Greer Humphrey, Gillian E. Caughey, Tracy Air
et al.
Objective: To study the trends in incident aged care service use among Aboriginal and Torres Strait Islander Australians. Methods: Annual incidence of aged care use among Aboriginal and Torres Strait Islander people (2010–2019) were evaluated using the Registry of Senior Australians Historical Cohort and Australian Bureau of Statistics population estimates. Trends were examined by incident rate ratios (IRRs) using Poisson or negative binomial regression adjusted for age, sex and remoteness. Results: Among 15,106 individuals, incident aged care assessments increased from 10.6/1000 [95% confidence interval [CI]: 9.7–11.1) in 2010 to 14.6/1000 (95%CI: 14.0–15.2) in 2019 (IRR=1.04/year, 95%CI: 1.03–1.05). Incident aged care service use increased from 7.4/1000 (95%CI: 6.8–8.0) to 9.7/1000 (95%CI: 9.2–10.2; IRR=1.02/year, 95%CI: 1.01–1.03). Increases occurred in metropolitan and regional areas, with the greatest increase observed for home care packages (≥8% annually). In remote areas, the use of home care packages decreased by ≥5% annually. Conclusions: Increased use of aged care programs is encouraging. However, declining use in remote areas highlight the need for improved access to aged care. Implications for Public Health: Equitable access and use of aged care services will require the reforms underway to incorporate Aboriginal and Torres Strait Islander preferences for aged care.
Abstract Background Diabetes mellitus significantly elevates the risk of sepsis and exacerbates its clinical outcomes, leading to increased mortality rates. Despite the importance of this association, the demographic and geographic patterns influencing it remain inadequately understood. Methods Utilizing data from CDC WONDER (1999–2020), we conducted an analysis of mortality trends among U.S. adults aged 65 and older, stratified by gender, race/ethnicity, and geographic region. Age-adjusted mortality rates (AAMRs) and annual percentage changes (APCs) were evaluated using the Joinpoint Regression methodology. Results Between 1999 and 2020, there were a total of 287,738 deaths attributed to diabetes and sepsis. The AAMR decreased from 33.6 per 100,000 population in 1999 to 27.7 in 2014; however, it subsequently surged to 38.4 by 2020 (APC: 13.65). The male AAMRs reached a peak of 39.1 in 2005, declined to 31.2 in 2012, and then increased to 46.9 in 2020 (APC 12.29). Female AAMRs decreased from 32.6 in 1999 to 24.8 in 2018, before rising again to 31.9 in 2020 (APC 13.66). Among African Americans, mortality declined to 46.3 in 2019 but experienced a sharp increase to 65.7 in 2020 (APC 20.52). The Hispanic AAMR also increased during this period (APC 25.05). The southern region consistently exhibited the highest mortality rates, rising from 31.7 in 2018 to 42.5 in 2020 (APC 13.69), with notable rises observed in the Midwest (APC 14.59). All these trends were statistically significant (p < 0.05). Furthermore, non-metropolitan areas consistently demonstrated higher mortality rates, with significant increases observed between 2018 and 2020. Conclusion The mortality rates associated with diabetes-related sepsis have recently risen, particularly between 2018 and 2020, thereby highlighting significant health disparities. It is essential to implement targeted healthcare interventions.
The rapid pace of urban growth in the 21st century has transformed cities into complex and interconnected systems that extend far beyond their municipal boundaries. As urbanisation intensifies, the terminology associated with city expansion-particularly metropolitan areas and metropolitan regions-is frequently used interchangeably, even though they represent conceptually distinct spatial, functional, and governance entities. Understanding the difference between these two frameworks is essential in urban and regional planning, transport planning, public policy, and sustainable development. This paper provides a comprehensive comparative analysis of metropolitan areas and metropolitan regions by examining their definitions, boundaries, functional characteristics, governance structures, socio-economic influence, and planning implications. Drawing insights from global examples and detailed case studies from India-including Delhi NCR, Mumbai MMR, and Bengaluru BMR-the paper highlights key similarities and contrasts and argues that while metropolitan areas represent the compact, continuous urban footprint, metropolitan regions reflect a broader sphere of economic, functional, and socio-spatial influence extending into peri-urban and rural territories. The study underscores the importance of adopting regionally integrated planning approaches to address contemporary challenges, such as transportation connectivity, land-use fragmentation, environmental stress, and socio-economic disparities. It concludes by emphasizing the need for coordinated governance models and integrated metropolitan regional planning frameworks to support sustainable urban futures.
This thesis reconceptualizes American metropolitan areas as dissipative thermodynamic structures governed by non-equilibrium dynamics. Drawing on process philosophy, non-equilibrium thermodynamics, and information geometry, I analyze 386 MSAs using publicly US Census data from 2006–2024 (2020 excluded due to data disruption).Among 102 major US MSAs, 9 (8.5%) meet all criteria for confirmed dissipative structures, with 46.2% operating in the dissipative regime; 340 MSAs (88%) exhibit predominantly geodesic demographic trajectories with a mean geodesic efficiency η of 72.6%. Furthermore, only one manifold tearing event was found to have occurred (2008 Financial Crisis), creating societal transformative changes; But 95.6% of MSAs showed adiabatic (resilient) responses to the 2008 crisis and 91.3% to COVID-19, with zero non-adiabatic classifications. Validation confirms non-equilibrium dynamics (p=0.023).The findings challenge equilibrium-based urban planning, suggesting policy should focus on managing flows and enabling adaptive capacity rather than optimizing fixed forms. A surprising result was the universal adiabatic response of all major MSAs surveyed, suggest great resilience in medium to large American cities while refuting the “urban doom” thesis following the COVID-19 pandemic.All source codes are available at: http://github.com/rogerwzeng/dissipative-urbanismKeywords: dissipative structures, non-equilibrium thermodynamics, information geometry, urban complexity, process philosophy, metropolitan dynamics, demographic flows
Many countries measure poverty based only on income or consumption. However, there is a growing awareness of measuring poverty through multiple dimensions that captures a more reasonable status of poverty. Estimating poverty measure(s) for small geographical areas, commonly referred to as poverty mapping, is challenging due to small or no sample for the small areas. While there is a huge literature available on unidimensional poverty mapping, only a limited effort has been made to address special challenges that arise only in the multidimensional poverty mapping. For example, in multidimensional poverty mapping, a new problem arises involving estimation of relative contributions of different dimensions to overall poverty for small areas. This problem has been grossly ignored in the small area estimation (SAE) literature. We address this issue using a multivariate hierarchical model implemented via a Bayesian method. Moreover, we demonstrate how a multidimensional poverty composite measure can be estimated for small areas. In this paper, we demonstrate our proposed methodology using a survey data specially designed by one of us for multidimensional poverty mapping. This paper adds a new direction to poverty mapping literature.
Space-time area laws play a fundamental role in modeling strongly interacting phenomena, such as in relativistic string models, QCD on the lattice, and in hadronization modeling. For the latter, an exact expression for relevant space-time areas related to the final state hadronic events for hadrons of any mass is calculated. Usage of this expression in the UCLA hadronization model helps validate its space-time area law (STAL) principle and unifies the treatment of heavy and light hadrons via a single fragmentation function.
Abstract Scientific and reasonable source-sink matching is an important basis for the site selection of CCUS (i.e., Carbon capture, utilization and storage) cluster deployment project. In this study, deep saltwater layer, depleted oil and gas reservoir and unrecoverable coal field in Anhui province are the research objects. Firstly, the evaluation methods of CO2 storage potential of multi-type geological bodies are discussed, respectively. Secondly, the methods of source-sink matching of CCS and its pipe network optimization are discussed. Then the application schemes of CCS source-sink matching and its cluster deployment are established. The results show that the cumulative CO2 emissions of 27 active coal-fired power plants in Anhui province are nearly one trillion tons during the 30-year planning period. The geological storage potential of CO2 is 899.08 × 108 t, and the deep saltwater layer has absolute storage advantage. After the optimization, the total amount of CO2 stored in saltwater layer is 9198.72 million tons, and the cumulative planning pipeline is 684.37 km, which requires a cumulative capital of 5.20*1011 $, and pipeline planning and accumulated capital can save 67.19% of pipeline length and 26.01% of total capital, respectively. The CCS cluster deployment in Anhui province can focus on Huaibei coalfield, Huainan coalfield, Hefei metropolitan area, and Yangtze River Economic Belt, and should give full play to the advantages of saltwater layer layout. Demonstration projects should be built in clusters to simplify the overall layout of CCS pipe network. Connecting C23 and C25, C27 and C10, and C18 and C13 can connect the four CCS cluster deployment areas in Anhui province into a whole. This study can provide theoretical support for the cluster deployment and demonstration project implementation of CCS in Anhui province.
The purpose of this article is to propose a novel model of the effects of changes in shelter and driving costs on car commuting distances in the overheated Toronto housing market from 2011 to 2016. The model borrows from theoretical concepts of microeconomics and urban geography to examine the Toronto housing market. Using 2011 and 2016 Census data for census metropolitan areas (CMAs) and census agglomerations (CAs) in Southern Ontario and computed driving costs, the model of car commuting distance is based on variables of allocation of monthly household income to monthly shelter costs and driving costs as a function of the car driving distance to Toronto. Using this model, we can predict the effect on car commuting distance due to changes in any of the variables. The model also offers an explanation for communities of Toronto car commuters beyond a driving radius that we might expect for daily commuting. The model confirms that increases in shelter costs in the Toronto housing market from 2011 to 2016 have forced the boundaries of feasible housing locations outward, and forced households to move farther away, thus increasing car commuting distance.
Sudipan Saha, Tushar Verma, Dario Augusto Borges Oliveira
With the global population on the rise, our cities have been expanding to accommodate the growing number of people. The expansion of cities generally leads to the engulfment of peripheral areas. However, such expansion of urban areas is likely to cause increment in areas with increased land surface temperature (LST). By considering each summer as a data point, we form LST multi-year time-series and cluster it to obtain spatio-temporal pattern. We observe several interesting phenomena from these patterns, e.g., some clusters show reasonable similarity to the built-up area, whereas the locations with high temporal variation are seen more in the peripheral areas. Furthermore, the LST center of mass shifts over the years for cities with development activities tilted towards a direction. We conduct the above-mentioned studies for three different cities in three different continents.
This paper introduces a physically-intuitive notion of inter-area dynamics in systems comprising multiple interconnected energy conversion modules. The idea builds on an earlier general approach of setting their structural properties by modeling internal dynamics in stand-alone modules (components, areas) using the fundamental conservation laws between energy stored and generated, and then constraining explicitly their Tellegen's quantities (power and rate of change of power). In this paper we derive, by following the same principles, a transformed state-space model for a general nonlinear system. Using this model we show the existence of an area-level interaction variable, intVar, whose rate of change depends solely on the area internal power imbalance and is independent of the model complexity used for representing individual module dynamics in the area. Given these structural properties of stand-alone modules, we define in this paper for the first time an inter-area variable as the difference of power wave incident to tie-line from Area I and the power reflected into tie-lie from Area II. Notably, these power waves represent the interaction variables associated with the two respective interconnected areas. We illustrate these notions using a linearized case of two lossless inter-connected areas, and show the existence of a new inter-area mode when the areas get connected. We suggest that lessons learned in this paper open possibilities for computationally-efficient modeling and control of inter-area oscillations, and offer further the basis for modeling and control of dynamics in changing systems comprising faster energy conversion processes.
We introduce extremal affine surface areas in a functional setting. We show their main properties. Among them are linear invariance, isoperimetric inequalities and monotonicity properties. We establish a new duality formula, which shows that the maximal (resp. minimal) inner affine surface area of an $s$-concave function on $\mathbb{R}^n$ equals the maximal (resp. minimal) outer affine surface area of its Legendre polar. We estimate the ``size" of these quantities: up to a constant depending on $n$ and $s$ only, the extremal affine surface areas are proportional to a power of the integral of $f$. This extends results obtained in the setting of convex bodies. We recover and improve those as a corollary to our results.
Resumo Este artigo propõe uma possibilidade de leitura do espaço urbano por meio da metodologia apresentada por Ewing e Clement (2013) no livro Measuring urban design. Essa metodologia foi aplicada em um trecho da área central da cidade de Laguna/SC tombada pelo Instituto de Patrimônio Histórico e Artístico Nacional nos anos 1980, por sua relevância histórica e cultural, o que determina quais espaços públicos de uma cidade são mais atrativos à presença humana em detrimento de outros, quais são as qualidades perceptíveis desse espaço e como essas qualidades podem ser mensuradas. Os resultados iniciais indicam que a metodologia proposta é adequada para identificar e mensurar as qualidades perceptíveis do ambiente urbano, tanto em áreas urbanas patrimoniais quanto nas demais áreas.
The field of pathology, often regarded as the bedrock of accurate medical diagnosis and treatment, stands at a pivotal juncture in the Philippines. With the rapid advancement of technology and evolving healthcare needs, we find ourselves asking: Quo Vadis? Where is the practice of pathology headed in our country, and what steps must we take to ensure its growth and relevance in the coming years?
Pathology in the Philippines has witnessed remarkable progress over the past decade. Advances in diagnostic techniques, improved laboratory infrastructure, and the dedication of our medical professionals have contributed to more accurate and timely diagnoses. However, significant challenges remain that must be addressed to ensure the continued development and effectiveness of pathology practice.
One of the most pressing issues is the unequal distribution of pathology services across the archipelago. While metropolitan areas boast well-equipped laboratories and a concentration of pathologists, many rural regions still lack access to basic diagnostic facilities. This disparity results in delayed diagnoses and suboptimal patient outcomes. Addressing this inequity requires strategic investments in telepathology and mobile diagnostic units to extend quality care to underserved areas.
Another challenge is the need for sustained funding and resources for pathology research and education. The rapid pace of technological advancements necessitates continuous learning and adaptation. However, financial constraints often hinder the ability of institutions to provide ongoing training and invest in cutting-edge diagnostic tools. Increased government support and private sector involvement are essential to bridge this gap and foster a culture of innovation within the pathology community.
Despite these challenges, the future of pathology in the Philippines is brimming with potential. Several transformative opportunities can propel the practice to new heights and ensure its alignment with global standards.
Digital pathology is one such opportunity that holds immense promise. By digitizing tissue slides and employing advanced imaging techniques, we can facilitate remote consultations and second opinions from experts around the world. This not only improves diagnostic accuracy but also reduces the turnaround time for critical diagnoses. Embracing digital pathology requires investment in the necessary infrastructure and training programs to equip pathologists with the skills needed to navigate this new paradigm.
Artificial intelligence (AI) is another frontier that can revolutionize pathology practice. AI-powered algorithms can assist in the interpretation of complex patterns in tissue samples, enhancing the precision and speed of diagnoses. Collaborative efforts between pathologists and data scientists can lead to the development of robust AI tools tailored to the unique needs of our healthcare system. These tools can augment the capabilities of pathologists, allowing them to focus on more complex and nuanced cases.
Furthermore, the integration of personalized medicine into pathology practice offers a transformative approach to patient care. By identifying specific genetic markers and tailoring treatment plans accordingly, pathologists can contribute to more effective and targeted therapies. This requires a concerted effort to incorporate genomic technologies into routine practice and to ensure that pathologists are proficient in interpreting genetic data.
To navigate the future of pathology practice in the Philippines effectively, several strategic initiatives must be undertaken. First and foremost, we need a comprehensive national strategy that prioritizes equitable access to diagnostic services. This includes expanding telepathology networks, establishing regional centers of excellence, and incentivizing pathologists to work in underserved areas.
Investment in education and training is equally crucial. Pathology residency programs should be enhanced to include training in digital pathology and AI applications. Continuing medical education (CME) programs should be made readily available to practicing pathologists to keep them abreast of the latest developments in the field.
Collaboration between government, academic institutions, and the private sector is essential to drive innovation and research. Public-private partnerships can facilitate the funding of research projects and the acquisition of advanced diagnostic tools. These collaborations can also help in developing standardized protocols and guidelines that ensure the consistent and accurate application of modern technologies.
The question of "Quo Vadis?"—where are we going? —invites us to envision a future where pathology practice in the Philippines is not only robust and innovative but also equitable and accessible to all. By addressing current challenges and embracing opportunities for transformation, we can chart a course toward a healthcare system where every Filipino has access to timely and accurate diagnoses. The journey ahead requires collective effort, strategic planning, and an unwavering commitment to excellence. Let us move forward with determination and optimism, knowing that the future of pathology in the Philippines holds great promise.
We prove that the number of dissections of a given polygon into triangles with fixed areas of faces is finite and that an equidissection is algebraic as long as the vertices of the original polygon have algebraic coordinates.
Resumo O presente artigo tem como objetivo compreender os processos de inovação social engendrados pelas práticas de agricultura urbana na cidade de Florianópolis. Apresentamos os resultados de um estudo de caso qualitativo intrínseco, realizado tendo como referência uma perspectiva pragmatista e o quadro analítico-metodológico da etnografia de arenas públicas. A partir de uma cartografia do campo de práticas de agricultura urbana na cidade, identificamos três grandes dinâmicas de inovação social situadas em três diferentes arenas públicas: a dos resíduos sólidos orgânicos, a do direito humano à alimentação adequada e a dos ciclos de produção e consumo. Os resultados auxiliam a compreensão da complexidade dos processos de inovação social e suas implicações para a governança na cidade.
Andrea Membretti, Fabio Lucchini, Monica Gilli
et al.
Even when they have access to housing and employment, international migrants struggle to develop their own agency, i.e. the capacity to act in their own life contexts, exercising citizenship rights within substantive inclusion processes in the wider communities. The territorial context in fact, especially in rural and mountainous areas such as the Alpine ones analysed here, seems in many ways to represent a limit to the development of capacities and exercise of rights. Difficulties in accessing public space and public sphere, scarce social recognition, low status, housing isolation (as is the case of those who live in small mountain villages), professional ghettoisation: these are factors that, even in presence of an acceptable working and housing inclusion, make it difficult for international migrants to exercise their rights, to have their skills recognised, and, ultimately, to develop an agency genuinely linked to their capabilities.
In this article, with reference to the action-research activities carried out in 2020-22 by the Horizon2020 MATILDE project in the Italian Alpine areas of South Tyrol and the Metropolitan City of Turin, attention is focused on the policies that could favour the effective migrants’ agency in mountain territories.
Most of the residents’ daily travel is concentrated within their 15-min walking distance. In China, derived from the 15-min city concept, the 15-min walkable area is often referred to as the 15-min pedestrian-scale neighborhood, and it has become a basic planning unit. Understanding the factors that influence the built environment of the 15-min pedestrian-scale neighborhood on the residents’ daily travel carbon emissions is critical to reduce urban carbon emissions. There may be spatial heterogeneity in daily travel carbon emissions as a dependent variable due to the spatial heterogeneity of built environment factors. Therefore, this study used data from the Wuhan City Resident Travel Survey to describe the spatial pattern of daily travel carbon emissions among Wuhan residents. The study examined the spatial heterogeneity of daily travel carbon emissions and explored the spatial differentiation of the built environment’s impact on daily travel carbon emissions within the 15-min pedestrian-scale neighborhood of the residents using spatial autocorrelation analysis and multi-scale geo-weighted regression (MGWR). The results indicate that Wuhan residents’ daily travel carbon emissions show an increasing circle structure from the center outward. In general, built environment elements in the 15-min pedestrian-scale neighborhood are closely related to the daily travel carbon emissions, and the direction and degree of impact of the built environment varies spatially. This study provides empirical evidence for controlling transportation carbon emissions.
Engida Yisma, Vincent L Versace, Martin Jones
et al.
<h4>Background</h4>In Australia, the distribution of occupational therapists, physiotherapists, and podiatrists density (per 10,000 population) by measure of location/rurality, usual resident population, and area-level socioeconomic status has not been described.<h4>Objective</h4>To describe the national as well as states-and territories-wide distribution of registered allied health workforce-occupational therapists, physiotherapists, and podiatrists-by measures of rurality and area-level socioeconomic position in Australia.<h4>Methods</h4>A linked data study that brings together (1) the location of health practitioners' principal place of practice from the Australian Health Practitioner Regulation Agency, (2) a measure of location/rurality-Modified Monash Model (MMM), and (3) an area-level measure of socioeconomic status-Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD). The provider-to-population ratio (i.e., density) of three Australia's allied health workforce (occupational therapists, physiotherapists, and podiatrists) was calculated according to the MMM classifications (i.e., Modified Monash 1-7) and IRSAD quintiles at state and national level.<h4>Results</h4>Nationwide, the density of occupational therapists and physiotherapists was highest in metropolitan areas (Modified Monash 1) and decreased with the increasing levels of the MMM categories. The national density of podiatrists was highest in Modified Monash 3 areas. The density of occupational therapists, physiotherapists, and podiatrists was highest in areas with IRSAD quintile 5 (i.e., the highest socioeconomic position) and decreased with the declining levels of the IRSAD quintiles nationwide. Moreover, there were notable disparities in the density of occupational therapists, physiotherapists, and podiatrists across each state and territory in Australia when stratified by the MMM classifications and IRSAD quintiles.<h4>Conclusions</h4>There was uneven distribution of registered occupational therapists, physiotherapists, and podiatrists when stratified by measures of location/rurality and area-level socioeconomic status across Australian jurisdictions. The density of these three groups of allied health workforce tended to be more concentrated in metropolitan and most advantaged areas while remote and most disadvantaged areas exhibited less allied health workforce distribution across each state and territory.
Corey Adams RN, GradDipPsych, MBA, Anthony Schembri BSW(Hons), GDipPubAdmin, MPP, Ashfaq Chauhan MHM, MIPH, BPT, PhD
et al.
Patients from ethnic minority backgrounds often experience disparities in healthcare quality and outcomes. This study aimed to compare the patient-reported experiences of patients with limited English proficiency (LEP) to general patients in the Australian healthcare setting. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used to evaluate patient experiences from patients in a metropolitan public healthcare network, spanning three hospitals. Level of English proficiency was based on primary language spoken at home. To identify disparities in experience ratings between patients with LEP and the general cohort, independent t -tests were employed. Data was analysed from 2,291 patients, collected over a five-year period (2017–2022), with 490 patients identified as LEP (i.e. speaking a language other than English at home). Statistically significant differences were identified between the cohorts, with LEP patients rating their experiences higher in three areas: doctors listening carefully, doctors explaining in a way they could understand, and quietness at night. Conversely, patients with LEP scored lower in areas regarding nursing respect and responsiveness to call bells. Although patients with LEP had a more positive overall experience, this difference was not statistically significant. The findings indicate potential misalignment between the often poorer health outcomes among people from ethnic minority backgrounds and their experiences in hospital. Additional research is crucial to delve into the unique experiences of ethnic minority patients, including those with LEP, to understand the differences influencing perceptions of care and contributing to disparities in health outcomes.
George Jó Bezerra Sousa, Geraldo Lucas Alves Monte, Davi Gomes Sousa
et al.
ABSTRACT: Objective To analyze the spatiotemporal pattern of tuberculosis incidence and its associated factors. Methods: Ecological study, which used tuberculosis notifications during 2001-2017 and as units of analysis the municipalities of the state of Ceará of the Notifiable Diseases Information System. Time pattern analysis techniques and geographically weighted regression were used. Results: The gross incidence rate in the state reached a peak of 226.1/100 thousand inhabitants with a significant decrease of 1.9% per year (95%CI −3.0–−0.7). The main clusters were identified in Fortaleza and its metropolitan region, as well as in the Sobral region. The socioeconomic indicators that were associated with the incidence were: occupation in the agricultural sector and services, population in households with bathrooms and running water and vulnerable to poverty. Conclusion: There was a significant decrease in the incidence of the disease in the state of Ceará. The spatial clusters were mostly located in areas with high population and the indicators most related to the formation of spatial clusters were related to employment/income, housing and vulnerability.