Services and the new economic landscape

The growth of the service economy in advanced and developing economies has created what are now being referred to as New Economic Landscapes. These landscapes are not only built forms, they are job generators and new sources of economic power for the regions that house them. This service economy is variegated, with differing sources of demand, and varying geographies of supply. A dynamic element in this mileaux is the evolving producer service complex--an amalgum of financial, business, legal, and professional services, which have had rapid expansion in most parts of the global economy. Existing conceptual paradigms in regional science have not fully acknowledged the manifold importances of The New Economic Landscape--they have essentially danced around it. In this paper we zero in on the central role of services, as well as primary and secondary industries, in the current economic era, relating on the one hand the expansion of information-oriented producer services to patterns of evolution in goods producing primary and secondary industries, as well as placing these dynamic producer service sectors in context of the ongoing expansion of the larger service sector. The goal of this paper is to make clear the regional development implications of the complex processes of service industry development occuring globally, while simultaneously speaking to the implications of this transformation for regions and theory in regional science. In this regard we build on recent conceptualizations of the role of industrial and information networks, economic underpinnings of regional economies, new perspectives on entrepreneurial activity, and behaviors which we have documented are important to the success of service industries on the New Economic Landscape. In doing so, we take advantage of and extend conceptualizations which have been developed largely in management science as they bear on firm-level performance, and marry these ideas with the emerging literature on the importance of the vital position of regions in the so-called global economy.

The case for the multi-species ecological system, with special reference to succession and stability

Multi-species life support system based on ecological theor

What role for knowledge-intensive business services (KIBS) in de-industrialised regions?

This paper seeks to provide insights into the structural role that Knowledge Intensive Business Services (KIBS) SMEs play in de-industrialised regions in the UK. The paper aims to establish what contribution KIBS make to their regional economies in terms of exports to other regions in the UK as well as abroad but also to what extent do they depend on the intermediate demand in their respective regions. The paper draws evidence from a survey of KIBS SMEs in the North East and the West Midlands conducted during the most recent recession. The results exhibit a degree of wider generalizability to other regions, which may be characterised by deindustrialisation. Results from the West Midlands and the North East survey show that although KIBS play an important role in the local economic base of de-industrialised regions they are not as important as their elite, tradable counterparts in global cities such as London. However, KIBS SMEs in the North East and West Midlands provide important support to their regional clients, many of which are in the declining manufacturing and public service sectors. A vast majority are also trading outside their respective regions

Peso al nacer de niños brasileños menores de dos años

Low birth weight is associated with increased risk of dying in the first year of life. This study was motivated by recent changes in the determination of birth weight patterns with the advent of the perinatal epidemiological transition. We analyzed data from the Brazilian National Survey of Demographic and Health of Children and Women including only children < 24 months. Prevalence of low birth weight in Brazil was 6.1%. Risk factors included female gender, residence in the South and Southeast geographic regions, low maternal education, and maternal smoking. The low birth weight profile changed, with higher prevalence in more economically developed regions, reflecting the neonatal epidemiological transition determined by changes in patterns of childbirth care and incorporation of perinatal life support technologies, in addition to the previously known biological risks associated with poverty and misinformation.El bajo peso al nacer tiene una gran relación con el riesgo de morir en el primer año de vida. Estudios muestran su asociación con problemas de desarrollo en la infancia y enfermedades en la vida adulta. Dada la importancia de este indicador, el objetivo de este estudio fue investigar los factores sociales, demográficos, biológicos y ambientales involucrados en su determinación. Se analizaron los datos de la Investigación Nacional de Demografía y Salud del Niño y de la Mujer (PNDS-2006), incluyendo solamente niños menores de 24 meses de vida. La prevalencia de bajo peso al nacer en Brasil fue de un 6,1%. Los factores de riesgo identificados fueron sexo femenino, residir en las macrorregiones Sur y Sudeste y ser hijo de madres con baja escolaridad o tabaquistas. Hubo cambios en el perfil de bajo peso al nacer, con mayor prevalencia en regiones más desarrolladas económicamente, reflejando la transición epidemiológica perinatal, caracterizada por cambios en los padrones de asistencia al parto e incorporación de los avances tecnológicos en la asistencia perinatal, además de factores de riesgo biológicos conocidos, asociados a la pobreza y a la desinformación.O baixo peso ao nascer tem grande relação com risco de morrer no primeiro ano de vida. Estudos mostram sua associação com problemas de desenvolvimento na infância e doenças na vida adulta. Dada a importância desse indicador, o objetivo deste estudo foi investigar os fatores sociais, demográficos, biológicos e ambientais envolvidos na sua determinação. Analisaram-se dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS-2006), incluindo apenas crianças menores de 24 meses de vida. A prevalência de baixo peso ao nascer no Brasil foi de 6,1%. Os fatores de risco identificados foram sexo feminino, residir nas macrorregiões Sul e Sudeste e ser filho de mães com baixa escolaridade ou tabagistas. Houve mudanças no perfil do baixo peso ao nascer, com maior prevalência em regiões mais desenvolvidas economicamente, refletindo a transição epidemiológica perinatal, caracterizada por mudanças nos padrões de assistência ao parto e incorporação dos avanços tecnológicos na assistência perinatal, além de fatores de risco biológicos conhecidos associados à pobreza e à desinformação.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Association Between Smoking and Tuberculosis Infection: A Population Survey in a High Tuberculosis Incidence Area

Associations between smoking and tuberculosis disease including death from tuberculosis have been reported, but there are few reports on the influence of smoking on the risk of developing Mycobacterium tuberculosis infection. The aim of this study was to determine the association between smoking and M tuberculosis infection. In a cross sectional population survey, data on smoking and tuberculin skin test (TST) results of 2401 adults aged >15 years were compared. A total of 1832 (76%) subjects had a positive TST (>10 mm induration). Of 1309 current smokers or ex-smokers, 1070 (82%) had a positive TST. This was significantly higher than for never smokers (unadjusted OR 1.99, 95% confidence interval (CI) 1.62 to 2.45). A positive relationship with pack-years was observed, with those smoking more than 15 pack-years having the highest risk (adjusted OR 1.90,95% CI 1.28 to 2.81). Smoking may increase the risk of M tuberculosis infection.\u

Bridges over troubled waters: an interdisciplinary framework for evaluating the interconnectedness within fragmented domestic flood risk management systems

Diversification of strategies in Flood Risk Management (FRM) is widely regarded as a necessary step forward in terms of lessening the likelihood and magnitude of flooding, as well as minimizing the exposure of people and property, and in turn the disruption, economic damage, health impacts and other adverse consequences that ensue when floods occur. Thus, diversification is often heralded as an essential condition for enhancing societal resilience to flooding. However, an inevitable consequence of diversifying strategies and practices in FRM is that it can lead to fragmentation within FRM systems, in terms of the distribution of responsibilities between actors and governing rules enacted within different policy domains. This can prove detrimental to the effectiveness of FRM. Building upon the notion of fragmentation developed in legal and governance literature, this paper introduces the concept of ‘bridging mechanisms’, i.e. instruments that remedy fragmentation by enhancing interconnectedness between relevant actors through information transfer, coordination and cooperation. This paper develops a typology of both fragmentation and bridging mechanisms and analyzes their relations, partly drawing upon empirical research conducted within the EU ‘STAR-FLOOD’ project. In turn, this paper outlines a novel interdisciplinary methodological framework for evaluating the degree and quality of the interconnectedness within fragmented domestic FRM systems. A pragmatic, flexible and broadly applicable tool, this framework is both suited for academic purposes, as well as for practically oriented analysis and (re)development of fragmented FRM systems, and potentially other fragmented systems, within the EU and abroad

Missed opportunities in the diagnosis of pulmonary tuberculosis in children

In 52% of children with confirmed and probable tuberculosis the diagnosis could have been made earlier than it was. The main clinical clues which should have led to suspicion of tuberculosis were close adult contacts and previous recurrent respiratory tract infections

The use of a geographical information system (GIS) to evaluate the distribution of tuberculosis in a high-incidence community

CITATION: Beyers, N. et al. 1996. The use of a geographical information system (GIS) to evaluate the distribution of tuberculosis in a high-incidence community. South African Medical Journal, 86(1):40-44.The original publication is available at http://www.samj.org.zaObjective. To determine the geographical distribution of tuberculosis in the two Western Cape suburbs with the highest reported incidence of tuberculosis. Design. Descriptive illustrative study. Setting. Two adjacent Western Cape suburbs covering 2.42 km2 with a population of 34 294 and a reported tuberculosis incidence of > 1 000/100 000. Subjects. All patients notified as having tuberculosis over a 10-year period (1985-1994). Interventions. None. Outcome measure. The geographical distribution of the cases was determined using a geographical information system (GIS) and the National Population Census (1991). Results. One thousand eight hundred and thirty-five of the 5 345 dwelling units (34.3%) housed at least 1 case of tuberculosis during the past decade and in 483 houses 3 or more cases occurred. These cases were distributed unevenly through the community, with the tuberculosis incidence per enumerator subdistrict (ESD) varying from 78 to 3 150/100 000 population. Conclusion. In a small area with a high incidence of tuberculosis, the cases are spread unevenly through the community and there are certain houses where tuberculosis occurs repeatedly. This information should be used to direct health services to concentrate on certain high-risk areas.Publisher’s versio

Comparing multidrug-resistant tuberculosis patient costs under molecular diagnostic algorithms in South Africa

SETTING: Ten primary health care facilities in Cape Town, South Africa, 2010–2013. OBJECTIVE: A comparison of costs incurred by patients in GenoType® MDRTBplus line-probe assay (LPA) and Xpert® MTB/RIF-based diagnostic algorithms from symptom onset until treatment initiation for multidrug-resistant tuberculosis (MDR-TB). METHODS: Eligible patients identified from laboratory and facility records were interviewed 3–6 months after treatment initiation and a cost questionnaire completed. Direct and indirect costs, individual and household income, loss of individual income and change in household income were recorded in local currency, adjusted to 2013 costs and converted to $US. RESULTS: Median number of visits to initiation of MDR-TB treatment was reduced from 20 to 7 (P < 0.001) and median costs fell from US$68.1 to US$38.3 (P = 0.004) in the Xpert group. From symptom onset to being interviewed, the proportion of unemployed increased from 39% to 73% in the LPA group (P < 0.001) and from 53% to 89% in the Xpert group (P < 0.001). Median household income decreased by 16% in the LPA group and by 13% in the Xpert group. CONCLUSION: The introduction of an Xpert-based algorithm brought relief by reducing the costs incurred by patients, but loss of employment and income persist. Patients require support to mitigate this impact

Comparing laboratory costs of smear/culture and Xpert(®) MTB/RIF-based tuberculosis diagnostic algorithms

SETTING: Cape Town, South Africa, where Xpert® MTB/RIF was introduced as a screening test for all presumptive tuberculosis (TB) cases. OBJECTIVE: To compare laboratory costs of smear/culture- and Xpert-based tuberculosis (TB) diagnostic algorithms in routine operational conditions. METHODS: Economic costing was undertaken from a laboratory perspective, using an ingredients-based costing approach. Cost allocation was based on reviews of standard operating procedures and laboratory records, timing of test procedures, measurement of laboratory areas and manager interviews. We analysed laboratory test data to assess overall costs and cost per pulmonary TB and multidrug-resistant TB (MDR-TB) case diagnosed. Costs were expressed as 2013 Consumer Price Index-adjusted values. RESULTS: Total TB diagnostic costs increased by 43%, from US$440 967 in the smear/culture-based algorithm (April–June 2011) to US$632 262 in the Xpert-based algorithm (April–June 2013). The cost per TB case diagnosed increased by 157%, from US$48.77 (n = 1601) to US$125.32 (n = 1281). The total cost per MDR-TB case diagnosed was similar, at US$190.14 and US$183.86, with 95 and 107 cases diagnosed in the respective algorithms. CONCLUSION: The introduction of the Xpert-based algorithm resulted in substantial cost increases. This was not matched by the expected increase in TB diagnostic efficacy, calling into question the sustainability of this expensive new technology