WRF-Chem Modeling of Summertime Air Pollution in the Northern Great Plains: Chemistry and Aerosol Mechanism Intercomparison

Oil and gas production in the Bakken region increased dramatically during the past decade. A WRF-Chem modeling study of the Northern Great Plains was conducted for a July 2010 baseline scenario prior to the largest of these production increases. Simulations using the RACM-MADE/SORGAM, CBMZ-MOSAIC, and MOZART-MOSAIC chemistry-aerosol mechanisms were compared to each other and against ground level observations. All three gas-aerosol modules produced similar prediction results for O3, and NO2, with moderate correlation to hourly measurements and monthly average values overpredicted by 20% for O3 and underpredicted by 5% for NO2. Monthly average PM2.5 concentrations were relatively accurate, but correlation to hourly measurements was very low and PM2.5 subspecies exhibited high variability with a mix of over and underpredictions depending on the mechanism. Pollutant concentrations were relatively low across the mostly rural study domain, especially in the Bakken region. Results from this work can be used as a basis of comparison for studies of more recent time periods that include increased oil and gas-related emissions.

A cross-sectional analysis of out-of-pocket expenses for people living with a cancer in rural and outer metropolitan Western Australia

ObjectiveTo determine the extent of medical and non-medical out-of-pocket expenses (OOPE) among regional/rural and outer metropolitan Western Australian patients diagnosed with cancer, and the factors associated with higher costs. MethodsCross-sectional data were collected from adult patients living in four regional/rural areas and two outer metropolitan regions in Western Australia who had been diagnosed with breast, prostate, colorectal or lung cancer. Consenting participants were mailed demographic and financial questionnaires, and requested to report all OOPE related to their cancer treatment. ResultsThe median total OOPE reported by 308 regional/rural participants and 119 outer metropolitan participants were A$1518 (interquartile range (IQR): A$581–A$3769) and A$2855 (IQR: A$958–A$7142) respectively. Participants most likely to experience higher total OOPE were younger than 65 years of age, male, resided in the outer metropolitan area, worked prior to diagnosis, had private health insurance, were in a relationship, and underwent surgery. Multivariate analysis of regional/rural participants revealed that receiving care at a rural cancer centre was associated with significantly lower non-medical OOPE (estimated mean A$805, 95% confidence interval (CI): A$735–A$875, P=0.038; compared with other rural participants (A$1347, 95% CI: A$743–A$1951, P<0.001)). ConclusionThe cancer patients who participated in this study experienced variation in OOPE, with outer metropolitan participants reporting higher OOPE compared with their regional/rural counterparts. There is a need for cost transparency and access to care close to home, so that patients can make informed choices about where to receive their care. What is known about the topic?In recent years, OOPE for health care in general and cancer in particular have been widely debated by consumers and not-for-profit organisations; the topic has attracted much political attention because it affects both equity and access to care and has wider financial implications for the community. Research studies and reports from both consumer organisations and a Ministerial Advisory Committee found that cancer patients can face exorbitant out-of-pocket costs, and that individuals with private health insurance and those with prostate and breast cancer reported higher costs. In Western Australia, a cancer centre providing comprehensive cancer care was established in the second most populous region to ameliorate the high costs for travel and accommodation that regional cancer patients are known to experience. What does this paper add?This study is unique because it collected detailed cost information from patients and reports on the OOPE of regional/rural and outer metropolitan Western Australian patients receiving care for one of the four most common cancers; it therefore offers novel insight into the experiences of these groups. This study demonstrates that outer metropolitan cancer patients are experiencing much higher OOPE compared with regional/rural cancer patients. Additionally, regional/rural study participants who accessed a Regional Cancer Centre experienced significantly lower non-medical OOPE, compared with regional/rural study participants receiving care elsewhere. What are the implications for practitioners?First, there is a need for improved communication of OOPE to minimise costs to the patient, for example, by facilitating access to local cancer care. Health service providers and insurance companies can improve cost transparency for cancer patients by making this information more readily available, allowing patients to make informed financial choices about where to seek care. Second, the needs of working patients deserve specific attention. These patients face significant work uncertainty and additional distress following a cancer diagnosis.

Sweet Greeks

This narrative is about Greek immigrants to America from 1880 to 1930. Unlike previous studies focusing on immigrant communities in major cities, this is a rural study, examining the Greeks who settled in central Illinois’s small towns and opened confectioneries and soda fountains. The author’s grandfather Gus Flesor was one of these, coming to Tuscola, Illinois, in 1901 and taking over the candy shop there. Gus’s shop is still in business today, run by the author and her sister. Gus’s experience serves as a case study that informs the stories of more than 100 other Greek confectioners who settled in over forty towns in central Illinois. The author describes why the Greeks came to America and recounts the obstacles they faced after arrival and their attempts to acculturate and assimilate and become confectioners. A significant amount of the narrative recounts the ethnic and racial hostility the Greeks faced, especially from the Ku Klux Klan. But the bulk of the text is about the Greek immigrant confectioners themselves who fulfilled the American dream by settling in a new land, raising families, operating profitable businesses, and contributing to their communities. As the author’s father once observed, “It’s a good story.”

A Comparative Study of Rural Entrepreneurial Challenges: Towards Rural Economic Development and a Policy Framework

The primary purpose of this rural study was to compare the challenges that impede successful operations of entrepreneurial activities and small businesses. Through quantitative design, a seven-point Likert-scale questionnaire was utilized to gather primary data. Two sampling techniques, namely simple random and purposive, were applied to select the research participants. Based on a Likert spectrum, 267 questionnaires were administered to SME owners by the researcher, assisted by two research trainees. These questionnaires were ranked from (1) strongly disagree to (7) strongly agree. Two main questions, which provided guidance to this study, were certified reliable by the Cronbach alpha coefficient of 0.768 and 0.976. Data analysis was possible through the descriptive and inferential tools supported by the independent t-test, Pearson’s chi-square test, and cross-tabulation. The final outcomes demonstrate higher levels of challenges in the Frances Baard (FB) District than in the John Taolo Gaetsewe (JTG) District. This implies that owner-managers of small businesses in the FB District experienced more challenges in operating their businesses. The study recommends SME Policy Framework (SPF) training and intensifying the existing processes of monitoring after training to justify the owner-managers’ moral commitments.

An assessment of PCV13 vaccine coverage using a repeated cross-sectional household survey in Malawi

Background: The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in Malawi from November 2011 using a three dose primary series at 6, 10, and 14 weeks of age to reduce Streptococcus pneumoniae-related diseases. To date, PCV13 paediatric coverage in Malawi has not been rigorously assessed. We used household surveys to longitudinally track paediatric PCV13 coverage in rural Malawi. Methods: Samples of 60 randomly selected children (30 infants aged 6 weeks to 4 months and 30 aged 4-16 months) were sought in each of 20 village clinic catchment ‘basins’ of Kabudula health area, Lilongwe, Malawi between March 2012 and June 2014. Child health information was reviewed and mothers interviewed to determine each child’s PCV13 dose status and vaccine timing. The survey was completed six times in 4-8 month intervals. Survey inference was used to assess PCV13 dose coverage in each basin for each age group. All 20 basins were pooled to assess area-wide vaccination coverage over time, by age in months, and adherence to the vaccination schedule. Results: We surveyed a total of 8,562 children in six surveys; 82% were in the older age group. Overall, in age-eligible children, two-dose and three-dose coverage increased from 30% to 85% and 10% to 86%, respectively, between March 2012 and June 2014. PCV13 coverage was higher in the older age group in all surveys. Although it varied by basin, PCV13 coverage was consistently delayed: median ages at first, second and third doses were 9, 15 and 21 weeks, respectively. Conclusion: In our rural study area, PCV13 introduction did not meet the Malawi Ministry of Health one-year three-dose 90% coverage target, but after 2 years reached levels likely to reduce the prevalence of both invasive and non-invasive paediatric pneumococcal diseases. Better adherence to the PCV13 schedule may reduce pneumococcal disease in younger Malawian children.