Accessibility and connectivity criteria for assessing walkability: an application in Qazvin, Iran

Distance is a recognized key determinant of walking. Pedestrians tend to choose the shortest route between two points. Shortest routes can be spatially described in terms of distances between two points or topologically described as the number of turns/directional changes between these points. This paper presents a methodology to evaluate the conditions provided by a street network to pedestrians, by using two space syntax measures. Accessibility was calculated through Angular Segment Analysis by Metric Distance (ASAMeD), a measure of street integration and choice strongly correlated with pedestrian movement pattern. Street Connectivity was calculated by using the space syntax measure of connectivity, which shows the direct connection of street nodes to each individual nodes. The streets criterion values of both approaches were normalized by using fuzzy logic linear functions. The method was applied in the city center of Qazvin, Iran. Results showed that the urban structure of Qazvin has a strong impact on the performance of the network. The old neighborhood centers widespread in the city center presented a high topological accessibility, while the most connected street are those streets crossing and surrounding the neighborhood areas. The method can be used to evaluate and improve pedestrian networks, as it can distinguish the most and least attractive streets according to the criteria used. These findings can be used to guide policies towards improving walkability and to create more walkable and sustainable cities.This research was funded by the JPI Urban Europe and FCT, grant number ENSUF/0004/2016

A parameter tuned hybrid algorithm for solving flow shop scheduling problems with parallel assembly stages

In this paper, we study the scheduling problem for a customized production system consisting of a flow shop production line with a parallel assembly stage that produces various products in two stages. In the first stage of the production line, parts are produced using a flow shop production line, and in the second stage, products are assembled on one of the parallel assembly lines. The objective is to minimize the time required to complete all goods (makespan) using efficient scheduling. A mathematical model is developed; however, the model is NP-hard and cannot be solved in a reasonable amount of time. To solve this NP-hard problem, we propose two well-known metaheuristics and a hybrid algorithm. To calibrate and improve the performance of our algorithms, we employ the Taguchi method. We evaluate the performance of our hybrid algorithm with the two well-known methods of Genetic Algorithm (GA) and Particle Swarm Optimization (PSO) and demonstrate that our hybrid algorithm outperforms both the GA and PSO approaches in terms of efficiency

Levels and characteristics of utilitarian walking in the central areas of the cities of Bologna and Porto

Walking is a mode of transport that offers many environmental and health benefits. Utilitarian walking refers to walking trips undertaken to fulfil routine purposes. The aim of this paper is to examine the extent to which walking is used as a transport mode for short urban trips in the city centers of Bologna and Porto and the barriers preventing utilitarian walking. Based on a questionnaire (n = 1117) administered in the two cities, results indicated that 21% of the individuals travel by foot, while 47% combine walking with other modes. This means that 68% of the daily trips to these city centers involve walking activity. From the overall trips, 84% were made to reach work and school/university. Statistical tests showed that utilitarian walkers were more likely to be females (p < 0.001) and undergraduates (p < 0.001). People from Bologna were more likely to engage in utilitarian walking than people from Porto (p < 0.001). Travel distance and time were the main barriers preventing people from engaging in utilitarian walking. The findings described in this paper provide a better understanding of utilitarian walking in the central areas of both cities, which can guide policies to promote healthier lifestyles and sustainable mobility.This research was funded by the JPI Urban Europe, FCT—PT (ENSUF/0004/2016), MIUR-I, FFG—A and RPF—C

Built environment attributes and their influence on walkability

Walking is a sustainable mode of transport and a healthy way of doing physical activity. Walkability is a concept that has gained enormous popularity in recent years due to its potential to promote more sustainable urban environments and healthy lifestyles. This paper provides a literature review to analyze the influence of built environment attributes on walkability. The Scopus and Web of Science databases were chosen to survey the peer-reviewed documents published up to June 2020. A total of 132 documents were selected by the search. The review of these 132 documents showed that various built environment attributes were differently analyzed and assessed. More specifically, the search identified 32 built environment attributes that were assessed by using 63 measures. Intersection density, residential density and land use mix were the most used attributes for assessing walkability, namely by using objective methods, such as ratios and spatial score tools. In turn, attributes related to streetscape design and security were much less adopted in walkability assessments. This paper provides additional insights into how built environment attributes influence walkability and identifies gaps and issues that should be analyzed in-depth in the future. The review could be helpful for researchers and urban planners in developing walkability studies and in defining policies to improve walkability

Use and perceptions of pedestrian navigation apps: findings from Bologna and Porto

Pedestrian Navigation Applications (PNAs) provide assistance in terms of self-localization, space recognition, and turn-by-turn navigation. The use, motivations and perceptions associated with these applications have been under investigated due to users being insufficiently involved in their design and development. This paper analyses the extent to which PNAs are used for assisting people to walk, the frequencies and reasons of using these applications, the perceptions about them, and the barriers preventing them from being used. The study is supported by a questionnaire (N = 1438) that was administered in Bologna (Italy) and Porto (Portugal). Results indicated that 42% of the respondents use PNAs mainly on an occasional basis to find locations and the shortest routes. Google Maps was the preferred navigation service. Statistical tests showed that PNAs were more likely to be used by younger adults and students. The lack of need was the main reason for not using these apps, due to the good spatial knowledge of the cities or the non-use of the pedestrian mode for regular trips. Respondents would like to have apps that are more accurate, usable, and adjusted to pedestrian navigation. The findings described in this paper could be helpful for future designs of PNAs, especially to match pedestrian needs more effectively and to enhance the role of these apps in promoting healthier and sustainable lifestyles.JPI Urban Europe, FCT—PT (ENSUF/0004/2016), MIUR-I, FFG—A and RPF—C

Perceived walkability and respective urban determinants: insights from Bologna and Porto

Walking is undoubtedly a sustainable and healthy mode of transport. However, the decision to walk is influenced by many built environment and streetscape attributes. Specifically, the term walkability is used to describe the extent to which the urban environment is pedestrian-friendly, usually by quantifying multiple built environment attributes at the neighbourhood scale. The present study adopts a qualitative approach to evaluate perceived walkability. Based on a questionnaire (n = 1438) administered in the cities of Bologna and Porto, this paper analyses how respondents perceived and evaluated 19 built environment and streetscape attributes. An Exploratory Factor Analysis was carried out to examine the correlations between the various attributes and to identify the underlying walkability determinants. The analysis indicated that 13 attributes were highly correlated, resulting in four determinants: (i) urban ambiance, which includes land use and street design attributes, such as land use mix, enclosure, transparency, and architectural and landscape diversity; (ii) pedestrian infrastructure, which is related to sidewalk conditions; (iii) street connectivity and proximity to community facilities; and iv) access to other modes of transport. In turn, traffic safety and security were not correlated with perceived walkability in both cities. These findings suggest that specific urban design and pedestrian infrastructure attributes should be highly considered when formulating policies aiming to create more pedestrian-friendly cities, as well as in walkability studies and when developing walkability scores and indexes.JPI Urban Europe, FCT–PT (ENSUF/0004/2016), MIUR-I, FFG-A, and RPF-CY

Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000-18 : a geospatial modelling study

Background More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels.Methods We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km x 5 km resolution in 98 LMICs based on 2.1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution.Findings Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205000 (95% uncertainty interval 147000-257000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution.Interpretation Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.publishedVersio

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens