Non-urban Areas Research Articles

What is Needed to Support Non-Urban Urology in the United States? Perspectives from Urologists in Rural and Underresourced Areas.

Twenty percent of Americans live in non-urban areas, and the challenges in providing high-quality health care in rural areas are well described. These challenges are further exacerbated by the fact that rural citizens are often older and sicker than their urban colleagues, as well as by the ongoing workforce shortage in urology. This study aims to describe the current practice experiences of non-metropolitan urologists (NMUs) in the United States. Based on the results of the 2022 American Urological Association Census, a secondary questionnaire was developed and distributed electronically to urologists who self-identified in the Census as practicing in non-metropolitan areas. Multiple choice answers were summarized as proportions and free-text answers were collected and grouped by theme. One hundred and thirteen of 552 (20.5%) urologists responded. Most respondents were male (92.9%), aged >55 years (76.1%), in practice >25 years, and in solo practice (25.5%) or a subspecialty group (20.8%). Stressors for NMUs included recruitment (61.3%), call concerns (59.3%), workforce issues (59.3%), difficulty interacting with tertiary medical centers (45.1%), and lack of resources (40.7%). Nearly half of respondents (48.5%) experience burnout more than once monthly, and 31.9% anticipate continuing their current practice and pace for the next five years. Call burden is the most likely reason to leave practice (40%). Most urologists practicing in non-metropolitan areas are older, endorse high rates of burnout, and have active plans to leave or decrease practice within five years. Understanding contemporary stressors can inform policies to support current and future NMUs.

Effectiveness of Communicative Language Teaching in Non-Urban Areas’ Primary Schools: The Case of Afif, Saudi Arabia

The main purpose of the study was to investigate the effectiveness of Communicative Language Teaching (CLT) in Teaching English to Speakers of Other Languages (TESOL) at primary schools in Afif city. The responses given by students covered their feelings towards CLT in terms of their English speaking levels, their motivation, their efforts, their grammar and vocabulary learning, their confidence in using English in real life, and their opinion towards other additional ways of learning English such as games and social media. A qualitative approach was used, with a sample of seven female students from two primary schools in the Afif district selected using a concentrated sampling procedure. Two instruments were used: the Students’ Attitude Scale, adapted from Savignon and Wang (2003), and peer observation. The Students’ Attitude Scale was used to evaluate students’ impressions of CLT, while peer observation was used to identify the impact of CLT in teaching English to non-native speakers. Overall, the most significant results of the study indicate that CLT has a positive effect on learners’ English comprehension skills, builds up their confidence to use English in different situations, and gives them more/more satisfaction with the experience. CLT also helps to motivate the students and bring about improvement in their dialogue/ communicative proficiency. Based on these results, the study recommends the continued implementation of CLT in English language teaching, ongoing professional development for teachers, promotion of student engagement, fostering confidence building, integration of technology, and encouragement of peer observation among teachers. These recommendations aim to enhance the effectiveness of CLT in TESOL settings in primary schools in Eastern Saudi Arabia.

Task shifting to improve practice efficiency: A survey among general practitioners in non-urban Baden-Wuerttemberg, Germany

Background Germany is challenged by an increasing shortage in general practice services, especially in non-urban areas. Task shifting from general practitioners (GPs) to other health professionals may improve practice efficiency to address this mismatch. Objectives Exploring GPs’ motives and beliefs towards task shifting in non-urban Germany and identifying potential factors influencing these. Methods The cross-sectional survey was disseminated by mail in three waves between July 2021 and August 2022 among all GPs in non-urban Baden-Wuerttemberg, Germany. It included items on demographics and practice characteristics as well as 15 Likert-scale items addressing motives and beliefs towards task shifting, based on the Theoretical Domain Framework. Likert-scale items were analysed descriptively, influencing factors on motives and beliefs were identified using multiple linear regression. Results Response rate was 24.2% (281/1162), with respondents comparable in age and gender to all GPs in Baden-Wuerttemberg. GPs’ motives and beliefs towards task shifting are positive overall. The majority expects task shifting to reduce their workload (87.9%) and increase practice efficiency (74.7%). They are open to shift additional tasks to other professionals (69.1%), even in the currently prohibited form of substitution (51.2%). Motives and beliefs were significantly more positive among younger GPs and those participating in the GP-centred care programme. Conclusion This study describes GPs’ motives and beliefs towards task shifting in non-urban Germany. Identifying younger GPs and those participating in the GP-centred care programme as particularly endorsing may help design future interventions aiming to improve efficiency in general practice in non-urban Germany.

Trends in Phototherapy Utilization, Payments, and Geographic Distribution: An Analysis of United States Medicare Part B From 2000 to 2021.

Trends in phototherapy utilization in the context of new therapeutics have not been evaluated. This study aimed to evaluate phototherapy utilization, payments, and geographic distribution for Medicare beneficiaries from 2000 to 2021. A longitudinal analysis of the Medicare Part B National Summary Data Files was conducted to obtain phototherapy utilization and payment amounts. Medicare Physician & Other Practitioners by Provider and Service datasets were used to determine provider type and geographic distribution. Between 2000 and 2021, total Medicare phototherapy volume increased from 335,152 to 621,850, correlating with a 3.0% annual growth rate (5.0% between 2000 and 2015, -3.1% between 2016 and 2021). Ultraviolet B phototherapy represented the majority of use, rising from 68.1% in 2000 to 78.0% in 2021. Psoralens plus ultraviolet A decreased by 11.3% annually, while laser treatments increased by 17.3%. Between 2013 and 2021, the number of clinics offering phototherapy declined; facilities were available in only 9.9% of counties, mainly clustered along both coasts and east of the Mississippi. Overall, phototherapy continues to be an important therapeutic option. Limited access in non-urban areas remains a significant challenge, and further work is necessary to both evaluate this impact and reduce disparities.

Environmental Inequality in Estimated Cancer Risk from Airborne Toxic Exposure across United States Communities from 2011 to 2019.

US Census Bureau data were matched to U.S. Environmental Protection Agency estimated cancer risks from airborne toxics from 2011 to 2019 to explore environmental inequality with nationwide census tract resolution. Spearman correlations showed modest associations between various socioeconomic status factors and estimated cancer risk. Multiple linear regression analyses show positive associations with increased estimated cancer risk (p < 0.05) for high proportions of Blacks in suburban and rural areas. A positive relationship with estimated cancer risk was found for increasing proportions of Asians and Hispanics in nonurban areas. Urban tracts that suffer from the highest estimated cancer risks were concentrated among the communities with a population of higher proportion of minorities. While environmental inequality seems to have improved across the examined years for certain demographics with respect to estimated cancer risk from air toxics, equity is far from achieved, and future work in identifying the sources of environmental inequality could help in achieving a more just environment.

United States Provider Experiences With Telemedicine for Hepatitis C Treatment: A Nationwide Survey.

Hepatitis C virus (HCV) elimination requires treatment access expansion, especially for underserved populations. Telehealth has the potential to improve HCV treatment access, although data are limited on its incorporation into standard clinical practice. We conducted a cross-sectional, email survey of 598 US HCV treatment providers who had valid email addresses and (1) were located in urban areas and had written ≥ 20 prescriptions for HCV treatment to US Medicare beneficiaries in 2019-2020 or (2) were located in non-urban areas and wrote any HCV prescriptions in 2019-2020. Through email, we notified providers of a self-administered electronic 28-item survey of clinical strategies and attitudes about telemedicine for HCV. We received 86 responses (14% response rate), of which 75 used telemedicine for HCV in 2022. Of those 75, 24% were gastroenterologists/hepatologists, 23% general medicine, 17% infectious diseases and 32% non-physicians. Most (82%) referred patients to commercial laboratories, and 85% had medications delivered directly to patients. Overwhelmingly, respondents (92%) felt that telehealth increases healthcare access, and 76% reported that it promotes or is neutral for treatment completion. Factors believed to be 'extremely' or 'very' important for telehealth use included patient access to technology (86%); patients' internet access (74%); laboratory access (76%); reimbursement for video visits (74%) and audio-only visits (66%). Non-physician licensing and liability statutes were rated 'extremely' or 'very' important by 43% and 44%, respectively. Providers felt that telehealth increases HCV treatment access. Major limitations were technological requirements, reimbursement, and access to ancillary services. These findings support the importance of digital equity and literacy to achieve HCV elimination goals.

The mechanism of urban agglomeration causing the enhancement of regional extreme heat and drought events

Urban agglomerations formed by rapid urbanization have been found to be important ways through which human activities influence regional weather and climate. However, the role of urban agglomerations in the formation of extreme heat and drought events remains unclear. We perform numerical simulations using RegCM 5.0 on an August 2022 extreme heat event in the Yangtze River Basin in China. The results show that urban agglomerations lead to significantly increased temperature in both urban (0.6 °C increase) and non-urban (0.2 °C increase) areas. The land feedback formed by urban agglomerations significantly increases the surface sensible heat, turbulence activity, urban upward movement, and urban heat island effect. As a result, the sinking airflow is enhanced, the surface wind is increased, and a dome-shaped wind field anomaly is formed around the urban agglomerations. This widens the geographic scope of the heat event and heightens its intensity.

Closing the distance gap: Evaluating patient travel distances in a community oncology practice.

157 Background: Patient travel distance is an important factor influencing healthcare access, health equity and outcomes. The Rural-Urban Commuting Area (RUCA) classification system categorizes geographic areas based on urbanization and commuting patterns to measure accessibility to healthcare. We study the relationship between RUCA and patient travel distance for a multi-site community-based, medical oncology practice in north-west Chicagoland area. Methods: Using patient ZIP code data and practice locations (clinics) from April 2023 to March 2024, we calculated and compared the straight-line, one-way, patient-clinic travel distance (travel distance) for about 20,000 patients at 5 clinics, using geospatial analysis techniques. We grouped clinics based on location and population characteristics, applied the RUCA classification to patient ZIP codes, and compared travel distances by RUCA categories. Results: The median travel distance for patients was 5.0 miles, with 82% of patients traveling 10 miles or less, and 89% traveling 15 miles or less. Table 1 shows % of patients traveling and travel distance by RUCA categories. Median travel distances for urban metro, suburban metro, and suburban small-town clinics were 4.8mi, 10.8mi and 20.6mi (Kruskal Wallis H-test, p &lt;0.001). Within 50 miles of each clinic, median travel distance for patients from urban ZIP codes (4.8 mi) was lower compared to metropolitan, micropolitan, small town and all other RUCA categories. Conclusions: Preliminary findings indicate a significant association between RUCA and travel distance, with longer travel distances for patients in non-urban locales. Proximity of cancer care sites to the patient’s home reduces distance traveled, minimizing the burden on the patients and their families. Interventions addressing transportation needs (such as improving infrastructure, increasing transportation options, subsidizing healthcare travel, etc.) can be augmented with efforts to strengthen access to community-based sites (expansion of telehealth, incentivizing providers serving non-urban areas, etc.) to reduce patient and caregiver burden. Clinic Site Category % of patients traveling &lt;5 mi &lt;10mi &lt;15mi &lt;50mi &gt;50mi A Suburban Metro 53.8% 30.7% 5.2% 9.1% 0.9% B Suburban Small Town 24.1% 40.6% 21.9% 12.3% 0.4% C Suburban Metro 45.7% 34.3% 5.01% 13.8% 1.0% D Suburban Metro 60.1% 23.9% 6.8% 7.9% 1.2% E Urban Metro 80.3% 9.7% 3.5% 5.2% 1.0% ALL SITES 54.7% 27.1% 7.2% 9.8% 0.9% Clinic Median travel distance in miles (% of patients) by patient RUCA within 50 miles of clinics Urban Metropolitan – High Commute Micropolitan – Flow to Large Urban Cluster Small Town – Flow to Small Urban Cluster All Other A 4.8 (98.2%) 27.5 (1.7%) 48.7 49.4 B 4.0 (42.3%) 8.6 (54.2%) 25.0 20.6 (3.2%) C 5.9 (95.2%) 17.7 (4.5%) 36.7 27.7 D 4.8 (97.1%) 23.7 (2.8%) 48.4 40.1 E 2.7 (98.9%) 32.3 (1.0%) 4.5 ALL 4.8 (91.2%) 10.8 (8.3%) 36.7 (0.1%) 20.6 (0.4%) 4.5

The Art of Sculpture in Public Space in China: The Wasteland Art Project

With the development of public art in China, artists have been experimenting with the artistic form and means of expression of public sculpture. Previously marginalised by public sculpture, wild non-urban areas have also begun to attract the attention of Chinese artists. The Wasteland art project, implemented in Guazhou, Gansu province, is very indicative in this regard. Sculptor Dong Shubin, a professor at Tsinghua University Academy of Fine Arts, is the initiator of this project and an experimental artist who aims to create a sustainable artistic community in the Gobi Desert in the northwest of the country. He believes that an artist should draw inspiration from a natural environment that is familiar to them, rather than simply imitate others or emphatically separate themselves from the general mass of people. After creating works such as Children of the Earth, Infinity, and Wind Talkers, Dong Shubin and his colleagues are gradually creating a Wasteland Art complex in the Gobi Desert.

Interactive effects of long-term exposure to air pollutants on SARS-CoV-2 infection and severity: a northern Italian population-based cohort study.

We examined interactions, to our knowledge not yet explored, between long-term exposures to particulate matter (PM 10 ) with nitrogen dioxide (NO 2 ) and ozone (O 3 ) on SARS-CoV-2 infectivity and severity. We followed 709,864 adult residents of Varese Province from 1 February 2020 until the first positive test, COVID-19 hospitalization, or death, up to 31 December 2020. We estimated residential annual means of PM 10 , NO 2 and O 3 in 2019 from chemical-transport and random-forest models. We estimated interactive effects of pollutants with urbanicity on SARS-CoV-2 infectivity, hospitalization, and mortality endpoints using Cox regression models adjusted for socio-demographic factors and comorbidities, and additional cases due to interactions using Poisson models. 41,065 individuals were infected, 5,203 were hospitalized and 1,543 died from COVID-19 during follow-up. Mean PM 10 was 1.6 times higher and NO 2 2.6 times higher than WHO limits, with wide gradients between urban and non-urban areas. PM 10 and NO 2 were positively associated with SARS-CoV-2 infectivity and mortality, and PM 10 with hospitalizations in urban areas. Interaction analyses estimated that the effect of PM 10 (per 3.5 µg/m 3 ) on infectivity was strongest in urban areas (HR=1.12, 95%CI:1.09-1.16), corresponding to 854 additional cases per 100,000 person-years, and in areas at high NO 2 co-exposure (HR=1.15, 1.08-1.22). At higher levels of PM 10 co-exposure the protective association of ozone reversed (HR=1.32, 1.17-1.49), yielding to 278 additional cases per µg/m 3 increase in O 3 . We estimated similar interactive effects for severity endpoints. We estimate that interactive effects between pollutants exacerbated the burden of SARS-CoV-2 pandemic in urban areas.

Abstract B140: Further evaluation of social determinants of health including association of neighborhood disadvantage and population density with severity of activity- and mood- related interference in primary brain tumor patients

Abstract Purpose: Growing evidence links living in rural or socioeconomically disadvantaged areas with worse outcomes in cancer patients. Our previous work indicated that growing up in a rural area and experiencing food insecurity in childhood are associated with more severe activity and mood-related interference from symptoms in the primary brain tumor (PBT) population. This study investigates the association of current neighborhood deprivation and population density with activity- and mood-related interference in a cross-sectional cohort of 555 patients with a PBT enrolled in a natural history study (NCT03251989). Methods: National Area Deprivation Index (ADI) and population density were dichotomized into more (&amp;gt;40) and less (&amp;lt;40) disadvantaged and urbanized (&amp;gt;1,000 persons/sq mi) and non-urbanized (&amp;lt;1,000 persons/sq mi). Activity- and mood-related interference was stratified into none/mild (0-1) and moderate/severe (2-10). Logistic regression was used to test univariate and multivariate associations of moderate/severe activity- and mood-related interference with demographic and clinical variables. Bonferroni-Holm was implemented to adjust for multiple comparisons (p &amp;lt; 0.001) in univariate analyses. We used backwards elimination multivariate analyses to fit the final model. Variables were included modeling when univariate p &amp;lt;0.10. Results: The sample included more males (57%), median age 49 (range 18-85), living in more disadvantage neighborhoods (25%), and primarily in urbanized areas (61%). The majority (74%) had high grade tumors, most commonly glioblastoma (39%), with 49% with tumor recurrence, and 21% on active treatment. Univariate analysis showed neither ADI nor population density was significantly associated with activity-related interference (ADI OR=1.35, 95% CI [0.85, 2.13]; population density OR=1.20, 95% CI [0.80, 1.79]) or mood-related interference (ADI OR=0.85, 95% CI [0.52, 1.38]; population density OR=1.19, 95% CI [0.78, 1.81]). In the multivariate analyses tumor diagnosis (OR=0.92 CI [0.53, 1.58]) growing up in a non-urbanized area (OR=1.56 CI [1.02, 2.40]), not having enough to eat when growing up (OR=2.50 CI [1.13, 5.54], and number of surgeries (OR=1.50 CI [1.00, 2.23]) remained associated with moderate/severe activity-related interference with ADI, and similar results were found in the population density model. Tumor recurrence (OR=1.77 CI [1.17, 2.66]) and comorbidities (OR=0.53 CI [0.33, 0.85]) were associated with moderate/severe mood-related interference with ADI and similar results were found in the population density model. Conclusions: Although activity- and mood-related interference were not associated with current ADI or population density, activity-related interference was significantly related to early life social variables including growing up in a rural area and not having enough to eat growing up. This study may be foundational for future study directions exploring other social deprivation factors early life or current that contributes to more interference in the PBT population. Citation Format: Tara S. Davis, Bennett A. McIver, Kimberly Reinhart, Elizabeth Vera, Vivian A. Guedes, Macy L. Stockdill, Orieta Celiku, Terri S. Armstrong, Michelle L. Wright. Further evaluation of social determinants of health including association of neighborhood disadvantage and population density with severity of activity- and mood- related interference in primary brain tumor patients [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B140.

Zróżnicowanie warunków bioklimatycznych między centrum Lublina i obszarem podmiejskim w półroczu letnim

The aim of this study is to assess the differences in the occurrence of harsh bioclimatic conditions between the center of Lublin and non-urban areas in the warm half of the year (April-September) and to determine the rate of changes in these conditions in both analysed meteorological stations in the years 1973–2022. To assess the bioclimatic conditions, the biometeorological index Humidex was used. In the first part of the study period, the number of days with unfavourable bioclimatic conditions prevailed in the city center, while in the last two decades the differences have decreased, mainly as a result of the development of concentrated buildings in the suburban area. In both measurement points, there was a significant increase in the number of days with strong thermal and hygric loads on the human body. The study also presents the reasons for the occurrence of selected cases with significant differences in the index values in the Lublin region, as well as the synoptic conditions on the day with the highest recorded Humidex value during the study period.

Drones reduce the time to defibrillation in a highly visited non-urban area: A randomized simulation-based trial

IntroductionOut-of-hospital cardiac arrest (OHCA) has a high global incidence and mortality rate, with early defibrillation significantly improving survival. Our aim was to assess the feasibility of autonomous drone delivery of automated external defibrillators (AED) in a non-urban area with physical barriers and compare the time to defibrillate (TTD) with bystander retrieval from a public access defibrillator (PAD) point and helicopter emergency medical services (HEMS) physician performed defibrillation. MethodsThis randomized simulation-based trial with a cross-over design included bystanders performing AED retrievals either delivered by automated drone flight or on foot from a PAD point, and simulated HEMS interventions. The primary outcome was the time to defibrillation, with secondary outcomes comparing workload, perceived physical effort, and ease of use. ResultsThirty-six simulations were performed. Drone-delivered AED intervention had a significantly shorter TTD [2.2 (95 % CI 2.0–2.3) min] compared to PAD retrieval [12.4 (95 % CI 10.4–14.4) min] and HEMS [18.2 (95 % CI 17.1–19.2) min].The self-reported physical effort on a visual analogue scale for drone-delivered AED was significantly lower versus PAD [2.5 (1 – 22) mm vs. 81 (65–99) mm, p = 0.02]. The overall mean workload measured by NASA-TLX was also significantly lower for drone delivery compared to PAD [4.3 (1.2–11.7) vs. 11.9 (5.5–14.5), p = 0.018]. ConclusionThe use of drones for automated AED delivery in a non-urban area with physical barriers is feasible and leads to a shorter time to defibrillation. Drone-delivered AEDs also involve a lower workload and perceived physical effort than AED retrieval on foot.

Physico-chemical Characteristics and Evolution of NR-PM1 in the Suburban Environment of Seoul

In South Korea, particulate matter (PM) is generated from various emission sources, including domestic air pollutants and long-range transport. Effective air quality policies require an understanding of the chemical characteristics of PM and differences between urban and non-urban areas (suburban and background areas). We analyzed the chemical characteristics of non-refractory submicron aerosols (NR-PM1) in Yongin City, a suburban area southeast of Seoul, using a high-resolution time-of-flight aerosol mass spectrometer (HR-ToF-AMS) in spring/summer. In spring/summer, photochemical reactions resulted in the highest proportion of Organic Aerosol (OA) among NR-PM1. Positive matrix factorization (PMF) revealed four OA sources: Primary OA and Secondary OA (Oxidized Primary OA (OPOA), Less Oxidized Oxygenated OA (LO-OOA), and More Oxidized Oxygenated OA (MO-OOA)). OPOA was formed from the oxidation of emissions from biomass burning and coal combustion; LO-OOA and MO-OOA were correlated with inorganic compounds and influenced by long-range transport. The majority of OA was SOA (82%). High temperatures and humidity accelerated the conversion of SO2 to SO42−, resulting in the proportion of SO42−, second only to OA. Despite favorable conditions for nitrate formation in ammonium-rich conditions, the proportion of NO3− was relatively low due to the decomposition of NH4NO3 into gaseous NH3 and HNO3 at high temperatures. This indicated that while ammonium-rich conditions are conducive to NH4NO3 production, elevated temperatures lead to its decomposition, resulting in lower NO3− concentrations in spring/summer. In the case study, for the case associated with long-range transport, the PM concentration increased due to inorganic compounds such as NO3− and SO42−. Conversely, in cases of domestic air stagnation, the concentration of PM increased primarily due to the presence of OA. These findings provide crucial insights for air quality management in suburban areas and can guide policies to reduce PM levels in spring and summer.

Diversity, Features, and Challenges of Managing Urban Protected Areas, the Case of Croatia

ABSTRACT Management strategies in protected areas are often based on experiences from large, remote sites, raising questions about their suitability for urban protected areas (UPAs). This paper compares management practices and impacts in non-urban protected areas (PAs) and urban protected areas. Focusing on twelve Croatian UPAs, the study explores challenges, activities, and resilience levels. Through field observations and interviews, it was found that UPA management is influenced by usage intensity, often requiring daily involvement of utility companies. UPAs face unique pressures due to frequent use, leading to longer recovery times compared to non-urban PAs. Moreover, the less natural the area, the greater its resistance to environmental pressures. While UPAs have distinctive challenges, effective management strategies that incorporate natural and cultural heritage, community engagement, and climate considerations can greatly improve their sustainability and public benefit.

Opting out of Medicare: Characteristics and differences between optometrists and ophthalmologists.

To determine the rate of Medicare opt-out among optometrists and ophthalmologists and to contrast the differences in the characteristics and geographic distribution of these populations. A retrospective cross-sectional study. Using a publicly available Centers for Medicare & Medicaid Services (CMS) data set, we collated data for ophthalmologists and optometrists who opted out in each year between 2005 and 2023. We calculated the rate of opt-out annually in each year window and cumulatively from 2005 to 2023. Comparative analysis was used to identify clinician characteristics associated with opt-out. Both annual and cumulative rate of ophthalmologist and optometrist opt-out from Medicare. The estimated prevalence of Medicare opt-outs was 0.52% (77/14,807) for ophthalmologists and 0.38% (154/40,526) for optometrists. Ophthalmologists opting out were predominantly male (67.5%), had a longer practice duration (average 31.8 years), and were more often located in urban areas (83.1%), compared to optometrists (53.2% male, average 19.6 years in practice, 59.1% in urban areas, p = 0.04, p<0.001, p<0.001 respectively). Approximately 83% of ophthalmologists were either anterior segment or oculoplastics specialties, while the majority (52.1%) of optometrists were in optometry-only practices; >75% of identified clinicians were in private practice. Geographical distribution across the US showed variable opt-out rates, with the top 3 states including Oklahoma (3.4%), Arizona (2.1%), and Kansas (1.6%) for ophthalmology and Idaho (4.3%), Montana (3.1%), and Wyoming (1.4%) for optometry. Few ophthalmologists and optometrists opt-out of Medicare but this trend has significantly increased since 2012. Of those who disenrolled from Medicare, 83% of ophthalmologists were in urbanized areas while 41% of optometrists were in non-urbanized areas. Because reasons for Medicare opt-out cannot be solely determined by administrative data, further investigation is warranted given the potential impact on healthcare accessibility.

A Statistical Analysis of Drought and Fire Weather Indicators in the Context of Climate Change: The Case of the Attica Region, Greece

As warmer and drier conditions associated with global warming are projected to increase in southern Europe, the Mediterranean countries are currently the most prone to wildfire danger. In the present study, we investigated the statistical relationship between drought and fire weather risks in the context of climate change using drought index and fire weather-related indicators. We focused on the vulnerable and long-suffering area of the Attica region using high-resolution gridded climate datasets. Concerning fire weather components and fire hazard days, the majority of Attica consistently produced values that were moderately to highly anti-correlated (−0.5 to −0.9). This suggests that drier circumstances raise the risk of fires. Additionally, it was shown that the spatial dependence of each variable on the 6-months scale Standardized Precipitation Evapotranspiration Index (SPEI6), varied based on the period and climate scenario. Under both scenarios, an increasing rate of change between the drought index and fire indicators was calculated over future periods versus the historical period. In the case of mean and 95th percentiles of FWI with SPEI6, abrupt changes in linear regression slope values were observed, shifting from lower in the past to higher values in the future periods. Finally, the fire indicators’ future projections demonstrated a tendency towards an increasing fire weather risk for the region’s non-urban (forested and agricultural) areas. This increase was evident from the probability distributions shifting to higher mean and even more extreme values in future periods and scenarios. The study demonstrated the region’s growing vulnerability to future fire incidents in the context of climate change.

Research on the level of digital literacy of English language teachers (a case study in China)

Introduction. As the main force in cultivating digital citizens in the new era, teachers’ digital literacy level is directly related to the development of the entire nation’s digital literacy. Therefore, it is necessary to study the current development status of teachers’ digital literacy. This study aims to investigate the development status of digital literacy of English teachers in Changzhi City, China, through empirical research, and to discover the problems faced by teachers in the development of digital literacy. Materials and methods. The respondents of this study were English teachers from urban and nonurban areas of Changzhi City, a total of 100 people, finally 83 valid questionnaires were collected. Methods: comparative method, generalization, literature analysis, questionnaire method, statistics and data analysis (descriptive statistics and ANOVA analysis). The results are obtained using computer programs MS Excel and IBM SPSS 26.0. Results. An assessment tool is developed to examine the current status of teachers' digital literacy development in China. The study finds that the overall digital literacy level of English teachers in Changzhi City is high (arithmetic mean = 3.94); teachers perform well in digital awareness (arithmetic mean = 4.98) and social responsibility (arithmetic mean = 4.05), while they perform poorly in digital technical knowledge and skills (arithmetic mean = 3.61) and digital applications (arithmetic mean = 3.47). There is no significant difference in teachers' digital literacy in terms of teacher gender, education and type of school where teachers work (p&gt;0.05). Teachers in urban areas are significantly better in digital literacy than teachers in non-urban areas. There are significant differences in the aspect of professional development(p=0.0360), digital technical knowledge and skills(p=0.0002), digital applications(p=0.0088). Teachers' digital literacy scores in five aspects differed significantly (p&lt;0.05) at different levels of teachers' age and years of teaching experience. Conclusion. The ability to integrate digital technologies and disciplines, innovative teaching awareness, and abilities of English teachers in Changzhi City should be improved. When improving the digital literacy of teachers, it is necessary to consider the characteristics of balanced development of the city and non-urban areas. The results obtained can be used as methodological recommendations for improving the level of digital literacy of teachers.

Espaços de turismo e lazer na zona rural de Teresina (PI): uma proposta de desenvolvimento sustentável

Tourism in rural areas comprises all activities carried out in non-urban areas, which consists of leisure activities in rural areas in various modalities defined based on the offer: rural tourism, agritourism, ecological tourism, etc. This work aims to understand the dynamics of tourism and leisure spaces in the rural area of the municipality of Teresina, Piaui, and their contributions to sustainable rural development. To this end, exploratory, bibliographic, and documentary research was used. The time frame to be worked on is contemporary, with the use of data and information from the Municipality of Teresina (PMT) through the Municipal Secretariat for Economic Development and Tourism (SEMDEC), in addition to the enterprises that operate in the field. In 2022, PMT created the Teresina Sites Route with the aim of strengthening rural tourism in the municipality. The results demonstrate that, among the businesses that make up the route, there is a variety of services offered, with most of them focused on gastronomy and sports and/or recreational activities. There are few enterprises that aim to offer an approximation to activities traditionally related to rural areas, such as agriculture and livestock farming. When considering that tourism and leisure options in rural areas can bring economic, environmental, and cultural benefits, it is essential to ensure that the activity does not grow in a disorderly manner, since a lack of planning can cause environmental degradation, loss of cultural identity and increased cost of living due to the appreciation of the area in question.

Atmospheric pollutants in Rosario, Argentina analysed through remote sensing: Wildfires and COVID-19 lockdown effects

Spatial-temporal dynamics of atmospheric pollutants can be analysed by space-based observations, contributing to environmental management and public health interventions. The influence of wildfires and anthropogenic activities on air quality is studied for the city of Rosario and its surroundings, including both urban and non-urban areas. Utilizing advanced satellite-based observations, we assess Aerosol Optical Depth (AOD) and Nitrogen Dioxide (NO2). The study employs Multi-Angle Implementation of Atmospheric Correction (MAIAC) and Moderate Resolution Imaging Spectroradiometer (MODIS) onboard NASA's Terra and Aqua satellites for AOD analysis. NO2 measurements were derived from the Ozone Monitoring Instrument (OMI) on the Aura satellite. Backward trajectory analysis using Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) shows the connection between fire pixels and air masses reaching Rosario. During the COVID-19 lockdown, a period with no significant fire events in the studied region was selected. This provided, for the first time, a baseline on the AOD median value of 0.05 for Rosario city and its surroundings, while NO2 total column median values were close to 3.00 x 1015 molecules/cm2. In a business-as-usual scenario, AOD increased by approximately 52.8% (March 2022) up to 111.3% (March 2019). NO2 median values remain almost the same (March 2019) or reached a median value of 3.38 x 1015 molecules/cm2 (March 2022). During wildfire events, such as March 2023, AOD surged by around 50.9%–108.6% compared to the business-as-usual scenario (March 2019 and March 2022, respectively). NO2 median values ranged from 3.52 x 1015 molecules/cm2 (March 2023) to 3.66 x 1015 molecules/cm (March 01, 2020 to March 19, 2020). NO2 levels correlated with intense fire periods. The analysis provides valuable insights into the complex interplay between natural events, human activities, and air quality dynamics in the region.