Large Urban City Research Articles

Roof Shape Classification from LiDAR and Satellite Image Data Fusion Using Supervised Learning.

Geographic information systems (GIS) provide accurate maps of terrain, roads, waterways, and building footprints and heights. Aircraft, particularly small unmanned aircraft systems (UAS), can exploit this and additional information such as building roof structure to improve navigation accuracy and safely perform contingency landings particularly in urban regions. However, building roof structure is not fully provided in maps. This paper proposes a method to automatically label building roof shape from publicly available GIS data. Satellite imagery and airborne LiDAR data are processed and manually labeled to create a diverse annotated roof image dataset for small to large urban cities. Multiple convolutional neural network (CNN) architectures are trained and tested, with the best performing networks providing a condensed feature set for support vector machine and decision tree classifiers. Satellite image and LiDAR data fusion is shown to provide greater classification accuracy than using either data type alone. Model confidence thresholds are adjusted leading to significant increases in models precision. Networks trained from roof data in Witten, Germany and Manhattan (New York City) are evaluated on independent data from these cities and Ann Arbor, Michigan.

“People like us”: spatialised notions of health, stigma, power and subjectivity among women in street sex work

Most spatially-oriented studies about health, safety and service provision among women in street sex work have taken place in large urban cities and document how the socio-legal and moral surveillance of geographical spaces constrain their daily movements and compromise their ability to care for themselves. Designed to contribute new knowledge about the broader socio-cultural and environmental landscape of sex work in smaller urban centres, we conducted qualitative interviews and social mapping activities with thirty-three women working in a medium-sized Canadian city. Our findings demonstrate a socio-spatial convergence regarding service provision, violence, and stigma, which is common in sex trading spaces that double as service landscapes for poor populations. Women in this study employ unique agential strategies to navigate these competing forces, many of which draw upon the multivalent uses of different urban spaces to optimise service access, reduce the propensity for violence, and manage their health with dignity. Their use of the spatialised term ‘everywhere’ as an idiom of distress regarding issues of power, agency and their desire to take part in wider civic discourse are also explored. These data contribute new insights about spatialised notions of health, stigma, agency, and subjectivity among women in sex work and how they manage ‘risky’ environments.

The Incidence of Inflammatory Bowel Disease in Chicago Over an 18-Year Period

Introduction: The prevalence of inflammatory bowel disease (IBD) is highest in North America and Europe, and the incidence has been increasing over time1.In North America,studies of epidemiology in IBD have been limited and there are no epidemiological studies in a large urban city such as Chicago. The aims of our study are to determine the incidence of IBD in Chicago, and to assess changes in the incidence over time. Methods: We identified patients 18 years or older who had been seen at the University of Chicago Medicine (UCM) from Jan 1, 2000 to Sept 20, 2017. We used a unique database, the Clinical Data Research Warehouse, which includes all patients who have had any prior encounter at UCM. The database was queried for patients without a prior diagnosis of IBD for at least 6 months, and who were subsequently diagnosed with IBD at 2 separate encounters. Incidence was calculated by the number of new IBD cases, divided by the total number of cases in the study period, multiplied by 100,000 person-yrs. Medians were used to characterize age and time to diagnosis. Results: 1055 incident cases of IBD (548 CD, 507 UC) were identified. 578 were women, 388 black, 565 white, and 24 Asian/Pacific Islander. The median age at diagnosis was 37 (IQR 26-55). The median lag time from first encounter at UCM to diagnosis was 26 months (IQR 11-62). The median lag time was longer for black patients (46 months, IQR 18-88) in comparison to white patients (17months, IQR 9-44). The overall crude incidence rate of IBD was 117/100,000 person yrs. The highest incidence was in the 20-29 and the 30-39 age groups (27.8/100,000 and 22.1/100,000 person-yrs). The incidence rate for females and men was 64/100,000 and 53/100,000 person-yrs respectively. The incidence rate for blacks was 43/100,000 person-yrs, and whites was 63/100,000 person-yrs. From the period of Jan 1, 2000 to Dec 31, 2008 the incidence was 57.9/100,000 person yrs. Subsequently, from Jan 1, 2009 to Sept 20, 2017, the incidence was 59.3/100,000 person yrs. Conclusion: To our knowledge, this is the first study that looks at the incidence of IBD in a large, ethnically diverse, urban setting in North America. We found no change in the incidence of IBD over time. However, the lag time to diagnosis was longer in blacks than in whites. Further understanding of differences in clinical presentation and approach to diagnosis by providers is needed.

From State Policy to School Practices: Accessibility and Implementation of Teen Dating Violence Awareness Education

Currently, 22 states legally require or urge schools to include teen dating violence (TDV) awareness education; yet, little research has examined how school districts are interpreting and implementing these policies. In a state that mandates such education for parents and children, and within a large urban city serving primary Hispanic youth, the present article assessed the types of TDV awareness education being provided in public schools, including the accessibility of this information. Specifically, we contacted independent school districts (ISDs; N= 10, serving over 15,000 youth) directly to assess whether and which TDV education programs were being implemented. We also assessed whether awareness education was being disseminated via school websites in the form of a policy on TDV, as well as whether additional information pertaining to TDV (e.g., resources, programs) was available. Results are discussed, highlighting the need for use of evidence-based programming, awareness accessibility, and culturally appropriate materials for Hispanic parents and youth.

Stakeholder Perspectives on the Social Determinants of Mental Health in Community Coalitions.

Although evidence supports the potential for community coalitions to positively address social determinants of mental health, little is known about the views of stakeholders involved in such efforts. This study sought to understand county leaders' perspectives about social determinants related to the Health Neighborhood Initiative (HNI), a new county effort to support community coalitions. Descriptive, qualitative study, 2014. Community coalitions, located in a large urban city, across eight service planning areas, that serve under-resourced, ethnic minority populations. We conducted key informant interviews with 49 health care and community leaders to understand their perspectives about the HNI. As part of a larger project, this study focused on leaders' views about social determinants of health related to the HNI. All interviews were audio-recorded and transcribed. An inductive approach to coding was used, with text segments grouped by social determinant categories. County leaders described multiple social determinants of mental health that were relevant to the HNI community coalitions: housing and safety, community violence, and employment and education. Leaders discussed how social determinants were interconnected with each other and the need for efforts to address multiple social determinants simultaneously to effectively improve mental health. Community coalitions have an opportunity to address multiple social determinants of health to meet social and mental health needs of low-resourced communities. Future research should examine how community coalitions, like those in the HNI, can actively engage with community members to identify needs and then deliver evidence-based care.

Impact and Ratio of Lead in Ambient Air from Vehicular Emission in Quetta Valley, Pakistan.

Air pollution is the fourth leading fatal health risk factor consider worldwide, resulting in 4.8 million premature deaths in 2013. Lead in Ambient Air remains a serious problem in many developing and industrializing countries, as well as in some developed countries. Toxic effects of lead is affecting many people especially in motorized, urban environments. Pakistan is the most urbanized country in South Asia and deteriorating Ambient Air conditions particularly in large urban cities are damaging the people’s health and quality of life and contributes to environmental degradation. Monitoring of Air Pollution was conducted in Quetta Valley. The seasonal Annual average concentration of Lead in Ambient Air was calculated. The ratio of vehicular emission from exhaust pipe of vehicles was also calculated in Ambient Air. The results were compared with the WHO standards and found four times higher than WHO Standard i.e. 0.5-1 μg. The concentration was found higher in spring and found lower in summer. The results were compare with the major cities of world and within Pakistan. The paper also highlighted the impacts of Lead pollution in Quetta Valley.

Emotions in Charter School Teaching: Three Stories From Year One

The purpose of this paper is to illuminate the experiences of two recent graduates from an undergraduate initial certification educator preparation program (EPP) who began their first year working for a charter school in a large urban city. Their background in the constructivist-oriented EPP contrasts sharply with the philosophy and instructional practices of the charter school. The extreme nature of this particular context sheds light on the teacher induction process and raises questions about enhancing new teachers’ adaptive capacities and emotional resilience to work through professional dissonance in the first years. These stories suggest that new teachers may benefit from additional training in communication skills and emotion management in the navigation of school workplace dilemmas.

Prevalence of pathogenic and non-pathogenic intestinal parasites in pregnant women living in poverty and social inequality

Background Intestinal parasitism in large urban cities is an ongoing public health challenge. Although most epidemiological studies were concentrating on children, there is an ongoing concern that adult vulnerable populations are prone to protozoal and helminthic pathogenic infestations. In pregnant women living in social inequality settings, this is particularly important as it may affect their overall health and that of their offspring. Methods We investigated the prevalence of intestinal parasitic infections in pregnant women in three districts of Bogota, the largest city in Colombia. We undertook a cross-sectional study including questionnaires on sociodemographic factors and living conditions, in addition to home visits. By examination of stool samples, we determined the prevalence of intestinal parasites, including protozoa and helminths that are pathogenic and of debated pathogenicity. The presence of microorganisms was detected by multiple approaches including direct smears, concentration techniques, double stool sampling and/or qPCR techniques. Five hundred and fifty pregnant women from low-income urban areas participated in this study by answering the questionnaire, with 331 providing in addition a stool sample, 98 of them providing two stool samples, and 48 of them being prospectively analyzed for the presence of protozoal and helminthic parasites with quantitative PCR. Results The findings revealed an overall 41.4% prevalence of intestinal parasites, with an unexpected 40.5% predominance of protozoa that are considered non-pathogenic and/or of debated pathogenicity, with Blastocystis hominis as the most prevalent parasite (25.1%). The low prevalence of pathogenic parasites was confirmed with all techniques. Double sampling and qPCR showed highest diagnostic capacity. Sociodemographic, pregnancy and living conditions analyses in women infected with any parasite revealed associations with civil status (higher parasites in married women or those living with someone, P Conclusions This is the first study focused on pregnant women in Bogota, the largest city in Colombia that estimates the prevalence and factors associated with intestinal parasitism in vulnerable populations living in conditions of poverty and social inequality. Although a low prevalence of pathogenic parasites was found in pregnant women, a high prevalence of parasites with disputed pathogenicity was revealed. In Bogota, the good quality of water for human consumption, open availability of broad-spectrum anti-parasitic drugs, better educational level and appropriate sanitary facilities play an important role in the prevention of pathogenic parasitic infections. However, the high prevalence of non-pathogenic parasites indicates that fecal-oral contamination continues in these communities. Accordingly, public health services should emphasize education campaigns to prevent these contamination routes, particularly in women belonging to minority groups, those without water sinks and who have not been dewormed recently. Additionally, public health services could take into account the findings that double stool sampling may increase diagnostic capacity in these populations, a cost-effective strategy in middle income countries like Colombia.

Effects of Fish Oil on HIV-Related Inflammation and Markers of Immunosenescence: A Randomized Clinical Trial.

Objective: To explore the safety and efficacy of fish oil to modulate parameters of inflammation and immunosenescence in HIV-infected older adults.Design: This study uses a randomized, controlled, double-blind clinical trial.Setting: The study was conducted in an outpatient HIV/AIDS clinic in a large urban Midwestern city in the United States.Subjects: A total of 37 clinically stable HIV-infected adults between the ages of 40 and 70 years of age participated.Interventions: Fish oil 1.6 g/day was administered for 12 weeks or placebo.Outcome measures: Inflammatory cytokine production, surface markers of immunosenescence, and adverse events were measured.Results: After 12 weeks of supplementation, there were no significant differences between the treatment and control groups on any measures of inflammation or immunosenescence in both CD4+ and CD8+ T lymphocytes. More participants in the treatment group reported adverse gastrointestinal events compared with the control group.Conclusions: A 12-week supplementation regimen of 1.6 g/day of fish oil did not favorably modulate parameters of inflammation or immune senescence in HIV-infected adults. Future studies should test agents that directly target mechanisms that underlie HIV-related inflammation to determine whether reducing inflammation can reverse immunosenescence.

Racial/ethnic minority segregation and low birth weight in five North American cities

ABSTRACT Comparisons of communities across cities are rare in social epidemiology. Our prior work exploring racial/ethnic segregation and the prevalence of low birth weight (LBW) in communities from two large urban cities showed a strong relationship in Chicago and a very weak relationship in Toronto. This study extends that work by examining the association between racial/ethnic minority segregation and LBW in total of 307 communities in five North American cities: Baltimore, Boston, Chicago, Philadelphia, and Toronto. We used Pearson correlation coefficients and OLS regression models to examine potential variability in the association between racial/ethnic minority segregation and LBW, controlling for community-level unemployment. In a combined model with community-level data from all cities, a 10% increase in minority composition is associated with a 0.7% increase in LBW. While racial/ethnic minority segregation and unemployment are not associated with LBW in Toronto, these social determinants have strong and significant associations with LBW across communities in the four US cities in the analysis. Subsequent models revealed opposite effects for percentage non-Hispanic Black and percentage Hispanic. Across communities in the US cities in this analysis, there is considerable similarity in the strength of the effect of racial/ethnic segregation on LBW. Future work should incorporate communities from additional cities, looking to identify community assets and public policies that allow some minority communities to thrive, while other minority communities suffer from a high prevalence of LBW. More work is also needed on the generalizability of these patterns to other health outcomes.

Engaging in Literacy: Latino Families Speak Up

Family engagement has long been evidenced to contribute to successful educational outcomes. In this qualitative study, we examined the language and literacy perspectives of Latino families of young children. A total of 17 participants who each represented a Latino family from a large urban city participated in focus group interviews. Interviews were analyzed using qualitative methodology. The major themes that emerged from the conversations related to how families define literacy, what literacy looks like in their home, the messages schools give families about literacy, and literacy activities parents would like for schools to promote.

Palliative Care Training and Decision-Making for Patients with Advanced Cancer: A Comparison of Surgeons and Medical Physicians

BackgroundSurgical decision-making in patients with advanced cancer requires careful thought and deliberation to balance the high risks with the potential palliative benefits. We sought to compare surgical decision-making and palliative care training among surgeons and medical physicians who commonly treat advanced cancer patients. We hypothesized that surgeons will report less palliative care training compared with medical physicians, and deficits in palliative care training will be associated with more aggressive treatment recommendations in clinical scenarios of advanced cancer patients with symptomatic surgical conditions. Study DesignPracticing surgeons, medical oncologists, intensivists, and palliative care physicians from a large urban city and its surrounding areas were surveyed with a 32-item questionnaire consisting of a survey addressing palliative care training and 4 clinical vignettes depicting patients with advanced cancer and symptomatic surgical conditions. ResultsOf the 299 physicians surveyed, 102 responded (response rate 34.1%). Surgeons reported fewer hours of palliative care training during residency, fellowship, and continuing medical education combined (median 10, IQR 2-15) compared with medical oncologists (median 30, IQR 20-80) and medical intensivists (median 50 IQR 30-100), P < .05. Additionally, 20% of surgeons reported no history of any palliative care training. Analysis of physician recommendations for treatment of the 4 clinical vignettes showed minimal consensus regardless of physician specialty. Absence of palliative care training was associated with recommending major operative intervention more frequently compared with physicians with ≥40 hours of palliative care training (0.7 ± 0.7 vs 1.6 ± 0.8, P =.01). ConclusionSubstantial deficiencies in palliative care training persist among surgeons and are associated with more aggressive recommendations for treatment for the selected scenarios presented in patients with advanced cancer. These findings highlight the need for greater efforts systemwide in palliative care education among surgeons, including incorporation of a structured palliative care training curriculum in graduate and continuing surgical education.

Draining Setons as Definitive Management of Fistula-in-Ano.

The ideal management for fistula-in-ano would resolve the disease while preserving anal continence. The purpose of this study was to determine the efficacy of draining seton alone in achieving resolution or significant amelioration of symptoms for patients with fistula-in-ano. This was a retrospective case series involving chart review and telephone interviews. A single colorectal surgeon performed surgeries between June 1, 2005, and June 30, 2014. The study was conducted by a single surgeon in a large urban city. Patient ≥18 years of age presenting with fistula-in-ano of cryptoglandular origin were included. Resolution of symptoms or significant symptom improvement requiring no additional surgical management and rate of recurrence were measured. A total of 76 patients (53 men) met the inclusion criteria. Mean age was 45 years (range, 19-73 y). The average time to seton removal was 36.6 weeks (range, 6.0-188.0 wk). Mean follow-up was 63 months (range, 7-121 mo). Fifty-seven patients (75%) were reached for telephone interview. Fifty-six patients (73.7%) had complete symptom resolution, and 14 (18.4%) had significant amelioration of symptoms with no additional surgical management required. Six (7.9%) had persistent severe symptoms. Five (7.1%) had a recurrence after seton removal. Rates of symptom resolution and recurrence were similar between patients whose setons were removed before or after 26 weeks (median time of seton removal) from the time of placement. Twenty-one patients (27.6%) required 1 or more additional operative procedures before planned seton removal to unroof a collection and/or replace the seton, and this represented the most significant risk factor for failure of resolution or improvement or recurrence (relative risk = 7.0). This study was retrospective and represents a single surgeon experience. Placement of draining seton alone is a viable treatment option for definitive symptomatic management of fistula-in-ano. Because draining setons are sphincter and function preserving, their use should be considered as primary management for fistula-in-ano. See Video Abstract at http://links.lww.com/DCR/A552.

Sorting retail locations in a large urban city by using ELECTRE TRI-C and trapezoidal fuzzy numbers

Selection of a retail location is a strategic decision-making problem that involves the long-term commitment of resources. However, very often managers look for several candidate locations that can be incorporated in a business plan. In this article, a case study developed in a large Brazilian company is presented where managers required to identify a set of interesting locations in a context of imprecise and qualitative information. ELECTRE TRI-C is applied, a multi-criteria decision analysis sorting method in which representative reference alternatives are used to model preference ordered categories, a priori. Trapezoidal fuzzy numbers (TrFNs) are used as input in ELECTRE TRI-C, which allows: (1) imprecision and uncertainty parameters to be set in a very transparent way; (2) in the case of qualitative criteria, to define a category by providing information about reference alternatives in the form of the membership degree of verbal values, a feature that was not available so far in this method; (3) the outranking indices to be calculated such that the rationale of assignment rules is preserved; (4) the proliferation of fuzzy numbers to evaluate alternatives to be avoided, thus reducing the cognitive effort of the decision maker. TrFNs obtained in a previous analysis are used in the case study, thereby showing the advantages of the approach.

Parental Depression and Cooperative Coparenting: A Longitudinal and Dyadic Approach.

To examine the relationship between parental depression and cooperative coparenting among couples over the first 5 years after a birth. Previous research has considered how depression affects coparenting but has not focused on the association as a longitudinal and dyadic process. Understanding coparenting is important as it is linked to parents' and children's well-being. Data from the Fragile Families and Child Wellbeing (FFCW) study were analyzed using actor-partner interdependence models. The FFCW follows families and their children as part of a birth cohort of children who were born in large urban cities of the United States in the late 1990s. The actor-partner interdependence models indicated that (a) parents' depression is associated with decreased coparenting perceptions for both mothers and fathers, and the effects endure over time; (b) fathers' depression was also associated with mothers' perceptions of cooperative coparenting over the later years; and (c) differences between mothers and fathers emerged only during the early years, with the effect of depression on coparenting being larger for fathers than mothers. The results not only highlight the importance of both parents' mental health on coparenting but also the added role that fathers' depression plays in shaping their own and their partners' perceptions of coparenting. Policy makers and family practitioners who are invested in building healthy families may find it valuable to screen for and treat mental illness in the context of creating programs to increase cooperative coparenting.

Preschool classroom quality and social-emotional functioning: Findings across geographic regions

This study examined whether classroom quality is related to preschoolers’ social-emotional functioning (social competence and behavior problems) and explored whether urbanicity (variation in geographic region: rural, small city, or large urban living) moderates this relation. Participants included 102 children (51% female) who were approximately 4.5 years old (M=53.57months, SD=5.42). Fifty-one percent of children were enrolled in Head Start. Linear regression models indicated that classroom quality was moderately related to social competence and not significantly associated with behavior problems for the full sample; however, urbanicity moderated relations between quality and social competence and behavior problems. Specifically, higher classroom quality was significantly related to fewer externalizing behaviors and marginally related to fewer internalizing behaviors for children in rural communities, but not for children in small or large urban settings. Similarly, higher quality was associated with stronger social competence for children in small urban cities, but not for children in large urban cities. Discussion addresses the importance of the geographic regions families reside in as a context for children’s development, and how early educational experiences may be particularly important for children living in rural and small urban communities.

Disagreements in surgical decision making for advanced cancer patients secondary to deficiencies in palliative care education.

34 Background: Surgical decision making in advanced cancer patients requires careful thought and deliberation balancing the high risks with the potential palliative benefits. We sought to compare palliative care education and decision-making for palliative surgery among physicians who commonly treat advanced cancer patients. Methods: Practicing surgeons, medical oncologists, palliative care physicians and critical care intensivists from a large urban city and its surrounding areas were surveyed with a 32-item questionnaire consisting of a palliative care education survey and 4 clinical vignettes depicting patients with advanced cancer and symptomatic surgical conditions. Results: Of the 299 physicians surveyed, 102 responded with a response rate of 34.1%. Respondents reflected the demographics of the total cohort. Physicians reported minimal hours of palliative care education during residency (median 0, IQR 0-8), fellowship (median 0, IQR 0-20), and continuing medical education (CME, median 8, IQR 0-20). Surgeons reported the fewest hours of palliative care education during residency, fellowship, and CME combined (median 10, IQR 2-15) compared to medical oncologists (median 30, IQR 20-80) and intensivists (median 50, IQR 30-100), p &lt; 0.05. 19.6% of surgeons reported receiving no palliative care education compared to none of the medical oncologists and 7.7% of intensivists. Analysis of physician treatment recommendations for the 4 clinical vignettes showed disagreement among physicians regardless of specialty. Absence of palliative care training was associated with recommending major surgical intervention more frequently compared to physicians with ≥40 hours of palliative care training (0.7 ± 0.7 vs. 1.6 ± 0.8, p = 0.01). Conclusions: Deficiencies in palliative care education persist and adversely impact quality of care. Recent national society recommendations for palliative care services are well founded given these deficiencies. Additionally, our findings highlight a sustained failure of the current postgraduate medical education system and the need for greater efforts system-wide in palliative care education across medical and surgical specialties.

A Qualitative Examination of Adolescent Girls’ Sport Participation in a Low-Income, Urban Environment

Even though African American girls and/or girls in low-income, urban environments are specifically challenged with their sport involvement, little research has focused specifically on this population’s experience with sport. The purpose of this study was to examine various factors related to sport participation for adolescent girls (predominantly African American) living in a low-income urban environment. The study examined the barriers that might impede their sport involvement, the benefits they perceive, and the reasons why they do or do not participate. Four focus groups were conducted in Detroit, Michigan (a large urban Midwestern city). Participants were grouped by age, as well as sport participation status (current sort participants and girls who have not participated in organized sport for at least one year). Each group consisted of 4 girls. Results revealed various reasons why the participants engaged in sport, including that sport occupies their time and that it is fun, while reasons like lack of opportunities and the negative role of others were some of the reasons provided for not participating in sport. These girls face numerous barriers to sport participation, such as logistical, financial, and cosmetic. Positive psychosocial development and scholarships were noted as benefits to participation. Directions for future research and programmatic level applications are described in light of these findings.

Single Frame Resection of Compact Digital Cameras for UAV Imagery

Recently, UAVs (Unmanned Aerial Vehicles) gain a wider acceptance from many disciplines. One major application is for monitoring and mapping. Flying beyond eye sight autonomously and collecting data over large areas are their obvious advantages. To support a large scale urban city mapping, we have developed a UAV system which can carry a compact digital camera as well as a navigational grade of a Global Positioning System (GPS) board mounted on the vehicle. Unfortunately, such a navigational system fails to provide sufficient accuracy required to process images become a large scale map. Ubiquitous digital compact cameras, despite their low cost benefits, are widely known to suffer instabilities in their internal lenses and electronics imaging system. Hence these cameras are less suitable for mapping related purposes. However, this paper presents a photogrammetric technique to precisely determine intrinsic and extrinsic camera parameters of photographed images provided that sufficient numbers of surveyed control points are available. A rigorous Mathematical model is derived to compute each image position with respect to the imaging coordinate system as well as a location of the principal point of an image sensor and the focal length of the camera. An iterative Gaussian-Newton least squares adjustment method is utilized to compute those parameters. Finally, surveyed data are processed and elaborated to justify the mathematical models.

In a bad place: Carers of patients with head and neck cancer experiences of travelling for cancer treatment.

To explore the effect that treatment-related commuting has on carers of patients with head and neck cancer. Semi-structured interviews, thematically analysed, with 31 carers. Treatment-related commuting had a considerable impact on carers of patients with head and neck cancer, both in practical terms (economic costs, disruption) and also in psychological terms. Many carers of patients with head and neck cancer described becoming distressed by their commute. Some carers from large urban cities appeared to have hidden commuting burdens. Some carers respond to commuting stress by 'zoning out' or becoming 'like zombies'. Treatment-related travel for head and neck cancer can have significant practical and psychological impacts. Health professionals should be aware of the impacts that commuting can have on head and neck caregivers. Health services may be able to take practical steps, such as providing subsidized parking, to address head and neck carergivers' difficulties.