Productive cities: opportunity in a changing economy

Most Australians live and work in cities. They are essential to generating growth and to creating and distributing opportunities. Cities are shaped by where people live, where they work, and how they get around. When these three things are in tune with the structure of the economy, cities operate efficiently and productively, and drive growth and innovation.This report examines housing, income and travel data in Australia\u27s four largest cities and reveals strains in the triangle of work, home and transport that could threaten national prosperity.Addressing these issues will provide a significant boost to national productivity, because as the economy becomes more knowledge intensive, deep labour markets and good links between firms become more important.Firms engaged in high-knowledge activities benefit from connections that enable them to collaborate and learn from one another. They locate in places with deep labour markets to ensure that they can attract the talent and skill they need.This report reveals, however, that labour markets are shallow in significant parts of Australia‟s biggest cities. In many suburbs – particularly outer suburbs – residents can reach fewer than 10 per cent of all metropolitan jobs with a reasonable commuting time.Increasingly, employees with high-level qualifications and high incomes live close to the heart of our cities. Meanwhile, workers with trade skills or low skills, and people on lower incomes, tend to live further from the centre. Rising house prices have exacerbated this divide. If this polarisation continues, then many people risk being locked out of the parts of the city that offer the richest access to jobs.How can government\u27s respond? Governments are frequently called upon to create jobs in outer suburban areas by offering incentives to business to relocate or by building new employment clusters from scratch. Yet there is little evidence that such policies work. A better option is to move people closer to jobs. This can be done in two ways. First, the supply and diversity of dwellings in existing suburbs can be increased. Previous Grattan research has shown that people want more housing choice. It can be created if the disincentives developers face are addressed, if suburbs are not locked down by restrictive zoning and planning rules and if residents are engaged up front in decisions affecting their neighbourhoods.Second, the transport system‟s capacity to connect people and jobs can and must be improved. That means better road systems and better public transport. Facing up to the challenges of road use pricing would go a long way to ensuring that space on city roads goes to the most important and most productive uses, and could raise revenue to help increase public transport capacity.The shape of our cities is above all an economic issue. Giving knowledge-intensive firms access to more workers would make them more productive. It would also give workers more opportunities to find rewarding jobs. Better functioning cities would unleash higher productivity, and provide everyone with more opportunities. In this case, what is good for the economy is also good for the fair go

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

Narratives of gang desistance amongst former gang members

Gangs are found all over the world, including South Africa. In Cape Town specifically, gang involvement is a critical problem in need of intervention. Despite this, little research has explored the perspectives of former gang members on leaving and staying out of the gang. Understanding how and why individuals desist from gangs has important implications for policymakers, the criminal justice system, and in the development of effective interventions, which is particularly important in low- and middle-income countries like South Africa, where very little is known about desistance from gangs, and where economic and other conditions that may lead to gang involvement are different from those in high-income countries. Drawing on a narrative theoretical framework as well as the theory of critical realism, this research sought to examine how former South African gang members understand and make sense of their desistance from gang involvement, focusing on exiting the gang life as well as maintaining a reformed lifestyle after exiting, despite the challenges this may present. Two rounds of life history interviews were conducted with twelve former gang members from a Cape Town community with a high prevalence of gangsterism. Thematic narrative analysis was used to analyse the interview data. Findings revealed that the participants’ narratives of desistance focused on a profound transformation in identity in which they moved away from the hardened, stoic gangster identity and embraced a more prosocial identity, such as that of a positive role model in the community. This transformation was a process punctuated with key turning points (such as incarceration or becoming religious) that prompted active reflection on the gang life and contributed to their decision to desist. The participants’ narratives also focused on their agency in the desistance process, which included forming a purposive intention to change their lives, committing to and maintaining this change, in spite of challenges they faced (for example, a relapse into drugs), taking personal responsibility for their pasts and striving for more independence in the future. Importantly, it also involved actively drawing on protective resources (such as meaningful and practical support from loved ones and religious belief systems) and prosocial identities (for example, being a caring husband and father) available to them within their environments, thus illustrating how the desistance process is an interaction between inner and outer resources. Therefore, it is imperative that interventions that assist desisting gangsters are targeted not only on an individual level, but a contextual level too, ensuring that individuals have access to the kinds of resources in their environment that will support their desistance

Epidemiology of HIV among American Indians and Alaska Natives – United States, 2008-2011

American Indians/Alaska Natives (AI/AN) diagnosed with HIV infection have poorer survivorship and a higher percentage of Stage 3 (AIDS] diagnoses within one year of HIV diagnosis, compared to most race/ethnicity groups. National HIV surveillance data for 2008-2011 were used to determine diagnosis rates of HIV infection, persons living with HIV, and persons with a late diagnosis (Stage 3 within three months of HIV diagnosis) by selected characteristics for AI/AN and a combined other race/ethnicity group. The highest percentages of 862 AI/AN diagnosed with HIV infection were among males (75.7%), AI/AN aged 25-34 years (32.9%), persons living in large metropolitan areas (53.4%), and those diagnosed in outpatient facilities (39.4%). Among males, the majority of infections were attributed to male-to-male sexual contact (MSM) (71.8%). The percentage of infections attributed to injection drug use (IDU) for AI/AN females (28.5%) was greater than the other race/ethnicity group (15.2%). Probability of late diagnosis among AI/AN males was associated with: age \u3e35 years, and diagnosis in emergency room or hospital, or outpatient settings, and among AI/AN females, diagnosis in hospital or emergency room. Early detection of HIV infection along with linkage to and retention in care are important for all populations, including AI/AN. Routine HIV screening at a variety of public health and outpatient facilities, and linkage to care are important to decrease HIV transmission and improve survival

Position statement and considerations for remotely delivered pulmonary rehabilitation services.

Statement and methods of development The challenge of access to pulmonary rehabilitation (PR) and meeting associated service demand is certainly not new. However, the COVID-19 pandemic set an unprecedented challenge evoking rapid adaptation of services. An inherent spotlight has been placed on remotely delivered services. As we look beyond the height of this pandemic, it is important to reflect and consider what has been learnt, and emerging perspectives on the future of PR service delivery. This document updates the ‘ACPRC statement and considerations for the remote delivery of pulmonary rehabilitation services during the COVID-19 pandemic’ (1) and seeks to provide pragmatic practical guidance for remotely delivered models of PR for healthcare professionals that should be used alongside local guidance. The recommendations provided are for guidance only, and may be updated in response to further national guidelines and new evidence. An online survey of PR healthcare professionals (ACPRC pulmonary rehabilitation provision during COVID-19 and beyond!) was conducted in the development of this document to scope current practice in PR services across the U.K. Informed by queries received by the ACPRC, the survey was first conducted in 2020 and repeated in July 2021 with the aim of capturing a snapshot of practice, one-year post onset of the COVID-19 pandemic. The survey was publicised and disseminated via Twitter using the @theACPRC handle, with request that one team member completed on behalf of their service. A summary of the 21 responses can be found in Appendix 1 which served to inform the content of this document. A literature review was undertaken to identify and integrate relevant published trials since the 2021 Cochrane review of telerehabilitation for people with chronic respiratory disease (2). Details of the search strategy can be found in Appendix 2 and summary of study characteristics and outcomes in Appendix 3. Anonymous feedback from four PR services was collated and analysed to identify common themes in experiences of remotely delivered PR services. A summary of this process and collated feedback can be found in Appendix 4. Key terms Remotely delivered models – the delivery of pulmonary rehabilitation services at a distance; the interaction between healthcare professional and participant using communication and information technologies, that may take place in real-time (synchronously) or asynchronously (1). It may be delivered by a virtual platform, an online web application or programme, or referred to as telerehabilitation (note: this terminology is used where studies have reported it). Field walking tests are commonly employed to evaluate exercise capacity, prescribe exercise, and evaluate treatment response in chronic respiratory diseases (3). The most valid, reliable and responsive ones are the six-minute walk test (6MWT), incremental (ISWT) and endurance walk test (ESWT). NACAP – the National Asthma and COPD Audit Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP), as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP), and currently covers England and Wales. The programme is led by the Royal College of Physicians (RCP) and includes a pulmonary rehabilitation workstream. PRSAS – the Pulmonary Rehabilitation Services Accreditation Scheme was launched in April 2018, and is run by the Royal College of Physicians (RCP)

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Cognitive Impairment Before Intracerebral Hemorrhage Is Associated With Cerebral Amyloid Angiopathy

Background and Purpose—Although the association between cerebral amyloid angiopathy (CAA) and cognitive impairment is increasingly recognized, it is not clear whether this is because of the impact of recurrent intracerebral hemorrhage (ICH) events, disruptions caused by cerebral small vessel damage, or both. We investigated this by considering whether cognitive impairment before ICH was associated with neuroimaging features of CAA on magnetic resonance imaging. Methods—We studied 166 patients with neuroimaging-confirmed ICH recruited to a prospective multicentre observational study. Preexisting cognitive impairment was determined using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Magnetic resonance imaging markers of cerebral small vessel disease, including CAA, were rated by trained observers according to consensus guidelines. Results—The prevalence of cognitive impairment before ICH was 24.7% (n=41) and, in adjusted analyses, was associated with fulfilling the modified Boston criteria for probable CAA at presentation (odds ratio, 4.01; 95% confidence interval, 1.53–10.51; P=0.005) and a higher composite CAA score (for each point increase, odds ratio, 1.42; 95% confidence interval, 1.03–1.97; P=0.033). We also found independent associations between pre-ICH cognitive decline and the presence of cortical superficial siderosis, strictly lobar microbleeds, and lobar ICH location, but not with other neuroimaging markers, or a composite small vessel disease score. Conclusions—CAA (defined using magnetic resonance imaging markers) is associated with cognitive decline before symptomatic ICH. This provides evidence that small vessel disruption in CAA makes an independent contribution to cognitive impairment, in addition to effects due to brain injury caused directly by ICH

Paediatric acute hepatitis of unknown aetiology : a national investigation and adenoviraemia case-control study in the UK

Funding Information: This work was undertaken as part of a national enhanced incident by UK public health agencies. We thank the parents and guardians of the children who gave up their valuable time to speak to the public health investigation teams; without their support we could not have been able to undertake a thorough investigation. We are grateful to the many paediatricians and liver specialists who reported cases to us and responded to follow-up with further information. We also thank Ezra Linley and Simon Tonge of the UK Health Security Agency Seroepidemiology Unit for rapidly providing serum samples for testing. We would like to thank the Incident Management Teams of the UK nations, members of the incident cells, epidemiology, laboratory, and local Health Protection Teams who supported the investigations, in particular: Katy Sinka, Mike Gent, Suzanna Howes, Eileen Gallagher, Selene Corsini, Eleanor Clarke, Rajani Raghu, Kelsey Mowat, Iain Hayden, Matt Hibbert, Skye Firminger, Catriona Angel, Donna Haskins, Kay Ratcliffe, Hannah Emmett, Alex Elliot, Helen Hughes, Sarah Deeny, Sarah Garner, Sarah Gerver, Flora Stevens, Paula Blomquist, Gabriel Gurmail Kauffman, Kristine Cooper, Hannah Taylor, Giovanni Leonardi, Michelle Dickinson and Michelle Watson from England; Kimberly Marsh, Michael Lockhart, David Yirrell, Sandra Currie, Kate Templeton, Samantha Shepherd, Roisin Ure, Jim McMenamin, Rachel Tayler, Louisa Pollock, Antonia Ho, Chris Cunningham and Hayley Peacock from Scotland; and Katie Binley and Meg Wallace from Northern Ireland.Peer reviewe