Investigating the environmental externalities of digital financial inclusion and the COVID-19 pandemic: an environmental sustainability perspective.

Financial inclusion enhances economic growth by facilitating businesses and individuals to access financial resources. Financial inclusion also contributes to environmental sustainability; however, very few studies have explored the link between financial inclusion and the environment. Also, the impact of the COVID-19 pandemic on environmental performance remains unexplored. From this perspective, this study probes the objective of whether financial inclusion and environmental performance co-move in COVID-19 in highly polluted economies. This objective is tested with the help of 2SLS and GMM approaches. The study also gets assistance from a panel quantile regression approach for empirical tasks. The results show that financial inclusion and the COVID-19 pandemic have a negative impact on CO2 emissions. Based on these findings, the study suggests that highly polluted economies should promote financial inclusion and assimilate environmental policies with financial inclusion policies to attain environment-related goals.

The Use of Qualitative Methods to Guide the Development of the Border Resilience Scale in a Participatory Research Study.

U.S.-Mexico border residents experience pervasive social and ecological stressors that contribute to a high burden of chronic disease. However, the border region is primarily composed of high-density Mexican-origin neighborhoods, a characteristic that is most commonly health-promoting. Understanding factors that contribute to border stress and resilience is essential to informing the effective design of community-level health promotion strategies. La Vida en La Frontera is a mixed-methods, participatory study designed to understand factors that may contribute to border resilience in San Luis, Arizona. The study's initial qualitative phase included interviews with 30 Mexican-origin adults exploring community perceptions of the border environment, cross-border ties, and health-related concepts. Border residents described the border as a Mexican enclave characterized by individuals with a common language and shared cultural values and perspectives. Positive characteristics related to living in proximity to Mexico included close extended family relationships, access to Mexican food and products, and access to more affordable health care and other services. Based on these findings, we co-designed the 9-item Border Resilience Scale that measures agreement with the psychosocial benefits of these border attributes. Pilot data with 60 residents suggest there are positive sociocultural attributes associated with living in border communities. Further research should test if they mitigate environmental stressors and contribute to a health-promoting environment for residents.

Unified real-time environmental-epidemiological data for multiscale modeling of the COVID-19 pandemic.

An impressive number of COVID-19 data catalogs exist. However, none are fully optimized for data science applications. Inconsistent naming and data conventions, uneven quality control, and lack of alignment between disease data and potential predictors pose barriers to robust modeling and analysis. To address this gap, we generated a unified dataset that integrates and implements quality checks of the data from numerous leading sources of COVID-19 epidemiological and environmental data. We use a globally consistent hierarchy of administrative units to facilitate analysis within and across countries. The dataset applies this unified hierarchy to align COVID-19 epidemiological data with a number of other data types relevant to understanding and predicting COVID-19 risk, including hydrometeorological data, air quality, information on COVID-19 control policies, vaccine data, and key demographic characteristics.

Plastic or plastic-free life: From formation to removal.

Microplastics (MPs) and nanoplastics (NPs) have caused global environmental concerns due to their ubiquitous existence in our surrounding environment and the potential threats posed to the ecosystem and human health. This review aims to extend current knowledge on the formation and degradation of MPs and NPs. The paper presents the potential sources of MPs and NPs including plastic containers, textiles, cosmetics, personal care products, COVID-19 wastes, and other plastic products. Once in the natural environment, the fragmentation and degradation of plastic wastes are thought to be initiated by physical, chemical, and biological factors. The corresponding degradation mechanism will be presented in the present review. Given the plastic life and environment, humans are inevitably exposed to MPs and NPs through ingestion, inhalation, and dermal contact. The potential risks MPs/NPs pose to humans will be also discussed in our study. Currently, the relevance of MP/NP exposure to human health outcomes is still controversial and not yet fully understood. Deciphering the translocation and degradation of plastics in the human body will be helpful to reveal their potential organotoxicity. In this case, available approaches to alleviate MP/NP pollution and advanced strategies to reduce MP/NP toxicity in humans are recommended to build a plastic-free life.

Integrating the natural environment into tourism firms' business model for sustainability.

The link between the business model (BM) and sustainability is recognized in tourism research and practice, especially as far as its socioeconomic consequences are concerned. Moreover, prior studies have highlighted some key factors influencing the sustainable business models (SBMs) of tourism firms but have mainly done so by adopting static perspectives. Thus, how these firms can contribute to sustainability through their BMs with positive effects, particularly on natural resources, remains overlooked. Thus, we adopt coevolutionary lenses to explore the main processes surrounding tourism firms' SBM. Coevolution conceives the firm-environment relationship as both circular, with mutual influence and reciprocal changes, and dialectical. Accordingly, we analyze 28 Italian agritourism firms during the COVID-19 pandemic emergency period focusing on the dynamics of their relationship with various multilevel actors (including institutions, local communities, tourists) by considering internal and external factors influencing their SBM. The dialectical nature of this relationship is stressed. We find three new factors: sustainable tourism culture, tourist loyalty, and local natural resource setting. Moreover, from the coevolutionary analysis of the findings, we derive a framework that conceptualizes agritourism SBMs as a virtuous coevolutionary process through effective coadaptations between multilevel actors influenced by 12 factors. Tourism entrepreneurs and policy-makers should carefully consider the factors influencing SBMs and try to act upon them to effectively organize and manage relationships of mutual functionality in light of current challenges, especially environmental concerns.

A Report on the Ke Ola O Ka 'Aina: 'Aina Connectedness Scale.

Optimal health from a Native Hawaiian worldview is achieved by being pono (righteous) and maintaining lokahi (balance) with all our relations, including our relationships as Kanaka (humankind) with 'Aina (land, nature, environment, that which feeds) and Akua (spiritual realm). The purpose of this study is to explore the role of 'Aina connectedness in Native Hawaiian health and resilience to inform the development of the 'Aina Connectedness Scale. Qualitative methods were conducted with 40 Native Hawaiian adults throughout Hawai'i. Three themes emerged: (1) 'Aina is everything; (2) Connection to 'Aina is imperative to health; and (3) Intergenerational health, healing, and resilience are reflected through intergenerational connectedness with 'Aina. Qualitative findings, supplemented with a scoping review of land, nature, and cultural connectedness scales, led to the development of the 'Aina Connectedness Scale, which examined the degree to which people feel connected to 'Aina, with implications for future research. 'Aina connectedness may address concerns related to health disparities that stem from colonization, historical trauma, and environmental changes and better our understanding of Native Hawaiian health by fostering stronger ties to land. Resilience- and 'Aina-based approaches are critically important to health equity and interventions that aim to improve Native Hawaiian health.

Social and occupational multidimensionality of the determinants of health in the face of Sars-CoV-2 / Polidimensionalidad social y laboral de los determinantes de la salud ante el Sars-CoV-2

Tras el advenimiento de un nuevo patógeno denominado Sars-CoV-2, los esfuerzos iniciales centraron su atención en la contención del virus a fin de disminuir su transmisibilidad, contrarrestando los efectos patológicos, disminuyendo el impacto psicosocial. Al ser un peligro emergente de alcance global, que afectó todos los estratos y entornos de la sociedad, pueden existir determinantes polidimensionales emergentes, en lo social y laboral, que aún pueden ser desconocidas, las cuales pueden repercutir en la esperanza de vida de una población. Se realizó una búsqueda sistemática y posterior caracterización de las polidimensiones sociales y laborales que emergieron de forma directa o indirecta a consecuencia del Sars-CoV-2, y a la declaración de pandemia Covid-19, la cual impuso el aislamiento generalizado de la población mundial, como primera barrera de contención para evitar el contagio masivo, e indujo profundas transformaciones en todos los ámbitos y determinantes de la salud del ser humano. La dimensión social, conformada por los factores modo de vida, circunstancias materiales y relaciones humanas, presentó múltiples desafíos y cambios para adaptarse a las nuevas circunstancias de la vida en pandemia. De igual manera, la dimensión laboral, ampliamente afectada por la desestabilización de los mercados y la crisis económica circundante, tuvo que modificar sensiblemente cada uno de sus factores constituyente para sobrellevar el efecto del confinamiento generalizado, afectando la productividad de las organizaciones, los riesgos de transmisibilidad del virus, las alteraciones en los social, familiar, personal y de salud y las múltiples interacciones con sus factores determinantes(AU)

After the advent of a new pathogen called Sars-CoV-2, the initial efforts focused on containing the virus in order to reduce its transmissibility, counteracting the pathological effects, and reducing the psychosocial impact. Being an emerging danger of global scope, which affected all strata and environments of society, there may be emerging multidimensional determinants, in the social and labor spheres, which may still be unknown, and may affect the life expectancy of a population.A systematic search and subsequent characterization of the social and labor polydimensions that emerged directly or indirectly as a result of Sars-CoV-2, and the declaration of the Covid-19 pandemic, which imposed the generalized isolation of the world population, was carried out as the first containment barrier to prevent massive contagion, and induced profound transformations in all areas and determinants of human health. The social dimension, made up of lifestyle factors, material circumstances, and human relationships, presented multiple challenges and changes to adapt to the new circumstances of life in a pandemic. Similarly, the labor dimension, widely affected by the destabilization of the markets and the surrounding economic crisis, had to significantly modify each of its constituent factors to withstand the effect of generalized confinement, affecting the productivity of organizations, the risks of transmissibility of the virus, alterations in social, family, personal and health conditions and the multiple interactions with its determining factors(AU)

Residential Environments for Older Persons: A Comprehensive Literature Review (2005-2022).

BACKGROUND: Independent noninstitutional and institutional residential long-term care environments for older persons have been the subject of significant empirical and qualitative research in the 2005-2022 period. A comprehensive review of this literature is reported, summarizing recent advancements in this rapidly expanding body of knowledge. PURPOSE AND AIM: This comprehensive review conceptually structures the recent literature on environment and aging to provide conceptual clarity and identify current and future trends. METHOD AND RESULT: Each source reviewed was classified as one of the five types-opinion piece/essay, cross-sectional empirical investigation, nonrandomized comparative investigation, randomized study, and policy review essay-within eight content categories: community-based aging in place; residentialism; nature, landscape, and biophilia; dementia special care units; voluntary/involuntary relocation; infection control/COVID-19, safety/environmental stress; ecological and cost-effective best practices; and recent design trends and prognostications. CONCLUSIONS: Among the findings embodied in the 204 literature sources reviewed, all-private room long-term care residential units are generally safer and provide greater privacy and personal autonomy to residents, the deleterious impacts of involuntary relocation continue, family engagement in policy making and daily routines has increased, multigenerational independent living alternatives are increasing, the therapeutic role of nature and landscape is increasingly well-documented, ecological sustainability has increased in priority, and infection control measures are of high priority in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review sets the stage for further research and design advancements on this subject in light of the rapid aging of societies around the globe.

The impact of physical environments on outpatient mental health recovery: A design-oriented qualitative study of patient perspectives.

The physical environment has been shown to affect the emotional states of patients receiving mental health treatment, yet it remains unknown whether physical space design may play a role in optimizing the delivery of mental health care. Principles of architectural design and human-centered co-design have been applied to enhance the patient experience of facility environments; however, little is known about how patients view the impact of physical spaces on their recovery. In this qualitative study, we aimed to understand patient perspectives of how physical environments contribute to mental wellbeing and personal experiences of recovery, in the context of informing future design efforts. Semi-structured telephone interviews were conducted with 13 participants receiving outpatient mental health treatment at the Kaiser Permanente San Jose Adult Psychiatry Clinic. Interviews were transcribed and themes were extracted that could inform future design concepts. The sample was comprised of nine female and three male participants, and one unidentified-gender participant, between the ages of 26-64, and across several self-reported racial/ethnic subgroups. We found four dimensions of physical environments that participants reported as impactful: 1) sensory design elements (colors, sounds, and textures), 2) engagement qualities (intensity of distracted activity such as crafting or commuting), 3) social relational aspects (privacy or connection), and 4) affective experiences evoked by being present in the space itself (feeling safe, calm, in control, self-aware, or creative was beneficial). Many of these elements were similarly noted across clinic and non-clinic environments. This study identifies key dimensions of physical environments that can serve as potential metrics of design success in supporting and facilitating mental health recovery. In the midst of the current COVID-19 pandemic, where mental health treatment has increasingly shifted outside of traditional clinics, our findings can support patients and clinicians seeking to harness potential in situ therapeutic benefits of physical environments.

CoSumNet: A video summarization-based framework for COVID-19 monitoring in crowded scenes.

The outbreak of COVID-19 pandemic poses new challenges to research community to investigate novel mechanisms for monitoring as well as controlling its further spread via crowded scenes. Moreover, the contemporary methods of COVID-19 preventions are enforcing strict protocols in the public places. The emergence of robust computer vision-enabled applications leverages intelligent frameworks for monitoring of the pandemic deterrence in public places. The employment of COVID-19 protocols via wearing face masks by human is an effective procedure that is implemented in several countries across the world. It is a challenging task for authorities to manually monitor these protocols particularly in densely crowded public gatherings such as, shopping malls, railway stations, airports, religious places etc. Thus, to overcome these issues, the proposed research aims to design an operative method that automatically detects the violation of face mask regulation for COVID-19 pandemic. In this research work, we expound a novel technique for COVID-19 protocol desecration via video summarization in the crowded scenes (CoSumNet). Our approach automatically yields short summaries from crowded video scenes (i.e., with and without mask human). Besides, the CoSumNet can be deployed in crowded places that may assist the controlling agencies to take appropriate actions to enforce the penalty to the protocol violators. To evaluate the efficacy of the approach, the CoSumNet is trained on a benchmark "Face Mask Detection ∼12K Images Dataset" and validated through various real-time CCTV videos. The CoSumNet demonstrates superior performance of 99.98 % and 99.92 % detection accuracy in the seen and unseen scenarios respectively. Our method offers promising performance in cross-datasets environments as well as on a variety of face masks. Furthermore, the model can convert the longer videos to short summaries in nearly 5-20 s approximately.

Using photovoice to explore Bolivian children's experiences of COVID-19.

Our capacity to facilitate the empowerment of children is dependent on our ability to understand their values and experiences. This study aimed to explore Bolivian children's experiences of COVID-19. This study used a participatory action research method, photovoice, which involved focus groups, individual interviews and the use of cameras by participants to capture their reality and express their ideas through photographs. Ten participants aged 12-15 years were recruited from a school in the municipality of Mecapaca in Bolivia. Thematic analysis was used to identify and report response patterns. Four themes were developed through analysis: (i) sadness and fear of getting sick, (ii) the challenges of online learning, (iii) the tension between traditional knowledge and modern medicine, and (iv) the role of nature and culture in supporting well-being-natural and cultural capital. The narratives and choice of images by the children illustrate some issues and experiences. These findings also highlighted the importance of considering and exploring how children's experiences and interactions with their habitat, nature and their physical environment impacts on their health and well-being.

Determinants of proper disposal of single-use masks: knowledge, perception, behavior, and intervention measures.

Background: Although many studies testify to consumer behavior's role in the context of waste-related sustainability objectives, little research examined what people know, think, and feel about the environmental impacts of their personal protective equipment (PPE) or their behavior towards them, in general. Therefore, the present article complements existing information about the public perceptions, knowledge, and behavior of single-use masks in a context where the pandemic has put increasing pressure on waste management public services. From February to June 2020, municipal solid waste increased ten times in Romania. The study identified the factors that predicted the proper disposal of single-use masks and the measures preferred to prevent or minimize the negative impact of single-use mask waste. Method: Data from a representative sample of 705 Romanians were collected using a structured questionnaire. The data were analyzed with SPSS and SmartPLS. The Cochran's Q test was run to determine the existence of differences between percentages of people who preferred various measures. Dunn's test with a Bonferroni correction was used to identify the exact pair of groups where the differences were located. The study utilized structural equation models (SEM) based on at least partial squares with SmartPLS software (3.2.8) to investigate causal links between constructs. The model considered that the dependent variable (environmentally friendly behavior: proper disposal of single-use masks) could be influenced by the knowledge, perception, behavior, and demographics variables. Results: The findings indicated that knowledge of the type of material of single-use masks had a direct positive (ß = 0.173) and significant effect on their proper disposal. The perception of mask waste impact has a negative and significant (ß = -0.153, p < 0.001) impact on the proper disposal of single-use masks. This path coefficient illustrates that the worse the perceived impact of single-use masks on waste management activity, the higher the proper disposal of single-use masks. Gender has a positive (ß = 0.115) and significant (p < 0.001) effect on the proper disposal of single-use masks. Conclusions: It was concluded that the 5Rs waste management approach should be reconsidered for single-use mask waste. For example, "Reuse" and the classic "Recycle" have limited applications since they may lead to virus transmission and possible infection. "Reducing" the use of single-use masks could have repercussions on one's health. Summing up, the study outlined recommendations for effective interventions for the proper disposal of single-use masks from the perspective of behavioral studies.

Obesity related to environmental pollutants, diet and epigenetic mechanisms / La obesidad y su relación con los contaminantes ambientales, la alimentación y los mecanismos epigenéticos

Introduction: Obesity is a chronic disease resulting from environmental, psychological and genetic factors. The objective was to carry out a bibliometry of the scientific literature on this pathology related to environmental pollutants, food and epigenetics, to elucidate lines of research. Materials and method: The documents were managed from the Web of Science database. The search strategy was Obesity AND (pollution OR contamination) in the Titles field, AND (epigenetic * OR obesity OR food OR nutrition OR diet) in Themes. 654 articles were found: 577 original investigations and 77 reviews. The articles were exported in BibTeX format to be analyzed with the Bibliometrix program. Results: The evolution of the production of reports per year has been upward. In 2020, the average number of references of the original articles was 38 and of the review articles, 200. Based on the Lotka index combined with the h index, the most prominent author was Joel Schwartz. The United States concentrated the largest production of scientific articles, which coincides with the location of the institutions with the highest affiliation of the authors. The 5 most frequent keywords were: air pollution, particulate matter, obesity, pollution and epigenetics. Conclusions: A line of research on obesity linked to DNA methylation, oxidative stress and PM2.5 is proposed; which will contribute to reducing this pandemic and, therefore, will impact the morbidity and mortality profiles of non-communicable diseases and COVID-19.

Introducción: La obesidad es una enfermedad crónica resultante de factores ambientales, psicológicos y genéticos. El objetivo fue realizar una bibliometría de la literatura científica sobre esta patología relacionada con contaminantes ambientales, alimentación y epigenética, para dilucidar líneas de investigación. Materiales y método: Los documentos se gestionaron de la base de datos Web of Science. La estrategia de búsqueda fue Obesity AND (pollution OR contamination) en el campo Titles, AND (epigenetic* OR obesity OR alimentation OR nutrition OR diet) en Themes. Se encontraron 654 artículos: 577 investigaciones originales y 77 revisiones. Los artículos se exportaron en formato BibTeX para ser analizados con el programa Bibliometrix. Resultados: La evolución que ha tenido la producción de infrmes por año ha sido ascendente. En 2020, el promedio del número de referencias de los artículos originales fue de 38 y de los artículos de revisión, 200. Con base en el índice de Lotka aunado con el índice h, el autor más destacado fue Schwartz. Estados Unidos concentró la mayor producción de artículos científicos, lo que coincide con la ubicación de las instituciones con más adscripción de los autores. Las cinco palabras clave más frecuentes fueron: contaminación del aire, material particulado, obesidad, contaminación y epigenética. Conclusiones: Se propone una línea de investigación sobre la obesidad vinculada con la metilación del ADN, estrés oxidativo y material particulado fino; lo que contribuirá a reducir esta pandemia y por lo tanto, impactará en los perfiles de morbimortalidad de las enfermedades no transmisibles y de la COVID-19.

Application of the child community health inclusion index for measuring health inclusion of children with disabilities in the community: a feasibility study.

BACKGROUND: Participation in the community is a fundamental human right for children with disabilities and is a key component of their health and development. Inclusive communities can enable children with disabilities to participate fully and effectively. The Child Community Health Inclusion Index (CHILD-CHII) is a comprehensive assessment tool developed to examine the extent to which community environments foster healthy, active living for children with disabilities. OBJECTIVES: To assess the feasibility of applying the CHILD-CHII measurement tool across different community settings. METHODS: Participants recruited through maximal representation, and purposeful sampling from four community sectors (Health, Education, Public Spaces, Community Organizations) applied the tool on their affiliated community facility. Feasibility was examined by assessing length, difficulty, clarity, and value for measuring inclusion; each rated on a 5-point Likert scale. Participants provided comments for each indicator through the questionnaire and a follow-up interview. RESULTS: Of the 12 participants, 92% indicated that the tool was 'long' or 'much too long'; 66% indicated that the tool was clear; 58% indicated that the tool was 'valuable' or 'very valuable'. No clear consensus was obtained for the level of difficulty. Participants provided comments for each indicator. CONCLUSION: Although the length of the tool was regarded as long, it was seen to be comprehensive and valuable for stakeholders in addressing the inclusion of children with disabilities in the community. The perceived value and the evaluators' knowledge, familiarity, and access to information can facilitate use of the CHILD-CHII. Further refinement and psychometric testing will be conducted.

Changes in Online Food Access During the COVID-19 Pandemic and Associations With Deprivation: Longitudinal Analysis.

BACKGROUND: Food prepared out of home is typically energy-dense and nutrient-poor. Online food delivery services have become a popular way to purchase such food. The number of accessible food outlets through these services can influence how frequently they are used. Anecdotally, food outlet access through online food delivery services increased in England between 2020 and 2022, in the context of the COVID-19 pandemic. However, the extent to which this access changed is poorly understood. OBJECTIVE: We aimed to investigate monthly changes in online access to food prepared out of home in England in the context of the first 2 years of the COVID-19 pandemic compared with November 2019 and the extent to which any changes were associated with deprivation. METHODS: In November 2019 and monthly between June 2020 and March 2022, we used automated data collection to construct a data set containing information about all food outlets in England registered to accept orders through the leading online food delivery service. Across postcode districts, we identified the number and percentage of food outlets registered to accept orders and the number that was accessible. We used generalized estimating equations (adjusted for population density, the number of food outlets in the physical food environment, and rural/urban classification) to investigate the change in outcomes compared with prepandemic levels (November 2019). We stratified analyses by deprivation quintile (Q). RESULTS: Across England, the summed number of food outlets registered to accept orders online increased from 29,232 in November 2019 to 49,752 in March 2022. Across postcode districts, the median percentage of food outlets registered to accept orders online increased from 14.3 (IQR 3.8-26.0) in November 2019 to 24.0 (IQR 6.2-43.5) in March 2022. The median number of food outlets accessible online decreased from 63.5 (IQR 16.0-156.0) in November 2019 to 57.0 (IQR 11.0-163.0) in March 2022. However, we observed variation by deprivation. In March 2022, the median number of outlets accessible online was 175.0 (IQR 104.0-292.0) in the most deprived areas (Q5) compared with 27.0 (IQR 8.5-60.5) in the least deprived (Q1). In adjusted analyses, we estimated that the number of outlets accessible online in the most deprived areas was 10% higher in March 2022 compared with November 2019 (incidence rate ratios: 1.10, 95% CI 1.07-1.13). In the least deprived areas, we estimated a 19% decrease (incidence rate ratios: 0.81, 95% CI 0.79-0.83). CONCLUSIONS: The number of food outlets accessible online increased only in the most deprived areas in England. Future research might attempt to understand the extent to which changes in online food access were associated with changes in online food delivery service use and the possible implications on diet quality and health.

Systematic Review: Neurodevelopmental Benefits of Active/Passive School Exposure to Green and/or Blue Spaces in Children and Adolescents.

Today more than half of the world's population lives in urban areas. Children spend about 40 h a week in the school environment. Knowing the influence of school exposure to green/blue spaces could improve the children's health, creating healthier environments and preventing exposure to legal/illegal drugs. This systematic review summarized the main results of published studies on active or passive exposure to green or blue spaces in different domains of child neurodevelopment. In August 2022, five databases were searched and twenty-eight eligible studies were included in the analysis. Cognitive and/or academic performance was the most frequently studied (15/28). Most studies evaluate passive exposure to green/blue spaces (19/28) versus active exposure (9/28). Only three studies addressed the relationship between blue space and neurodevelopment. The main results point toward mixed evidence of a protective relationship between green/blue space exposure and neurodevelopment, especially in improving cognitive/academic performance, attention restoration, behavior, and impulsivity. Renaturalizing school spaces and promoting "greener" capacities for school environmental health could improve children's neurodevelopment. There was great heterogeneity in methodologies and adjustment for confounding factors across studies. Future research should seek a standardized approach to delivering school environmental health interventions beneficial to children's development.

Effect of cities and distance on COVID-19 spreading in the United States.

The COVID-19 pandemic has evolved over time through multiple spatial and temporal dynamics. The varying extent of interactions among different geographical areas can result in a complex pattern of spreading so that influences between these areas can be hard to discern. Here, we use cross-correlation analysis to detect synchronous evolution and potential interinfluences in the time evolution of new COVID-19 cases at the county level in the United States. Our analysis identified two main time periods with distinguishable features in the behavior of correlations. In the first phase, there were few strong correlations that only emerged between urban areas. In the second phase of the epidemic, strong correlations became widespread and there was a clear directionality of influence from urban-to-rural areas. In general, the effect of distance between two counties was much weaker than that of the counties' population. Such analysis can provide possible clues on the evolution of the disease and may identify parts of the country where intervention may be more efficient in limiting the disease spread.

Environmental impact of telehealth use for pediatric surgery.

BACKGROUND: The healthcare sector is responsible for 10% of US greenhouse gas emissions. Telehealth use may decrease healthcare's carbon footprint. Our institution introduced telehealth to support SARS-CoV-2 social distancing. We aimed to evaluate the environmental impact of telehealth rollout. METHODS: We conducted a retrospective cohort study of pediatric patients seen by a surgical or pre anesthesia provider between March 1, 2020 and March 1, 2021. We measured patient-miles saved and CO2 emissions prevented to quantify the environmental impact of telehealth. Miles saved were calculated by geodesic distance between patient home address and our institution. Emissions prevented were calculated assuming 25 miles per gallon fuel efficiency and 19.4 pounds of CO2 produced per gallon of gasoline consumed. Unadjusted Poisson regression was used to assess relationships between patient demographics, geography, and telehealth use. RESULTS: 60,773 in-person and 10,626 telehealth encounters were included. This represented an 8,755% increase in telehealth use compared to the year prior. Telehealth resulted in 887,006 patient-miles saved and 688,317 fewer pounds of CO2 emitted. Demographics significantly associated with decreased telehealth use included Asian and Black/African American racial identity, Hispanic ethnic identity, and primary language other than English. Further distance from the hospital and higher area deprivation index were associated with increased telehealth use (IRR 1.0006 and 1.0077, respectively). CONCLUSION: Incorporating telehealth into pediatric surgical and pre anesthesia clinics resulted in significant CO2 emission reductions. Expanded telehealth use could mitigate surgical and anesthesia service contributions to climate change. Racial and linguistic minority status were associated with significantly lower rates of telehealth utilization, necessitating additional inquiry into equitable telemedicine use for minoritized populations. LEVEL OF EVIDENCE: Level IV.