Metropolitan District Research Articles

Urban Resilience Index Study on Ankara Metropolitan Area

Nowadays, urban planning, urban resilience, and climate change issues are discussed differently within the frame of developing and changing technological conditions. Studies on climate change, disasters, environmental data, and effective use of resources indicate that cities are responsible for exceeding their ecological limits. Cities are both the source of these problems and the most affected in terms of threats to urban residents and urban infrastructures. As a result of the uncertain and ever-changing risks brought on by urbanization and population growth worldwide that put pressure on cities in a variety of interconnected and complex ways perceptions of the preparedness and safety of cities are evolving. To manage these issues, new paradigms are needed. There is no consensus on the concept of urban resilience and methods for applying this concept in urban areas. In this research, how to create a relationship between existing approaches, theories, and practices in the field of urban resilience is discussed. The necessity to include resilience in numerical measurement techniques and planning applications and how these application methods will be operated was explained. In the process of creating a planning decision support system to ensure urban resilience, indicators that would provide input to measurement and index studies were researched, and new indicators were proposed. In this study, a formula for the urban resilience index was determined, and analyses that would provide input to the planning in Ankara metropolitan districts according to these indicators and urban resilience characteristics were put forward through geographic information systems. According to these studies, Gölbaşı was determined to be the district with the highest urban resilience index and Keçiören as the district with the lowest.

Socio-Economic Factors behind Migration: A Case of Pakistan

The primary cause of the fast urbanization is the migration of people from rural to urban regions. In this study, individual migratory patterns were investigated in a socioeconomic setting. The purpose of the study was to shed light on how individuals migrate in response to shifting socioeconomic and demographic trends. The current study was carried out in Islamabad, one of Pakistan's metropolitan districts. A purposive sampling technique was used to select the respondents. The only respondents included in this research were those who moved from rural to urban areas and began a family at least three years ago. Information was gathered on socioeconomic factors, such as age, work, health facilities, family income, and literacy. In addition, inquiries were made concerning their reasons for relocating, push and pull factors, and viewpoints on urbanization and its effects. The data analysis was done using the relevant statistical methods. The migratory behavior of most respondents is found to be mostly affected by "Pull Factors," with sixty-six percent of them being drawn to cities in search of a "better lifestyle." Three socioeconomic factors, age, income, and education, were shown to have the most effects on the respondents' attitudes regarding migration.

The role of Intellectual Property as a tool for business development in the informal economy of Ghana

AbstractInnovation has become one of the main drivers of economic growth and development making its protection the focus of contemporary economic strategies. Intellectual Property (IP) protects and promotes innovation. The IP system strives to create an environment where creativity and innovation thrive by finding a suitable equilibrium between the interests of innovators and the broader public interest. Although IP has been shown to play a particularly important role in formal‐economy innovation, its role in the informal economy (IE) has been less explored. This study therefore sought to interrogate the utilisation of IP in the IE of Ghana and the role it plays in business development and competitiveness. This was achieved by determining innovative capacity, IP knowledge uptake/awareness, utilisation and challenges as well as discussing the policy approaches and institutional mechanisms necessary to promote growth and development of the IE for national gain. A qualitative research design was adopted and using the purposive sampling method, a sample of 100 respondents from two metropolitan districts in Ghana was selected. The findings revealed that 72% of the informal businesses studied had developed new products, processes or methods. Although 53% of the respondents had heard of or were conscious of the existence of some words relating to IP such as ‘copyright’ and ‘trademarks’, the respondents had little practical understanding of IP as a subject matter relevant for business. Only 19% out of the total number of respondents had acquired formal IP rights while most of the businesses employed other appropriation mechanisms outside of the use of conventional IP tools in protecting knowledge and innovation. Challenges to IP acquisition identified include financial constraints, lack of appreciation for the value of IP for business and the difficulty in meeting registration requirements. The study concluded that the IE is innovative and the utilisation of various IP tools such as trademarks, industrial designs, copyright and utility models were identified to be desirable to be employed in the pursuit for business development. It is recommended that decision making bodies such as the national IP office must establish effective policies aimed at promoting awareness and utilisation of IP rights in the IE. The government should also institute incentives such as cost waivers that are needed to stimulate innovation and creativity and create an enabling environment that supports the acquisition of IP for development and growth of the IE.

Assessing Service Imbalances as Contributing Factors to Mobility Issues in the Metropolitan District of Quito, Ecuador

This article analyzes the service distribution imbalance within the Metropolitan District of Quito (DMQ) and its impact on urban mobility, aiming to propose strategies for more equitable territorial planning. The data were gathered from sources such as the National Institute of Statistics and Census (INEC), the Ministry of Health, the Ministry of Education, and OpenStreetMap. These data were integrated with GIS tools to model patterns of accessibility and mobility. Through a comprehensive approach, the study assessed education, banking services, employment, and healthcare, identifying how inequitable access to these services drives increased travel demand, especially in rural and peri-urban areas. In the education field, over 500 neighborhoods faced a shortage of institutions, compelling students to commute to other neighborhoods. For financial services, only 67% of neighborhoods had adequate access, with disparities across different socioeconomic zones. Additionally, employment-related mobility posed another challenge, with 88% of workers commuting outside their residential parish. Finally, access to healthcare was also unequal across the DMQ, particularly in peripheral areas where residents must travel long distances. In this context, it can be concluded that more efficient urban planning in the Metropolitan District of Quito (DMQ) is crucial to address imbalances in the distribution of services and enhance quality of life. Proposed strategies include establishing a land reserve, decentralizing services to underserved areas, integrating smart technologies, and promoting incentives for remote work, sustainable mobility, and public transport. These actions aim to foster greater territorial equity and accessibility.

Benchmarking hospital clinical pharmacy practice using standardised key performance indicators (KPIs).

Background: Hospital pharmacy services support quality use of medicines and medication safety through clinical pharmacy activities such as medication reviews and patient education. These activities can be measured and monitored using evidence-based and standardised key performance indicators (KPIs), which highlight the value of pharmacy services. Standardisation of KPIs supports long-term benchmarking and inter- and intra-site comparisons to target key areas for improvement in clinical pharmacy services. Aim: To describe the type and frequency of clinical pharmacy activity across five hospitals within one metropolitan hospital district. Methods: Key Performance Indicator data were collected by pharmacists from five hospital sites at one metropolitan hospital district, in Queensland Australia. Data were collected over one week for the following clinical settings: inpatient, discharge, outpatient clinic, and the dispensary. Data were collected using a manual, paper-based data collection tool previously developed using a co-design process. Results: Across 11,215 inpatient encounters, hospital pharmacy services provided: best possible medication history (BPMH) within 24 h of admission: 69.5%; daily medication chart review: 57.2%; discharge education: 82.7%, discharge reconciliation: 88.2%; and provision of discharge medication record: 82.4%. Across 1,092 outpatient encounters, pharmacists documented BPMH for 33.3% of patients. Pharmacists identified a total of 5,009 drug-related problems (DRPs) across the data collection period, with the rate of identification highest in the outpatient clinic setting (64.8 per 100 patient reviews) followed by discharge (52.6 per 100 patient reviews) and then inpatient (48.1 per 100 patient reviews). Almost 20% of DRPs identified (n = 975) were high risk. Conclusion: Reporting and benchmarking clinical pharmacy activity through standardised KPIs supports opportunities to identify service improvements. Future research should focus on larger scale studies using routinely recorded data to monitor clinical pharmacy KPIs across all care settings.

Defining a core set of research and development priorities for virtual care in the post-pandemic environment: a call to action.

To identify research and development priorities for virtual care following the coronavirus disease 2019 pandemic from the perspective of key stakeholders (patients, clinicians, informaticians and academics). Qualitative study using a modified nominal group technique. Online semi-structured interviews and workshops held in November 2022 and February 2023. Health workers involved in delivering virtual care in two metropolitan local health districts and one specialty statewide network, and people who had received care from these sites, were recruited using passive snowball sampling. Research and academic staff from a tertiary institution were also invited to participate. Priorities to support a translational research agenda for virtual care. Twenty-five individuals participated including 18 innovation deliverers, two innovation recipients and five implementation facilitators. Stakeholders identified several key priorities for developing virtual care models and for sustaining and scaling virtual care services. These included demonstrating the economic and societal value of virtual care, developing a common framework to support evaluation and comparison of virtual care services, ensuring virtual care services integrate acute and primary care, and defining which models of care are most appropriate for virtual care delivery. As the health system recalibrates with the return of in-person care, there is a growing need to demonstrate the value of virtual care models to patients, the health system, and society at large. Demonstrating this value while also demonstrating improvements to health outcomes will future-proof virtual care, enabling it to be used to address broader challenges of health care delivery. In addition, sustaining virtual care will depend on robust operational structures and workforce training and education. As services evolve, research and development priorities must be revisited to ensure that translational research aligns with stakeholder interests.

Sickle cell retinopathy among Ghanaian high school students: a school-based screening

IntroductionSickle cell disease (SCD) remains a significant health concern, particularly in Ghana and Sub-Saharan African countries. School-based ocular screenings provide a unique opportunity for early detection of sickle cell retinopathy (SCR).MethodsStudents from five major schools in the Kumasi Metropolitan District of Ghana were included. Research assistants educated students on SCD and type 1 diabetes (T1DM) during school-wide assemblies, emphasising destigmatisation and vision health. Students completed questionnaires to self-report SCD or T1DM. Those who self-reported underwent in-depth interviews and dilated fundus exams (DFE).ResultsOf 17 987 total student population, 8168 students completed the survey (45.4% response rate) of which 2.4% of students were aware of their SCD status, while most 69.3% were unaware. No students reported having T1DM. 24 students identified as having SCD (14 haemoglobin SS and 10 HbSC) resulting in a prevalence of 0.07% and 0.05% for SS and SC, respectively. Among the SCD cohort, four had Proliferative SCR (PSCR). Of the students with stage 3 PSCR, one was 15 years old with SS genotype and bilateral stage 3 PSCR; another was 18 years old with SC disease, unilateral stage 3 PSCR. Only one SCD patient (SS genotype) had a history of previous DFE. 20.8% of SCD students were aware of SCD ocular complications and 75% felt uncomfortable sharing their SCD status.ConclusionsWe conclude (1) an alarmingly low rate of self-reporting SCD (11× and 24× lower than expected for SS and SC-SCD, respectively), (2) low health literacy given 0% of students with SC-SCD had previously undergone a DFE and (3) 17% of students had PSCR and 8% of students had treatment-warranted PSCR (stage 3). These findings highlight the need for universal SCD screening, improved health education on the ocular complications of SCD and routine school-based vision screenings for patients with SCD.

Socio‐Economic Development Performance and Convergence Among Metropolitan Municipal and District Assemblies in Ghana

ABSTRACTEquitable development is one of the conditions for achieving a stable and just society. This assertion is corroborated by the numerous global and regional efforts to minimize inequality and ensure balanced development. By this recognition, decentralization, a system of governance where power cascades from centralized, remote structures to accessible local bodies, has long been floated as a tool for achieving development equity. In Ghana, decentralized units are unequally endowed, resulting in differing capacities for resource mobilization and service delivery. This study sought to accomplish two fundamental objectives, first to understand the nature of socioeconomic development performance dynamics among Metropolitan, Municipal and District Assemblies (MMDAs) and whether spatial spillovers exist and mediate these dynamics. Second was to investigate whether socioeconomic development performance is converging over time. Using performance on the District League Table (DLT) as a proxy for socioeconomic development, global and local Moran's I analysis revealed statistically significant clustering of development performance, hinting at the presence of spatial spillovers. Leveraging spatially explicit Markov chains, findings indicated that most MMDAs were more likely to stay in their performance classes than transition to a different cohort, with this probability being the highest in the upper and lower classes. Nonetheless, MMDAs located within high performing neighborhoods were more likely to improve in their performance than their counterparts located in low performing neighborhoods. Further analysis also revealed a high degree of cohesion, where MMDAs' development performance tend to assume the direction of their neighborhoods. In the second objective, decomposed Theil index analysis revealed processes of convergence overall and within decomposed groups while between groups convergence appeared to have saturated. The study advocates for collective as opposed to piecemeal strategies for achieving equitable development.

Evaluation of a Method for the Quantification of Cadmium, Lead, and Zinc in Craft Beers Manufactured in Quito, Ecuador.

The brewing process of craft beer can introduce contamination by heavy metals such as Cd, Pb, and Zn from various sources. Cadmium and lead metals are particularly worrisome because of their harmful effects on human health. This study aimed to evaluate a method for quantifying the levels of Cd, Pb, and Zn in craft beer brands sold in the northern region of the Metropolitan District of Quito, Ecuador, using atomic absorption spectroscopy. For confidentiality, the brands were anonymized as Brands A to I. Standard addition curves were employed for metal quantification, with repeatability assessed via the coefficient of variation (CV%) and accuracy determined by recovery (R%). The Cd content in Brands B-G and I was below the threshold established by the Mercosur Resolution Nº 12/11. Additionally, Brands A and D-H complied with the Ecuadorian INEN 2262 standard for maximum Pb concentration in beer. All samples showed Zn levels substantially below the maximum levels permitted by Ecuadorian regulations. Brands A, B, C, and H exhibited the highest concentrations of Cd and Pb.

The Impact of Store Atmosphere, Service Quality, and Social Media Marketing on Purchase Decisions: Insight from the Coffee Shop Market (Case Study at Kedai Kopi Distrik Metropolitan Surabaya)

This research aims to identify the influence of store atmosphere, service quality, and social media marketing on purchasing decisions at the Surabaya Metropolitan District Coffee Shop. Using quantitative methods with non-probability sampling techniques through purposive sampling, this research involved 115 respondents aged over 17 years who had bought and visited shops and had social media. Data was collected via Google Form and analyzed using Partial Least Square (PLS). The research results show that store atmosphere, service quality, and social media marketing have a positive influence on purchasing decisions. Consumers consider the design at Kedai Distrik Metropolitan to be quite unique by combining Vintage Chinatown-Sumatra themes. With a unique place and cheap product prices, consumers are happy to visit Kedai Kopi Distrik Metropolitan Surabaya, especially among teenagers.

Total mercury exposure through canned tuna in water sold in Quito, Ecuador

Mercury is a toxic trace metal found in seafood products owing to its bioaccumulative and ubiquitous nature. Seafood and fish are frequently consumed, being necessary to assess its human health risk. Accordingly, this study quantified total mercury in samples of canned tuna in water from supermarkets in the Metropolitan District of Quito in Ecuador, in order to ensure that Hg content is within the maximum limits stablished in national and international regulations. Total mercury levels were measured through cold vapor atomic fluorescence spectrophotometry. Three of the most consumed tuna brands in Ecuador were analyzed, coded as A, B, and C, according to the price at which they are sold in the market (A < B < C). Results indicated that mean total mercury in different tuna brands were within the permissible limits. Total mercury concentrations were 0.14 ± 0.11 mg kg−1; 0.41 ± 0.42 mg kg−1; and 0.25 ± 0.22 mg kg−1 for brands A, B, and C, respectively. However, for brand B the potential non-carcinogenic risk of mercury for consumers exceeded the threshold limit (> 1). When considering the highest total mercury content to which Ecuadorian population is exposed through the consumption of brand A, B, and C, the recommended weekly intake for children and adults were: A: 63 g and 306 g; B: 12 g and 57 g; C: 30 g and 144 g, respectively.

Primary healthcare rehabilitation users' views on activity limitations and participation in South Africa.

Increasing functional limitations and disabilities have raised the need for comprehensive rehabilitation services at the primary healthcare (PHC) level, particularly in low- and middle-income countries. To support the integration of these services into PHC in South Africa, assessing outcomes from the service users' perspectives is essential. This study examined service users' views on their PHC rehabilitation outcomes in a Metropolitan District of Gauteng, South Africa. The aim was to understand perceived changes in activity limitations and participation restrictions following the rehabilitation intervention. A quantitative survey design, including self-rating measurements and structured interviews, was employed. Thirty-eight rehabilitation service users from eight clinics and community health centres were purposively sampled. Participants rated their pre- and post-rehabilitation levels of difficulty in activity limitations and participation restrictions, with open-ended questions providing additional insights. Data analysis used descriptive statistics, quantitative content analysis, and non-parametric tests. Significant improvements in mobility, self-perception, and quality of life were reported by both adult and child service users. Caregivers of child service users also noted positive experiences (p = 0.019) in community, social, and civic life. This study highlights the perceived positive changes experienced by PHC rehabilitation service users in addressing functional limitations and disabilities. It underscores the effectiveness of integrated rehabilitation service delivery in improving user outcomes. The findings offer valuable insights into how rehabilitation interventions enhance functional abilities, social participation, and overall well-being. By focusing on activity limitations and participation restrictions from service users' perspectives, this study supports the priority of providing person-centred rehabilitation services at the PHC level.

Digital educational resources: Impact on communication skills of high school students in Quito, Ecuador

This study analyzes the impact of digital educational resources (DER) on the development of oral and written comprehension and expression skills in high school students in the Metropolitan District of Quito, Ecuador. A quasi-experimental research with a mixed approach was carried out in two educational institutions, in which an experimental group used these digital tools, while a control group continued with traditional methods. The results of the statistical analysis revealed a significant positive effect on the communication skills of the group that used the digital resources, compared to the control group. These findings, contextualized with previous studies, suggest that the appropriate integration of technology in the classroom can considerably improve educational quality. However, effectiveness may vary depending on individual and contextual factors, highlighting the importance of personalized approaches. In conclusion, the study provides empirical evidence on the value of educational technology in secondary education and suggests the need for further research on its implementation to optimize its impact on learning.

Spatial Needs for Healthcare Access During Disasters in Informal Settings for Elderly People with Disabilities

Older adults with disabilities and their caregivers require certain spatial conditions that allow them to carry out protective actions and healthcare access during disasters. This study aims to identify these spatial needs in the first few hours of an emergency within informal settings. For this purpose, a case study methodology with several phases was applied. The first phase focused on case definition through a literature review and case studies selection in the Metropolitan District of Quito-Ecuador. Phase two centered on spatial audits and collecting quotes and experiences from older adults with disabilities and their caregivers, conducted through focus groups. The third phase analyzed quantitative and qualitative data, generating three thematic categories: autonomous, support-driven, and institutional response access needs to healthcare. Findings highlight that special attention should be paid to the relationship between spatial conditions and individual or group behaviors during disasters, as these can exacerbate vulnerable outcomes for older adults.

Beyond error: A qualitative study of human factors in serious adverse events.

The field of healthcare quality and safety has been informed by the study of Human Factors contributing to adverse events. Hitherto, much of the study of Human Factors has been focused on a narrow lens of human error, identifying cognitive-based or knowledge-based errors and cognitive processes such as loss of situational awareness contributing to error. While these factors are important, this narrow approach fails to consider the complexity of relational and systemic factors that also contribute to adverse events. We aimed to explore the relational and systemic human factors, including shared clinician attitudes and behavior, that contribute to serious adverse patient events in a public health setting. The study, set in a metropolitan local health district in New South Wales, Australia, was conducted using a retrospective qualitative multi-incident content analysis design. Serious adverse event reviews (SAER) over 6 months (2022-2023) were subject to qualitative content analysis until data saturation was reached. Data saturation reached at 20 reports. Emergent themes related to human factors in serious adverse events included: (i) delays and inertia-with a subtheme of inertia of ageism; (ii) "All-or-nothing" approach to end-of-life care and planning; (iii) communication lapses; and (iv) implementation gap between standards and practice. Error-based incidents accounted for only 35% of the serious adverse events examined. The sample studied involved mostly (65%) male patients, with a mean age of 69 (70% aged >65), managed across the gamut of specialties, with the most common incident being the management of acutely deteriorating patients. In conclusion, there is more to Human Factors in adverse events than cognitive or knowledge-based error. While identifying and correcting errors is absolutely essential, we need adjunctive "soft measures" to address clinical attitudes, behaviors, and relationships in health care, particularly in increasingly complex, fraught, and stressful health care environments.

An Implementation of Educational Multimedia Applications in Schools of the Metropolitan Districts

An Implementation of Educational Multimedia Applications in Schools of the Metropolitan Districts

'Profound personal and professional impacts': A qualitative study of clinician experiences of a mental health disaster response to Australia's black summer bushfires.

To explore the experiences of clinician and management stakeholders involved in a rural/metropolitan collaborative mental health disaster response to the 2019-2020 Black Summer bushfires in the Snowy Valleys region of southern New South Wales (NSW), Australia. A mental health and drug health service in the Snowy Valleys region of rural NSW in collaboration with a mental health service from metropolitan Sydney, NSW. Mental health clinicians and managers from a rural health district (n = 6) and a metropolitan health district (n = 8) involved in a collaborative disaster response to the 2019-2020 Black Summer bushfire disaster in the Snowy Valleys region of southern NSW, Australia. An interpretive qualitative study design using semi-structured individual interviews, with transcripts analysed using Reflexive Thematic Analysis. Thematic findings on participant experiences are presented under three organising constructs of before (stepping up and jumping right in), during (finding a rhythm of working together), and after (profound personal and professional impacts) the mental health disaster response. Participant experiences had shared and distinct components before, during and after the mental health disaster response, culminating in profound personal and professional impacts. Findings highlight positive aspects and challenges for clinicians participating in a rural/metropolitan collaborative mental health disaster response. The findings of this study contribute new knowledge about experiences of mental health clinicians participating in a disaster response after bushfires, from dual perspectives of members of a bushfire-affected community and those responding from outside a bushfire-affected community, which may inform ongoing planning of responses to disaster in Australia.

School knowledge of infectious diseases in schools: conducting surveillance and on-demand, symptomatic respiratory viral testing in a large pre-kindergarten-12th grade school district.

Limited data about acute respiratory illness (ARI) and respiratory virus circulation are available in congregate community settings, specifically schools. To better characterize the epidemiology of ARI and respiratory viruses in schools, we developed School Knowledge of Infectious Diseases in Schools (School KIDS). School KIDS is a prospective, respiratory viral testing program in a large metropolitan school district (pre-kindergarten-12th grade) in Kansas City, Missouri. During the 2022-2023 school year, all students and staff were eligible to participate in surveillance respiratory viral testing at school by submitting observed self-administered nasal swabs monthly. Participants could also submit a nasal swab for on-demand symptomatic testing when experiencing ≥1 ARI symptom, including cough, fever, nasal congestion, runny nose, shortness of breath, sore throat, and/or wheezing. Swabs were tested in a research laboratory using multipathogen respiratory polymerase chain reaction assays. Participants were evaluated for ongoing viral shedding by collecting two weekly nasal swabs (i.e., convalescent), following initial on-demand symptomatic testing. Participants were asked to complete an electronic survey to capture the presence and type of ARI symptom(s) before the collection of respiratory swabs. From 31 October 2022 to 29 June 2023, School KIDS enrolled 978 participants, including 700 students, representing 3.4% of the district student population, and 278 staff members. Participants submitted a median of six surveillance, one symptomatic, and two convalescent specimens during the study period. A total of 6,315 respiratory specimens, including 4,700 surveillance, 721 on-demand symptomatic, and 894 convalescent specimens, were tested. Overall, a virus was detected in 1,168 (24.9%) surveillance and 363 (50.3%) symptomatic specimens. Of the 5,538 symptom surveys sent to participants before scheduled surveillance testing, 4,069 (73.5%) were completed; ARI symptoms were reported on 1,348 (33.1%) surveys. Respiratory surveillance testing in schools is feasible and provides novel information about respiratory virus detections in students and staff attending school. Schools are an important community setting, and better knowledge of respiratory virus circulation in schools may be useful to identify respiratory virus transmission in the community and assess the impact of effective infection prevention measures.

El diseño de políticas públicas con base en la idea de la otredad y el ejercicio del derecho a la ciudad en el Distrito Metropolitano de Quito- Ecuador

The Ecuadorian State, through the 2008 Constitution of Montecristi, enshrines the right to the city as a fundamental right and guarantees the adoption of policies that allow for its viable exercise through democratic and participatory management. This final Master’s Thesis presents a research project to analyze the effects of the notion of Otherness in the process of public policymaking, so that they serve as mechanisms for the fulfillment of the right to the city in the Quito Metropolitan District. This was done at a exploratory level, aiming to determine the absence and/or ineffectiveness of the exercise of the aforementioned right by means of a diagnosis of public policies enforced during 2019 that show this issue.

Bioclimatic and Energy Performance by Eco-Efficiency in Buildings of the Metropolitan District of Quito, Ecuador

Bioclimatic and Energy Performance by Eco-Efficiency in Buildings of the Metropolitan District of Quito, Ecuador