Mapping Australia’s economy: cities as engines of prosperity

This report maps the Australian economy by the location of economic activity, defined as the dollar value of goods and services produced by workers within a particular area. Overview Eighty per cent of the value of all goods and services produced in Australia is generated on just 0.2 per cent of the nation’s land mass – mostly in cities. Today, cities are the engines of economic prosperity. But the concentration of highly productive activity in city centres presents challenges for policymakers. Too many workers live too far away to fulfil our cities’ economic potential. This report maps the Australian economy by the location of economic activity, defined as the dollar value of goods and services produced by workers within a particular area. It finds that economic activity is concentrated most heavily in the central business districts (CBDs) and inner areas of large cities. The CBDs of Sydney and Melbourne – just 7.1 square kilometres in total – generated $118 billion in 2011-12, almost 10 per cent of all economic activity in Australia, and triple the contribution of the entire agriculture sector. The intense economic contribution of CBDs occurs partly because of the concentration of jobs in these areas. But CBD businesses are also much more productive on average than those in other areas. Inner city areas and secondary commercial hubs, such as those around large cities’ airports, also tend to be more productive than other locations. For example, in 2011-12 the Sydney CBD produced$64.1 billion worth of goods and services: about $100 for every hour worked there. Employing only 13 per cent of Sydney’s workforce, this small area generates almost a quarter of the value of the Greater Sydney economy. Parramatta, often said to be Sydney’s second CBD, generated only$68 for each hour worked, and its total of $6.8 billion was about a tenth of the value generated in the CBD. There is a reason intense economic activity is concentrating in CBDs and inner suburbs. Many businesses in these areas provide highly knowledge-intensive and specialised services such as funds management, insurance, design, engineering and international education. These businesses depend on highly skilled workers, and locating in the heart of large cities gives them access to the largest possible pools of them. Proximity to suppliers, customers and partners also helps businesses to work efficiently, to generate opportunities and to come up with new ideas and ways of working. Knowledge-intensive activity is present in all sectors, including manufacturing and mining. Perth’s CBD is home to more than a third of Western Australian mining jobs, including accountants, administrators, geologists and specialist engineers. In the early 20th century one in three workers were employed in primary industry and almost half of the population lived on rural properties or in towns of less than 3,000 people. By 1960 manufacturing had grown to make up almost 30 per cent of GDP and employ one in four Australians, with a big presence in suburban areas. But today the small areas that generate most value are often a very long commute from the fast-growing outer suburbs in which many Australians live. If the prosperity that comes from knowledge-intensive activity is to be widely shared, governments need to enable more people to live closer to these areas, and to improve road and public transport networks so that they better connect employers and workers

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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