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.

Local COVID-19 Epicenter in Detroit Metropolitan Area Causing Profound and Pervasive Reorganization of Clinical, Educational, Research, and Financial Programs of a Large Academic Gastroenterology Division with a GI Fellowship and Primary Medical School Affiliation.

AIM: To report revolutionary reorganization of academic gastroenterology division from COVID-19 pandemic surge at metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to > 300 infected patients in hospital census in April 2020 and > 200 infected patients in April 2021. SETTING: GI Division, William Beaumont Hospital, Royal Oak, has 36 GI clinical faculty; performs > 23,000 endoscopies annually; fully accredited GI fellowship since 1973; employs > 400 house staff annually since 1995; tertiary academic hospital; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. METHODS: This was a prospective study. Expert opinion. Personal experience includes Hospital GI chief > 14 years until 2020; GI fellowship program director, several hospitals > 20 years; author of > 300 publications in peer-reviewed GI journals; committee-member, Food-and-Drug-Administration-GI-Advisory Committee > 5 years; and key hospital/medical school committee memberships. Computerized PubMed literature review was performed on hospital changes and pandemic. Study was exempted/approved by Hospital IRB, April 14, 2020. RESULTS: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19 infection. Affiliated medical school changes included: changing "live" to virtual lectures; canceling medical student GI electives; exempting medical students from treating COVID-19-infected patients; and graduating medical students on time despite partly missing clinical electives. Division was reorganized by changing "live" GI lectures to virtual lectures; four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; temporarily mandated intubation of COVID-19-infected patients for esophagogastroduodenoscopy; postponing elective GI endoscopies; and reducing average number of endoscopies from 100 to 4 per weekday during pandemic peak! GI clinic visits reduced by half (postponing non-urgent visits), and physical visits replaced by virtual visits. Economic pandemic impact included temporary, hospital deficit subsequently relieved by federal grants; hospital employee terminations/furloughs; and severe temporary decline in GI practitioner's income during surge. Hospital temporarily enhanced security and gradually ameliorated facemask shortage. GI program director contacted GI fellows twice weekly to ameliorate pandemic-induced stress. Divisional parties held virtually. GI fellowship applicants interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling ACGME annual fellowship survey, changing ACGME physical to virtual site visits; and changing national conventions from physical to virtual. CONCLUSION: Reports profound and pervasive GI divisional changes to maximize clinical resources devoted to COVID-19-infected patients and minimize risks of transmitting infection.

Cost-Savings Associated with Reductions in Public Service Utilization with Provision of Permanent Supported Housing in Midsized City in the United States.

Severe and persistent mental illnesses are frequently associated with homelessness and extensive use of public services. Cost savings after the provision of permanent supportive housing (PSH) have been examined in large metropolitan areas but not in medium-sized communities. Administrative and clinical data were collected to determine use of public services, such as use of emergency services, inpatient psychiatric and medical services, and correctional facilities, in the year preceding and the year subsequent to placement in PSH. Costs of the housing and the utilized services were also calculated. Ninety-one subjects were in housing first (HF) programs and 19 were in treatment first (TF) programs. Overall there was a net cost savings of over $1.2 million or $6134/consumer/year of PSH. Nearly all cost savings were in reduced service utilization which implies prevention of both medical and psychiatric morbidity. In HF the average per patient cost savings ($21,082.12) was not significantly greater than TF ($12,907.29; p = 0.33). Provision of PSH in a mid-sized city provides significant cost savings.

Urban sustainability in an age of enduring inequalities: Advancing theory and ecometrics for the 21st-century city.

The environmental fragility of cities under advanced urbanization has motivated extensive efforts to promote the sustainability of urban ecosystems and physical infrastructures. Less attention has been devoted to neighborhood inequalities and fissures in the civic infrastructure that potentially challenge social sustainability and the capacity of cities to collectively address environmental challenges. This article draws on a program of research in three American cities-Boston, Chicago, and Los Angeles-to develop hypotheses and methodological strategies for assessing how the multidimensional and multilevel inequalities that characterize contemporary cities bear on sustainability. In addition to standard concerns with relative inequality in income, the article reviews evidence on compounded deprivation, racial cleavages, civic engagement, institutional cynicism, and segregated patterns of urban mobility and organizational ties that differentially connect neighborhood resources. Harnessing "ecometric" measurement tools and emerging sources of urban data with a theoretically guided framework on neighborhood inequality can enhance the pursuit of sustainable cities, both in the United States and globally.

Health impact of climate change in cities of middle-income countries: the case of China.

BACKGROUND: This review examines the human health impact of climate change in China. Through reviewing available research findings under four major climate change phenomena, namely extreme temperature, altered rainfall pattern, rise of sea level and extreme weather events, relevant implications for other middle-income population with similar contexts will be synthesized. SOURCES OF DATA: Sources of data included bilingual peer-reviewed articles published between 2000 and 2018 in PubMed, Google Scholar and China Academic Journals Full-text Database. AREAS OF AGREEMENT: The impact of temperature on mortality outcomes was the most extensively studied, with the strongest cause-specific mortality risks between temperature and cardiovascular and respiratory mortality. The geographical focuses of the studies indicated variations in health risks and impacts of different climate change phenomena across the country. AREAS OF CONTROVERSY: While rainfall-related studies predominantly focus on its impact on infectious and vector-borne diseases, consistent associations were not often found. GROWING POINTS: Mental health outcomes of climate change had been gaining increasing attention, particularly in the context of extreme weather events. The number of projection studies on the long-term impact had been growing. AREAS TIMELY FOR DEVELOPING RESEARCH: The lack of studies on the health implications of rising sea levels and on comorbidity and injury outcomes warrants immediate attention. Evidence is needed to understand health impacts on vulnerable populations living in growing urbanized cities and urban enclaves, in particular migrant workers. Location-specific climate-health outcome thresholds (such as temperature-mortality threshold) will be needed to support evidence-based clinical management plans and health impact mitigation strategies to protect vulnerable communities.

Effect of the Brazilian cash transfer programme on suicide rates: a longitudinal analysis of the Brazilian municipalities.

PURPOSE: There is a growing awareness of the economic and contextual factors that may play a role in the aetiology of suicide. The Programa Bolsa Família (PBF) the Brazilian conditional cash transfer programme, established in 2004, aims to attenuate the effects of poverty of Brazilians. Our study aims to evaluate the effect of Bolsa Família Programme (BFP) coverage on suicide rates in Brazilian municipalities. METHODS: We conducted an ecological study using 2004-2012 panel data for 5507 Brazilian municipalities. We calculated age-standardized suicide rates for each municipality and year. BFP coverage was categorized according to three levels (< 30%, ≥ 30% and < 70% and ≥ 70%) and duration (coverage ≤ 70% for all years, ≥ 70% for 1 year, ≥ 70% for 2 years, ≥ 70% for 3 or more years). We used negative binomial regression models with fixed effects, adjusting for socio-economic, demographic and social welfare co-variables. RESULTS: An increase in BFP coverage was associated with a reduction in suicide rates. The strongest effect was observed when in addition to greater municipal coverage (RR 0.942, 95% CI 0.936-0.947), the duration of the high coverage was maintained for 3 years or more (RR 0.952 95% CI 0.950-0.954). CONCLUSIONS: The results provide evidence that the conditional cash transfer programme may reduce suicide in Brazilian municipalities, mitigating the effect of poverty on suicide incidence.

Planning future care services: Analyses of investments in Norwegian municipalities.

AIMS: To analyse whether the Norwegian Central Government's goal of subsidizing 12,000 places in nursing homes or sheltered housing using an earmarked grant was reached and to determine towards which group of users the planned investments were targeted. METHODS: Data from the investment plans at municipal level were provided by the Norwegian Housing Bank and linked to variables describing the municipalities' financial situation as well as variables describing the local needs for services provided by Statistics Norway. Using regression analyses we estimated the associations between municipal characteristics and planned investments in total and by type of care place. RESULTS: The Norwegian Central Government reached its goal of giving subsidies to 12,000 new or rebuilt places in nursing homes and sheltered housing. A total of 54% of the subsidies (6878 places) were given to places in nursing homes. About 7500 places were available by the end of the planning period and the rest were under construction. About 50% of the places were planned for user groups aged <67 years and 23% of the places for users aged <25 years. One-third of the places were planned for users with intellectual disabilities. Investments in nursing homes were correlated with the share of the population older than 80 years and investments in sheltered houses were correlated with the share of users with intellectual disabilities. CONCLUSIONS: Earmarked grants to municipalities can be adequate measures to affect local resource allocation and thereby stimulate investments in future care. With the current institutional setup the municipalities adapt investments to local needs.

Temporal Dynamics of the Driving Factors of Urban Landscape Change of Addis Ababa During the Past Three Decades.

Mapping and quantifying urban landscape dynamics and the underlying driving factors are crucial for devising appropriate policies, especially in cities of developing countries where the change is rapid. This study analyzed three decades (1984-2014) of land use land cover change of Addis Ababa using Landsat imagery and examined the underlying factors and their temporal dynamics through expert interview using Analytic Hierarchy Process (AHP). Classification results revealed that urban area increased by 50%, while agricultural land and forest decreased by 34 and 16%, respectively. The driving factors operated differently during the pre and post-1991 period. The year 1991 was chosen because it marked government change in the country resulting in policy change. Policy had the highest influence during the pre-1991 period. Land use change in this period was associated with the housing sector as policies and institutional setups were permissive to this sector. Population growth and in-migration were also important factors. Economic factors played significant role in the post-1991 period. The fact that urban land has a market value, the growth of private investment, and the speculated property market were among the economic factors. Policy reforms since 2003 were also influential to the change. Others such as accessibility, demography, and neighborhood factors were a response to economic factors. All the above-mentioned factors had vital role in shaping the urban pattern of the city. These findings can help planners and policymakers to better understand the dynamic relationship of urban land use and the driving factors to better manage the city.

Heterogeneous Costs of Alcohol and Drug Problems Across Cities and Counties in California.

BACKGROUND: Estimates of economic and social costs related to alcohol and other drug (AOD) use and abuse are usually made at state and national levels. Ecological analyses demonstrate, however, that substantial variations exist in the incidence and prevalence of AOD use and problems including impaired driving, violence, and chronic disease between smaller geopolitical units like counties and cities. This study examines the ranges of these costs across counties and cities in California. METHODS: We used estimates of the incidence and prevalence of AOD use, abuse, and related problems to calculate costs in 2010 dollars for all 58 counties and an ecological sample of 50 cities with populations between 50,000 and 500,000 persons in California. The estimates were built from archival and public-use survey data collected at state, county, and city levels over the years from 2009 to 2010. RESULTS: Costs related to alcohol use and related problems exceeded those related to illegal drugs across all counties and most cities in the study. Substantial heterogeneities in costs were observed between cities within counties. CONCLUSIONS: AOD costs are heterogeneously distributed across counties and cities, reflecting the degree to which different populations are engaged in use and abuse across the state. These findings provide a strong argument for the distribution of treatment and prevention resources proportional to need.