Large Regional Variations Research Articles

Reduction in NOx Emission Trends over China: Regional and Seasonal Variations

We analyzed satellite observations of nitrogen dioxide (NO2) columns by the Ozone Monitoring Instrument (OMI) over China from 2005 to 2010 in order to estimate the top-down anthropogenic nitrogen oxides (NOx) emission trends. Since NOx emissions were affected by the economic slowdown in 2009, we removed one year of abnormal data in the analysis. The estimated average emission trend is 4.01 ± 1.39% yr(-1), which is slower than the trend of 5.8-10.8% yr(-1) reported for previous years. We find large regional, seasonal, and urban-rural variations in emission trends. The average NOx emission trend of 3.47 ± 1.07% yr(-1) in warm season (June-September) is less than the trend of 5.03 ± 1.92% yr(-1) in cool season (October-May). The regional annual emission trends decrease from 4.76 ± 1.61% yr(-1) in North China Plain to 3.11 ± 0.98% yr(-1) in Yangtze River Delta and further down to -4.39 ± 1.81% yr(-1) in Pearl River Delta. The annual emission trends of the four largest megacities, Shanghai, Beijing, Guangzhou, and Shenzhen are -0.76 ± 0.29%, 0.69 ± 0.27%, -4.46 ± 1.22%, and -7.18 ± 2.88% yr(-1), considerably lower than the regional averages or surrounding rural regions. These results appear to suggest that a number of factors, including emission control measures of thermal power plants, increased hydro-power usage, vehicle emission regulations, and closure or migration of high-emission industries, have significantly reduced or even reversed the increasing trend of NOx emissions in more economically developed megacities and southern coastal regions, but their effects are not as significant in other major cities or less economically developed regions.

Health Vulnerability Assessment of Heat waves in Korea

Background and aims: Heat waves are well known to be associated with increases in mortality and the burden of heat-related illness in population. The health effects due to heat waves appear differently depending on the population characteristics and regions. However, there is limited regional information available to guide the public health adaptation plan and climate change decision-making. Therefore, regional health vulnerability of heat waves is assessed in this study. Methods: Health vulnerability related to heat waves is determined based on three components; climate change exposure, sensitivity and adaptive capacity. Vulnerability index (VI) for each region was calculated based on values of 19 variables identified for three components with weights from Delphi consensus of experts. VI was mapped for entire Korean peninsula from 2000s to 2100s, applying SRES A1B and RCP scenarios with assessment units of 232 local governments and results units of 16 aggregated areas. The contribution analyses of VI were performed to grasp contributable variables. Results: Climate change vulnerabilities related to heat waves showed large regional variations. Contribution of three components, climate change exposure, sensitivity and adaptive capacity, were 0.33, 0.28 and 0.28 respectively. VI was highly associated with socio-demographic characteristics and healthcare access conditions. Vulnerable areas are mostly distributed southern part of Korea in 2000s, and tend to be gradually moving northward as time goes by. Currently vulnerable areas appear to stay or be more vulnerable in the future. Conclusions: Overall vulnerability is predicted to be increasing over time. It is important to consider spatial data within a single country when evaluating climate change vulnerability for identifying cost-effective intervention and early planning of public health adaptation strategies.

Multistate implementation of guideline-based cardiac resuscitation systems of care: Description of the HeartRescue Project

There is large and significant regional variation in out-of-hospital cardiac arrest (OHCA), and despite advances in treatment, survival remains low. The American Heart Association has called for the creation of integrated cardiac resuscitation systems of care capable of measuring and improving evidence-based care from bystanders through to hospital discharge. The HeartRescue Project was initiated in 2010 by the Medtronic Foundation in collaboration with 5 academic medical centers and American Medical Response. The HeartRescue Project aims to develop regional cardiac resuscitation systems of care that will implement guideline-based best practice bystander, prehospital, and hospital care with standardized data reporting linked to outcomes. The primary goal is to improve collective OHCA survival by 50% over 5 years. The total population in the 5 participating states is 41.1 million. At baseline, the HeartRescue Project covers approximately 26.1 million people (63.6%) and has engaged 767 emergency medical services agencies and 269 hospitals. Data will be collected for quality improvement, to inform provider feedback, and serve to define effective strategies to improve cardiac arrest care. The HeartRescue Project is the largest public health initiative of its kind focused entirely on cardiac arrest outcomes. The project is designed to significantly improve OHCA survival by implementing and measuring model systems of care for cardiac resuscitation.

Human settlement and regional development in the context of climate change: a spatial analysis of low elevation coastal zones in China

Low elevation coastal zone (LECZ) in China is densely populated and economically developed, which is exposed to increasing risks of hazards related to climate change and sea level rise. To mitigate risks and achieve sustainable development, we need to better understand LECZ. As the first step, in this paper we define the extent of the LECZ in China, and analyze the spatial distribution of LECZ and its population, using a geographic information system software (ArcGIS) to combine elevation models and population data sets. Our findings show that, overall, this zone covers 2.0 % of China’s land area but contains 12.3 % of the total population, which is the largest population living in LECZ in the world. There are large regional variations in the distribution of both LECZ and LECZ population, with half of the LECZ within 30 km from the coastline, and Jiangsu Province having the largest LECZ area and population. The LECZ is also concentrated in three major economic zones in China, which accounts for 54 % of LECZ and three quarters of all LECZ population in China. The impact of future climate change on China’s LECZ is exacerbated by rapid economic and population growth, urbanization and environmental degradation. Coordinating development in coastal and inland China, enhancing adaptive capacity and implementing integrated risk management for LECZ are needed to reduce the risks related to climate change and to achieve sustainable development.

Spatial, seasonal, and source variability in the stable oxygen and hydrogen isotopic composition of tap waters throughout the USA

AbstractTo assess spatial, seasonal, and source variability in stable isotopic composition of human drinking waters throughout the entire USA, we have constructed a database of δ18O and δ2H of US tap waters. An additional purpose was to create a publicly available dataset useful for evaluating the forensic applicability of these isotopes for human tissue source geolocation. Samples were obtained at 349 sites, from diverse population centres, grouped by surface hydrologic units for regional comparisons. Samples were taken concurrently during two contrasting seasons, summer and winter. Source supply (surface, groundwater, mixed, and cistern) and system (public and private) types were noted. The isotopic composition of tap waters exhibits large spatial and regional variation within each season as well as significant at‐site differences between seasons at many locations, consistent with patterns found in environmental (river and precipitation) waters deriving from hydrologic processes influenced by geographic factors. However, anthropogenic factors, such as the population of a tap's surrounding community and local availability from diverse sources, also influence the isotopic composition of tap waters. Even within a locale as small as a single metropolitan area, tap waters with greatly differing isotopic compositions can be found, so that tap water within a region may not exhibit the spatial or temporal coherence predicted for environmental water. Such heterogeneities can be confounding factors when attempting forensic inference of source water location, and they underscore the necessity of measurements, not just predictions, with which to characterize the isotopic composition of regional tap waters. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

The effect of municipality characteristics on disability retirement

In addition to individual-level characteristics also contextual factors may contribute to the large regional variation seen in disability retirement. We examined the associations of municipality-level characteristics and disability retirement due to all causes, musculoskeletal diseases, mental disorders and other diseases. A register-based study was conducted with a 20% random sample of the Finnish population aged 25-62 years. Municipalities were separately divided into quintiles by their proportion of manual workers, unemployed and industrial employees. Multilevel Poisson regression analysis was applied to examine associations between the three municipality characteristics and disability retirement during a 5-year follow-up. All three municipality-level indicators were associated with disability retirement, but the association between the proportion of industrial workers and disability retirement disappeared after adjustment for age, gender, marital status, socioeconomic position, unemployment and industrial employee status at the individual level. The associations were particularly strong for disability retirement due to musculoskeletal diseases: in the municipalities with the highest proportion of manual workers, the risk for disability retirement due to musculoskeletal diseases was 2.5 times higher than in the municipalities with least manual workers. After adjustment for the individual-level factors, the risk was 1.5 times higher. Cross-level interactions showed that the risk of disability retirement increased with the increasing proportion of unemployment in the municipality only among those who had not experienced unemployment themselves. Municipality-level characteristics made an independent contribution to the probability of disability retirement in particular due to musculoskeletal diseases. Also, area-level characteristics should be considered when targeting disability retirement.

Long‐term changes in total and extreme precipitation over China and the United States and their links to oceanic–atmospheric features

ABSTRACTWe investigate the variations of total and extreme precipitations over China and the United States, focusing on long‐term changes. We also explain the features of precipitation by changes in sea surface temperature (SST) and atmospheric circulation. Features of total precipitation and the ratio of extreme to total precipitation are different between China and the United States, and differences occur in both annual and seasonal means. Both total precipitation and precipitation ratio show large seasonal and regional variations over China, but change modestly over the United States Annually, China total precipitation changes insignificantly and the ratio shows only a slight positive trend. However, the US annual total precipitation increases significantly, although the ratio decreases moderately. In China, the ratio exhibits positive trends in all seasons and total precipitation shows small positive trends except a negative trend in fall. The US total precipitation increases remarkably in all seasons except winter when a slight decrease occurs, and the ratio decreases in winter and summer but increases in spring and fall. The change in China precipitation ratio has a strong link to SSTs around the Indian Ocean and the South and East China Seas, and the change in US total precipitation is associated with changes in the Indian Ocean and eastern Pacific SSTs. These relationships become weaker when the trend of total precipitation or precipitation ratio is removed, indicating an impact of SST on the long‐term change in precipitation. The trends of US total precipitation and China precipitation ratio are also linked to the long‐term changes inatmospheric circulation including the trade wind, the North Pacific anticyclone, and the circulation patternsover Asia. In most cases, the total and extreme precipitations are associated with similar SST and atmospheric patterns, except in China where the annual extreme precipitation is associated with SST and circulation features as is the precipitation ratio.

Overview of the current state of the epidemic.

At the end of 2011, about half of the 34.0 million [31.4–35.9 million] people living with HIV infection knew their HIV status. With large regional variations, an estimated 0.8 % of all adults aged 15 to 49 years have HIV infection and HIV subtype diversity is increasing. Although HIV incidence has declined in 39 countries, it is stable or increasing in others. HIV prevalence continues to rise as antiretroviral treatment scale-up results in fewer HIV-related deaths while new infections continue to occur. Increased treatment uptake is likely reducing HIV transmission in countries with large mortality declines. Key populations, including sex workers, men who have sex with men, transgender people, people who inject drugs and young women in high prevalence settings require effective prevention programs urgently. Correcting mismatches in resource allocation and reducing community viral load will accelerate incidence declines and affect future epidemic trends, if concerted action is taken now.

Regional variation in the proportion of red heartwood in sugar maple and yellow birch

Stems of sugar maple (Acer saccharum Marsh.) and yellow birch (Betula alleghaniensis Britt.) trees often contain a column of discoloured wood known as red heartwood, which reduces lumber value. To quantify the regional-scale variation in red heartwood, 192 trees of each species were sampled in 12 locations across the temperate forest zone of southern Québec, Canada. Large regional variation in the radial proportion of red heartwood (RHP) at breast height (1.3 m) was observed in both species. Statistical modeling showed that such variation was mainly attributable to factors related to tree development. Cambial age had a strong positive effect on RHP in both species, suggesting that the occurrence of red heartwood ultimately might be unavoidable. There was also a positive effect of ring area increment at the limit of the discoloured zone. In the case of sugar maple, there was an added effect of the trend in ring area increments observed in the same zone, with a negative trend being generally indicative of a larger RHP. Further variability in this species was also associated with the annual minimum temperature of the sampling locations. The models developed for each species explained around 60% of the variance in RHP and could be used to improve forest management and wood procurement decisions.

Aerosol-Precipitation Interactions over India: Review and Future Perspectives

Atmospheric aerosols can interact with clouds and influence the hydrological cycle by acting as cloud condensation nuclei. The current study reviews the results obtained on aerosol-precipitation interactions over India and the surrounding oceanic regions. An analysis of aerosol and cloud characteristics over the Arabian Sea, India, and the Bay of Bengal during summer monsoon in the last decade reveals large regional, intraseasonal, and interannual variations. Aerosol optical depth (AOD) and aerosol absorbing index (AAI) in 2002 (a drought year) are higher over India when compared to normal monsoon years. Cloud effective radius (CER) and cloud optical thickness exhibit a negative correlation with AOD over India, which agrees well with the indirect radiative effects of aerosols. Over Bay of Bengal CER is positively correlated with AOD suggesting an inverse aerosol indirect effect. In future, observatories to measure aerosol characteristics (amount, size, type, chemical composition, mixing, vertical and horizontal distributions), and cloud properties (number and size) over several locations in India, and intense observational campaigns involving aircraft and ships are crucial to unravel the quantitative impact that aerosols have on Indian monsoon. Satellite remote sensing of aerosol distribution, their chemical composition, microphysical properties of clouds, solar irradiance, and terrestrial longwave radiation is important.

Competitive Pressure and Technology Adoption: Evidence from a Policy Reform in Western Canada

We measure the impact of the removal of a railway transportation subsidy on the adoption of technology for Western Canadian farms, using a unique combination of Census and freight rate data. We exploit the large regional variation in these one-time freight rate increases in order to identify causal effects of increased competitive pressure. Using a difference-in-differences methodology we find that higher freights rates – and hence lower farm gate prices – induced farmers to adopt new, more efficient production technology. We also find that farmers experiencing the greatest transportation cost increases also increased fertilizer usage and made significant land use changes.

The effect of windstress change on future sea level change in the Southern Ocean

AOGCMs of the two latest phases (CMIP3 and CMIP5) of the Coupled Model Intercomparison Project, like earlier AOGCMs, predict large regional variations in future sea level change. The model‐mean pattern of change in CMIP3 and CMIP5 is very similar, and its most prominent feature is a zonal dipole in the Southern Ocean: sea level rise is larger than the global mean north of 50°S and smaller than the global mean south of 50°S in most models. The individual models show widely varying patterns, although the inter‐model spread in local sea level change is smaller in CMIP5 than in CMIP3. Here we investigate whether changes in windstress can explain the different patterns of projected sea level change, especially the Southern Ocean feature, using two AOGCMs forced by the changes in windstress from the CMIP3 and CMIP5 AOGCMs. We show that the strengthening and poleward shift of westerly windstress accounts for the most of the large spread among models in magnitude of this feature. In the Indian, North Pacific and Arctic Oceans, the windstress change is influential, but does not completely account for the projected sea level change.

Aerosol, clouds and rainfall: inter-annual and regional variations over India

Inter-annual and regional variations in aerosol and cloud characteristics, water vapor and rainfall over six homogeneous rainfall zones in India during the core monsoon month of July from 2000 to 2010, and their correlations are analyzed. Aerosol optical depth (AOD) and aerosol absorbing index (AAI) in July 2002, a drought year are higher over India when compared to normal monsoon years. The drier conditions that existed due to deficient rainfall in July 2002 could be responsible for raising more dust and smoke resulting in higher AODs over India. In addition, over India precipitation is not uniform and large-scale interruptions occur during the monsoon season. During these interruptions aerosols can build up over a region and contribute to an increase in AODs. This finding is supported by the occurrence of higher anomalies in AOD, AAI and rainfall over India in July 2002. Aerosol characteristics and rainfall exhibit large regional variations. Cloud effective radius (CER), cloud optical thickness and columnar water vapor over India are the lowest in July 2002. CER decreases as AOD and AAI increase, providing an observational evidence for the indirect effect of aerosols. Eighty percent of CER in northwest India, and 30% of CER over All India in July 2002 are <14 μm, the precipitation threshold critical cloud effective radius. Northeast India shows contrasting features of correlation among aerosols, clouds and rainfall when compared to other regions. These results will be important while examining the inter-annual variation in aerosols, cloud characteristics, rainfall and their trends.

Marine productivity response to Heinrich events: a model-data comparison

Abstract. Marine sediments records suggest large changes in marine productivity during glacial periods, with abrupt variations especially during the Heinrich events. Here, we study the response of marine biogeochemistry to such an event by using a biogeochemical model of the global ocean (PISCES) coupled to an ocean-atmosphere general circulation model (IPSL-CM4). We conduct a 400-yr-long transient simulation under glacial climate conditions with a freshwater forcing of 0.1 Sv applied to the North Atlantic to mimic a Heinrich event, alongside a glacial control simulation. To evaluate our numerical results, we have compiled the available marine productivity records covering Heinrich events. We find that simulated primary productivity and organic carbon export decrease globally (by 16% for both) during a Heinrich event, albeit with large regional variations. In our experiments, the North Atlantic displays a significant decrease, whereas the Southern Ocean shows an increase, in agreement with paleo-productivity reconstructions. In the Equatorial Pacific, the model simulates an increase in organic matter export production but decreased biogenic silica export. This antagonistic behaviour results from changes in relative uptake of carbon and silicic acid by diatoms. Reasonable agreement between model and data for the large-scale response to Heinrich events gives confidence in models used to predict future centennial changes in marine production. In addition, our model allows us to investigate the mechanisms behind the observed changes in the response to Heinrich events.

Antarctic temperature changes during the last millennium: evaluation of simulations and reconstructions

Temperature changes in Antarctica over the last millennium are investigated using proxy records, a set of simulations driven by natural and anthropogenic forcings and one simulation with data assimilation. Over Antarctica, a long term cooling trend in annual mean is simulated during the period 1000–1850. The main contributor to this cooling trend is the volcanic forcing, astronomical forcing playing a dominant role at seasonal timescale. Since 1850, all the models produce an Antarctic warming in response to the increase in greenhouse gas concentrations. We present a composite of Antarctic temperature, calculated by averaging seven temperature records derived from isotope measurements in ice cores. This simple approach is supported by the coherency displayed between model results at these data grid points and Antarctic mean temperature. The composite shows a weak multi-centennial cooling trend during the pre-industrial period and a warming after 1850 that is broadly consistent with model results. In both data and simulations, large regional variations are superimposed on this common signal, at decadal to centennial timescales. The model results appear spatially more consistent than ice core records. We conclude that more records are needed to resolve the complex spatial distribution of Antarctic temperature variations during the last millennium.

Trends in outpatient antibiotic use in Israel during the years 2000–2010: setting targets for an intervention

The abundant use of antibiotics (Abs) in the community plays a major role in inducing Ab resistance, but the literature concerning patterns in outpatient Ab use is limited. This study aims to lay the foundations for future policy and interventional programs to address the rise in Ab resistance by looking at long-term trends in Ab usage in Israel. Defined daily doses per 1,000 inhabitants per day (DID) of total Ab use, consumption in different age groups, and of different Ab preparations were calculated for the years 2000, 2005, and 2010 in the eight districts of Israel. Data were collected from the pharmacy registries of "Clalit Health Services", the largest Health Maintenance Organization (HMO) in Israel, covering 4 million patients, representing 53 % of the population. Trends in use over time were analyzed. The overall Ab usage in Israel has remained constant in the last decade. Three significant trends were identified in this study: an increase in the consumption of expensive, broad-spectrum Abs, paralleled by a reduction in narrow-spectrum Abs; an increase in Ab consumption among the elderly, counteracted by reduced usage among children; large regional variations in the overall and specific use of Ab agents. Our main findings of increased broad-spectrum Ab consumption, primarily among the adult population in Israel, and a wide variability in Ab use between the regions in Israel, can focus our future studies on searching for the factors behind these trends to aid in constructing interventional methods for decreasing outpatient Ab overuse.

PS37 Does the Route to Diagnosis Affect Outcomes for Oesophago-Gastric Cancer Patients

BackgroundThe UK Cancer Reform strategy aims to improve early diagnosis but there is little evidence on how the route to diagnosis and affects outcomes for patients with oesophago-gastric (O-G) cancer....

Space Matters. The Group Threat Hypothesis Revisited with Geographically Weighted Regression. The Case of the NPD 2009 Electoral Success

Summary A geographically weighted regression approach is used to assess the association of the electoral success of the NPD, an extreme right-wing political party, during the 2009 German federal election with levels of and changes in immigrant and unemployment rates. The results do not support the group threat hypothesis: the immigrant rate remains non-significant in large areas of West Germany while it shows a negative and significant relationship with NPD electoral success in most localities in East Germany as well as in Northern Bavaria. Instead, findings tend to confirm the contact hypothesis: a higher percentage of immigrants within an electoral district seems to lead to larger interethnic contact opportunities and thus to a lower proportion of votes for the NPD. The largest significant positive association of unemployment rate with NPD electoral results is observed with respect to localities that are situated around the former border between East and West Germany. The large regional variations in the effects of immigrant and unemployment rates point to different mechanisms which are at stake in the association of populist radical right success with unemployment and immigrant rates. These findings illustrate the importance of spatial variability and make the case for a broader new research agenda dedicated to exploring the mechanisms underlying spatial nonstationarity.

Is There a Starling Curve for Intensive Care?

Large differences exist in the provision of ICU beds worldwide, with a complicated mix of risks and benefits to the population of having either too few or too many beds. Having too few beds can result in delayed admission of patients to the ICU or no admission at all, with either scenario potentially increasing mortality. Potential societal benefits of having few beds include lower costs for health care and less futile intensive care at the end of life. With added ICU beds for a population, mortality benefit should accrue, but there is still the question of whether the addition of beds always means that more lives will be saved or whether there is a point at which no additional mortality benefit is gained. With an abundance of ICU beds may come the possibility of increasing harm in the forms of unnecessary costs, poor quality of deaths (ie, excessively intensive), and iatrogenic complications. The possibility of harm may be likened to the concept of falling off a Starling curve, which is traditionally used to describe worsening heart function when overfilling occurs. This commentary examines the possible implications of having too few or too many ICU beds and proposes the concept of a family of Starling curves as a way to conceptualize the balance of societal benefits and harms associated with different availability of ICU beds for a population.

Opportunity for all? Socioeconomic disparities in chemotherapy (CT) use for metastatic prostate cancer (mPC).

e15186 Background: CT for mPC is a category 1 recommendation after progression despite hormone therapy (NCCN Clinical Guidelines in Oncology). Having previously documented large regional variations in CT use (Perlroth et al, GU-ASCO, Feb 2-4, 2012), we sought to determine if such disparities exist for patients across socioeconomic status (SES) indicators. Methods: Using Surveillance, Epidemiology, and End Results data linked to Medicare claims, we identified all men diagnosed between 2000 and 2007 with mPC initiated on hormones, excluding patients not continuously enrolled in Medicare Parts A/B or diagnosed with other cancers. We used logistic regression to estimate probability of CT, adjusting for demographic, SES, grade stage and PSA of cancer, and other comorbidities, and tested alternative measures of SES in sensitivity analyses. We report odds ratios (OR) for CT use by socioeconomic status, 95% confidence intervals (CI), and estimates for differences in CT use for high and low SES patients. Results: 7852 patients were in the cohort, mean and median age of 76 and 74 years. 19% advanced to CT, but patients living in regions below the federal poverty level were significantly less likely to do so (OR=0.85, 95% CI: 0.73-0.98). Patients in regions in the bottom quartile of education exhibited OR=0.67 (95% CI: 0.57-0.80) compared with the top quartile. Black race, education, and income factors were not associated with CT use. There were no significant interactions between race and education or income. Median-aged patients residing in the highest-quartile areas versus lowest for education had an estimated 6% higher absolute probability of advancing to CT. After controlling for poverty and education, black race conferred an additional 1% nonsignificant lower probability of advancing to CT over nonblacks. Treatment disparities between groups remained stable during 2000-2007. Conclusions: Education status was the strongest predictor of CT initiation in men with mPC. Poverty and black race also predicted lower CT use. Given that all men in this study were enrolled in Medicare, efforts and research to reduce treatment disparities may need to focus on health system needs serving low socioeconomic communities.