Geographic access to family physicians in urban areas across Canada

Primary health care (PHC) is a term used to refer to the parts of the health system that people interact with most of the time when health care is needed. It is considered the first point of contact for health services in Canada. Access to PHC services is an important issue regarding health care delivery in Canada today. There is a need to advance current understanding of access to PHC providers at local scales such as neighbourhoods. The primary objective of this study is to examine the variation in geographic (spatial) accessibility to permanently located primary care services in the Canadian urban environment. Furthermore, the analysis of spatial patterns of accessibility, both visually and statistically using GIS, is to provide a better understanding of among and between neighbourhood variations. This research took place in the 14 urban areas across Canada: Victoria and Vancouver, British Columbia; Calgary and Edmonton, Alberta; Saskatoon, Saskatchewan; Winnipeg, Manitoba; Hamilton, and Toronto, Ontario; Montréal and Québec, Quebec; Halifax, Nova Scotia; St. John’s, Newfoundland; Saint John, New Brunswick; and Ottawa–Gatineau, Ontario and Quebec. A GIS based method, the Three-Step Floating Catchment Area (3SFCA), was applied to determine the spatial accessibility to PHC services (accessibility score). First, for increasing geocoding match rates with reduced positional uncertainty, an integrated geocoding technique was developed after an empirical comparison of the geocoding results based on manually built and online geocoding services and subsequently applied to generate geographic coordinates of PHC practices which are an essential element for measuring potential access to health care. Next, the results of the Three-Step Floating Catchment Area (3SFCA) method was compared with simpler approachs to calculate the City level physician-to-population ratios and this research highlights the benefit of using the 3SFCA method over simpler approaches in urban areas by providing similar or comparable results of City level physician-to-population ratios with the advantage of intra-urban measurements. Further, the results point out that considerable spatial variation in geographical accessibility to PHC services exists within and across Canadian urban areas and indicate the existence of clusters of poorly served neighbourhoods in all urban areas. In order to investigate the low accessibility scores in relation to population health care needs, spatial statistical modeling techniques were applied that revealed variations in geographical accessibility to PHC services by comparing the accessibility scores to different socio-demographic characteristics across Canadian urban settings. In order to analyse how these relationships between accessibility and predictors vary at a local scale within an urban area, a local spatial regression technique (i.e., geographically weighted regression or GWR) was applied in two urban areas. The results of GWR modelling demonstrates intra-urban variations in the relationships between socio-demographic variables and the geographic accessibility to PHC services. In addition, the influences of “unit of analysis” on accessibility score were analyzed using spatial statistical modeling that emphasize the use of units of analysis that are pertinent to policy and planning purposes such as city defined neighbourhoods. Overall, this research shows the importance of measuring geographic accessibility of PHC services at local levels for decision makers, planners, researchers, and policy makers in the field of public health and health geography. This dissertation will advance current understanding of access to primary care in Canadian urban settings from the perspective of the neighbourhood

Influence of the Natural and Built Environment on Personal Exposure to Fine Particulate Matter (PM2.5) in Cyclists Using City Designated Bicycle Routes

Urban cyclists are exposed to many traffic-related air pollutants including particulate matter (PM) that may increase vulnerability to health effects. This study investigates second-by-second personal exposure to PM2.5 (fine particulate matter that is 2.5 microns in diameter and less) along bicycle commuting paths, and assesses elements of the natural and built environment for the relative importance of these factors in understanding the variability in PM2.5 personal exposure. Urban cyclists were carrying high resolution PM2.5 monitors (placed in a backpack) in combination with portable GPS trackers to provide a spatial identity to each one-second pollutant measurement. The results of this study indicate that daily averages of PM2.5 concentrations from all bicycle routes were weakly correlated with meteorological variables, however, a strong influence of regional levels of PM2.5 was observed. Geospatial analysis of PM2.5 personal exposure concentrations showed a considerable variation within routes, correlated with land use (with lower concentrations in parks and higher in industrial areas) and clustered at four areas: busiest bridge, heavily trafficked road segments, the downtown urban core, and two construction sites. This study has found many incidences of personal exposure to PM2.5 exceeding the provincial guidelines for healthy activity (e.g., very poor (PM2.5 \u3e 91 μg/m3) pollution concentrations are clustered in three regions: approaching the bridge in the west part of the city; the downtown urban core; and two under construction spots), which suggests behavioural and infrastructure modifications in balancing the health benefits of cycling with the environmental exposure to air pollutants

Application of Nanofluids for Thermal Management of Photovoltaic Modules: A Review

Mounting temperature impedes the conversion efficiency of photovoltaic systems. Studies have shown drastic efficiency escalation of PV modules, if cooled by nanofluids. Ability of nanofluids to supplement the efficiency improvement of PV cells has sought attention of researchers. This chapter presents the magnitude of improved efficiency found by different researchers due to the cooling via nanofluids. The effect of factors (such as, nanoparticle size, nanofluid concentration, flowrate of nanofluid and geometry of channel containing nanofluid) influencing the efficiency of PV systems has been discussed. Collective results of different researchers indicate that the efficiency of the PV/T systems (using nanofluids as coolant) increases with increasing flowrate. Efficiency of these systems increases with increasing concentration of nanofluid up to a certain amount, but as the concentration gets above this certain value, the efficiency tends to decline due to agglomeration/clustering of nanoparticles. Pertaining to the most recent studies, stability of nanoparticles is still the major unresolved issue, hindering the commercial scale application of nanofluids for the cooling of PV panels. Eventually, the environmental and economic advantages of these systems are presented

Spatial accessibility to health care services: identifying under - serviced neighbourhoods in Canadian urban areas

Background Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC) in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods. Methods This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA) method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings. An index of spatial access to PHC services, representing an accessibility score (physicians-per-1000 population), was calculated for neighborhoods using a 3km road network distance. Information about primary health care providers (this definition does not include mobile services such as health buses or nurse practitioners or less distributed services such as emergency rooms) used in this research was gathered from publicly available and routinely updated sources (i.e. provincial colleges of physicians and surgeons). An integrated geocoding approach was used to establish PHC locations. Results The results found that the three methods, Simple Ratio, Neighbourhood Simple Ratio, and 3SFCA that produce City level access scores are positively correlated with each other. Comparative analyses were performed both within and across urban settings to examine disparities in distributions of PHC services. It is found that neighbourhoods with poor accessibility scores in the main urban settings across Canada have further disadvantages in relation to population high health care needs. Conclusions The results of this study show substantial variations in geographical accessibility to PHC services both within and among urban areas. This research enhances our understanding of spatial accessibility to health care services at the neighbourhood level. In particular, the results show that the low access neighbourhoods tend to be clustered in the neighbourhoods at the urban periphery and immediately surrounding the downtown area

Integrated use of aerial photographs and LiDAR images for landslide and soil erosion analysis: a case study of Wakamow Valley, Moose Jaw, Canada

Urban parks and open spaces offer a unique setting that can play a vital role in improving health and quality of life in cities and towns, making cities more attractive places to live and work, and connecting residents to nature. Degradation of park facilities caused by natural processes or recreational activities requires continuous monitoring for efficient maintenance and management. Identification and continuous monitoring of areas prone to natural hazards such as landslides within an urban park are particularly important for public safety. Traditional techniques for identification and monitoring of such areas involving field surveys, being costly and time-consuming, cannot be used on a regular basis. This research explored the integrated use of aerial photographs and point cloud LiDAR data for identification of areas prone to landslide and soil erosion zones in an urban park and a conservation area known as Wakamow Valley, Moose Jaw, Saskatchewan, Canada. This study used the point cloud LiDAR of 2014 to develop a Digital Elevation Model (DEM) of the area. The accuracy of the DEM was validated through a series of well-distributed ground control points collected through a survey grade handheld GPS device. The areas prone to potential landslides and soil erosion were identified using slope analysis techniques. A typical criterion of areas having a slope greater than 35° was used for classification of potential hazardous zones. Geospatial information including land-cover, land-use, and trail system was extracted from a 2014 aerial photograph to create a base map. It has been estimated that 5.3 km along the banks of the Moose Jaw River and 8 km along the cliff of the canyon-shaped Wakamow Valley are under a possible threat of soil erosion and landslides. This portion of the valley was classified as high-risk for possible landslides and soil erosion

Low dose albumin for the prevention of renal impairment following large volume paracentesis in cirrhosis.

OBJECTIVES: To evaluate the effect of low dose Albumin i.e. 4 grams per litre of ascitic fluid after large volume paracentesis (LVP) for the prevention of paracentesis induced circulatory dysfunction (PICD) related renal impairment in cirrhosis. METHODS: Case records of all patients with cirrhosis who underwent LVP from January 12(th), 2011 till December 29(th), 2013 were reviewed. Patients were excluded if they had spontaneous bacterial peritonitis, creatinine \u3e1.5 mg/dl, hepatoma or if volume of ascitic fluid removed was \u3c5 litres. Data including age, gender, cause of cirrhosis, CTP score and volume of ascitic fluid drained were noted. In addition serum creatinine and serum sodium at baseline and one week post paracentesis were recorded. RESULTS: Two hundred and fourteen patients with cirrhosis underwent LVP during the study period. One hundred and thirty nine patients met the inclusion criteria and were analyzed. Patients were divided into two groups based on the amount of albumin given. The amount of albumin given was 25 grams and 50 grams while the volume of ascitic fluid removed were 6.2±1 litres and 10.4±1.5 litres in groups A and B respectively. One hundred and eight patients were in group A while thirty one patients were in group B respectively. Both groups received albumin at a dose of 4 grams per litre of ascitic fluid removed. Mean age in both groups were 53 years. Hepatitis C was the commonest etiology in both the groups, followed by Hepatitis B. More than 70% patients in both the groups were in child class C. Serum creatinine at baseline and one week post LVP was 1.04±0.24 mg/dl and 1.07±0.35 mg/dl in GROUP A while 1.11±0.23 mg/dl and 1.41±0.94 mg/dl in GROUP B. (P value 0.35). Similarly, serum sodium at baseline and one week post LVP was 130 ±5.6 meq/lit and 129.6±5.9 meq/lit in GROUP A while 127.6±5.8 meq/lit and 128±6.2 meq/lit in GROUP B respectively. (P value 0.14). CONCLUSION: This study suggests that 4 grams of albumin per litre of ascitic fluid drained is effective in preventing the PICD related renal impairment following large volume paracentesis in cirrhosis

''Does Pakistan still have polio cases?": Exploring discussions on polio and polio vaccine in online news comments in Pakistan

Introduction: Polio, which is caused by poliovirus, is a contagious, potentially crippling, and deadly disease. Pakistan is one of the countries in which polio is still endemic in the 21st century. In 2019, 146 polio cases were reported across the country with some resulting in deaths. Following the spread of rumors insinuating that children were falling sick after receiving an anti-polio vaccine, a mob attacked and set fire to a small hospital in the Peshawar district in April 2019. The present study investigates readers' discussions that emerged from Dawn's online readers' comments on polio-related news stories in Pakistan. Methods: Using thematic analysis, we analyzed (N = 2216) comments made by readers in the polio-related news stories published on Dawn.com from January 1, 2012, to March 1, 2020. Results: Seven major themes emerged from the analysis of the comments: 1) reasons for and challenges resulting in the failure to eradicate polio; 2) proposed solutions and policy changes to eradicate polio; 3) misinformation; 4) criticism, frustration, and shame; 5) comparison of Pakistan to other countries; 6) the internet as a public sphere; 7) suffering, empathy, and appreciation. Overall, our findings suggested that commenters are knowledgeable about polio vaccines and consider polio a serious threat to public health in Pakistan. Conclusion: Our study not only validated previous study findings such as reasons, challenges, and issues related to polio vaccination, but also found new challenges in online news sites concerning misinformation on polio and polio vaccination in Pakistan

The promise of nanofluids: A bibliometric journey through advanced heat transfer fluids in heat exchanger tubes

© 2024 The Author(s). Published by Elsevier B.V. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Thermal management is a critical challenge in advanced systems such as electric vehicles (EVs), electronic components, and photoelectric modules. Thermal alleviation is carried out through the cooling systems in which the coolant and the heat exchangers are the key components. The study examines recent literature on nanofluids and heat exchanger tubes along with state-of-the-art concepts being tested for heat transfer intensification. The performance of nanofluids in several common heat transfer tubes’ geometries/configurations and the effectiveness of novel heat transfer augmentation mechanisms are presented. Promising results have been reported, showing improved heat transfer parameters with the use of nanofluids and intensification mechanisms like turbulators, fins, grooves, and variations in temperature and flow velocity. These mechanisms enhance dispersion stability, achieve a more uniform temperature distribution, and reduce the boundary layer thickness, resulting in lower tube wall temperatures. Moreover, introducing flow pulsations and magnetic effects further enhances particle mobility and heat exchange. However, there are limitations, such as increased frictional losses and pressure drop due to magnetic effects. The combination of nanofluids, novel heat exchanger tube geometries, and turbulators holds great promise for highly efficient cooling systems in the future. The study also presents a bibliometric analysis that offers valuable insights into the impact and visibility of research in the integration of nanofluids into heat transfer systems. These insights aid in identifying emerging trends and advancing the field towards more efficient and compact systems, paving the way for future advancements.Peer reviewe