Metropolitan Population Research Articles

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.

Australian Preferences for Prenatal Screening: A Discrete Choice Experiment Comparing Metropolitan and Rural/Regional Areas.

Non-invasive prenatal testing has the potential to be a useful genetic screening tool in Australia. However, concerns have been raised about its cost, commercial provision, the psychological impacts of the screening process, and disparities in access experienced by rural and regional communities. The aims of this study are (1) to estimate Australian preferences for features of prenatal screening; (2) to explore potential variations in preferences between metropolitan and rural/regional communities; (3) to estimate the extent to which respondents are willing to trade-off between attributes, using willingness to pay (WTP) and willingness to wait estimates. A discrete choice experiment (DCE) was conducted with 12 choice tasks. The DCE recruited participants from metropolitan (n=160) and rural/regional (n=168) locations across Australia. Mixed logit and latent class analyses were conducted and WTP and willingness to wait were calculated. Both metropolitan and rural/regional preferences were significantly impacted by the false-positive rate, false-negative rate, and cost. In addition, rural preferences were significantly impacted by the scope of the conditions covered, the inconclusive rate, and wait times. The number of screening tests and revealing the sex of the foetus were not significant within either group. Willingness to pay estimates ranged from AU$13 to avoid a test with a 1% increase in the false-positive rate to AU$323 to screen for a wide range of conditions. This study highlights the importance of considering differing preferences between rural and metropolitan populations when delivering prenatal screening. Further, this study provides Australian-specific WTP estimates to be incorporated into economic evaluations.

Health care access barriers among metropolitan and nonmetropolitan populations of eight geographically diverse states, 2018.

Nonmetropolitan populations face frequent health care access barriers compared to their metropolitan counterparts, but differences in the number of these barriers across groups are not known. Our objective was to examine the differences in health care access barriers across metropolitan, micropolitan, and noncore populations. We used Behavioral Risk Factor Surveillance System data from the optional "Health Care Access" module to perform a cross-sectional analysis examining access barriers across levels of rurality using bivariate analyses and Poisson models. Access barriers were operationalized as a count ranging from 0 to 5, reflective of the number of financial barriers and nonfinancial barriers. Micropolitan and noncore respondents had lower educational attainment, were older, and were less racially/ethnically diverse than metropolitan respondents. They also reported more barriers, including lacking health insurance, medical debt, and foregoing care or medication due to cost. These barriers were most pronounced in non-Hispanic Black, Hispanic, and American Indian/Alaska Native nonmetropolitan populations, compared to their White counterparts. In adjusted analysis, micropolitan respondents reported more barriers compared to metropolitan (prevalence rate ratio=1.06; 95% confidence interval: 1.02-1.10) as did women, racial/ethnic minority populations, and those with less education. Micropolitan populations experience more barriers to health care, and nonmetropolitan respondents report more cost-related barriers than their metropolitan counterparts, raising concerns on health care disparities and financial burdens for these underserved populations. This underscores the need to mitigate these barriers, particularly among those in micropolitan areas and minorized populations.

The Australian clinical trial landscape: Perceptions of rural, regional and remote health service capacity and capability

BackgroundAccess to clinical trials is limited for rural, regional and remote Australians, adding to the current health inequity between rural and metropolitan populations. The Australasian Teletrial Model was developed to bring clinical trials “closer to home”. In 2020, the Australian Teletrial Program was funded to expand and support the uptake of the model across six Australian states and territories. The aim of this study was to explore and describe the clinical trial landscape in Australia prior to the implementation of the Australian Teletrial Program with a particular focus on rural, regional and remote health services.MethodsThis qualitative study provides a descriptive exploration of the clinical trial landscape across rural, regional and remote Australia. Data were obtained from semi-structured interviews (n = 33) and one focus group (n = 5) involving clinical trial stakeholders between August 2022 and May 2023. Deductive then inductive thematic analysis used the broad topic areas of the interview schedule as a framework, as follows: education and training, workforce, equipment and services, clinical trial sites, participant recruitment and clinical trial approval process.ResultsThis study identified barriers that are generalizable to the Australian clinical trial landscape and those specific to the rural, regional and remote health service context. The main barriers to conducting clinical trials in rural, regional and remote areas were lack of investment and engagement on the part of health service executives, workforce limitations, inconsistent training, lack of physical infrastructure and competing clinical priorities. Despite these challenges, clinicians reported enthusiasm for conducting clinical trials, and opportunities were reported for these health services to partner with larger metropolitan/regional health services, regional universities and communities to support the growth of clinical trial capability and capacity.ConclusionsThe clinical trial landscape in Australian health services varies in terms of quality and availability of training, workforce capacity, executive support, site capability and approval processes. The Australian Teletrial Program has an immense opportunity to overcome some of the reported challenges by supporting capacity and capability building. Ultimately, however, sustainable reform to bring trials closer to home requires a collaborative approach that considers implementation strategies across all levels of the health service and government, alongside other initiatives.

Situación de los asentamientos informales en el AMSS y sus virtudes frente a la ciudad consolidada

This article seeks to expose the current situation of the Precarious Urban Settlements (PUS) in the Metropolitan Area of San Salvador (AMSS), their typological relationships, distribution in the territory and social aspects that have been identified both in the metropolitan research and through research within a representative sample. Among the findings its shown that population densities are greater than the metropolitan average, high concentrations of PUS in densely populated municipalities yields data of approximately 20% of the metropolitan population living in settlements which in turn occupy only 7% of the metropolitan territory; high typological dispersion in which it is evident that in 63.5 % of these settlements only 15.6 % of precarious housing is contained. This characterization allowed the identification of most representative study cases to carry out a qualitative study, which for this case brought together four settlements in the municipality of Ciudad Delgado whose study revealed aspects of livelihoods and habitability that allow comparisons with the consolidated city. ILIA: Investigaciones Latinoamericanas en Ingeniería y Arquitectura, No. 01, 2024: 62-66.

Methodological proposal for measuring economic efficiency in regional transportation networks

This article seeks to improve the understanding and efficiency of transportation within and between metropolitan areas. Efficient transportation infrastructure and services are essential for achieving sustainable development, fostering economic growth, and minimizing environmental impacts. In metropolitan regions, where urbanization and population growth are concentrated, the significance of transportation efficiency becomes even more critical. To address this issue, the study proposes a methodology that combines graph theory and centrality measures to analyze regional hierarchies and their influence on transportation efficiency. By representing the regional road network, cities, and toll plazas as a graph with attributes linked to quantitative data of urban economies, this approach provides a concise and replicable method for examining network hierarchy in urban economies.

The Spatial Structure of the Moscow Metropolis

Due to the scale of population and economic concentration, Moscow is a mega-polis forming a vast zone of influence around itself. The accumulated economic and financial potential of the capital, as well as its huge consumer demand, consistently act as the most important factors in the development of the surrounding regions of the Non-Chernozem region. These regions can be considered as the periphery of the Moscow Metropolis, a supra-agglomeration spatial structure developing around Moscow. During the post-Soviet period, there has been a steady trend towards the centralization of demographic, economic and investment resources in Moscow and the Moscow region. Active population growth, investment penetration and active suburbanization in the 50-60-kilometer zone closest to Moscow are taking place against the background of socio-economic depression in rural areas, small and medium-sized urban centers in areas more remote from the capital. Today, Moscow and the 60-kilometer zone around it concentrate 65% of the metropolitan population, as well as over 80% of its gross product and investments in fixed assets. This is also the zone of active daily pendulum labor migrations to Moscow (up to 1.5 million people daily), which are carried out by 15 to 60% of the total able-bodied population living here. Along with this, there are prerequisites for promising development as part of the metropolis and more remote territories. In particular, there is an integration of regional labor markets with Moscow, through alternative work formats – over a million residents of the periphery are othodniki (shift workers), remote and hybrid employment is widespread. An important factor in the socio-economic development of the “bloodless” rural area of the peripheral metropolis is the filling of its 4 million summer residents in the summer season. Thus, joining the Moscow Metropolis of the regions surrounding the capital, along with risks, creates unique integration opportunities for them and sets a strategic vector for their spatial development.

Assessing Exercise Habits of Cardiovascular Risks in Middle-Aged Adults: A Descriptive Study

ABSTRACT Background: Cardiovascular problems are the leading cause of death among adults in our country. These illnesses primarily affect metropolitan populations, particularly in major cities. To prevent these diseases, efforts have focused on identifying and controlling cardiovascular risk factors such sedentary lifestyle. Aim: The study aimed to assess the exercise habits of cardiovascular risks middle-aged adults. Materials and Methods: The research approach used in this study was quantitative approach with descriptive design. Purposive sampling technique was used to select the samples. Totally 60 cardiovascular patients were recruited from Saveetha Medical College and Hospital Thandalam, Chennai. Data were gathered by using structured questionnaires and risk score calculator. Collected data were analyzed by using descriptive and inferential statistics. Results: The above Table 1 shows that 59 (98.33%) had moderate level of physical activity and 1 (1.67%) had high level of physical activity among middle-aged adults. The mean and standard deviation of physical activity among middle-aged adults was 62.26 ± 5.92. The median was 62.0 with minimum score of 38.0 and maximum score of 73.0. The demographic variable age (χ 2 = 6.610, P = 0.037) had statistically significant association with level of physical activity among middle-aged adults at P < 0.05 level and the other demographic variables had not shown statistically significant association with level of physical activity among middle-aged adults. Conclusion: Physical activity promotion and support should be a global priority because of the health benefits it provides for adults.

The Prevalence of Cervical Neoplastic Changes Among Sudanese Community Without Settled Screening Program

Background: While cervical cancer is decreasing in most countries that have undertaken long-term screening programs, the incidence is increasing in developing nations with low resources. As a result, the current study sought to investigate the incidence of cervical neoplastic alterations in the Sudanese community in the absence of a formal screening program. Methodology: This is a descriptive longitudinal study conducted at the Obst. & Gyn. hospital in El-Obeid, North Kordofan State, Sudan, from January 2021 to December 2022. This screening involved around 120 volunteers. Results: In this study, 14% of participants had neoplastic alterations. Positive cases were highest in the 31-35 age group (29.4%), followed by 36-40 and ≤25 age groups (23.5%). The majority of positive cases (58.8%) were from metropolitan areas. The risk of neoplastic alterations is connected with urban residency; RR (95%CI) = 2.558 (1.050-6.235), P-value < 0.03. Approximately 11.1% of illiterate participants had neoplastic alterations, as did approximately 25% of those with a basic degree of education. The risk associated with a basic education level is 2.2750 (95% CI) (0.9550 to 5.4197), P = 0.0635. Conclusion: Cervical neoplastic alterations are common in northern Kordofan, yet there are few screening programs. Cervical neoplastic alterations are substantially higher in the metropolitan population.

Accommodating the Rise in Urbanisation: Are New Towns a Good Solution?

Abstract This paper studies the performance of New Towns, that is, planned large urban sub-centres, as a central tool to accommodate the global rise in urbanisation. A spatial quantifiable general equilibrium framework suitable to study large-scale urban master plans is presented. The framework is then used to investigate the equilibrium effects of five New Towns developed in the 1970s in Paris’s metropolitan area. By 2015, the development of New Towns appears to have increased metropolitan population ($+$18%), metropolitan gross domestic product ($+$11%) and reduced average commuting times (−6.9%). The results obtained for Paris’s metropolitan area are externally validated using a difference-in-differences approach on all 314 New Towns developed worldwide between 1992 and 2012.

Contemporary Prevalence of Oral Clefts in the US: Geographic and Socioeconomic Considerations.

Background: Socio-economic status, living environments, and race have been implicated in the development of different congenital abnormalities. As orofacial clefting is the most common anomaly affecting the face, an understanding of its prevalence in the United States and its relationship with different determinants of health is paramount. Therefore, the purpose of this study is to determine the modern prevalence of oral-facial clefting in the United States and its association with different social determinants of health. Methods: Utilizing Epic Cosmos, data from approximately 180 US institutions were queried. Patients born between November 2012 and November 2022 were included. Eight orofacial clefting (OC) cohorts were identified. The Social Vulnerability Index (SVI) was used to assess social determinants of health. Results: Of the 15,697,366 patients identified, 31,216 were diagnosed with OC, resulting in a prevalence of 19.9 (95% CI: 19.7-20.1) per 10,000 live births. OC prevalence was highest among Asian (27.5 CI: 26.2-28.8) and Native American (32.8 CI: 30.4-35.2) patients and lowest among Black patients (12.96 CI: 12.5-13.4). Male and Hispanic patients exhibited higher OC prevalence than female and non-Hispanic patients. No significant differences were found among metropolitan (20.23/10,000), micropolitan (20.18/10,000), and rural populations (20.02/10,000). SVI data demonstrated that OC prevalence was positively associated with the percentage of the population below the poverty line and negatively associated with the proportion of minority language speakers. Conclusions: This study examined the largest US cohort of OC patients to date to define contemporary US prevalence, reporting a marginally higher rate than previous estimates. Multiple social determinants of health were found to be associated with OC prevalence, underscoring the importance of holistic prenatal care. These data may inform clinicians about screening and counseling of expectant families based on socio-economic factors and direct future research as it identifies potential risk factors and provides prevalence data, both of which are useful in addressing common questions related to screening and counseling.

Healthy food delivery for type 2 diabetes management in rural clinics' patients: A comparative effectiveness randomized controlled trial protocol

BackgroundRural populations experience a higher prevalence of both food insecurity and type 2 diabetes mellitus (T2DM) than metropolitan populations and face many challenges in accessing resources essential to optimal T2DM self-management. This study aims to address these challenges by delivering a T2DM-appropriate food box and recipes directly to rural participants' homes. MethodsThis is a comparative effectiveness randomized controlled trial including 400 English- or Spanish-speaking rural adult participants with T2DM (HbA1c ≥6.5%) experiencing food insecurity. Participants are randomly assigned to a 3-month Healthy Food Delivery Intervention (HFDI) plus one 60-min virtual consultation with a diabetes educator or consultation only. The HFDI includes a weekly food box delivery with recipes. Data are collected at pre-intervention, 3-months (post-intervention), 9-months, and 15-months. The primary outcome is change in HbA1c, with secondary measures including diet quality (Healthy Eating Index-2015, calculated from one 24-h dietary recall at each data collection time point), cardio-metabolic risk factors (i.e., blood pressure, lipids, body mass index, glucose), and patient-centered outcomes (e.g., T2DM self-efficacy, T2DM-related distress). Process evaluation data (e.g., successful food box deliveries, diabetes educator consultation attendance, intervention satisfaction) are collected during and post-intervention (3-months). A cost-effectiveness analysis based on traditional cost per quality-adjusted life year gain thresholds will be conducted to estimate the incremental cost-effectiveness between HFDI plus consultation and consultation alone. ConclusionFindings from this study will provide evidence regarding the effectiveness of an intervention that promotes participant adherence and improves access to healthy food.Clinical Trial Registration:NCT04876053

Inequalities in urban air pollution in sub-Saharan Africa: an empirical modeling of ambient NO and NO2 concentrations in Accra, Ghana.

Road traffic has become the leading source of air pollution in fast-growing sub-Saharan African cities. Yet, there is a dearth of robust city-wide data for understanding space-time variations and inequalities in combustion related emissions and exposures. We combined nitrogen dioxide (NO2) and nitric oxide (NO) measurement data from 134 locations in the Greater Accra Metropolitan Area (GAMA), with geographical, meteorological, and population factors in spatio-temporal mixed effects models to predict NO2 and NO concentrations at fine spatial (50 m) and temporal (weekly) resolution over the entire GAMA. Model performance was evaluated with 10-fold cross-validation (CV), and predictions were summarized as annual and seasonal (dusty [Harmattan] and rainy [non-Harmattan]) mean concentrations. The predictions were used to examine population distributions of, and socioeconomic inequalities in, exposure at the census enumeration area (EA) level. The models explained 88% and 79% of the spatiotemporal variability in NO2 and NO concentrations, respectively. The mean predicted annual, non-Harmattan and Harmattan NO2 levels were 37 (range: 1-189), 28 (range: 1-170) and 50 (range: 1-195) µg m-3, respectively. Unlike NO2, NO concentrations were highest in the non-Harmattan season (41 [range: 31-521] µg m-3). Road traffic was the dominant factor for both pollutants, but NO2 had higher spatial heterogeneity than NO. For both pollutants, the levels were substantially higher in the city core, where the entire population (100%) was exposed to annual NO2 levels exceeding the World Health Organization (WHO) guideline of 10 µg m-3. Significant disparities in NO2 concentrations existed across socioeconomic gradients, with residents in the poorest communities exposed to levels about 15 µg m-3 higher compared with the wealthiest (p < 0.001). The results showed the important role of road traffic emissions in air pollution concentrations in the GAMA, which has major implications for the health of the city's poorest residents. These data could support climate and health impact assessments as well as policy evaluations in the city.

Racing to Zipf's law: Race and metropolitan population size 1910–2020

AbstractScholarship demonstrates that urban systems follow a power law population distribution if the population has full labor mobility. Theoretically, subpopulations should also follow a power law population distribution if that subpopulation also has full labor mobility. Examining city population distributions for White and Black Americans across US metropolitan areas from 1910 to 2020 shows that the White distribution mostly conforms to both Zipf's and Gibrat's laws throughout this period. In contrast, the Black population does not follow either law until the second half of the 20th century, a result that is consistent with theories of restricted mobility out of the South for Black Americans during the Jim Crow era.

Comparative analysis of mammary lump histology and elasto-graphy results at a tertiary hospital

In the majority of India's metropolitan populations, mammary carcinoma has become the commonest type of carcinoma. A non-invasive imaging method called mammary sono-elasto-graphy can reveal information about mammary lesions. Aims &amp; objectives: In the current research, we examined the diagnostic efficacy of elasto-graphy and histopathological findings of mammary lumps. Material and Methods: The current investigation involved Female patients had solid mammary lesions less than 3 cm in size that were visible on sonography. Classified as BI RADS 3 and 4 lesions, these lesions. Results: 252 female patients had U.S.G. elastography, followed by biopsy or surgery, and histopathology reports were available during the research period. Histopathologically, 104 (41.72%) samples were benign, and the remaining 148 (58.73%) were malignant. Age, B.I.R.A.D.S., Elastography Score, and Strain Ratio were all statistically higher in malignant cases than in benign patients (p 0.001). According to Histo-pathological analysis, fibroadenoma (77.03%) accounted for the majority of benign lesions, followed by Abscess (5.41%), sclerosing adenosis (1.35%), benign fibroepithelial lesion (6.76%), and fibrocystic disease (9.46%). Conversely, poorly differentiated invasive carcinoma (5.77%), invasive ductal carcinoma (67.31%), and invasive mucinous carcinoma (13.46%), IL.C. (5.77%), medullary carcinoma (1.92%), papillary carcinoma (1.92%), and phylloid (1.92%) made up the bulk of malignant cases, Excellent results were noticed with the combination of Ultrasound Score + Elastography Score + Strain Ratio, with scores of 96.00%, 96.05%, 96.03%, 94.12%, and 97.33%, respectively, for susceptibility, accuracy, diagnostic accuracy, and N.P.V. and PPV. Conclusion: The ability to distinguish between benign and malignant mammary masses using ultra-sound elasto-graphy, strain elasto-graphy, and ultra-sound score has good susceptibility, accuracy, and diagnostic accuracy.

Let Us Build for Ourselves a City: A Biblical Look at the Correlation Between Secularism, Liberalism, and Urbanization in America

A map of the 2022 U.S. mid-term election results per House district shows a vastness of ‘Republican red’ engulfing most of the country’s landmass in comparison to small pockets of ‘Democrat blue’ that is concentrated upon the most urbanized metropolitan population centers. Such a unique phenomenon begs the following question: ‘What has happened within the most urbanized metropolitan populations to cause them to overwhelmingly vote for the politically liberal Democratic party, a party whose platform is antithetical in many ways to what is expressly taught in the Bible?’ This question also spawns another: ‘Why have the most populous areas in the country also become bastions of paganism, hedonism, and liberalism?’ This paper demonstrates that past human behavior detailed in biblical narratives is being replicated in today’s modern urbanized culture. As is seen in Scripture, for a large city or metropolitan area to obtain and maintain a consistent and achievable level of peace and prosperity, a compromising layer of tolerance towards immorality and evil must materialize. Subsequently, the sustained tolerance of evil and violence will eventually lead to the approval, propagation, and adoption of evil and violence. Then and now, to the degree an urban population ‘goes along to get along’, the further it drifts from the Lord and plunges downward into paganism, hedonism, and idolatry. Thus, when a society consciously usurps the sovereignty of God and thinks it possesses the highest level of authority, then it has arrived at the point where it believes it has the freedom to redefine societal rules according to what it determines to be “right in its own eyes” (Judg. 21:25). By dismissing God’s existence or discounting His holiness, justice, and power, a population cognitively thinks it has effectively shaken off the yoke of sin, guilt, and shame, and has achieved the human right to “call evil good and good evil” (Isa. 5:20).

“#ESSACONTANÃOÉMINHA” ativismo online e engajamento nas redes sociais digitais

Abstract This paper seeks to better understand the production of meanings in the context of online activism. Based on an interpretative and exploratory qualitative investigation approach, we seek to examine the path of the activist campaign “Cedae, this bill is not mine”, by the organization Meu Rio, in the context of the crisis of water supply to the metropolitan population of Rio de Janeiro, in early 2020. The study analyzes different strategies for mobilization and engagement in digital social networks and interprets the interpretation of people, from a web of interactions in search of meanings. The investigation takes place under the aegis of a larger interpretive category, sustainability, as the transformations that one wants to see in the world depend on actions that involve social mobilization for change. Activism thus reveals itself as an emerging and fundamental activity for the design and expansion of communication practices in sustainable development.

What would it look like? Visualizing a future US Corn Belt landscape with more table food production

Abstract Most farmland in the US Corn Belt is used to grow row crops at large scales (e.g., corn, soybean) that are highly processed before entering the human food stream rather than specialty crops grown in smaller areas and meant for direct human consumption (table food). Bolstering local table food production close to urban populations in this region through peri-urban agriculture (PUA) could enhance sustainability and resilience. Understanding factors influencing PUA producers' preferences and willingness to produce table food would enable supportive planning and policy efforts. This study combined land use visualization and survey data to examine the potential for increased local table food production for the US Corn Belt. We developed a spatial visualization of current agricultural land use and a future scenario with increased table food production designed to meet 50% of dietary requirements for a metropolitan population in 2050. A survey was administered to row crop (1360) and specialty crop (55) producers near Des Moines, Iowa, US to understand current and intended agricultural land use and factors influencing production. Responses from 316 row crop and 25 specialty crop producers were eligible for this analysis. A future scenario with increased table food production would require less than 3% of available agricultural land and some additional producers (approximately 130, primarily for grain production). Survey responses indicated PUA producers planned small increases in table food production in the next three to five years. Producer plans, including land rental for table food production, could provide approximately 25% of residents' fruit, vegetables, and grains, an increase from the baseline of 2%. Row crop producers ranked food safety regulations, and specialty producers ranked labor concerns as strong influences on their decision-making. Both groups indicated that crop insurance and processing facilities were also important. Increasing table food production by clustering mid-scale operations to increase economies of scale and strengthening supply chains and production infrastructure could provide new profitable opportunities for farmers and more resilient food systems for growing urban regions in the US Corn Belt. Continuing to address producer factors and landscape-scale environmental impacts will be critical in considering food system sustainability challenges holistically.

Geospatial Evaluation of Disparities in Access to Cervical Spine Fusion in Metropolitan Areas Across the United States.

Retrospective study with epidemiologic analysis of public Medicare data. The purpose of this study is to use geospatial analysis to identify disparities in access to cervical spine fusions in metropolitan Medicare populations. Cervical spine fusion is among the most common elective procedures performed by spine surgeons and is the most common surgical intervention for degenerative cervical spine disease. Although some studies have examined demographic and socioeconomic trends in cervical spine fusion, few have attempted to identify where disparities exist and quantify them at a community level. Center for Medicare and Medicaid Services physician billing and Medicare demographic data sets from 2013 to 2020 were filtered to contain only cervical spine fusion procedures and then combined with US Census socioeconomic data. The Moran Index geospatial clustering algorithm was used to identify statistically significant hotspot and coldspots of cervical spine fusions per 100,000 Medicare members at a county level. Univariate and multivariate analysis was subsequently conducted to identify demographic and socioeconomic factors that are associated with access to care. A total of 285,405 cervical spine fusions were analyzed. Hotspots of cervical spine fusion were located in the South, while coldspots were throughout the Northern Midwest, the Northeast, South Florida, and West Coast. The percent of Medicare patients that were Black was the largest negative predictor of cervical spine fusions per 100,000 Medicare members ( β =-0.13, 95% CI: -0.16, -0.10). Barriers to access can have significant impacts on health outcomes, and these impacts can be disproportionately felt by marginalized groups. Accounting for socioeconomic disadvantage and geography, this analysis found the Black race to be a significant negative predictor of access to cervical spine fusions. Future studies are needed to further explore potential socioeconomic barriers that exist in access to specialized surgical care. Level III-retrospective.

The urban mobility of elder workers: evidence with the American Time Use Survey (2003-2018)

This paper explores the commuting behavior of elder workers in the United States, with a focus on metropolitan areas and metropolitan population sizes. Using the American Time Use Survey for the years 2003-2018, estimates reveal a positive correlation between commuting time and residing in metropolitan areas, driven by longer commutes in more populated areas. Furthermore, elder workers in metropolitan areas of more than 2.5 million inhabitants use more public transports than workers in less-populated or non-metropolitan areas. The analysis may allow policy makers to identify which workers may be more affected by the negative consequences of commuting, and also who has more limitations in their commuting behaviors.