Large Regional Differences Research Articles

A network data-based survey and analysis of attention towards breast reconstruction after breast cancer surgery in Chinese and American populations

BackgroundBreast reconstruction is an effective technique to rebuild the appearance of the breasts in patients after mastectomy and improves the prognosis. The current study aimed to compare and analyze willingness for breast reconstruction after breast cancer between populations in China and the United States, from the perspective of social concern, using big data analysis. We also aimed to explore factors affecting surgical selection and to identify methods that can improve social cognition and acceptance of breast reconstruction. MethodsUsing Baidu and Google, two representative Internet search engines in China and the United States as research tools, and using big data search volume as the benchmark, we compared and analyzed breast reconstruction willingness and attention characteristics between Chinese and American people, based on search heat, geographical distribution, age and sex, keyword distribution, ethnic group, and social development degree. ResultsIn both the long-term and short-term, Chinese people paid more attention towards searching about breast cancer, but less attention to breast reconstruction after breast cancer surgery. However, in both the short-term and long-term, people from the United States paid more attention towards breast cancer and breast reconstruction with the help of the Internet, showing a synchronous change relationship. There was a large regional difference in the search volume for breast cancer among the Chinese population, while no significant regional differences were noted in the search volume for breast cancer in the United States. However, a large regional difference was observed in the search volume for breast reconstruction between the two countries; people in the coastal and economically developed areas paid more attention to it. Most people who paid attention to breast reconstruction in China were women aged 20–39 years, while the attention among men was low. Search keywords were also limited to breast cancer-related information. However, between Asians and European Americans, Americans paid more attention to breast cancer and were affected by regional development, religious beliefs, and health facilities. ConclusionAttention towards breast reconstruction after breast cancer was lower in the Chinese population than in the American population, and this difference was closely related to the level of regional development. There is insufficient information on breast reconstruction after breast cancer in recent Internet media. In addition to strengthening communication in clinics, media education is important to improve the cognitive level and social awareness of patients and their families, which is conducive to breast reconstruction.

Age-dependent seroprevalence of SARS-CoV-2 antibodies in school-aged children from areas with low and high community transmission.

It is not yet clear to what extent SARS-CoV-2 infection rates in children reflect community transmission, nor whether infection rates differ between primary schoolchildren and young teenagers. A cross-sectional serosurvey compared the SARS-CoV2 attack-rate in a sample of 362 children recruited from September 21 to October 6, 2020, in primary (ages 6–12) or lower secondary school (ages 12–15) in a municipality with low community transmission (Pelt) to a municipality with high community transmission (Alken) in Belgium. Children were equally distributed over grades and regions. Blood samples were tested for the presence of antibodies to SARS-CoV-2 with an enzyme-linked immunosorbent assay. We found anti-SARS-CoV-2 antibodies in 4.4% of children in the low transmission region and in 14.4% of children in the high transmission region. None of the primary schoolchildren were seropositive in the low transmission region, whereas the seroprevalence among primary and secondary schoolchildren did not differ significantly in the high transmission region. None of the seropositive children suffered from severe disease. Children who were in contact with a confirmed case (RR 2.9; 95%CI 1.6–4.5), who participated in extracurricular activities (RR 5.6; 95%CI 1.2–25.3), or whose caregiver is a healthcare worker who had contact with COVID-19 patients (RR 2.2; 95%CI 1.0–4.6) were at higher risk of seropositivity. If SARS-CoV2 circulation in the community is high, this will be reflected in the pediatric population with similar infection rates in children aged 6–12 years and 12–15 years. What is Known:•Children are generally less affected by COVID-19 than adults but SARS-CoV2 infection rates among children are not well known.•There were large regional differences in infection rates during the first wave of the SARS-CoV2 pandemic.What is New:•None of the primary schoolchildren (6–12 years) were seropositive for SARS-CoV2 in an area with a low community transmission, but infection rates were higher in adolescents (12–15 years).•In an area with high community transmission, seroprevalence rates in younger children were more comparable to those in adolescents.

Land surface modeling over the Dry Chaco: the impact of model structures, and soil, vegetation and land cover parameters

Abstract. In this study, we tested the impact of a revised set of soil, vegetation and land cover parameters on the performance of three different state-of-the-art land surface models (LSMs) within the NASA Land Information System (LIS). The impact of this revision was tested over the South American Dry Chaco, an ecoregion characterized by deforestation and forest degradation since the 1980s. Most large-scale LSMs may lack the ability to correctly represent the ongoing deforestation processes in this region, because most LSMs use climatological vegetation indices and static land cover information. The default LIS parameters were revised with (i) improved soil parameters, (ii) satellite-based interannually varying vegetation indices (leaf area index and green vegetation fraction) instead of climatological vegetation indices, and (iii) yearly land cover information instead of static land cover. A relative comparison in terms of water budget components and “efficiency space” for various baseline and revised experiments showed that large regional and long-term differences in the simulated water budget partitioning relate to different LSM structures, whereas smaller local differences resulted from updated soil, vegetation and land cover parameters. Furthermore, the different LSM structures redistributed water differently in response to these parameter updates. A time-series comparison of the simulations to independent satellite-based estimates of evapotranspiration and brightness temperature (Tb) showed that no LSM setup significantly outperformed another for the entire region and that not all LSM simulations improved with updated parameter values. However, the revised soil parameters generally reduced the bias between simulated surface soil moisture and pixel-scale in situ observations and the bias between simulated Tb and regional Soil Moisture Ocean Salinity (SMOS) observations. Our results suggest that the different hydrological responses of various LSMs to vegetation changes may need further attention to gain benefits from vegetation data assimilation.

Third Revision of the Global Surface Seawater Dimethyl Sulfide Climatology (DMS-Rev3)

Abstract. This paper presents an updated estimation of the bottom-up global surface seawater dimethyl sulfide (DMS) climatology. This update, called DMS-Rev3, is the third of its kind and includes five significant changes from the last climatology, ‘L11’ (Lana et al., 2011) that was released about a decade ago. The first change is the inclusion of new observations that have become available over the last decade, creating a database of 872,427 observations leading to a ~18-fold increase in raw data as compared to the last estimation The second is significant improvements in data handling, processing, and filtering, to avoid biases due to different observation frequencies which results from different measurement techniques. Thirdly, we incorporate the dynamic seasonal changes observed in the geographic boundaries of the ocean biogeochemical provinces. The fourth change involves the refinement of the interpolation algorithm used to fill in the missing data. And finally, an upgraded smoothing algorithm based on observed DMS variability length scales (VLS) helps to reproduce a more realistic distribution of the DMS concentration data. The results show that DMS-Rev3 estimates the global annual mean DMS concentration to be ~1.87 nM (2.35 nM without a sea-ice mask), i.e., about 4 % lower than the previous bottom-up ‘L11’ climatology. However, significant regional differences of more than 100 % as compared to L11 are observed. The global sea to air flux of DMS is estimated at ~27 TgS yr−1 which is about 4 % lower than L11, although, like the DMS distribution, large regional differences were observed. The largest changes are observed in high concentration regions such as the polar oceans, although oceanic regions that were under-sampled in the past also show large differences between revisions of the climatology. Finally, DMS-Rev3 reduces the previously observed patchiness in high productivity regions.

Analysis of Coupling Degree of Economic Governance Capability and Ecological Governance Capability of Regional Industry

Promoting the modernization of the national governance system and governance capabilities is an important starting point to promote the advancement of the industrial structure and the green development of the industry, and it is also an inevitable requirement for my country to achieve high-quality economic development. The relationship between ecological governance capabilities and economic governance capabilities runs through national governance. A main line of the modernization of the system and governance capabilities,only by accurately measuring and evaluating my country’s ecological and economic governance and the synergy between the two can we better promote the development of the new normal economy. For this reason,based on the research and evaluation of province data from 2015 to 2019, this paper found that the ecological governance capabilities and economic governance capabilities of China's provinces are quite different. Further, in terms of the coupling coordination degree between the two, in the time dimension, the coupling coordination degree between the ecological governance capacity and economic governance capacity of each province showed a trend of increasing and then decreasing during the period 2015-2019, but generally showed an upward trend, with the highest point being reached in 2016; in the regional dimension, there were large regional differences in the coupling coordination degree between the ecological governance capacity and economic governance capacity, the coupling coordination degree of ecological governance capacity and economic governance capacity is positively correlated with the level of economic development. This paper provides a theoretical basis for the objective evaluation of the coupling coordination degree of ecological and economic governance capacity in China, and has important practical significance for the coordinated promotion of the modernization of the national governance system and governance capacity.

Regional variation in COVID-19 positive hospitalisation across Scotland during the first wave of the pandemic and its relation to population density: A cross-sectional observation study.

There have been large regional differences in COVID-19 virus activity across the UK with many commentators suggesting that these are related to age, ethnicity and social class. There has also been a focus on cases, hospitalisations and deaths rather than on hospitalisation rates expressed per 100,000 population. The purpose of our study was to examine regional variation in COVID-19 positive hospitalisation rates in Scotland during the first wave of the pandemic and the possibility that these might be related to population density. This was a repeated point prevalence study. The number of COVID-19 positive patients hospitalised in the eleven Scottish mainland health boards peaked at 1517 on 19th April, then fell to a low of 243 on 16th August before rising slightly to 262 on 15th September. In July, August and September only four boards had more than 5 hospitalised patients. There was a statistically significant relationship between hospitalisation rates and population density on 97.7% of individual days during the first wave of the pandemic (Pearson's r 0.62-0.93, with 123 of a possible 174 days having p values <0.001). Multiple linear regression analyses performed on data from the 11 mainland boards across six time points suggest that population density accounted for 70.2% of the variation in hospitalisation rate in April, 72.3% in May, 81.2% in June, 91.0% in July, 91.0% in August, and 88.1% in September. Neither population median age nor median social deprivation score at health board level were statistically significant in the final model for hospitalisation. There were large differences in crude COVID-19 hospitalisation rates across the 11 mainland Scottish health boards, that were significantly related to population density. Given that lockdown was originally introduced to prevent the NHS from being overwhelmed, we believe our results support a regional rather than a national approach to lifting or reimposing more restrictive measures, and that hospitalisation rates should be part of the decision making process.

Coupling Coordination between Technology Transfer in Universities and High-Tech Industries Development in China

Only through successful transformation and application in industries, technology achievements in universities can promote economic and social development. Meanwhile, technological progress in high-tech industries depends in part on universities’ technology achievements. Coupling coordination between technology transfer in universities (TTU) and high-tech industries development (HTID) is of great significance to the sustainable development of the regional sci-tech innovation system. In this paper, the coupling mechanism of TTU and HTID is analyzed and comprehensive evaluation index systems are established by using the evaluation indicator to screen and assign weights based on information contribution rate. The coupling coordination index (CCI) and productivity index (PI) are introduced to derive the spatiotemporal characteristics of the coupling and coordination of TTU and HTID from 2010 to 2019 in China and analyze its influence factors by System-Generalized Method of Moments (SYS-GMM). The results show the following: (1) the overall national TTU-HTID CCI shows a gradual upward trend and large regional differences; (2) CCI of most provinces is increasing, but the differences are widening; (3) the national TTU PI is in a state of volatility and decline, but the ability of TTU is still much higher than the level of HTID; (4) technological innovation in high-tech industries, high-tech industry technology absorption capacity, high-tech industry development level, industry-university cooperation, and technological finance development have significant roles in promoting the coupling coordination of TTU-HTID. Meanwhile, the sci-tech innovation level in universities, technology transferability in universities, government support, development of sci-tech intermediary, and development of other research institutions have no significant impact.

Spatiotemporal Changes of Land Ecological Security and Its Obstacle Indicators Diagnosis in the Beijing–Tianjin–Hebei Region

Land ecological security (LES) is a cornerstone of sustainable development, and the study of the LES evaluation has become a hot field in the LES problems. The coordinated development of the Beijing–Tianjin–Hebei (BTH) region is one of China’s national development strategies. With the development of urbanization and industrialization, the conflicts between people and land in this area are increasingly prominent, and there are large regional differences in land ecological quality. To evaluate the land ecological security (LES) of this region, an evaluation index system is constructed based on the pressure–state–response (PSR) framework model, and the entropy-weighted TOPSIS method is applied to calculate the LES index. Then, the spatio-temporal changes of LES in the BTH region from 2007 to 2018 are analyzed. In addition, we adopt an obstacle degree model to analyze the obstacle indicators. The results show that the LES of the BTH region increased from 0.1934 to 0.3284 during 2007–2018, and the LES level increased from the dangerous level (I) to the critical level (III). Despite the improved LES in all areas in the BTH region, there were different trends (high in the central area, relatively low in the northern and southern areas). We identified seven obstacle indicators and discussed different development strategies. Our findings will provide guidelines for land use management and offer references for the coordinated development of the BTH region.

Time patterns of precautionary health behaviours during an easing phase of the COVID-19 pandemic in Europe.

Using data from the COVID-19 questionnaire of the Survey of Health, Ageing and Retirement in Europe (SHARE), we investigate the time patterns of precautionary health behaviours of individuals aged 50 years and above during the summer of 2020, an easing phase of the COVID-19 pandemic in Europe. We also examine how these health behaviours differ by the presence of chronic conditions such as hypertension, high cholesterol level, heart disease, diabetes or chronic bronchitis, which can be considered as risk factors for COVID-19. Our results suggest that while on average, people became less precautious during the analysed time period, this is less so for those who are at higher risk. We also document large regional differences in precautionary health behaviours and show that higher-risk individuals are on average more cautious in all regions. We conclude that people adjusted their health behaviours in line with the generally understood risk of the COVID-19 disease. At the same time, our results also point out divergences in the level of willingness to take different precautionary steps.

Projections of temperature-attributable mortality in Europe: a time series analysis of 147 contiguous regions in 16 countries

Europe has emerged as a major climate change hotspot, both in terms of an increase in seasonal averages and climate extremes. Projections of temperature-attributable mortality, however, have not been comprehensively reported for an extensive part of the continent. Therefore, we aim to estimate the future effect of climate change on temperature-attributable mortality across Europe. We did a time series analysis study. We derived temperature-mortality associations by collecting daily temperature and all-cause mortality records of both urban and rural areas for the observational period between 1998 and 2012 from 147 regions in 16 European countries. We estimated the location-specific temperature-mortality relationships by using standard time series quasi-Poisson regression in conjunction with a distributed lag non-linear model. These associations were used to transform the daily temperature simulations from the climate models in the historical period (1971-2005) and scenario period (2006-2099) into projections of temperature-attributable mortality. We combined the resulting risk functions with daily time series of future temperatures simulated by four climate models (ie, GFDL-ESM2M, HadGEM2-ES, IPSL-CM5A-LR, and MIROC5) under three greenhouse gas emission scenarios (ie, Representative Concentration Pathway [RCP]2.6, RCP6.0, and RCP8.5), providing projections of future mortality attributable fraction due to moderate and extreme cold and heat temperatures. Overall, 7·17% (95% CI 5·81-8·50) of deaths registered in the observational period were attributed to non-optimal temperatures, cold being more harmful than heat by a factor of ten (6·51% [95% CI 5·14-7·80] vs 0·65% [0·40-0·89]), and with large regional differences across countries-eg, ranging from 4·85% (95% CI 3·75-6·00) in Germany to 9·87% (8·53-11·19) in Italy. The projection of temperature anomalies by RCP scenario depicts a progressive increase in temperatures, more exacerbated in the high-emission scenario RCP8.5 (4·54°C by 2070-2099) than in RCP6.0 (2·89°C) and RCP2.6 (1·67°C). This increase in temperatures was transformed into attributable fraction. Projections consistently indicated that the increase in heat attributable fraction will start to exceed the reduction of cold attributable fraction in the second half of the 21st century, especially in the Mediterranean and in the higher emission scenarios. The comparison between scenarios highlighted the important role of mitigation, given that the total attributable fraction will only remain stable in RCP2.6, whereas the total attributable fraction will rapidly start to increase in RCP6.0 by the end of the century and in RCP8.5 already by the middle of the century. The increase in heat attributable fraction will start to exceed the reduction of cold attributable fraction in the second half of the 21st century. This finding highlights the importance of implementing mitigation policies. These measures would be especially beneficial in the Mediterranean, where the high vulnerability to heat will lead to an imbalance between the decreasing cold and increasing heat-attributable mortality. None.

Invasive and Non-Invasive Home Mechanical Ventilation in Germany - A Rapid Development with Large Regional Differences

The number of patients using home mechanical ventilation (HMV) is steadily increasing in Germany. Detailed data on inpatient initiation and control of HMV are not available. This, however, is absolutely necessary in order to optimize the medical care structures in Germany. Regional diversities must be taken into consideration in order to provide care structures that reflect the local needs. The data sets of the German Federal Statistical Office on the OPS (Operation and Procedure Classification System) for HMV from 2008 to 2019 were analysed (N = 572,494). Between 2008 and 2019 there was a doubling of the number of HMV initiations and controls. The number of initiations (N = 17,958) and controls (N = 49,140) was highest in 2019. Furthermore, at the state level, the development of HMV is very heterogeneous. Finally, the increases were particularly due to an increase in non-invasively ventilated patients. The rapid increase in HMV is reaching capacity limits of the existing healthcare structure. New healthcare structures should provide an integrated approach between outpatient and inpatient care in order to ensure a high quality of care for patients receiving HMV without compromising the human and economic resources of the system.

Estimating economic impacts from future energy demand changes due to climate change and economic development in China

The energy demand is significantly affected by climate change and economic factors, and the distribution of the demand among different regions in China is unequal because of the large regional differences in climate and economic development. Moreover, demand changes will directly affect the energy sector as the supply side amplifies the economic impact through the industrial linkages among regions and sectors. Therefore, we developed an integrated assessment model combining an energy demand-driven model (EDD) and adaptive multiregional input-output model (AMRIO). The assumptions were used in the model based on China's future climate, economy and energy development. In addition, we evaluated the century-scale energy demand change and its possible economic impact in 5 future scenarios (SSPx-y of CMIP6). The results show that the following: (i) The energy demand in China will continue to increase by approximately 1.89–1.94 times by 2100, resulting in a negative economic impact on GDP ranging from 8.19% to 12.05%. (ii) The energy sector will cumulatively benefit by 26% because of the increase in demand; however, other sectors will suffer negative economic ripple impacts due to the imbalance of supply and demand, especially manufacturing (719%) and agriculture (577%). The results provide quantitative information for policymakers to fully consider the positive and negative impacts of future energy change when making climate mitigation strategies.

Gender differences in perceived workplace harassment and gender egalitarianism: A comparative cross‐national analysis

AbstractUsing 2015 International Social Survey Program (ISSP) data on 38,179 individuals from 36 countries in 9 relatively homogeneous global regions, we analyze the gender differences and the gender gap in perceived workplace harassment (PWH) with particular attention to gender equality's and gender egalitarianism's roles in molding these differences. We find that despite large regional differences, women in most countries are more likely than men to perceive workplace harassment, although this likelihood is higher in countries that score favorably on our gender equality measures. Hence, political empowerment and better economic opportunities alter women's perceptions of workplace harassment, increasing the probability of their experiencing it. Our results also underscore the important roles of values and gender egalitarian practices. Whereas enhanced gender egalitarianism values increase women's perceptions of workplace harassment, concrete practices tend to reduce them. Especially for management, this result highlights the importance of actually implementing gender equality policies at a corporate level, because a discrepancy between corporate values and practices on this issue will only accentuate the perception of harassment.

Patents, exports and technological specialization at the state level in Germany

Germany is a highly innovative country with large regional differences, both in economic performance and innovation potential. This paper focuses on the knowledge production and technological specialization at the state level in Germany and how it affects the exports of individual states. We measured the technological specialization based on average relatedness between patent classes. We demonstrated that technological specialization increased between 1988–1992 and 1998–2002 in most German states, whereas between 2008 and 2012 it slightly declined or remained stable in all states except Saarland and Bremen. Highly innovative states, such as Bayern, as well as the least innovative Sachsen-Anhalt, belong among the most specialized states. Therefore, there is no obvious trend indicating that large specialization is related to higher innovativeness or vice versa. In accordance with other studies, we found that having a higher number of patent applications increases exports. This is especially valid at the state level. However, within the seven examined industrial categories, the relationship is weaker. Apart from patenting, we also estimated other R&amp;D indicators such as Gross Domestic Expenditure on Research and Development (GERD), R&amp;D personnel and technological specialization. Whilst the higher relative numbers of R&amp;D personnel increase the volume of exports relative to regional GDP, in the case of GERD, the results were inconclusive. Furthermore, a higher technological specialization measured by average relatedness between patent classes negatively affects exports. This finding is surprising, and other measures of specialization in different regions should be tested to support it.

Assessment of the burden of clonorchiasis and its temporal changes in China

To assess the burden of clonorchiasis and identify its temporal and spatial changes in China, thus to provide insights into the control and prevention of the diseases. The disability-adjusted life years (DALYs) was employed as the primary indicator for the disease burden. The prevalence data of Clonorchis sinensis infection were obtainted from the three national surveys on important human parasitic diseases in China, conducting during the period from 1988 to 1922, from 2001 to 2004 and from 2014 to 2016, respectively, and the demographic data from National Bureau of Statistics of China. DALYs of clonorchiasis were calculated and the temporal changes were analyzed at both national and provincial levels, using the disability weight (DW) obtained from a community study in China. Sensitivity analysis was carried out to compare the resulted DALYs of China calculated under the method adopted in this study and that calculated with other commonly used methods. The national burden of clonorchiasis was 489174.04 [95% confidence interval (CI): (391648.87, 597509.87)] DALYs in China in 2016, indicating 0.36 [95% CI: (0.28, 0.43)] DALYs per 1 000 populations. The regions with a high burden of clonorchiasis were concentrated in southern China and northeastern China, and the provinces with the three highest burdens of clonorchiasis included Guangxi Zhuang Autonomous Region, Guangdong Province and Heilongjiang Province, which accounted for 91.18% of total burdens of clonorchiasis in China. During the periods of the three national surveys on important human parasitic diseases in China, the national burden of clonorchiasis was found to show a tendency of first rise and then decrease in China; however, the burden of clonorchiasis has recently shown a tendency towards a rise in Guangxi Zhuang Autonomous Region, Heilongjiang Province and Jiangxi Province. Sensitivity analysis showed that the calculation of diseases burden with age-stratified prevalence of clonorchiasis was similar to that of our method without age stratification; however, the burden estimates calculated only based on the DW of the severe symptoms were much lower than our estimates. The burden of clonorchiasis is high in China, with a large regional difference. Recently, the overall burden of clonorchiasis has shown a tendency of decline in China; however, there is a tendency towards a rise in some provinces. Therefore, the control of clonorchiasis requires more adaptations to local circumstances.

Status and Determinants of Treatment Outcomes Among New Tuberculosis Patients in South Korea: A Retrospective Cohort Study.

This is a retrospective cohort study using notification data in South Korea. We evaluated the nationwide status, regional differences, and the determinants of treatment outcomes among tuberculosis patients. Treatment success rate improved from 77.0% in 2012 to 86.0% in 2015. The lost to follow-up rate was higher among older people, males, and foreign nationals. Health care facilities designated for the Public-Private Mix (PPM) project showed higher success rate and lower rate of lost to follow-up. Moreover, municipalities with low regional deprivation index had higher PPM project coverage. Since there is a large regional difference in the coverage of the PPM project, an additional community-based support program should be implemented, especially for tuberculosis patients residing in region with low PPM project coverage.

The Emergence of the Dutch Housewife Revised. How Shifts in Local Labour Market Structures Shaped Dutch Unmarried Women’s Labour Force Participation, 1812–1929

Most studies on the long-term development of female labour force participation argue that social norms and rising wages were key drivers. However, the majority of these conclusions apply to married women. Instead, this study zooms in on unmarried women. Based on nearly 2 million marriage records that have been digitised by Kees Mandemakers' LINKS project, it shows that there were large regional differences in the levels of labour force participation that were closely connected to local job opportunities. This research concludes that even though social norms and income levels were indeed important, local sectoral employment shares were the key driver of Dutch unmarried women's work during the long-19th century.

Cesarean delivery rates for overall and multiple pregnancies in Japan: A descriptive study using nationwide health insurance claims data.

Due to the lack of national perinatal registries, population-wide descriptive statistics on cesarean deliveries in Japan are unknown. We aim to describe cesarean deliveries for overall and multiple pregnancies using the Japan National Database of health insurance claims. We calculated the national and prefectural cesarean delivery rates for overall and multiple pregnancies in 2014. We described maternal morbidities (e.g., blood transfusion) and the place and type of the institutions providing prenatal and perinatal care. The national cesarean delivery rates were 18.6% overall and 82.7% for women with multiple pregnancies. Prefectural cesarean delivery rates for overall and multiple pregnancies varied from 12.5% to 24.2% and from 49.2% to 100%, respectively, showing a moderate positive correlation (r=0.59, p < 0.001). Overall, 1.4% of cesarean patients received an allogeneic blood transfusion, compared to 3.2% for those with multiple pregnancies. In addition, 65.9% of overall cesarean deliveries occurred at hospitals with ≥20 beds, whereas 94.6% of cesarean patients with multiple pregnancies delivered at hospitals. Older patients were more likely to receive their cesarean section at a different institution than their first visit within the same prefecture, but trans-prefectural movement during pregnancy covered by health insurance was most frequent among those in their early thirties: 7.0% overall and 10.7% for multiple pregnancies. The overall cesarean delivery rate in Japan was optimal, but the rate was high for multiple pregnancies, with large regional differences. Data on patient movement across institutions and areas would help to improve the perinatal care system.

New Observational Constraints on Warm Rain Processes and Their Climate Implications

AbstractLow stratiform clouds have profound impacts on the hydrological cycle and the Earth’s radiation budget. However, realistic simulation of low clouds in climate models presents a major challenge. Here we employ the newly retrieved cloud and drizzle microphysical properties to improve the autoconversion and accretion parameterizations in a microphysical scheme. We find that the new autoconversion (accretion) rate contributes 14% lower (greater) to total drizzle water content than the original scheme near the cloud top. Compared to satellite results, the simulated cloud liquid water path (LWP) and shortwave cloud radiative effect using the original scheme in a climate model agree well on global average but with large regional differences. Simulations using the updated scheme show a 7.3% decrease in the light rain frequency, and a 10% increase in LWP. The updated microphysics scheme alleviates the long‐lasting problem in most climate models, that is “too frequent and too light precipitation.”

Deforestation and bird habitat loss in Colombia

Tropical deforestation continues at high rates in many regions, but it is often reported only in terms of area lost or its impacts on high-profile threatened species. Here, we examined the impact of both past and projected future deforestation on habitat extent for the entire assemblage of forest-dependent birds across the country with the greatest richness of bird species: Colombia. Of the 550 forest-dependent species analysed, almost all (n = 536; 96.5%) had lost habitat, and 18% had lost at least half of their habitat by 2015. We used the recently developed Loss Index (LI) to capture the severity of habitat loss for the forest bird assemblage, discovering that the current LI for Colombia is 35, which means 35% of bird species have lost at least 35% of their habitat. However, there were large regional differences. The national LI for Colombia is projected to rise to 43 by 2040 if recent forest loss trends continue. A threat assessment for the regionally-endemic species in the country showed that 12 (30%) of the species that are projected to lose 50% or more of their historical habitat by 2040 are not currently classified as threatened by the IUCN, suggesting that there are many unlisted species that face an imminent extinction threat from ongoing habitat loss. This extensive habitat depletion affecting entire species assemblages has significant implications for tropical forest ecosystems. We consider the risks this poses to ecosystem function and ecosystem service provision in Colombia's forests, and the ramifications of our findings for other tropical biodiversity hotspots.