Congested Sidewalks: The Effects of the Built Environment on E-scooter Parking Compliance

With the proliferation of electric scooters (e-scooters) in cities across the world, concerns continue to arise about their parking spots on sidewalks and other public spaces. Research has looked at e-scooter parking compliance and compared compliance to other mobility devices, but research has not yet examined the impacts of the built environment on parking compliance. Using a field observation dataset in Portland, Oregon, and novel GIS data, we attempt to understand the spatial distribution of e-scooter parking and the impact of built features on parking compliance, offering recommendations for policymakers and future research. The results of our study show that 76% of e-scooters observed fail at least one of the Portland’s parking compliance requirements and 59% fail at least two criteria. However, compliance varies spatially and by violation type, indicating that parking compliance (or non-compliance) is dependent on features of the built environment. Parking compliance is significantly higher on blocks with designated e-scooter parking than blocks without designated e-scooter parking. A statistically significant relationship is observed between the amount of legally parkable area on a city block and parking compliance. Parking compliance increases with larger percentages of legally parkable area. This finding can help policymakers prioritize dedicated e-scooter parking for blocks with limited legally parkable area

Women\u27s groups and COVID-19: Challenges, engagement, and opportunities

COVID-19, a novel infectious disease, was declared a pandemic by the World Health Organization in March 2020. Unlike the world’s persistent, high-burden infectious diseases—such as tuberculosis and malaria—that are more prevalent among the most vulnerable in low and middle-income countries, COVID-19 is unique because of (1) its wide geographic spread across a range of populations, (2) its partially asymptomatic transmission, (3) a disproportionate effect on older people and those with underlying morbidities, and (4) potentially, the level of intensive care required when geographic areas experience a large number of severe cases. Many countries and states have chosen to place entire populations under lockdown to reduce mortality and mitigate the potential burden on health systems. Lockdowns vary greatly in severity, with some countries instituting full lockdowns, mandating social distancing, and strengthening public health responses, and other countries implementing shelter-in-place policies. This policy brief presents the implications of the pandemic and the lockdown for women’s groups, with a focus on India, Nigeria, and Uganda

Women\u27s groups and COVID-19: An evidence review on savings groups in Africa

This paper presents emerging evidence from studies in diverse contexts in sub-Saharan Africa —with a deep dive into Nigeria and Uganda—on how COVID-19 has affected women’s groups and how these groups have helped mitigate the gendered effects of the pandemic’s and the associated policy responses’ consequences up until April 2021. The synthesis presents evidence that savings groups found ways to continue operating, provided leadership opportunities for women during the pandemic, and mitigated some of the negative economic consequences of COVID-19 on individual savings group members. Savings, credit, and group support from other members all likely contributed to the ability of groups to positively affect women’s group member’s resilience during COVID-19. However, savings groups themselves often faced financial challenges because of decreased savings, which sometimes resulted in the depletion of group assets. These findings are consistent with a recent evidence synthesis on how past covariate shocks affected women’s groups and their members. We conclude the paper by presenting various policy recommendations to enable savings groups to achieve improvements in women’s empowerment and economic outcomes and research recommendations to address some of the current evidence-gaps on how COVID-19 is affecting women’s groups and their members

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

How the Built Environment Affects Car Ownership and Travel: Evidence from San Francisco Housing Lotteries

Credibly identifying how the built environment shapes behavior is empirically challenging, because people select residential locations based on differing constraints and preferences for site amenities. Our study overcomes these research barriers by leveraging San Francisco's affordable housing lotteries, which randomly allow specific households to move to specific residences. Using administrative data, we demonstrate that lottery-winning households' baseline preferences are uncorrelated with their allotted residential features such as public transportation accessibility, parking availability, and bicycle infrastructure---meaning that neighborhood attributes and a building's parking supply are effectively assigned at random. Surveying the households, we find that these attributes significantly affect transportation mode choices. Most notably, we show that essentially random variation in on-site parking availability greatly changes households' car ownership decisions and driving frequency, with substitution away from public transit. In contrast, we find that parking availability does not affect employment or job mobility. Overall, the evidence from our study robustly supports that local features of the built environment are important determinants of transportation behavior

What do residential lotteries show us about transportation choices?

Credibly identifying how the built environment shapes behaviour is empirically challenging, because people select residential locations based on differing constraints and preferences for site amenities. Our study overcomes these research barriers by leveraging San Francisco’s affordable housing lotteries, which randomly allow specific households to move to specific residences. Using administrative data, we demonstrate that lottery-winning households’ baseline preferences are uncorrelated with their allotted residential features such as public transportation accessibility, parking availability and bicycle infrastructure – meaning that neighbourhood attributes and a building’s parking supply are effectively assigned at random. Surveying the households, we find that these attributes significantly affect transportation mode choices. Most notably, we show that essentially random variation in on-site parking availability greatly changes households’ car ownership decisions and driving frequency, with substitution away from public transport. In contrast, we find that parking availability does not affect employment or job mobility. Overall, the evidence from our study robustly supports that local features of the built environment are important determinants of transportation behaviour

How the Built Environment Affects Car Ownership and Travel: Evidence from San Francisco Housing Lotteries

Credibly identifying how the built environment shapes behavior is empirically challenging, because people select residential locations based on differing constraints and preferences for site amenities. Our study overcomes these research barriers by leveraging San Francisco's affordable housing lotteries, which randomly allow specific households to move to specific residences. Using administrative data, we demonstrate that lottery-winning households' baseline preferences are uncorrelated with their allotted residential features such as public transportation accessibility, parking availability, and bicycle infrastructure---meaning that neighborhood attributes and a building's parking supply are effectively assigned at random. Surveying the households, we find that these attributes significantly affect transportation mode choices. Most notably, we show that essentially random variation in on-site parking availability greatly changes households' car ownership decisions and driving frequency, with substitution away from public transit. In contrast, we find that parking availability does not affect employment or job mobility. Overall, the evidence from our study robustly supports that local features of the built environment are important determinants of transportation behavior

Urinary filariasis masquerading as the bladder tumor: A case report with cyto-histological correlation

Filariasis is a prevalent parasitic infection of lymphatic frequently seen in tropical countries. It has been reported in cytological samples from various sites; however, presence of microfilaria in smears from the urine sample is an uncommon finding. We describe an interesting and unusual case of elderly female who presented with achylous hematuria and an exophytic mass lesion in urinary bladder on computed tomography scan suspected of neoplastic mass lesion; however diagnosed as urinary filariasis on urine cytology and bladder biopsy