, in part, because of the imbalance between the demand for “New Starts” funds and available resources.Decisions to make BRT investments should be the result of a planning process that stresses problem solving, addressing needs, and the objective examination of a full range of potential solutions, of which BRT is only one. Good planning practice means matching potential market characteristics with available rights-of-way. BRT involves an integrated system of facilities, services, amenities, operations, and Intelligent Transportation Systems (ITS) improvements that are designed to improve performance, attractiveness to passengers, image, and identity. Because they can be steered as well as guided, BRT vehicles can operate in a wide range of environments without forcing transfers or requiring expensive running way construction over the entire range of their operation. Through this flexibility, BRT can provide one-seat, high-quality transit performance over a geographic range beyond that of dedicated guideways. To the maximum extent practical, the system should transfer the service attributes of rail transit to BRT.Even where implementation of a comprehensive, integrated BRT system is not possible, many of its components can be adapted for use in conventional bus systems with attendant benefits in speed, reliability, and transit image/attractiveness.In summary, BRT is growing in popularity because it can be cost-effective and it works. This article describes BRT concepts and components, traces BRT’s evolution, gives its current status, and outlines some of the findings to date of the Transportation Research Board’s (TRB) Transit Cooperative Research Program (TCRP) A-23 project, “Implementation Guidelines for Bus Rapid Transit.”

Analysis of Baseline Characteristics, Length of Stay, Cost of Care, Complications and Subgroup Analysis of Patients Undergoing Total Ankle Arthroplasty–A Large Database Study

Although total ankle arthroplasty (TAA) is becoming a progressively common procedure with a reported 10-fold increase in its prevalence over the past 2 decades; there is still limited large-scale data regarding its overall outcome. Using the National Inpatient Sample (NIS) database, patients who underwent TAA between 2016 and 2019 were identified (ICD-10 CMP code). Data regarding demographic details, co-morbidities, geographic locations of procedure, hospital stay, expenditure incurred, and complications encountered were analyzed. Additionally, a comprehensive subgroup analysis was performed to evaluate the impact of multiple preoperative variables (including gender, diabetes, obesity, CKD and tobacco abuse) on the patient outcome. Overall, 5087 patients (mean age: 65.1 years, 54% males, 85% Caucasians, 75% from large metropolitan regions) underwent TAA. Eighty eight percent of patients were discharged to home; and the mean length of hospital stay and hospital-related expenditure were 1.7 ± 1.41 days and $92,304.5 ± 50,794.1, respectively. The overall complication rate was 8.39% {commonest medical complications: anemia [131 (2.6%) patients) and acute renal failure [37 (0.7%) patients]; commonest local complication: periprosthetic mechanical adversities [90 (1.7%) patients]}. Female and CKD patients demonstrated significantly higher risks of medical (female: p = .003; CKD: p < .001) and surgical (female: p = .005; CKD: p < .019) complications; while obesity substantially enhanced the risk of medical adversities (p < .001). Based on our study, we could conclude that the rates of TAA in the United States are on the rise, especially in regions with population greater than 250,000. TAA is a safe procedure with relatively low complication rates. The complications and hospital-associated expenditure seem to vary between different patient subgroups.