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Mozambican cities are characterized by the prevalence and indiscriminate increase of land occupations, as a result dwellings are demolished for being built in areas that are considered 'inappropriate'. Looking at the context of Lichinga City (Mozambique) it is assumed that the control and orientation of access to land, in a collaborative way, involving the Municipality and the community authorities, can alleviate the problems related to the indiscriminate occupation of the land. Therefore, this article aims to bring elements that promote reflections on the role of the Municipality-Community authorities' articulation in land management and their influence on the way the territory is occupied. A collaborative diagnosis methodology for land occupation is proposed, involving the main agents with interference in access to land, that is, the Municipality and the Community Authorities, whose purpose is to identify the inappropriate areas of land, the ways inappropriate lands are accessed and set action strategies. [ABSTRACT FROM AUTHOR]

Bacillary dysentery (BD) is an acute diarrheal disease prevalent in areas affected by socioeconomic disparities. We investigated BD risk and its associations with socioeconomic factors at the county-level in Jiangsu province, China using epidemiological and socioeconomic data from 2011–2014. We fitted four Bayesian hierarchical models with various prior specifications for random effects. As all model comparison criteria values were similar, we presented results from a reparameterized Besag-York-Mollié model, which addressed issues with the identifiability of variance captured by spatial and independent effects. Our model adjusted for year and socioeconomic status showed 18-65% decreased BD risk compared to 2011. We found a high relative risk in the northwestern and southwestern counties. Increasing the percentage of rural households, rural income per capita, health institutions per capita, or hospital beds per capita decreases the relative risk of BD, respectively. Our findings can be used to improve infectious diarrhea surveillance and enhance existing public health interventions. [ABSTRACT FROM AUTHOR]

The research analyzed how the internal control of the Municipality of Fortaleza monitors the notifications sent by the external control bodies to the various bodies of the Municipal Public Administration. For this purpose, a qualitative, descriptive research was used. The case study method is used, and secondary and primary data are used. It was concluded that the analyzed mechanism consists of an important internal control tool, which seeks to avoid the congestion of notifications coming from the external control institutions, serving as an aid in the adequacy of the answers to be forwarded. [ABSTRACT FROM AUTHOR]

This article examines territorial inequalities in health resources in relation to the COVID-19 pandemic. The typology built differentiates between the following four categories: (1) counties that succeeded in ensuring good access to both COVID-19 patients and patients with chronic illness; (2) counties with good access to COVID-19 patients but rather low access to patients with chronic illness; (3) counties with mixed situations and (4) poor access for COVID-19 patients and patients with chronic illness. Counties that succeeded in providing good access for both categories of patients are to a significantly greater extent from counties with high GDP per capita. [ABSTRACT FROM AUTHOR]

Recent studies of Sicilian architecture falling into the period of the Norman County (1061-1130) have recognized that it was formed in particular cultural circumstances; the result of both the importation of architectural knowledge to serve the needs of patrons and sites, and its adaptation to a local skill base. To clarify the theme, the following paper focuses on crypts in Sicilian cathedrals where construction was ordered by Roger I of Altavilla in the late 11th century and early 12th century. We will first examine all surviving examples, to identify the role played by the choice of the site. Most were chosen for their strategic position in respect of their natural and inhabited surroundings; e will also enquire as to the relationship between the crypt and the cathedral; finally, we will try to identify the dynamics of the interaction between Norman architectural culture and that of the population already present on the Island at the time of the conquest [ABSTRACT FROM AUTHOR]

Probably organized at the end of the 15th century, the county of Severin overlapped the old Romanian districts in the upper part of Banat. From the 16th century it merged administratively with the district of Caransebeș, with which it had a common body of officials. Integrated into the principality of Transylvania, following the conquest of lowland Banat by the Ottomans, the county of Severin retained a number of peculiarities in its organization. Perhaps the most notable aspects were the fact that the ban of Caransebeș-Lugoj replaced the function of County lord (Lat. comes suppremus, Hung. Ispán) and that the banat and the County, although two administrative units terminologically speaking, functioned as one in terms of the body of officials. In the 17th century, the area was aligned with the legislative system of the principality of Transylvania, but nevertheless retained the use of certain legal practices that recalled the medieval tradition of ius valahicum. The functioning of this administrative unit was violently interrupted in 1658 following the the Ottoman occupation. The present analysis aimed at capturing, through the institutions, how an administrative unit on the periphery/border of the Transylvanian principality functioned in the 16th–17th centuries. [ABSTRACT FROM AUTHOR]

Currently, the administrative-territorial delimitation of Romania is based on two levels: the communes and cities that make up the basic level and the counties corresponding to the intermediate level. Starting from 1999, the regional level was also created, which is not an administrative level, but only a way of functional organization to respond to some requirements of the regional policy of the European Union. With regard to the administrative-territorial organization of Romania, in the two parts of this study we proposed to dwell on the theories that were formulated regarding the administrative-territorial reorganization. We conclude that there is no ideal model to follow in terms of administrativeterritorial reorganization, following that each country, depending on the economic, social, political and geographical specifics, will establish its own criterion of administrative-territorial organization, in such a way that it responds to the demands generated by their own development needs and aiming to eliminate economic disparities and achieve territorial and social cohesion. [ABSTRACT FROM AUTHOR]

The relationship between entrepreneurship and economic development is studied widely in academic research and is of interest to policymakers. A majority of past studies have focused on the association between country-level entrepreneurship and gross domestic product (GDP), though more recently, studies have also focused on associations between state-, region-, and city-level entrepreneurship and economic development. Complementing prior studies at these different geographic levels, in this study, we use 774 neighbor county pairs across state borders and the recently released data on county GDP from 2001 to 2017 (18,652 country-year observations) in the US. We find the lag of log of non-employer establishments in the county Granger-cause log of real county GDP. Our results, controlling for neighbor-county-pair time-trends, show that for a 1% increase in non-employer establishments, there is a small but positive effect on GDP (0.049%). Estimates across subsamples of major industry sectors further support the positive association, especially in construction, transportation and warehousing, and most service sectors. Robustness checks using vector autoregression (three lags), distributed lag models (up to five lags), and macroeconomic cyclical patterns under bivariate panel correlations for non-employer establishments were consistent with the main results. For a 1% increase in small firms with 1–4 employees, the increase in GDP is 0.13%. The county-level inferences add further to the growing body of studies focused on the within-country entrepreneurship and economic development. [ABSTRACT FROM AUTHOR]

Cities in China do not constitute a few global metropolises, but are characterized by heterogeneity. Studying counties can give us a comprehensive picture of urban sprawl in China. This study measured the sprawl index of 1880 counties in China from 2005 to 2020 for the first time and then revealed the evolution of their spatiotemporal characteristics and driving mechanisms. The results revealed the following. (1) China’s counties had a noticeable sprawling trend from 2005 to 2020, and their evolutionary process was characterized by spatiotemporal heterogeneity. (2) From 2005 to 2020, the counties’ sprawl gradually evolved into a spatial distribution pattern of high in the east and low in the west. The spatial distribution of sprawl in county and municipal districts had the characteristics of an interlocking distribution. (3) High–high cluster areas of CSI are mainly distributed in plains, and hilly, basin, and plateau areas tend to be low–low cluster areas. High–low outliers were distributed in a “point–line” pattern along the railroad lines and a cluster pattern near railroad intersections and central cities. Low–high outliers had the trend of encircling the high–high cluster areas. (4) The coefficient of the natural drivers was higher but tended to decrease, while the coefficient of economic and spatial drivers was lower but gradually increased. This study is the first to refine the study of urban sprawl to the county scale, which provides a reference for decision making to optimize the spatial structure of counties and thus promote high-quality development.

The USA leads the world in healthcare spending but trails dozens of countries in life expectancy. Government spending may reduce overall mortality by redistributing resources from the rich to the poor. We linked mortality data from 2006 to 2015 to municipal and state government spending in 149 of the largest American cities. We modeled the association of mortality with city and state government spending per capita in 2005 using weighted linear regression. A 10% increase in state government expenditures was associated (P = 0.008) with a 1.4% (95%CI: 0.4–2.4%) reduction in mortality in American cities. Total city government expenditures were not associated with mortality (P > 0.10). However, among Whites, increases in city government spending were associated with a reduction in mortality of 4.8% (2.1–7.5%), but among Blacks and Asians, increased city government spending was associated with respective mortality increases of 1.7% (0.6–2.9%) and 5.1% (2.1–6.2%). State government spending is associated with reduced mortality in American cities. City government spending appears to benefit White longevity and hurt non-White longevity. [ABSTRACT FROM AUTHOR]

Throughout history, mines have occupied an important place for the Ottoman State as well as for every state. For the Ottoman Empire, the importance and value of coal mines among these mines increased with the industrial revolution. As a matter of fact, coal mines were used as fuel for the most important inventions of the era, such as steamships and trains. However, the operation of coal mines depends on labor and capital power. In this respect, the Ottoman State sometimes connected the places around the mine to the region where the mine was extracted to form financial units in order to operate the mines more actively, and sometimes transformed the region where the mine was located into an administratively independent unit. In this way, both labor power was taken care of and bureaucratic convenience was tried to be provided in mineral extraction. In this study, the reason why Ereğli Coal Mine was turned into a sanjak will be discussed, especially within the framework of archival sources, due to the income it provides to the state and its contributions to industry and other branches. Thus, it will be revealed that financial units have an important place in the determination of the Ottoman administrative structure. [ABSTRACT FROM AUTHOR]

Top-down emission reduction target setting results in inability of local governments to develop differentiated plans for emission reduction. Forests have received considerable attention as an important source of carbon sequestration, especially following China's commitment to carbon neutrality. However, studies have paid little attention to spatiotemporal differences of downscale forest carbon sequestration in China over the long term due to data limitations, while also ignoring the large differences in forest carbon sequestration per unit area among different regions. Here, a basic dataset of forest carbon sequestration among counties and grids in China is constructed and the temporal drivers and spatial differences of forest carbon sequestration were investigated from the perspectives of counties' administrative boundaries and 0.5 by 0.5 degree grid combining modelling, GIS spatial analysis and a decomposition method. Changes in forest land use between 2000 and 2020 were also analysed. The results highlight the importance of forests in managing carbon sequestration among all types of terrestrial vegetation and the differences in forest carbon sequestration per unit area. The scale effect increased forest carbon sequestration in the first two periods (2000–2005 and 2005–2010), followed by a decrease since 2010. The intensity effect promoted carbon sequestration; in particular, a dramatic increase was observed from the second (2005–2010) to the third period (2010–2015). The heterogeneity of the scale effect of forest carbon sequestration increased compared to that of the intensity effect, both from administrative and geographical divisions. The scale and intensity effects of counties located in the northern regions of northeast China enhanced forest carbon sequestration, while counties located in southern and central China inhibited it during the study period. The scale effect of grids changed from enhanced to inhibited forest carbon sequestration mainly in northeast China near 120°E, whereas the intensity effect of grids increased from inland regions in central China to eastern coastal regions during the study period. This study provides references for policymakers to set differentiated emission reduction targets considering the local forest carbon sequestration. • Local governments lack downscaled information on forest carbon sequestration. • Spatiotemporal differences in forest carbon sequestration are identified. • Remote sensing data facilitates down-scaling and long-term research. • The constructed dataset enables differentiated emission reduction targets setting. • Future work may focus on complementary remote sensing data from other platforms. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine and evaluate the level of sustainable development of counties in Poland. Counties were divided into four types – voivodship cities, other cities, land counties in the immediate vicinity of voivodship cities and other land counties. Statistical data from the Local Data Bank of the Central Statistical Office of Poland for 2018 were applied. A set of indicators of sustainable development was defined. Using methods of multidimensional comparative analysis, synthetic indicators of economic, social and environmental development were determined. The measure of cohesion was used to assess the level of sustainable development of counties. It enabled dividing counties into five groups: a very low, low, medium, high and very high level of sustainability. The results show that only 20% of counties in 2018 was classified as a very high level of sustainable development class. Relatively, the highest level of sustainability was observed in land counties, both those bordering large cities and other ones. It was found that the environmental aspect may be a barrier in shaping the sustainable development of counties.

Safety-net hospitals rely on disproportionate-share hospital (DSH) payments to help cover uncompensated care costs and underpayments by Medicaid (known as Medicaid shortfalls). The Affordable Care Act (ACA) anticipates that insurance expansion will increase safety-net hospitals' revenues and will reduce DSH payments accordingly. We examined the impact of the ACA's Medicaid DSH reductions on California public hospitals' financial stability by estimating how total DSH costs (uncompensated care costs and Medicaid shortfalls) will change as a result of insurance expansion and the offsetting DSH reductions. Decreases in uncompensated care costs resulting from the ACA insurance expansion may not match the act's DSH reductions because of the high number of people who will remain uninsured, low Medicaid reimbursement rates, and medical cost inflation. Taking these three factors into account, we estimate that California public hospitals' total DSH costs will increase from $2.044 billion in 2010 to $2.363-$2.503 billion in 2019, with unmet DSH costs of $1.381-$1.537 billion.

The study used the county institutional capacity assessment tool (CICAT) to assess the capacities of selected county health departments (CHDs) along the World Health Organization (WHO) health systems framework that is organized around the six building blocks. The aim was to determine the current status of the six health system building blocks in Kenya’s county health departments. The article emanates from data collected for a technical report on county institutional capacity assessment. Data were analysed using Microsoft Excel spreadsheet and thematic analysis. The overall performance of the counties was 54% indicating average capacity. The performance scores were: leadership and governance (39%), human resources for health (44%), health information systems (66%), medical products and technologies (50%), health system financing (50%), and service delivery (71%). There was no statistically significant difference in the overall performance of the counties (p= 0.892). The key issues in some of the worst performing building blocks included poor work-planning and lack of transparency in budgeting and expenditure, low funding and irregular disbursements of health budgets, lack of key policies, e.g. workforce strategy and commodity supply chain. In conclusion, the study proved that the CICAT is useful for assessing the process of strengthening health systems in Kenyan counties.

Objectives: Coronavirus disease 2019 (COVID-19) threatens vulnerable patient populations, resulting in immense pressures at the local, regional, national, and international levels to contain the virus. Laboratory-based studies demonstrate that masks may offer benefit in reducing the spread of droplet-based illnesses, but few data are available to assess mask effects via executive order on a population basis. We assess the effects of a county-wide mask order on per-population mortality, intensive care unit (ICU) utilization, and ventilator utilization in Bexar County, Texas.Methods: We used publicly reported county-level data to perform a mixed-methods before-and-after analysis along with other sources of public data for analyses of covariance. We used a least-squares regression analysis to adjust for confounders. A Texas state-level mask order was issued on July 3, 2020, followed by a Bexar County-level order on July 15, 2020. We defined the control period as June 2 to July 2 and the postmask order period as July 8, 2020-August 12, 2020, with a 5-day gap to account for the median incubation period for cases; longer periods of 7 and 10 days were used for hospitalization and ICU admission/death, respectively. Data are reported on a per-100,000 population basis using respective US Census Bureau-reported populations.Results: From June 2, 2020 through August 12, 2020, there were 40,771 reported cases of COVID-19 within Bexar County, with 470 total deaths. The average number of new cases per day within the county was 565.4 (95% confidence interval [CI] 394.6-736.2). The average number of positive hospitalized patients was 754.1 (95% CI 657.2-851.0), in the ICU was 273.1 (95% CI 238.2-308.0), and on a ventilator was 170.5 (95% CI 146.4-194.6). The average deaths per day was 6.5 (95% CI 4.4-8.6). All of the measured outcomes were higher on average in the postmask period as were covariables included in the adjusted model. When adjusting for traffic activity, total statewide caseload, public health complaints, and mean temperature, the daily caseload, hospital bed occupancy, ICU bed occupancy, ventilator occupancy, and daily mortality remained higher in the postmask period.Conclusions: There was no reduction in per-population daily mortality, hospital bed, ICU bed, or ventilator occupancy of COVID-19-positive patients attributable to the implementation of a mask-wearing mandate. [ABSTRACT FROM AUTHOR]

Introduction: Geographic variations in access to care exist in the USA. We sought to characterize county-level disparities relative to access to surgery among patients with early-stage hepatopancreatic (HP) cancer. Methods: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Linked database from 2004 to 2015 to identify patients undergoing surgery for early-stage HP cancer. County-level information was acquired from the Area Health Resources Files (AHRF). Multivariable logistic regression analysis was performed to assess factors associated with utilization of HP surgery on the county level. Results: Among 13,639 patients who met inclusion criteria, 66.9% (n = 9125) were diagnosed with pancreatic cancer and 33.1% (n = 4514) of patients had liver cancer. Among patients diagnosed with early-stage liver and pancreas malignancy, two-thirds (n = 8878, 65%) underwent surgery. Marked county-level variation in the utilization of surgery was noted among patients with early-stage HP cancer ranging from 57.1% to more than 83.3% depending on which county a patient resided. After controlling for patient and tumor-related characteristics, counties with the highest quartile of patients living below the poverty level had 35% lower odds of receiving surgery for early stage HP cancer compared patients who lived in a county with the lowest proportion of patients below the poverty line (OR 0.65, 95% CI 0.55–0.77). In addition, patients residing in counties with the highest surgeon-to-population ratio (OR 2.01, 95% CI 1.52–2.65), as well as the highest hospital bed-to-population ratio (OR 1.29, 95% CI 1.07–1.54), were more likely to undergo surgical treatment for an early-stage HP malignancy. Conclusion: Area-level variations among patients undergoing surgery for early-stage HP cancer were mainly due to differences in structural measures and county-level factors. Policies targeting high-poverty counties and improvement in structural measures may reduce variations in utilization of surgery among patients diagnosed with early-stage HP cancer. [ABSTRACT FROM AUTHOR]

Copyright of Environmental Science & Technology (10036504) is the property of Editorial Board of Environmental Science & Technology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The economic recession that began in California in 2008 did not affect all counties equally. Using data from several years of the California Health Interview Survey, this policy brief examines the differences between 2007 and 2009 for the populations who were uninsured "for all or part of the prior year." During this time period, counties with high unemployment and lower household income saw the highest growth in the uninsured population, due to a large drop in job-based coverage and only a small increase in public coverage. Compared to the uninsured population in California in 2007, Californians who were uninsured for all or part of 2009 were older, more likely to be U.S.-born citizens, had lower household incomes, and were more likely to be unemployed and looking for work.

Grandparents over the age of 65 who are raising grandchildren are a small but extremely vulnerable population in California. These older adults usually become the primary caregivers of their grandchildren after an unexpected event. They are further faced with the financial challenge of having an additional dependent without additional income. This policy brief documents that the actual income needed to support a basic standard of living for older adults with grandchildren in California is about twice the Federal Poverty Level (FPL), depending on the county. Using 200% FPL as an approximate measure, about two-fifths of older grandparents who are responsible for their grandchildren in the state do not have enough income to make ends meet. The Elder Economic Security Standard™ Index (Elder Index) for California calculates that the costs of housing, food, and the older adults' health care account for more than two-thirds of total household expenses for grandparents and the grandchildren they are raising. Despite the high cost of basic needs, public assistance for low-income older adults and children continues to be squeezed. If they are to efficiently serve members of this fragile population, the existing programs that serve them need to maximize and streamline their impact through better coordination and collaboration.

Objective: To estimate the association between weather and COVID-19 fatality rates during US stay-at-home orders. Methods: With a county-level longitudinal design, this study analyzed COVID-19 deaths from public health departments' daily reports and considered exposure as the 18 to 22 day-period before death. Models included state-level social distancing measures, Census Bureau demographics, daily weather information, and daily air pollution. The primary measures included minimum and maximum daily temperature, precipitation, ozone concentration, PM2.5 concentrations, and U.V. light index. Results: A 1 °F increase in the minimum temperature was associated with 1.9% (95% CI, 0.2% to 3.6%) increase in deaths 20days later. An ozone concentration increase of 1 ppb (part per billion) decreased daily deaths by 2.0% (95% CI, 0.1% to 3.6%); ozone levels below 38 ppb negatively correlated with deaths. Conclusions: Increased mobility may drive the observed association of minimum daily temperature on COVID-19 deaths. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Sino-Western Studies is the property of Sanovan Press, Nordic Forum of Sino-Western Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The village has always been the cradle of the Ukrainian people. The spiritual world of our ancestors was formed in it, on the inseparable unity of man and the environment. The language, rites, and customs of the lands were subject to a certain worldview, traditions that reached the depths of millennia. In the nineteenth century about 92% of the population lived in the villages of the Volyn province. [ABSTRACT FROM AUTHOR]

Introduction: health financing aims to ensure that the overall goal of the health system is attained. Countries with decentralised healthcare systems such as Kenya, face further challenges due to limited public financial management capacity within sub-national governments. While partner support has proved impactful in addressing these challenges, there is a paucity of evidence on the nature and distribution of the support in Kenya. This study sought to examine the current technical support and health financing support offered by partners across the 47 counties in Kenya., Methods: the study used a descriptive cross-sectional design with a mixed methods approach. Quantitative data were collected from organisation representatives using semi-structured questionnaires and analysed using Microsoft Excel. Qualitative data were collected through key informants and in-depth interviews involving county Department of Health officials in 15 counties in Kenya. Interview recordings were transcribed and thematically analysed using NVIVO version 14., Results: twenty (20) organisations reportedly provided health financing support to counties with planning, budgeting and health financing advocacy being the most supported work streams by partners. While each county had more than one partner supporting health financing activities, the western counties had more partners compared to other regions of Kenya. Whereas partner support was well acknowledged at the county level, there was a lack of coordination and alignment of partner activities with county priorities., Conclusion: these findings highlight the essential need for national governments to ensure effective coordination of the technical assistance provided by partners to subnational levels and to ensure equitable distribution of support and alignment with county health priorities and needs., Competing Interests: The authors declare no competing interests., (Copyright: Alex Olateju Adjagba et al.)

ObjectiveAlthough clinical training programs aspire to develop competency in violence risk assessment, little research has examined whether level of training is associated with the accuracy of clinicians' evaluations of violence potential. This is the first study to compare the accuracy of risk assessments by experienced psychiatrists with those performed by psychiatric residents. It also examined the potential of a structured decision support tool to improve residents' risk assessments.MethodsThe study used a retrospective case-control design. Medical records were reviewed for 151 patients who assaulted staff at a county hospital and 150 comparison patients. At admission, violence risk assessments had been completed by psychiatric residents (N=38) for 52 patients and by attending psychiatrists (N=41) for 249 patients. Trained research clinicians, who were blind to whether patients later became violent, coded information available at hospital admission by using a structured risk assessment tool-the Historical, Clinical, Risk Management-20 clinical subscale (HCR-20-C).ResultsReceiver operating characteristic analyses showed that clinical estimates of violence risk by attending psychiatrists had significantly higher predictive validity than those of psychiatric residents. Risk assessments by attending psychiatrists were moderately accurate (area under the curve [AUC]=.70), whereas assessments by residents were no better than chance (AUC=.52). Incremental validity analyses showed that addition of information from the HCR-20-C had the potential to improve the accuracy of risk assessments by residents to a level (AUC=.67) close to that of attending psychiatrists.ConclusionsHaving less training and experience was associated with inaccurate violence risk assessment. Structured methods hold promise for improving training in risk assessment for violence.

In California, more than one-third (38%) of fifth-, seventh-, and ninth-grade public school students were overweight or obese in 2010. This number represents a 1.1 percent decrease in the statewide prevalence of overweight and obesity from 2005, suggesting that the 30-year trend of increasing childhood obesity rates may be leveling off. However, overweight and obesity continue to be of major concern in the state, with more than half of California counties experiencing increases in rates of overweight and obesity among youth between 2005 and 2010. Public policy options that promote healthy eating and physical activity will continue to be critical to reducing overweight and obesity among California’s youth.

This paper traces the history of local government in England (as opposed to the United Kingdom) since the early nineteenth century, and explores five long-term trends in its evolution. These are path dependence; the occurrence of major structural change; the phenomenon of policy reversal; the treatment of urban areas; and resistance to regional government. The author concludes that throughout the period under study, policy towards local government has exhibited a ‘pendulum effect’, with two opposing emphases operating in a sequential, rather than a simultaneous manner.

INTRODUCTION: Major external structural birth defects are typical and have been attributed to childhood morbidity, mortality and lifelong resource-intensive disabilities. These defects continue to occur; however, they are yet to be recognized as public health problems in Kenya. The objective of this study was to estimate the prevalence of major external structural birth defects in Kiambu County in Kenya, 2014-2018. METHODS: a cross-sectional study design was adopted; a retrospective review of medical records was conducted between 2014 and 2018 abstracting 873 birth defects. Following a predetermined inclusion criterion, a five-year prevalence numerator of 362 cases was determined, whereas, a five-year prevalence denominator of 299,854 cases of registered live-births was obtained from the birth registrar. Annual prevalence estimates of 29 sub-groups and 6 groups of these defects were calculated as the number of cases (numerator) divided by the number of live-births (denominator). Associated 95% binomial exact 95% confidence intervals were also computed and expressed per 100,000 live-births. RESULTS: defects of the musculoskeletal system, the central nervous system, orofacial, genital organs, eye and anus were observed. Defects of the musculoskeletal system were the most prevalent, ranging from 22.98 (95% CI: 11.87-40.13) to 116.9 (95% CI: 92.98-145.08) per 100,000 live-births. Defects of the central nervous system followed ranging between 13.40 (95% CI: 5.39-27.61) and 32.79 (95% CI: 20.79-49.19) per 100,000 live-births. CONCLUSIONS: despite musculoskeletal system defects being the most common group, hypospadias; a defect of the male genital organ was the most prevalent among the sub-group of these defects.

ObjectivesWe applied social network analyses to determine how hospitals within Orange County, California, are interconnected by patient sharing, a system which may have numerous public health implications.MethodsOur analyses considered 2 general patient-sharing networks: uninterrupted patient sharing (UPS; i.e., direct interhospital transfers) and total patient sharing (TPS; i.e., all interhospital patient sharing, including patients with intervening nonhospital stays). We considered these networks at 3 thresholds of patient sharing: at least 1, at least 10, and at least 100 patients shared.ResultsGeographically proximate hospitals were somewhat more likely to share patients, but many hospitals shared patients with distant hospitals. Number of patient admissions and percentage of cancer patients were associated with greater connectivity across the system. The TPS network revealed numerous connections not seen in the UPS network, meaning that direct transfers only accounted for a fraction of total patient sharing.ConclusionsOur analysis demonstrated that Orange County's 32 hospitals were highly and heterogeneously interconnected by patient sharing. Different hospital populations had different levels of influence over the patient-sharing network.

ABSTRACT Large game management units often lead to criticisms from hunters because they assume smaller units possess less variation in wildlife populations and more closely represent their local area. In 2003, Pennsylvania, USA, replaced smaller, socio‐political county‐based management units with larger wildlife management units (WMUs). We tested the hypothesis that smaller county units possessed less variation in antlered and antlerless white‐tailed deer (Odocoileus virginianus) harvest densities among municipalities than did larger WMUs. Spatial variation, as measured by standard deviation and coefficient of variation of deer harvested per km2 was similar for antlered deer (county units 0.44 SD, CV = 0.35; WMUs 0.43 SD, CV = 0.38) and antlerless deer (county units 0.71 SD, CV = 0.44; WMUs 0.84 SD, CV = 0.45). We found no support for the assumption that larger management units resulted in greater spatial variation in deer harvest density. © 2019 The Wildlife Society.

INTRODUCTION: In 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures. METHODS: we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged 2 years with acute watery diarrhea (4 stools/â12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli. RESULTS: during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one had Escherichia coli. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7). CONCLUSION: we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak.

The study presented in this paper represents a comparative and dynamic analysis of the activity recorded in four fields of activity (according to the CAEN classification): "Wholesale and retail trade; repair of motor vehicles and motorcycles", "Transport and storage", "Hotels and restaurants", "Professional, scientific and technical activities", using two economic and financial indicators: "value added" and "average number of employees". A large database was consulted for the study, consisting of the information recorded in the financial and accounting balance sheets of the companies operating in Constanta County for the years 2016 and 2017. The analysis started from a microeconomic approach, and the results provided support for meso-economic assessments. The study includes assessments of the importance of each analyzed field of activity, as well as the impact of the four fields as a whole on the economy of Constanta County in terms of their contribution to the creation of value added.

This paper presents a quantitative research of a database based on two economic and financial indicators: the "value added" and the "average number of employees" registered and reported during 2016 and 2017 by the companies operating in Constanta County, which belong to four fields of activity, corresponding to the Classification of Activities in the National Economy (CAEN): "Agriculture, forestry and fishing", " Extractive industries", "Manufacturing industry " and "Construction". The results obtained by processing the database have created the framework for a comparative and dynamic analysis regarding the particularities and the contribution of each selected field of activity to the economy of Constanta County, over the analyzed period. The specificity of this study is that it started from a microeconomic approach, and the mesoeconomic level has been reached after processing the database. Interpretation of the results can be used to inform and determine decisions at all economic levels.

The rural revitalization strategy is a key strategic deployment to resolve the “San Nong” (Agriculture, Rural Areas, and Farmers) issue and attain agricultural and rural modernization in the new era. The strategy has practical significance in determining the differentiation principle of rural areas, identifying their development types, and elucidating the goal orientation of rural revitalization. Starting from the current situation of villages in Gangu County, this study thoroughly analyzes and evaluates the functions of the village system using the ArcGIS spatial analysis method, with urban–rural overall planning as the core concept and various function and correcting factor evaluations as the basis. Based on the functional characteristics of different dimensions, villages in Gangu County were categorized as follows: Weihe River Valley high-efficiency economic zone, Sandu River Taiwan grain and vegetable multi-characteristic economic zone, North Front Mountain grain, vegetable, medicine, and oil zone, South Front Mountain grain, vegetable, and oil zone, North Back Mountain grain, oil, and medicine zone, and South Back Mountain grain and economic zone as corresponding planning strategies for classified development guidance.

This fact sheet presents county-by-county estimates of the number of California residents who have lost health insurance during the economic downturn. The authors find that the number of Californians without health insurance grew in all counties and that 37 counties — from Imperial to Kern to Shasta — had uninsured rates above the statewide average of 24.3%.Loss of health insurance was concentrated in Southern California (Imperial, Riverside, San Bernardino counties), the San Joaquin Valley (all counties), and the Northern/ Sierra areas (all but Sutter and Humbolt), all of which had 2009 uninsured rates that were above the statewide average (24%).The losses were due to sharp increases in local unemployment and corresponding drops in both household income and job-based coverage.

Aim: Ecological niche models (ENMs) typically require point locations of species' occurrence as input data. Where exact locations are not available, geographical centroids of the respective administrational spatial units (ASUs) are often used as a substitute. We investigated how the use of ASU centroids in ENMs affects model performance, what role the size of ASUs plays, and what effects different grain sizes of explanatory variables have. Location: Europe. Major taxa studied: Virtual species. Methods: We set up a two‐factorial study design with artificial ASUs of three different sizes and environmental data of four commonly used grain sizes, repeated over three study regions. To control other factors that may affect ENM performance, we created a virtual species with a known response to environmental variables, precise and even sampling and a known spatial distribution. We ran a series of Maxent models for the virtual species based on centroids and precise occurrence locations under varying ASU and grain sizes. Results: The use of ASU centroids introduces a value frequency mismatch of the explanatory variables between centroids and true occurrence locations, and it has a negative effect on ENM performance. Value frequency mismatch, negative effect on ENM performance and over‐prediction of the species' range all increase with ASU size. The effect of grain size of environmental data, on the contrary, was small in comparison. Main conclusions: ENMs built upon ASU centroids can suffer considerably from the introduced error. For ASUs that are sufficiently small or show low spatial heterogeneity of explanatory variables, ASU centroids can still be a viable and convenient surrogate for precise occurrence locations. When possible, however, central tendency values (median, mean) that represent the whole ASU rather than just a single point location need to be considered. [ABSTRACT FROM AUTHOR]

Unbalanced economic growth is a ubiquitous phenomenon while investigating the regional development at a large spatial scale. Therefore, it is of great significance to analyze the spatio-temporal pattern of regional economic growth and the drivers to understand and facilitate the economic development of low development areas. Taking a county as a fundamental study unit, we used the county-level per capita GDP data on the Loess Plateau from 2005 to 2017, and geographic variables such as slope, elevation, and population density to analyze the spatio-temporal differences and the driving factors of the county-level economic development in the Loess Plateau by employing both conventional and advanced quantitative methods including Exploratory Spatial Data Analysis (ESDA) and the geographic detector model. Our results suggested that: (1) The selected indicators, including absolute difference, the fluctuation of relative difference and total difference of economic development on the Loess Plateau, all show steady increasing trends, respectively. (2) There are 64.5% of the counties with economic development being below the average level of the whole Loss Plateau region. The relatively high developed counties are distributed in the "A"-shaped regions in Inner Mongolia Autonomous Region, Shaanxi, and Henan provinces, however, the low development counties are mainly located in the "V"-shaped regions in Gansu and Shanxi provinces. (3) GDP, investment in fixed assets and urbanization rate are the major driving factors influencing the regional economic development, and the combined effects are far greater than that of any individual factor. [ABSTRACT FROM AUTHOR]

To investigate how racial/ethnic density and residential segregation shape the uneven burden of COVID-19 in US counties and whether (if yes, how) residential segregation moderates the association between racial/ethnic density and infections. We first merge various risk factors from federal agencies (e.g. Census Bureau and Centers for Disease Control and Prevention) with COVID-19 cases as of June 13th in contiguous US counties (N = 3,042). We then apply negative binomial regression to the county-level dataset to test three interrelated research hypotheses and the moderating role of residential segregation is presented with a figure. Several key results are obtained. (1) Counties with high racial/ethnic density of minority groups experience more confirmed cases than those with low levels of density. (2) High levels of residential segregation between whites and non-whites increase the number of COVID-19 infections in a county, net of other risk factors. (3) The relationship between racial/ethnic density and COVID-19 infections is enhanced with the increase in residential segregation between whites and non-whites in a county. The pre-existing social structure like residential segregation may facilitate the spread of COVID-19 and aggravate racial/ethnic health disparities in infections. Minorities are disproportionately affected by the novel coronavirus and focusing on pre-existing social structures and discrimination in housing market may narrow the uneven burden across racial/ethnic groups. [ABSTRACT FROM AUTHOR]

The Huedin region is a geographical area that transmits to future generations cultural and historical values based on the interethnic coexistence of the inhabitants of this area. The ethnographical and spiritual heritage is an argument to support the identity of the inhabitants of a country. The element that connected the multiethnic communities in the depression and mountain-hilly units from the region is the city of Huedin, which has evidence of millennial existence and preserves the values of local identity through traditions and traditional crafts. Conscious of this fact, we will try there to bring into attention its heritage and to speak about its relevance for the contemporary space, using different sources and emphasizing both the touristic, geographic, historical or cultural landmarks of the area. [ABSTRACT FROM AUTHOR]

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The objective of the study is to determine the leading trends in changing administrative boundaries in Poland. Based on 194 Regulations of the Council of Ministers concerning the changes of boundaries and granting city status, which covered a total of 1,383.8 sq. km, multidimensional analyses for the years 2010-2020 were conducted, and their results were referred to territorial reforms in Europe and Poland. The analyses provided the basis for selecting the leading trends, including: (1) the 'new wave' of the restitution of city status (from 2018 in the new fast-track mode), resulting in quantitative changes within 3rd-tier units, (2) a significant increase in the area of cities and city counties primarily caused by annexations in suburban zones and establishing new cities, and (3) the politicisation of the process of changing boundaries, especially in the years preceding local government elections. The trend of unit fragmentation observed in the 1990s has disappeared. The initiators of the changes of administrative boundaries are still predominantly local elites and rarely the inhabitants of communes. [ABSTRACT FROM AUTHOR]