Urban Commuting Research Articles

Rural Residence Associated with Receipt of Recommended Post-Discharge COPD Care among a Cohort of U.S. Veterans.

Individuals with chronic obstructive pulmonary disease (COPD) in rural areas experience inequitable access to care. To assess whether rural residence is associated with receipt of recommended post-discharge COPD care. We conducted a cohort study of all U.S. Veterans discharged from a VA Medical Center following COPD hospitalization from 2010 to 2019. Rural residence was defined by Rural Urban Commuting Area classification. Our primary outcome was the proportion of recommended care received within 90 days of hospital discharge, including: smoking cessation therapy; appropriate management of supplemental oxygen; appropriate prescription of inhaled therapy; and pulmonary rehabilitation. We conducted multi-variable linear regression between rural residence and the proportion of recommended care received, adjusting for age, sex, race, ethnicity, comorbidities, and primary care facility type. We tested multi-variable linear probability models for each of the recommended therapies. Of 67,649 patients, 7,370 (10.8%) resided in rural areas, and 2,000 (3.0%) in highly rural areas. Overall, the proportion of recommended COPD treatments received was low (mean 15.0%, standard deviation 21.0%). Compared with urban residence, patients with rural and highly rural residence received fewer recommended COPD care treatments (rural estimate [adjusted % difference (95% CI)]: -1.1 (-1.6, -0.6); highly rural estimate: -1.2 (-2.1, -0.3)). Rural and highly rural residence were associated with lower likelihood of receiving appropriate inhaled therapy escalation (rural estimate: -4.0 (-5.1, -3.0); highly rural estimate: -3.0 (-5.0, -1.1)) and pulmonary rehabilitation referral (rural estimate: -1.2 (-1.6, -0.9); highly rural estimate: -2.1 (-2.7, -1.4)), but a higher likelihood of receiving smoking cessation therapy (rural estimate: 5.4 (3.3, 7.5); highly rural estimate: 7.2 (3.3, 11.2)). There was no significant difference in appropriate oxygen management (rural estimate: -1.0 (-2.8, 0.9); highly rural estimate: 3.1 (-0.7, 6.9)). Patients across the rural-urban spectrum received few recommended post-discharge COPD treatments. Health systems approaches are needed to address widespread underutilization of evidence-based COPD care.

Key themes of community-oriented primary care projects from a longitudinal, rural interprofessional health professions curriculum (1997–2023)

BackgroundThe Community Oriented Primary Care Project Model (COPC) has been well studied globally as well as in the United States as a way to provide both community-centered primary care and to engage in community based research. Rural trainees through the University of Illinois College of Medicine’s Rural Medical Education Program (RMED) and Rural Pharmacy Education Program (RPHARM) students through the University of Illinois Chicago College of Pharmacy have participated in a COPC project as a capstone to a four month longitudinal, immersive community-based experience in a rural primary care setting. The purpose of this study was to assess the type of projects implemented through a rural health professions curriculum over a 30 year project period. .MethodsA research team reviewed projects on 30 elements; including topic and demographics. Patterns in COPC topics and rurality of the location in which the COPC project were also examined by using 2021 U.S. Census Bureau population data and Rural Urban Commuting Area (RUCA) Code.ResultsCOPC projects were categorized into 31 main topic areas with mental health being the most prevalent topic area covered by projects (n = 67, 15.7%) followed by 43 (10.1%) projects that focused on nutrition/exercise, and 41 (9.6%) focused on substance use (presented as a separate category from mental health in this analysis).ConclusionsFor three decades, COPC themes reflect priority health issues in rural communities while providing a scholarly activity for health profession student trainees Past projects have also been implemented in highly rural areas where research is not often conducted. The COPC research process can be easily replicated in other trainee models such as to fulfill ACGME requirements of scholarly activity and can provide a template for trainees of this model to implement community-engaged research in the future.

Abstract B166: Impact of rurality on early-onset colorectal cancer outcomes: Age, geographic disparities, and the need for improved access and awareness in the United States

Abstract BACKGROUND: While overall colorectal cancer (CRC) rates have stabilized or declined in the United States (U.S.), early-onset CRC (EO-CRC), diagnoses before age 50, has increased. Rural U.S. residents face a higher CRC incidence (43.9 vs. 40.1 per 100,000) than urban residents. CRC mortality, once highest in the Northeast, is now most prevalent in the South and Midwest, particularly among Non-Hispanic Black populations. This geographic shift is also evident in EO-CRC. Existing literature lacks comprehensive analysis on the influence of rurality and age at CRC diagnosis. In this study, we sought to elucidate the relationships between age at diagnosis with CRC outcomes, while examining the moderating role of rurality. Methods: We used data from the 2006-2020 Surveillance, Epidemiology, and End Results (SEER) Program. Rurality was defined using census tract level U.S. Department of Agriculture (USDA)’s 2010 Rural Urban Commuting Area (RUCA) codes: rural (codes 8, 9, 10) and urban (all other listed codes). We conducted multilevel regression modeling (logistic and Cox proportional hazards) to examine the associations between age at diagnosis, rurality, and CRC outcomes (late-stage diagnosis and survival), adjusting for race, marital status, sex, and year of diagnosis. Results: We identified 835,907 patients aged 20-79 from the 2006-2020 SEER program. Most patients lived in urban areas (86%), were non-Hispanic white (66%), and married (41%). After adjusting for marital status, race, sex, and diagnosis year, we found that patients aged 30-39 (aOR: 1.49, 95% CI: 1.44–1.55) and 40-49 (aOR: 1.43, 95% CI: 1.39–1.46) had over a 40% increased likelihood of late-stage CRC compared to patients aged 50-59. Urban patients aged 30-39 had a 52% higher likelihood of late-stage CRC (aOR: 1.52, 95% CI: 1.46–1.58). Patients aged 20-29 (aOR: 0.81, 95% CI: 0.77–0.86) had a reduced risk of CRC death compared to those aged 50-59. Conversely, patients aged 40-49 (aOR: 1.09, 95% CI: 1.07–1.11), 60-69 (aOR: 1.16, 95% CI: 1.14–1.17), and 70-79 (aOR: 1.39, 95% CI: 1.28–1.36) had increased risks of CRC death compared to patients aged 50-59. Rural patients aged 20-29 (aOR: 0.79, 95% CI: 0.68–0.94) and 30-39 (aOR: 0.95, 95% CI: 0.87–1.03) had a reduced risk of CRC death compared to rural patients aged 50-59. Conclusion: We observed that patients aged 30-49 were more likely to be diagnosed with late- stage CRC compared to those aged 50-59, particularly in urban areas. To reduce the burden of EO-CRC and prevent advanced-stage diagnoses in young adults, it is essential to enhance access to care and raise awareness of CRC symptoms among younger Americans. Future research should explore urban -rural barriers to healthcare access, including the role of healthcare infrastructure, transportation, and provider availability, to develop strategies for improving EO-CRC early detection and treatment outcomes. Citation Format: Meng-Han Tsai, Justin X. Moore, Caitlyn Grunert. Impact of rurality on early-onset colorectal cancer outcomes: Age, geographic disparities, and the need for improved access and awareness in the United States [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 B166.

Abstract A132: Missed Opportunities? Regional availability of Low Dose CT lung cancer screening facility locations in the year prior to diagnoses: A descriptive comparison of American Indian and Non-Hispanic White lung cancer patients in North Carolina

Abstract INTRODUCTION American Indians (AI) have much higher incidence rates of lung cancer (LC) compared with non-Hispanic Whites (NHW) in the US. While low-dose computed tomography (LDCT) screening facilitates early detection of lung cancer, it is unknown how available LDCT screenings are to racially and geographically diverse populations in North Carolina (NC). To address this gap in knowledge, we conducted a descriptive study to characterize incident LC cases among AIs and NHWs, the distance from their location at diagnosis to the nearest LDCT screening facility and explored whether distance was associated with late-stage LC diagnoses. Methods Data were obtained from the Cancer Information and Population Health Resource (CIPHR), which comprise data from NC Central Cancer Registry (CCR) as well as public and private health insurance claims for the state. We identified ZIP codes and dates of rendered service for facilities providing LDCT by searching through claims from 2015-20. In addition, we identified incident LC cases among AIs and NHWs aged ≥18 years, from 2015-19. We assembled lists of LDCT facilities that existed in the year prior to each incident LC case. We calculated the minimum centroid to centroid distance to all facilities. Clinical attributes included age at diagnosis, sex, histology, stage at diagnosis, and rurality as measured by Rural Urban Commuting Area. Risk ratios were calculated for late-stage LC diagnoses across a range of thresholds for patient’s distance to nearest LDCT screening facility for AIs and NHWs. Results We identified 388 AI and 26,867 NHW incident LC cases in NC between 2015-20. Compared to NHWs, the median age at diagnosis for AIs was 5 years younger (AI: 65 vs. NHW: 69); more frequently male (AI: 54% vs NHW: 51%); and almost twice as likely to reside in rural areas (AI: 52% vs. NHW: 28%). There were no differences in late-stage LC diagnoses (AI: 54% vs. NHW: 52%). For distance (in miles) to the nearest LDCT screening facility, the median [Interquartile range] was twice as high for AIs (9.9 miles [0.8, 16.30]) compared to NHWs (5.3 miles [0, 12.1]). Among NHWs, there were statistically significant associations between distance and late-stage LC diagnosis at the shortest distance threshold of 5 miles (RR=1.04; 95%CL: 1.02, 1.07) through the threshold of 30 miles (RR=1.10 95%CL: 1.05, 1.15). There was no association across any distance threshold among AI lung cancer patients. Conclusions The large difference in accessibility of LDCT screening was not strongly associated with metastatic lung cancer diagnoses, possibly because so many patients were diagnosed late, reflecting poor early detection across all populations. We found that 80% of AIs with LC lived more than 10 miles away from LDCT screening facilities. This geographic distance may increase difficulty accessing cancer care geographically, and contribute to suboptimal LC screening rates. If efforts are to be made to increase early detection and improve survival, accessibility needs to be addressed on different dimensions. Citation Format: Bradford E. Jackson, Marc Emerson, Daniel Carrizosa, Chris Baggett, Lisa Spees, Joel Begay, Ana Salas, Yadurshirni Raveendran, Tomi Akinyemiju, Rachel Denlinger-Apte, Stephanie Wheeler, Ronny Bell. Missed Opportunities? Regional availability of Low Dose CT lung cancer screening facility locations in the year prior to diagnoses: A descriptive comparison of American Indian and Non-Hispanic White lung cancer patients in North Carolina [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 A132.

Satyadarshan Technologies & Services: revolutionizing urban mobility?

Learning outcomes After reading and analyzing this case study, students will be able to describe the challenges of creating an electric vehicle (EV) start-up with the objective of zero-carbon emissions, identify opportunities and challenges for Satyadarshan Technologies & Services (STS) in enhancing the B2B customer base and sales volumes in the EV market, identify and assess government incentives to reinforce STS’s existing EV business and compose an understanding of and determine an ability to use various industrial marketing and promotion strategies for STS in the present environment. Case overview/synopsis STS was launched in 2020 to provide environmentally conscious urban commuting. Himanshu Purohit, the founder of STS, commenced an e-bicycle assembly unit and produced the first advanced electric drivetrain technology. The vision was to transform how people viewed mobility and make EVs the standard for a healthier globe. Nurturing a start-up with zero-carbon emissions was tedious due to limited infrastructure, high costs, low market acceptance and supply chain constraints. With the relentless pursuit of excellence, STS constantly pushed the boundaries and crossed the break-even ceiling in the year 2022. As a budding player in the souk, the company expected to gain a strong presence in the EV market with particular attention to the B2B customer segment. At the same time, the company aimed to ensure business sustainability by leveraging government incentives. The company needed to expand its corporate sales volume and craft a sustainable competitive advantage. Purohit recognized various challenges to the sustainability of STS that stood between the company's goals and their realization, particularly in achieving a sustainable move in the EV segment. Consequently, Purohit found himself at a critical juncture to pave the path toward the growth of the start-up. Eventually, analysis of the company's business challenges, industrial marketing and promotional strategies required strategic planning to appraise and evaluate the business model. Complexity academic level This case study is designed for new-age Master of Business Administration and executive management programs. It should be used in entrepreneurship and strategic management courses to discuss small innovative e-bike start-ups. This includes conducting a competitive analysis and self-assessing a firm's market-oriented strategies. Prima facie, undergraduate and postgraduate students are beneficiaries of this case. This case study may also be conducive to teaching how to initiate a sustainable and green vehicle business. This case study guides students entering the EV business, addressing industry-specific challenges and conducting market analysis. Supplementary materials Teaching notes are available for educators only. Subject code CSS 3: Entrepreneurship.

Association of Neighborhood Social Determinants of Health with Acute Kidney Injury during Hospitalization.

Acute kidney injury (AKI) is common among hospitalized patients. However, the contribution of social determinants of health (SDOH) to AKI risk remains unclear. This study evaluated the association between neighborhood measures of SDOH and AKI development and recovery during hospitalization. This is a retrospective cohort study of adults without end-stage kidney disease admitted to a large southern U.S. healthcare system from 10/2014 to 9/2017. Neighborhood SDOH measures included: 1) Socioeconomic status: Area Deprivation Index (ADI) scores, 2) Food access: Low Income Low Access (LILA) scores, 3) Rurality: Rural Urban Commuting Area (RUCA) scores, and (4) Residential segregation: dissimilarity and isolation scores. The primary study outcome was AKI based on serum creatinine (SCr)-KDIGO criteria. Our secondary outcome was lack of AKI recovery (requiring dialysis or elevated SCr at discharge). The association of SDOH measures with AKI was evaluated using generalized estimating equation models adjusted for demographics and clinical characteristics. Among 26,769 patients, 26% developed AKI during hospitalization. Compared with those who did not develop AKI, those who developed AKI were older (median 60 vs. 57 years), more commonly men (55% vs. 50%), and more commonly self-identified as Black (38% vs. 33%). Patients residing in most disadvantaged neighborhoods (highest ADI tertile) had 10% (95%CI: 1.02-1.19) greater adjusted odds of developing AKI during hospitalization than counterparts in least disadvantaged areas (lowest ADI tertile). Patients living in rural areas had 25% higher adjusted odds of lack of AKI recovery by hospital discharge (95% CI: 1.07, 1.46). Food access and residential segregation were not associated with AKI development or recovery. Hospitalized patients from the most socioeconomically disadvantaged neighborhoods and from rural areas had higher odds of developing AKI and not recovering from AKI by hospital discharge, respectively. A better understanding of the mechanisms underlying these associations is needed to inform interventions to reduce AKI risk during hospitalization among disadvantaged populations.

Scenario-Based Analysis of High-End New Energy Vehicle User Demands

With the rise in global environmental awareness and the rapid development of new energy technologies, high-end new energy vehicles (NEV) have become an important direction for the automotive industry. Consumer demand is evolving from merely seeking a means of transportation to desiring a comprehensive experience across various scenarios, emphasizing high quality, high performance, and environmental friendliness. Understanding the characteristics and trends of high-end NEV users' demands is crucial for car manufacturers in formulating market strategies, product design, and service improvement. However, current focus is often on policies and product design, lacking analysis of actual usage scenarios. To address this gap, this article employs scenario research methods to delve into the needs of high-end NEV users, selecting typical scenarios such as urban commuting, long-distance travel, and business operations. The research indicates that high-end NEV users are primarily young, highly educated, middle-to-high income individuals who exhibit rational consumption habits. Their most common usage scenarios include commuting to work, transporting family members, and shopping. In these contexts, there is a pronounced demand for vehicle safety performance, ride comfort, and intelligent features, each showing differentiated characteristics across various user groups. For instance, female users demonstrate a particularly strong preference for comfort-related configurations, whereas married users with children have the highest demand for spacious and convenient features. Based on these insights, this paper offers targeted recommendations from the perspectives of product design and marketing.

Practice outcomes for the first decade of Rural Pharmacy Education (RPHARM) Program graduates

BackgroundThe maldistribution of pharmacy services in underserved areas is a national issue. Analysis of data from the 2019 National Pharmacist Workforce Study indicated that 13.9% of pharmacists were working in a rural community. However, the percentage of people living in rural communities in the United States is 20.0%. Currently, there are 20 rural pharmacy programs in the United States, including the Rural Pharmacy Education (RPHARM) Program at University of Illinois Chicago (UIC) College of Pharmacy, which contain both didactic and experiential rural components. This research project examines the practice outcomes of the RPHARM Program graduates.MethodsDescriptive analysis was used to examine the practice outcome characteristics of RPHARM Program graduates between 2014 and 2023. The characteristics of the RPHARM graduates included the rurality of hometowns, practice locations and populations, and distance of practice locations to hometowns. Rural practice outcomes were described utilizing frequently used rural definitions. The practice locations of 54 of the 61 RPHARM graduates were used in the analysis.ResultsApproximately 41% of the practicing RPHARM graduates were from rural hometowns and two-thirds were female. RPHARM graduates mostly work in either a community setting (44.4%) or a hospital setting (37.0%). Approximately 11% worked in a federal government organization and 5.6% worked in a long-term care pharmacy. When examining job location, 42.6% were working in a rural location based on Rural–Urban Commuting Area Version 3.0 and 35.2% of RPHARM graduates had always worked in a rural location. Approximately 57% of practicing RPHARM graduates are working in a location < 50 miles from their hometown, and 13% are working 50 to 100 miles from their hometown. Approximately 74% of RPHARM graduates are practicing in Illinois.ConclusionsApproximately 40% of RPHARM graduates practice in rural locations. A significant portion (35.2%) of RPHARM graduates have always practiced in rural locations, and many (57.4%) are practicing near their hometowns. Results indicate that the RPHARM Program is making meaningful contributions to increasing the rural pharmacy workforce. Due to the lack of information on rural pharmacy practice outcomes, all programs with rural pharmacy content are encouraged to track graduates’ practice locations.

Urban cyclists’ perception of risk using body and environmental monitoring

There is limited information on the influence of environmental and behavioural factors on cyclists’ risk perception. This study gives insights into the factors shaping cyclists’ perception of risk. Twenty-six cyclists were assessed for their psychological distress and previous cycling experience, following which their heart rate was monitored while cycling along a variety of urban routes. The findings are that cycling through commercial areas, one-way routes, and routes with speed limits reduced their perceived risk. However, wider cycling routes and bikeways were associated with an increased heart rate. This study implied that both individual and environmental characteristics significantly influence risk perception. Both the psychological well-being of cyclists and cycling infrastructure should be considered to promote urban cycling. Risk perception serves as an indicator to guide the development of urban cycling facilities, enabling urban planners and policymakers to promote healthier, more sustainable cities through effective promotion of cycling for urban commuting.

Pre-injury methamphetamine use is associated with increased length of hospital stay in rural orthopaedic trauma patients

ObjectivesThe primary focus of this study is to determine if rural methamphetamine positive patients experience longer hospital length of stays compared to urban methamphetamine positive patients following an orthopaedic trauma. MethodsPatients presenting with traumatic orthopaedic injuries and urine drug screen were categorized into urban, suburban, and rural cohorts found in the Rural Urban Commuting Area codes based on home residence zip codes. Demographic, injury, hospital stay, and follow-up data were collected from the medical records. Comparisons between cohorts were determined by Chi square, Fisher exact, unpaired t-Tests, or ranked sum tests. DesignA retrospective cohort analysis. SettingAcademic Level I Trauma Center. Patient selection criteriaPatient records were examined between January 2013 to January 2023 for a traumatic orthopaedic injury and a urine drug screen result at the time of presentation to an academic Level I trauma center. Outcome measures and comparisonsMethamphetamine use status, patient age at time of admission, sex, marital status, insurance status, home zip code, orthopaedic injury location, complications, if the patient underwent surgery for orthopaedic injuries, admission date, discharge date, and discharge location were measured. Results249 patients met inclusion criteria for this analysis. Methamphetamine positive patients are significantly more likely to be younger, more likely to have surgery for orthopaedic injuries, experience a medical complication, or be discharged to home or a rehabilitation facility compared to methamphetamine negative patients. Urban patients experienced a shorter length of stay compared to suburban and rural patients, regardless of methamphetamine use status. Patients with Medicare, military, workers compensation, or commercial insurance are significantly more likely to attend follow-up appointments than patients with Medicaid or self-pay. ConclusionsMethamphetamine positive patients overall do not experience a longer length of hospital stay compared to methamphetamine negative patients. Rural methamphetamine positive patients experience a longer length of hospital stay compared to urban methamphetamine positive patients.

Impact of rural location on receipt of standard of care treatment and survival for locally advanced bladder cancer in Louisiana.

We aim to determine the effect of region of residence (urban vs. rural) on the odds of receiving standard of care treatment for locally advanced BCa in Louisiana and its impact on survival outcomes. Using the Louisiana Tumor Registry, we identified American Joint Committee on Cancer (AJCC) stage II or III, BCa diagnoses in Louisiana residents between 2010 and 2020. Treatment received was classified as standard or non-standard of care according to American Urological Association (AUA) guidelines and location of residence was determined using Rural Urban Commuting Area-Tract-level 2010 (RUCA). Multivariable logistic regression analyses and multivariate cox proportional hazard analyses were performed. Of 983 eligible patients, 85.6% (841/983) lived in urban areas. Overall, only 37.5% received standard-of-care (SOC) for the definitive management of locally advanced bladder cancer. Individuals living in rural areas (OR 0.53, 95% CI: 0.31-0.91, p = 0.02) were less likely to receive standard of care treatment. Both rural residence and receipt of non-standard of care therapy were associated with an increased risk of bladder cancer-specific (adj HR 1.53, 95% CI: 1.09-2.14, p = 0.01 and adj HR: 1.85, 95% CI: 1.43-2.39, <0.0001) and overall mortality (adj HR: 1.28, 95% CI: 1.01-1.61, p = 0.04 and adj HR: 1.73 95% CI: 1.44-2.07, p < 0.0001). Most patients with locally advanced bladder cancer in Louisiana do not receive SOC therapy. Individuals living in rural locations are more likely to receive non-standard of care therapy than individuals in urban areas. Nonstandard of care treatment and rural residence are both associated with worse survival outcomes for Louisiana residents with locally advanced bladder cancer.

Understanding the benefits and mechanisms of working from home as a sustainable urban strategy on air pollution: Empirical study in 19 cities in China

Working from home (WFH) arrangements are already acknowledged as a sustainable measure for alleviating urban congestion and air quality issues, but fewer large-scale empirical studies investigating the benefits and mechanisms of WFH on air pollution (AP). The exogenous shock of the epidemic provides unique conditions that enable us to conduct empirical studies on the positive impacts of working from home. Building upon this background, this paper designs a series of empirical models to investigate the benefits of WFH on AP and the mediating effect of intra-city travel intensity (ITI) concerning the WFH-AP relationship to depict the mechanism of the impact of WFH on AP. This paper collected panel data on ITI and AP from January 1 to March 15, 2020, in 19 cities in China for regression analyses. The findings indicate that WFH reduces ITI by 65.0 %, while an increase in ITI leads to higher AP emissions, particularly of NO2. WFH positively impacts urban air quality, resulting in a 26.3 % decrease in the Air Quality Index (AQI) and reductions of 17.2 %, 4.1 %, 32.7 %, 18.8 %, and 13.6 % for the five air pollution categories (CO, NO2, PM2.5, PM10, SO2) respectively. Intermediate analyses demonstrated that ITI partially mediated the decrease in AQI, PM2.5, and CO, while PM10 and NO2 showed complete mediation. However, ITI had a weak mediating effect on SO2 emissions. The contribution of this study is that it provides supporting evidence that working from home positively impacts urban air quality and commuting. Additionally, it offers urban administrators a fact-based approach to traffic management and environmental protection, pointing to important directions for future urban sustainability strategy development.

The Integrated optimization of intermittent lane intersection design and dynamic signal control: efficiency, safety, and fuel consumption

ABSTRACT Existing unconventional intersection designs can enhance the capacity of intersections to deal with repaid pressure on urban commuting, whereas they force vehicles to multi-stop and reorganize, resulting in safety risks and high fuel consumption. This paper proposes the Intermittent Lane Intersection (ILI) that combines the advantages of variable lane intersection and CTE (Combining the tandem control and exit lanes for left-turn control). An integrated optimization model is established to obtain the optimal geometric and signal control parameters, and a homothermic genetic algorithm is used to solve the model. Then, the application of ILI in different traffic demands of the Tianfu Third Street intersection is analyzed. Compared with the benchmark design (TI, CTE, and CTE with signal coordinated control), ILI can effectively reduce intersection delay, fuel consumption, and parking times. Additionally, ILI has great application superiority when the traffic arrival rate is [1500,1700] and the left-turn ratio is [0.40,0.60].

Abstract 426: The Rural Experience of Cardiac Arrest in Maine: Geography, EMS Access, and Social Determinants of Health

Introduction: Resuscitation resources and outcomes differ between rural and urban areas, largely due to patient risk factors and limited emergency medical service (EMS) resources. The current definitions of rural areas are inconsistent and do not encompass all the factors that may affect post-resuscitation care, such as healthcare access, and social determinants of health (SDOH). Hypothesis: In addition to rurality category, measures of healthcare access and SDOH further explain variability in cardiac arrest outcomes across the state of Maine. Goals: Evaluate the difference in model performance in determining survival at three months, using EMS-data, measures of geographic rurality, healthcare access, and SDOH. Approach: We utilized Maine EMS &amp; Fire Information Systems to identify non-traumatic out-of-hospital cardiac arrests in Maine from 2018-2021. We merged this data with state Center for Disease Control data to determine 30-day survival. Risk adjusted models were developed and measures of healthcare access and SDOH were added for all patients and for a cohort of patients who were transported to an Emergency Department (ED). We measured model performance and compared models using likelihood ratio tests. Results: Inclusion criteria was met in 4,277 patients and 1,167 (27%) patients were transported to an ED. After risk adjustment, the best performing model included Rural Urban Commuting Area (p=0.083), time from arrest to highest level of EMS provider (p&lt;0.001) and Area Deprivation Index (p=0.01). For patients transported to EDs, the best performing model included population per square mile (p=0.001), time from arrest to highest level of EMS provider (p=0.041) and census tract with high school education or greater (p&lt;0.001). In both cohorts, the model with all three factors and other risk adjustment was superior to the baseline and models with any individual factor (likelihood ratio test p&lt;0.05). Conclusions: The addition of rurality measures to cardiac arrest characteristics improves model association with good outcome and the addition of markers of EMS response and SDOH explained additional variability. These factors should be considered in combination when evaluating outcome disparities among patients with cardiac arrest.

Classifying oncologist rurality by practice location and patient population.

136 Background: Geographic variation in the oncology workforce has contributed to reduced access to cancer specialists in rural areas. Workforce studies most often classify provider rurality by their practice location. We hypothesized this approach, given its high specificity, would miss the true extent of providers involved in rural cancer care. In this study, we aim to identify a new method for classifying oncologist rurality. Methods: We created a cohort of Medicare beneficiaries diagnosed with breast, colorectal, or lung cancer in 2018. This informed a cohort of all medical, radiation, and surgical oncologists who treated these patients. Two methods were used to classify oncologists’ rurality using Rural Urban Commuting Area (RUCA) codes: 1) Based on the ZIP Code where they provided the plurality of their care; and 2) Based on the percentage of their patients who reside in a rural ZIP Code. We used sensitivity, specificity, and summary statistics to compare these methods and identify a threshold of rural patients to classify provider rurality. Results: We identified 815 rural oncologists by their practice location and 5,450 by their patient population. We found high concordance between these two definitions (AUC: 0.87), with providers practicing in a rural location treating the highest proportion of rural patients (n=658 [80.7%]). Oncologists practicing in a rural area had a lower patient volume (6.4 [SD: 7.8] vs. 12.2 [SD: 14.2]) and were more likely to be a surgeon (73.1% vs. 51.8%) than their metropolitan counterparts. By categorizing oncologist rurality by their patient panel, we have expanded who is considered a rural oncologist (n=5,450 vs. n=815) and created a continuous measure of oncologist rurality. Oncologists treating a high proportion of rural patients had a higher patient volume than those treating no rural patients (10.9 [SD: 11.6] vs. 8.7 [SD: 10.7]). Conclusions: Special consideration should be made when defining oncologists’ rurality status. Basing rurality on their patient panel results in a broader definition of a rural physician, and could be useful for interventions aiming to improve quality of rural cancer care.[Table: see text]

A Literature Survey on Carpooling

This paper embarks on an exploratory journey through a collection of diverse studies, shedding light on the multifaceted world of carpooling. These papers collectively underscore the compelling advantages of carpooling, from economic benefits to addressing traffic congestion and pollution, highlighting its potential to reshape urban commuting and contribute to sustainability. Simultaneously, these studies address inherent carpooling challenges, proposing solutions that encompass logistical considerations and social barriers. We also witness the evolution of carpooling design and technology, from dedicated lanes to advanced matching algorithms, emphasizing innovation at its core. These papers collectively provide valuable insights into carpooling's multifaceted world, illuminating its transformative potential and resilience in the face of urban challenges. This paper provides an overview of the existing research related to the carpooling concept.

Divulging the dust: An examination of particle deposition on soft ocular lens during urban commuting

Air pollution affecting the eye is a relatively new, emerging area of research that has implications for urban commuting and is the key first study. This article emphasizes the importance of understanding the effects of particle deposition on the human eye using soft lenses and their exposure, as well as identifying the chemical, elemental composition, and morphology of particles when commuting over a period of 21-day period. In this study, the focus is on personal sampling with soft contact lenses (42% Hioxifilcon A, 58% H2O) to understand particle deposition on ocular along with cascade to understand cut-off size. Volunteers are used for five different modes, namely bus, open and closed car windows, pedestrian, and two-wheeler. The SEM results show that the morphology in buses, pedestrians and cars are denser, irregular, and nodular, with no or minimal interstitial pores, while the particles in two-wheelers appeared to be fibrous, thin, crystalline, and non-porous ranging from 51.2 nm to 406.3 nm. The ICPMS results show the higher concentration compositions for different commuter types, namely: zinc (0.0562 μg/m3 and 0.1076 μg/m3) for buses and pedestrians, potassium (1.5013 μg/m3) and calcium (2.5892 μg/m3), magnesium (2.978 μg/m3), potassium (4.197 μg/m3), calcium (22.335 μg/m3) and iron (7.526 μg/m3) for two-wheelers. The organic elemental composition from FTIR predominant groups namely carbonyl, carboxylic, OH, N–H, C–H, CC, CO, and C–O. The experiment concludes that travellers in two-wheelers and pedestrians are more susceptible to particle deposits which leads to several ocular effects such as eye-irritation, dryness, and visual impairment.

Gentrification as a Factor in the Incidence of Firearm Injuries

Firearm injuries are an epidemic in the US; more than 45 000 fatal injuries were recorded in 2020 alone. Gaining a deeper understanding of socioeconomic factors that may contribute to increasing firearm injury rates is critical to prevent future injuries. To explore whether neighborhood gentrification is associated with firearm injury incidence rates over time. This cross-sectional study used nationwide, urban US Census tract-level data on gentrification between 2010 and 2019 and firearm injuries data collected between 2014 and 2019. All urban Census tracts, as defined by Rural Urban Commuting Area codes 1 to 3, were included in the analysis, for a total of 59 379 tracts examined from 2014 through 2019. Data were analyzed from January 2022 through April 2023. Gentrification, defined to be an area in a central city neighborhood with median housing prices appreciating over the median regional value and a median household income at or below the 40th percentile of the median regional household income and continuing for at least 2 consecutive years. The number of firearm injuries, controlling for Census tract population characteristics. A total of 59 379 urban Census tracts were evaluated for gentrification; of these tracts, 14 125 (23.8%) were identified as gentrifying, involving approximately 57 million residents annually. The firearm injury incidence rate for gentrifying neighborhoods was 62% higher than the incidence rate in nongentrifying neighborhoods with similar sociodemographic characteristics (incidence rate ratio [IRR], 1.62; 95% CI, 1.56-1.69). In a multivariable analysis, firearm injury incidence rates increased by 57% per year for low-income Census tracts that did not gentrify (IRR, 1.57; 95% CI, 1.56-1.58), 42% per year for high-income tracts that did not gentrify (IRR, 1.42; 95% CI, 1.41-1.43), and 49% per year for gentrifying tracts (IRR, 1.49; 95% CI, 1.48-1.50). Neighborhoods undergoing the gentrification process experienced an additional 26% increase in firearm injury incidence above baseline increase experienced in neighborhoods not undergoing gentrification (IRR, 1.26; 95% CI, 1.23-1.30). Results of this study suggest that gentrification is associated with an increase in the incidence of firearm injuries within gentrifying neighborhoods. Social disruption and residential displacement associated with gentrification may help explain this finding, although future research is needed to evaluate the underlying mechanisms. These findings support use of targeted firearm prevention interventions in communities experiencing gentrification.

Development of the Rural Perception Scale (RPS-18).

People living in rural areas often experience limited access to health resources, slow knowledge diffusion, and geographical isolation, and tend to be at higher risk for poor physical and mental health outcomes compared with nonrural populations. It is unclear, yet, how the concept of "rural" shapes observed differences from nonrural populations. We aim to develop a psychometrically sound scale to assess key dimensions that constitute individual-level perceived rurality. We first conducted a broad literature review to identify a priori concepts related to rurality and adapted survey items measuring relevant constructs, such as loneliness, attitudes toward people living in rural areas, and perceived social membership. We used these conceptual constructs and measures to develop a survey questionnaire focused on rural perceptions. We recruit residents in 3 rural states: Kentucky, New Hampshire, and Vermont. Using the explorative factor analysis and second-order measurement model in the structural equation model framework, we developed a rural perception scale consisting of 18 items. We recruited 1,384 participants (n = 686 from KY; n = 698 from NH/VT) using Amazon Mechanical Turk (n = 897, 64.8%) and social media paid ads (n = 487, 35.2%). The average age of participants was 41 years old (SD = 15); 54.7% of respondents had less than college graduate education, and 94.2% reported their race as non-Hispanic White. Majority of the participants were from Rural Urban Commuting Area (RUCA)-designated urban areas (n = 798, 57.7%), followed by RUCA-designated large rural areas (257, 18.6%), RUCA-designated rural areas (n = 174, 12.6%) and RUCA-designated isolated areas (n = 133, 9.6%). Our final model revealed 4 latent constructs: "belonging" (Cronbach's α = 0.896), "attitudes toward rural life" (Cronbach's α= 0.807), "loneliness" (Cronbach's α = 0.898), and "community social ties to people in their community" (Cronbach's α = 0.846). We identified 4 subfactors of the umbrella concept of rurality that explain how people in rural regions may perceive being in rural environments and having rural lifestyles.

Do Patients Living in Rural Areas Report Inferior 1-Year Outcomes After Total Knee Arthroplasty? A Matched Cohort Analysis

BackgroundRural status has been associated with poor outcomes for several health problems, but its relationship and outcomes following total knee arthroplasty (TKA) has not been fully characterized. Patient-reported outcomes (PROs) are key measures of success following TKA. Therefore, this matched cohort study was designed to test the hypothesis that patients who live in rural settings will report significantly worse PRO scores 1 year after TKA when compared to those who live in urban or suburban settings. MethodsPatients undergoing TKA at our institution were categorized into urban, suburban, and rural cohorts based on Rural Urban Commuting Area scores using reported living setting zip codes. Cohorts were matched for body mass index classification. Demographic data were extracted from the medical records, and PRO data (Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR), Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health and Mental Health, University of California, Los Angeles (UCLA) Activity Score, and Visual Analog Scale Pain were collected preoperatively and 1-year postoperatively. Comparisons across living settings were made using analysis of variance (ANOVA) tests or Chi-square tests. A total of 882 TKA patients (n = 294 per cohort) were analyzed. ResultsPatients living in urban areas had significantly lower preoperative pain scores compared to suburban and rural residents. All measured PROs significantly improved from preoperative levels at 1 year post-TKA with no significant differences among living setting cohorts. ConclusionsIn cohorts matched for body mass index, living in a rural setting was not associated with inferior PROs 1 year after TKA. Level of evidenceLevel 4, retrospective cohort study.