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Urban stormwater infrastructure as a microplastic superhighway: a critical review of transport dynamics, modelling, and mitigation across pavements and drainage networks.

This review examines the transport, fate, modelling, and mitigation of Microplastics (MPs) in urban stormwater infrastructure, with emphasis on pavements, runoff pathways, micro-drainage, and macro-drainage systems. Following a systematic review approach, more than 1000 records were screened and approximately 50 core studies were retained when they addressed urban stormwater or drainage-related MP transport with adequate methodological reporting; marine-only studies and biological-effect studies without direct relevance to transport processes were excluded. The evidence shows that stormwater systems function not merely as passive conduits but as dynamic reactive transport systems with temporary storage, where particle mobilisation, sedimentation, resuspension, and temporary retention regulate MP export. Road surfaces, especially high-traffic areas, are major reservoirs of tyre wear, road-marking, atmospheric, and litter-derived particles that are rapidly mobilised during rainfall. Conventional grab sampling may underestimate MP loads, which in some cases exceed treated wastewater effluent loads by up to six-fold. Drainage structures such as manholes can immobilise up to 17.3% of near-neutrally buoyant particles, while biofouling and aggregation may shift buoyant polymers from wash-load to bedload. Mitigation systems, including permeable pavements, bioretention, wetlands, and technical inserts, can achieve high removal of coarse MPs, but performance declines for fine particles below 100 µm. The review highlights the need for standardised flow-proportional sampling, physically informed modelling, and treatment-train strategies targeting both surface sources and in-network storage.

Microplastics

Patterns of use of Madang Hospital.

The patterns of inpatient use of Madang Hospital were examined. A highly disproportionate use of the hospital by the neighbouring population was demonstrated. The implications of this for health care planning are discussed and some methods of alleviating the inequalities in health care provision to urban as opposed to rural communities are suggested.

Bed Occupancy

The accessibility of primary care to urban patients: a geographical analysis.

Techniques of analysis now used in geography can be applied to general practice. They show that the locations of general practitioners' premises are not randomly distributed and are not related to the sites of populations or to patients in greatest need of medical services. The findings suggest a concentration of surgeries in middle class areas and lack of surgeries in areas of low social class.

Catchment Area, Health

Analysis of perinatal mortality rate in the Stockholm area.

During the period 1973--1976, a significant decrease in perinatal mortality from 14.2 to 10.4/10 newborns occurred in Sweden. In the Stockholm area, the mean perinatal mortality during the same period varied significantly between the different maternity hospitals, even when pre-term and high risk pregnancies were excluded from the comparison. The majority of hospitals with fewer deliveries and without pediatric wards had a perinatal mortality above the mean. Some explanations of these differences were also looked for in differences between the total population of the referral area of each maternity hospital. In the referral areas of the hospitals with a perinatal mortality above the mean, there were higher percentages of low-income households and over-crowded dwellings and fewer professional people than in the other area. The results suggest a need for analysis of individually-based data to find etiological factors which account for differences in perinatal mortality.

Adolescent

The public hospital and its local ecology in the United States: some relationships between the "plight of the public hospital" and the "plight of the cities".

The "plight" of the public hospital in the United States is examined from the point of view of its relationship to the "plight" of the cities. Fifty-five large cities are examined and for 38 of these cities that have such hospitals the relationships of levels of public hospital services to local demographic, government fiscal, and tax structure conditions are analyzed. The principal findings point to the existence of some strong relationships and the implications for public policy of these associations are discussed.

Catchment Area, Health

Comparing the medical utilization and expenditures of low income health plan enrollees with Medicaid recipients and with low income enrollees having Medicaid eligibility.

The study examines the medical care (hospital, physician, drug, diagnostic) utilization and expenditures of low income persons enrolled in a prepaid health plan with a matched group of Medicaid recipients. The study also examines the medical care utilization of low income persons enrolled in a prepaid health plan with a similar group of low income persons enrolled in the health plan but also eligible for Medicaid benefits. Utilization and population-at-risk data were obtained from the Kaiser-Permanente Medical Care Program of Portland, Oregon and from the State of Oregon Welfare Division. A hypothesis of lower hospital utilization by low income enrollees compared with Medicaid recipients was accepted. A hypothesis of higher ambulatory care utilization was accepted for diagnostic procedures and prescription use, but rejected for office visit utilization. An analysis of the findings appeared to implicate the Medicaid program for differences observed. The hypotheses of no significant differences in inpatient and ambulatory medical care utilization of low income health plan enrollees with and without Medicaid eligibility were generally rejected. Low income enrollees with concurrent Medicaid had consistently higher utilization rates for all services resulting in substantially higher medical care expenditures per person. The findings appear to contribute some useful information to planning or establishing policy for Medicaid Prepayment programs or other programs enrolling low income persons in prepaid health plans or HMOs.

Adolescent

The effect of length of membership upon the utilization of ambulatory care services. A comparison of disadvantaged and general membership populations in a prepaid group practice.

The relationships between duration of membership and the use of outpatient medical care services for disadvantaged and general membership groups in a prepaid group practice were analyzed. The effects of duration of membership upon utilization rates during a six-year study period were estimated by retrospective cohort analyses. Rates were computed for successive three-month intervals. There were no significant start-up effects on use for new enrollees in either study population. This finding is in contrast to what has been reported in other studies. New HMOs or existing HMOs with many new members may not require the additional resources previously thought necessary. Average cohort utilization rates were higher for the disadvantaged cohorts, with the exception of young males 0 to 14 years old. We also examined the persistence of utilization patterns over time. Consistently high users and nonusers were found in both populations. In general, these findings suggest that length of time does not affect ambulatory care use. Age, sex, socioeconomic background and health status are more important than duration of membership in accounting for differences in utilization.

Adolescent

The relationship between utilization of mental health and somatic health services among low income enrolees in two provider plans.

Mental health services were included in comprehensive benefits available with no out-of-pocket expenses to enrollees in the Seattle Prepaid Health Care Project. This study was designed to examine the characteristics of users as compared to nonusers of mental health services and to examine the possibility of lower use of somatic health services attributable to the availability of mental health services. Two enrollee groups were studied: one group included enrollees with at least one mental health service (MH-U) and the other included those with some somatic utilization but without mental health utilization (MH-NU). Results indicated that mental health users were different from nonusers based on sociodemographic, health status, and prior utilization measures. Further, the mental health utilizers consumed more somatic services than other enrollees, even controlling for background variables. The visit and admission rates for the MH-U group were 2.4 times that of the MH-NU group, and total inpatient and outpatient costs were three times as high. On all three comparisons, approximately 60 per cent of the difference was accounted for by mental health utilization and by differences in sociodemographic and health status characteristics. The remaining 40 per cent could not be explained, but there is a suggestion that the higher utilization occurred for conditions where medical care is discretionary.

Adolescent

Modelling peak microbial pollution events caused by combined sewer overflows in a source-to-sea system.

Predicting peak microbial pollution events in downstream coastal bathing waters caused by combined sewer overflows (CSOs) is essential for protecting public health. In urban areas, wastewater effluents, CSOs, and surface runoff can contribute to elevated microorganism loads to downstream waters. These pressures are likely to be intensified by growing population density and more frequent heavy rainfalls due to climate change. This study developed a process-based model to simulate Escherichia coli (E. coli) emissions, transport, and fate from the initial sources to coastal beaches. A three-year retrospective simulation (2017-2019) shows that E. coli concentrations in CSO discharges varied widely across the catchment (4.6 - 7.3 (log10 CFU 100 ml-1)). 99th percentile E. coli concentrations (4.0 (log10 CFU 100 ml-1)) at the inland water outlet were dominated by local CSO emissions, whereas 90th percentile E. coli concentrations (3.6 (log10 CFU 100 ml-1)) reflected cumulative upstream contributions from both CSO and effluent emissions. With the simulation accuracy of 89%, the model reliably reproduced the E. coli dynamics on the downstream beach and showed strong performance in representing peak concentrations based on Complementary Cumulative Distribution Function (CCDF) analysis. The process-based model enables quantitative tracking of source contributions and identification of pollution hotspots, providing support for mitigation measures. The study lays down a source-to-sea modelling framework for representing pollution transport across the aquatic continuum and provides a transferable tool for microbial pollution forecasting and climate adaptation planning.

Climate projection

Environmental interventions and therapeutic outcome.

An eveluation study to determine whether intensive environmental interventions for individual patients help their psychotherapeutic progress was conducted at a community mental health center serving a multi-ethnic, inner-city catchment area with multiple social stressors. Using the Kiresuk-Sherman goal attainment scaling method for therapeutic and environmental goals, researchers analyzed outcome levels of a random sample of 150 patients. Ninety-two of those patients received both psychotherapeutic and environmental interventions, 37 received only psychotherapy, and 21 received only environmental interventions. Evaluation indicated that environmental goal attainment effectively predicted therapeutic outcome among high-, moderate-, and low-success groups.

Community Mental Health Centers