London Metropolitan Area Research Articles

Did the First COVID-19 National Lockdown Lead to an Increase in Domestic Abuse in the U.K.'s Capital City of London?

On March 23, 2020, the United Kingdom went into national lockdown to stop the spread of COVID-19. In this paper, we examine whether a policy aimed at minimizing the health consequences of the pandemic had unintended negative consequences for domestic abuse. Using data from the Metropolitan Police in England we estimate the impact of lockdown on domestic abuse in the 32 boroughs that make up the London metropolitan area. Using a before and after approach, and controlling for other factors, we show an increase in the probability of being a victim of domestic abuse during lockdown similar in magnitude to the increase experienced over the Christmas holidays. However, the overall picture masks inequalities across groups: with women, younger and older people, and people of Asian, Arab, and Middle Eastern ethnicity subject to the highest increases, reflecting vulnerabilities and existing inequalities. Of the domestic abuse-related crimes, it is the most violent crimes that saw the greatest increases during lockdown. Once lockdown restrictions are eased, rates decline but remain slightly higher than prior to lockdown up to 3 months later. The results present a clear message for policy makers: a policy adopted to alleviate one problem, even in times of crisis, must factor in the impact this may have in other areas. Failure to do so in this situation, despite existing evidence linking domestic abuse to stress, confinement, and crisis situations prior to lockdown, has resulted in an increase in domestic violence in the U.K.'s capital city, during lockdown and beyond.

Comparison of Mothership Versus Drip‐and‐Ship Models for Endovascular Treatment of Basilar Artery Occlusion in the London Metropolitan Area

Background To date it is uncertain whether the drip‐and‐ship (DS) model (transport to the nearest primary stroke centers) or the mothership (MS) model (direct transportation to the comprehensive stroke center) is the best prehospital stroke system of care to deliver endovascular thrombectomy in patients with basilar artery occlusion. In the present analysis, we aim to investigate the impact of MS versus DS model in patients with basilar artery occlusion treated with endovascular thrombectomy in the London metropolitan area. Methods This is a multicenter observational, investigator‐initiated, retrospective study comparing outcomes (functional independence, defined as modified Rankin scale scores of 0 through 2, the rate of successful reperfusion, and the rate of complications postprocedure) in DS versus MS stroke patients with basilar artery occlusion admitted in 5 thrombectomy capable centers in London (United Kingdom). Results Of 113 patients, 38 (33.6%) patients were MS and 75 (66.4%) were DS. Between the 2 groups we did not observe statistically significant differences for most of the clinical characteristics. There was a significant difference regarding the rate of functional independence at 3 months between the MS and DS groups, respectively 47.4% versus 36% ( P = 0.047). Rates of complications postprocedure and successful recanalization did not differ between the 2 groups. Multivariable regression analysis demonstrated that MS model was an independent predictor of functional independence at 90 days (odds ratio [OR] 1.17; [95% CI, 1.11–1.26]; P = 0.003 and independent negative predictor of postoperative complications (OR, 0.39; [95% CI, 0.16–0.98]; P = 0.045). Conclusion Our study showed that MS model was a predictor of functional independence at 3 months and reduced risk of postoperative complications post‐endovascular thrombectomy in patients with basilar artery occlusion in a metropolitan area.

Unveiling the Spatial Distribution of Heat Demand in North-West-Europe Compiled with National Heat Consumption Data

Space and water heating for residential and commercial buildings amount to a third of the European Union’s total final energy consumption. Approximately 75% of the primary energy is still produced by burning fossil fuels, leading to high greenhouse gas emissions in the heating sector. Therefore, policymakers increasingly strive to trigger investments in sustainable and low-emission heating systems. This study forms part of the “Roll-out of Deep Geothermal Energy in North-West-Europe”-project and aims at quantifying the spatial heat demand distribution in the Interreg North-West-Europe region. An open-source geographic information system and selected Python packages for advanced geospatial processing, analysis, and visualization are utilized to constrain the maps. These were combined, streamlined, and optimized within the open-source Python package PyHeatDemand. Based on national and regional heat demand input data, three maps are developed to better constrain heat demand at a high spatial resolution of 100 m × 100 m (=1 ha) for the residential and commercial sectors, and for both together (in total). The developed methodology can not only be applied to transnational heat demand mapping but also on various scales ranging from city district level to states and countries. In addition, the workflow is highly flexible working with raster data, vector data, and tabular data. The results reveal a total heat demand of the Interreg North-West-Europe region of around 1700 TWh. The spatial distribution of the heat demand follows specific patterns, where heat demand peaks are usually in metropolitan regions like for the city of Paris (1400 MWh/ha), the city of Brussels (1300 MWh/ha), the London metropolitan area (520 MWh/ha), and the Rhine-Ruhr region (500 MWh/ha). The developed maps are compared with two international projects, Hotmaps and Heat Roadmap Europe’s Pan European Thermal Atlas. The average total heat demand difference from values obtained in this study to Hotmaps and Heat Roadmap Europe is 24 MWh/ha and 84 MWh/ha, respectively. Assuming the implementation of real consumption data, an enhancement in spatial predictability is expected. The heat demand maps are therefore predestined to provide a conceptual first overview for decision-makers and market investors. The developed methods will further allow for anticipated mandatory municipal heat demand analyses.

The spread of COVID-19 in London: Network effects and optimal lockdowns

We generalise a stochastic version of the workhorse SIR (Susceptible-Infectious-Removed) epidemiological model to account for spatial dynamics generated by network interactions. Using the London metropolitan area as a salient case study, we show that commuter network externalities account for about 42% of the propagation of COVID-19. We find that the UK lockdown measure reduced total propagation by 44%, with more than one third of the effect coming from the reduction in network externalities. Counterfactual analyses suggest that: (i) the lockdown was somehow late, but further delay would have had more extreme consequences; (ii) a targeted lockdown of a small number of highly connected geographic regions would have been equally effective, arguably with significantly lower economic costs; (iii) targeted lockdowns based on threshold number of cases are not effective, since they fail to account for network externalities.

Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study.

BackgroundPrior to the COVID-19 pandemic, in-clinic visits were the standard of care for pediatric physicians and surgeons at our center. At the pandemic onset, web-based care was adopted at an unprecedented scale and pace.ObjectiveThis descriptive study explores the web-based care experience of pediatric physicians and surgeons during the pandemic by determining factors that supported and challenged web-based care adoption.MethodsThis study took place at the Children’s Hospital at London Health Sciences Centre, a children’s hospital in London, Ontario, Canada, which provides pediatric care for patients from the London metropolitan area and the rest of Southwestern Ontario. The Donabedian model was used to structure a web-based survey evaluating web-based care experience, which was distributed to 121 department-affiliated pediatric physicians (including generalists and subspecialists in surgery and medicine). Recruitment occurred via department listserv email. Qualitative data were collected through discrete and free-text survey responses.ResultsSurvey response rate was 52.1% (63/121). Before the pandemic, few physicians within the Department of Paediatrics used web-based care, and physicians saw <10% of patients digitally. During March-May 2020, the majority transitioned to web-based care, seeing >50% of patients digitally. Web-based care use in our sample fell from June to September 2020, with the majority seeing <50% of patients digitally. Telephone and Ontario Telemedicine Network were the platforms most used from March to September 2020. Web-based care was rated to be convenient for most providers and their patients, despite the presence of technical difficulties. Challenges included lack of physical exam, lower patient volumes, and poor patient digital care etiquette. Regardless of demographics, 96.4% (116/121) would continue web-based care, ideally for patients who live far away and for follow-ups or established diagnoses.ConclusionsTransition to web-based care during COVID-19 was associated with challenges but also positive experiences. Willingness among pediatricians and pediatric surgeons to continue web-based care was high. Web-based care experiences at our center could be improved with patient education and targeting select populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for web-based care.

Understanding the roles of rail stations: Insights from network approaches in the London metropolitan area

In strategic transport planning, rail stations play different roles at different scales, particularly in large cities and metropolitan regions, where movement structure shows polycentric patterns. However, there is a general lack of evidence-based studies investigating the relative network roles of rail stations. Therefore, this paper aims to explore rail stations' roles within and beyond metropolitan communities in London. Drawing on the Transport for London's newly released NUMBAT passenger origin-destination data, we unravel the travel structure and identify the stations' roles through network methods, community detection and Z-P scores. Our research has three results: First, London's passenger movement network can be subdivided into seven communities. The majority of stations within the same communities are geographically localised with few exceptions. Second, stations play distinct roles in handling the patterns of movement at different scales. Typically, there exists a set of stations that are significant for connecting between metropolitan communities, because the disruption of those stations will have a greater impact on overall network efficiency and affect a larger and more diverse group of passengers. Third, a classification of rail stations is developed based on stations' commitment at two scales. This classification allows planners to have a finer level of understanding of the network role of the stations and thus develop and adjust tailored (re)development strategies.

The Spread of COVID-19 in London: Network Effects and Optimal Lockdowns

We generalise a stochastic version of the workhorse SIR (Susceptible-Infectious- Removed) epidemiological model to account for spatial dynamics generated by network interactions. Using the London metropolitan area as a salient case study, we show that commuter network externalities account for about 42% of the propagation of COVID-19. We find that the UK lockdown measure reduced total propagation by 57%, with more than one third of the effect coming from the reduction in network externalities. Counterfactual analyses suggest that: i) the lockdown was somehow late, but further delay would have had more extreme consequences; ii) a targeted lockdown of a small number of highly connected geographic regions would have been equally effective, arguably with significantly lower economic costs; iii) targeted lockdowns based on threshold number of cases are not effective, since they fail to account for network externalities.

Delineating the perceived functional regions of London from commuting flows

Well-connected urban areas defined by different types of urban flow define the boundaries reflecting the relatedness of places in terms of their functionality. Yet, attempts to define cities and their communities based on aggregated data normally neglect the inherent differences between different groups of people. Based on the disaggregated flow data, this study detects community structures in the London Metropolitan Area perceived by different occupations by using the multi-level modularity optimisation algorithm. The results show the difference between our perceptions of different functional regions across occupations. The higher managerial groups have a more global sense than the lesser managerial occupations who have more segmented and local perceptions regarding their functional regions. This is well illustrated by the shift of the documented modularity scores across groups. Although the transport network and various natural boundaries do play a part in the locational patterns of the derived communities, it is found that the relative self-containment of functional regions is interpreted differently by different occupations. This kind of representation is of great value in advancing our knowledge regarding how different places are perceived by different occupations with all the implications for future commuting that future planning for housing and employment will bring.

Disruptive Technology as an Enabler of the Circular Economy: What Potential Does 3D Printing Hold?

Three-dimensional (3D) printing has been widely identified as an emerging disruptive technology. This study examines how this technology could enable the circular economy by disrupting the existing materials value chain. Specifically, could this novel technology be used to locally manufacture new goods from local sources of recycled plastic waste, thereby offering benefits for the efficiency and effectiveness of materials cycling? This article uses the London metropolitan area—where system conditions already exist in the form of material flows, technology policy, and facilities—in order to assess 3D printing’s viability as an enabler of a circular economy at the local level. An analysis of stakeholder perceptions identifies economic, technological, social, organizational, and regulatory barriers to mainstream implementation, and their likelihood of being overcome.

Rethinking the law and politics of democratic police accountability

This paper evaluates the work and impact of a number of Police and Crime Commissioners (PCCs) in England and Wales and attempts to refocus public discourse and scrutiny on their police and crime plans as a key prism through which their performance should be measured. Drawing upon the literature published by various PCCs, the Stevens Commission, the Home Affairs Committee and numerous academics, the paper will argue that a major reform of democratic police accountability in England and Wales is needed. Due to the often voluminous and piecemeal nature of the documents published on the PCCs’ websites, the textual analysis is limited to the police and crime plans for Greater Manchester, the West Midlands and the London Metropolitan area.

The daily dynamic potential accessibility by car in London on Wednesdays

ABSTRACTThe map presented in this paper shows the effect of congestion on daily accessibility in the London metropolitan area on Wednesdays. Because of its dynamic nature, it is challenging to both calculate the effects of this phenomenon and to represent it clearly on simple maps. Although we can use many traditional techniques for this purpose, they are usually static, and they may lose some essential information on the effects studied. In this paper, we used two cartographic techniques rarely used in accessibility studies – cartograms and 3D maps, which we believe can achieve a more striking representation in static and animations of both the traffic-induced spatial distortion and the accessibility levels obtained. The results are presented in two animated maps and some snapshots of them – static maps. Both types of maps reinforce each other: Together, they can properly show the direct space–time link between congestion and accessibility, and can, therefore, give a more detailed overview of the consequences of this phenomenon.

Poor sleep health and its association with mental health, substance use, and condomless anal intercourse among gay, bisexual, and other men who have sex with men

ObjectivesThe purpose of this study was to evaluate the prevalence of poor sleep health (ie, poor sleep quality and short sleep duration) in a sample of men who have sex with men (MSM). In addition, this study examined whether poor sleep health was associated with depressive symptoms, substance use, and sexual risk behaviors in this sample. DesignCross-sectional survey. ParticipantsBroadcast advertisements were placed on a popular smartphone application for MSM in January 2016 to recruit users in the London metropolitan area (n=202) to complete a Web-based survey, which included validated measures of sleep quality and duration. MeasurementsPoor sleep quality was defined based on self-report as very or fairly bad. Short sleep duration was defined as less than 7 hours each night. Regression models were used to assess associations between sleep variables and self-reported depressive symptoms, substance use, and sexual risk behaviors. ResultsAbout one-third (34.6%) of the respondents reported poor sleep quality and almost half (43.6%) reported sleeping less than 7 hours every night. Several poor sleep health variables were independently associated with depressive symptoms, substance use (eg, use of alcohol or marijuana), and condomless anal intercourse. For example, typical nightly sleep duration of less than 7 hours was associated with condomless receptive anal intercourse with a higher number of sexual partners (incidence rate ratio, 2.65; 95% confidence interval: 1.63-4.30; P<.001). ConclusionSleep health promotion interventions should be developed for MSM, which may promote positive mental health as well as reduce substance use and sexual risk behaviors in this population.

Characteristics of the Immigration Path and Residential Location of Korean Immigrants in London Metropolitan Area

Characteristics of the Immigration Path and Residential Location of Korean Immigrants in London Metropolitan Area

Geographically varying associations between personality and life satisfaction in the London metropolitan area

Residential location is thought to influence people's well-being, but different individuals may value residential areas differently. We examined how life satisfaction and personality traits are geographically distributed within the UK London metropolitan area, and how the strength of associations between personality traits and life satisfaction vary by residential location (i.e., personality-neighborhood interactions). Residential area was recorded at the level of postal districts (216 districts, n = 56,019 participants). Results indicated that the strength of associations between personality traits and life satisfaction depended on neighborhood characteristics. Higher openness to experience was more positively associated with life satisfaction in postal districts characterized by higher average openness to experience, population density, and ethnic diversity. Higher agreeableness and conscientiousness were more strongly associated with life satisfaction in postal districts with lower overall levels of life satisfaction. The associations of extraversion and emotional stability were not modified by neighborhood characteristics. These findings suggest that people's life satisfaction depends, in part, on the interaction between individual personality and particular features of the places they live.

A study of HIV positive undocumented African migrants' access to health services in the UK

Newly immigrated persons, whatever their origin, tend to fall in the lower socioeconomic levels. In fact, failure of an asylum application renders one destitute in a large proportion of cases, often resulting in a profound lack of access to basic necessities. With over a third of HIV positive failed asylum seekers reporting no income, and the remainder reporting highly limited resources, poverty is a reality for the vast majority. The purpose of the study was to determine the basic social processes that guide HIV positive undocumented migrant's efforts to gain health services in the UK. The study used the Grounded Theory Approach. Theoretical saturation occurred after 16 participants were included in the study. The data included reflections of the prominent factors related to the establishment of a safe and productive life and the ability of individuals to remain within the UK. The data reflected heavily upon the ability of migrants to enter the medical care system during their asylum period, and on an emerging pattern of service denial after loss on immigration appeal. The findings of this study are notable in that they have demonstrated sequence of events along a timeline related to the interaction between the asylum process and access to health-related services. The results reflect that African migrants maintain a degree of formal access to health services during the period that they possess legal access to services and informal access after the failure of their asylum claim. The purpose of this paper is to examine the basic social processes that characterize efforts to gain access to health services among HIV positive undocumented African migrants to the UK. The most recent estimates indicate that there are a total of 618,000 migrants who lack legal status within the UK. Other studies have placed the number of undocumented migrants within the UK in the range of 525,000–950,000. More than 442,000 are thought to dwell in the London metropolitan area. Even in cases where African migrants enter the UK legally, they often face considerable difficulty in their quest to gain legal employment due to barriers inherent to the system that grants work permits. With over a third of HIV positive failed asylum seekers reporting no income, and the remainder reporting highly limited resources, poverty is a reality for the vast majority.

Dynamic simulation modeling and policy analysis of an area-based congestion pricing scheme for a transportation socioeconomic system

This paper evaluates the impact of an area-based congestion pricing scheme in terms of its effectiveness on mitigating traffic congestion by using a system dynamics model. Unknown parameter values are calibrated using data available from the area-based pricing scheme implemented in the London metropolitan area. The key features of our model are that individual behavior is affected by the level of congestion, the cost of driving, and the supply/capacity and demand associated with metro transit. Perceptions of users are captured by three separate linguistic variables and fuzzy set theory is used to evaluate the combined effects of individual perceptions on the travel mode selection and the switching behavior between travel modes. As part of our analysis we explore three premises, i.e., that revenues generated from a congestion pricing scheme can substantially improve alternative transportation modes, that the improvement of these modes can have a positive effect on the mitigation of traffic congestion, and that a congestion pricing scheme cannot effectively resolve congestion problems in short term due to the existence of material and information delays. We assess various policies and determine appropriate values for critical parameters to find the best results in terms of implementing the area-based pricing scheme.

Using kernel methods to visualise crime data

Kernel smoothing methods can be used to visualise complex point event data that are distributed geographically. The visualisations generated by these methods allow users to observe trends in the data which may not be apparent from numerical summaries or by visualising the point data themselves. Crime data in the UK has recently been made available to the public for the smallest postal delivery areas in the country (post- codes). Visualisations of the number of recorded events at each postcode for a given area are provided online. In this paper we apply some widely used kernel smoothing methods to this data, to assess the use of kernel smoothing methods as applied to open access data. Kernel smoothing methods are applied to crime data from the Greater London metropolitan area using freely available packages for the open source R program. We also investigate the utility of using simple methods to smooth the data over time. The kernel smoothers used are demonstrated to provide effective and useful visualisations of the data, and it is proposed that these methods should be more widely applied in exploratory data visualisation in the future.

The Elusive Price Premium for Ecolabelled Products: Evidence from Seafood in the UK Market

Ecolabelling is an increasingly important tool used in the promotion of sustainable forestry and fishery products around the world. Whether the consumer is actually paying a price premium for ecolabelled products is of fundamental importance as it indicates a return on the investment of sustainable practices, providing an incentive for producers to undertake such practices. This article seeks to address the question of whether or not an actual premium is being paid by consumers for ecolabelled seafood by conducting a hedonic analysis of Marine Stewardship Council (MSC)-certified frozen processed Alaska pollock products in the London metropolitan area in the UK market using scanner data. Regression results show a statistically significant premium of 14.2%. This implies the presence of market differentiation for sustainable seafood and the potential of the MSC’s fisheries certification programme to generate market incentives for sustainable fisheries practices.

Developing a Spatial‐Temporal Method for the Geographic Investigation of Shoeprint Evidence

This article examines the potential of a spatial-temporal method for analysis of forensic shoeprint data. The large volume of shoeprint evidence recovered at crime scenes results in varied success in matching a print to a known shoe type and subsequently linking sets of matched prints to suspected offenders. Unlike DNA and fingerprint data, a major challenge is to reduce the uncertainty in linking sets of matched shoeprints to a suspected serial offender. Shoeprint data for 2004 were imported from the Greater London Metropolitan Area Bigfoot database into a geographic information system, and a spatial-temporal algorithm developed for this project. The results show that by using distance and time constraints interactively, the number of candidate shoeprints that can implicate one or few suspects can be substantially reduced. It concludes that the use of space-time and other ancillary information within a geographic information system can be quite helpful for forensic investigation.

Audit of appendicectomies at Frere Hospital, Eastern Cape.

We sought to evaluate the surgical service in the central part of the Eastern Cape Province by reviewing the practice of appendicectomy at Frere Hospital. Specifically, it was our aim to compare the service to those patients who reside in and outside the East London metropolitan area and the outcomes of patients according to their operative finding. A retrospective study was performed on the medical records of all patients who underwent appendicectomy in a 26-month period. This entailed a thorough review of demographic factors, mode of presentation, operation factors and findings, and the postoperative course. . In the study period, 436 appendicectomies were performed, of which 81% were performed after hours, with a consultant surgeon present in only 6% of cases. Of the group, 51% had a perforated appendix at surgery, and 12% a normal appendix. There was a significantly increased risk of perforation at the extremes of age and in patients from outside East London (63% v. 35% in East London). Those with perforated appendices stayed an average of 7.3 days in hospital, compared with 5 days for those with earlier appendicitis. Of the perforated group, 21% developed a complication, with 86% of all complications occurring in this group. The hospital stays were longer in those perforated appendices that were drained (10.7 days v. 6.1 days), and the rate of complications higher in this subgroup. Four patients died (1%)--all in the perforated group. The perforation rate in our setting is significantly higher than other published results. Patients with perforated appendices have longer hospital stays and are more likely to develop significant complications, including re-operation. Patients from outside East London, males and those at the extremes of age are more likely to have perforated appendices. This study lends little support to the advocates of drains, and recommends the use of non-absorbable sutures for skin closure. The majority of procedures are performed after hours by medical officers and registrars, but there is no evidence to suggest that this practice be altered, particularly in light of the high perforation rate. The main factor identified as contributing to the huge discrepancy between perforation rates (and hence morbidity) is delay in presentation to the operating surgeon for the region. Patient factors may contribute, but service factors are regarded as significant, including poor access to clinics and hospitals, transport and ambulance services, and the expertise of the referring medical staff. The need to improve the quality of patient care in the under-serviced rural areas of the Eastern Cape is highlighted.