Metropolitan Area Research Articles

Retrospective analysis of 80 patients diagnosed with reversible cerebral vasoconstriction syndrome in the Helsinki Metropolitan Area.

Up to 80% of patients diagnosed with reversible cerebral vasoconstriction syndrome (RCVS) experience complications such as ischaemic stroke, intracerebral or subarachnoid haemorrhage or posterior reversible encephalopathy syndrome. The aim was to evaluate the incidence of complications in patients diagnosed with RCVS in our clinic. All adult patients (age >16 years) diagnosed with RCVS at the Helsinki University Central Hospital during the period between 1 January 2016 and 31 December 2022 were retrospectively identified. Medical and follow-up data were collected from medical records. Eighty patients diagnosed with RCVS were identified, of whom four patients had parenchymal lesions such as ischaemic stroke, intracerebral haemorrhage, posterior cerebral encephalopathy syndrome, subarachnoid haemorrhage or combinations thereof. The complication rate of RCVS is lower than in previously published cohorts. This may be related to better and earlier diagnostics and earlier withdrawal of possible triggers.

Does inter-city commuting lead to increasing disparity of public service accessibility within Chinese metropolitan areas? A case study of Guangzhou

Does inter-city commuting lead to increasing disparity of public service accessibility within Chinese metropolitan areas? A case study of Guangzhou

Survival disparities in small intestine carcinoid tumors: A SEER-based analysis.

653 Background: Small intestine carcinoid tumors (SI-carcinoids) are rare neuroendocrine neoplasms with variable survival outcomes. This study examines the impact of age, sex, race, income, and geographic location on overall survival (OS) in patients with SI-carcinoid tumors. Methods: A retrospective cohort study was conducted using the Surveillance, Epidemiology, and End Results (SEER) registry 22 to identify patients aged 20 and above with SI-carcinoid tumors from 2000 to 2021. Kaplan-Meier survival analysis and log-rank tests were used to assess differences in survival. Cox proportional hazards models estimated hazard ratios (HR) for Overall Survival (OS). Results: 20,777 patients were included, with 7,029 deaths recorded. Median OS varied significantly by age, sex, race, income, and tumor site. Patients aged 60-85 had a median OS of 10 months (95% CI: 9.75-10.42), while those over 85 had 2.92 months (95% CI: 2.67-3.33). Females had better OS (13.92 months; 95% CI: 13.42-14.42) than males (12.83 months; 95% CI: 12.42-13.25). Non-Hispanic Black patients had worse OS (12.33 months; 95% CI: 11.50-13.33) compared to Non-Hispanic Whites (13.25 months; 95% CI: 12.92-13.67). Patients earning less than $50,000 had worse OS (11.42 months; 95% CI: 10.67-12.42) than those earning $100,000–$120,000 (15.42 months; 95% CI: 14.25-17.83). Geographic disparities were noted, with nonmetropolitan areas showing worse OS (11.42 months; 95% CI: 10.83-12.92) compared to large metropolitan areas (14.00 months; 95% CI: 13.50-14.42). Cox models confirmed age (HR for 85+ years: 21.99; 95% CI: 17.40-27.81), male sex (HR: 1.12; 95% CI: 1.07-1.17), and Black race (HR: 1.29; 95% CI: 1.18-1.42) were linked to worse OS. Tumor site also affected OS, with ileal tumors showing better survival compared to duodenal tumors (HR: 0.89; 95% CI: 0.84-0.94). Conclusions: Age, sex, race, income, and geographic location significantly affect OS in patients with small intestine carcinoid tumors, highlighting the need for tailored interventions for vulnerable groups.

Impact of Reduced Anthropogenic Emissions Associated With COVID-19 Lockdown on PM2.5 Concentration and Canopy Urban Heat Island in Canada.

Extensive lockdowns during the COVID-19 pandemic caused a remarkable decline in human activities that have influenced urban climate, especially air quality and urban heat islands. However, the impact of such changes on local climate based on long term ground-level observations has hitherto not been investigated. Using air pollution measurements for the four major Canadian metropolitan areas (Toronto, Montreal, Vancouver, and Calgary), we find that PM2.5 markedly decreased during and after lockdowns with peak reduction ranging between 42% and 53% relative to the 2000-2019 reference period. Moreover, we show a substantial decline in canopy urban heat island intensity during lockdown and in the post lockdowns periods with peak reduction ranging between 0.7°C and 1.6°C in comparison with the 20-year preceding period. The results of this study may provide insights for local policymakers to define the regulation strategies to facilitate air quality improvement in urban areas.

Regulating (ecosystem) services of an urban natural area: A case study in the State of Rio de Janeiro, Brazil.

Peri-urban conserved natural or semi-natural areas provide several ecosystem services and assist in reducing air pollution in cities. The aim of this study is to assess the contribution to the improvement of air quality of a small area (<1km2) adjacent to a city in the Metropolitan Region of Rio de Janeiro (Brazil), which is seriously affected by vehicular and industrial emissions of pollutants. Hydrocarbon (HC) and carbonyl compounds (CC) levels were determined, by employing TO-15 and TO-11A US EPA Methods, respectively, in both the urban and green areas. The results showed that the concentrations of anthropogenic HC were approximately 1.7-2.1 times higher in the urban area which confirms that the natural park assists in the dispersion and reduction of pollutants. In the case of the CC compounds, for samples that were collected in the morning, the total mean and median values were 1.3-1.6 times higher in the urbanized zone, while during the afternoon the green area showed values that were 1.5-1.9 times higher. These results suggest that in the green area, the emission or formation of CC compounds through photochemical processes is significant, particularly in the afternoon. Anyway, the ozone forming potential was found to be lower within the natural park in both periods, which confirms the positive role played by conserved natural areas outside or surrounding extensive metropolitan areas in the reduction of atmospheric pollution, in spite of the negative impact of anthropogenic emissions.

Assessment of pollution in Alibeykoy Dam Lake (Istanbul, Türkiye) and its influent streams: Phytoplankton composition and heavy metal accumulation.

In this study, the pollution levels of Alibeykoy Dam Lake were assessed by examining phytoplankton distribution, physicochemical parameters, nutrient content, and heavy metal concentrations. Alibeykoy Dam is a critical drinking water source for the Istanbul metropolitan area. Water samples were collected from the lake and six influent streams (Cebeci, Pirincci, Sidan, Bolluca, Gulgen, and Kocaman) in January, February, May, and September of 2021. A total of 36 taxa from seven divisions were identified, including Bacillariophyta (14), Charophyta (2), Chlorophyta (9), Cryptophyta (1), Cyanobacteria (3), Euglenozoa (4), and Miozoa (3). Diatoms were found to be the dominant group in terms of species richness and abundance. The dominant species recorded in each site were as follows: Microcystis aeruginosa in Alibeykoy Dam and Sidan Creek, Cyclotella ocellata in Cebeci and Gulgen Creeks, Scenedesmus sp. in Pirincci Creek, Navicula cryptocephala in Bolluca Creek, and Sphaerocystis planctonica in Kocaman Creek. Mesotrophic and eutrophic phytoplankton species suggested that the lake is nearing eutrophic conditions. This conclusion was further supported by high concentrations of heavy metals and nutrients detected in the water samples. This research is significant because it provides a comprehensive understanding of the ecological status of Alibeykoy Dam Lake, a critical resource for drinking water in Istanbul. The study highlights potential risks associated with eutrophication and heavy metal accumulation by identifying pollution levels and dominant species. These findings are vital for implementing effective water resource management strategies, ensuring the lake's sustainability, and protecting public health. PRACTITIONER POINTS: The pollution rate of Alibeykoy Dam Lake was determined. The presence of mesotrophic and eutrophic species of phytoplankton indicated the lake's trophic structure. The measurements were done to estimate the lake's heavy metal and nutrient contents.

Characteristics of Zero-Vehicle Households Among Older Americans and Their Travel Implications

Problem, research strategy, and findings As the number of older Americans increases rapidly and many of them age in low-density areas, understanding their transportation difficulties and needs is crucial. Using the 2017 National Household Travel Survey, I categorized zero-vehicle older individuals into four groups: urban commuters, nonrural low-income nondrivers, rural unemployed nondrivers, and nonurban moderate transit users. I then examined who they are and how they travel. More than one-third of zero-vehicle individuals were rural unemployed nondrivers. They mostly lived in rural areas and towns without readily available public or private transportation services and thus made the fewest trips among all zero-vehicle groups. In contrast, urban commuters—who mostly lived in metropolitan areas with rail systems and were healthy—had more experience using public transit and did not report any travel disadvantages compared with those using vehicles. Nonrural low-income nondrivers, however, manifested travel difficulties, largely due to their relatively poor health and income constraints. Takeaway for practice Planners and policymakers should consider providing additional transportation services and neighborhood designs for older people without vehicles. They should offer transportation services in suburban and rural areas, as well as in small towns lacking convenient public transport services. For older people who still drive, provision of both vehicle and safety support for cars and roads should be of paramount concern, because this assistance can help such individuals remain drivers longer. They should also provide affordable and accessible transportation solutions for older people, because income and health are two main obstacles in daily travel for older people without vehicles. In the long run, planners should muse over land use and design changes in low-density areas to facilitate older people’s out-of-home activities.

THE FOUNDATION OF INFRASTRUCTURE DEVELOPMENT IN MINNA TOWN BEFORE 1976

This study examines the trajectory of infrastructural development and urban growth in Minna town during the colonial and post-colonial era from 1903 to 1976. It investigates the expansion of the metropolitan area, initiated by the Minna town council in 1964, which incorporated suburban districts and necessitated the renaming of major roads and streets. Through a historical lens in the use of documented and oral sources, the study explores the role of leadership in promoting inter-group harmony and detribalizing administrative systems. Additionally, it analyzes the impact of railway construction on labour migration, population density, and economic enterprises such as mining activities and commercial firms. The study underscores the foundational role of the British colonial administration in shaping Minna's infrastructural landscape and how post-colonial initiatives further propelled urban growth.

베트남 결혼이주여성을 형상화한 소설의 독서 경험을 통한 대학원생의 다문화 인식 변화 연구

Objectives The purpose of this study is to examine the changes in graduate students' multicultural awareness through the reading experience of a novel embodying Vietnamese immigrant women through marriage, and to ex plore whether the reading experience of a novel embodying Vietnamese immigrant women through marriage is effective in fostering and improving multicultural awareness in adults. Methods Six graduate students majoring in multicultural education at a university in the metropolitan area were selected as research participants. For the reading experience of the research participants, book selection criteria were established, and four books were selected according to the selection criteria. The four novels were read in four sessions, and focus group interviews (FGIs) were conducted. The interview data were analyzed by subdivid ing each subcategory into the changes before and during the reading experience, and the multicultural awareness after the reading experience. Results Before the reading experience, the research participants’ thoughts on Vietnamese immigrant women through marriage had a stereotype of young brides with strong vitality, and their understanding of the difficulties experienced by Vietnamese immigrant women through marriage was also superficial. However, as the reading experience continued, the research participants discovered the problems embodying in the novel, and their multi cultural awareness began to change. After the reading experience, the research participants recognized Vietnamese immigrant women through marriage as members of our society, and viewed them as active actors rather than simple victims. They also came to prepare alternatives out of concern about the negative image that was being fixed when embodying Vietnamese immigrant women through marriage. In addition, the research par ticipants’ multicultural awareness expanded not only to Vietnamese immigrant women through marriage, but also to low-income poor classes, socially disadvantaged people, and migrant workers. The research participants fos tered multicultural awareness through sharing various perspectives and meta-reflection, and it was confirmed that the reading experience was effective in improving multicultural awareness. Conclusions This study showed that the reading experience through a novel embodying Vietnamese immigrant women brought about positive changes in graduate students' multicultural awareness, and the reading experience conducted in this study has the meaning of social reading. If this social reading is utilized in education for adults, it will contribute to fostering and improving adults' multicultural awareness.

Empirical validation of a leisure crafting model

ABSTRACT Purpose/Rationale This study aimed to investigate the antecedents (i.e. leisure self-efficacy and leisure activity characteristics) and consequences (i.e. leisure activity fit, leisure engagement, leisure satisfaction and well-being) of leisure crafting and the moderating role of leisure type. Design/Methodology/Approach An analytical approach was employed to examine the associations between constructs. Quota sampling was used to sample 585 Taiwanese citizens in metropolitan areas. Findings The results demonstrated that leisure self-efficacy and leisure activity characteristics were positively associated with leisure crafting, and leisure crafting was positively associated with leisure engagement, leisure activity fit, leisure satisfaction and well-being. However, the moderating effect of leisure type was nonsignificant. Practical Implications Leisure operators can evaluate participants’ psychology prior to the activity and employ curriculum design or venue resources to increase participants’ knowledge and skills. Venue managers should provide adequate information regarding the venue or environment. Leisure activity operators should identify methods to encourage participants to engage in leisure crafting. Research Contribution This study proposes a research model of leisure crafting. The understanding of the role of leisure crafting in the field of leisure can supplement theories related to leisure crafting.

Atmospheric pollution affects the morphoanatomical and physiological responses of plants in urban Atlantic Forest remnants.

The Metropolitan Area of São Paulo (MASP) in southern Brazil is impacted by high ozone levels posing significant threats to its urban forests and the Atlantic Forest remnants. These green areas, covering 540 km2 and constituting 30% of MASP's territory, necessitate an urgent assessment of air pollution impacts on their flora. Our study investigates the effects of atmospheric pollution on the morphoanatomical and physiological responses of four native tree species (Alchornea sidifolia, Casearia sylvestris, Guarea macrophylla, and Machaerium nyctitans) across two Atlantic Forest remnants in MASP. We examined visual and morphoanatomical changes in leaves, gas exchange, photosynthetic pigments, and plant volatile organic compounds to identify markers for biomonitoring urban environments. Our results reveal that MASP vegetation is adversely affected by tropospheric ozone. Species with porous mesophyll structures, such as M. nyctitans and G. macrophylla, exhibited greater visual and structural damage. In contrast, species with compact mesophyll, such as A. sidifolia and C. sylvestris, demonstrated higher tolerance. This suggests that anatomical architecture critically influences species' responses to atmospheric pollutants, such as tropospheric ozone. Additionally, we propose that ozone influx occurs through both stomatal pathways and as a result of direct and indirect injuries to the plant tissues. Additionally, our study identifies non-visual markers, including anatomical and physiological parameters and plant volatile organic compounds (e.g., presence of salicylates), as effective tools for monitoring plant species in urban environments. These insights highlight key anatomical and metabolic markers that help distinguish ozone-tolerant species from sensitive species, providing valuable information for monitoring air pollution in urban forests.

Mapping Disaster Hazards and Risks – A Case Study in Kuala Lumpur City (KLC)

Kuala Lumpur, the capital city of Malaysia, is vulnerable to various natural and man-made disasters. Kuala Lumpur City (KLC) encounters distinctive difficulties in managing urban disasters, mainly because of its dense population, critical infrastructure, and economic importance. Mapping the hazards and risks of disasters in KLC is crucial for enhancing its resilience against disasters and ensuring the effectiveness of emergency response, humanitarian aid, and disaster relief efforts. The objective of this study is to develop a comprehensive master plan for the management of disasters in KLC. The plan will serve as the initial phase in the civil-military coordinating response architecture for humanitarian aid and disaster relief (HADR). The approach entails creating a hazard map delineating regions susceptible to flash fl oods and landslides, frequently occurring in KLC. In addition, a vulnerability map was generated to evaluate the region’s proneness to disasters and identify safe areas within KLC. Additionally, road vulnerability assessments were performed to determine the most direct route for HADR activities. Furthermore, a customised disaster risk map was created exclusively for the KLC. This work contributes to the growing body of literature on urban disaster management, offering valuable insights for other metropolitan areas facing similar challenges.

Mortality and diurnal temperature range in Virginia.

The relationship between diurnal temperature range (DTR) and daily mortality from 2005 to 2020 is examined for seven large metropolitan areas in Virginia using distributed lag non-linear models that control for temperature and humidity. The relative risk of mortality increases for very high DTR, and there is a short lag effect of several days. High risk DTR days are rare, typically occurring less than 1% of the time at most locations. These days primarily occur in spring and are characterized by high pressure and low humidity that allow overnight temperatures to drop substantially. High DTR days are often associated with elevated respiratory and cardiovascular mortality and tend to impact the elderly. The similarity between the mortality response to high DTR and that of high temperatures alone, coupled with the lack of clear physiological underpinnings, challenges the notion that these responses are independent. The prevalent spring peak in dangerous DTR days suggests that lack of acclimatization to hot and humid conditions may impose strain on the cardiovascular and respiratory systems.

A community-based approach to address lung cancer screening disparities in the black community using the Witness Project® framework: development and pilot trial.

Disparities in lung cancer outcomes persist among Black Americans, necessitating targeted interventions to address screening inequities. This paper reports the development and refinement of Witness Project® Lung, a community-based initiative tailored to the specific needs of the Black community, aiming to improve awareness and engagement with lung cancer screening. Utilizing a user-centered design and guided by the original Witness Project® framework - an evidence-based lay health advisor intervention program originally developed to increase knowledge and awareness about breast cancer risk and screening in the Black community and later trans-created to the cervical and colorectal cancer screening contexts - Witness Project® Lung was developed and refined through qualitative input from key stakeholders in the Black faith community. Guided by the PEN-3 model and the Conceptual Model for Lung Cancer Screening Participation, the program underwent a rigorous development process to ensure cultural relevance and was pilot tested in the New York City metropolitan area in faith-based and community-based organizational sites in the Black community. Pilot testing conducted in New York and New Jersey demonstrated high acceptability, satisfaction, and increased knowledge among participants. The community-based approach, culturally sensitive messaging, and partnerships with faith-based organizations were critical to the refinements of Witness Project® to Witness Project® Lung. The program's focus on addressing social determinants of health and its delivery by trained lay health advisors showcased feasibility and potential effectiveness. Witness Project® Lung presents a promising alternative to traditional health system-based interventions for improving lung screening rates among Black Americans. The community-based, culturally tailored approach, coupled with the involvement of trusted community leaders, has the potential to reduce disparities in lung cancer outcomes. Further research is needed to assess the long-term impact and cost-effectiveness of Witness Project® Lung in promoting lung screening uptake and improving health outcomes within underserved populations.

Hybrid low-complexity baud-rate sampling and adaptive equalization technique for 400 G/800 G coherent metropolitan area networks

Baud-rate sampling and adaptive equalization (BSAE) techniques digitize and adaptively equalize received optical signals at the baud-rate and thus can concurrently reduce ADC and equalization power consumption compared with oversampling and fractionally-spaced adaptive equalization (OFAE) techniques operating at a higher sampling rate. Although suitable for short-reach intensity modulation-direct detection (IM-DD) based access networks or intra-datacenter networks, the BSAE techniques are generally regarded as not suitable for metropolitan area networks (MANs), owing to their limited capability to compensate for the large chromatic dispersion (CD) and in-phase/quadrature (IQ) skew distortions encountered in MANs. This constraint renders them inferior to the OFAE techniques able to compensate for arbitrary CD and IQ skew distortions. In this paper, we propose a BSAE technique combining a baud-rate frequency and time domain hybrid adaptive equalizer (AEQ) and Nyquist filtering for dynamic 400 G/800 G coherent MANs. Numerical simulations and experiments show that the BSAE technique can overcome the limitations and compensate for large CD and IQ skew distortions encountered in 400 G/800 G coherent MANs with spans up to 120 km. Furthermore, compared with the current state-of-the-art BSAE and OFAE techniques, the proposed BSAE technique can reduce the equalization computation complexity by about 40% and 80%, respectively, while maintaining a superior performance as the OFAE techniques. These merits make it a highly attractive solution for the dynamic 400 G/800 G coherent MANs.

Ten-Year Trends in Last Known Well to Arrival Time in Acute Ischemic Stroke Patients: 2014 to 2023.

Many national initiatives focus on promoting early hospital arrival of patients with acute ischemic stroke (AIS) because treatment effectiveness is time-dependent. However, several studies reported time-delays in hospital arrival, especially during the COVID-19 pandemic. Our purpose was to evaluate the 10-year trends in last known well to arrival (LKWA) time and assess disparities in patients with AIS. A retrospective study of consecutive patients with AIS in the United States admitted to a large, socioeconomically diverse health care system in the New York metropolitan area was performed from 2014 to 2023. LKWA time groups were categorized according to treatment eligibility: 0 to 4.5, >4.5 to 24, and >24 hours. Demographic and clinical characteristics, treatment utilization, and modified Rankin Scale at discharge were extracted from electronic health records. Trend, bivariable, and multivariable logistic regression analyses were conducted. A total of 11 563 patients with AIS were included with 53% (6163) LKWA 0 to 4.5, 34% (3988) LKWA >4.5 to 24, and 12% (1412) LKWA >24 groups. From 2014 to 2023, there was a significant downtrend in the early LKWA 0 to 4.5 (61%-46%) with uptrends in the later LKWA >4.5 to 24 (31%-43%) and LKWA >24 (8%-11%) groups (P<0.001). In the LKWA >4.5 groups, the gap widened between racial categories after COVID (2021-2023; P=0.004). Compared with LKWA 0 to 4.5, the LKWA >4.5 to 24 group was less likely to receive endovascular thrombectomy (P<0.001) and more likely to have worse outcomes (modified Rankin Scale, 2-5; P<0.001). LKWA >4.5 groups were more likely to be older >80 years of age (odds ratio, 1.33 [95% CIs, 1.11-1.58]), men (1.11 [1.03-1.20]), Black patients (1.21 [1.09-1.34]), Asian patients (1.20 [1.03-1.39]), Medicaid insurance (1.18 [1.08-1.29]), and low-income <$80 000 (1.39 [1.20-1.61]). In the past decade, there was a significant uptrend in patients with AIS arriving in the late LKWA >4.5 groups. Socioeconomic disparities were observed with a persistent uptrend in non-White patients in the late LKWA >4.5 groups after the COVID pandemic. These findings highlight the need to implement targeted efforts to improve disparities in LKWA time in patients with AIS.

Measurement of population agglomeration, dynamic change characteristics, and motivations in metropolitan agglomerations-A case study of the Xi'an metropolitan area.

This article compares the population agglomeration characteristics of the Xi'an metropolitan area in western China with those of metropolitan areas in other regions officially approved by the Chinese government. The kernel density estimation method and Markov chain model were used to conduct the study. The results revealed that from 2010 to 2020, the population agglomeration level of the Xi'an metropolitan area showed a trend of first increasing and then decreasing. The absolute gap in the population agglomeration level between cities within the metropolitan area gradually narrowed, and the polarization phenomenon of population agglomeration was not obvious. Compared with metropolitan agglomerations such as Nanjing, Wuhan, Fuzhou, Changsha-Zhuzhou-Xiangtan, Chongqing, and Chengdu, the Xi'an metropolitan agglomeration had a lower population agglomeration level, with a significant gap. Moreover, there was an obvious "club convergence" phenomenon in the population agglomeration levels of different urban agglomerations. The probability of the population agglomeration level remaining stable was at least 53.85%, indicating that there was a "Matthew effect" in which the rich become richer and the poor become poorer. Through the convergence models of α and β, the analysis suggested that there was no significant α convergence between the population agglomeration level of the Xi'an metropolitan agglomeration and that of other metropolitan agglomerations. Instead, there was a significant β divergence, indicating that the gap between the Xi'an metropolitan agglomeration's population agglomeration level and that of other metropolitan agglomerations is gradually widening. An integrated theoretical framework of population agglomeration was constructed from three dimensions: producers, consumers, and social people. An empirical analysis was conducted on the causes of population agglomeration in the Xi'an metropolitan area and other metropolitan areas. The multiple regression results showed that the income level, public consumption expenditure level, education level, comfortable living environment, and educational level were important factors leading to differences in population agglomeration. The geographic detector results showed that factors in the consumer dimension were the main reasons for population agglomeration in metropolitan areas.

P-1178. Trends in invasive methicillin-resistant Staphylococcus aureus infections among children in the United States, 2011–2021

Abstract Background During 2005–2010, incidence of community-associated (CA) invasive methicillin-resistant Staphylococcus aureus (MRSA) infections among children was rising, whereas hospital-onset (HO) rates were unchanged except for a decline among young infants. Recent trends in invasive MRSA infections among children have not been described.Figure 1.Epidemiologic classification of cases Methods We analyzed invasive MRSA cases in children aged &amp;lt; 18 years reported during 2011–2021 through active population- and laboratory-based surveillance by CDC's Emerging Infections Program in seven U.S. metropolitan areas. A case was defined as isolation of MRSA from a normally sterile body site in a surveillance area resident. Cases aged ≥3 days were assigned an epidemiologic class based on healthcare exposure: HO, healthcare-associated community-onset (HACO), or CA (Figure 1). Annual incidence was calculated using U.S. census population estimates and stratified by age category and epidemiologic class. Crude incidence-rate ratios (IRR) were modeled using negative-binomial regression.Table 1.Demographic characteristics of children with invasive methicillin-resistant Staphylococcus aureus (MRSA) infections overall and by epidemiologic class, Emerging Infections Program, seven U.S. metropolitan areas, 2011–2021Abbreviations: CA, community-associated; HACO, healthcare-associated community-onset; HO, hospital-onset.a: Children aged &amp;lt;3 days were not assigned an epidemiologic class Results Of 956 cases reported, 938 (98%) were assigned an epidemiologic class: 436 (47%) CA, 197 (21%) HACO, and 306 (33%) HO. Infants (3 days–11 months) accounted for 21% of CA, 28% of HACO, and 67% of HO cases (Table 1). Overall incidence declined by 6% per year on average, from 3.7 per 100,000 population in 2011 to 2.1 in 2021 (Table 2 and Figure 2). Incidence of CA and HACO cases declined, whereas HO rates did not significantly change. Compared to 11–17-year-olds, overall incidence was highest (30-fold greater) among 3–89-day-olds (Table 2); 164 (80%) cases in this age group were HO. Nearly all (152, 93%) HO cases among 3–89-day-olds had bloodstream infection (BSI); among 47 cases during 2019–2021 with additional clinical data, 46 (98%) were admitted to the neonatal intensive care unit (NICU) at birth, 39 (83%) were born premature, and 29 (62%) had a central venous catheter within two days prior to MRSA culture.Table 2.Incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection among children per year and by age category, overall and stratified by epidemiologic class, Emerging Infections Program, seven U.S. metropolitan areas, 2011–2021.Abbreviations: CA, community-associated; CI, confidence interval; HACO, healthcare-associated community-onset; HO, hospital-onset; IRR, incidence-rate ratio. Conclusion During the past decade, nearly half of invasive MRSA infections among children were CA. Incidence of CA and HACO cases, primarily occurring among children aged &amp;gt;1 year, declined. However, HO rates remained disproportionately high among young infants, emphasizing the importance of BSI prevention among infants in the NICU.Figure 2.Crude annual incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections, overall and by epidemiologic class, for (A) all children, (B) children aged 3–89 days, and (C) children aged 90 days–17 years, Emerging Infections Program, seven U.S. metropolitan areas, 2011–2021. Disclosures Lee Harrison, MD, GSK: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant

Determinants of rural practice among a cohort of dental professionals in Australia

BackgroundMost research on tracking practice locations of health students has focused on medical students, particularly the factors influencing their choice to work in rural and remote areas. However, there is limited research on how rural origin and training in regional or rural settings affect the employment destinations of dental and oral health graduates. This paper explores the practice locations of dentistry and oral health therapy (OHT) graduates from rural backgrounds compared to those from metropolitan areas in Australia.Materials and methodsThe target population was dental and OHT graduates from La Trobe University’s Rural Health School (Australia) who completed their studies between 2009 and 2023. The graduates’ primary place of practice was sourced from the Australian Health Practitioners Regulation Agency (AHPRA) data. The 2019 Modified Monash Model (MMM) was used to categorise the students’ original place of residence by rurality and practice locations. Multivariable analyses were conducted to explore the association between home and practice locations while controlling for the effect of socio-demographic characteristics collected from students at enrolment.ResultsData were available for 819 graduates matched to the AHPRA register. Of these, 541 (66.1%) were dentists, and 278 (33.9%) were OHTs. The majority were female (56.7% dentists and 81.7% OHTs), 11.3% (dentists) and 21.6% (OHTs) of the graduates originated from rural and remote areas, 16.6% (dentists) and 18% (OHTs) from regional areas, and 72.1% (dentists) and 60.4% (OHTs) from metropolitan areas. Multinomial logistic regression analyses for dentists and OHTs identified that , having a regional background, or having a rural or remote background were the most significant predictors for regional, rural/remote practice over metropolitan areas.ConclusionRegional background is the strongest predictor for graduate dentists and OHTs practicing in Australia’s regional or rural and remote locations. Similarly, students from rural and remote locations were highly likely to practice in rural/ remote locations. Increasing the recruitment of students with rural backgrounds may positively impact graduates’ decisions to practice in rural areas.

From Sexting to Sexpreading: Trivialization of Digital Violence, Gender Differences and Collective Responsibilities

Abstract This article starts from a pedagogical disambiguation around sexting elaborated from the socio-educational cooperatives edPAC and CANDELA. This nuanced definition understands sexting as the practice of voluntarily and consensually sharing intimate and sexual content through different platforms and devices. In contrast, sexpreading is understood as the practice of disseminating sexual content without consent. We conducted short-term ethnographic research with adolescents in Barcelona with the objective of understanding how they perceive sexting and sexpreading based on their own experiences and social context. The research was carried out in three education centers in Barcelona and its metropolitan area and involved 59 diverse young people from 14 to 18 years old with different gender identifications. Our results point to three main dimensions: 1) the trivialization of violence and the creation of men spaces; 2) the gender differences involved in practicing sexting and preventing sexpreading; and 3) the consequences of sexpreading experienced by young people, including roles of intermediaries and responsibilities associated with them. We provide empirical and ethnographical support for the idea that merging sexting and sexpreading is problematic, especially for educational interventions, as it can detrimentally generalize issues and negatively impact adolescent sexualities, in particular those of girls and women. We believe that it is very important to incorporate discussions about sexting and sexpreading practices into educational contexts and to consider the high degree of media skills young women already have for a pedagogy of sexting and a community intervention against sexpreading.