Large Metropolitan Areas Research Articles

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.

Linking Jakarta’s Typical Indonesian Urban Context, Air Pollution, and Child Health

Introduction: Jakarta, the second largest metropolitan area in the world after Tokyo, has experienced rapid development that may not have adhered to the established urban planning regulations. These have caused multiple urban health risk issues, such as high private transportation use, coal-powered plants, lack of green spaces, and industrialization. All of regulations have contributed to the high level of air pollutants in Jakarta Metropolitan Area (JMA). Air pollution is one of the most significant health problems in the world and children are especially exposed confirmed. The fact that children’s organs are still in growth and development phase means that they are especially susceptible to the pollutants entering the body. Existing data showed that the air pollutants in JMA, specifically PM2.5, SO2, NO2, and CO are categorized as moderate to high compared to the international standards, therefore, could potentially become a contributing factor to the mortality and morbidity of children living in Jakarta. Conclusion: More aggressive approaches are required to tackle air pollution issues, especially because the United Nations News. UN General Assembly declares access to clean and healthy environment a universal human right. 2022. Available from: https://news.un.org/en/story/2022/07/1123482.

Microplastics are ubiquitous and increasing in soil of a sprawling urban area, Phoenix (Arizona)

Microplastics are environmental contaminants that have been extensively studied in marine and aquatic environments; terrestrial ecosystems, where most microplastics originate and have the potential to accumulate, typically receive less attention. This study aims to investigate the spatial and temporal soil concentrations of microplastics in a large desert metropolitan area, the Central Arizona–Phoenix Long-Term Ecological Research (CAP-LTER) area. Soil samples from the Ecological Survey of Central Arizona (ESCA) surveys (2005 and 2015) were leveraged to study spatial distributions and the temporal change of microplastic abundances. The temporal soil microplastics data were supplemented by microplastics deposition fluxes in a central location within the area (Tempe, AZ) for a period of one year (Oct 5th, 2020 to Sept 22nd, 2021). Samples were processed and microplastics were counted under an optical microscope to obtain quantitative information of their distribution in soil. Results for the spatial variation of the microplastic abundances in soil samples in Phoenix and the surrounding areas of the Sonoran Desert from 2015 depict microplastics as ubiquitous and abundant in soils (122 to 1299 microplastics/kg) with no clear trends between different locations. Microplastics deposition fluxes show substantial deposition in the local area (71 to 389 microplastics/m2/day with an average deposition flux of 178 microplastics/m2/day) but the role of resuspension and redistribution by dust storms to deposition may contribute to the unclear spatial trends. Comparison between the 2005 and 2015 surveys show a systematic increase in the abundance of microplastics and a decrease in microplastics size. Micro-Raman spectroscopy identified a variety of plastics including PE, PS, PVC, PA, PES and PP. However, a majority of microplastics remained chemically unidentifiable. Polyethylene was present in 75 % of the sampling sites and was the most abundant polymer on average in all soil samples.

Understanding Factors Contributing to Vaccine Hesitancy in a Large Metropolitan Area.

Vaccine hesitancy has become a major global concern, leading to a significant decrease in the vaccination rate, with the World Health Organization recognizing it as one of the top ten threats to public health. Moreover, the health cost generated is evaluated to be 27 billion dollars per year in the US alone. To investigate the association between demographic variables and knowledge, attitudes, and behaviours related to vaccination, a survey-based cross-sectional study was conducted with 1163 individuals. Three models were used to perform a multiple linear regression analysis. In Model I, knowledge about vaccinations was found to be associated with smoking habits, education, and marital status. In Model II, attitudes towards vaccinations were significantly associated with sex, smoking habits, education, marital status, and knowledge. In Model III, behaviours related to vaccination were associated with sex, smoking habits, having children, knowledge, and attitudes. One potential solution to improve behaviours related to vaccinations in the general population is to implement specific public health programs, which can be a cost-effective intervention. This study provides valuable insights into the determinants of knowledge, attitudes, and behaviours related to vaccinations in the general population.

What Are the Trends in the Utilization of Orthopaedic Advanced Practice Professionals? A Large Database Medicare Study

Background: Advanced practice professionals (APPs), such as physician assistants (PAs) and nurse practitioners (NPs), are expected to have an increasing role in delivering high-quality orthopaedic care in the coming years. Our analysis aimed to determine the current proportion and geographic distribution of APPs in orthopaedics. In addition, we predicted future growth into 2025. Methods: Our analysis was a retrospective, large national database study evaluating services provided by APPs from 2014 to 2019 using the Medicare Provider Utilization and Payment Data prepared by the Centers for Medicare &amp; Medicaid Services (CMS). NPs and PAs were recognized by provider type and aggregated to form the APP group for analysis. Mann-Kendall trend tests were used to evaluate changes in the number of each provider type. Poisson regression will be used to predict the expected number of APPs in the field up to the year 2025. Results: From 2014 to 2019, there was a 34.36% increase in the number of orthopaedic APPs (5,480-7,363), compared with a 5.37% increase in orthopaedic surgeons (22,518-23,728). APPs were located in predominately large metropolitan areas (96%), followed by small metropolitan (3.6%) and rural areas (0.4%). Using data from our study period, we projected that by 2025, there will be 10,484 APPs in orthopaedic surgery [95% Confidence Interval (CI): 9,004-11,964 providers]. This represents an 84% increase over the decade between 2015 and 2025. Conclusion: Our analysis demonstrated that the volume of established patient visits and various nonsurgical services provided by APPs in orthopaedic surgery continues to grow. The number of APPs and surgeons in orthopaedics is increasing, but the proportion of APPs choosing orthopaedics as a speciality is on the decline. Furthermore, we found a greater proportion of PAs in orthopaedics than NPs. Because the demand for services for orthopaedic surgery continues to grow, APPs may serve as one possible solution to increase access to orthopaedic care, and additional programs should be developed to improve the educational access for APPs to train in orthopaedics.

“I Thought It Was a Little Risky”: Transfer Barriers for Students with Scholarship Support

ABSTRACT A study of hidden risks, anxieties and barriers to STEM student transfer from community college to a large, comprehensive university is presented. This qualitative study employed a thematic analysis of student responses to a semi-structured interview that asked students about their hesitancy to transfer to a 4-year institution. Participants included students enrolled in a collaborative NSF-sponsored S-STEM scholarship project between three community colleges and a large public university (all in the same large metropolitan area). The project included elements that are well documented in the literature to encourage transfer. These include advising visits by university staff, clear articulation pathways, scholarship support to assist with costs, peer and near peer mentoring opportunities, and cohort-building activities between campuses and on each individual campus. Transfer rates in this group were higher, but still many students with declared interest in transferring did not transfer on time or at all. The authors identified numerous hidden risks and barriers to transfer, in addition to the well-known ones found in the literature. These include additional academic, financial, social, logistical and external/family related barriers. A theme common to many of these barriers was complex bureaucratic processes and events outside of student’s direct control. Many student comments highlighted the importance of in-person connections, mentoring and advising.

Atmospheric Transport of Adulticides Used to Control Mosquito Populations across an Urban Metropolitan Area

Pesticides registered with the U.S. EPA for mosquito control are called adulticides and are released directly into the atmosphere as aerosols to target flying mosquitos. This adulticide application approach is different from traditional (agricultural) pesticide applications, yet the fate and transport of adulticides in large metropolitan areas is largely unknown. The Houston Metropolitan Area encompasses eight counties, many of which require county-level mosquito control programs that utilize adulticides. Malathion and permethrin are the primary adulticides used by Harris County (HC) in Houston, TX, USA. Houston, like many other metropolitan areas, has an urban atmosphere supporting the oxidation of both gas and particle phase pollutants. During the summer mosquito season of 2016, we collected atmospheric total suspended particulate matter (PM) samples at Jones Forest (JF), located in Montgomery County (directly north of HC) to investigate the atmospheric transport and oxidation of adulticides in an urban atmosphere. Despite HC alternating the adulticide treatment schedule, we measured permethrin, malathion, and malaoxon (oxidation product of malathion), throughout the sampling campaign. These consistent measurements, in conjunction with 12 h backward trajectories, support the conclusion that JF is influenced by other county-level mosquito-control programs and agricultural pesticide use. This cross-county transport may impact adulticide effectiveness by supporting pesticide resistance in mosquito populations due to repeated exposures to pesticides. This study highlights the need for mosquito control collaborations between counties, especially in areas of urban expansion overlapping with agricultural activities.

Multiple Case Study Exploring the Impact of Visitor Restrictions in Hospitals on Childbirth Support during the COVID-19 Pandemic.

Childbirth is a life-changing experience for new mothers, birth partners, and families. The COVID-19 pandemic restricted laboring mothers' access to support in hospitals through visitor restrictions. The goal of this research was to describe childbirth support in hospitals during the COVID-19 pandemic. A qualitative study using a multiple case study design describes childbirth support in hospitals during the COVID-19 pandemic from the perspectives of the new mother, birth partner, and obstetric hospital staff, including doulas, nurses, and obstetric providers. The setting was a large metropolitan area in South Texas. Sixteen participants were interviewed including four new mothers, three birth partners, three doulas, three obstetric nurses, and three obstetric providers. Themes that emerged from the data include: under a spotlight, unmet expectations, discovering serenity, and quality childbirth support. During the pandemic, new mothers and birth partners experienced fewer distractions, better communication with the hospital staff, and had better opportunities to bond with the newborn during labor and after birth, but did report missing the presence of their family and friends. Doulas, obstetric nurses, and obstetric providers found they were able to provide better quality and safer care to laboring mothers and birth partners.

Theory, Measurement, and Psychometric Properties of Risk and Protective Factors for Drug Misuse Among Adolescents Living on or near the Cherokee Nation Reservation

A team of tribe-based behavioral health specialists and university-based researchers partnered to implement a cluster randomized trial for the prevention of drug misuse among adolescents attending public high schools on or near the Cherokee Nation Reservation in northeastern Oklahoma. The conceptual framework, which guided intervention and measurement design for the trial, incorporates indigenous knowledge and worldviews with empirically-based frameworks and evidence-based practices. Our goal is to serve multicultural youth, families, and schools and to provide a model of effective strategies for wide dissemination. This paper presents the conceptual model, survey design, and psychometric properties of scales to measure risk and protective factors for substance misuse. The survey includes common measures drawn from the PhenX Toolkit on substance use patterns—adolescent module, measured with standard items from the Monitoring the Future (MTF) study and items harmonized across ten NIH-funded research projects with diverse samples of youth. In our trial, brief (20-minute) self-report questionnaires were administered to 10th grade students in fall 2021 (n = 919, 87% response rate) and spring 2022 (n = 929, 89% response rate) in 20 participating high schools on or near the Cherokee Nation Reservation. The sample primarily fell into the following three categories of race/ethnicity identification: only American Indian (AI-only, 29%), AI and another race/ethnicity (AI+, 27%), and only White (35%). Results indicate that risk and protective factor scales were reliably and validly measured with 10 scales and 10 subscales. There were minimal differences between youth who identified as AI only, AI+, and White only, especially for the main scales, which provide confidence in the interpretation of trial outcomes across demographic groups. Study results may not be generalizable to AI/AN youth who live and attend school in more homogenous reservation lands, or alternatively, live in large diverse metropolitan areas.

Insights from a Cross-Sectional Study on Knowledge, Attitudes and Behaviors Concerning Antibiotic Use in a Large Metropolitan Area: Implications for Public Health and Policy Interventions.

The overuse and inappropriate use of antibiotics pose a grave threat to public health, contributing significantly to the accelerated development of antimicrobial resistance (AMR) and increased rates of morbidity and mortality, making it a leading cause of death globally. To examine the relationship between demographic variables and knowledge, attitudes, and behaviors concerning antibiotic use, a survey-based cross-sectional study was conducted involving 1158 individuals. The questionnaire included two sections: in the first section, participants' socio-demographic characteristics were analyzed; the second investigated knowledge, attitudes, and behaviors concerning antibiotics utilization using a total of 36 questions. Descriptive statistics were used, and then a multiple linear regression analysis (MLRA) using three models was carried out. In Model I, knowledge about antibiotics exhibited correlations with smoking habits and educational attainment. In Model II, attitudes were significantly associated with gender, smoking habits, age, education, relationship status, and knowledge. In Model III, behaviors related to antibiotics were correlated with educational attainment, having children, knowledge, and attitudes. Implementing tailored public health programs could be a cost-effective intervention to enhance behaviors associated with antibiotic use in the general population. This study offers valuable insights into the determinants of knowledge, attitudes, and behaviors regarding antibiotics in the general population.

Disabled People or Their Support Persons' Perceptions of a Community Based Multi-Sensory Environment (MSE): A Mixed-Method Study.

Multi-sensory environments (MSEs) are specialised spaces purposely designed to stimulate the senses, whilst providing a calming and relaxing environment for leisure and enjoyment, predominantly intended for disabled people. Most MSEs are in institutions, hospitals, or educational settings, with a few in community-based settings. We explored disabled users' experiences of a community based MSE in a large metropolitan area in New Zealand, with a view to expanding access to MSE-type environments within the area. We used a convergent mixed method design with a web-based electronic survey (e-survey; n = 105), as well as semi-structured interviews (n = 14) with disabled MSE users (adults and children), who were supported, where necessary, by their support person/s. We collected the MSE users' demographics, frequency of use with respect to age, disability, and ethnicity, and experiences of the room, equipment, and accessibility. The participants and their support persons' perspectives about their experiences of using the MSE were represented by four themes: (i) Self-determination; (ii) Enhancing wellbeing opportunities; (iii) the MSE itself; (iv) Accessibility. While the MSE was considered positively, the MSE experience could be enhanced by addressing access challenges and broadening the scope of equipment to improve the usability and make it a more inclusive environment for all.