Large Metropolitan Areas Research Articles

High Resolution WRF Modelling of Extreme Heat Events and Mapping of the Urban Heat Island Characteristics in Athens, Greece

In recent decades, large-scale urbanisation has developed rapidly, resulting in significant changes in the local and regional environment and climate. Large metropolitan areas worldwide induce significant changes in local atmospheric circulation and boundary layer meteorology by modifying the underlying surface characteristics and through the emission of anthropogenic heat and pollutants into the atmosphere. We investigate the urban heat island (UHI) characteristics in the city of Athens, Greece, which is one of Europe’s largest metropolitan complexes with a population of approximately 3.7 million inhabitants. The UHI effect is intense due to the city’s size, dense construction, high incident solar radiation, and almost complete lack of natural vegetation, with previous studies suggesting a temperature rise of 4 °C on average in the city centre compared to summer background conditions. We used high-resolution WRF simulations (1-km horizontal grid) driven with ERA5 reanalysis data to produce surface temperature maps in the city of Athens and the surrounding areas (Region of Attiki) during the summer period of 1 July–20 August 2021. Different model parameterizations were tested, both with respect to urban characteristics and physical parameters. The daily minimum and maximum temperatures (Tmin and Tmax) derived from the model were validated against observational data from a dense network of weather stations covering metropolitan Athens and surrounding locations. We further investigate the influence of different meteorological conditions on the UHI gradients as produced by the model and the observational dataset, including the extreme heat wave of 28 July–5 August 2021, during which persistent maximum temperatures of >40 °C were recorded for nine consecutive days. The results indicate a strong correlation between WRF output and recorded minimum and maximum temperatures throughout the test period (R ranges from 0.80 to 0.93), with an average mean absolute bias (MAB) of 1.5 °C, and reveal the intensity and spatiotemporal variability of the UHI phenomenon in the city of Athens, with UHI magnitude reaching 8–9 °C at times. Our work aims to maximise the potential of using high-resolution WRF modelling for simulating extreme heat events and mapping the UHI effect in large metropolitan complexes.

Abstract A095: Rural disparities in telemedicine use among cancer survivors during the COVID-19 pandemic

Abstract Background: The COVID-19 pandemic has led to significant changes in the delivery of healthcare across the world, including the widespread adoption of telemedicine. This study examined the prevalence of telemedicine use by rurality and determined whether rurality was associated with its use among cancer survivors in the United States (US). Methods: The 2021 National Health Interview Survey (NHIS) was used to examine the use of telemedicine among cancer survivors during the pandemic. Our primary outcome is telemedicine use and rurality is our main exposure of interest. Other covariates of interest include demographics, health-related factors (number of comorbidities, self-rated health), and types of cancer history. Descriptive statistics and multiple logistic regression models were used to examine the mentioned association. Results: Among 27,500 eligible cancer survivors, 51.6% (14,140 participants) of them reported telemedicine use. The use of telemedicine varied by rurality, with 41.4% of rural cancer survivors using telemedicine compared to 58.4% of cancer survivors in large central metropolitan areas (p<0.001). Rural cancer survivors had significantly lower odds of using telemedicine during the pandemic compared to metropolitan cancer survivors. Cancer survivors residing in rural were 0.58 times less likely (95% CI, 0.43 to 0.78) and cancer survivors residing in medium and small metropolitan areas were 0.72 times less likely (95% CI, 0.56 to 0.93) to report telemedicine use compared to cancer survivors residing in large central metropolitan areas. Conclusion: Significant rural disparities in telemedicine use were evident among cancer survivors. Rural cancer survivors were less likely to use telemedicine during the COVID-19 pandemic. To ensure equitable access to telemedicine, continued reimbursement for telemedicine services, but additional efforts are needed to improve access to and utilization of healthcare for rural cancer survivors. Citation Format: Minjee Lee, Meng-Han Tsai. Rural disparities in telemedicine use among cancer survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A095.

Epidemiology, Outcomes, and 30-Day Readmissions in Acquired Hemophilia

Background: Acquired Hemophilia is a rare bleeding disorder characterized by the presence of autoantibodies (inhibitors) against coagulation factors, mainly targeting factor VIII. It predominantly affects older individuals with underlying autoimmune disorders or malignancies. Achieving hemostasis and inhibiting autoantibody production through immunosuppression are the mainstays of treatment. However, overcorrection of bleeding poses a risk of thrombosis, while immunosuppression increases the risk of infectious complications in older patients with co-existing comorbidities. This study sheds light on the epidemiology of acquired hemophilia, including readmission rates and causes of readmission. Methods: We conducted a retrospective cohort study using the Nationwide Readmissions Database from 2016 to 2019 to identify hospitalizations with acquired hemophilia, using the ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) code D68.311. Descriptive analysis was performed to report patient demographics, hospital characteristics, various comorbid conditions, and complications. The all-cause 30-day readmission rate was calculated, excluding index admissions from December and deaths during index admissions. Additionally, primary diagnoses at readmission were identified. The analysis produced national estimates after applying weights, utilizing the methodology provided by the Healthcare Cost and Utilization Project. Results: Out of 1,450 admissions for acquired hemophilia between 2016 and 2019 in the United States, 803 (55.4%) were males, and 857 (59.1%) belonged to the age group of 61-80 years, with a median age at admission of 73 years. Furthermore, the majority were admitted to a teaching hospital (83.5%), with the highest quintile of acquired hemophilia-specific hospital volumes (43.8%) in a large metropolitan area with at least 1 million residents (59.8%). Although 20.9% had an underlying solid malignancy, only 28.5% had an otherwise high comorbidity burden with the Charlson comorbidity index of >3. Underlying hematologic malignancy was reported in 3.9% of admissions, and 13.5% had a diagnosis of an autoimmune disease. Regarding complications, acute myocardial infarction occurred in 9.5%, disseminated intravascular coagulation was noted in 1.2%, intracranial hemorrhage in 1.5%, ischemic stroke in 2.5%, and venous thromboembolism in 4.4%, with 30.2% of admissions experiencing some form of bleeding. The median length of stay was 7 days, and 101 deaths occurred during the index admission, resulting in a 7% inpatient mortality rate. Out of 1,349 patients who were discharged alive, 371 were readmitted within 30 days, with a 30-day readmission rate of 27% (table 1). The median time to readmission was 10 days (interquartile range 5-18), and the median length of stay during readmission was 7 days (interquartile range 3-14), with 10.8% mortality during readmission. The median hospitalization charges were $11,3008 for both index admissions and readmissions. After omitting readmissions coded as hemophilia, infection (30.8%), followed by bleeding (28.2%), was the most common cause for readmission (figure 1). Conclusion: The study highlights a high rate of bleeding and thrombotic complications in acquired hemophilia, necessitating a careful approach to factor replacement for achieving hemostasis. Moreover, bleeding and infection are the primary reasons for the elevated 30-day readmission rate of 27%, and there is an additional 11% mortality during readmission, indicating a significant incidence of treatment-related toxicity and disease relapse.

Phase I Safety and Feasibility Pilot of Hepatic Artery Infusion Chemotherapy in a Rural Catchment Area Using The Codman Vascular Catheter with The Medtronic SynchroMed II Pump for Intrahepatic Cancers.

Discontinuation of the Codman 3000 pump in 2018 left no Food and Drug Administration (FDA)-approved hepatic artery infusion (HAI) device for unresectable colorectal liver metastases (uCLM) and intrahepatic cholangiocarcinoma (uIHC). Historically, HAI has been performed at academic medical centers in large metropolitan areas, which are often inaccessible to rural patients. Consequently, feasibility of dissemination of HAI to rural populations is unknown. Under an FDA investigational device exemption, we opened the only HAI program in Kentucky and enrolled patients with uCLM and uIHC in a phase I clinical trial. The trial examined the safety of the hybrid Codman catheter/Medtronic SynchroMed II pump (hCMP) combination, defined as successful completion of one cycle of HAI chemotherapy. Rural feasibility was assessed by number of missed pump fills appointments. A total of 21 patients (n = 17uCLM, n = 4uIHC) underwent hCMP implantation before accrual was stopped early owing to FDA approval of the Intera 3000 pump. 20/21 (95%) patients met the primary safety endpoint. Serious adverse events (AEs) included a grade 5 coronavirus disease 2019 (COVID-19) infection (n = 1) and a grade 3 catheter erosion into the bowel (n = 1). Biliary sclerosis developed in two patients (9.5%). Median distance to infusion center was 47.6 miles (2-138 miles), and 62% were from Appalachia, yet there were no missed pump fill appointments. The 2-year overall survival was 82.4% (uCLM) and 50% (uIHC). The hCMP device had an acceptable safety profile. Despite the complexity of starting a new HAI program, early results showed feasibility for HAI delivery in a rural catchment area and comparable outcomes to larger urban-based HAI centers.

Effects of the COVID-19 pandemic on short-term postoperative outcomes for colorectal perforation: A nationwide study in Japan based on the National Clinical Database.

Possible negative effects of the COVID-19 pandemic on short-term postoperative outcomes for colorectal perforation in Japan were examined in this study. The National Clinical Database (NCD) is a large-scale database including more than 95% of surgical cases in Japan. We analyzed 13 107 cases of colorectal perforation from 2019 to 2021. National data were analyzed, and subgroup analyses were conducted for subjects in prefectures with high infection levels (HILs) and metropolitan areas (Tokyo Met. and Osaka Pref.). Postoperative 30-day mortality, surgical mortality, and postoperative complications (Clavien-Dindo grade ≥3) were examined. Months were considered to have significantly high or low mortality or complication rates, if the 95% confidence interval (CI) of the standardized mortality (morbidity) ratio (SMR) does not contain 1. In the NCD, postoperative 30-day mortality occurred in 1371 subjects (10.5%), surgical mortality in 1805 (13.8%), and postoperative complications in 3950 (30.1%). Significantly higher SMRs were found for 30-day mortality in November 2020 (14.6%, 1.39 [95% CI: 1.04-1.83]) and February 2021 (14.6%, 1.48 [95% CI: 1.10-1.96]), and for postoperative complications in June 2020 (37.3%, 1.28 [95% CI: 1.08-1.52]) and November 2020 (36.4%, 1.21 [95% CI: 1.01-1.44]). The SMRs for surgical mortality were not significantly high in any month. In prefectures with HILs and large metropolitan areas, there were few months with significantly higher SMRs. The COVID-19 pandemic had limited negative effects on postoperative outcomes in patients with colorectal perforation. These findings suggest that the emergency system for colorectal perforation in Japan was generally maintained during the pandemic.

Inter-basin water transfers under changing climate and land use: Assessing water security and hydropower in the Paraíba do Sul River basin, Brazil

The intensification of climate extremes and land uses poses a major challenge for water managers, especially in heavily populated basins with large reservoirs, multiple uses, and inter-basin transfers. In this study, we analyzed water security in the Paraíba do Sul River basin, responsible for supplying a significant fraction of the needs of Brazil's two largest metropolitan areas through water transfer. Unless existent studies emphasize aspects of water scarcity disregarding other competitive water use, we considered the impacts on hydropower generation in a fully integrated modeling framework, which includes reservoir operation rules. To achieve this, we integrated future projections of land uses, global climate change (RCP 4.5 and RCP 8.5), and water demand for the period 2016–2055. Most of the climate change scenarios suggested a reduction in the frequency of both high and low flows, by nearly 25%, which resulted in an increase in flow regularization in the main basin's reservoirs. An undesirable consequence of those trends was the reduction of hydropower generation. Regarding water supply to the metropolis outside the basin, results indicated a possibility of a more contentious water governance scenario. The long-term sustainability of the basin's water resources will require implementing policies to enhance water use efficiency and reuse, in combination with other renewable energy sources.

Teachers’ perceptions and lived experiences of challenges in culturally diverse classrooms: establishing an equitable school environment

Abstract The increasing population of students of color in public school settings in the United States is a persistent challenge for White teachers teaching diverse student populations with students from racially, ethnically, culturally, and linguistically diverse families and communities of lower socioeconomic status to make learning more effective in their classrooms. This qualitative study aimed to identify the challenges in teaching students of diverse backgrounds in public school settings in a school district in Houston, the most ethnically diverse large metropolitan area in the United States. The study focused on the lived experiences with in-depth and semi-structured interviews conducted with 7 participants (6 females; 1 male) to gain insights into their perspectives and understand the essence of their experiences. The findings showed that the lack of language proficiency and trained teachers in culturally responsive teaching often create barriers to effective schooling. The findings emphasize the importance of culturally responsive teaching to prepare highly effective teachers to address the needs of an increasingly diverse student population in the United States.

American Cancer Society's report on the status of cancer disparities in the United States, 2023.

In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12years of education than in those with ≥16years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65years than among those aged 65years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.

Abstract 15304: Nature Exposure and Cardiovascular Outcomes in a Large Metropolitan Area: The Role of Access to Nature

Background: Previous studies have found conflicting results regarding the association between greenspaces and cardiovascular health. We aimed to investigate the relationship between cardiovascular risk factors (CVRF) and diseases (CVD), and NatureScore, as well as access to nature using the Walk Score. Methods: Cross-sectional study including one million adult patients in Houston Methodist Outpatient Registry (2016-2022) living in the greater Houston metroplex. NatureScore is a composite score of natural environment exposure and quality of greenspace calculated for each patient. NatureScore was categorized as follows: nature-deficient/light (0-39), nature-adequate (40-59), nature-rich (60-79), and nature-utopia (80-100). Walk Score was divided into 4 categories: car-dependent (all errands) (0-19), car-dependent (most errands) (20-39), somewhat walkable (40-59), and very walkable/ walker’s paradise (60-100). Results: A total of 1.07 million patients (mean age 52, female 59%, Hispanic 16%, NHB 14%) were included with median NatureScore of 69 and 99% living in urban areas. The prevalence of CVRF and CVD (CAD, PAD, and stroke) was significantly higher in patients living in neighborhoods with high NatureScore without taking access to nature into account (Figure). On adjusting for access to nature (Walk Score), patients living in the highest NatureScore areas had 9% lower odds of any CVRF and 4% of any CVD, than those living in the lowest NatureScore areas. On stratification by Walk Score, those living in high NatureScore high walkability areas had lower odds of CVRF than those in high NatureScore low walkability areas (Figure). Conclusion: Our findings suggest that greenspace can positively impact cardiovascular health, yet its accessibility plays a crucial role in determining its actual effect. Our results can guide stakeholders in allocating resources for population health improvement and urban design that consider both exposure and access to nature.

Rural-urban disparities in lung cancer-related mortality in the United States.

186 Background: Lung cancer survival outcomes have improved substantially over the last two decades, largely due to the advent of immunotherapy and targeted therapy. However, it is still the leading cause of death among all malignancies in the United States (U.S.). It is hence vital to identify the disparities between different population groups to further decrease lung cancer-related mortality. We, therefore, sought to analyze the outcome variances between urban and rural populations. Methods: We retrieved the mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database (years: 1999–2020). We analyzed age-adjusted mortality rates (AAMRs) per 100,000 population and assessed temporal trends in the average percent change (APC) of AAMRs by applying the simplest model with a maximum of 3 joinpoints (using the Joinpoint regression program 5.0.2). We conducted nonparallel pairwise comparisons to assess differences in trends between large metropolitan, small/medium metropolitan, and rural areas (per National Center for Health Statistics Urban-Rural Classification Scheme, 2016) using average annual percentage change difference (AAPCD). Results: A total of 5,409,649,211 lung cancer-related deaths were retrieved from CDC Wonder between 1999-2020, amongst which 2,972,877,175 (54.9%) were in the large metropolitan, 1,622,092,262 (30%) were in the small/medium metropolitan, and 814,672,274 (15.1%) were in the rural regions. We noted a decline in the AAMR overall and across large metropolitan, small/medium metropolitan, and rural areas (table). However, the decline in AAMR was significantly higher among large metropolitan areas as compared to small/medium metropolitan (AAPCD -0.5257, 95% CI -0.93, -0.11, p=0.012) and rural areas (AAPCD: -1.2617, 95% CI -1.67, -0.85, p<0.000001). A similar difference was also distinguished when the small/medium metropolitan group was compared with the rural group (AAPCD -0.7360, 95% CI -1.14, -0.32, p=0.0004). Conclusions: We identify discrepancies in the decline in lung cancer AAMR between urban and rural areas. A substantially lower decline in AAMR is eminent in the rural regions, as compared to the urban counterparts. This raises the concern for poor access to cancer care in this population group. Our results, therefore, emphasize the imperative of prioritizing and designing strategies to ensure healthcare equity.[Table: see text]

Telemedicine use prevalence and disparities among sexual minority adults with cancers in the US: National Health Interview Survey, 2021.

514 Background: Telemedicine can help facilitate access to health care and oncology services for adults with cancers (AWCs); however, little is known about its utilization among lesbian, gay, bisexual, or other (LGB+) populations in the US. This study aimed to estimate the national prevalence of telemedicine use and examine disparities in telemedicine use among AWCs by sexual orientation. Methods: We obtained a population-based sample of US adults aged ≥18 years from the 2021 National Health Interview Survey. In this analysis, our sample was further limited to adults who 1) ever had a cancer diagnosis, 2) reported sex assigned at birth, and 3) self-identified as either heterosexual/straight or LGB+. Telemedicine use was defined as having had a virtual (i.e., phone and video) medical visit with a provider in the past 12 months and was dichotomized as “yes/no.” Weighted percentages and 95% confidence intervals (CI) were compared using Rao-Scott chi-squared tests. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% CIs. All analyses accounted for complex sample design and survey weights. Results: The unweighted sample was 3,517 which represented a weighted sample of 23,747,209 US AWCs; of whom, the mean age was 65.4 years; 55.5% were female, and 3.1% self-identified as LGB+. Overall, 50.8% (95% CI: 48.8%–52.4%) had a virtual medical visit with a provider in the past 12 months. LGB+ AWCs reported a significantly higher percentage of telemedicine use than heterosexual AWCs (64.8% [95% CI: 53.3%–76.2%] vs. 50.4% [95% CI: 48.4%–52.4%], p=0.019). After controlling for key sociodemographic covariates, LGB+ AWCs had higher odds of telemedicine use than heterosexual AWCs (aOR=1.75, 95% CI: 1.09–2.80). In the same adjusted regression model, we also observed that AWCs with an Associate’s (aOR=1.50, 95% CI: 1.23–1.84), Bachelor’s (aOR=1.72, 95% CI: 1.38–2.13), or graduate (aOR=1.79, 95% CI: 1.40–2.27) degree had a greater likelihood of telemedicine use than those with high school or less education. Uninsured AWCs were less likely than those privately insured to have used telemedicine (aOR=0.20, 95% CI: 0.09–0.40). AWCs residing in rural areas had a lower likelihood of telemedicine use than those residing in large metropolitan areas (aOR=0.62, 95% CI: 0.50–0.76). Conclusions: In this nationally representative sample of AWCs, the prevalence of telemedicine use was higher in LGB+ groups, suggesting a greater need for virtual care in these sexual minority populations. Our findings also suggest that to increase the utilization of telemedicine, oncology services and telehealth programs may need to improve equitable access among AWCs with a lower level of education, living in rural areas, or without insurance coverage.

Maintaining safety in the new urban mobility

Ensuring the protection of any city is the protection of citizens from various influences. In relation to vehicles (TC), hazardous effects are the consequences of road accidents, environmental pollution, increased noise and vibration. In large metropolitan areas, new categories of vehicles have appeared, their safety is closed in the article. Keywords: safety, means of individual mobility, MIM, electric scooter, mobility, unicycle, compact transport, CoT

Rural-urban disparities in breast cancer-related mortality in the United States (1999-2020).

181 Background: Breast cancer is the most commonly diagnosed cancer and the second most common cause of cancer death among women in the United States (U.S.). While racial and ethnic disparities in outcomes are known, large population-based data on rural and urban disparities in breast cancer-related mortality are lacking. Methods: We retrieved de-identified data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database (years: 1999–2020) for females (aged 15 years and upwards) with “malignant neoplasm of breast” (ICD-10 C50) listed as “underlying cause of death”. We analyzed age-adjusted mortality rates (AAMRs) per 100,000 population and assessed temporal trends in the average percent change (APC) of AAMRs applying the simplest model with a maximum of 3 joinpoints (using Joinpoint regression program 4.9.1.0). We conducted nonparallel pairwise comparisons to assess differences in trends between large metropolitan, medium to small metropolitan and rural areas (per National Center for Health Statistics Urban-Rural Classification Scheme, 2016) using average annual percentage change difference (AAPCD). Results: A total of 909,467 breast-cancer related deaths were analyzed between 1999-2020. We noted a decline in breast cancer related AAMR overall and across large metropolitan, small to medium metropolitan and rural areas (table). However, the decline in AAMR was significantly higher among large metropolitan areas as compared to small to medium metropolitan (AAPCD -0.3371, 95% CI -0.61, -2.4187, p=0.02) and rural areas (AAPCD: -0.48, 95% CI -0.79, -3.12, p=0.002). No significant difference in AAMR trend in small to medium metropolitan and rural areas was noted (AAPCD -0.15, 95% CI -0.37, 0.08, p=0.19). Conclusions: We demonstrate disparities in decline in breast cancer related AAMR between urban and rural areas. A significantly higher decline in AAMR among large metropolitan areas compared to medium to small metropolitan and rural areas suggests discrepancy in access to cancer care among populations. Further work is needed to develop strategies aimed at ensuring equitable cancer care access for all patients with breast cancer regardless of their geographical location.[Table: see text]

Country-scale assessment of urban areas, population, and households exposed to land subsidence using Sentinel-1 InSAR, and GPS time series

The increased need for water resources in urban sprawls and intense droughts has forced more aggressive groundwater extraction resulting in numerous urban areas undergoing land subsidence. In most cases, only some large metropolitan areas have been well-characterized for subsidence. However, there is no existing country-wide assessment of urban areas, population, and households exposed to this process. This research showcases a methodology to systematically evaluate urban localities with land subsidence higher than − 2.8 cm/year throughout Mexico. We used Interferometric Synthetic Aperture Radar (InSAR) tools with a dataset of 4611 scenes from European Space Agency’s Sentinel-1 A/B SAR sensors acquired from descending orbits from September 2018 through October 2019. This dataset was processed at a supercomputer using InSAR Scientific Computing Environment and the Miami InSAR Time Series software in Python software. The quality and calibration of the resulting velocity maps are assessed through a large-scale comparison with observations from 100 continuous GPS sites throughout Mexico. Our results show that an urban area of 3797 km2, 6.9 million households, and 17% of the total population in Mexico is exposed to subsidence velocities of faster than − 2.8 cm/year, in more than 853 urban localities within 29 land subsidence regions. We also confirm previous global potential estimations of subsidence occurrence in low relief areas over unconsolidated deposits and where groundwater aquifers are under stress. The presented research demonstrates the capabilities for surveying urban areas exposed to land subsidence at a country-scale level by combining Sentinel-1 velocities with spatial national census data.

Clinical features, etiologies, and outcomes of central nervous system infections in intensive care: A multicentric retrospective study in a large Brazilian metropolitan area

PurposeThe goal of this study was to investigate severe central nervous system infections (CNSI) in adults admitted to the intensive care unit (ICU). We analyzed the clinical presentation, causes, and outcomes of these infections, while also identifying factors linked to higher in-hospital mortality rates. Materials and methodsWe conducted a retrospective multicenter study in Rio de Janeiro, Brazil, from 2012 to 2019. Using a prediction tool, we selected ICU patients suspected of having CNSI and reviewed their medical records. Multivariate analyses identified variables associated with in-hospital mortality. ResultsIn a cohort of 451 CNSI patients, 69 (15.3%) died after a median 11-day hospitalization (5–25 IQR). The distribution of cases was as follows: 29 (6.4%) had brain abscess, 161 (35.7%) had encephalitis, and 261 (57.8%) had meningitis. Characteristics: median age 41 years (27–53 IQR), 260 (58%) male, and 77 (17%) HIV positive. The independent mortality predictors for encephalitis were AIDS (OR = 4.3, p = 0.01), ECOG functional capacity limitation (OR = 4.0, p < 0.01), ICU admission from ward (OR = 4.0, p < 0.01), mechanical ventilation ≥10 days (OR = 6.1, p = 0.04), SAPS 3 ≥ 55 points (OR = 3.2, p = 0.02). Meningitis: Age > 60 years (OR = 234.2, p = 0.04), delay >3 days for treatment (OR = 2.9, p = 0.04), mechanical ventilation ≥10 days (OR = 254.3, p = 0.04), SOFA >3 points (OR = 2.7, p = 0.03). Brain abscess: No associated factors found in multivariate regression. ConclusionsPatients' overall health, prompt treatment, infection severity, and prolonged respiratory support in the ICU all significantly affect in-hospital mortality rates. Additionally, the implementation of CNSI surveillance with the used prediction tool could enhance public health policies.

Social-spatial network structures among young urban and suburban persons who inject drugs in a large metropolitan area

BackgroundRecent studies underscore the significance of adopting a syndemics approach to study opioid misuse, overdose, hepatitis C (HCV) and HIV infections, within the broader context of social and environmental contexts in already marginalized communities. Social interactions and spatial contexts are crucial structural factors that remain relatively underexplored. This study examines the intersections of social interactions and spatial contexts around injection drug use. More specifically, we investigate the experiences of different residential groups among young (aged 18-30) people who inject drugs (PWID) regarding their social interactions, travel behaviors, and locations connected to their risk behaviors. By doing so, we aim to achieve a more comprehensive understanding of the multidimensional risk environment, thereby facilitating the development of informed policies. MethodsWe collected and examined data regarding young PWID's egocentric injection network and geographic activity spaces (i.e., where they reside, inject drugs, purchase drugs, and meet sex partners). Participants were stratified based on the location of all place(s) of residence in the past year i.e., urban, suburban, and transient (both urban and suburban) to i) elucidate geospatial concentration of risk activities within multidimensional risk environments based on kernel density estimates; and ii) examine spatialized social networks for each residential group. ResultsParticipants were mostly non-Hispanic white (59%); 42% were urban residents, 28% suburban, and 30% transient. We identified a spatial area with concentrated risky activities for each residential group on the West side of Chicago in Illinois where a large outdoor drug market area is located. The urban group (80%) reported a smaller concentrated area (14 census tracts) compared to the transient (93%) and suburban (91%) with 30 and 51 tracts, respectively. Compared to other areas in Chicago, the identified area had significantly higher neighborhood disadvantages. Significant differences were observed in social network structures and travel behaviors: suburban participants had the most homogenous network in terms of age and residence, transient participants had the largest network (degree) and more non-redundant connections, while the urban group had the shortest travel distance for all types of risk activities. ConclusionDistinct residential groups exhibit varying patterns of network interaction, travel behaviors, and geographical contexts related to their risk behaviors. Nonetheless, these groups share common concentrated risk activity spaces in a large outdoor urban drug market area, underscoring the significance of accounting for risk spaces and social networks in addressing syndemics within PWID populations.

Climatological assessment of the vertically resolved optical and microphysical aerosol properties by lidar measurements, sun photometer, and in situ observations over 17 years at Universitat Politècnica de Catalunya (UPC) Barcelona

Abstract. Aerosols are one of the most important pollutants in the atmosphere and have been monitored for the past few decades by remote sensing and in situ observation platforms to assess the effectiveness of government-managed reduction emission policies and assess their impact on the radiative budget of the Earth's atmosphere. In fact, aerosols can directly modulate incoming short-wave solar radiation and outgoing long-wave radiation and indirectly influence cloud formation, lifetime, and precipitation. In this study, we quantitatively evaluated long-term temporal trends and seasonal variability from a climatological point of view of the optical and microphysical properties of atmospheric particulate matter at the Universitat Politècnica de Catalunya (UPC), Barcelona, Spain, over the past 17 years, through a synergy of lidar, sun photometer, and in situ concentration measurements. Interannual temporal changes in aerosol optical and microphysical properties are evaluated through the seasonal Mann–Kendall test. Long-term trends in the optical depth of the recovered aerosol; the Ångström exponent (AE); and the concentrations of PM10, PM2.5, and PM1 reveal that emission reduction policies implemented in the past decades were effective in improving air quality, with consistent drops in PM concentrations and optical depth of aerosols. The seasonal analysis of the 17-year average vertically resolved aerosol profiles obtained from lidar observations shows that during summer the aerosol layer can be found up to an altitude of 5 km, after a sharp decay in the first kilometer. In contrast, during the other seasons, the backscatter profiles fit a pronounced exponential decay well with a well-defined scale height. Long-range transport, especially dust outbreaks from the Sahara, is likely to occur throughout the year. During winter, the dust aerosol layers are floating above the boundary layer, while during the other seasons they can penetrate the layer. The analysis also revealed that intense, short-duration pollution events during winter, associated with dust outbreaks, have become more frequent and intense since 2016. This study sheds some light on the meteorological processes and conditions that can lead to the formation of haze and helps decision makers adopt mitigation strategies to preserve large metropolitan areas in the Mediterranean basin.

Benchmarking urban competitiveness for economic recovery: an application to Porto and Lisbon

PurposeThis paper aims to investigate the competitive potential of different classes of municipalities within larger metropolitan areas, considering three dimensions of place competitiveness, associated to contemporary economic recovery agendas: the “dual transition” (green and digital) and socio-economic resilience.Design/methodology/approachThe proposed methodology is divided in two stages, the first aiming at developing a new Index of Urban Competitiveness, based on three key dimensions of place development, by using principal component analysis and hierarchical cluster analysis; the second intends to identify municipalities’ main competitive assets, throughout the examination of the existing links between the overall competitiveness index and intra-metropolitan place conditions in each dimension. This methodology is applied to the metropolitan areas of Porto and Lisbon.FindingsThe analysis shows a weak link between population size and urban competitiveness, suggesting that economic recovery investments primarily targeting larger municipalities will not necessarily lead to greater metropolitan competitive advantages. On the contrary, taking into consideration place-based interventions for different “clubs” of municipalities would more likely contribute to enhance competitive performance and valorise territorial assets. Furthermore, while the relationship between competitiveness and environmental performance appears to be non-linear, digitalization and economic and social resilience prove to be key for urban competitive potential.Originality/valueBy drawing on contemporary notions of urban competitiveness, the work proposes a revised method to evaluate competitiveness, latent qualities and intrinsic features of places, constituting an initial step to conceive suitable metropolitan development and investment strategies for economic recovery.

From lowland plains to the Altiplano: The impacts of regional transport of wildfire smoke on the air quality of Bolivian cities

Wildfires emerged as a global concern in recent decades, because they deteriorate the air quality in urban centres situated downwind, impact human health, ecosystems and regional climate. In this study, we assessed the air quality of Bolivia's three largest metropolitan areas during the period 2017–2019 by analysing in situ criteria air pollutant data (PM10, O3 and NOx) coupled with satellite (aerosol optical depth AOD and total CO column), fire foci data, and airmass backward trajectories. The Bolivian lowland plains were highly impacted by smoke transported from the Amazon and Cerrado biomes. Due to its proximity to the fire foci, Santa Cruz was the most affected city, where PM10, CO and AOD increased between 1.3- and 3.9-fold in September (maximum fire activity) compared to April (lowest fire activity). In Cochabamba and La Paz-El Alto, the impacts of wildfires on AOD and CO were lower (15–16% increase). A case study of regional smoke in September 2019 using Cochabamba as an example revealed that: i) airmass trajectories passed over regions with high fire radiative power density in southern Bolivia, Paraguay and northern Argentina; ii) the advection of wildfire smoke caused unusual episodes of enhanced nocturnal O3 concentrations (20–45 μg/m3) over a four-day pollution event. The results indicated that local sources (e.g., motorised traffic, brick kilns and dust resuspension) largely contributed to deteriorate the air quality, particularly in the dry months, surpassing the World Health Organization recommendations for PM10, in La Paz-El Alto and Cochabamba. We highlight the need of international cooperation among South American countries to combat fire practices in the region, given the transboundary nature of the biomass burning plumes. Moreover, it is crucial to implement local measures aimed at tackling local air pollution sources, especially in a changing climate in which drier conditions can favour the onset and propagation of wildfires and accumulation of air pollutants.

Predicting Accident Severity: An Analysis of Factors Affecting Accident Severity Using Random Forest Model

Road accidents have significant economic and societal costs, with a small number of severe accidents accounting for a large portion of these costs. Predicting accident severity can help in the proactive approach to road safety by identifying potential unsafe road conditions and taking well-informed actions to reduce the number of severe accidents. This study investigates the effectiveness of the Random Forest machine learning algorithm for predicting the severity of an accident. The model is trained on a dataset of accident records from a large metropolitan area and evaluated using various metrics. Hyperparameters and feature selection are optimized to improve the model's performance. The results show that the Random Forest model is an effective tool for predicting accident severity with an accuracy of over 80%. The study also identifies the top six most important variables in the model, which include wind speed, pressure, humidity, visibility, clear conditions, and cloud cover. The fitted model has an Area Under the Curve of 80%, a recall of 79.2%, a precision of 97.1%, and an F1 score of 87.3%. These results suggest that the proposed model has higher performance in explaining the target variable, which is the accident severity class. Overall, the study provides evidence that the Random Forest model is a viable and reliable tool for predicting accident severity and can be used to help reduce the number of fatalities and injuries due to road accidents in the United States.