Non-urban Areas Research Articles

Rural entrepreneurship

Motivation: The issue of rural development is an important topic from the perspective of the science of territorial development for several reasons. First, from the perspective of the growing importance of cities, with which the depopulation of the countryside is associated. Secondly, from the point of view of the development opportunities of non-urbanized areas, whose position in the context of fund distribution is weak. Finally, from the point of view of the possibility of diversifying food production, to which much attention is currently being paid in Europe and around the world. However, as studies show, not only the existence, but the development of rural areas is a determinant of the development of urban areas.Aim: The purpose of the article is to demonstrate that rural development continues to be a significant challenge, while especially important for this development is the involvement of people — entrepreneurial leaders.Results: As a result of the study, it was possible to gain input in the form of knowledge regarding the differential impact of the rural development factors identified in the study. The phenomenon of the possibility of digitization of social and business life, which has emerged as globalization has progressed, and quite clearly as a result of the pandemic, has shown that it is a factor of great importance in leveling the marginalization of rural areas. What’s more, the entrepreneurship of rural leaders is a key element in building strategies for the development of these areas, even outweighing the factor of a financial and administrative nature.

Treatments and prognostic factors for bone and soft tissue sarcoma in non-urban areas in Japan.

Although bone and soft tissue sarcoma is recognized as a rare cancer that originates throughout the body, few comprehensive reports regarding it have been published in Japan. Bone and soft tissue sarcomas were tabulated from the Cancer Registries at eight university hospitals in the Chugoku-Shikoku region. Prognostic factors in cases were extracted in a single facility and have been analyzed. From 2016 to 2019, 3.4 patients with bone and soft tissue sarcomas per a general population of 100,000 were treated at eight university hospitals. The number of patients who underwent multidisciplinary treatment involving collaboration among multiple clinical departments has been increasing recently. In the analysis carried out at a single institute (Ehime University Hospital), a total of 127 patients (male/female: 54/73) with an average age of 67.0 y (median 69.5) were treated for four years, with a 5-year survival rate of 55.0%. In the analysis of prognostic factors by multivariate, disease stage and its relative treatment, renal function (creatinine), and a patient's ability of self-judgment, and a patient's mobility and physical capability were associated with patient prognosis regarding bone and soft tissue sarcomas. Interestingly, age did not affect the patient's prognosis (> 70 vs ≦70). Physical and social factors may affect the prognosis of patients with bone and soft tissue sarcomas, especially those living in non-urban areas.

Genomic footprints of (pre) colonialism: Population declines in urban and forest túngara frogs coincident with historical human activity.

Urbanisation is rapidly altering ecosystems, leading to profound biodiversity loss. To mitigate these effects, we need a better understanding of how urbanisation impacts dispersal and reproduction. Two contrasting population demographic models have been proposed that predict that urbanisation either promotes (facilitation model) or constrains (fragmentation model) gene flow and genetic diversity. Which of these models prevails likely depends on the strength of selection on specific phenotypic traits that influence dispersal, survival, or reproduction. Here, we a priori examined the genomic impact of urbanisation on the Neotropical túngara frog (Engystomops pustulosus), a species known to adapt its reproductive traits to urban selective pressures. Using whole-genome resequencing for multiple urban and forest populations we examined genomic diversity, population connectivity and demographic history. Contrary to both the fragmentation and facilitation models, urban populations did not exhibit substantial changes in genomic diversity or differentiation compared with forest populations, and genomic variation was best explained by geographic distance rather than environmental factors. Adopting an a posteriori approach, we additionally found both urban and forest populations to have undergone population declines. The timing of these declines appears to coincide with extensive human activity around the Panama Canal during the last few centuries rather than recent urbanisation. Our study highlights the long-lasting legacy of past anthropogenic disturbances in the genome and the importance of considering the historical context in urban evolution studies as anthropogenic effects may be extensive and impact nonurban areas on both recent and older timescales.

Bracing community in rural coworking: emerging trends and categories

PurposeThe objective of this study is to explore the concept of rural coworking in the scientific literature and examine how it generates community narratives based on the value of space and business practices. This study aims to contribute to the understanding of rural coworking as a driver of participation and relationships among diverse stakeholders.Design/methodology/approachTo identify and analyse trends and categories in rural coworking studies, understand the concept of rural coworking and how community narratives have been focused, the authors carried out a systematic literature review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) tool. The review was performed using Scopus, obtaining 22 papers.FindingsThe findings reveal that rural coworking is on definition, but it emphasises the role of community as a main actor in its consolidation. On the other hand, rural coworking is seen as an opportunity to create impactful new business strategies through space regeneration and revitalisation. Management perspectives prevail in this research field, highlighting the role of public administrations, entrepreneurs and policymakers, and their capacities to build a business environment to enhance coworking activity.Originality/valueThe paper establishes conceptual categories and research trends in the rural coworking literature, and how its actors have a strategic importance in defining their own practices and narratives. The interrelationship between coworking activity and local business development is continually seen as an opportunity for growth, so this paper will have value for rural coworking planners and consultants in non-urban areas.

Elevated TSH Levels: A Database Study of General Practitioners’ Course of Action

ObjectiveTo investigate general practitioners’ course of action after detection of elevated thyroid stimulating hormone (TSH) levels regarding repeat testing, direct levothyroxine replacement, or neither. MethodsWe conducted a retrospective study of adults without prior evidence of thyroid disease and with a first detection of elevated TSH levels from January 1, 2015, to December 31, 2020, using data from electronic medical records of a Swiss primary care database. We determined the occurrence of either repeat TSH testing or direct levothyroxine initiation in primary care during 12-month follow-up and determined associations with demographic and clinical factors. ResultsOf the 1 591 patients included (median age 65 years, 64.4% female, median TSH 5.7 mIU/L), 34.3% received repeat TSH testing and 12.4% received direct levothyroxine replacement in primary care during follow-up. Repeat TSH testing showed the strongest association with overt hypothyroidism and was more common among patients with high primary care utilization and among patients aged 40-64 years compared to patients aged <40 years. Direct levothyroxine initiation was more likely for TSH levels >7 mIU/L, overt hypothyroidism, female patients, and nonurban practices. ConclusionsWhile the degree of thyroid dysfunction was the main driver of follow-up, we identified important gaps in the primary care-based monitoring of elevated TSH levels in young patients and in patients with infrequent consultations. We also observed potential overtreatment of women and patients in nonurban areas. Our findings highlight the need for standardization and dissemination of guidelines for the management of elevated TSH levels among general practitioners.

Spatial Characteristics and Temporal Trend of Urban Heat Island Effect over Major Cities in India Using Long-Term Space-Based MODIS Land Surface Temperature Observations (2000–2023)

The alteration of the Earth’s surface due to urbanization and the formation of urban heat islands is one of the most evident and widely discussed anthropogenic impacts on Earth’s microclimate. The elevated land surface temperature in the urban perimeter compared with the surrounding non-urban area is known as the surface urban heat island (SUHI) effect. India has experienced swift urban growth over the past few decades, and this trend is expected to persist in years to come. The literature published on SUHI in India focuses only on a few specific cities, and there is limited understanding of its geospatial variation across a broader region and its long-term trend. Here, we present one of the first studies exploring the long-term diurnal (daytime, and nighttime), seasonal, and annual characteristics of SUHI in the 20 largest urban centers of India and its neighboring countries. The study highlights a statistically significant (95% confidence interval) rise in nighttime surface temperatures across major cities based on a linear fit over 23 years (2000–2023) of MODIS land surface temperature satellite observations. The nighttime SUHI was found to be more conspicuous, positive, and consistent when compared with daytime satellite observations. The nighttime SUHI for April–May–June representing the pre-monsoon and onset of monsoon months for the top 10 cities, ranged from 0.92 to 2.33 °C; for December–January–February, representing the winter season, it ranged from 1.38 to 2.63 °C. In general, the total change in the nighttime SUHI based on linear fit (2000–2023) for the top ten cities showed warming over the urban region ranging from 2.04 to 3.7 °C. The highest warming trend was observed during the months of May–June–July (3.7 and 3.01 °C) in Ahmedabad and Delhi, cities that have undergone rapid urbanization in the last two to three decades. The study identified strongly positive annual SUHI intensity during nighttime, and weakly negative to moderately positive annual SUHI intensity during daytime, for major cities. Jaipur (India), Lahore (Pakistan), Dhaka (Bangladesh), and Colombo (Sri Lanka) showed a nighttime SUHI intensity of 2.17, 2.33, 0.32, and 0.21 °C, respectively, during the months of April–May–June, and a nighttime SUHI intensity of 2.63, 1.68, 0.94, 0.33 °C, respectively, for the months of December–January–February (2000–2023). It is apparent that the geographical location (inland/coastal) of the city has a high influence on the daytime and nighttime SUHI patterns. The current research is intended to help city planners and policymakers better understand SUHI intensity (day and night/seasonal basis) for developing strategies to mitigate urban heat island effects.

SURFACE DISPLACEMENT MONITORING OF SUBURBAN EXPRESSWAY UNDER CONSTRUCTION BASED ON SENTINEL-1 SBAS-INSAR ANALYSIS

Abstract. The Synthetic Aperture Radar Interferometry (InSAR) technique can quickly obtain millimeter-level surface deformation in urban areas with high coherence. However, expanding the application of time series InSAR in non-urban areas is an important research focus. An improved SBAS-InSAR analysis approach is applied in this study to present the surface displacement along two expressways under construction. Taking the Kejiao and Yicheng Highway in the Shenzhen Shanwei Special Cooperation Zone as examples, the deformation along the highways under construction and the surrounding ground objects is revealed. Moreover, the time series displacements and construction conditions are combined to explain the possible mechanisms behind the different displacements of various ground objects along the expressways. The results show that the climate, environment, and construction conditions of the cooperation zone had an impact on the deformation of various ground objects along the route. Compared to traditional PS-InSAR methods, the density and accuracy of coherence points are improved, which better overcomes the spatiotemporal incoherence effects in non-urban areas.

Higher UHI Intensity, Higher Urban Temperature? A Synthetical Analysis of Urban Heat Environment in Urban Megaregion

Urban heat islands (UHIs) aggravate urban heat stress and, therefore, exacerbate heat-related morbidity and mortality as global warming continues. Numerous studies used surface urban heat island intensity (SUHII) to quantify the change in the UHI effect and its drivers for heat mitigation. However, whether the variations in SUHII among cities can demonstrate the physical difference and fluctuation of the urban thermal environment is poorly understood. Here, we present a comparison study on the temporal trends of SUHII and LST in urban and nonurban areas in 13 cities of the Beijing–Tianjin–Hebei (BTH) megaregion in China and further identify different types of changes in SUHII based on the temporal trends of land surface temperature (LST) in urban and nonurban areas from 2000 to 2020. We also measured the effect of the changes in four socioecological factors (i.e., population density, vegetation greenness (EVI), GDP, and built-up area) on the trends of SUHII to understand the dynamic interaction between the UHI effect and socioecological development. We found the following. (1) Nine out of thirteen cities showed a significant increasing trend in SUHII, indicating that the SUHI effects have been intensified in most of the cities in the BTH megaregion. (2) The spatial pattern of summer mean SUHII and LST in urban areas varied greatly. Among the 13 cities, Beijing had the highest mean SUHII, but Handan had the highest urban temperature, which suggests that a city with stronger SUHII does not necessarily have a higher urban temperature or hazardous urban thermal environment. (3) Four types of changes in SUHII were identified in the 13 cities, which resulted from different temporal trends of LST in urban areas and nonurban areas. In particular, one type of increasing trend of SUHII in seven cities resulted from a greater warming trend (increasing LST) in urban than nonurban areas (SUHII↑1), and another type of increasing trend of SUHII in Beijing and Chengde was attributed to the warming trends (increasing LST) in urban areas and the cooling trends (decreasing LST) in nonurban areas (SUHII↑2). Meanwhile, the third type of increasing trend of SUHII in Zhangjiakou was due to a greater cooling (decreasing LST) trend in nonurban areas than in urban areas (SUHII↑3). In contrast, three cities with a decreasing trend of SUHII were caused by the increase in LST in urban and nonurban areas, but the warming trend in nonurban areas was greater than in urban areas (SUHII↓1). (4) Among the relationship between the trend of SUHII (TrendSUHII) and the changes in socioecological factors (Trendpopulation density, TrendGDP per captica, TrendEVI, and Trendbuild-up area), a significantly positive correlation between TrendSUHII and TrendEVI indicated that the change in SUHII was significantly related to an increased rate of EVI. This is mainly because increased vegetation in nonurban areas would result in lower temperatures in nonurban areas.

Examining the existing usage gap of electronic health records in the United States: A study of National Health Survey

BackgroundLittle is known about the extent of geographic variation in online health record usage and related demographic characteristics in the United States. MethodsIn order to examine geographical variation in the usage of online e-health records (EHR) patient portals in the US, and the sociodemographic factors effects on the access and use of the EHR patient's portal. This study using data from the 2019 and 2020 Health Information National Trends Survey. Specifically, predictors associated with accessing patients' EHR portal were examined. Furthermore, geographic variation of EHR portal’ availability and usage gap were examined and mapped. ResultsRespondents had significantly higher likelihood to access EHR portals when they are higher educated, willing to seek health information online, insured and had regular providers (adjusted OR = 2.01, 95% CI: 1.44 – 2.80; adjusted OR = 3.51, 95% CI: 2.49 – 4.94; adjusted OR = 2.38, 95% CI: 1.05 – 5.43; adjusted OR = 2.1, 95% CI: 1.51 – 2.92, respectively). Individuals living in Central-West, South regions or other non-urban areas as well as deprived urban areas are less likely to access their EHR portals (adjusted OR = 0.6, 95% CI: 0.41 – 0.89). Furthermore, we found that people living in the Midwest, Southern regions, and Mountain rural areas are more likely to have greater difficulties to access EHR than other regions. Therefore, populations residing in these underserved (deprived urban, rural or remote) areas tend to face more considerable obstacles to e-healthcare. ConclusionsImprove the disparities, accessibility, and educational initiatives on the usage of eHealth resources and encouragement from both healthcare providers and policymakers should be implemented with a particular focus on targeting non-urban areas and underserved population.

Influence of selection of rural reference area for quantifying the surface urban heat islands intensity in major South Korean cities

Surface urban heat island intensity (SUHII), which is the difference in land surface temperature (LST) between urban and rural areas, depends on selection of rural reference and studies that have analyzed the impacts of different methods on estimating SUHII are few. This study aims to analyze impact of two different methods for defining rural areas, buffer area around city, and non-urban areas within city, on estimating SUHII in five major cities of South Korea using satellite measurements for period 2018–2022. Using a buffer region around city to define rural reference area results in a higher estimate of SUHII compared to using rural areas within city limits. The largest differences in SUHII were found in Seoul (both day and night) and Busan (night), with Seoul exhibiting a difference of 1.14°C (day) and 1.51°C (night), and the differences are mostly driven by the physical characteristics of the city and geographical location.

Characterizing Opioid Prescribing Trends of Medical Oncologists From 2013 to 2019: Analysis From the Centers for Medicare & Medicaid Services Medicare Part D Prescribers Database.

Opioid prescribing trends in medical oncology are poorly defined past 2017, the year after the CDC updated opioid prescription guidelines in noncancer settings. We aim to characterize pain management by medical oncologists by analyzing opioid and gabapentin prescribing trends from 2013 to 2019, identify physician-related factors associated with prescribing patterns, and assess whether CDC guidelines for nononcologic settings changed prescribing patterns. The Centers for Medicare & Medicaid Services (CMS) Medicare Part D Prescribers-by Provider, CMS Medicare Part D Prescribers-by Provider and Drug, and CMS Medicare Physician National Downloadable files from 2013 to 2019 were merged by National Provider Identification. The database included physicians' sex, years of practice, regions, and practice settings. Multivariable binary logistic regression identified significant predictors of total opioid, long-acting opioid, and gabapentin prescriptions. Binary logistic regression modeling revealed no significant difference in mean daily total opioid prescriptions from 2013 to 2017. Daily opioid prescriptions by medical oncologists decreased significantly after 2017 (P < .001). Increased opioid prescribing was associated with physician male sex (P < .001), practicing over 10 years (P < .001), and practice in nonurban areas (P < .001). Opioid prescribing was greatest in the South and Midwest United States (P < .001). The same patterns were observed with total long-acting opioid prescriptions, whereas gabapentin prescribing increased from 2013 to 2019 (P < .001). Opioid prescriptions by medical oncologists decreased significantly from 2013 to 2019, but this decrease was most substantial from 2017 to 2019. These results may imply that the 2016 CDC guidelines influenced medical oncologists, particularly more junior physicians in urban settings, to manage chronic cancer pain with alternative therapies.

Proposal of policies based on temporal-spatial dynamic characteristics and co-benefits of CO2 and air pollutants from vehicles in Shanghai, China

In megacities, vehicle emissions face urgent challenges related to air pollution and CO2 control. To achieve the refinement of vehicle control policies for the co-control of air pollutants and CO2, this study established a vehicle emission inventory with high spatial and temporal resolution based on the hourly traffic flow in Shanghai and analyzed the spatial and temporal distribution characteristics of the real-time vehicle emissions. Meanwhile, a policy evaluation framework was constructed by combining pollutant emission predictions with quantitative co-control effect assessments. The results indicated that spatio-temporal variations in different air pollutants and CO2 could mainly be attributed to primary contributing vehicle types. The pollutants (CO2, CO and VOCs) primarily contributed by private cars exhibited a bimodal pattern in 24-h time series and their spatial distribution was concentrated in the urban city center. The spatial distribution of NOx and PM primarily contributed by heavy trucks was still obvious on non-urban center areas. Furthermore, the results of synergistic effect analysis revealed that the alternative energy replacement scenario demonstrated the most significant potential for the co-control. Based on temporal-spatial and co-benefit analysis, the precise control policy of vehicle emissions can be established through time-, region-, and model-control. This study provides references and research methods for the formulation of the vehicle refinement control policies in worldwide megacities.

Benefits, enablers and barriers in deploying PPP when developing smart infrastructure in non-urban areas

PurposeThe widespread lockdown restrictions brought by the global COVID-19 epidemic inculcated a culture of “work-from-home”. However, most rural areas lack reliable and effective community amenities including transportation, health and education, thereby impeding healthy living and productive employment. Therefore, the underlying goal of this research is to investigate the development of smart infrastructure (SI) in non-urban areas. However, governments' resource limitations must be addressed to develop SI, which urges the research on the potential for public-private partnerships (PPP) to supplement public sector resources when necessary.Design/methodology/approachThis paper examined and evaluated the “benefits and enablers” and “barriers” to deploying PPPs to create SI in non-urban areas, using a thorough literature review, five expert interviews and analytic hierarchy process (AHP)-based questionnaire responses. The AHP technique and content analysis were used to analyse the results and generate the conclusions.FindingsThe availability of a favourable investment climate and legal framework were identified as the significant factors among the “benefits and enablers” of adopting PPP in SI developments in non-urban areas, while low community acceptance of the private sector involvement, and community culture and values were identified as the significant factors among the “barriers”. These highlight the significance of removing barriers connected to community culture and “values”.Originality/valueThe findings and conclusions of this study provide a strong foundation to support the growth of SI in non-urban settings, facilitating more sustainable development that is more evenly distributed in the post-COVID-19 future.

비도시지역 관리체계 개선 방향에 관한 연구

In 2003, the National Land Planning And Utilization Act was enacted, but the non-urban area management system through the use area system has problems due to the too wide range of restrictions on management areas, small-scale development using loopholes in the existing legal system, and double administrative procedures due to the lifting of conservation areas. To solve this problem, it is necessary to re-establish the permit standards of non-urban areas or incorporate management areas into the vertical use area classification system to clearly distinguish the identity of the management area. In order to prevent waste of administrative power, it is necessary to give special-purpose areas to areas released from preserved mountainous districts and agricultural promotion areas without separate administrative procedures, strengthen diversion requirements for in preserved mountainous districts, and reorganize the management system so that accommodation facilities can only be made possible through planned locations such as district unit planning areas or growth management planning areas. The growth management plan is an auxiliary means for Permission for Development Activities and can designate non-permissible uses, but it cannot relax permitted uses, so it has limitations as a means of inducing location. In the case of planning management areas, most facilities are permitted due to negative use regulations, so it is difficult to induce location through additional relaxations. Therefore local governments and residents will actively establish growth management plans only when restrictions on behavior in existing special-purpose area are strengthened and ease of allowable use through growth management plan. The planned development of non-urban areas is possible only by planting the perception that regional development in non-urban areas is possible only through district unit plans and growth management plans.

Audiological Service Delivery and Uptake in New Zealand Regional Areas

Background: In New Zealand, as in many places, a significant proportion of the population lives outside the main urban centres. People living in regional areas have similar needs for audiological services as those living in urban centres; however, economic and geographical barriers can be a barrier to accessible services. The objective of this research was to explore factors that influence equitable audiological service provision and user uptake of services in regional areas of New Zealand. Methods: Fifteen participants who represented either audiological service users living in rural or non-urban areas (regional) or audiological service providers in these areas were recruited. Semi-structured interviews were conducted virtually and on average took forty minutes to complete. The interviews were transcribed and analysed using thematic analysis to identify themes and subthemes related to audiological service delivery and uptake. Results: Seven themes were identified. These are related to service provision, geographical barriers, and cultural appropriateness. Conclusions: This study provides a basis for understanding the challenges of delivering and accessing audiological services in non-urban areas in New Zealand, and in principle elsewhere. There is scope for future research to further understand policy directions needed to achieve equitable audiological service provision in regional areas.

Warming up through buildings and roads: what we know and should know about the urban heat island effect on bees

Urbanization leads to cities having higher temperatures than surrounding non-urban areas [this is known as the urban heat island (UHI) effect]. Very little is known about the impacts of the UHI effect on bees, despite the importance of temperature on many aspects of bees’ life suggesting that these may be not negligible. In this study, we aimed to highlight how the UHI effect could impact relevant functional traits of bees in cities, proposing several ad hoc hypotheses for traits that have thus far been investigated only in few studies or not at all, based on what we know from non-urban studies. The UHI effect was shown to influence bee body size, and generally tended to reduce the body size of bees in cities. Urban temperature may also affect bees’ wing morphology, and thus their overall flight morphology parameters. Individuals may be more brightly colored in cities. Bee ommatidial size and the number of antennal thermoreceptors they have may be smaller and fewer, respectively, in cities than in non-urban areas. As expected, because urban bees face a higher risk of desiccation, higher proportions of alkanes and longer main-carbon chain lengths are expected in their cuticular hydrocarbon (CHC) profiles. Stress biomarkers can also occur at greater concentrations in bees in cities and specific bacteria in the bee gut may occur at lower abundances. Warm urban temperatures may impact the life cycle of pathogens by reducing their proliferation. Aggression levels may be increased, and eusocial species may present more worker phases per year due to the UHI effect. All of these proposed impacts could be likely more visible in solitary and primitively eusocial bee species, which are those suspected to have a more limited dispersal ability. Comparative studies would help in the proper testing of these hypotheses.

Disparities in Access to Spasticity Chemodenervation Specialists in the United States: A Retrospective Cross-Sectional Study.

The aim of the study is to explore variations in access to spasticity chemodenervation specialists across several geographical, ethnic, racial, and population density factors. This is a retrospective cross-sectional study on Medicare Provider Utilization and Payment Data. Providers with substantial adult spasticity chemodenervation practices were included. Ratios were assessed across geographical regions as well as hospital referral regions. A multivariate linear regression model for the top 100 hospital referral regions by beneficiary population was created, using backward stepwise selection to eliminate variables with P values > 0.10 from final model. A total of 566 providers with spasticity chemodenervation practices were included. Unadjusted results showed lower access in nonurban versus urban areas in the form of higher patient:provider ratios (83,106 vs. 51,897). Access was also lower in areas with ≥25% Hispanic populations (141,800 vs. 58,600). Multivariate linear regression results showed similar findings with urban hospital referral regions having significantly lower ratios (-45,764 [ P = 0.004] vs. nonurban) and areas with ≥25% Hispanic populations having significantly higher ratios (+96,249 [ P = 0.003] vs. <25% Hispanic areas). Patients in nonurban and highly Hispanic communities face inequities in access to chemodenervation specialists. The Medicare data set analyzed only includes 12% of the US patient population; however, this elderly national cross-sectional cohort represents a saturated share of patients needing access to spasticity chemodenervation therapy. Future studies should venture to confirm whether findings are limited to this specialization, and strategies to improve access for these underserved communities should be explored.

Feasibility and Acceptability of a Mobile Game to Support Smoking Cessation: Repeated Measures Study.

Approximately half of smokers attempt to quit, but 90% of these attempts fail. Video game-based interventions have the potential to address common barriers to evidence-based smoking cessation treatment, including high cost, lack of health care access, and low engagement. The purpose of this study was to evaluate the feasibility and acceptability of a video game-based smoking cessation intervention called Inspired and its impact on the 7-day smoking point prevalence at the 30-day follow-up. US adults (n=48) were recruited via the web to use Inspired on their smartphones for 7 weeks. The object of the game was to defend a healing tree against attackers. Levels of the game were unlocked twice daily when participants self-reported the number of cigarettes they smoked since the previous entry. Completion of the levels awarded players in-game currency, which could strengthen in-game abilities. Participants received additional in-game rewards to aid gameplay by submitting either smoking self-reports only or self-reports indicating abstinence, determined through random assignment. In addition, participants completed a web-based survey at intake, week 4, week 7, and the 30-day follow-up. Of the 48 participants, who had an average age of 39.8 (SD 10.7) years, 27 (56%) were female, 4 (8%) Hispanic, 37 (77%) White, and 27 (56%) employed; 26 (54%) earned <US $40,000 a year; and 14 (29%) lived in nonurban areas (eg, rural and suburban). There were no significant differences between the groups, so all outcome data were combined. Participants averaged 20.6 (SD 15.3) days of gameplay and reached a mean highest game level of 10.7 (SD 8.4), although there was a high degree of variability. Participants reported abstinence on 31.4% (SD 38.2%) of all cessation phase reports and averaged 5.4 (SD 9.8) consecutive abstinent smoke reports. For every 1 SD increase in the highest level achieved, there was a 27% increase in the percentage of abstinent samples and a 405% increase in longest continuous abstinence. At the 30-day follow-up, 23% (11/48) of the participants reported having not taken a cigarette puff in the prior 7 days and 31% (15/48) had spent at least 24 hours without smoking in the prior 14 days. On an 11-point scale, participants rated the intervention moderately favorably: if they had to do it again, they would use Inspired to help them quit (mean 6.4, SD 3.4), and Inspired was helpful in their current attempt to quit (mean 5.4, SD 3.6). These results support the acceptability of Inspired. Although high dropout rates prevent conclusions on feasibility, a subset of the participants responded favorably. Scalable and accessible video game-based smoking cessation interventions could be the key to addressing the foremost cause of preventable morbidity and mortality in the United States. ClinicalTrials.gov NCT03929003; https://clinicaltrials.gov/ct2/show/NCT03929003.

Nationwide study of the triple landscape gradient across natural, agricultural and urban areas for the richness of flower-visiting insects

Studies investigating urbanisation effects on pollinator diversity have shown contrasting results, ranging from predicting urban areas as ecological sinks to possible refuges for pollinators. These divergent results may stem from the diversity of non-urban areas being compared with urban areas as well as the existence of interactions among habitats. We tested the interactive effects of urban, agricultural and semi-natural areas on the richness of flower-visiting insects at the landscape scale. Using the dataset from a citizen science programme, we investigated how the richness pattern varied (i) along the triple gradient across urban, agricultural and semi-natural areas and (ii) among the different visitor taxa. We stratified the dataset to have a balanced landscape composition and spatial distribution of sampling sites for each plant species sampled. Accounting for general sampling factors (e.g., plant species, temperature, shading, time of observation), we showed that urbanisation negatively impacted the total richness of flower visitors, especially when associated with agricultural areas. We observed maximum richness in agricultural landscapes composed of ∼30 % of semi-natural areas, thus suggesting synergistic effects between these land uses on insect richness. Our results showed contrasting richness patterns for different taxa. For bees, urban areas were less detrimental to richness than agricultural areas. By contrast, for syrphids and butterflies, richness was highest in agricultural and semi-natural areas, respectively. Our study revealed the necessity to distinguish among rural areas when studying urbanisation gradients and highlighted synergistic landscape effects that could help inform landscape planners about how to attract a diversity of flower visitors.

Impact of Urban Slum Residence on Coverage of Maternal, Neonatal, and Child Health Service Indicators in the Greater Accra Region of Ghana: an Ecological Time-Series Analysis, 2018-2021.

Among other focus areas, the global Sustainable Development Goals (SDGs) 3 and 11 seek to advance progress toward universal coverage of maternal, neonatal, and child health (MNCH) services and access to safe and affordable housing and basic services by 2030. Governments and development agencies have historically neglected the health and well-being associated with living in urban slums across major capital cities in sub-Saharan Africa since health policies and programs have tended to focus on people living in rural communities. This study assessed the trends and compared inequities in MNCH service utilization between slum and non-slum districts in the Greater Accra region of Ghana. It analyzed information from 29 districts using monthly time-series Health Management Information System (HMIS) data on MNCH service utilization between January 2018 and December 2021. Multivariable quantile regression models with robust standard errors were used to quantify the impact of urban slum residence on MNCH service utilization. We assessed the inequality of MNCH coverage indicators between slum and non-slum districts using the Gini index with bootstrapped standard errors and the generalized Lorenz curve. The results indicate that rates of vaccination coverage and antenatal care (ANC) attendance have declined significantly in slum districts compared to those in non-slum districts. However, skilled birth delivery and postnatal care (PNC) were found to be higher in urban slum areas compared to those in non-urban slum areas. To help achieve the SDGs' targets, it is important for the government of Ghana and other relevant stakeholders to prioritize the implementation of effective policies, programs, and interventions that will improve access to and utilization of ANC and immunization services among urban slum dwellers.