The persistence of ancient settlements and urban sustainability.

We propose a dedicated research effort on the determinants of settlement persistence in the ancient world, with the potential to significantly advance the scientific understanding of urban sustainability today. Settlements (cities, towns, villages) are locations with two key attributes: They frame human interactions and activities in space, and they are where people dwell or live. Sustainability, in this case, focuses on the capacity of structures and functions of a settlement system (geography, demography, institutions) to provide for continuity of safe habitation. The 7,000-y-old experience of urbanism, as revealed by archaeology and history, includes many instances of settlements and settlement systems enduring, adapting to, or generating environmental, institutional, and technological changes. The field of urban sustainability lacks a firm scientific foundation for understanding the long durée, relying instead on narratives of collapse informed by limited case studies. We argue for the development of a new interdisciplinary research effort to establish scientific understanding of settlement and settlement system persistence. Such an effort would build upon the many fields that study human settlements to develop new theories and databases from the extensive documentation of ancient and premodern urban systems. A scientific foundation will generate novel insights to advance the field of urban sustainability.

Are urban landscapes associated with reported life satisfaction and inequalities in life satisfaction at the city level? A cross-sectional study of 66 European cities.

With more than half the world's population residing in urban areas and this proportion rising, it is important to understand how well-planned urban environments might improve, and reduce inequalities in, quality of life (QoL). Although studies suggest city-level characteristics hold independent influence on QoL, they generally lack a theoretically informed approach to understanding how the whole city landscape might be implicated, have paid scant attention to inequalities in QoL and often focus on small numbers of cities or countries. We applied theory and methods from landscape ecology to explore associations between cities' land cover/use, residents' reported life satisfaction and within-city socio-economic inequalities in life satisfaction. We joined individual-level responses to the European Urban Audit (EUA) Perception Surveys (2012, 2015) with city-level data from the European Urban Atlas classifying land cover/use into 26 different classes. Our sample included 63,554 people from 66 cities in 28 countries. Multilevel binary logistic models found that specific land use measures were associated with life satisfaction, including the amount of a city which was: residential (OR:0.991, 95%CI 0.984-0.997); isolated structures (OR:1.046, 95 CI 1.002-1.091); roads (OR:0.989, 95%CI 0.982-0.996); pastures (OR: 1.002, 95% CI 1.002-1.003) and herbaceous vegetation (OR:0.998, 95%CI 0.997-0.100). A more even distribution of land cover/use (ß: 1.561, 95%CI -3.021 to -0.102) was associated with lower inequality in life satisfaction. This is the first study to theorise and examine how the entire urban landscape may affect levels of and inequalities in wellbeing in a large international sample. Our finding that more equal distribution of land cover/use is associated with lower levels of socio-economic inequality in life satisfaction supports the idea that city environments could be equigenic - that is, could create equality. Our findings can aid urban planners to develop and build cities that can contribute to improving, and narrowing inequalities in, residents' life satisfaction.

Urban networks among Chinese cities along "the Belt and Road": A case of web search activity in cyberspace.

"The Belt and Road" initiative has been expected to facilitate interactions among numerous city centers. This initiative would generate a number of centers, both economic and political, which would facilitate greater interaction. To explore how information flows are merged and the specific opportunities that may be offered, Chinese cities along "the Belt and Road" are selected for a case study. Furthermore, urban networks in cyberspace have been characterized by their infrastructure orientation, which implies that there is a relative dearth of studies focusing on the investigation of urban hierarchies by capturing information flows between Chinese cities along "the Belt and Road". This paper employs Baidu, the main web search engine in China, to examine urban hierarchies. The results show that urban networks become more balanced, shifting from a polycentric to a homogenized pattern. Furthermore, cities in networks tend to have both a hierarchical system and a spatial concentration primarily in regions such as Beijing-Tianjin-Hebei, Yangtze River Delta and the Pearl River Delta region. Urban hierarchy based on web search activity does not follow the existing hierarchical system based on geospatial and economic development in all cases. Moreover, urban networks, under the framework of "the Belt and Road", show several significant corridors and more opportunities for more cities, particularly western cities. Furthermore, factors that may influence web search activity are explored. The results show that web search activity is significantly influenced by the economic gap, geographical proximity and administrative rank of the city.

[Municipalities Stratification for Health Performance Evaluation]. / Estratificação de municípios brasileiros para avaliação de desempenho em saúde.

OBJECTIVE: to propose and present a stratification of Brazilian municipalities into homogeneous groups for evaluation studies of health management performance. METHODS: this was a methodological study, with selected indicators which classify municipalities according to conditions that influence the health management and population size; data for the year 2010 were collected from demographic and health databases; correlation tests and factor analysis were used. RESULTS: seven strata were identified - Large-sized; Medium-sized with favorable, regular or unfavorable influences; and Small-sized with favorable, regular or unfavorable influences -; there was a concentration of municipalities with favorable influences in strata with better purchasing power and funding, as well as a concentration of municipalities with unfavorable influences in the North and Northeast regions. CONCLUSION: the proposed classification grouped similar municipalities regarding influential factors in health management, which allowed the identification of comparable groups of municipalities, setting up a consistent alternative to performance evaluation studies.

Assessing the validity of health impact assessment predictions regarding a Japanese city's transition to core city status: a monitoring review.

BACKGROUND: The validity of health impact assessment (HIA) predictions has not been accurately assessed to date. In recent years, legislative attempts to promote decentralization have been progressing in Japan, and Kurume was designated as a core city in April 2008. An HIA into the transition of Kurume to a core city was conducted before the event, but the recommendations were not accepted by city officials. OBJECTIVE: The aim of this study was to examine the validity of predictions made in the HIA on Kurume by conducting a monitoring review into the accuracy of the predictions. METHOD: Before Kurume was designated as a core city, the residents completed an online questionnaire and city officials were interviewed. The findings and recommendations were presented to the city administration. One year after the transition, a monitoring review was performed to clarify the accuracy of the HIA predictions by evaluating the correlation between the predictions and reality. RESULTS: Many of the HIA predictions were found to conflict with reality in Kurume. Prediction validity was evaluated for two groups: residents of Kurume and city officials. For the residents, 17% (2/12 items) of the predictions were found to be compatible, 58% (7/12) were incompatible and 25% (3/12) were difficult to evaluate. For city officials, the analysis was divided into those whose department was directly involved in tasks transferred to them (transfer tasks) and those whose department was not. For the city officials in departments responsible for conducting core city transfer tasks, 33% (3/9 items) of the predictions were found to be compatible, 33% (3/9) were incompatible and 33% (3/9) were difficult to evaluate. However, for the city officials whose responsibilities were unrelated to core city transfer tasks, 11% (1/9) of predictions were found to be compatible, 78% (7/9) were incompatible and 11% (1/9) were difficult to evaluate. CONCLUSION: Although it was possible to validate some of the HIA predictions, the results of this monitoring review found substantial discrepancies between the predictions and reality 1 year after the transition of Kurume to a core city. This suggests that the accuracy of HIA predictions may be called into question. However, it should be noted that the review was conducted very soon after the transition and the steering group was very small, which may explain why the HIA predictions were inaccurate. Further, long-term studies may be needed to assess the accuracy of HIA predictions in similar contexts.

Custo-benefício do serviço de telecardiologia no Estado de Minas Gerais: projeto Minas Telecardio / Cost-benefit of the telecardiology service in the state of Minas Gerais: Minas Telecardio Project

FUNDAMENTO: A telecardiologia é instrumento que pode auxiliar na atenção cardiovascular, principalmente em municípios localizados em áreas remotas. Entretanto, as avaliações econômicas sobre o assunto são escassas e com resultados controversos. OBJETIVO: Avaliar o custo-benefício da implantação do serviço de telecardiologia em municípios remotos, de pequeno porte, no estado de Minas Gerais, Brasil. MÉTODOS: O estudo utilizou a base de dados do Projeto Minas Telecardio (MTC), desenvolvido de junho/2006 a novembro/2008, em 82 municípios do interior do estado. Cada município recebeu um microcomputador com eletrocardiógrafo digital, com possibilidade de envio dos traçados e comunicação com plantão de cardiologia em pólo universitário. A análise custo-benefício foi realizada comparando o custo de realização de um ECG no projeto MTC ao custo de realizar este exame por encaminhamento em outra localidade. RESULTADOS: O custo médio de um ECG no projeto MTC foi de R$ 28,92, decomposto em R$ 8,08 referente ao custo de implantação e R$ 20,84 ao de manutenção do programa. A simulação do custo do ECG com encaminhamento variou de R$ 30,91 a R$ 54,58, sendo a relação custo-benefício sempre favorável ao programa MTC, independente da forma de cálculo da distância de encaminhamento. Nas simulações, foram consideradas as abordagens do financiador e da sociedade. A análise de sensibilidade com variação dos parâmetros de calibração confirmou esses resultados. CONCLUSÃO: A implantação de sistema de telecardiologia como apoio a atenção primária em cidades brasileiras de pequeno porte é factível e economicamente benéfica, podendo ser transformada em programa regular do sistema público de saúde.

BACKGROUND: Telecardiology is a tool that can aid in cardiovascular care, mainly in towns located in remote areas. However, economic assessments on this subject are scarce and have yielded controversial results. OBJECTIVE: To evaluate the cost-benefit of implementing a Telecardiology service in remote, small towns in the state of Minas Gerais, Brazil. METHODS: The study used the database from the Minas Telecardio (MTC) Project, developed from June 2006 to November 2008, in 82 towns in the countryside of the state. Each municipality received a microcomputer with a digital electrocardiograph, with the possibility of transmitting ECG tracings and communicating with the on-duty cardiologist at the University hospital. The cost-benefit analysis was carried out by comparing the cost of performing an ECG in the project versus the cost of performing it by patient referral to another city. RESULTS: The average cost of an ECG in the MTC project was R$ 28.92, decomposed into R$ 8.08 for the cost of implementation and R$ 20.84 for maintenance. The cost simulation of the ECG with referral ranged from R$ 30.91 to R$ 54.58, with the cost-benefit ratio being always favorable to the MTC program, regardless of the type of calculation used for referral distance. The simulations considered the financial sponsor's and society's points-of-view. The sensitivity analysis with variation of calibration parameters confirmed these results. CONCLUSION: The implementation of a Telecardiology system as support to primary care in small Brazilian towns is feasible and economically beneficial, and can be used as a regular program within the Brazilian public health system.

Cost-benefit of the telecardiology service in the state of Minas Gerais: Minas Telecardio Project.

BACKGROUND: Telecardiology is a tool that can aid in cardiovascular care, mainly in towns located in remote areas. However, economic assessments on this subject are scarce and have yielded controversial results. OBJECTIVE: To evaluate the cost-benefit of implementing a Telecardiology service in remote, small towns in the state of Minas Gerais, Brazil. METHODS: The study used the database from the Minas Telecardio (MTC) Project, developed from June 2006 to November 2008, in 82 towns in the countryside of the state. Each municipality received a microcomputer with a digital electrocardiograph, with the possibility of transmitting ECG tracings and communicating with the on-duty cardiologist at the University hospital. The cost-benefit analysis was carried out by comparing the cost of performing an ECG in the project versus the cost of performing it by patient referral to another city. RESULTS: The average cost of an ECG in the MTC project was R$ 28.92, decomposed into R$ 8.08 for the cost of implementation and R$ 20.84 for maintenance. The cost simulation of the ECG with referral ranged from R$ 30.91 to R$ 54.58, with the cost-benefit ratio being always favorable to the MTC program, regardless of the type of calculation used for referral distance. The simulations considered the financial sponsor's and society's points-of-view. The sensitivity analysis with variation of calibration parameters confirmed these results. CONCLUSION: The implementation of a Telecardiology system as support to primary care in small Brazilian towns is feasible and economically beneficial, and can be used as a regular program within the Brazilian public health system.