Measuring Accessibility to Medical Centers in Isfahan City Using 2SFCA Method

AbstractOne of the most important challenges facing policymakers and urban planners in recent decades is the issue of accessibility to a variety of urban services. The main purpose of this study was thecalculation of the accessibility of census blocks to medical centers using the Two-Step Floating Catchment Area (2SFCA) method in Isfahan City. In the present study, according to the conditions with and without the limitations of the accessibility radii, different types of distance decay functions were used. The results showed that the 2SFCA method with the use of the cumulative opportunity negative linear function had the highest average of correlation for calculating accessibility to medical centers in comparison with other functions. Calculation of average accessibility in the 15 main regions of Isfahan City showed that the central regions (3, 1, and 5) had the highest decrease and the marginal regions (9, 8, and 11) had the highest increase in the unlimited compared to the limited mode. In general, based on the obtained results of 2SFCA method and the calculated Gini index, the level of inequality in accessibility of census blocks to health services was high in Isfahan City and this inequality increased in terms of accessibility to both hospitals and clinics. Since the extended 2SFCA method has a high capability for assessing supply and demand, as well as catchment area, application of this method can provide a great help for managers and planners in theassessment of the population’s access to a variety of services, such as emergency services and healthcare.Keywords: spatial accessibility, 2SFCA method, distance decay function, medical centers, Isfahan IntroductionOne of the most important challenges faced by policymakers and urban planners in recent decades has been the subjct of access to a variety of urban services. Hospital and clinic centers as the most important urban facilities play an important role in serving people. handeling access to healthcare requires examining the factors, such as spatial distribution of services and demands. Distribution of healthcare centers can affect ease of accessibility for applicants. As health is the basis of social, economic, political, and cultural developments of human societies, identifying deprived areas in terms of accessibility and planning for equitable accessibility to health services for all members of society are essential. MethodologyIn the present study, the Two-Step Floating Catchment Area Method (2SFCA) was employed to calculate the access of census blocks to medical centers (hospitals and clinics) in the city of Isfahan for limited and unlimited accessibility radii. To define the most appropriate distance decay function in the 2SFCA method, the average of Pearson’s correlation coefficient between the accessibility values ​​obtained from different distance decay functions was used. The distance decay function with the highest mean correlation of accessibility values compared to other functions was determined as the most appropriate function in the 2SFCA method. Also, the Lorenz curve and Gini coefficient were applied to compare inequalities of access to medical centers in Isfahan. Results and DiscussionThe results showed that the use of the negative linear cumulative opportunity distance decay function had the highest average correlation in the accessibility values compared to other functions. In the case of limited accessibility radius, the central regions and some northwest and east areas had the highest accessibility to hospitals. In the case of unlimited radius, the central areas had the most accessibility, while accessibility decreased as the distance from these areas increased. Calculation of the average accessibility in the 15 main regions of Isfahan showed that the central (3, 1 and 5) and marginal (9, 8, and 11) regions had the highest decrease and increase in the unlimited compared to the limited mode, respectively. Also, the sensitivity analysis of accessibility to hospitals showed that Al-Zahra and Hazrat Zahra hospitals in Districts 5 and 14 had the greatest impacts on the accessibility of cesus blocks to hospital services in Isfahan City. Comparing the accessibility of census blocks to both hospitals and clinics with accessibility only to hospitals showed an increase in accessibility in the central areas of the city due to the greater concentration of clinics in those areas. However, in the case of combination of hospitals and clinics, the Gini coefficient was equal to 0.60, which showed an increase of 0.04 compared to the case of accessibility only to hospitals, which indicated that inequality was higher in the combinatorial case. ConclusionConsidering the supply and demand simultaneously, the 2SFCA method can provide a more realistic assessment of the accessibility status of census blocks to medical services. In general, based on the obtained results by this method and due to considering the limited radius of accessibility and calculating the Gini index, the level of inequality in the accessibility of census blocks to health services was high in Isfahan City, while this inequality increased in the case of  accessibility to both hospitals and clinics. References- Apparicio, P., Gelb, J., Dubé, A. S., Kingham, S., Gauvin, L., & Robitaille, É. (2017). The approaches to measuring the potential spatial access to urban health services revisited: distance types and aggregation-error issues. International Journal of Health Geographics, 16(1), 1-24.- Bryant Jr, J. and Delamater, P. L. (2019). Examination of spatial accessibility at micro- and macro-levels using the enhanced two-step floating catchment area (E2SFCA) method. Annals of GIS, 25(3), 219-229.- Chatterjee, S. and Hadi, A. S. (2006). Regression analysis by example. 4th Ed., John Wiley & Sons.- Chen, X. and Jia, P. (2019). 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Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10–24 years during the past three decades. Methods: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10–14, 15–19, and 20–24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10–24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010–19, the rate per 100 000 of transport injury DALYs was reduced by 16·7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48·5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0·2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010–19. Interpretation: As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low–middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding: Bill & Melinda Gates Foundation

Global, regional, and national mortality among young people aged 10-24 years, 1950-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings In 2019 there were 1.49 million deaths (95% uncertainty interval 1.39-1.59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32.7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32.1% were due to communicable, nutritional, or maternal causes; 27.0% were due to non-communicable diseases; and 8.2% were due to self-harm. Since 1950, deaths in this age group decreased by 30.0% in females and 15.3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1.3% in males and 1.6% in females, almost half that of males aged 1-4 years (2.4%), and around a third less than in females aged 1-4 years (2.5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9.5% to 21.6%. Interpretation Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million 95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% 95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

A Proposed Approach towards Quantifying the Resilience of Water Systems to the Potential Climate Change in the Lali Region, Southwest Iran

Computing the resilience of water resources, especially groundwater, has hitherto presented difficulties. This study highlights the calculation of the resilience of water resources in the small-scale Lali region, southwest Iran, to potential climate change in the base (1961–1990) and future (2021–2050) time periods under two Representative Concentration Pathways, i.e., RCP4.5 and RCP8.5. The Lali region is eminently suitable for comparing the resilience of alluvial groundwater (Pali aquifer), karst groundwater (Bibitarkhoun spring and the observation wells W1, W2 and W3) and surface water (Taraz-Harkesh stream). The log-normal distribution of the mean annual groundwater level and discharge rate of the water resources was initially calculated. Subsequently, different conditions from extremely dry to extremely wet were assigned to the different years for every water system. Finally, the resilience values of the water systems were quantified as a number between zero and one, such that they can be explicitly compared. The Pali alluvial aquifer demonstrated the maximum resilience, i.e., 1, to the future climate change. The Taraz-Harkesh stream, which is fed by the alluvial aquifer and the Bibitarkhoun karst spring, which is the largest spring of the Lali region, depicted average resilience of 0.79 and 0.59, respectively. Regarding the karstic observation wells, W1 being located in the recharge zone had the lowest resilience (i.e., 0.52), W3 being located in the discharge zone had the most resilience (i.e., 1) and W2 being located between W1 and W3 had an intermediate resilience (i.e., 0.60) to future climate change

A Proposed Approach towards Quantifying the Resilience of Water Systems to the Potential Climate Change in the Lali Region, Southwest Iran

Computing the resilience of water resources, especially groundwater, has hitherto presented difficulties. This study highlights the calculation of the resilience of water resources in the small-scale Lali region, southwest Iran, to potential climate change in the base (1961–1990) and future (2021–2050) time periods under two Representative Concentration Pathways, i.e., RCP4.5 and RCP8.5. The Lali region is eminently suitable for comparing the resilience of alluvial groundwater (Pali aquifer), karst groundwater (Bibitarkhoun spring and the observation wells W1, W2 and W3) and surface water (Taraz-Harkesh stream). The log-normal distribution of the mean annual groundwater level and discharge rate of the water resources was initially calculated. Subsequently, different conditions from extremely dry to extremely wet were assigned to the different years for every water system. Finally, the resilience values of the water systems were quantified as a number between zero and one, such that they can be explicitly compared. The Pali alluvial aquifer demonstrated the maximum resilience, i.e., 1, to the future climate change. The Taraz-Harkesh stream, which is fed by the alluvial aquifer and the Bibitarkhoun karst spring, which is the largest spring of the Lali region, depicted average resilience of 0.79 and 0.59, respectively. Regarding the karstic observation wells, W1 being located in the recharge zone had the lowest resilience (i.e., 0.52), W3 being located in the discharge zone had the most resilience (i.e., 1) and W2 being located between W1 and W3 had an intermediate resilience (i.e., 0.60) to future climate change

Degeneration of Aortic Valves in a Bioreactor System with Pulsatile Flow

Calcific aortic valve disease is the most common valvular heart disease in industrialized countries. Pulsatile pressure, sheer and bending stress promote initiation and progression of aortic valve degeneration. The aim of this work is to establish an ex vivo model to study the therein involved processes. Ovine aortic roots bearing aortic valve leaflets were cultivated in an elaborated bioreactor system with pulsatile flow, physiological temperature, and controlled pressure and pH values. Standard and pro-degenerative treatment were studied regarding the impact on morphology, calcification, and gene expression. In particular, differentiation, matrix remodeling, and degeneration were also compared to a static cultivation model. Bioreactor cultivation led to shrinking and thickening of the valve leaflets compared to native leaflets while gross morphology and the presence of valvular interstitial cells were preserved. Degenerative conditions induced considerable leaflet calcification. In comparison to static cultivation, collagen gene expression was stable under bioreactor cultivation, whereas expression of hypoxia-related markers was increased. Osteopontin gene expression was differentially altered compared to protein expression, indicating an enhanced protein turnover. The present ex vivo model is an adequate and effective system to analyze aortic valve degeneration under controlled physiological conditions without the need of additional growth factors

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health : all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million [95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% [95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe