To examine the response of long‐term care (LTC) residential facilities to the COVID‐19 pandemic worldwide, and the antecedents and outcomes of this response.A protocol of a cross‐sectional survey.Two online questionnaires will be used to collect data from LTC residential facilities' managers and staff worldwide. Collected data include participants' socio‐demographic characteristics, facility‐related characteristics, facility response to the COVID‐19 pandemic, and possible influences of the pandemic on staff, residents, and residents' families. Data collection has started in April 2021. Data analyses will be conducted on the pooled sample and stratified by the type of facility, participants, or country if required. Multi‐level regression analysis will be considered to account for participants' data clustering in countries and facilities.The data collection is ongoing. The findings would guide policy‐makers and healthcare organizations to reform their protocols for the best interest of facilities, staff, residents, and residents' families. In the present study, these variables are of three types: country‐, facility‐, and staff‐related variables.To examine how LTC residential facilities' response to the COVID‐19 pandemic influenced facilities' staff, residents, and residents' families. In the current study, the influence of the pandemic refers to the reported difference between “during the pandemic” and “before the pandemic” statuses of certain variables. In the present study, these variables are of three types: staff‐, resident‐, and residents' family‐related variables.The specific research questions of the current study are as follows.How did LTC residential facilities respond to the COVID‐19 pandemic?What are the predictors of LTC residential facilities' response to the COVID‐19 pandemic?How did LTC facilities' response to the COVID‐19 pandemic influence their staff, residents, and residents' families?Three hypotheses were set for the current study . We assume that the scope of care and type of residents would vary among LTC facilities with and without a nurse. Despite the absence of strong evidence to support this assumption, the authors believe this inclusion criterion would increase the homogeneity of the study sample.A facility that agrees to participate in the study.The study will be conducted in a convenience sample of LTC residential facilities anywhere in the world that could adhere to the study protocol. A country will be eligible for participation if it includes at least 10 LTC residential facilities. To date, 15 countries have participated in the study: Australia, Brazil, Egypt, Hong Kong, Indonesia, Japan, Norway, Portugal, Saudi Arabia, South Korea, Spain, Thailand, Turkey, the United Kingdom, and the United States of America. Research collaborators in each country will be responsible for recruiting LTC facilities for participation in the study see . Variati2.3This study will include participating facilities' managers and direct care staff. Participants will be recruited by research collaborators in each country see  section.2.4A convenience sampling approach will be used in this study. The rationale for adopting the convenience sampling technique is three‐fold. First, using random sampling necessitates having a sampling framework ; such a framework might be missing or difficult to obtain in many countries, particularly in developing countries. Existing databases may not give complete information that allows researchers to judge the facility’s eligibility for the current study. Therefore, adopting a convenience sampling approach facilitates the conduct of the study by enabling researchers to involve facilities they already know as being eligible. Second, the current research is self‐supported at local study settings, and therefore, no commuting fees compensation will be given to research collaborators. Convenience sampling allows recruiting easy‐to‐access facilities and limits the need to commute to distant areas. Third, the workload in most LTC facilities worldwide has been increasing during the pandemic. This lowers facilities’ tendency to agree to participate in the research, particularly when the facilities are not acquainted with the researchers. Convenience sampling allows researchers to involve facilities with which they already have connections, which saves the time and efforts of research collaborators.In terms of sample size, there will be no restrictions on the number of countries, facilities, or participants. To minimize the demerits of the convenience‐based sampling approach and increase the representativeness of the sample, we will attempt to include countries from the six continents and increase the homogeneity of the sample by pre‐defining eligibility criteria for both settings and participants. Besides, we will strive to include at least 10 facilities and at least 100 staff members from each country. Specifying a minimum required sample per country was set to prevent under‐ or over‐representation of any country in the overall sample. The minimum required sample per country was decided after a thorough discussion between the research management team and research collaborators in participating countries. The sample size of each country will be reported in the final report and will be considered before pooling data from different countries.2.5before the pandemic” to refer to the period before January 2020 and the term “during the pandemic” to refer to the period from January 2020 to the date of filling the questionnaire.Save for the country‐related data, data of the current study are self‐reported data collected using two questionnaires: the managers' questionnaire and the staff questionnaire. Questionnaires will collect data about the situation before and during the COVID‐19 pandemic. The COVID‐19 pandemic was announced to be a Public Health Emergency of International Concern on January 30, 2020 , economic status , healthcare status , and COVID‐19‐related statistics  will be gathered from publicly available data. Data sources include but are not limited to the World Health Organization and the World Bank.2.5.3The survey will collect data about manager’s characteristics , staffing pattern in the facility , facility characteristics , and residents’ characteristics . The survey will also collect data about the situation before the COVID‐19 pandemic, such as the presence of infection control education and the presence of airborne infection‐related policy.2.5.4Participating staff’s demography, qualification, work experience, motivation to work with older people, and source and ease of getting information about COVID‐19 will be elicited. The survey will also assess whether the participant is working across different facilities, has experienced social discrimination because of the job, lives with an older person, and whether any household members tested positive for SARS‐CoV‐2.2.5.5Strongly agree,” “4 = Somewhat agree,” “3 = Undecided,” “2 = Somewhat disagree,” and “1 = Strongly disagree.” Further, the number of staff who tested positive for SARS‐CoV‐2 and those quarantined or passed away because of COVID‐19 will be assessed.The survey will examine the impact of the pandemic on staff absenteeism, shortage, turnover, intention to leave the job, workload, work stress, work satisfaction, work‐life balance, and the frequency of committing medication errors. Each of these outcomes will be assessed using a single item question, and responses are elicited on a 5‐level Likert scale. An example item is, “Compared to the situation before the COVID‐19 pandemic, your work‐life balance increased,” with five response options: “5 = 2.5.6Strongly agree,” “4 = Somewhat agree,” “3 = Undecided,” “2 = Somewhat disagree,” and “1 = Strongly disagree.” The number of residents who tested positive for SARS‐CoV‐2 and those hospitalized or passed away because of COVID‐19 will also be assessed. In the current study, residents' outcomes were assessed by managers and staff instead of residents themselves for two reasons. First, since researchers were not allowed to enter LTC facilities in many countries due to the pandemic, and data would be collected only online, involving residents in the current study would require the facility manager or staff to recruit residents, explain to them the purpose of the study, and help them in responding to questions when needed. This would place additional efforts and load on staff and might negatively affect facilities and staff willing to participate in the study. Second, several research collaborators of the current study reported that involving residents would substantially lengthen the time needed for getting Research Ethics Committee approval in their countries, which threatens the feasibility of the data collection.The survey will examine the impact of the pandemic on residents' fall rate, aggressive behaviours, feeling of loneliness and social isolation, feeling down and hopeless, physical condition, skin problems, and cognitive status. Each of these outcomes will be assessed using a single item , and responses will be elicited on a 5‐level Likert scale: “5 = 2.5.7Compared to the situation before the COVID‐19 pandemic, the frequency of making complaints by residents' families increased); response options are “5 = Strongly agree,” “4 = Somewhat agree,” “3 = Undecided,” “2 = Somewhat disagree,” and “1 = Strongly disagree.” Like residents' outcomes, family outcomes were assessed by managers and staff instead of residents' families themselves for two reasons. First, since families were refrained from visiting their relatives in LTC facilities in many countries amid the pandemic, it is highly probable that researchers will not have the opportunity to meet residents' families and will not be able to recruit them for participation. Requesting facility staff to carry out the recruitment process would place additional efforts and load on already loaded and busy staff. Second, several research collaborators of the current study reported that involving residents' families would substantially lengthen the time needed for getting Research Ethics Committee approval in their countries, which threatens the feasibility of the data collection.The survey will examine the impact of the pandemic on the frequency of making complaints by residents' families and their aggressive behaviours. Each of these outcomes will be assessed using a single item  and dealt with according to their pattern . Research collaborators will obtain Research Ethics Committee and administrative approval from study settings, following their national regulations. The cover page of the questionnaire will explain the study’s purpose and assure anonymity, confidentiality, and the right to refuse to participate in the study. The cover letter will also state that the completion and return of the questionnaire would be regarded as consent for participation. Further, a question asking participants if they want to participate in the study will be included; only participants who respond “Yes, I agree” will be included in the analysis. No personal or facility identification  are collected. Each participating facility will be anonymously coded using a 1‐ to 4‐digit code assigned by research collaborators at the time of the data collection; this code will be linked to each survey response whenever the participant responds.3Acknowledgement section of the final report. Research collaborators may use data of the current study for secondary analysis, publishing in scientific journals, or presenting in academic conferences; requests are addressed to and should be approved in advance by the principal investigator. Approval may be given after a written mutual agreement on what data will be used and co‐authors of the secondary publication. Some requests may be declined to prevent duplicate and salami‐slicing publication. Research collaborators are not allowed to use any of the data collected in this study for any purpose without written approval from the principal investigator.Researchers participating in international studies are often referred to as authors, collaborators, contributors, research group, or collaborative group, and an explicit distinction between researchers' roles is often lacking. The current protocol clearly defines participating researchers' roles and contributions to prevent possible conflicts or unethical authorship. The International Committee of Medical Journal Editors  defines 4The current study is expected to identify strength and vulnerability areas in LTC residential facilities' response to the COVID‐19 pandemic, variables associated with better responses, and response actions associated with better outcomes. The findings, therefore, would give real‐world research‐driven data that may help countries, institutions, and staff improves their performance during future infection outbreaks. To the best of our knowledge, this would be among the first international studies on the topic. The results are expected to show deficiency and strength areas in LTC facilities' response to the pandemic, which would help managers and policy‐makers identify areas that need attention and improvement. The results are also expected to show which response actions were associated with better outcomes, which helps facilities with low resources prioritize their actions. Besides, the current study is expected to identify factors associated with better response and better outcomes, which may help the development of proactive strategies to achieve better response and better outcomes.Study protocol publication enhances research transparency, reduces publication bias, and informs the scientific community about what studies are being done, which helps avoid duplication and better coordinate research efforts. Making study protocols publicly available also has the benefit of disseminating the most contemporary ideas concerning study design and data analysis (Ohtake & Childs, A major challenge in the current study is the period of data collection, which was planned to take up to 1 month. This period, however, was extended for 6 months for three reasons. First, obtaining Research Ethics Committee approval in some countries was lengthy and took up to 8 months, which delayed the beginning of the data collection in these countries. Second, many countries were hit by the third wave of the COVID‐19 pandemic at the time of the data collection, which disturbed the schedule of research collaborators and hindered accomplishing the data collection on time. Third, most LTC facilities were overwhelmed with the care process and vaccinating the residents, engaged in other research, or both, making many facilities decline participation in this research. Future research needs to consider these challenges in designing and planning international surveys in similar contexts.4.1Certain limitations of the current study merit mention. First, as mentioned above, several issues had led to extending the period of data collection, which might hinder cross‐country comparisons. To account for this issue, the period of data collection in each country will be reported in the final report and will be considered before pooling data from different countries. Second, the current study was planned and commenced before the initiation of any COVID‐19 vaccination and before the global widespread of different SARS‐CoV‐2 variants. Therefore, the current study did not take into account the contribution of vaccination nor different variants on the studied outcomes. Third, despite the strict eligibility criteria adopted to recruit LTC facilities and participants for the current study, participating facilities and subjects might still show a degree of variation. The authors believe that such variability is inevitable, and its influence on the validity and generalizability of the results would be minimal. The current survey was developed taking into account that items could be broad enough to fit all types of LTC facilities in all participating counties, to be easily responded to by study participants, and to give useful and sufficient information for assessing the actual situation in each participating facility. Fourth, resident‐ and family‐related outcomes will be sought from the facility managers and staff instead of residents and families themselves, which may raise questions about the validity of these outcomes. Finally, different sources of response bias exist. This includes convenience sampling and recall bias, and subjectivity and social desirability of self‐reported data.Sameh Eltaybani: Conceptualization, Writing—Original Draft, Writing—Review and Editing, Project administration. Haruno Suzuki, Ayumi Igarashi, Mariko Sakka and Yuko Amamiya: Conceptualization, Writing—Original Draft, Writing—Review and Editing. Noriko Yamamoto‐Mitani: Conceptualization, Writing—Original Draft, Writing—Review and Editing, Supervision.None declared.Not applicable for this research.


Objectives: In this communication, we wish to remember the important historical role played by Marcel Proust’s father, the now mostly forgotten Achille-Adrien Proust (1834–1903). Study Design and Methods: His career, scientific interests and, above all, his brilliant intuitions and suggestions in the fight against cholera in the 19th century are recalled. Results and Conclusions: His role in the promotion of a globally effective vision of public hygiene and health is stressed as a bright example for modern physicians fighting contemporary epidemics. In the centenary of the death of the celebrated French writer Marcel Proust 1871–1922), the author of the masterpiece “À la recherche du temps perdu” , it is important to remember his father, the famous physician and public health official Achille-Adrien Proust (1834–1903), who was a pioneer of public hygiene, setting up a fruitful policy against the spread of epidemics. The importance of this learned author has been overshadowed by his son’s posthumous fame . He When he came back, he was awarded the Legion of Honour from the Empress-Regent Eugénié . That thAt a conference held in Venice in 1892 he played a considerable role by adopting, against certain proposals of England, conclusions which indicated, with precision, the method to be followed to reconcile the interests of public health and universal commerce, that often conflicted.Endowed with great activity, Proust published numerous works, both on pathology and on hygiene.professeur agrégé on the different forms of softening of the brain [Among his medical works, his doctoral thesis on essential pneumothorax , his thehe brain  and a laNonetheless, international hygiene was Dr Proust’s great concern, and since his trip to the East, he never ceased to occupy himself with the means of defence that should be opposed to major epidemics, as evidenced by the brilliant reports that he often communicated on the origin and progress of these scourges through different peoples. His numerous publications on this subject are summarized in an important treatise on private and public hygiene, in which ethnography, demography and international hygiene, which has taken on such great development in recent years, are united . WrittenIn his various works about international hygiene, Proust endeavoured to illustrate the terrestrial routes and the sea routes followed by the great epidemics. He pursued the creation of an international health union, which, while respecting the sovereignty of States and their sensitivities, would have a non-executive but moral power, capable of overcoming resistance and coordinating the efforts of the various governments.He died in Paris on 26 November 1903.At the middle of the 19th century, France was the leader of Western clinical medicine and played a very important role in hygiene, too . As in mIn this conflict, more deaths of French soldiers occurred due to the smallpox epidemic than to the war because the French military contingent had not been vaccinated, unlike the German one. From this period onwards, doctors engaged in politics in large numbers as deputies and senators.Société de médecine publique et d’hygiène professionnelle was founded in Paris. Apollinaire Bouchardat, professor of Hygiene at the Sorbonne Faculty of Medicine, joined it, together with the greatest exponents of French medicine and biology and some members of the Académie de médecine, the École vétèrinaire, the École d’Anthropologie, the Conservatoire des arts et métiers, as well as the head of the Statistique municipale de la Ville de Paris service and numerous politicians.In 1877, the Societé was divided into different sections, each of which dealt with a specific subject: hygiène de l’enfance, hygiène urbaine et rurale, hygiène industrielle et professionnelle, prophylaxie des maladies contagieuses, hygiène alimentaire, hygiene internationale et administrative and démographie et statistique.In 1889, in fact, the This public health process was possible thanks to a widespread hygienist movement supported by the works of Pasteur (1822–1895), which paved the way to the birth of microbiology and provided the explanation of the role played by microorganisms in the emergence and development of disease in humans and animals.The concept of “hygiene”, between the end of the 19th century and the beginning of the 20th century did not only indicate the set of individual and public prevention rules against diseases but had a broader value, including a real “lifestyle”.Bibliothèque d’Hygiène Thérapeutique, published by Masson in Paris, which included many texts dedicated to various pathologies, from gout to tuberculosis, from syphilis to obesity, can be considered paradigmatic. The cover of the books included in the series was illustrated with a representation of Hygieia (Ὑγεία), the Greek goddess of health. The purpose of this collection was to form a true treatise on “Therapeutic Hygiene”, each volume being dedicated to a single disease or to a single group of diseases. Adrien Proust was the editor.From this point of view, the In 1869, the minister of Agriculture and Commerce sent Adrien on a hard journey to Russia and Persia to determine by which route cholera had arrived from Russia during the 1832 epidemic. He returned to Paris via Mecca, Turkey, and Egypt, thus following the route of the epidemics of 1849 and 1866.He traced the routes of the great epidemics, taking an interest in their spread during the pilgrimage to Mecca, and paying great attention to hygiene in transport, especially maritime transport.Proust proposed an international endeavour to prevent the spreading of epidemics, reactivating the sanitary cords, theorizing systematic containment and rigorous sequestration, interrupting communications by land or by sea. In Proust’s view the international hygiene was a much bigger question than the nations’ frontiers, and he considered countries where the cholera epidemic began spreading as a sort of barrier to protect Europe, especially when the first cases would have been identified and early interventions of isolation and other preventive measures would have been adopted .As he had studied the outbreak phenomena well, he maintained that quarantines “close to the starting point of the disease” are of unquestionable effectiveness but if prescribed too late, they can even become harmful. He recommended keeping distance from the sick people and the washing hands and face frequently. The “cordon sanitaire” (sanitary cordon) would create a border whereby nations would collaborate to enforce a strict quarantine for ships entering their waters. However, the Suez Canal Company raised strong objections to his proposals, and so a fifth cholera epidemic occurred in 1884, carried by ships that had passed through the Canal. The spreading was limited to Toulon and Marseilles, as State-enforced cordons sanitaires around these towns successfully prevented the spread of cholera to other parts of France.As Inspector General of Sanitary Services, Adrian Proust participated in the Conference of Vienne (1874), proposing the establishment of an international health organization permanent office known as the Office International d’Hygiene Publique.During the ninth conference, held in Paris in 1894, Proust gave a summary of the outcome of previous international sanitary conferences since 1851, and insisted on the need not only for sanitary surveillance of the Red Sea and the Persian Gulf but also for adequate precautions to be applied to pilgrim ships at their ports of departure. However, too many European countries had a direct interest in the Mecca Pilgrimage: Britain, the Netherlands, France and Russia and Austria-Hungary. During the conference, Robert Koch (1943–1910) affirmed that the 10-year struggle over the nature of cholera was at an end, but different opinions persisted for a long time among “contagionists” and “localists” [Despite Proust’s efforts, at the tenth Venice conference in 1897, his idea was not met with success, and the proposals made for cholera containment were only arranged for plague: It was only in 1908, 5 years after Proust’s death, that a specific convention was signed, providing a coordinating body to fight against the terrible triad of plague, yellow fever and cholera.Nowadays, we have vaccines available, but in the past, quarantine and sanitation were the only methods to limit the spread of epidemics. We have learned from the epidemics of the past and from the COVID-19 global emergency that, to stop pandemics, we must control the circulation of host and virus: Inter-human contagion and cellular attack depend on the transfer of people across borders and viruses across cell membranes . The IHR


The United Nations’ First and Second World Ocean Assessments UN , 2021 al3Framework for a Pacific Oceanscape, with its overarching vision of “a secure future for Pacific Island Countries and Territories based on sustainable development, management, and conservation of our Ocean” connect different scales , spaces , temporalities , and/or stakeholders  Riera . This moThe special section ‘Oceania: A Sea of Connections’ endeavors to contribute to this relational thinking through a focus on the Pacific Ocean and its fisheries. It emerged from the research project ‘A Sea of Connections: Contextualizing Fisheries in the South Pacific Region’ , species , values , management instruments and processes , and stakeholders . The juxtaposition of these case studies allows us to minimize, “on the one hand, the myopic scholarly tendency to study individual island communities in relative isolation, and on the other, homogenizing views of Oceania that arise not only from foreign clichés, but also from the unifying rhetoric of affirmative regionalist paradigms” Looser : 467. ThPacific Islands and Oceania.” his region:ocean of connection among Islanders”  becoming a “primary symbol for both local sovereignty and connectivity across a considerable portion of the globe”  boundaries of the South Pacific, reflecting how the Oceanian diaspora around the world has struck “roots in new resource areas, securing employment and overseas family property, expanding kinship networks through which they circulate themselves, their relatives, their material goods, and their stories” (Hau’ofa 1994: 155). As illustrated by Tongans and Samoans living in Brisbane, Australia, the Oceanian diaspora usually remains connected to its homelands, while maintaining its spiritual, familial, social, and cultural connectivity across different locations and generations; a connectivity that is expressed through ‘material cultural adaptations’ and spatial behaviors, and which is essential to individual and collective wellbeing Faleolo .“The ocean that surrounds us is the one physical entity that all of us in Oceania share. It is the inescapable fact of our lives. [...] All of us in Oceania today, whether indigenous or otherwise, can truly assert that the sea is our single common heritage.” Hau’ofa : 38–39“Many of us today are not directly or personally dependent on the sea for our livelihood; and would probably get sea-sick as soon as we set foot on a rocking boat. This means only that we are no longer sea travelers or fisherfolk, but as long as we live on our islands we remain very much under the spell of the sea; we cannot avoid it.” Hau’ofa : 37“[...] the sea is our pathway to each other and to everyone else, the sea is our endless saga, the sea is our most powerful metaphor, the ocean is in us.” Hau’ofa : 43Hau’ofa’s “enlarged world of Oceania” Jolly : 532, inThis vision bares important implications for local-to-regional governance of the Pacific Ocean. In particular, it reframes Oceania “from the sea to the shore”  inhabitants Gillett , increas*banua . Since the ‘renaissance of community-based marine resource management’ at the turn of the twenty-first century  are accepted or rejected in daily practices and across scaling phases. Their analysis of connectivity thus refers to the various social, political, and/or economic networks that local stakeholders  engage in, among other objectives, to coordinate fisheries management and ‘get things done.’ They also claim the need to move away from mosaicked landscapes of siloed projects and actor-groups, and toward an integrated national program relying on coordinated programmatic approaches.Another contribution deals with local perceptions and conceptualizations of a locally managed marine closure in Fiji’s neighboring country, Vanuatu. Pascht  highlighPlan de Gestion de l’Espace Maritime or PGEM). As argued by Wencélius et al. political angle by looking at how such connections are revived, redefined, or ignored through interactions and frictions between various stakeholders . Such processes do not unfold only on a local level, but also at the global scale. Notably, under the United Nations Convention on the Law of the Sea, the Commission on the Limits of the Continental Shelf provides nations-states with the ability to extend their exclusive economic zones over their continental shelves, which reduces the surface of the high seas . This case suggests that land-sea connections should not only be considered from the surface, but also from the depths of the ocean and water bodies. This aspect is touched on by Breckwoldt et al. (b) through their focus on reef passages. Reef passages are natural or human-made breaks and channels in the coastal and fringing reefs of many Pacific islands, and their depths seem to play an important  role for their functional characteristics, as well as the activities of many of its human and non-human users  call attention to the interrelated, multi-faceted, ecological, and socio-cultural connectivity that reef passages operate in within land-sea territories. Based on qualitative interviews with users  of these extremely important reef spaces, this study vitalizes—to our knowledge for the first time in the marine realm—the concept of ‘ecological and cultural keystone places,’ whose understanding and protection will strengthen and support both reef ecosystems and the people who depend on them. These reflections are critical today, as in many Pacific contexts, these keystone places are the subject of increasingly palpable customary claims and recognition processes  and thus forms “a common boundary” between these worlds by inhabiting them simultaneously, yet with “different identities in each” . The analysis of movements of marine species, sediments, nutrients, etc. from estuaries to offshore waters has increased the understanding of complex ecological processes. For instance, the movements of sea turtles, which connect feeding and breeding areas via variable and complex routes, constitute a ‘diffuse connection’ Spotila . Beyond A comprehensive view of ocean connectivity (including its embodiment and enactment) therefore requires the development of inter- and transdisciplinary research approaches and methodologies. An important contribution in this respect is the study by Harding et al. , where aiTaukei rules in better policy for sea turtle governance in Fiji in Kitolelei et al. All contributions to this special section explore ocean connectivity through the point of view of local and Indigenous communities . The contributions to this special section explore this view of the connecting ocean, while also weaving together various types of ecological connectivity. This allows for a more comprehensive understanding of human-ocean relations and their potential implications for the management and conservation of spaces and species within the land-sea continuum. We therefore propose to superimpose on Hau’ofa’s view of Oceania as ‘a sea of islands’ a conceptualisation of Oceania as ‘a sea of connections,’ highlighting the multiple meanings and expressions of ocean connectivity from/in Oceania.This ‘sea of connections’ shapes  a land-sea continuum, to be considered from both the surface and depths of the Pacific Ocean, and whose health and sustainability are essential to the well-being and future(s) of Oceanians. This land-sea continuum is home to ‘ecological and cultural keystone’ places and species that should be considered through inter- and transdisciplinary approaches to tackle their multi-faceted character. The very use of this expression, ‘a sea of connections,’ is intended to emphasize the need for an expanded notion of ‘ocean connectivity,’ one that is all at once what we might think of as geo-physical, biological, ecological, cultural, social, political, etc.More generally, this special section outlines timely linkages between: (1) the relational turn in the social sciences and humanities as well as among some sustainability scientists (West et al.


Linked data presents different social and ethical issues for different contexts and communities. The Statistics New Zealand Integrated Data Infrastructure (IDI) is a collection of de-identified whole-population administrative datasets that researchers are increasingly using to answer pressing social and policy research questions. Our work seeks to provide an overview of the IDI, associated issues for Māori , and steps to realise Māori data aspirations. In this paper, we first introduce the IDI including what it is and how it developed. We then move to an overview of Māori Data Sovereignty. Our paper then turns to examples of organisations, agreements, and frameworks which seek to make the IDI and data better for Māori communities. We then discuss the main issues with the IDI for Māori including technical issues, deficit-framed work, involvement from communities, consent, social license, further data linkage, and barriers to access for Māori. We finish with a set of recommendations around how to improve the IDI for Māori, making sure that Māori can get the most out of administrative data for our communities. These include the need to build data researcher capacity and capability for Māori, Māori data co-governance and accountability, reducing practical and skill barriers for access by Māori and Māori organisations, providing robust, consistent and transparent practice exemplars for best practice, and potentially even abolishing the IDI and starting again. These issues are being worked through via Indigenous engagement and co-governance processes that could provide useful exemplars for Indigenous and community engagement with linked data resources.


Objective: This was a large-scale multicenter study with two objectives. One was to study the factors influencing pedestrian smartphone use while crossing roads, and the other was to study the effect of combined visual and auditory intervention on smartphone zombies (smombies) at crossroads.Methods: This study was conducted in four different Chinese cities. By observing pedestrians crossing intersections, the weather, time, and characteristics of the pedestrians were recorded by four researchers. Then, its influencing factors and the effects of the intervention were studied in two consecutive periods.Results: A total of 25,860 pedestrians  were observed in this study. Logistic regressions showed that gender, age of the pedestrians, weather, and time were the factors influencing smombies crossing roads. The number of smartphone users decreased from 4,289 to 3,579 (28.1%)  when the intervention was conducted.Conclusion: Based on large-sample, multicenter research, this study revealed the factors influencing pedestrian smartphone use while crossing roads, contributing to our understanding of the current situation of smombies in China. Furthermore, the effect of visual and auditory intervention was demonstrated, providing a new paradigm for global prevention of smombie behavior. With the rapid advancement of the mobile internet, the functions of smartphones are becoming increasingly diversified, making smartphones indispensable in people’s work and lives. However, the massive use of smartphones is a double-edged sword. The term “smombie”, derived from “smartphone” and “zombie”, refers to pedestrians who use smartphones while walking . Gazing In Beijing, the percentage of pedestrian smartphone use while crossing varied from 11.7% to 21.8% , while iThe phenomenon of smombieism has attracted the concerns of researchers around the world. In addition to the prevalence of smombieism , 6, manyTherefore, the current study aims to explore the factors influencing pedestrian smartphone use and the effect of a potential intervention on smombies while crossing roads. Four cities  in different parts of China were selected as research sites to observe pedestrian smartphone use while crossing roads. In addition to the gender and age of the pedestrians, weather and time were also studied as potential factors in the first 11 days without intervention. In the next 11 days, combined visual and auditory intervention was taken to prevent pedestrians from using their smartphone while crossing the road. We hypothesized that ① variables influencing whether pedestrians are smombies while crossing the road include age, gender, weather, and time, and that ② visual and auditory intervention will prevent pedestrians from using smartphones while crossing the road.Here, we conducted a large-sample and multicenter observational study to explore the factors influencing pedestrian smartphone use and the effect of the potential intervention on smombies while crossing roads. Observing the pedestrians crossing the intersections, the factors influencing smartphone use while crossing the road were studied in the first 11 days without intervention. Then, visual and auditory intervention was performed over the next 11 days. The differences in pedestrian smartphone use between these two periods were compared to study the effect of visual and auditory intervention on smombies at crossroads.In the present study, the following four cities located in different parts of China were selected as research sites: Changchun (in northeast China), Lanzhou (in northwest China), Zhuzhou , and Luzhou (in southwest China). A crossroad near a residential area was randomly selected in each city.The study was conducted from 19 August 2020 to 9 September 2020, in the four selected cities. The observation time was from Monday to Sunday, 07:30–09:00 in the morning and 17:00–18:30 in the afternoon. Days with extremely bad weather such as heavy rain, hail, and gale were excluded.1) Pedestrians openly using smartphones while crossing a road who were defined as smombies;2) Pedestrians passing through the fixed zebra crossings (crossing both the first and last standard zebra crossings lines);3) Including but not limited to those jogging or walking (including those leading pets or pushing strollers);4) Only the accompanying person was included for wheelchair users with an accompanying person.The following pedestrians were included:A fixed zebra sign is shown in 1) Those who wore a watch (it is difficult for observers to judge whether the watch is a smartwatch);2) Bike riders or skateboarders;3) People who had severe visual disabilities (such as blind people);4) People at work ;5) Other unsafe behaviors while crossing the road, such as reading or looking for things with their head down.The following pedestrians were excluded:1) Not observed: The pedestrians did not openly carry or use smartphones;2) Talking: The pedestrians were making calls in a traditional way by holding the smartphones in their hands close to their ears and mouths;3) Earphones: The pedestrians were wearing earphones;4) Holding: The pedestrians had their smartphones in hand while crossing the road, but were not looking at the smartphones;5) Slight smombie: The pedestrians were looking at smartphone screens, but were not operating the smartphone screens directly;6) Severe smombie: The pedestrians were interacting with smartphones while crossing, such as operating the smartphones, typing on the screens, or using other functions of the smartphones.By drawing on and slightly modifying the existing research , 21, thiThe pedestrians with two established behaviors (or mixed categories) simultaneously were placed in the higher use category. For example, pedestrians wearing earphones and holding smartphones simultaneously were classified as “holding”.1) Under 10 years old: children aged 4–10;2) Aged 11–25: teenagers;3) Aged 26–44: young people;4) Aged 45–59: middle-aged people;5) Over 60 years old: older people.The researchers registered the gender and approximate age of the pedestrians based on perceived appearance. Gender was divided into the following two categories: male and female. The weather was divided into the following three categories: sunny, cloudy, and rainy. The time of day was divided into morning and afternoon. The time of the week was divided into weekdays and weekends. For the age of the pedestrians, five classes were used as follows:1) Safety warning signsTo study the effect of the intervention on preventing smartphone use while crossing the road, we intervened with pedestrians in the last 11 days. It should be pointed out here that the pedestrians who were study subjects on the 11 days of intervention did not necessarily coincide with those observed during the first 11 days. Considering smartphone distraction, this study proposed a combined visual and auditory measure to prevent pedestrians from using smartphones while crossing the road.2) Sound alertsThe “no smartphone” sign was placed at the intersections to remind pedestrians not to use smartphones while crossing the road. The safety warning sign is shown in A broadcasting device was placed near the safety sign, repeating “do not use smartphones while crossing the road”  in Chinese, to remind pedestrians in an auditory way.In this study, we had four researchers, one in each city, record the circumstances surrounding pedestrians using smartphones while crossing a road. We recorded smombie gender and age, the time and weather, and the types of smartphone use. Only the pedestrians who passed the preset zebra crossings and crossed the road in a specific direction were recorded. Pedestrians walking alone or in a group of four people or less were observed directly, while pedestrians in a group of more than four were videoed , 22 becaResearchers quickly registered the digital codes while observing. Male pedestrians were marked as 1, and female pedestrians were marked as 2. The different weather conditions were classified as 1, 2, and 3; the age groups were divided into 1, 2, 3, 4, and 5; and the different types of smartphone users were recorded as 1, 2, 3, 4, 5, and 6. For example, for a 23-year-old man wearing earphones while crossing a road on a sunny day, the code was 1231. In addition, the morning was marked as 1, while the afternoon was marked as 2; the weekday was marked as 1, while the weekend was marked as 2.p < 0.001). This process was performed by a supervisor other than the four researchers.In pre-observation, Kendall’s W test was used to check the consistency of results from the four different researchers. The results verified the consistency among researchers , in accordance with the Declaration of Helsinki.α = 0.05, the required sample size calculated by PASS software (version 15.0) is 2543. The formula is as follows: Previous studies have shown that the proportion of pedestrian smartphone use is approximately 30% , 6. If δAll statistical analyses were performed with SPSS (version 25.0) software. All variables were considered categorical . Bivariate and multivariate logistic regression analyses were used to analyze the impacts of the influencing factors on pedestrian smartphone use (two categories/multiple categories) and the effect of the combined visual and auditory intervention. In addition, chi-square tests were used to evaluate the significant differences with and without intervention.A total of 25,860 pedestrians  were observed in this study. The detailed descriptive statistical results of this study are shown in χ2 = 120.905, p < 0.001); smartphone use while crossing roads was most prevalent among 11 to 25-year-old people, followed by young people aged 24–44 , and was more prevalent on weekdays than on weekends . See By analyzing the usage rate of smartphones without intervention, it was found that women were more likely to use smartphones while crossing roads . Teenagers had the highest “earphone”, “holding”, “slight smombie”, and “severe smombie” rates among all age groups, and the “talking” rates in both the teenage and young people groups were much higher than those in the other groups  and “severe smombie”  were more prevalent in the afternoon than in the morning. See Further analysis of different types of pedestrian smartphone use revealed the distribution of different conditions. The “holding” rates were higher in women than in men . In terms of age, teenagers were more likely to use smartphones than elderly pedestrians , followed by young people . In terms of weather, pedestrians were more likely to use smartphones on sunny days  and cloudy days (OR 1.781 95% CI 1.477–2.147) than on rainy days. Pedestrians were also found to be more likely to use smartphones in the afternoon  and on weekdays . See For the multivariate logistic regression analysis, the results were more complicated, as shown in In the category of “talking”, teenagers were the most likely to be on a call while crossing the road  and young people  and middle-aged people  followed.Regarding the category of “earphones”, teenagers were the most likely to wear earphones while crossing the road . Following these were young people . Pedestrians were more likely to use earphones in the morning  and on weekdays .With respect to “holding”, women were much more likely to hold smartphones than men . Teenagers were more likely to cross the road with their smartphones in their hands than older people . Young people were the second most likely to hold their phones , followed by the middle-aged group . Children were less likely to hold their smartphones than older people . Pedestrians were more likely to hold smartphones in the afternoon  and on weekdays .In the category of “slight smombie,” teenagers were more likely to be slightly more addicted to smartphone use than elderly pedestrians . Young people aged 26 to 44 were the second most likely to be in the “slight smombie” category , followed by the middle-aged group aged 45 to 59 .Similar to the situation in “slight smombie”, in the category of “severe smombie,” those aged 11 to 25 were more likely to use smartphones than elderly individuals , and young people aged 26–44 years  and middle-aged people aged 45–59 years  followed. Pedestrians were more likely to be in the “severe smombie” category in the afternoon .χ2 = 69.120, p < 0.001), smartphone usage rates with visual and auditory intervention were statistically lower than without intervention. See There were 4,289 pedestrians who used smartphones in the first 11 days of the study without intervention, accounting for 32.8% of the observed people. In the next 11 days, with the visual and auditory intervention, 3,579 pedestrians were found to have used smartphones, accounting for 28.1% of the observed people. Through chi-square tests , “slight smombie” , and “severe smombie”  decreased significantly. See The results on the effect of visual and auditory intervention on six categories showed that in comparison to those without intervention, the pedestrians with the intervention were more resistant to smartphones while crossing the road. The rates of “holding”  and men  in comparison to those without intervention. The smartphone usage rates were decreased in all age groups , except for young people aged 26–45 . Smartphone usage rates were also found to decrease on sunny days . The usage rates with intervention in the morning  and afternoon  also decreased, as well as those on weekdays  and weekends . See The distribution of smartphone usage with intervention showed that usage rates were decreased both in women  and men , young people , on sunny  and rainy days , in the afternoon , and on weekdays  and weekends . The “talking” rates showed no significant change in all conditions. See The “severe smombie” rates and the “holding” rates with the intervention were decreased in almost all conditions. The “slight smombie” rates were decreased both in women . Pedestrians with visual and auditory intervention were less likely to use smartphones than those without intervention . See Using bivariate logistic regression analysis, we found that the visual and auditory intervention reduced the risk of pedestrian smartphone use while crossing the road , “slight smombie” , and “severe smombie” . See The current study was a large-sample and multicenter observational study conducted in four cities in China with 25,680 pedestrians, which aimed to analyze the factors influencing pedestrian smartphone use while crossing roads, and the effect of visual and auditory intervention on smombie behavior. The results of this study showed that the proportion of pedestrian smartphone use while crossing roads was approximately one-third of the total number of observations, which is consistent with other studies [In our study, the smartphone usage rates among the pedestrians crossing the road were 32.8%. Among the smartphone users, the usage rates of women were higher than those of men; teenagers had the highest prevalence of smartphone use while crossing the road, and pedestrians were more inclined to use smartphones while crossing the road, in the afternoon, on weekdays, and in good weather. In particular, women were more inclined to “hold” than men; teenagers were more inclined to use almost all types of smartphones use.The bivariate logistic regression results showed that gender, age, weather, and time were the key factors influencing pedestrian smartphone use while crossing roads. In terms of gender, women were more likely to use their smartphones while crossing roads than men, which suggested that women might be more dependent on their smartphones. Previous studies have also confirmed the dependence of women on smartphones and attributed the phenomenon to their preference for social networks, in which reception and response to messages in a timely manner are necessary –25.Of all the age groups, teenagers were most likely to use smartphones while crossing the road. Byington et al.  exploredIn terms of weather, the results were consistent with actual experience that pedestrians were more likely to use their smartphones on fine days. These results further confirmed why traffic accidents relative to pedestrians occurred more often on fine days , 29.As we all have experienced, people are often short on time in the mornings when they go to school or work, but have plenty of time in the afternoon when they are leaving school or work. Therefore, it is not surprising that pedestrians are more likely to use smartphones in the afternoon. In addition, through our analysis of age, we found that the proportion of main users of smartphones (11–44 years) was much lower on weekends, which might explain the lower usage of smartphones on weekends compared to weekdays.The “holding” rates were highest in all different types of smartphone use, followed by “severe smombie”. In both the teenage and young people groups, the behavior of “talking” was prominent.Further multivariate logistic regression results found gender differences in the category of “holding”. Women were more likely to be “holding” their phones, which might be attributed to the season in which this study was conducted. We performed this study in summer, and the women’s clothes may have had no pockets for smartphones. Therefore, smartphones could only be held in their hand. Additionally, as women were more inclined to use smartphones for social networking , “holdinOn rainy days, the behavior of “holding” and “severe smombie” was much less than that on non-rainy days, which might be due to the risk of potential harm caused by rain. Similar to the bivariate analysis, almost all smartphone use was more likely to occur in the afternoon than in the morning; and more likely to occur on weekdays than weekends. This was the first study on the influence of weather and time on pedestrian smartphone use while crossing roads.With visual and auditory intervention, the smartphone usage rate decreased to 28.1%, which was significantly different from that without intervention. Specifically, the usage rates on “holding”, “slight smombie”, and “severe smombie” were significantly decreased compared to without intervention. Further analysis showed that our intervention was effective regardless of gender, age (except for young people), and time of day and week, suggesting that the combined visual and auditory intervention was generally available.Through logistic regression analysis with and without intervention, we further confirmed the effectiveness of visual and auditory intervention in reducing smartphone use behavior while crossing roads. Because of distracted concerns, a single visual or auditory stimulus might be ignored by smombies , 19. TheIt is important to note that there was no significant difference in the category of “talking” with and without intervention. This might be related to the instantaneous nature of talking , 32. EveUnexpectedly, the usage of “earphones” by pedestrians increased rather than decreased with intervention. We thought that might be related to the intervention we performed. In pedestrians’ opinion, wearing earphones was relatively safe . Thus, aTo the best of our knowledge, this study is the first large-sample, multicenter observation study on smartphone use while crossing roads. This study could reflect the current status of pedestrian smartphone use in China. Bivariate and multivariate logistic regression analyses were used to explore the influencing factors, such as gender, age, weather, and time. Moreover, visual and auditory intervention was used to prevent this behavior, and demonstrated an effect in reducing the use of smartphones while crossing the road.There are also some limitations to our study. First due to the potential bias in estimating some variables (such as age), the results might have been influenced, even though we converted the continuous variables to categorical variables. Second, there was only one observer in each city, and the results might be biased. Moreover, this study did not conduct a statistical analysis of the regional effects. Then, there was no unified standard for the classification of smartphone types, and the devices that earphones were connecting to were unknown. In addition, the findings might be influenced by the seasons we conducted this study in. Moreover, the exclusion of pedestrians wearing watches in this study might not be easily distinguishable for observers, and therefore, the actual percentage of smartphone use might have been higher. In addition, the visual and auditory intervention was proven effective in the short term, but the long-term effects were not studied. Last, although visual and auditory intervention effectively reduced smartphone usage, more than a quarter of the pedestrians still used their smartphones while crossing the road. Thus, other interventions should be considered in the future, such as pedestrian bridges or dedicated “smartphone sidewalks”.In summary, through this observational study, we found that smartphone use while crossing roads is common in four cities in China. Gender, age, weather, and time were the main factors influencing pedestrian smartphone use while crossing roads. Moreover, our findings also verified the effect of the combined visual and auditory intervention on smartphone use. To our knowledge, this study is the first large-sample, multicenter observational study on pedestrian smartphone use and the intervention for it, which might provide a reference for future research.