2023 Western Medical Research Conference

The proceedings contain 549 papers. The topics discussed include: interleukin-2 kinase-mediated T-cell receptor signaling is critical in the development of type 1 diabetes by OT-1 T-cells;the effect of the COVID-19 pandemic on anxiety and depression in adolescents in the military population;dollars sense: a school-based effort to increase financial literacy in high school students;fostering the next generation of healthcare leaders in a pandemic world;walkability of San Bernardino county?s elementary schools in relation to various school characteristics;placebo-controlled trial in tanner 2-3 males with Klinefelter syndrome: effect of testosterone gel versus placebo in motor skills outcomes;my implant is expiring: a national secret shopper study of extended use of the contraceptive implant;comparing the effects of aerobic exercise and yoga on stress levels in college students;and are patients with a history of chest radiation therapy at higher risk for sternal wound problems after heart transplant?.

Role of the neighborhood environment in psychological resilience

Psychological resilience of residents is an important but often neglected component of community and urban resilience. This study explores what neighborhood environment features contribute to better psychological resilience. Using a survey conducted in Greater Melbourne during a COVID-19 pandemic lockdown, we examined the role of the neighborhood physical and social environments in mitigating the psychological shock of the pandemic. Overall, we found that suburban residents are more resilient in mental health than those in the inner city. In particular, the mental health of residents living in middle-density suburbs is least likely to be severely impacted. We further found that neighborhood walkability, vegetation cover, and social cohesion all contribute to better psychological resilience. Walkability and social cohesion influence psychological resilience indirectly through affecting the perceived risks of COVID-19 infection and satisfaction with neighborhood during the lockdown, whereas neighborhood greenery has a direct and beneficial effect on psychological resilience. These findings imply that planning interventions to improve neighborhood walkability and greenness, and foster social cohesion may help improve the psychological resilience of local residents, and hence promote urban resilience. These findings also support middle-density development, which promotes walkability and proximity to nature, as well as a close-knit community. © 2023 Elsevier B.V.

The association between core job components, physical activity, and mental health in African academics in a post-COVID-19 context.

This study examined the association between core job components (i.e. teaching, research, and student assessment), physical activity (PA), and mental health in a post-COVID-19 context. An online questionnaire administered via Google Forms was used to gather data from 1064 African academics in four countries. A sensitivity analysis was applied to adjust for covariates. Data were analyzed with the hierarchical linear regression analysis. The average age of participants was 44 years. The study found that PA was positively associated with research but negatively associated with student assessment. Mental health was positively associated with onsite teaching but negatively associated with online teaching and research. PA did not predict mental health and mediate the relationship between the job components and mental health. It is concluded that PA may not increase mental health in African academics in a post-COVID-19 situation that required the resumption of work while observing social distancing protocols.

Impacts of commute mode on body mass index: A longitudinal analysis before and during the COVID-19 pandemic.

Introduction: COVID-19 has impacted millions of commuters by decreasing their mobility and transport patterns. While these changes in travel have been studied, less is known about how commute changes may have impacted individuals' body mass index (BMI). The present longitudinal study explores the relationship between commute mode and BMI of employed individuals in Montréal, Canada. Methods: This study uses panel data drawn from two waves of the Montréal Mobility Survey (MMS) conducted before and during the COVID-19 pandemic (n = 458). BMI was modeled separately for women and men as a function of commuting mode, WalkScore©, sociodemographic, and behavioral covariates using a multilevel regression modeling approach. Results: For women, BMI significantly increased during the COVID-19 pandemic, but telecommuting frequency, and more specifically telecommuting as a replacement of driving, led to a statistically significant decrease in BMI. For men, higher levels of residential local accessibility decreased BMI, while telecommuting did not have a statistically significant effect on BMI. Conclusions: This study's findings confirm previously observed gendered differences in the relations between the built environment, transport behaviors, and BMI, while offering new insights regarding the impacts of the changes in commute patterns linked to the COVID-19 pandemic. Since some of the COVID-19 impacts on commute are expected to be lasting, findings from this research can be of use by health and transport practitioners as they work towards generating policies that improve population health.

Road Modes: Walking

As walking is a zero-emission mode of transport with well-documented health, environmental, economic, and social benefits, researchers and policy-makers in the domains of urban transport planning, public health, engineering, and other fields have been exploring how to increase both utilitarian and leisure walking. Efforts to identify built environment characteristics associated with these desired behaviors have therefore also flourished in recent years and the provision of walkable urban space has become a common policy goal in cities around the world. However, there are many social, cultural, political barriers that slow down a shift back to pedestrian-focused development patterns. This entry will introduce background on walking as a travel mode and discuss its many social, environmental, and economic benefits. How cities can plan for more livable and walkable areas as well as both the possible roadblocks and opportunities associated with these changes will be discussed. Measurement issues, such as the concept of "walkability” will be explored as well as emerging issues such as what walkable space might mean in an era of increasing online shopping and how pedestrians may need to share street space with autonomous vehicles. While the majority of impacts of increased walkability are positive, possible gentrification, displacement, and exclusion impacts have also been documented with improved walkable urbanism. New global health threats (such as COVID-19 and, e.g., urban heat islands exacerbated by climate change) have also shone a light on discrepancies across race, income, and other socio-economic factors on the availability of safe places to walk and access urban amenities and green space. © 2021 Elsevier Ltd. All rights reserved

Increasing physical activity and active transportation in an arid city: Slow Streets and the COVID-19 pandemic

Slow Streets promote walkability and provide safe spaces for active travel and recreation by minimizing vehicle traffic on roads. Their effectiveness was tested when the City of Tucson implemented Slow Streets by temporarily closing certain neighbourhood streets to all but local traffic, giving people more space to safely walk, run, and bicycle. Using a quasi-experimental research design, it was possible to measure differences in walking and bicycling between Slow Streets and control streets. Results show Slow Streets are effective in increasing the number of people walking and bicycling on neighbourhood streets, especially while the temporary traffic barriers were in place.

Assessing Micro-Mobility Services in Pandemics for Studying the 10-Minutes Cities Concept in India Using Geospatial Data Analysis: an Application

Active micro-mobility decreases traffic, bolsters personal health, and helps communities thrive by protecting the environment Moreover, sustainable micro-mobility demand is expected to get boosted in the present and post-COVID society. In this work we highlight the micro-mobility modes of walkability and bicycling to city administrators controlling urban city-space, by adapting the mobility parameters and their use cases through a map-based interface. Software tools and web-based applications are introduced for easy policy decisions by city managers. Present study scope is circumscribed by exploration of different parameters in traditional and state of art data science models, for resource planning like cycle usage prediction and planning. These parameters show hazard safe-distance pedestrian flow, optimal resource planning, amenity reach (10 min cycling and walking distance) and mobility using walking and cycling modes. Parameters of the traditional Social Force Model for Pedestrian Dynamics are also inspected, according to COVID social norms, to capture safe pedestrian flow density. Finally, the analysis of two case studies, of Bhubaneshwar city and New Delhi, in India, are discussed for policy suggestions to enhance mobility via sustainable micro-mobility modes. The developed system assists managers in decisions based on urban data intelligence, and at user end eases commute related mental tension, anxiety and dependencies. The developed application is running live on our server maintained at Edinburgh University. © 2022 ACM.

Increasing physical activity and active transportation in an arid city: Slow Streets and the COVID-19 pandemic

Slow Streets promote walkability and provide safe spaces for active travel and recreation by minimizing vehicle traffic on roads. Their effectiveness was tested when the City of Tucson implemented Slow Streets by temporarily closing certain neighbourhood streets to all but local traffic, giving people more space to safely walk, run, and bicycle. Using a quasi-experimental research design, it was possible to measure differences in walking and bicycling between Slow Streets and control streets. Results show Slow Streets are effective in increasing the number of people walking and bicycling on neighbourhood streets, especially while the temporary traffic barriers were in place. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Rural Tourism and Walkability. Compare Sardinia and Gran Canaria Models

The tourism crisis following the Covid-19 pandemic has caused many communities to rethink and review tourism. In fact, in European countries, many destinations are now focused on more inclusive and sustainable measures rather than over tourism, so they have invested in sustainability to create tourist-friendly places. The rural areas, in particular, are affected by a demand motivated by a longing for discovery and authenticity, and they seem to be working towards a multi-scalar planning: walkability and digitalization stand out as fundamental choices to meet the needs of tourists and residents. In this context, the paper aims, after a preliminary review of the literature on rural areas’ walkability, to highlight the relationship between rural walkability and tourism through the analysis and comparison of two rural paths: the Mining Path of Santa Barbara (Sardinia, Italy) and the Path of Saint James (Gran Canaria, Spain). It represents virtuous examples of fruition and enhancement of the insular landscape, promoting a place-based approach for a sustainable and cohesive local development. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

15-MINUTE CITY CONCEPT AS A SUSTAINABLE URBAN DEVELOPMENT ALTERNATIVE: A BRIEF OUTLINE OF CONCEPTUAL FRAMEWORKS AND SLOVAK CITIES AS A CASE

In this review article, we intend to initiate a discussion on the possibilities of implementing the 15-minute city concept (FMC) in Slovak cities. Our research motivation is the relatively high potential of the idea to contribute to solving current problems of sustainable urban development to strengthen cities' resilience. It is not only about coping with the impacts of the COVID 19 pandemic but also about the need for synergy of mitigation and adaptation measures in the context of climate change and the transition to a low- to the zero-carbon development paradigm. Last but not least, it can be pointed out that the 15-minute city model will also contribute to reducing inequalities between different parts of cities, which is one of the consequences of poorly regulated suburbanization processes. The paper is structured in several parts. In the introductory section, we look for common features of the concept and its theoretical framework within various traditions and paradigms of geographical thought. We then analyse its basic functions and dimensions that are considered when planning this concept in the current conditions of urban life. We also address specific applications in world metropolises while pointing out that the concept is not rigid and can still be adapted to local natural, historical, socio-economic conditions and intraurban structures. In the last section, we present the first examples of implementing the 15-minute city ideas in Slovak cities.

Healthcare disparity among elderly patients with cirrhosis during the COVID pandemic

Background and Aim: We aimed to study the healthcare disparity among elderly patients with cirrhosis and its impact on composite outcomes during the COVID pandemic. Methods: We conducted a prospective observational study between July 21- May 2022 via telephonic interview or physical consultations at 2 large tertiary care centers in India. The data was captured using pre-validated questionnaires to assess healthcare disparity amongst elderly patients with cirrhosis. Results: Of 475 elderly (≥65years) patients with cirrhosis (based on imaging) were included with mean age of 72.1years, male:female(3.8:1) with aetiology of cirrhosis being NAFL/NASH (58%), alcohol(32%) in majority. 323 (69%) had access to internet, however amongst them only 247 (52%) were conversant with use of WhatsApp, the preferred platform for tele-consultations in most hospitals in India. 147(31%) had walkability and accessibility to hospitals and 223(47%) had access to a family physician or community nurse, 271 (67%) had laboratory access. 295(62%) had taken both Covid vaccines, 349(74%) had first dose alone and only 38(8%) had booster dose. 213 (45%) felt that they needed admission/ expert opinion at least once during the period with 137 (29%) needed inpatient treatment. 266 (56%) missed at least 15 days doses of drugs with 85(32%) citing unavailability and 48(18%) unaffordability. Cancellation/rescheduling of medical services was widely prevalent with 74(15.5%) needing to reschedule endoscopy, 132 (28%) had cancellation of imaging of any form at least once, loco-regional therapy was rescheduled in 14(18%) patients of HCC. Advanced age, presence of >1 co-morbidity, tense ascites, hepatic encephalopathy, lack of caregivers were signi cantly associated with poor quality of life, restricted access and utilization of healthcare Conclusions: Elderly patients with cirrhosis had significant barriers in seeking healthcare during Covid19 pandemic highlighting the disparity and need for concerted e orts to improve their access to care.

A sustainable approach for planning of urban pedestrian routes and footpaths in a pandemic scenario

The coronavirus disease (COVID-19) pandemic has forced national and local governments to re-consider the relationship between mobility, urban space and health in order to ensure physical distancing while meeting the travel needs of inhabitants. In the first stage, corresponding to the expansion of infection, mobility was limited to essential workers and freight. In the second stage, with the easing of restrictions, limitations still remained for public transport. Limitations associated with perceived risk of infection significantly influenced travel behaviors, pushing a modal repositioning in demand to active mobility (walking, cycling, and use of micro-mobility). On the other hand, the World Health Organization (WHO) guidelines on mobility during the COVID outbreak are mostly directed at dedicating more urban space to cyclists and pedestrians, especially in densely populated urban areas, thus avoiding crowding on public transport and the use of private cars. In the same direction, the National Association of City Transportation Officials (NACTO, 2020) went during periods of stabilization and long-term recovery. It suggests policies and measures for the cities mobility to help people maintain physical distance while moving around the city. In the given conditions, walking becomes predominant for a sustainable mobility scenario, and structural measures (widening of the pathway) or regulatory measures (regulation of pedestrian flows) can be adopted withing the given strategy. Current pedestrian infrastructural offer is severely limited in functional terms by the urban planning and development, therefore measures oriented to enhance non-motorized mobility require the development and planning of new public spaces and infrastructures for pedestrian mobility within the urban layout. Policy makers and town planners need to rethink urban spaces and mobility in the pedestrian perspective. A methodology for classification of pathways, by capacity and level of service, is presented in the paper, on which to base strategies, policies and specific measures to verify pedestrian mobility demand.

Age-Friendly Built Environment

DefinitionAge-friendly built environments have been promoted by the World Health Organisation (WHO, Geneva, Switzerland) under the Global Age-friendly Cities (AFC) movement in which three domains are related to the built environment. These are: housing, transportation, outdoor spaces and public buildings. The aim is to foster active ageing by optimising opportunities for older adults to maximise their independent living ability and participate in their communities to enhance their quality of life and wellbeing. An age-friendly built environment is inclusive, accessible, respects individual needs and addresses the wide range of capacities across the course of life. Age-friendly housing promotes ageing in familiar surroundings and maintains social connections at the neighbourhood and community levels. Both age-friendly housing and buildings provide barrier-free provisions to minimise the needs for subsequent adaptations. Age-friendly public and outdoor spaces encourage older adults to spend time outside and engage with others against isolation and loneliness. Age-friendly public transport enables older adults to get around and enhances their mobility. For achieving an age-friendly living environment, a holistic approach is required to enable independent living, inclusion and active participation of older adults in society. The eight domains of the AFC movement are not mutually exclusive but overlap and support with one another.

The changing context of walking behavior: coping with the COVID- 19 Pandemic in urban neighborhoods

Purpose - It is observed that the COVID-19 Pandemic mostly restricts people's movement and walking habits. In this direction, this study aims to highlight how the walking behaviors of individuals affected in different geographies' neighborhoods before and during the Pandemic. Design/methodology/approach - This paper focuses on the relationship between neighborhood characteristics and the changing walking behavior of 24 sample regions (514 participants) with the highest incidents of COVID-19 infection from American, European, Asian, Western Pacific, African and Middle Eastern cities. The paper's methodology is supported by an /online questionnaire survey conducted in these 24 disparate neighborhoods in December 2020. Findings - Findings show that "walkable access" varies over geographies during the Pandemic. Urban amenities within 15-20 min of access become more important than ever. The results unravel that either walkable or non-walkable neighborhoods showcased similarities despite that urban amenities were not within 15-20 min of access. Three prominent aspects should be emphasized to plan walkable neighborhoods: providing walkable access, forming spatial proximity and sustaining social cohesion. Social implications - The availability of daily amenities, such as shopping stores, health care, education services and pharmacies within a 15-20-min walking distance maintain everyday life and increase social interactions. In addition, places with walkable access encourage an active lifestyle and contribute the public health. The impact of the COVID-19 Pandemic movement restrictions on the walking behavior of individuals highlights how the qualities of distance-based urban planning need to be supported with time-based practical attributes that can shape neighborhood planning frameworks. Originality/value - This paper highlights the coexistence of "walkability" and "accessibility" measures in urban practice and research to create resilient and sustainable neighborhoods. The "walkable access" term used in the paper addresses joint measures of walkability and accessibility.

The 15-minute city as a hybrid model for Milan

With a special focus on Milan, we explore the interpretation of the 15-minute city as a hybrid model, where soft mobility is integrated in a holistic urbanism approach. Contemporary urban challenges, synthetized in the 15-minute city model, look for a sustainable "proximity mix": mix of uses (overcoming rigid zoning and building codes), mix of inhabitants and users, mix of time schedules and multi-purpose open space. The proposed hybrid approach considers the living-working urban experience as a whole: it proposes to consider, as a starting point for measuring the timeframe of 15 minutes, not only homes but workplaces as well. It welcomes innovative working facilities among those to be considered as essential services reachable within the 15-minute walking timeframe and it integrates open spaces within urban infrastructures by mixing the neighborhood "eco-system" -both of environment and mobility- and designing them around the central role of walking.

15-minute neighbourhood accessibility: a comparison between Naples and London

The 15-minute city seems to represent a new way of looking at the city and responding to many current challenges, including climate change, aging population, and most recently Covid-19. However, if the 15-minute city idea is useful to guarantee an adequate supply of basic services, its basic principles cannot be adaptable to what we consider a city, especially to the big city. To this end, the paper considers the 15-minute city idea as an approach to be applied to the neighbourhood scale, in which the suitable supply of basic services and pedestrian paths and spaces allows to increase accessibility to places and the quality of life of the inhabitants. In this perspective, the work provides a methodology, based mainly on spatial analysis, aimed at defining 15-minute neighbourhoods by adopting a systemic approach. The methodology is tested on some suburbs located in the cities of Naples and London, whose different morphological, settlement and functional characteristics make them a significant experimentation test.

Urban regeneration effects on walkability scenarios An application of space-time assessment for the people-and-climate oriented perspective

International programs have shown that implementing people-and-climate oriented cities goes through two processes in physical contexts: (i) urban regeneration of the existing city, particularly on public services for each urban unit, and (ii) planning of their accessibility. Therefore, there is a strong relationship between the goals of people-and-climate oriented and temporal-and-proximity perspectives. Moreover, the Covid-19 pandemic emergency highlighted the relevance of proximity again through the (not new) concept of "15 minutes cities". Nevertheless, an evaluation of how urban regeneration projects can contribute to achieving sustainability goals in ordinary practice still struggles to consolidate. Consequently, according to both perspectives, this contribution aims to observe and evaluate the effects of local urban regeneration projects on pedestrian mobility. Therefore, it presents a space-time and GIS-based methodology to assess the walkability scenarios in public open spaces. The analysis consists of double temporal analysis: (i) it analyses pedestrian accessibility in a cells grid and through a backtracking algorithm that measures the spatialized isochronous of access time, and (ii) it evaluates accessibility in two temporal moments, ex-ante and ex post. The assessment framework proposed is applied to the case study of unit Tintoretto tower in Brescia. Results show how urban design produces different space-time effects on pedestrian accessibility and proximity connection within 15 minutes.

Walkability Compass—A Space Syntax Solution for Comparative Studies

The ongoing discourse on air quality and climate changes positions walkability as a pivotal point of sustainable urban planning. Urban studies examine a city’s walkability in terms of pedestrian flows, design qualities, and street network topology, leaving walkability comparative frameworks under development. Building on the space syntax theory, this research introduces a “walkability compass”, a four spatial indicator-designed tool for city walkability assessment and comparison. The tools are being tested on eight Baltic region cities: Vilnius, Kaunas (LT), Malmö (SE), Riga (LV), Tallinn (ES), Gdansk, Bialystok, Lublin (PL). The nine-step method framework integrates four indexes: Gravity (Gr), Reach (Re), Straightness (St), and Population density (Pop). The “walkability compass” results reveal significant Re and St correlations;thus, visual and cultural aspects become the main factors in pedestrian-friendly cities. The spatial pattern typology has matched similar cities (Malmö and Kaunas) to work closely on sustainable urban planning development. In all case studies, specific walkability zones were mapped, but the Gr zones turned out to be the most compact ones (the Z-score of Gr was ranged from 355.4 to 584;other indexes oscillated between 209.4 and 542.6). The walkability mapping results are publicly shared via WebMap to stimulate the participatory discussion on case studies cities further development.

Stress and Distress during the COVID-19 Pandemic: The Role of Neighborhood Context.

Neighborhoods play a central role in health and mental health, particularly during disasters and crises such as the COVID-19 pandemic. We examined changes in psychological distress following the pandemic, and the potential role of neighborhood conditions among 244 residents of New Orleans, Louisiana. Using modified linear regression models, we assessed associations between neighborhood characteristics and change in psychological distress from before to during the pandemic, testing effect modification by sex and social support. While higher density of offsite alcohol outlets (ß = 0.89; 95% CI: 0.52, 1.23), assault rate (ß = 0.14; 95% CI: 0.03, 0.24), and walkable streets (ß = 0.05; 95% CI: 0.02, 0.07) in neighborhoods were associated with an increase in distress, access to neighborhood parks (ß = -0.03; 95% CI: -0.05, -0.01), collective efficacy (ß = -0.23; 95% CI: -0.35, -0.09), and homicide rate (ß = -1.2; 95% CI: -1.8, -0.6) were associated with reduced distress related to the pandemic. These relationships were modified by sex and social support. Findings revealed the important but complicated relationship between psychological distress and neighborhood characteristics. While a deeper understanding of the neighborhoods' role in distress is needed, interventions that target neighborhood environments to ameliorate or prevent the residents' distress may be important not only during crisis situations.

The 15-minute city: interpreting the model to bring out urban resiliencies

In a globally connected world and increasingly smart cities, the demand for living in a physical neighborhood where one can walk and cycle among familiar people and a variety of services is always alive. It is a quality of life which meets the deep desire of community and place identity. In this regard, the 15-minutes city is the contemporary version of the classical “human measure”. The model offers a refreshing chrono-centric vision for the city that prioritizes people’s time, energy and physio-psychological health by relieving their daily commutes. The recent pandemic clearly showed this potential;the daily outdoor movement by soft mobility allowed for social life even during lockdown periods. The paper is subdivided into two main components: a theoretical discussion of the 15-minute city model as part of a broader sustainable urban planning narrative, and a practical application mapping the potentials of Milan as a 15-minute city, focusing on population distribution and urban fabric structure as a measure of performance evaluation. The emergence of the 15-minute model rebalances the building volume concentration of the consolidated Transit Oriented Development paradigm;suggesting an innovative and more articulated vision. The 15-minute approach, rooted in the organic planning of the’60, is pushed by the covid-19 emergency, making treasure of the experience of urban regeneration masterplans of the last decade. The approach falls in line with real estate strategies for place making, which aim to create new sustainable urban districts that are pedestrian oriented and carbon free. After interpreting the international framework of urbanism trends with respect to the 15-minute model, the paper focuses on the Milan case. The potentials for neighborhoods across the city of Milan is investigated to conform to an inclusive 15-minute city model, using fully-fledged and innovative mapping of proximity. This analysis aims to explore the resilience of urban resources to support walkable living environments with a guaranteed basic level of accessibility to daily needs by walking. The support to this model offered by soft mobility modes and micro-mobility devices is also raised. The results show, in a number of urban neighborhoods, a limited level of walkability although related to a spatial city structure which is able to be regenerated as a dense and effective network of 15-minute neighborhoods through tactical urbanism actions on existing open spaces and soft mobility policies, combined with long term strategies (infrastructure capacity and digital upgrading). It is a first methodological test which opens up the research towards a new inclusive concept of accessibility. © 2022 The Authors. Published by ELSEVIER B.V. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0)