Prior research highlights that rural populations have been historically underrepresented/excluded from clinical research. The primary objective of this study was to describe the inclusion of rural populations within our research enterprise using Clinical Research Management System demographic information at a large academic medical center in the Southeast. This was a cross-sectional study using participant demographic information for all protocols entered into our Clinical Research Management System between May 2018 and March 2021. Descriptive statistics were used to analyze the representation of rural and non-rural participants and demographic breakdown by age, sex, race, and ethnicity for our entire enterprise and at the state level. We also compared Material Community Deprivation Index levels between urban and rural participants. Results indicated that 19% of the research population was classified as rural and 81% as non-rural for our entire sample, and 17.5% rural and 82.5% urban for our state-level sample. There were significant differences in race, sex, and age between rural and non-rural participants and Material Community Deprivation Indices between rural and non-rural participants. Lessons learned and recommendations for increasing the inclusion of rural populations in research are discussed.

BACKGROUND: Biologic strain such as oxidative stress has been associated with short leukocyte telomere length (LTL), as well as with preeclampsia and spontaneous preterm birth, yet little is known about their relationships with each other. We investigated associations of postpartum maternal LTL with preeclampsia and spontaneous preterm birth.
METHODS: This pilot nested case control study included independent cohorts of pregnant people with singleton gestations from two academic institutions: Cohort 1 (hereafter referred to as Suburban) were enrolled prior to 20 weeks\' gestation between 2012 and 2018; and Cohort 2 (hereafter referred to as Urban) were enrolled at delivery between 2000 and 2012. Spontaneous preterm birth or preeclampsia were the selected pregnancy complications and served as cases. Cases were compared with controls from each study cohort of uncomplicated term births. Blood was collected between postpartum day 1 and up to 6 months postpartum and samples were frozen, then simultaneously thawed for analysis. Postpartum LTL was the primary outcome, measured using quantitative polymerase chain reaction (PCR) and compared using linear multivariable regression models adjusting for maternal age. Secondary analyses were done stratified by mode of delivery and self-reported level of stress during pregnancy.
RESULTS: 156 people were included; 66 from the Suburban Cohort and 90 from the Urban Cohort. The Suburban Cohort was predominantly White, Hispanic, higher income and the Urban Cohort was predominantly Black, Haitian, and lower income. We found a trend towards shorter LTLs among people with preeclampsia in the Urban Cohort (6517 versus 6913 bp, p = 0.07), but not in the Suburban Cohort. There were no significant differences in LTLs among people with spontaneous preterm birth compared to term controls in the Suburban Cohort (6044 versus 6144 bp, p = 0.64) or in the Urban Cohort (6717 versus 6913, p = 0.37). No differences were noted by mode of delivery. When stratifying by stress levels in the Urban Cohort, preeclampsia was associated with shorter postpartum LTLs in people with moderate stress levels (p = 0.02).
CONCLUSIONS: Our exploratory results compare postpartum maternal LTLs between cases with preeclampsia or spontaneous preterm birth and controls in two distinct cohorts. These pilot data contribute to emerging literature on LTLs in pregnancy.

Brazil is one of the most unequal democracies in the world. Although the number of homeless individuals in our country has increased due to the reproduction of people living in extreme poverty, little has been discussed about their welfare and rights. In the present study, we provide analysis with a theoretical-methodological approach directed at homeless people living in the wealthy neoliberal middle-sized southeast city of São Paulo, Brazil\'s richest state. Data was acquired from police reports with prior permission from the Civil Police of São Paulo and the São Paulo Interior Judiciary Police Department. Our results illustrate that the homelessness phenomenon in Franca appears to be comparable to that of other large urban cities, where Blacks, a minority of the population, make up the bulk of homeless individuals. It also denies that homeless activity increases criminality, emphasizes the difference between Blacks and Whites drug users\' criminal behavior, with Whites being more active in theft and robbery and Blacks in trafficking, and extends the idea that drug use by homeless people is stress-related and hence an indicator of a health condition.

The layout, scale and spatial form of urban employment centers are important guidelines for the rational layout of public service facilities such as urban transportation, medical care, and education. In this paper, we use Internet cell phone positioning data to identify the workplace and residence of users in the Beijing city area and obtain commuting data of the employed to measure the employment center system in Beijing. Firstly, the employment density distribution is generated using the data of the working places of the employed persons, and the employment centers are identified based on the employment density of Beijing. Then, we use the business registration data of employment centers to measure the industrial diversity within the employment centers by using the ecological Shannon Wiener Diversity Index, and combine the commuting links between employment centers and places of residence to measure the energy level of each employment center, analyze the hinterland and sphere of influence of each center, and finally using the industrial diversity index of employment centers and the average commuting time of employed persons, combined with the K-Means clustering algorithm, to classify the employment centers in Beijing. The employment center identification and classification method based on big data constructed in this study can help solve the limitations of the previous employment center system research in terms of center identification and commuting linkage measurement due to large spatial units and lack of commuting data to a certain extent. The study can provide reference for the regular understanding and technical analysis of employment centers and provide help for the employment multi-center system in Beijing in terms of quantifying the employment spatial structure, guiding the construction of multi-center system, and adjusting the land use rules.

BACKGROUND: Qingyang is located in the northwest of China. By analyzing the current situation and risk factors of bullying in junior high schools in Qingyang City, and identify relevant data for formulating prevention and control measures of bullying in western backward areas.
METHODS: Qingyang City is divided into four regions based on economic level and population quality. One junior high school is randomly selected from each region, a total of 1200 students from 4 junior high schools of different levels in Qingyang City were randomly selected, and the \"Questionnaire on Middle School Students\' School bullying\" was administered between December 2021 and February 2022.
RESULTS: The reporting rate of bullying in junior high schools in Qingyang was 47.35%. The incidence of campus bullying among urban-rural integration junior high schools, senior students, and male students is higher than that of municipal -level junior high schools, junior students, and female students (P< 0.05). The results of binary logistic regression showed that the second grade of junior high school (OR = 1.39,95% CI: 1.022-1.894), poor student performance (OR = 1.744,95% CI: 1.09-2.743), external dissatisfaction (OR = 2.09,95% CI: 1.177-3.427), mother working in an enterprise (OR = 1.623,95% CI: 1.074-2.453), and urban-rural integration middle school (OR = 3.631,95% CI: 2.547-5.177) were factors affecting bullying in junior high school campus.
CONCLUSIONS: The reporting rate of bullying in junior high schools in Qingyang City was relatively high, mostly occurring in places lacking supervision and after-school hours.
BACKGROUND: Not applicable.

There is a lack of empirical data on design effects (DEFF) for mortality rate for highly clustered data such as with Ebola virus disease (EVD), along with a lack of documentation of methodological limitations and operational utility of mortality estimated from cluster-sampled studies when the DEFF is high.
The objectives of this paper are to report EVD mortality rate and DEFF estimates, and discuss the methodological limitations of cluster surveys when data are highly clustered such as during an EVD outbreak.
We analysed the outputs of two independent population-based surveys conducted at the end of the 2014-2016 EVD outbreak in Bo District, Sierra Leone, in urban and rural areas. In each area, 35 clusters of 14 households were selected with probability proportional to population size. We collected information on morbidity, mortality and changes in household composition during the recall period (May 2014 to April 2015). Rates were calculated for all-cause, all-age, under-5 and EVD-specific mortality, respectively, by areas and overall. Crude and adjusted mortality rates were estimated using Poisson regression, accounting for the surveys sample weights and the clustered design.
Overall 980 households and 6,522 individuals participated in both surveys. A total of 64 deaths were reported, of which 20 were attributed to EVD. The crude and EVD-specific mortality rates were 0.35/10,000 person-days (95%CI: 0.23-0.52) and 0.12/10,000 person-days (95%CI: 0.05-0.32), respectively. The DEFF for EVD mortality was 5.53, and for non-EVD mortality, it was 1.53. DEFF for EVD-specific mortality was 6.18 in the rural area and 0.58 in the urban area. DEFF for non-EVD-specific mortality was 1.87 in the rural area and 0.44 in the urban area.
Our findings demonstrate a high degree of clustering; this contributed to imprecise mortality estimates, which have limited utility when assessing the impact of disease. We provide DEFF estimates that can inform future cluster surveys and discuss design improvements to mitigate the limitations of surveys for highly clustered data.
Main findings: For humanitarian organizations it is imperative to document the methodological limitations of cluster surveys and discuss the utility.Added knowledge: This paper adds new knowledge on cluster surveys for highly clustered data such us in Ebola virus disease.Global health impact of policy and action: We provided empirical estimates and discuss design improvements to inform future study.

After COVID-19, more and more travelers are more inclined to walk in cities, and the sensory elements of streets can have a significant impact on urban tourism. Local residents and travelers have different perceptions of the street and preferences for its use. The purpose of this study is to evaluate and analyse the streets from the perspective of locals and travelers.
In this study, a questionnaire was designed to obtain local residents\' and travelers\' evaluations of the sensory elements of the street and a quadrant analysis of the street\'s sensory elements was carried out using the IPA-Kano model.
The results of the study show that travelers are particularly concerned about maps and signage guidance, while local residents are more concerned about the green environment of the surroundings and how well it is maintained.
There is a difference in the indicators chosen by the two groups in the results of the comparison between locals and travelers, and this study is hoped to provide some data support for future urban managers and designers to learn from and refer to for street improvements and renewal.

BACKGROUND: Nutritive sucking and nonnutritive sucking (NNS) may affect the craniofacial development, differently.
OBJECTIVE: We investigated associations between NNS habits (NNSHs), developing malocclusion, and various feeding practices in 3-6-year-old children.
METHODS: A sample of 350 children 3-6-year-old from various preschools were selected for this case-control study (94 with NNSH and 256 without NNSH). NNSH (outcome) and feeding practices and developing malocclusions (exposures) were assessed using a structured study tool.
RESULTS: The prevalence of NNSH in 3-6-year-old children was 26.8%. The odds (95% [confidence interval (CI)]) of boys compared to girls having NNSH were 0.66 (0.4121-1.706) (P = 0.0290). The overall prevalence of developing malocclusion in 3-6-year-old children was 34.01% out of which open bite was most commonly reported with 12.57% followed by spacing 8.5%, increased overjet 6.8%, crowding 2.2%, posterior crossbite and rotation 1.4%, and overbite 1.14%. Breastfeeding was found to be the most commonly used mode of feeding reported by 53.42% of mothers. It was found that the odds (95% [CI]) of subjects having NNSH were 0.66 (0.4694-0.9460) (P < 0.0001) who were not breastfed as compared to those who were breastfed. Among developing malocclusions, increased overjet with P = 0.0019, open bite with P = 0.0416, and spacing with P = 0.0243 were found to be associated with feeding practices.
CONCLUSIONS: The prevalence of NNSH and developing malocclusions (increased overjet, open bite, and spacing) was 26.8% and 34.01%, respectively. Breastfeeding played a protective role against developing NNSH.

BACKGROUND: MPOX (Monkeypox) viral infection, a zoonotic disease previously confined to the African sub-continent, has caught attention worldwide recently due to its resurgence in a new \'avatar\' among urban communities. Dermatologists in the U. A. E. started to see patients with fever and a self-limiting pustular necrotic rash that was negative for all other infectious investigations.
METHODS: We performed a prospective observational multicenter clinical study of the demographics, skin manifestations, and outcomes of patients presenting with necrotic pustular lesions and/or fever.
RESULTS: 35 cases of PCR confirmed MPOX cases, mostly in the expatriate population, were followed up and found to have high-risk heterosexual contact on an average of 1 week prior to disease onset. We found that they have characteristic annular pustular lesions with necrotic center or \"Smoke ring pustules\' in all cases. Lesion tenderness and predilection for the lower abdomen, pubic area, and genitalia were observed. Most cases were systemically stable, with fever lasting for an average of 4 days and elevated CRP levels. Genital lesions were prone to secondary bacterial infections. The disease was severe, with larger annular plaques in one of our patients found to be living with HIV.
CONCLUSIONS: The overall prognosis in healthy individuals is good, with lesions healing within an average of 2 weeks without scarring. \'New world MPOX\' should be unclassified from zoonosis to a sexually transmitted infection (STI) capable of transmission in an urban population. Our findings can help in early clinical suspicion and differentiation from other STI\'s for primary and secondary health care physicians.

The construction of tourist towns is an important aspect of new-type urbanization construction. In this study, 155 tourist towns in Fujian Province were selected as samples to analyze spatiotemporal differentiation using the geographical concentration index, nearest neighbor index, and local correlation index. Then, a geographic detector model was used to detect the factors that influence the spatiotemporal differentiation of tourist towns and to analyze the explanatory power and interaction of these detection factors. Finally, the mechanisms underlying the detection factors were discussed. Factors affecting the spatiotemporal differentiation of tourist towns in Fujian Province were core factors of traffic network, level of urbanization and population distribution; important factors of industrial structure and socioeconomic basis; and a fundamental factor of policy guidance. These six factors interacted to jointly affect the spatiotemporal differentiation of tourist towns in Fujian Province. The results of this study can provide a basis for the development of tourist towns in other similar regions and have reference value for better optimizing the pattern of urban and town systems and coordinating the synergistic development of urban and rural areas.