Large Urban Centers Research Articles

Integrating criticality concepts into road network disruption assessments for volcanic eruptions

Road networks in volcanically active regions can be exposed to various volcanic hazards from multiple volcanoes. Exposure assessments are often used in these environments to prioritise risk management and mitigation efforts towards volcanoes or hazards that present the greatest threat. Typically, road exposure has been assessed by quantifying the amount of road network affected by different hazards and/or hazard intensity. Whilst this approach is computationally efficient, it largely fails to consider the relative importance of road segments within the network (i.e., road criticality). However, road criticality is an important indicator of the disruption that may be caused by an eruption. In this work, we aim to integrate road criticality concepts to enhance typical volcanic eruption road exposure assessments into road disruption assessments. We use three key components to quantify disruption: a) road criticality, b) impact severity, and c) affected road quantity. Two case study eruptions: Merapi 2010 and Kelud 2014, both in Java, Indonesia, are used to demonstrate the usefulness of integrating road criticality into road disruption assessments from volcanic eruptions. We found that disruption of the road network from the Kelud 2014 case study was an order of magnitude greater than the Merapi 2010 case study. This is primarily driven by the more widely dispersed tephra fall from the Kelud 2014 event, which affected nearly 28% of Java’s road network length, compared to Merapi 2010, which affected 1.5%. We also identified potential disruption hotspots that were affected by both of these case study eruptions. At Merapi, roads that carry traffic directly away from the summit, those that cross major valleys, and the major Yogyakarta-Magelang highway were key disruption hotspots, which has implications for moving large volumes of traffic efficiently, such as in an evacuation. The Kelud case study highlighted the potential impacts of widespread tephra falls on socio-economic activity and connectivity of large urban centres. Our approach has been designed such that it can be applied entirely using open-sourced datasets. Therefore, the approach to integrating road criticality in this paper can be used, applied, and adapted to assess road network disruption at any volcano in the world.

Contrasts of urban development in Bauru city (SP): slum and fortified enclaves in Jardim Nicéia

The urban development of medium-sized cities in the interior of São Paulo state reproduced, to a large extent, the segregating logic of the Brazilian urbanization of large urban centers throughout the XX century. This paper analyzes the remarkable characteristics of the recent urbanization process in the city of Bauru (SP), relating them to the rise of precarious settlements in the form of the favela and the phenomenon of contemporary segregation in fortified enclaves. The object of analysis is the Jardim Nicéia slum, located between gated condominiums in the southern part of the city. The methodology used included a bibliographic review of theoretical and analytical references, research on demographic and socioeconomic data sources (IBGE, City Hall and municipal public agencies) and socio-spatial analysis of the area, in order to interpret how segregation is reproduced in this specific territorial area.

Do socially responsible higher education institutions contribute to sustainable regional growth and innovation?

Purpose This study aims to analyse the efficiency of public higher education institutions (HEIs) through teaching and learning (T&L), research and technology (R&T) and social responsibility (SR) activities. It also aims to assess the external factors influencing the efficiency of T&L, R&T and SR, and influence of this efficiency on sustainable regional economic growth and innovation intensity. Design/methodology/approach The empirical approach is based on a two-step data envelopment analysis to compare the efficiency of 23 Portuguese public HEIs, using a Tobit regression, to assess the influence of the factors affecting HEI efficiency which in turn affects regional sustainability and innovation. Findings The results lead to the following conclusions: HEIs with better SR efficiency are situated in large urban centres; an insular location is positively associated with HEIs’ T&L and SR efficiency; HEIs’ T&L and SR efficiency positively influence regional gross domestic product (GDP); and HEIs’ R&T efficiency positively influences R&D in regional GDP. Practical implications This study offers implications in the domain of sustainable regional growth. The study recommends that the policies of HEIs should concentrate on developing activities that meet the needs of the region. It also emphasizes the need to invest in recruitment of qualified lecturers and researchers, and creation of relevant PhD positions. The study also emphasizes the need for government actions to consider the most disadvantaged regions and create infrastructure to attract new companies and people. Originality/value This study contributes to the existing literature on the efficiency of HEIs by considering the efficiency of not only T&L and R&T but also SR. It also analyses the influencers of both HEIs’ efficiency and regional development.

Smart Cities and Urban Mobility for Innovation and Sustainability

This study is grounded in theories of degrowth and the circular economy. The general objective of this research leads to a thematic discussion of urban mobility in big cities that will suggest solutions for implementation in sustainable forms of technology which could transform metropolises into smart cities. As specific objectives, it seeks (1) to demonstrate the problem of urban mobility in large cities; (2) to address the global trend of changing unsustainable consumption habits into habits of minimal consumption, linked to Latouche's theory of degrowth and the circular economy; and (3) to interpret new trends in large urban centers with a focus on the smart city. As it happens, young millennials choose to enjoy goods, instead of owning them; with the availability of the Internet, people have started to interact with cities, exchanging information about traffic (congestion and public transport routes); they also access alternative modes of transport, such as the use of shared vehicles, bicycles, electric scooters and other modes that can be rented through apps. However, many companies which claim to offer sharing services in fact practice pseudo-sharing for the sake of profit. The methodology in this study was inductive in nature, using secondary sources, from qualitative bibliographic research starting from electronic searches of articles available in public domain pages, which allowed various publications on the chosen topic to be accessed for review. The result is an academic contribution to the public understanding of current conditions that may lead the elaboration of public policies for updated scenarios of smart cities to the benefit of residents.

Sociocultural Influences Contribute to Overeating and Unhealthy Eating: Creating and Maintaining an Obesogenic Social Environment in Indigenous Communities in Urban Fiji.

Pacific Island countries (PICs), such as Fiji, lead the world statistics in obesity and deaths caused by non-communicable diseases. The impacts of obesity overburden the healthcare system and social services and have major impacts on the Fijian economy. This study is the first of its kind to undertake an in-depth exploration of the determinants of the obesity epidemic in PICs by exploring the sociocultural influences and situations that impact nutrient transitions, overconsumption, and unhealthy eating in an urban indigenous community. In-depth qualitative interviews were conducted with 15 indigenous Fijian women from the largest urban center in Fiji who self-identified as gatekeepers of family meal planning, preparing, and shopping for groceries, fruits, and vegetables. The women identified several cultural norms and expectations of both the individuals providing the food and the individuals consuming the food that create and maintain an obesogenic social environment. Moreover, participants also shared a misplaced value on meat, energy-dense foods, junk food, and fast foods that further contribute to unhealthy eating and overeating within this urban indigenous community. These novel findings highlight the importance of considering sociocultural influences on unhealthy eating and overeating and may be used to assist decision-makers in developing contextualized obesity prevention strategies and health messaging to target obesity in this community.

City puzzles: Does urban land scape affect genetic population structure in Aedes aegypti?

Cities usually offer a suitable environment for the dengue vector Aedes aegypti, providing oviposition sites, accessibility to human hosts and nectar meals. However, large urban centres are highly heterogeneous environments, forming a patched landscape that could affect Ae. aegypti population dynamics and dispersal. Here, we performed a genome-wide analysis using Rad-seq data from 99 Ae. aegypti specimens collected in three areas within Buenos Aires city with varying levels of urbanization/land use: highly urbanized Area 1, intermediate Area 2 and poorly urbanized Area 3. We found an inverse association between urbanization levels and spatial genetic structure. Populations from highly urbanized Area 1 did not present genetic structure whereas two and three clusters were detected in Areas 2 and 3, respectively. In the case of Area 3, initial analyses showed separation in clusters was mostly due to elevated consanguinity within sites although three clusters were still detected after closely related individuals were discarded. Mosquitoes around each site displayed a high degree of isolation, evidencing a close dependence between the vector and human dwellings. Interestingly, specimens from distant boroughs (within the limits of the city) and the city’s outskirts formed a single cluster with inner city sites (Area 1), highlighting the role of passive transport in shaping population structure. Genetic distances were poorly correlated with geographic distances in Buenos Aires, suggesting a stronger influence of passive than active dispersal on population structure. Only Area 2 displayed a significant isolation-by-distance pattern (p = 0.046), with males dispersing more than females (p = 0.004 and p = 0.016, respectively). Kinship analyses allowed us to detect full-siblings located 1.5 km apart in Area 1, which could be due to an extreme event of active female dispersal. Effective population size was higher in Area 2 confirming that cemeteries represent highly favourable environments for Ae. aegypti and need to be specifically targeted. Our results suggest that control programs should take into account urban landscape heterogeneity in order to improve vector control.

Unfolding time, race and class inequalities to access leisure

The access to leisure activities is an important element to understand the potential participation and integration of individuals in the society. Despite its importance, urban planners in large urban centers in developing countries seek to prioritize access to mandatory activities. This study quantifies the accessibility to leisure and its inequalities in the municipality of São Paulo, considering the opening hours of leisure opportunities and racial and class population groups. Tracking data from buses and TomTom speed profile were used in the public and the private transport networks, respectively, to analyze and compare accessibility to parks and cultural equipment. A multitemporal analysis was performed to better understand the fluctuation of accessibility to leisure through different hours considering the opening hours of parks and cultural equipment. The population was stratified into four groups according to race and class (higher black, higher white, lower black, and lower white) to perform accessibility inequalities analysis. Results show that accessibility to leisure is higher for private transport users, it decreases from the central to the peripheral areas, and it changes significantly during the day due to traffic conditions, transit supply, and leisure opportunities opening hours. The Lorenz curves, Gini, and the Palma coefficients showed a highly unequal level of accessibility to leisure for different population groups, with the low-black population having the lowest level of leisure accessibility. Our findings may support policy makers in designing strategies to provide more spatial equity in the access to leisure opportunities.

A Regional Command Center for Pandemic Surge

The COVID-19 pandemic has challenged the health system but has provided opportunities for improvement. Affected regions have experienced an unprecedented shortage in ICU beds and qualified staff, therefore requiring the transfer of patients.1 Regions far away from large urban centers are more likely to be overwhelmed because of fewer resources.2 A guideline and consensus statement recently published in Chest by Dichter et al3 has proposed as a strategy to face new mass critical surge response that the load could be balanced across regions before the hospitals are overwhelmed and the standard routine affected.

Adolescent medicine subspecialty workforce: Insights from Canada.

Adolescent Medicine (AM) in Canada has undergone significant growth since being accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) in May 2007. A deeper understanding of the workforce is needed in order to identify current gaps, to improve clinical care and scholarly endeavors, and to inform future developments. This is the first AM workforce survey administered in Canada and included 39 multiple-choice and 3 open-ended questions. Descriptive statistics were calculated, and thematic analysis was used for open-ended questions. We identified 62 AM specialists from across Canada. The overall response was 97% (60/62). Most AM specialists were women (39/53, 74%), Caucasian (38/53, 72%), between 30 and 39 years old (22/53, 42%), and completed their subspecialty training in either Toronto (24/48, 50%) or Montreal (12/48, 25%). Nearly half of participants worked in either the Toronto, Ontario (13/49, 27%) or Montreal, Quebec (10/49, 20%). Nearly all participants (46/49, 94%) practiced in large urban population centres and were based in academic health science centres. The primary clinical areas of focus included eating disorders (25/51, 49%) and mental health (9/51, 18%). Almost all participants were satisfied with their career choice (41/50, 82%). Two-thirds of the participants (31/48, 65%) believed that there was an insufficient number of AM specialists in Canada. Highlighting current characteristics of the AM subspecialty will help government and academic policymakers in understanding the workforce available to care for Canadian adolescents and the need to develop training programs and policies to address gaps and shortages.

Asset-Based, Sustainable Local Economic Development: Using Community Participation to Improve Quality of Life Across Rural, Small-Town, and Urban Communities

We analyze survey data from 5,487 residents of 85 Texas communities, including rural communities, small towns, medium-sized cities, and the five largest urban centers, to model the influence of the degree of urbanity and rurality of a community as well as residents’ social position, values, and their satisfaction with local assets. The paper’s central argument is that a wide range of factors impact how community members think about their needs and thus should be considered in any community development process. This human-centered approach looks at how community specific factors impact economic and quality-of-life development project preferences in support of adapting community development decision-making processes according to the context of each community. For the sake of parsimony, this paper presents results for three community development project concepts: (1) renovating some downtown buildings as mixed-use facilities with retail shops and apartments, (2) opening a community health center, and (3) deploying gigabit high-speed fiber broadband internet in the downtown area. Our findings specifically highlight areas where participatory processes can be introduced to guide further interactions between experts and community members to (1) identify groups in the community to bring into the process who may be most impacted by the choice of one intervention over another, and (2) target areas where further community discussion and deliberation is necessary around which community dialogues (round tables, town halls, workshops, etc.) could be facilitated.

Group social intervention by social workers: Challenges and issues

ABSTRACT Social work with groups is one of the social work intervention methods, and describes an approach directed at individuals, families, and communities. Most articles discussing this intervention method result from research conducted in larger urban centers. This research is based on the training and needs of social workers doing group work; specifically, qualitative research on social workers practising group intervention work in northern Quebec (Canada). The results indicate social workers’ satisfaction with training that simultaneously integrates practical work and group theory in a university setting. Group intervention work in rural areas has certain advantages over social work in large urban centers (sharing and understanding of a shared reality, breaking down isolation barriers), but social workers also have to face certain challenges specific to their region, such as confidentiality, a lack of public transit for users, and the lack of importance placed by the health network on this type of intervention work.

Association of genetic variants and survival in patients with acute myeloid leukemia in rural Appalachia.

e19022 Background: Many previous population health studies examining adults with acute myeloid leukemia (AML) are derived from national databases within large urban centers. To address the concern of under-representation of rural Appalachian population in cancer genomic databases, we performed exploratory whole exome sequencing in patients with newly diagnosed AML. As the only stem cell transplantation center in the state, WVU is uniquely situated to capture most of these patients from the state and surrounding area. Due to its unique industry and environmental exposures, we hypothesized that WV may have both different rates of mutations and differing outcomes than the nation as a whole. Methods: We performed whole exome sequencing on 26 patients with newly diagnosed AML from paired bone marrow and buccal samples that were obtained from 2015 to 2017. Whole exome sequencing libraries were prepared using Agilent SureSelect Human Whole Exome technology. The libraries were sequenced on an Illumina HiSeq1500 sequencer using paired end runs. Correlations between genetic variants and clinical outcome variables were examined via retrospective chart review. Variables measured included association between biomarker data and progression-free survival (PFS) and overall survival (OS). Results: Median patient age was 68 years and women represented 10 of the patients (37%). Twenty-one patients had de novo AML (84%), 3 patients had preceding MDS (12%), and 1 patient had therapy-related AML (4%). As per ELN criteria, 8 patients were favorable (32%), 12 were intermediate (48%), and 5 were adverse risk (20%). Eight patients proceeded to transplant with the following donors: 4 MUD (50%), DUCB (37.5%), and 1 haploidentical (12.5%). The median PFS and OS were 16.5 months and 26.6 months, respectively. Tobacco use was the largest known exposure with 7 patients. We noted a similar mutational trend compared to national TCGA data, except for an increased tumor mutation burden and higher frequency of the following mutations as seen in Table. Neither MUC3A or MUC5AC were identified in the TCGA database. Of our five patients with BCOR mutations, two had a co-existing FLT3-ITD mutation, one of which also had a NPM1 mutation. Two patients had secondary AML, while the other 3 had de novo disease. The median OS was 63 days. While not statistically significant, BCOR mutation was trending toward a poor prognostic indicator.Conclusions: Despite our small patient cohort, the findings provide further assessment of predisposing detrimental mutations in AML in the Appalachian region and associated survival outcomes.[Table: see text]

Catalytic Systems in the Reduction of Nitrogen Oxide Emissions in Diesel-Powered Trucks

In recent years, the number of motor vehicles in circulation has increased in proportion to Brazil’s economic growth, resulting in an increase in emissions of toxic gases from combustion, such as nitrogen oxide, particulate matter, carbon dioxide and volatile organic compounds, among other polluting compounds. This type of pollution has its impacts potentiated in large cities, accumulating due to the configuration of streets and buildings in large urban centers, and can even penetrate indoor environments, having harmful effects on the health of residents. To minimize the emission of these gases, catalytic converters can be used in the vehicle exhausts. Catalytic converters are a promising technology used to reduce exhaust emissions from the engine. In this context, this paper presents an overview of the emission of toxic gases by heavy transport powered by diesel oil and the influence of the use of automotive catalysts in reducing the emission of toxic gases. Additionally, a proposal for monitoring the useful life of automotive catalysts is presented through an electronic sensing system, which makes it possible to determine the catalyst efficiency and the appropriate point for its reactivation or replacement.

Classification of poviats in terms of the degree of development of their tourist function

The development of a tourist function, which is one of the factors of local development in Poland, varies from region to region. The aim of the article is to determine the optimal method for dividing Polish poviats in terms of the degree of development of their tourism function. The study draws upon the division of gminas (the smallest administrative units in Poland) into five classes, proposed by Jadwiga Warszyńska in 1985. The classification of poviats in this study was performed on the basis of the values of four tourist function indicators: Baretje-Defert’s index, the density of accommodation index, the Schneider index and Defert’s index. Threshold values determined for these indicators, which define a fullydeveloped tourism function of a poviat, made it possible to distinguish the fifth class. The remaining four classes were determined by dividing the values of the considered indicators below the threshold value. To this end, various methods of the selection of the class intervals have been used, including the Jenks, the geometric progress, the k-means, and the head-tail method. The precision of the obtained class intervals was compared using the GVF (Goodness of Variance Fit) and TAI (Tabular Accuracy Index) indicators. The selection of the optimal division allowed the performance of the classification of poviats in terms of the degree of development of their tourist function. The obtained results were illustrated on the example of data for 2019. The study used data on Polish poviats for 2002–2019 from the Local Data Bank of Statistics Poland. The analysis demonstrated that the poviats with the highest degree of development of the tourist function were the least numerous group and constituted 6.3% of all Polish poviats. Poviats located in the western and the central part of the Polish sea coast comprised half of this group, while the rest were large urban centers and poviats located in the Bieszczady, Tatra and the Karkonosze Mountains as well as in the Polish Lake District (Mazury).

Addiction in the family: Two Indigenous families overcoming barriers to opioid agonist therapy.

Every day, Indigenous people in Canada leave their communities to access health care services[1][1]—the norm for all people living outside of large urban centres, owing to hospital closures and a centralizing of services all across Canada. For Indigenous peoples—especially those who live on

The bias in estimating accessibility inequalities using gravity-based metrics

Accessibility measures have been extensively used to explore the outcomes of the spatial distribution of transport, jobs, and population groups in cities. Despite its wide use, identifying the population groups that most benefit from accessibility is not straightforward and different metrics might result in different conclusions. The present work aims to analyze the potential bias of using gravity-based measures based on revealed mobilities to identify job accessibility inequalities. By looking at two large and very different regions, the municipality of São Paulo (SP) and the Greater London Area (GLA), we argue that distance decay functions built from current trip behaviors should be carefully used in evaluations of accessibility inequalities because it may underestimate disparities between socio-occupational groups and also result in a misleading interpretation of impedance factors. Two distinct approaches were implemented to support those claims. We first estimate group-specific distance decay functions, considering only travel time. Secondly, we consider both travel time and travel cost relative to income to estimate zone-specific and city-specific distance decay functions for each one of the study areas. The population of both cases studies was stratified according to the NS-SEC standard to select the highest and the lowest socio-occupational groups and to explore job accessibility inequalities. It was found that higher-level and lower-level socio-occupational groups of SP and GLA present striking differences in terms of travel times and relative travel costs, with SP being more unequal. By applying the distance decay function of the lowest level socio-occupational group to the calculations of the job accessibility of the highest level group, and by adding travel cost to the analysis, we highlight inconsistencies between gravity-based accessibility calculations and theory, as trips taken by different groups can be mistakenly associated with willingness to travel. From a policy perspective, our findings emphasize that accessibility inequalities in large urban centers, especially in the Global South, can be underestimated if revealed mobilities are considered to represent the willingness to travel and by not taking into account the relative cost of travel.

Profile and Migration of Members of Residency Programs in Family Medicine.

ABSTRACTOBJECTIVE To describe the sociodemographic profile and analyze the migratory characteristics of the members of the Residency Programs in Family Medicine in 2020 in Brazil.METHODS The study follows a cross-sectional observational design of a quantitative nature from the perspective of the members of the Residency Programs in Family Medicine. Questionnaires adapted for each participating group were developed, applied through an online platform.RESULTS Most participants are female and white. Most supervisors and preceptors were residents of Residency Programs in Family Medicine, however, there are some who are not specialists in the field. Most participants are based in capitals or metropolitan regions. In relation to retention, 41.1% of supervisors and 73.1% of preceptors are affiliated to a program in the same municipality where they lived. For most resident physicians, the place of residence coincides with the place of birth and/or graduation (57.4%), and 48.5% are in the same place of graduation.CONCLUSIONS The research reinforces the need for policies to promote the migration of residents to Residency Programs in Family Medicine outside capital cities and metropolitan regions, as well as encouraging the retention of graduates trained outside large urban centers so that they can contribute to distribution and provision of doctors where they are still needed.

Epidemiological and Clinical Characteristics of Acute Dengue Virus Infections Detected through Acute Febrile Illness Surveillance, Belize 2020.

The Acute Febrile Illness (AFI) Surveillance Network in Belize is a country-wide active surveillance program aimed at diagnosing vector-borne, respiratory, and enteric pathogens among patients presenting to 11 participating hospitals and clinics with new onset fever. This study describes the epidemiology of dengue virus (DENV) infections in Belize diagnosed through AFI surveillance in 2020. Of the 894 patients enrolled and PCR-tested for DENV in this period, 44 DENV-positive cases (5%) were identified. All four DENV serotypes were detected, with two cases testing positive for DENV serotype 4, which is the first report of this serotype in Belize since 2004. The majority of DENV cases (66%) were diagnosed in the Belize District, which contains the largest urban center in the country (Belize City). Positive cases were detected between January 2020 and September 2020, with the majority (89%) diagnosed during the dry season between January and April, unlike years prior when cases were more often diagnosed during the wet season. Clinical signs and symptoms varied slightly between DENV serotypes. Active surveillance of DENV among AFI cases provides insight into the epidemiologic and clinical characteristics of DENV in Belize. This information is important for informing public health interventions to mitigate DENV transmission.

Traffic Simulation with Open-Source and Commercial Traffic Microsimulators: A Case Study

The analysis of traffic problems in large urban centers often requires the use of computational tools, which give the possibility to make a more detailed analysis of the issue, suggest solutions, predict behaviors and, above all, support efficient decision-making. Transport microsimulation software programs are a handy set of tools for this type of analysis. This research paper shows a case study where functions and limitations of Aimsun version 8.2.0, a commercial-like European software and Sumo version 1.3.1, a European open-source software, are presented. The input and output data are similar in both software and the interpretation of results is quite intuitive for both, as well. However, Aimsun's graphical interface interprets results more user-friendly, because Sumo is an open-access software presented as an effective alternative tool for transport modeling.

Strategies for Improving Access to Cancer Services in Rural Communities: A Pre-implementation Study.

Implementation science is defined as the scientific study of methods and strategies that facilitate the uptake of evidence-based practice into regular use by practitioners. Failure of implementation is more common in resource-limited settings and may contribute to health disparities between rural and urban communities. In this pre-implementation study, we aimed to (1) evaluate barriers and facilitators for implementation of guideline-concordant healthcare services for cancer patients in rural communities in Upstate New York and (2) identify key strategies for successful implementation of cancer services and supportive programs in resource-poor settings. The mixed methods study was guided by the Consolidated Framework for Implementation Research (CFIR). Using engagement approaches from Community-Based Participatory Research, we collected qualitative and quantitative data to assess barriers and facilitators to implementation of rural cancer survivorship services (three focus groups, n = 43, survey n = 120). Information was collected using both in-person and web-based approaches and assessed attitude and preferences for various models of cancer care organization and delivery in rural communities. Stakeholders included cancer survivors, their families and caregivers, local public services administrators, health providers, and allied health-care professionals from rural and remote communities in Upstate New York. Data was analyzed using grounded theory. Responders reported preferences for cross-region team-based cancer care delivery and emphasized the importance of connecting local providers with cancer care networks and multidisciplinary teams at large urban cancer centers. The main reported barriers to rural cancer program implementation included regional variation in infrastructure and services delivery practices, inadequate number of providers/specialists, lack of integration among oncology, primary care and supportive services within the regions, and misalignment between clinical guideline recommendations and current reimbursement policies. Our findings revealed a unique combination of community, socio-economic, financial, and workforce barriers to implementation of guideline-concordant healthcare services for cancer patients in rural communities. One strategy to overcome these barriers is to improve provider cross-region collaboration and care coordination by means of teamwork and facilitation. Augmenting implementation framework with provider team-building strategies across and within regions could improve rural provider confidence and performance, minimize chances of implementation failure, and improve continuity of care for cancer patients living in rural areas.