Small towns and the rural economy : a study of their contemporary functions and potential role in rural development

As Rural Development assumes a greater importance in European policy, one strategy to stimulate economic activity across a broad range of sectors is to use small towns as a focal point for economic development. This may be particularly relevant in the UK where there is increasing concern over the future vitality and viability of these towns. However, such a strategy rests on the assumption that there is a strong level of interdependence between small towns and their surrounding areas. While their historical legacy suggests close integration, developments in the wider economy and resultant socio-economic restructuring have undermined the traditional functions of small towns and may have severed many of these local linkages. Methodologies are developed to measure the size and spatial distribution of economic linkages in and around two small towns in rural England; one located in the 'remote' area of South Devon, and one in more 'accessible' Buckinghamshire. Results from two validation exercises indicate that self-completion methods are a useful means of obtaining spatial economic data from producers and consumers. Analysis compares the degree of economic integration of the towns into their respective local economies, and identifies key characteristics of firms and households that are good predictors of strong local integration. Results show that the strength of local economic integration is a function of economic and demographic structure as well as proximity to urban centres. This illustrates that the functional role of small towns in the economy is a more useful criterion on which to base policy recommendations than is demographic size. The town in the 'remote' rural area is found to be more strongly integrated into its locality than the town in the 'accessible' area; indicating that benefits of intervention are more likely to 'trickle out' into the surrounding area in the former case. Further, the minimal role of agriculture in the local economy implies that traditional measures of farm support are no longer likely to provide a valuable method of supporting rural communities. A useful area for subsequent enquiry would be to employ an 'integration index' to develop settlement typologies so that more generalisations can be made to aid the process of policy formulation

Basin bifurcations, oscillatory instability and rate-induced thresholds for AMOC in a global oceanic box model

The Atlantic Meridional Overturning Circulation (AMOC) transports substantial amounts of heat into the North Atlantic sector, and hence is of very high importance in regional climate projections. The AMOC has been observed to show multi-stability across a range of models of different complexity. The simplest models find a bifurcation associated with the AMOC `on' state losing stability that is a saddle node. Here we study a physically derived global oceanic model of Wood {\em et al} with five boxes, that is calibrated to runs of the FAMOUS coupled atmosphere-ocean general circulation model. We find the loss of stability of the `on' state is due to a subcritical Hopf for parameters from both pre-industrial and doubled CO${}_2$ atmospheres. This loss of stability via subcritical Hopf bifurcation has important consequences for the behaviour of the basin of attraction close to bifurcation. We consider various time-dependent profiles of freshwater forcing to the system, and find that rate-induced thresholds for tipping can appear, even for perturbations that do not cross the bifurcation. Understanding how such state transitions occur is important in determining allowable safe climate change mitigation pathways to avoid collapse of the AMOC.Comment: 18 figure

Alternative Financial Services as a Social Determinant of Health in U.S. Metropolitan Statistical Areas

Alternative financial services (AFS) such as payday lenders, pawn brokers, tax refund loans, and check cashers are more prevalent in minority and lower income neighborhoods. These are neighborhoods also found to have disparities in health, compared to more affluent neighborhoods and communities. The focus of this paper is to determine if any relationship exists between use of AFS and health disparities. Using data from a survey performed by the Federal Deposit Insurance Corporation (FDIC), we compared four banking variables to several measures of health for 85 metropolitan statistical areas (MSA) across the nation. The four banking variables all related to degrees of reliance on alternative financial services. The three health related measures were all-cause mortality, cancer mortality, and drug and alcohol related mortality. The regression analysis controlled for income, education, and relative size of the nonwhite population. We found that for all-cause mortality there is a statistically significant relationship between three of the four banking variables, in particular “Used an AFS” has a strong association with a coefficient of 0.25 and a p-value of 0.001. The conclusion of this analysis is that when use of AFS increases for an MSA, health status declines, as seen with all-cause mortality. This study adds evidence to establish a finer and often unrecognized dimension of “social determinants of health.

Alternative Financial Services and Health Status in U.S. Metropolitan Statistical Areas

Abstract Alternative financial services (AFS) such as, payday lenders, pawn brokers, tax refund loans, and check cashers are more prevalent in minority and lower income neighborhoods. These are neighborhoods also found to have disparities in health, compared to more affluent neighborhoods and communities. The focus of this paper is to determine if any relationship exists between use of AFS and health disparities. Using data from a survey performed by the Federal Deposit Insurance Corporation (FDIC), we compared four banking variables to several measures of health for 85 metropolitan statistical areas (MSA) across the nation. The four banking variables all related to degrees of reliance on alternative financial services. The three health related measures were all-cause mortality, cancer mortality, and drug and alcohol related mortality. The regression analysis controlled for income, education, and relative size of the nonwhite population. We found that for all-cause mortality there is a statistically significant relationship between three of the four banking variables, in particular “Used an AFS” has a strong association with a coefficient of 0.25 and a p-value of 0.001. The conclusion of this analysis is that when use of AFS increases for an MSA, health status declines, as seen with all-cause mortality. This study adds evidence to establish a finer and often unrecognized dimension of “social determinants of health.

A Method of Altering Coronal Plane Prosthetic Foot Stiffness for Studying its Effect on Amputee Gait

In an effort to understand the effects of prosthetic foot stiffness on amputee gait and mobility, it is useful to produce prototype prosthetic feet that differ in stiffness. While many commercial prosthetic feet are made out of carbon fiber, the manufacturing process is ill-suited to design experimentation as it is expensive, time consuming and requires tooling modifications to produce design changes. In order to facilitate a study of the effects of coronal plane prosthetic foot stiffness on amputee maneuvering gait, we are manufacturing custom prosthetic feet using a form of additive manufacturing, selective laser sintering (SLS), that was developed at the University of Texas at Austin. We have previously used SLS technology to create functional transtibial prosthetic sockets, ankle-foot orthoses, and prosthetic foot prototypes. To manufacture prosthetic feet with different stiffnesses, we first measured the stiffness profile of a commercially available carbon fiber prosthetic foot on an Instron 3345 (Norwood, MA) in two configurations where the foot was loaded to 114 kg in foot flat at 0° eversion and toe-only at 5° eversion positions. A computer aided design model of an SLS prosthetic foot was developed and adjusted to match the stiffness profile of the carbon fiber foot. Finite element analysis (SolidWorks Corp.; Waltham, MA) was then used to verify that the desired stiffness level was achieved. This process was repeated to create three prosthetic feet with altered coronal plane stiffness profiles (25% greater, 50% greater, and 25% less) while sagittal stiffness was held constant. The prototype feet were fabricated using selective laser sintering in a Vanguard HiQ/HS SLS Machine (3D Systems Corp.; Rock Hill, SC). Finally, the feet were mechanically tested in the same configurations as the carbon fiber foot to confirm that they had the desired stiffness profiles. Prototype feet closely matched the sagittal stiffness of the chosen prosthetic foot while coronal plane stiffnesses were approximately the same, 30% greater and 30% less than the carbon fiber foot. Future work will be to use these feet to observe the influence of coronal plane stiffness on amputee gait

Rash morphology as a predictor of COVID-19 severity:A systematic review of the cutaneous manifestations of COVID-19

Approximately 6% of those with COVID‐19 will experience cutaneous manifestations. Examining data from this cohort could provide useful information to help with the management of COVID‐19. To that end, we conducted a systematic review primarily to assess rash morphologies associated with COVID‐19 and their relationship with disease severity. Secondary outcomes include demographics, distribution, dermatological symptoms, timeline, diagnostic method and medication history. The literature was searched for all patients with skin manifestations thought to be related to suspected or confirmed COVID‐19. Patients with a history of dermatological, rheumatological or occupational skin disorders were excluded. Of the 2056 patients selected, the most common morphologies were chilblain‐like lesions (54.2%), maculopapular (13.6%) and urticaria (8.3%). Chilblain‐like lesions were more frequent in the younger population (mean age 21.5, standard deviation ± 10.8) and were strongly linked with milder disease, not requiring an admission (odds ratio [OR] 35.36 [95% confidence interval {CI} 23.58, 53.03]). Conversely, acro‐ischaemia and livedo reticularis were associated with worse outcomes, including a need for ICU (OR 34.01 [95% CI 16.62, 69.57] and OR 5.57 [95% CI 3.02, 10.30], respectively) and mortality (OR 25.66 [95% CI 10.83, 60.79] and OR 10.71 [95% CI 4.76, 24.13], respectively). Acral lesions were the most common site (83.5%). 35.1% experienced pruritus, 16.4% had pain and 4.7% reported a burning sensation. 34.1% had asymptomatic lesions. Rash was the only symptom in 20.9% and occurred before or alongside systemic symptoms in 12.4%. 28.3% had a positive polymerase chain reaction nasopharyngeal swab and 5.4% had positive antibodies, while 21.9% tested negative and 45.1% were not tested. In conclusion, COVID‐19 causes a variety of rashes, which may cause symptoms and add to morbidity. Rash type could be helpful in determining COVID‐19 prognosis

Partnering with pediatric patients and families in high reliability to identify and reduce preventable safety events

Frameworks for designing highly reliable behaviors and tools to reduce preventable harm are the result of the continued effort to improve patient safety in healthcare. Evidence shows that there has been limited research on engaging patients and families in the development of safety and reliability efforts to achieve zero harm. Our aim was to develop a tool that engages patients and families in an effort to reduce preventable harm in a pediatric academic medical center