Large Towns Research Articles

Exploring local perspectives on flood risk: A participatory GIS approach for bridging the gap between modelled and perceived flood risk zones

As cities continue to expand and climate change exacerbates flooding, development within flood risk zones becomes an increasingly pressing concern. Engineered solutions alone cannot fully address the risks to individuals and communities, especially when local officials and residents have conflicting understanding of the risk. Participatory GIS (PGIS) offers a unique opportunity to bridge this gap by engaging with communities to better understand their perceptions of flood risk. While PGIS has traditionally been used in developing nations as an alternative to numerical flood models, its potential for use in developed nations is largely unexplored. This paper presents a case study of survey-based PGIS conducted in Reading, a large town in Berkshire, UK. Findings suggest that local residents possess a surprisingly accurate understanding of flood risk zones, but discrepancies with modelled flood risk were also identified. These discrepancies may be due to issues with cartographic representation, but also raise concerns about the accuracy of numerical flood models. By examining local perceptions of flood risk, this study highlights the importance of considering community perspectives in flood risk management and offers valuable insights for practitioners seeking to bridge the gap between modelled and perceived flood risk zones.

Comparison of Flight Periods of Solitary and Primitively Eusocial Bees in Urban Environments and Nature Conservation Areas: a Preliminary Report

Solitary and primitively eusocial bees, an important group of pollinators, have declined in the past few decades. In view of the recent focus on safeguarding pollinating insects, it is vital to understand the basic ecology of species for their conservation, for example their phenologies. We observed the flight periods of solitary and primitively eusocial bees in both the urban core of a large British town and nearby nature conservation areas. The bee surveys were conducted with standardised methods, on warm sunny days from the first appearance of bees in March 2012 and continued until October 2012. This study confirmed that a high number of species are active in the spring season. The emergence dates of species in urban areas and nature sites varied; about 26 of the 35 species were recorded at least one week earlier in urban areas; in contrast, only four species were seen earlier in nature conservation sites. When comparing this with the expected flight periods recorded (largely in nature sites) in the literature, many species were recorded at their expected time. However, a few individuals were recorded after their usual flight activity time, suggesting that the populations were possibly affected by the microclimate in urban areas. More urban phenological data are needed to understand the phenological trends in bees in urban habitats.

On the state of the environment and natural environment of the East Kazakhstan region

The article analyzes the state of the environment in the East Kazakhstan region. The authors, having analyzed official sources, showed that as a result of the restoration of production volumes at non-ferrous metallurgy and thermal power enterprises, there is an increase in emissions of hazardous waste by individual enterprises in this industry into the environment. In the atmospheric air of large industrial cities and towns in the region, maximum permissible concentrations of lead, sulfur dioxide, nitrogen oxides, phenol, formaldehyde and other components are observed to be exceeded. The authors emphasize that mining enterprises have a negative impact on the state of water resources and the unsatisfactory technical condition of sewer networks and treatment facilities, which leads to bacterial contamination of water sources, including sources of drinking water supply. The authors also discuss the state of forest resources and wildlife in the region. The conclusion that was done by the authors – there is a real threat of environmental pollution from waste from non-ferrous metallurgy and mining enterprises in the region and at the present moment.

COVID-19 vaccine acceptance among pregnant women: a multicentre cross-sectional survey in Port Harcourt, Nigeria.

effective COVID-19 vaccines for the prevention of severe illness have been available for more than one year now. This study was carried out to ascertain vaccine hesitancy and its associations among pregnant women receiving antenatal care in Port Harcourt, a large cosmopolitan town in Nigeria. we conducted a cross-sectional online survey over 2 months among consenting pregnant women receiving antenatal care in the 3 largest obstetric service centers in Port Harcourt to evaluate COVID-19 vaccine hesitancy and its associations. the prevalence of vaccine hesitancy was 669 (72.2%). Of the respondents, 27 (2.9%) had been infected or had a close family member infected with SARS-CoV-2, and 897 (96.8%) of them had heard of the COVID-19 vaccine; however, only 133 (14.4%) had been vaccinated against COVID-19. The safety of the mother in 260 (32.8%) and the safety of the unborn baby in 114 (14.4%) of the respondents were the reasons for vaccine hesitancy. A small proportion of women 7(0.9%) were hesitant on religious grounds. Tertiary education, use of childhood immunization for previous infants delivered, and availability of COVID-19 vaccine in the antenatal clinic at no cost to the women, were statistically significant predictors of vaccine uptake among the respondents. the prevalence of vaccine hesitancy among pregnant women in Port Harcourt was 72.2%. Higher academic achievement and availability of the COVID-19 vaccine in the antenatal clinic were predictors of vaccine uptake, while reasons for hesitancy were mostly due to safety concerns for the mother and unborn baby.

Identifying heat thresholds for South Africa towards the development of a heat-health warning system.

Exposure to heatwaves may result in adverse human health impacts. Heat alerts in South Africa are currently based on defined temperature-fixed threshold values for large towns and cities. However, heat-health warning systems (HHWS) should incorporate metrics that have been shown to be effective predictors of negative heat-related health outcomes. This study contributes to the development of a HHWS for South Africa that can potentially minimize heat-related mortality. Distributed lag nonlinear models (DLNM) were used to assess the association between maximum and minimum temperature and diurnal temperature range (DTR) and population-adjusted mortality during summer months, and the effects were presented as incidence rate ratios (IRR). District-level thresholds for the best predictor from these three metrics were estimated with threshold regression. The mortality dataset contained records of daily registered deaths (n = 8,476,532) from 1997 to 2013 and data for the temperature indices were for the same period. Maximum temperature appeared to be the most statistically significant predictor of all-cause mortality with strong associations observed in 40 out of 52 districts. Maximum temperature was associated with increased risk of mortality in all but three of the districts. Our results also found that heat-related mortality was influenced by regional climate because the spatial distribution of the thresholds varied according to the climate zones across the country. On average, districts located in the hot, arid interior provinces of the Northern Cape and North West experienced some of the highest thresholds compared to districts located in temperate interior or coastal provinces. As the effects of climate change become more significant, population exposure to heat is increasing. Therefore, evidence-based HHWS are required to reduce heat-related mortality and morbidity. The exceedance of the maximum temperature thresholds provided in this study could be used to issue heat alerts as part of effective heat health action plans.

On public participation in efforts to beautify the towns and cities of Galicia in times of its autonomy. Prolegomenon

This paper is an introduction to studies of Urban Beautification Societies (“UBSs” in the plural) active in times of Galicia’s autonomy (1867–1914). The Societies were community organisations set up in many cities and towns across Galicia from the 1880s onwards with a view to improve the aesthetic in public urban space. To Galicia, years of its autonomy yielded years of considerable expansion of civic freedoms, including the re-enacted right to association. Formed by individuals with university education, UBSs were popular throughout Galicia, their structure frequently reflecting the local cross-section and specificity of social strata. Established in large, medium-sized, and small cities and towns (such as Cracow and Lviv; Przemyśl; Wadowice and Wieliczka), they attempted to reach their goals chiefly through establishing urban parks and green squares (often as not with accompanying infrastructure, such as tennis courts or bowling alleys); planting trees in market and other public squares and along communication routes; developing aesthetically pleasing small architecture; and taking initiative to erect monuments and install commemorative plaques, usually commissioned with eminent artists. The latter – in large cities in particular, where art communities were large and powerful – were occasionally UBS co-organisers and members, and thus capable of considerable influence over any Society activities, potentially including publishing, graphic artists and painters especially prominent therein.

Cultural heritage and event tourism as a driver of a large historical town development (on the example of Avignon, southeastern France)

The authors investigate development resources and mechanisms for managing cultural tourism in Avignon, a large historical city (200 thousand inhabitants) located in southeastern France in Provence. The main attractions of the historical center are described (in the UNESCO World Heritage List), as well as famous theater festivals and other events, that form a very powerful tourist flow to this city on the Ron – over 3 million a year. A well-developed system of internal tourist arrangement has been studied, this system allows to use the Old City territory rationally without damaging valuable architectural objects. The surroundings of Avignon are briefly described – a picturesque cultural landscape, saturated with interesting historical and natural objects. Statistics characterizing the volume, composition and seasonality of tourist flow to Avignon is given.

IoT based Smart Car Parking System using RFID in a Community

With the growth of technology in the current decade, we are confronting a parking challenge. Because large towns have a dense population, there are many vehicles on the road, which causes parking and traffic problems. The globe is confronted with a new challenge that is vehicle parking. It is estimated that one million automobiles use oil on a daily basis. This paper proposes an RFID based car parking system in a community. This system was created with the assistance of the internet of things (IOTs). IoT mainly involves the exchange of information or data between two physical devices. In the suggested system, an Arduino Uno microcontroller, ESP32, RFID sensors and IR sensors are used. The value of automation is growing every day. The primary function of Arduino in the proposed system is to serve as a platform for communicating digital devices and interactive objects capable of sensing and controlling physical components. The proposed system was built using an Arduino Uno board for vehicle parking and a ESP32 to connect the parking area to the web. In order to obtain information regarding the vacancy position of the parking slot, the suggested system included an infrared sensor in each slot. Therefore, to determine whether or not a person is in the database for the car parking system, RFID sensors are used. If the driver is listed in the database, the car will be allowed to enter the parking lot and the gate will open when the motors rotate in a clockwise direction. When the gate closes, the door will rotate in an anticlockwise direction and shows the user via led. From this proposed system, we get the information about the vacancy position of parking spot and notify the user through website. Keywords—IOT, RFID, IR Sensors, ESP32, Arduino

Incidence of occult appendiceal neoplasm in patients over 40 years with acute appendicitis: A single-institution review.

To investigate the incidence of occult appendiceal neoplasm in patients aged 40 years and over who underwent appendicectomy for appendicitis. The clinical coding electronic database was used to identify patients aged 40 years and over who were diagnosed with appendicitis from September 2010 to September 2022. Patients were included if they were managed operatively. Retrospective cohort study. Modified Monash category 3 (large rural town). Patients aged 40 years and over undergoing appendicectomy for appendicitis. Incidence of appendiceal neoplasm within appendicectomy specimen. A total of 279 patients aged 40 years and over underwent appendicectomy, with a median age of 53 years (range 40-95). Nineteen patients (7%) were found to have a primary neoplastic lesion within the appendix: seven neuroendocrine neoplasms (37%), six sessile serrated lesions (32%), two colonic-type adenocarcinoma (11%), two goblet cell adenocarcinoma (11%) and two appendiceal mucinous neoplasms (11%). Additionally, one patient had a metastatic adenocarcinoma of pancreaticobiliary aetiology. Occult appendiceal neoplasm was higher than reported in the literature in our cohort. This would support appendicectomy as the treatment of choice for patients aged 40 years and over with acute appendicitis and caution against nonoperative management in this demographic.

Lessons learnt from a community-driven digital social connection pilot program for people living with dementia: A qualitative interview study with key stakeholders.

In response to COVID-19 and mandated physical distancing, a new digital social connection program was developed and implemented by the local community in a large regional town in western Victoria, Australia. This pilot program, the Digital Inclusion-Social Connections (DI-SC) program, aimed to support people living with dementia to use a digital device to access social connection activities. The objective of this study is to inform the local community implementing the DI-SC program of key stakeholder experience of DI-SC process and outcomes to support future development and potential translation of digital social connections programs for people living with dementia. Three semi-structured focus groups and two interviews were conducted with a total of fifteen participants. Data was transcribed verbatim and thematically analysed. Three main themes were identified describing factors as influencing the process and outcomes of the DI-SC program: understanding dementia; personal choice and control; and service planning and coordination. Six sub-themes were identified: matching capability; establishing a relationship; creating opportunities for different interactions; ownership of the device, program coordination and defining the volunteer digital mentor role. Key stakeholders perceived the DI-SC program as an acceptable way of supporting people living with dementia to engage in activities they found enjoyable promoting social connection with care partners and others. DI-SC program outcomes were impacted by inappropriate training and a lack of program coordination. The findings of this study may inform future development and implementation of digital social connection programs for vulnerable populations at risk of social isolation.

In the footsteps of Ohthere: biomolecular analysis of early Viking Age hair combs from Hedeby (Haithabu)

Hedeby was the largest town in the Viking North. Investigations have identified imports at the site from central and northern Scandinavia revealing long-distance connections. The chronology of this trade, however, is unclear. Here, the authors use a typological-biomolecular approach to examine connections during the early Viking Age. The application of ZooMS to an assemblage of antler combs, stylistically dated to the ninth century AD, reveals nearly all were made of reindeer antler. As most craft production waste from Hedeby comprises red deer antler, it is argued that these combs were manufactured elsewhere, perhaps hundreds of kilometres further north. The results have implications for understanding of production and regional connectivity in early medieval Scandinavia.

Effectiveness of a Community Empowerment Intervention to Improve Access to Pre-exposure Prophylaxis in Migrant Women Sex Workers: Protocol for a Mixed Methods Implementation Study.

The World Health Organization recommends pre-exposure prophylaxis (PrEP) for all populations at substantial risk of HIV infection. However, at-risk women very rarely use PrEP in France-this represents a critical issue among migrant women sex workers (MWSWs). Previous studies on PrEP use among women sex workers or migrants focused on individual or social determinants of motivation. However, operational studies in real-word settings using a holistic population approach to maximize PrEP adherence among MWSWs are lacking. FASSETS (ie, "Favoriser l'Accès à la Santé Sexuelle des Travailleuses du Sexe"; English: "facilitate the access to Sexual Health in women sex workers") is a participative, multilevel, mixed methods study aiming to improve global knowledge of and access to sexual health care and PrEP among MWSWs through targeted empowerment strategies. This study comprises several phases: (1) phase 1: an initial qualitative study combining semistructured interviews, informal interviews, and participative observations will be performed among MWSWs, local community nongovernmental organizations, and institutions providing sexual reproductive health services to identify the determinants of PrEP access among MWSWs and for respondent-driven sampling (RDS); (2) phase 2: the size of the hidden MWSW population is estimated in Marseille through capture-recapture (the RDS survey will serve as "recapture"); (3) phase 3: a longitudinal cohort will be formed through RDS to represent the MWSW population with a goal of 150 inclusions-this cohort will be followed up for 12 months, and sequential questionnaires exploring medical history; knowledge of sexual health, HIV, and sexually transmitted infections; migration route; and current living conditions will be administered at inclusion (month 0) and months 3, 6, and 12 to measure the following interventional phase's outcomes; and (4) phase 4: an interventional study with community empowerment actions about sexual health and PrEP will be conducted with community health workers; standardized questionnaires and semistructured interviews, observations, and focus groups will highlight MWSWs' experiences with empowerment resources, concerns about sexual health, and especially PrEP use or uptake, and we will evaluate whether and how community-adapted empowerment actions conducted by community health workers are effective in increasing access to sexual health, prevention and screening of sexually transmitted infections, and PrEP knowledge and access among MWSWs. Recruitment commenced on March 1, 2022. We estimate the follow-up period to end on September 30, 2023. This multiphase study will provide robust evidence about the magnitude of the MWSW population in Marseille (the second largest town in France) and their current conditions of living, access to and knowledge of sexual health, and PrEP access. Using a mixed methods analysis, we will investigate whether individual and collective community health empowerment approaches can facilitate access to PrEP and its initiation, use, and adherence in this vulnerable population. DERR1-10.2196/42844.

The Influence of Pandemic Lockdowns on Municipal Wastewater Quality as a Consequence of Not Discharging Food Waste from Restaurants

The use of food waste disposers in gastronomical facilities influences municipal wastewater composition. Ground food waste poses problems in the operation of the sewerage network and generates high electric energy consumption in wastewater treatment plants (WWTPs). This study aimed to determine, for five towns with a PE (Population Equivalent) ranging from 4000 to 220,000, the volumes of catering waste discharged to the WWTPs. The towns differed in the number of inhabitants, beds in hotels, and catering places. The calculations were undertaken based on data received from the operators of the WWTPs. The pollutant concentrations in 2019 were compared with data from the “pandemic” year—2020. The loads of catering waste entering the sewerage system in 2019 ranged from 32.7 to 1062 tons. In the town with the largest tourist base, the BOD (Biochemical Oxygen Demand) value in 2020 accounted for 62.3% of the 2019 value. In the largest town, the annual energy consumption for food waste treatment could be up to 2,539,770 kWh. If the waste was fermented, up to 1,376,650 m3 of methane could be obtained. There is a strong need to implement a collection system for food waste from catering facilities, and the fermentation of this waste to produce methane, which can be used for energy purposes.

Analysis of Public Perspective on Oil Fuel Prices Increase and Factors Affecting Intention to Visit Tourist Destination. Case Study: Ciletuh-Palabuhanratu UNESCO Global Geopark

Tourism is a phenomenon with a growing sector in many nations, including Indonesia. In 2022, Indonesia experienced a considerable increase in the price of oil fuel (BBM). The rise in oil fuel prices might impact people’s intentions to visit Indonesian tourist destinations. Ciletuh-Palabuhanratu UNESCO Global Geopark (CPUGGp) is one of Sukabumi, West Java, Indonesia’s natural tourism spots. Its location, which is quite far from larger towns such as as Bandung and Jakarta, may be a factor in people visiting in this situation. The purpose of this study is to examine the public various perspectives or points of view on the 2022 oil fuel prices increase in Indonesia, as well as the impact on everyday life and intention to visit tourist destination. This study employs 7Ps analysis, PESTLE, Porter’s Five Forces, and qualitative and quantitative customer analysis. Interviews with respondents were done as part of the qualitative research. In quantitative research, questionnaire was distributed with the requirement that respondents be Bandung City residents between the ages of 20 and 40. The variables included in the questionnaire are based on Theory of Planned Behavior (TPB) by Ajzen, which are Attitude, Perceived Behavioral Control, and Subjective Norms. The questionnaire data were then processed using the SmartPLS 3.2.9 program. According to the findings of this study, attitudes and perceived behavioral control have a positive and statistically significant effect on the intention to visit CPUGGp.

Circulation of Lassa virus across the endemic Edo-Ondo axis, Nigeria, with cross-species transmission between multimammate mice

ABSTRACT We phylogenetically compared sequences of the zoonotic Lassa virus (LASV) obtained from Mastomys rodents in seven localities across the highly endemic Edo and Ondo States within Nigeria. Sequencing 1641 nt from the S segment of the virus genome, we resolved clades within lineage II that were either limited to Ebudin and Okhuesan in Edo state (2g-beta) or along Owo-Okeluse-Ifon in Ondo state (2g-gamma). We also found clades within Ekpoma, a relatively large cosmopolitan town in Edo state, that extended into other localities within Edo (2g-alpha) and Ondo (2g-delta). LASV variants from M. natalensis within Ebudin and Ekpoma in Edo State (dated approximately 1961) were more ancient compared to those from Ondo state (approximately 1977), suggesting a broadly east-west virus migration across south-western Nigeria; a pattern not always consistent with LASV sequences derived from humans in the same localities. Additionally, in Ebudin and Ekpoma, LASV sequences between M. natalensis and M. erythroleucus were interspersed on the phylogenetic tree, but those from M. erythroleucus were estimated to emerge more recently (approximately 2005). Overall, our results show that LASV amplification in certain localities (reaching a prevalence as high as 76% in Okeluse), anthropogenically-aided spread of rodent-borne variants amidst the larger towns (involving communal accommodation such as student hostels), and virus-exchange between syntopic M. natalensis and M. erythroleucus rodents (as the latter, a savanna species, encroaches southward into the degraded forest) pose perpetual zoonotic hazard across the Edo-Ondo Lassa fever belt, threatening to accelerate the dissemination of the virus into non endemic areas.

Identifying care fragmentation in the management of non-metastatic muscle-invasive bladder cancer.

e13527 Background: Measuring care fragmentation facilitates exploration of breakdowns in cancer care delivery that may impact quality of care and patient outcomes. Bladder cancer often requires a multimodal approach of surgery, chemotherapy and radiation, increasing the risk of fragmented care. This study assesses the extent of care fragmentation across different inpatient facilities and examines patient characteristics associated with inpatient care fragmentation. Methods: We adapt the modified Herfindahl-Hirschman market concentration index to construct a Fragmentation Index (FI) capturing the distribution of a patient’s care across inpatient facilities. We calculate FI for the 15 months following diagnosis for non-metastatic muscle-invasive bladder cancer (MIBC) patients who underwent radical cystectomy from 2010-2016 and had at least 2 admissions during the study period. We use Pennsylvania Cancer Registry data linked to statewide facility discharge records to estimate patient-level multivariable regression models of the relationship between FI and patient demographics, disease features, rurality, area deprivation index (ADI), payer, and Commission on Cancer hospital (CoC-H) accreditation status. Results: Of 965 patients, 87.3% (n = 842) lived in urban areas, 8.9% in large towns and 3.8% rural. Approximately 8% had Medicaid and 5.7% had uninsured or unknown payer status. A majority (64%; n = 614) were age 60-79; 76% were men and 92% non-Hispanic White; 19.5% (n = 188) had T4 disease and 25% (n = 239) received neoadjuvant chemotherapy. Almost half of patients (45.3%; n = 437) had an FI of 0, indicating all admissions were at the same hospital. The mean FI was 0.254 for the total cohort and 0.464 for patients with FI > 0. Residency in a large town or rural area was associated with 0.59 (CI 0.003—0.114) and 0.14 (CI 0.060—0.220) higher FI relative to urban areas. T4 disease was associated with 0.063 higher FI (CI 0.019—0.107) relative to <T2 disease. Factors associated with lower FI included Non-White race (-0.092, CI -0.151 – -0.033) and no admissions to CoC-H (-0.138, CI -0.182 – -0.095) relative to patients admitted to at least 1 CoC-H. Patients never admitted to a CoC-H (n = 134) mostly lived in urban areas (88%) and 49% had Medicare insurance: they were disproportionately from the most disadvantaged ADI quartile in the cohort (37.3%). Conclusions: Our findings highlight that many MIBC patients receive inpatient care across at least two different hospitals. Advanced disease and patient residence in non-urban areas are associated with greater fragmentation of inpatient care. Patients who never received care at a CoC hospital experienced less fragmentation but were more likely to be relatively economically disadvantaged. Future research will investigate relationships between fragmentation and clinical outcomes to inform policy and clinical strategies aimed at optimizing patterns of care.

Deep learning-based multi-target regression for traffic-related air pollution forecasting

Traffic-related air pollution (TRAP) remains one of the main contributors to urban pollution and its impact on climate change cannot be overemphasised. Experts in developed countries strive to make optimal use of traffic and air quality data to gain valuable insights into its effect on public health. Over the years, the research community has developed advanced methods of forecasting traffic-related pollution using several machine learning methods albeit with persistent accuracy and insufficient data challenges. Despite the potentials of emerging techniques such as multi-target deep neural network to achieve optimal solutions, they are yet to be fully exploited in the air quality space due to their complexity and unavailability of the right training data. It is to this end that this study investigates the impact of integrating an updated data set including road elevation, vehicle emissions factor and background maps with traffic flow, weather and pollution data on TRAP forecasting. To explore the robustness and adaptability of our methodology, the study was carried out in one major city (London), one smaller city (Newport) and one large town (Chepstow) in the United Kingdom. The forecasting task was modelled as a multi-target regression problem and experiments were carried out to predict NO2,PM2.5 and PM10 concentrations over multiple timesteps. Fastai’s tabular model was used alongside prophet’s time-series model and scikit-learn’s multioutputregressor for experimentation with fastai recording the overall best performance. Statistical tests run using Friedman and Wilcoxon test also revealed the significance of the fastai model with a p-values < 0.05. Finally, a model explanation tool was then used to reveal the most and least influential features from the newly curated data set. Results showed traffic count and speed were part of the most contributing features. This result demonstrates the impact of these and other introduced features on TRAP forecasting and will serve as a foundation for related studies.

Does Geography Play a Role in the Receipt of End-of-Life Care for Advanced Cancer Patients? Evidence from an Australian Local Health District Population-Based Study.

Objectives: To assess the influence of geographic remoteness on health care utilization at end of life (EOL) by people with advanced cancer in a geographically diverse Australian local health district, using two objective measures of rurality and travel-time estimations to health care facilities. Methods: This retrospective cohort study examined the association between rurality (using the Modified Monash Model) and travel-time estimation, and demographic and clinical factors, with the receipt of >1 inpatient and outpatient health service in the last year of life in multivariate models. The study cohort comprised of 3546 patients with cancer, aged ≥18 years, who died in a public hospital between 2015 and 2019. Results: Compared with decedents from metropolitan areas, decedents from some rural areas had higher rates of emergency department visits (small rural towns: aRR 1.29, 95% CI: 1.07-1.57) and ICU admissions (large rural towns: aRR 1.32, 95% CI: 1.03-1.69), but lower rates of acute hospital admissions (large rural towns: aRR 0.83, 95% CI: 0.76-0.90), inpatient palliative care (PC) (regional centers: aRR 0.85, 95% CI: 0.75-0.97), and inpatient radiotherapy (lowest in small rural towns: aRR 0.07, 95% CI: 0.03-0.18). Decedents from rural and regional centers had lower rates of outpatient chemotherapy and radiotherapy use, yet higher rates of outpatient cancer service utilization (p < 0.05). Shorter travel times (10-<30 minutes) were associated with higher rates of inpatient specialist PC (aRR 1.48, 95% CI: 1.09-1.98). Conclusions: Reporting on a series of inpatient and outpatient services used in the last year of life, measures of rurality and travel-time estimates can be useful tools to estimate geographic variation in EOL cancer care provision, with significant gaps uncovered in inpatient PC and outpatient service utilization in rural areas. Policies aimed at redistributing EOL resources in rural and regional communities to reduce travel times to health care facilities could help to reduce regional disparities and ensure equitable access to EOL care services.

Biographies of a Reformation: Religious Change and Confessional Coexistence in Upper Lusatia, 1520–1635, by Martin Christ

In this engaging and award-winning book, Martin Christ examines the development of the Reformation in a collection of six towns that formed the Lusatian League in the Kingdom of Bohemia. The themes of toleration and coexistence remain a fruitful area of research in early modern European history and these form the basis for Christ’s volume on Upper Lusatia. Historiography regarding tolerance and intolerance is becoming increasingly diverse and it is clear that generalisations do not recognise the nuanced nature of confessional coexistence and the lived experience of religious plurality. Christ’s volume is a welcome addition to this scholarship, and over the course of eight case-studies the book examines how Catholic and Lutheran populations negotiated with each other, the established Catholic institutions, and the Catholic kings of Bohemia during the sixteenth and early seventeenth centuries. Christ identifies three ways in which the monograph deepens our knowledge of the Reformation in this period. First, Upper Lusatia is an underexplored region. When considering themes pertaining to coexistence, scholars have tended to focus on larger towns and the significant role of smaller towns and rural areas is overlooked. Secondly, Christ’s chronology of more than a century not only shows how men and women of different beliefs lived side by side but also sheds light on how they influenced ‘each other’s practices, spaces and identities’ (p. 15). Finally, while toleration was extended to some religious groups, Christ demonstrates that this was neither universally applied nor consistently accepted. For instance, Anabaptists and Calvinists were not tolerated, while Schwenckfelders and those perceived to be crypto-Calvinists could find a limited degree of toleration in some, but not all, areas.

Out of the Land of Ice and Fire: Icelandic Immigrants in the Midlands During the Fifteenth Century

ABSTRACT English towns during the medieval period have, in recent years, become increasingly recognised as places of diversity, with some of their inhabitants born in several European regions. Studies of immigration have, however, focussed on port towns and large towns and with an emphasis on those who originated from mainland Europe. This study examines, for the first time, the intriguing communities of Icelanders who lived in the Midlands and asks what these individuals can tell us about England’s relations with Iceland. Up to four Icelanders lived in Nottingham and up to three in Coventry at any one time, serving mercers who may have traded stockfish and fish liver oil, which were sold in both towns. In exchange, Nottingham produced goods including alabaster altar pieces, which were given homes in churches in Iceland’s coastal towns.