Urban Units Research Articles

Environmental noise exposure is associated with atherothrombotic risk

There is growing evidence that environmental noise exposure could increase the risk of atherothrombotic events, including acute myocardial infarction (MI). We analysed the burden of environmental noise on atherothrombotic risk in MI patients. From the RICO survey, 879 consecutive MI patients included from 2004 to 2008 and living in an urban unit of > 237,000 inhabitants were analysed. Atherothrombotic risk was calculated using the TRS-2P score. TRS-2P categories were split into low (TRS-2P = 0/1) (40.8%), medium–low (TRS-2P = 2) (25.7%), medium–high (TRS-2P = 3) (21.8%) and high risk (TRS-2P ≥ 4) (11.6%). Noise exposure was associated with atherothrombotic risk, with the LAeq,24 h (OR (95% CI): 1.165 (1.026–1.324)) and Lnight (OR (95CI): 1.157 (1.031–1.298)), for each 10 dB(A) increase. After adjustment, noise exposure remained a predictor of atherothrombotic risk, with LAeq,24 h (OR (95% CI): 1.162 (1.011–1.337)) and with Lnight (OR (95% CI): 1.159 (1.019–1.317)). The relationship with transportation Lnight was significant for men (OR (95% CI): 1.260 (1.078–1.472)) but not for women (OR (95% CI): 0.959 (0.763–1.205)). We found a significant association between residential traffic noise exposure and atherothrombotic risk in men but not in women. These results could have major consequences for secondary prevention.

Use of Vegetation to Classify Urban Landscape Types: Application in a Mediterranean Coastal Area

The objectives of this paper are (a) to incorporate vegetation cover into quantitative techniques for identifying and classifying urban landscape types, (b) to implement a methodology to analyse the urban landscape units of three zones in the Mediterranean coastal area and (c) to design a methodology that could be extrapolated to other urban spaces with a similar type and spatial scale. To achieve the objectives, the urban landscape units are characterized in three Mediterranean coastal municipalities in the south of Spain, in the province of Málaga: Benalmádena, Marbella and Manilva. The characterization is based on some of the most representative variables of the urban morphology, such as construction density, road density and building height, also incorporating the presence of vegetation cover, both arboreal and herbaceous and shrub. Data were obtained from the Spanish Cadastral (urban morphology variables) and through remote sensing techniques (vegetation), spatial analysis tools and multivariate analysis were implemented to obtain the characterization and spatial delimitation of the urban typologies. As a result, six clusters are recognized with predominant urban landscape typologies. The proposed procedure is a useful tool to segment the city following landscape criteria, as well as to assess the changes experienced in urban spaces.

Comparing air quality during nationwide and regional lockdown in Mumbai Metropolitan City of India

The second wave of COVID-19 triggered crises in India and resulted in a regional scale lockdown (March 2021), exempting specific economic sectors from economic misery. A national lockdown was announced during the first wave of this pandemic (March, 2020), resulting in a dramatic improvement in air quality. The present study explored whether the regional lockdown has an equal influence on air quality in various urban morphological units as the national lockdown. Results show that the regional lockdown in 2021 improved air quality by 32% more than the national lockdown in 2020. The rate of air quality improved between pre-lockdown and during a nationwide lockdown was 33%, 41% and 15% in industrial, commercial, and residential zones, respectively, but 53%, 46% and 43% during the regional lockdown. Because of the regional lockdown, air quality has improved at a quicker pace.

Energy Systems and Energy Sharing in Traditional and Sustainable Archetypes of Urban Developments

Diverse factors influence the energy profile of an urban development including density, shape of buildings and their types, energy demand, and available energy resources. A systematic investigation of the energy characteristics of urban areas, involves the determination of representative archetypes of urban developments. This study presents a comparison of energy performance and resources between two categories of traditionally built urban development building clusters (BCs) in the North American urban context, and neighborhood units (NUs) designed with various sustainable principles and considerations. The study presents a methodology to optimize the mix of energy resources of individual building clusters and neighborhoods, as well as the optimization of energy sharing among the individual urban units of each category. Optimal energy sharing is determined based on the best combination of energy deficit and energy surplus of various clusters and neighborhoods. The study shows that in general neighborhood units encompassing diverse building uses and designed to allow different amenities within a walking distance perform better than commonly built building clusters with low usage diversity. Highly diverse neighborhoods that combine large commercial areas to high density residential buildings can generate up to 84% of their annual electrical and up to 37% of their annual thermal consumption. PV generation accounts for major part of the electrical energy generation of both individual urban units (BCs and NUs) and combination of these units. This can reach up to 92% of the total energy consumption of some combinations of NUs, while the remaining energy requirement is fulfilled by wind and waste to energy (3.4% and 4.9%, respectively). On the other hand, the study shows that thermal energy is mostly supplied by alternative energy sources, since building surfaces prioritize the accommodation of PV modules.

Provider and Manager Perspectives on the Use of an Integrated Clinical Pathway for Community-Dwelling Older Adults: A Qualitative Case Study.

Background:Integrated care pathways (ICPs) could improve the organisation and delivery of care for community dwelling older adults. An ICP was developed and implemented in Québec to support home care processes. This study explores the perspectives of home care staff on the use of an ICP to support the organisation and delivery of health and social care to community-dwelling older adults with complex needs.Theory and Methods:A case study based on eleven semi-structured interviews and analysis of documents was carried out in an urban home care unit. The Normalization Process Theory was used for mixed thematic analysis.Results:While its capacity to store data and enhance interprofessional information exchange was appreciated by home care staff, the broad scope, and automated features of the ICP tool were often problematic. Concerns about increased provider workloads, disruption to provider-client relationships during clinical encounters, and difficulties engaging clients in decision-making were main obstacles in the use of the ICP.Conclusion:Given the importance of ICPs in advancing clinical integration, it is critical to continuously adjust their design to align with providers’ realities in order to optimize their potential in real life contexts.

Patient and Clinician Perspectives on the use of Remote Patient Monitoring in Peritoneal Dialysis.

Background:Numerous factors influence patient recruitment to, and retention on, peritoneal dialysis (PD), but a major challenge is a perceived “inaccessibility” to treating clinicians. It has been suggested that remote patient monitoring (RPM) could be a means of improving such oversight and, thereby, uptake of PD.Objective:To describe patient and clinician perspectives toward RPM and the use of applications (Apps) suitable for mobiles, tablets, or computers to support the provision of PD care.Design:Qualitative design using semi-structured interviews.Setting:All patient participants perform PD treatment at home under the oversight of an urban PD unit in Sydney, Australia. Patient and clinician interviews were conducted within the PD unit.Participants:14 participants (5 clinicians [2 nephrologists, 3 PD nurses] and 9 patients treated with PD).Methods:Semi-structured interviews were conducted using interview guides tailored for clinician and patient participants. Transcripts were coded and analyzed by a single researcher using thematic analysis.Results:Six themes were identified: perceived benefits of RPM implementation (offering convenience and efficiency, patient assurance through increased surveillance, more complete data and monitoring adherence), uncertainty regarding data governance (protection of personal data, data reliability), reduced patient engagement (transfer of responsibility leading to complacency), changing patient-clinician relationships (reduced patient-initiated communication, the need to maintain patient independence), increased patient and clinician burden (inadequate technological literacy, overmanagement leading to frequent treatment changes), and clinician preference influencing patient behavior.Limitations:The interviews were conducted in English only and with participants from a single urban dialysis unit, which may limit generalizability.Conclusions:For patients and clinicians, advantages from the use of RPM in PD may include increased patient confidence and assurance, improved treatment oversight, more complete data capture, and overcoming barriers to data documentation. Careful patient selection and patient and clinician education may help to optimize the benefits of RPM, maintain patient independence, and reduce the risks of patient disengagement. The use of an App may support RPM; however, participants expressed concerns about increasing the burden on some patients through the use of unfamiliar technology.Human Research Ethics Committee Approval Number:CH62/6/2019-028

Depression, anxiety, and diabetes-related distress in type 2 diabetes in primary care in Greece: Different roles for glycemic control and self-care.

Objectives:The psychological distress of people living with diabetes is increased and associated with poorer glycemic outcomes and self-care. We aimed to examine the frequency of depression, anxiety, and diabetes-related distress (DRD) of individuals with type 2 diabetes (T2D) in primary care (PC) and their comparative associations with clinical, self-care, and socio-demographic characteristics, testing for possible different roles on glycemic control and self-care.Methods:This is a cross-sectional study of 182 adults with a T2D diagnosis of at least six months, recruited between August 2019-March 2020 and May-October 2020, from an urban PC unit. Participants were screened for symptoms of depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder-7 (GAD-7)), and DRD (Diabetes Distress Scale (DDS)). Clinical, self-care, and socio-demographic parameters were recorded.Results:The frequency of clinically significant symptoms of depression was 16.6%, (PHQ-9 score ⩾10), anxiety 17.7% (GAD-7 score ⩾10), and DRD 22.6% (DDS score ⩾2). All PHQ-9, GAD-7, and DDS scores intercorrelated, and higher scores were found to be associated with female gender, lower income, and prior diagnosis of depression. Higher PHQ-9 and GAD-7 scores were found to be associated with lower education, more hypoglycemia episodes, more blood glucose self-tests and antidepressant or benzodiazepine use. The retired/housewives scored significantly lower in GAD-7 and DDS compared to the unemployed participants. Higher DDS scores were associated with higher glycated hemoglobin, higher fasting plasma glucose, and insulin use. It was also noted that higher PHQ-9 scores were associated with lower uric acid levels and were significantly higher in the sedentary lifestyle group.Conclusion:DRD was associated with poorer glycemic outcomes while depressive symptoms were associated with lower physical activity perhaps sharing different roles for glycemic control and self-care. The psychological burden of individuals with T2D may be considered in PC.

Prospects of using the urban railway for logistics support of urban areas

Relevance of the conducted study is determined by the prospects of involving urban railway to provide logistical support of urban territorial units. Both urban light freight railways and passenger railways and their development perspectives were considered. Within the framework of the study, methods of expert evaluations, abstract logical method, methods of theoretical generalization and system analysis, statistical analysis, as well as clustering were used. The advantages of creating an urban light freight railway were identified, the opportunities of interaction with logistics centers and other modes of transport were determined, and examples of effective public-private partnerships in this process were analyzed. The factors determining the effectiveness of functioning of the logistic link “urban passenger transport – city train” were determined. Overall, the authors conclude that to implement the proposed projects, efforts should be intensified to unite the potential of a large number of companies, give them access to preferential credit lines, attracting foreign investment funds, and the freight and passenger railways can work on a joint network but separate from other rail connections.

Gravimetric and Number Distributions of Urban PM Residuals from Urban Maintenance Practices

AbstractParticulate matter (PM) recovery from street sweeping (SS), catch basin (CB), and unit operation (UO) is essential for sustainability of these urban hydrologic functional units (HFUs). PM i...

Vancomycin area under the curve/minimum inhibitory concentration and trough level concordance-evaluation on an urban health unit.

A vancomycin AUC/MIC (area under the curve/minimum inhibitory concentration) of 400-600 mg•h/L is associated with improved clinical outcomes for the treatment of methicillin resistant Staphylococcus aureus (MRSA) infections. Currently, there are still limited studies evaluating the relationship between vancomycin trough and AUC. To evaluate the correlation between vancomycin trough and AUC/MIC and determine if trough-guided monitoring is an adequate predictor of AUC/MIC in the Urban Health population at St Paul's Hospital. This was a retrospective chart review of 29 patients from November 2019 to February 2021. Patient demographics and laboratory data were collected from electronic medical records. The two-level equation-based approach was used to calculate AUC/MIC. The proportion of AUC/MIC values within target (400-600 mg•h/L) despite subtherapeutic troughs, and the proportion of AUC/MIC values supratherapeutic when trough is within target (15-20 mg/L) were the primary endpoints. Fifty-seven sets of levels were collected and 75% of vancomycin troughs and AUC24 were found to be discordant. When trough was 10-14.9 mg/L, AUC24 was > 400 mg•h/L in 94% of cases and when trough was 15-20 mg/L, AUC24 was > 600 mg•h/L in 69% of cases. There was a moderate correlation between vancomycin trough and AUC24h (R 2 = 0.57; p < 0.001). A vancomycin trough between 15 and 20 mg/L may result in an AUC/MIC greater than necessary for clinical efficacy. Considering these findings and the practical concerns of AUC-guided monitoring, a modest reduction in target troughs to prevent vancomycin toxicity warrants clinical consideration and further evaluation.

An antifragile strategy for Rome post-Covid mobility

We are aware that we will have to live with COVID-19 at least until the vaccination of a minimum percentage of the population will guarantee the achievement of “herd immunity”. Until then, it is proved that the most effective strategy to limit contagion is social distancing. Despite the adoption of countermeasures, this strategy is having heavy effects on the economy and social relations, putting the issue of people’s mobility at the centre of attention (OECD, 2020a; Un-habitat, 2020). This moment must therefore represent the opportunity to build an urban resilience strategy around mobility policies based on necessary “anti-fragile” scenarios (Taleb, 2008; Blečić & Cecchini, 2016), seizing this phase for an urban and social transformation capable of strengthening the complex “city” system toward “a new normal” (OECD, 2020b). In some Italian and foreign cities, the partial reopening carried out from May 2020 led to the resumption of some productive activities. The consequent increase in the flows has given rise to a complex challenge related to the reorganization of mobility. Rome has put in place measures such as the strengthening of public transport during peak hours and the start of the construction of 150 km of cycle paths, already foreseen by the Sustainable Urban Mobility Plans (SUMP) of 2019. However, it falls behind cities like Milan and Bologna, who have drawn up specific documents such as Adaptation Strategies and Emergency Plans for Sustainable Mobility, promptly engaged in the reorganization of mobility following the example of other European cities (such as Barcelona, Paris, Vienna) that pursue clear objectives and long-standing strategies of environmental, social and economic sustainability. Nevertheless, the backwardness of Rome also deals with the complexity of the urban “form” of the city and its immeasurable extension, as well as to the paucity of municipal mobility policies of the last decades. In view of a “post-COVID” phase, two essential factors are overriding: the demand for travel (Who should move? From where to where? How?) and the supply of urban and metropolitan mobility. However, it is necessary to counter immediately the risk of an uncontrolled return to the use of private vehicles, which, for Rome in particular, would mean the collapse of the city, also related to an immediate increase in atmospheric pollution and roads accidents. The paper is aimed at proposing an anti-fragile strategy for Roman mobility, starting from the functional and morphological analysis of the Roman settlement system, related to its articulation and specificities, which constitute a fundamental component in evaluating the potential and weaknesses of new mobility scenarios, highlighting the relationships between forms of the city and mobility models.The proposal for a planning methodology, based on the identification of the “elementary urban units” of the “theoretical grid” (Vittorini, 1987; Cerasoli, 2008), is supported by the international debate and practices of the last decades (Superillas in Barcelona; 15-minutes city model; Good Moove Plan in Bruxelles) and by the arising temporary practices in the Covid-19 phase. A planning methodology that will be able to easily switch from emergency to ordinary, combining ordinary and post-COVID extraordinary funds.

Can Urban Regeneration improve Walkability? A space-time assessment for the Tintoretto area in Brescia

In recent years, shared programs have shown that one of the most critical challenges to promote sustainability in the contemporary city is mobility. The actions on physical context can be divided into two correlated themes: (i) the urban regeneration of existing city with a particular focus on public services for each urban unit and (ii) the planning of their accessibility. Nevertheless, if the correlation is clear and generally recognised in theory, an evaluation of how the urban regeneration projects can contribute to achieving sustainability goals in technical and ordinary practice still struggles to consolidate. Hence, the contribution aims to observing and evaluating the effects of local urban regeneration projects from a people-and-climate perspective, highlighting the pros of integrated urban planning and mobility management approaches.The paper presents an assessment framework that consists of a GIS-based time-space analysis of the walkability scenarios of public open spaces. It maps the urban spaces’ pedestrian permeability in a cells grid, which is applied to an algorithm able to measure the isochronic curve of access time. The approach proposed is applied to the case study of the urban regeneration project of the Tintoretto tower unit in Brescia, which is analysed in two temporal instant, ex-ante and ex-post. The results’ framework reflects on the proactive importance of measuring public space’s systemic regeneration strategies towards "projects people-and-climate oriented".

123 Tint: Training in Trauma Simulation Programme

Major trauma is one of the leading contributors to death for several age groups globally making it a public health concern. There are approximately 20,000 cases of major trauma per year in England and over 25% of these result in deaths This Emergency Medicine (EM) course was designed for Specialty and Associate Specialist Grade (SASG) doctors to develop leadership skills and to demonstrate technical and non-technical skills as a trauma team leader (TTL) when assessing severely injured patients. This course has a strong focus on the understanding of hospital systems and processes for the timely assessment and treatment of complex trauma patients.After a successful HEE funding bid, a simulation training course was devised to cover the main principles of trauma management and the non-technical skills required to manage a trauma patient and help up-skill the 14 SASG doctors at an urban trauma unit. Five scenarios were designed based on real patients seen in urban trauma units in London. On designing the scenarios, an understanding of the functioning of hospital systems such as requesting and administering blood products and transferring patients both within the hospital and within the trauma network, were crucial learning objectives.This course was delivered weekly from January to June 2021. Sessions involved the EM SASG doctor, two EM nurses and the members of the wider MDT expected at each trauma call, to recreate the resuscitation room environment. Each SASG doctor underwent all five trauma simulation scenarios individually as the TTL. Each scenario was followed by a focussed debrief by two EM consultants, with discussion around human factors, technical and academic aspects of trauma management. All 14 SASG doctors completed the five trauma scenarios. As a result of this training, there has been an improvement in the management of patients with higher injury severity scores in the ED based on both clinical supervision and feedback from the candidates. Given the impact on practice that this training has had, this course will be delivered to the wider trauma teams within the trust, with the EM SASG doctors continuing as TTLs.

Clean heating in Northern China: Regional investigations and roadmap studies for urban area towards 2050

With rapid urbanization, the building stock and related winter heating demands are developing fast in the urban regions of Northern China. In addition to the national strategy to alleviate the air pollution, China has also pledged to achieve carbon neutrality in the future. Although the planning of heating system has been studied from national level, bottom-level regional plans are still lacking, which is especially crucial for a huge country as China that has significantly different characteristics across regions. Therefore, this study examined the transitions of the heating sectors towards 2035 and 2050 for 1047 third-level urban units in Northern China. Future changes in heating resources under the low-carbon transitions and future heating demands with the urbanization trend were investigated. Through geographic mapping of resources and demands for county-level units, the regional differences in future scenarios owing to the uneven socioeconomic development of Northern China were presented, which fill in the knowledge gap. By combining supply-side investigations and demand-side forecasts, various roadmaps were evaluated in terms of primary energy consumption, pollution emissions, and economic benefits. Although significant pollution reductions can be achieved in all proposed roadmaps, the clean heating roadmap with the optimal utilization of available resources presents a lower annualized cost than the business-as-usual roadmap, which simply relies on biomass and supplementary sources such as natural gas. In 2050, the primary energy consumption can be reduced to approximately 3 kgce/m2, with an annualized cost of 6 CNY/m2. Balancing the carbon emissions and economic performance, the optimal renovation pattern, together with supply side technologies, were identified in this study.

A Hybrid Intelligent Model for Urban Seismic Risk Assessment from the Perspective of Possibility and Vulnerability Based on Particle Swarm Optimization

Assessing seismic risk is an essential element of urban risk management and urban spatial security work. In response to the issues posed by the complexity and openness of urban systems, the nonlinearity of driving factors, and sudden changes in geological processes that affect urban seismic research, this paper is based on a variety of intelligent algorithms to develop a hybrid intelligent model that integrates probability and vulnerability to evaluate and quantify the difference in the urban spatial units distribution of earthquake risk. We applied this model to Hefei, one of the few superlarge provincial capital cities on the “Tancheng-Lujiang” fault zone, one of the four major earthquake zones in China, which suffers frequent earthquakes. Our method combined the genetic algorithm (GA), particle swarm optimization (PSO), and backpropagation neural network methods (BP) to automatically calculate rules from inputted data on known seismic events and predict the probability of seismic events in unknown areas. Then, based on the analytic hierarchy process (AHP), spatial appraisal and valuation of environment and ecosystems method (SAVEE), and EMYCIN model, an urban seismic vulnerability was evaluated from the four perspectives of buildings, risk of secondary disasters, socioeconomic conditions, and urban emergency response capabilities. In the next step, the overall urban seismic risk was obtained by standardizing and superimposing seismic probability and vulnerability. Using the hybrid intelligent model, earthquake probability, seismic vulnerability, and overall seismic risk were obtained for Hefei, and the spatial characteristics of its overall seismic risk were examined. This study concludes that areas with very high, high, low, and very low earthquake risk in Hefei account for 8.10%, 31.90%, 40.94%, and 19.06% of its total area, respectively. Areas with very high earthquake risk are concentrated in the old city, the government affairs district, Science City, and Xinzhan District. This study concludes that government authorities of Hefei should target earthquake safety measures consisting of basic earthquake mitigation measures and pre- and postearthquake emergency measures. In the face of regional disasters such as earthquakes, coordinating and governing should be strengthened between cities and regions.

Demystifying the Geography of Urbanization in Indonesia (Case Study: Southeast Sulawesi Province)

What is a city? How can we define the boundaries of a city? Despite being the popular subject of research in rapid urbanization, the discussion of the spatial dimension of urbanization is still few in Indonesia. This paper aims to make the geography of urbanization in Indonesia clearer and easier to understand by applying the degree of urbanization (DEGURBA/DoU) methodology. The case study location proposed is Southeast Sulawesi province (SSP)which has distinctive urbanization trajectories with rapid urbanization trends and a relatively stable rural population, but a lack of research regarding its urbanization patterns. This research used Global Human Settlement Layer (GHSL) data as the primary source to conduct spatial analysis to produce the degree of urbanization with complementary national statistical and spatial data to compare with the current conventional classification methodology. The findings show that based on DoU, 39.87% of the SSP population live in urban centers, 22.58% in urban cluster/periurban, and 37.56%. SSP has a total of 49 urban units with 6 urban centers/cities, and 43 urban clusters/towns. By testing the rank-size distribution of SSP’s urban units, it shows that SSP’s urban systems pattern satisfy Zipf’s law with R2 = .9885, and the slope of the fitted line is -0.9554. Based on this result, currently, SSP has 4 medium cities, 2 small cities, 21 large towns, and 20 small towns. In addition, the DoU also has an opportunity to understand how should urban areas be governed and managed, and by whom. Despite the Greater Kendari Urban Area has not yet fulfilled the national’s Metropolitan population threshold (1 million pop), the urban management and development should be conducted more collaboratively with neighboring regencies such as Konawe and South Konawe. The advantages are shown by these findings highlight the importance of scaling up this research to a national scale and using finer and nationally available data.

Pregnant during the COVID-19 pandemic: an exploration of patients\u2019 lived experiences

BackgroundInfectious outbreaks are known to cause fear and panic. Exploration of pregnant individuals’ psychosocial condition using a qualitative lens during an infectious outbreak is limited. In this study we explore pregnant individuals’ lived experiences as well as their psychological and behavioural responses during COVID-19 with the goal of providing useful strategies from the patient’s perspective to enable health care providers to help pregnant patients navigate this and future pandemics.MethodsPregnant individuals between 20-weeks gestation and 3 months postpartum who received maternity care from an urban academic interprofessional teaching unit in Toronto, Canada were invited to participate. Semi-structured 60 min interviews were audio-recorded, transcribed and analyzed using descriptive thematic analysis. Interview questions probed psychological responses to the pandemic, behavioural and lifestyle changes, strategies to mitigate distress while pregnant during COVID-19 and advice for other patients and the healthcare team.ResultsThere were 12 participants, mean age 35 years (range 30–43 years), all 1 to 6 months postpartum. Six main themes emerged: 1) Childbearing-related challenges to everyday life; 2) Increased worry, uncertainty and fear; 3) Pervasive sense of loss; 4) Challenges accessing care; 5) Strategies for coping with pandemic stress; 6) Reflections and advice to other pregnant people and health care professionals. Pregnant individuals described lack of social support due to COVID-19 pandemic restrictions and a profound sense of loss of what they thought their pregnancy and postpartum period should have been. Advice to healthcare providers included providing mental health support, clear and up to date communication as well as more postpartum and breastfeeding support.ConclusionsThese participants described experiencing psychosocial distress during their pregnancies and postpartum. In a stressful situation such as a global pandemic, health care providers need to play a pivotal role to ensure pregnant individuals feel supported and receive consistent care throughout the pregnancy and postpartum period. The health care provider should ensure that mental health concerns are addressed and provide postpartum and breastfeeding support. Without addressing this need for support, parental mental health, relationships, parent-infant bonding, and infant development may be negatively impacted.

Drivers of spontaneous and cultivated species diversity in the tropical city of Zhanjiang, China

Urban plant diversity influences the social functioning and well-being of urban dwellers. However, the patterns and drivers of plant diversity in tropical urban areas are still not entirely understood. In response to the knowledge deficiencies in this area, we investigated spontaneous and cultivated plant richness and their phylogenetic diversity and relatedness in 260 Urban Functional Units (UFUs), which represented nine different land use types according to anthropogenic function, in the tropical coastal city of Zhanjiang, China. Plant diversity was modelled as a function of UFU characteristics and human maintenance practices. Spontaneous species richness was highest in urban villages and vacant lands and lowest in transportation areas, while phylogenetic diversity was highest in utilities and lowest in parks. In comparison, cultivated species richness was highest in multi-family residential areas and lowest in vacant lands, while phylogenetic diversity of cultivated species was highest in commercial/industry areas and lowest in agriculture areas. The number of cultivated species and the degree of phylogenetic relatedness of spontaneous species were positively correlated with the human population density. The phylogenetic diversity of cultivated species within UFUs was generally higher than that of spontaneous species. Human maintenance of landscapes acted as an environmental filter for spontaneous species, but also promoted the number of cultivated plants. We conclude that appropriate investment in urban green areas may improve both plant species richness and phylogenetic diversity in urban environments.

Routine screening for hepatitis C in pregnancy is cost-effective in a large urban population in Ireland: a retrospective study.

To investigate whether risk factor-based screening in pregnancy is failing to identify women with hepatitis C virus (HCV) infection and to assess the cost-effectiveness of universal screening. Retrospective study and model-based economic evaluation. Two urban tertiary referral maternity units, currently using risk factor-based screening for HCV infection. Pregnant women who had been tested for hepatitis B, HIV but not HCV. Anonymised sera were tested for HCV antibody. Positive sera were tested for HCV antigen. A cost-effectiveness analysis of a change to universal screening was performed using a Markov model to simulate disease progression and Monte Carlo simulations for probabilistic sensitivity analysis. Presence of HCV antigen and cost per quality-adjusted life year (QALY). In all, 4655 samples were analysed. Twenty had HCV antibodies and five HCV antigen. This gives an active infection rate of 5/4655, or 0.11%, compared with a rate of 0.15% in the risk-factor group. This prevalence is 65% lower than a previous study in the same hospitals from 2001 to 2005. The calculated incremental cost-effectiveness ratio (ICER) for universal screening was €3,315 per QALY gained. This study showed that the prevalence of HCV infection in pregnant women in the Dublin region has declined by 65% over the past two decades. Risk factor-based screening misses a significant proportion of infections. A change to universal maternal screening for hepatitis C would be cost-effective in our population. Universal maternal screening for hepatitis C is cost-effective in this urban Irish population.

Sexual health issues postpartum–A mixed methods study of women's help-seeking behavior after the birth of their first baby

ObjectiveTo identify women's help-seeking behavior in relation to sexual health issues after the birth of their first baby. DesignA mixed methods sequential explanatory study design was utilized. Phase one of the study consisted of a prospective cohort study to identify the help-seeking behavior of women experiencing sexual health issues at 3, 6, and 12 months postpartum. Phase two consisted of a qualitative descriptive design to explore women's help-seeking behavior for sexual health issues postpartum. Setting & ParticipantsThe setting was a large urban tertiary referral maternity unit (greater than 8000 births per year) in the Republic of Ireland. Nulliparous women aged 18 years and over were invited to participate in phase one. Phase two consisted of a subsample of women who consented to being contacted for further research on admission to the study. FindingsFew women consulted a clinician for postpartum sexual health issues at each of the study's three, six and twelve month time-points. For example, only 2.9% (n=18) of women experiencing dyspareunia, and 3.6% (n=16) of those experiencing a lack of vaginal lubrication spoke to their General Practitioner (GP) about these issues at three months postpartum. The qualitative data supported the quantitative findings and suggested that even when women proactively sought help from healthcare professionals they were met with unhelpful responses. In the absence of support from practitioners, women became active agents and sought information from other women or the internet. In an effort to improve practice women recommended a greater focus on their physical and emotional recovery from birth. Key conclusions and implications for practiceVery few women consulted with a clinician about their experience of sexual health issues after birth. Findings will contribute to and assist policy makers in planning future postnatal services for women to include extending the final postnatal assessment beyond six weeks after birth.