Access to healthcare services during the COVID-19 pandemic: a cross-sectional analysis of income and user-access across 16 economically diverse countries

Background: National health systems have different strengths and resilience levels. During the COVID-19 pandemic, resources often had to be reallocated and this impacted the availability of healthcare services in many countries. To date there have been few quantitative contemporary studies of inequalities in access to healthcare within and between countries. In this study, we aim to compare inequality within and between 16 economically diverse countries. Methods: Online surveys were conducted on 22 150 adults in 16 countries across six continents in 2022. Quota sampling and post-stratification weighting was used to obtain an age, gender, geographically, and educationally representative sample. The study assesses the differences in challenges in access to healthcare during the pandemic (for GP, surgical/clinical and digital GP services) using country-specific expanded health-needs-adjusted Erreygers’ concentration indices and compares these values between countries using a Spearman’s rank correlation coefficient. Results: Results show wide variation in income-related challenges in access within countries for different types of care. For example, Erreygers’ concentration index for digital services in Colombia exhibited highly regressive inequality at 0·17, compared to Japan with an index of -0·15. Inequalities between countries were also evident, with Spearman rank coefficients of -0·69 and -0·65 (p-values of 0·003 and 0·006) for digital and surgical access, indicating that lower income countries had greater inequality in healthcare access challenges. Conclusion: During the pandemic, inequalities in challenges to accessing healthcare were greatest in low and middle-income countries. Digital technologies offer a reasonable means to address some of this inequality if adequate support is provided and accessible digital infrastructure exists

Metals, dust and the cosmic microwave background: fragmentation of high-redshift star-forming clouds

We investigate the effects of the Cosmic Microwave Background (CMB) radiation field on the collapse of prestellar clouds. Using a semi-analytic model to follow the thermal evolution of clouds with varying initial metallicities and dust contents at different redshifts, we study self-consistently the response of the mean Jeans mass at cloud fragmentation to metal line-cooling, dust-cooling and the CMB. In the absence of dust grains, at redshifts z < 10 moderate characteristic masses (of 10s of Msun) are formed when the metallicity is 10^{-4} Zsun < Z < 10^{-2.5} Zsun; at higher metallicities, the CMB inhibits fragmentation and only very large masses (of ~ 100s of Msun) are formed. These effects become even more dramatic at z > 10 and the fragmentation mass scales are always > 100s of Msun, independent of the initial metallicity. When dust grains are present, sub-solar mass fragments are formed at any redshift for metallicities Z > 10^{-6} Zsun because dust-cooling remains relatively insensitive to the presence of the CMB. When Z > 10^{-3} Zsun, heating of dust grains by the CMB at z > 5 favors the formation of larger masses, which become super-solar when Z > 10^{-2} Zsun and z > 10. Finally, we discuss the implications of our result for the interpretation of the observed abundance patterns of very metal-poor stars in the galactic halo.Comment: 9 pages, 5 figures, MNRAS, accepte

The Origin and Kinematics of Cold Gas in Galactic Winds: Insight from Numerical Simulations

We study the origin of Na I absorbing gas in ultraluminous infrared galaxies motivated by the recent observations by Martin of extremely superthermal linewidths in this cool gas. We model the effects of repeated supernova explosions driving supershells in the central regions of molecular disks with M_d=10^10 M_\sun, using cylindrically symmetric gas dynamical simulations run with ZEUS-3D. The shocked swept-up shells quickly cool and fragment by Rayleigh-Taylor instability as they accelerate out of the dense, stratified disks. The numerical resolution of the cooling and compression at the shock fronts determines the peak shell density, and so the speed of Rayleigh-Taylor fragmentation. We identify cooled shells and shell fragments as Na I absorbing gas and study its kinematics. We find that simulations with a numerical resolution of \le 0.2 pc produce multiple Rayleigh-Taylor fragmented shells in a given line of sight. We suggest that the observed wide Na I absorption lines, = 320 \pm 120 km s^-1 are produced by these multiple fragmented shells traveling at different velocities. We also suggest that some shell fragments can be accelerated above the observed average terminal velocity of 750 km s^-1 by the same energy-driven wind with an instantaneous starburst of \sim 10^9 M_\sun. The bulk of mass is traveling with the observed average shell velocity 330 \pm 100 km s^-1. Our results show that an energy-driven bubble causing Rayleigh-Taylor instabilities can explain the kinematics of cool gas seen in the Na I observations without invoking additional physics relying primarily on momentum conservation, such as entrainment of gas by Kelvin-Helmholtz instabilities, ram pressure driving of cold clouds by a hot wind, or radiation pressure acting on dust. (abridged)Comment: 65 pages, 22 figures, accepted by Astrophys. J. Changes during refereeing focused on context and comparison to observation

The Formation of the First Low-Mass Stars From Gas With Low Carbon and Oxygen Abundances

The first stars in the Universe are predicted to have been much more massive than the Sun. Gravitational condensation accompanied by cooling of the primordial gas due to molecular hydrogen, yields a minimum fragmentation scale of a few hundred solar masses. Numerical simulations indicate that once a gas clump acquires this mass, it undergoes a slow, quasi-hydrostatic contraction without further fragmentation. Here we show that as soon as the primordial gas - left over from the Big Bang - is enriched by supernovae to a carbon or oxygen abundance as small as ~0.01-0.1% of that found in the Sun, cooling by singly-ionized carbon or neutral oxygen can lead to the formation of low-mass stars. This mechanism naturally accommodates the discovery of solar mass stars with unusually low (10^{-5.3} of the solar value) iron abundance but with a high (10^{-1.3} solar) carbon abundance. The minimum stellar mass at early epochs is partially regulated by the temperature of the cosmic microwave background. The derived critical abundances can be used to identify those metal-poor stars in our Milky Way galaxy with elemental patterns imprinted by the first supernovae.Comment: 14 pages, 2 figures (appeared today in Nature

The Characterisation of an Adrenergic Signalling System Involved in the Encystment of the Ocular Pathogen Acanthamoeba spp.

The aim of this study was to identify and characterise the receptor system involved in controlling encystment in Acanthamoeba using specific agonists and antagonists and to examine whether endogenous stores of catecholamines are produced by the organism. Acanthamoeba trophozoites suspended in axenic growth medium were exposed to adrenoceptor agonists and antagonists to determine which compounds promoted or prevented encystment. Secondly, trophozoites were cultured in medium containing a catecholamine synthesis inhibitor to investigate the effect this had on natural encystment. Non-specific adrenoceptor agonists including epinephrine, isoprotenerol and the selective β1 adrenoceptor agonist dobutamine were found to cause >90% encystment of Acanthamoeba trophozoites compared to 55%. Cultures of Acanthamoeba with the catecholamine synthesis inhibitor α-methyl-p-tyrosine significantly reduced the level of amoebic encystment compared to controls. In conclusion Acanthamoeba appear to contain a functional adrenergic receptor system of unknown structure which is involved in initiating the encystment process that can be activated and blocked by β1 agonists and antagonists respectively. Furthermore the presence of this receptor system in Acanthamoeba indicates that topical β adrenoceptor blockers may be effective adjunct therapy by reducing the transformation of trophozoites into the highly resistant cyst stage. This article is protected by copyright. All rights reserved

Computational Eulerian Hydrodynamics and Galilean Invariance

Eulerian hydrodynamical simulations are a powerful and popular tool for modeling fluids in astrophysical systems. In this work, we critically examine recent claims that these methods violate Galilean invariance of the Euler equations. We demonstrate that Eulerian hydrodynamics methods do converge to a Galilean-invariant solution, provided a well-defined convergent solution exists. Specifically, we show that numerical diffusion, resulting from diffusion-like terms in the discretized hydrodynamical equations solved by Eulerian methods, accounts for the effects previously identified as evidence for the Galilean non-invariance of these methods. These velocity-dependent diffusive terms lead to different results for different bulk velocities when the spatial resolution of the simulation is kept fixed, but their effect becomes negligible as the resolution of the simulation is increased to obtain a converged solution. In particular, we find that Kelvin-Helmholtz instabilities develop properly in realistic Eulerian calculations regardless of the bulk velocity provided the problem is simulated with sufficient resolution (a factor of 2-4 increase compared to the case without bulk flows for realistic velocities). Our results reiterate that high-resolution Eulerian methods can perform well and obtain a convergent solution, even in the presence of highly supersonic bulk flows.Comment: Version accepted by MNRAS Oct 2, 2009. Figures degraded. For high-resolution color figures and movies of the numerical simulations, please visit http://www.astro.caltech.edu/~brant/Site/Computational_Eulerian_Hydrodynamics_and_Galilean_Invariance.htm

Bringing democracy back home: Community localism and the domestication of political space

Strategies of localism have constituted the community as a metaphor for democracy and empowerment as part of a wider reordering of state institutions and state power. In conflating the smallest scale with increased participation, however, community localism provides a framework through which the power of sociospatial positioning might be made vulnerable to resistance and change. This paper identifies four spatial practices through which marginalised communities apply the technology of localism to challenge the limitations of their positioning and imprint promises of empowerment and democracy on space. Drawing on the work of Judith Butler, the paper theorises these practices as the incursion into the public realm of regulatory norms related to domestic and private spaces, rendering political space familiar and malleable, and suggesting that power and decision making can be brought within reach. It is argued that these spatial practices of community rehearse a more fundamental transformation of the political ordering of space than that authorised by the state strategies of localism. © 2014 Pion and its Licensors

Galaxy Formation Theory

We review the current theory of how galaxies form within the cosmological framework provided by the cold dark matter paradigm for structure formation. Beginning with the pre-galactic evolution of baryonic material we describe the analytical and numerical understanding of how baryons condense into galaxies, what determines the structure of those galaxies and how internal and external processes (including star formation, merging, active galactic nuclei etc.) determine their gross properties and evolution. Throughout, we highlight successes and failings of current galaxy formation theory. We include a review of computational implementations of galaxy formation theory and assess their ability to provide reliable modelling of this complex phenomenon. We finish with a discussion of several "hot topics" in contemporary galaxy formation theory and assess future directions for this field.Comment: 58 pages, to appear in Physics Reports. This version includes minor corrections and a handful of additional reference

Cancellous bone and theropod dinosaur locomotion. Part I—an examination of cancellous bone architecture in the hindlimb bones of theropods

This paper is the first of a three-part series that investigates the architecture of cancellous (‘spongy’) bone in the main hindlimb bones of theropod dinosaurs, and uses cancellous bone architectural patterns to infer locomotor biomechanics in extinct non-avian species. Cancellous bone is widely known to be highly sensitive to its mechanical environment, and has previously been used to infer locomotor biomechanics in extinct tetrapod vertebrates, especially primates. Despite great promise, cancellous bone architecture has remained little utilized for investigating locomotion in many other extinct vertebrate groups, such as dinosaurs. Documentation and quantification of architectural patterns across a whole bone, and across multiple bones, can provide much information on cancellous bone architectural patterns and variation across species. Additionally, this also lends itself to analysis of the musculoskeletal biomechanical factors involved in a direct, mechanistic fashion. On this premise, computed tomographic and image analysis techniques were used to describe and analyse the three-dimensional architecture of cancellous bone in the main hindlimb bones of theropod dinosaurs for the first time. A comprehensive survey across many extant and extinct species is produced, identifying several patterns of similarity and contrast between groups. For instance, more stemward non-avian theropods (e.g. ceratosaurs and tyrannosaurids) exhibit cancellous bone architectures more comparable to that present in humans, whereas species more closely related to birds (e.g. paravians) exhibit architectural patterns bearing greater similarity to those of extant birds. Many of the observed patterns may be linked to particular aspects of locomotor biomechanics, such as the degree of hip or knee flexion during stance and gait. A further important observation is the abundance of markedly oblique trabeculae in the diaphyses of the femur and tibia of birds, which in large species produces spiralling patterns along the endosteal surface. Not only do these observations provide new insight into theropod anatomy and behaviour, they also provide the foundation for mechanistic testing of locomotor hypotheses via musculoskeletal biomechanical modelling