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December 2018 , 18:51 | Cite as
Exploring the determinants of health and wellbeing in communities living in proximity to coal seam gas developments in regional Queensland
Fiona Mactaggart
Liane McDermott
Anna Tynan
Christian A. Gericke
First Online: 03 August 2017
Part of the following topical collections:
There is some concern that coal seam gas mining may affect health and wellbeing through changes in social determinants such as living and working conditions, local economy and the environment. The onward impact of these conditions on health and wellbeing is often not monitored to the same degree as direct environmental health impacts in the mining context, but merits attention. This study reports on the findings from a recurrent theme that emerged from analysis of the qualitative component of a comprehensive Health Needs Assessment (HNA) conducted in regional Queensland: that health and wellbeing of communities was reportedly affected by nearby coal seam gas (CSG) development beyond direct environmental impacts.
Qualitative analysis was initially completed using the Framework Method to explore key themes from 11 focus group discussions, 19 in-depth interviews, and 45 key informant interviews with health and wellbeing service providers and community members. A key theme emerged from the analysis that forms the basis of this paper. This study is part of a larger comprehensive HNA involving qualitative and quantitative data collection to explore the health and wellbeing needs of three communities living in proximity to CSG development in regional Queensland, Australia.
Communities faced social, economic and environmental impacts from the rapid growth of CSG development, which were perceived to have direct and indirect effects on individual lifestyle factors such as alcohol and drug abuse, family relationships, social capital and mental health; and community-level factors including social connectedness, civic engagement and trust.
Outer regional communities discussed the effects of mining activity on the fabric of their town and community, whereas the inner regional community that had a longer history of industrial activity discussed the impacts on families and individual health and wellbeing. The findings from this study may inform future health service planning in regions affected by CSG in the development /construction phase and provide the mining sector in regional areas with evidence from which to develop social responsibility programs that encompass health, social, economic and environmental assessments that more accurately reflect the needs of the affected communities.
Health needs assessment Wellbeing Rural health Social determinants of health
Accessibility/ Remoteness Index of Australia
Coal seam gas
Drive-in-drive-out
Fly-in-fly-out
HNA
Health needs assessment
In-depth interview
Key informant interviews
Local government area
SDoH
An erratum to this article is available at https://doi.org/10.1186/s12889-017-4709-6.
Regional Queensland has been a focus of Australia's coal seam gas (CSG) development over the past decade. CSG is a natural gas that is extracted via wells drilled in to coal seams, and involves exploration of land for CSG deposits, production, transportation and distribution. Significant CSG deposits are found in Canada, China, USA, and Australia, and were first explored in regional Queensland in the late 1970's, which led to commercial production from 2006. CSG is utilised domestically, but a proportion is converted in to liquefied natural gas (LNG) and exported internationally off the Queensland coast [1]. Growth of the CSG industry and the relatively large geographic span of exploration and extraction means that 'mining activity' often co-exists with primary production of some of Queensland's most diverse agricultural land, with positive and negative implications [1]. There is anecdotal concern that the environmental, economical and social change in the community brought about by the labour intensive development stage of CSG mining can have implications for health and wellbeing [2].
CSG development and public health
There is rich evidence of potential public health implications of extracting conventional resources like coal, diamond and oil internationally [3, 4, 5]. However, with the recent emergence of CSG development, there is less known of the potential health impacts in communities as they undergo changes in their environment [6, 7, 8, 9]. Broader social determinants of health, like changes in working conditions, community networks or access to services could have serious implications for health and wellbeing in mining or resource settings, and are less understood [2, 10]. There is anecdotal concern that CSG development may have indirect and long-term impacts on the health of communities in which they operate but the scientific evidence is lacking [10].
Growth of CSG development has been rapid, in that approximately 1634 wells have been drilled between 2013 and 2014 alone, and reserves were being discovered at an unprecedented rate. Regional Queensland represents more than 90% of the total gas produced in the state [11]. CSG extraction often occurs on active farms and grazing properties, involving direct interaction with farmers and local community members, and there is some evidence that CSG development can bring about stress and anxiety [1]. There is also a huge demand for labour in the early stages of CSG development; these roles cannot be completely filled locally and thus large workforces often temporarily reside in 'host communities'. Population influx and influence on community structure can impact social capital through reduced social bonds and networks and there is concern for increased risky lifestyle behaviours like drug use and alcoholism that spill over to the communities from the mine workforce [12, 13].
The following paper forms part of a larger Health Needs Assessment (HNA) research project conducted in regions were CSG development was occurring. The purpose of the larger project was not to specifically identify the direct impacts of mining activity, but rather to assess broader population-level health and wellbeing issues in the communities and explore trends and possible determinants. Health is defined as 'a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity' [14]. In conjunction, wellbeing is used to describe elements of life that impact on its quality, determining an individual's level of personal satisfaction, happiness and psychological health. Wellbeing may also include community-level factors, such as satisfaction with one's environment, and the level of social connectedness and belonging. This study reports on the findings from a recurring theme that emerged from the qualitative component of the analysis: that health and wellbeing needs were associated with the development stage of nearby CSG mining.
The cyclical nature of mining and the unpredictability of its activity lifespan can have serious implications for surrounding communities and presents governments with the challenge of responding efficiently and effectively to evolving needs. A deeper understanding of the health and wellbeing context in mining communities is pertinent to enable community and health services to prepare for the impacts of social, environmental and economic fluctuations that might come with a mining boom or bust.
Theoretical framework: Health needs assessment
This study utilised an HNA model to investigate the communities of interest. HNAs are a systematic tool to explore and identify inequalities and health priorities and are useful in identifying health gaps and trends [15]. An HNA starts with a population rather than a project and underpinning the HNA approach is the social determinants of health framework, which describes the complex, multi-layered influencing factors, which can impact the health of an individual [15]. These factors include individual lifestyle factors, social and community networks, and the broader socio-economic, cultural and environmental conditions within which one lives. Inclusion of wellbeing indicators at an individual and community level give an indication of quality of life and satisfaction with one's living environment [16].
The study was conducted in three local government areas (LGAs): A, B and C in regional Queensland, Australia during June and December 2014. The major township of LGA A, which is furthest from Queensland's capital city of Brisbane, de-identified as Region 1, is classified as outer regional. LGA B's two major townships, Region 2 and 3 are defined as inner and outer; and LGA C's major township, Region 4, is defined as inner regional, according to the Accessibility/Remoteness Index of Australia (ARIA) (Table 1) [17]. ARIA criteria determines remoteness by measuring road distance to service centres, and is compared to 'unrestricted' accessibility in major cities. Geographical areas are categorised as major cities, inner regional, outer regional, remote or very remote. [18] ARIA is deemed an appropriate index for this research given it explores implications of the rural context and social determinants of health.
Demographic and economic summaries of four study sites in regional Queensland, 2014
Region 2 & 3
ARIA classification
Outer regionala
Inner and outer regional
Inner regionalb
LGA Land Area
58,800 km2
% aged <55 years
74.5%c
Mining and agriculture
Agriculture, mining and manufacturing
Median family income
$1444/week
aSignificantly restricted accessibility to goods, services and opportunities for social interaction
bSome restricted accessibility to goods, services and opportunities for social interaction
cOn average, population slightly older than the total Queensland population [37]
Mining activity in all of the LGAs was in the development phase during data collection in 2014, which brought a high demand for labour, mostly in the form of non-resident workers, or fly-in-fly-out (FIFO) and drive-in-drive-out (DIDO) employees who resided in the communities whilst on shift. LGA B experienced an increase in non-resident population by 9100 during 2015, compared with 5120 in LGA A. The number of businesses increased from 495 in Region 2 in 2012 to 1255 in 2013, and to 1166 in 2014. In Region 1 a similar pattern was seen but on a smaller scale (435, 790 and 755). At the time of publication, however, mining construction has drawn to a close, leading to an operational phase and a marked decrease in housing and rental prices following the out flux of FIFO and DIDO workforce.
Qualitative research methodology was utilised to explore the health and wellbeing needs of the communities of interest. This method was part of a larger mixed-method cross-sectional study based on the five principles of HNAs as defined by the National Institute for Health and Care Excellence (Fig. 1) [15]. The research team is preparing a further manuscript that presents quantitative results from the HNA and aims to compare and contrast with qualitative findings.
A simplified HNA process describing the first two stages used in this study. Adapted from Cavanagh and Chadwick [14]
Data collection tools
Qualitative methods included In-Depth Interviews (IDIs), Focus Group Discussions (FGDs), and workshops with community members. Key informant interviews (KII) were also held with service providers. Development and implementation of the overall HNA was overseen by a steering committee of representatives from academia, government and the mining sector. A community champion provided local-level knowledge and support during participant recruitment and implementation. The qualitative findings for this paper are from the first two steps of the HNA framework. For the full HNA report with comprehensive methodology, refer to: http://www.wesleyresearch.org.au/wellbeing/.
Theme content for the qualitative research tools was originally developed by the qualitative research team following review of the literature and discussion with both the steering committee and local community contacts. Theme lists were developed and included perceptions of health and wellbeing at a community (IDI, FGD, KII) and service level (KII); multi-sectoral interaction and support (KII); barriers and facilitators to achieving good health (all); influences on good health (all) and perceptions of how to engage the community in health and wellbeing activities (all). FGD theme lists were further developed from preliminary findings from the quantitative survey and KIIs; for example, few survey respondents answered the open-ended questions about health and wellbeing priorities and so the FGD questions were adapted to include an emphasis on exploring the prioritisation of needs.
For the workshops, participants were asked to list and rank key health and wellbeing needs and discuss a chosen photo that represented health or wellbeing in the community. Questions were open-ended and participants were encouraged to talk about topics in their own terms. Continual reflection and debriefing occurred within the research team following each interview. Field notes assisted with reflexivity of the experiences.
Recruitment of study participants
Stakeholder analysis and consultation with service providers and community leaders
A detailed mapping process identified service providers, health authorities, local governments and key community leaders in the health and community sector. Stakeholders were informed about the research project and invited to participate in a KII. Additional informants were recruited via snowball sampling and through attendance at local interagency meetings. Only the resident population was contacted for research in this study.
Community consultation with the general population
An expression of interest form was attached to the surveys sent out to a random sample of adults (>18 years of age) in each LGA (total = 6000) as part of the larger mixed method study. Those interested in further participation were invited to attend a FGD in their local community or an IDI over the phone. When there was clear indication of specific non-responding groups (e.g. young adults) to the survey or expression of interest, targeted stratified purposive sampling was utilised. Key informants assisted with promotion of research through email mail-outs and distribution of flyers. Middle- to older-aged community members were more likely to participate in the community FGDs and overall, females were more likely to be involved compared to males (Table 2).
Qualitative primary research involved 45 key informant interviews with health and community service providers; and 11 focus group discussions and 19 individual in-depth interviews with community members across the four study sites
Key informant interviews (KII) Organisations (n)
Focus group discussions (FGD) Community members (n)
Individual interviews (IDI) Community members (n)
Primary care and community services (5)
Male group (3)
Female group (10)
Specialised health and community services (3)
Mixed group (4; 1 male, 3 females)
Public health services (2)
Regions 2&3
Specialised health and community services (11)
Primary care and community health services (4)
Mixed group (9; 2 males, 7 females)
Qualitative analysis was initially completed using the Framework Method to explore key themes from the FGD, IDI, KII and workshop transcriptions. The Framework Method provides an initial structure whereby the researcher can systematically reduce the data in order to analyse it. This Framework Method was guided by the social determinants of health and social capital frameworks (Fig. 2). In the first instance the first and second author analysed the data for the comprehensive HNA. The first author then coded the data again based on the emerging theme of public health and mining activity, which was then independently verified by the second author. NVivo Qualitative Software was used to analyse the data. Findings from the KIIs, IDIs and FGDs were triangulated against each other to confirm and verify findings.
The Framework Method was developed with reference to the social determinants of health model and provided the authors with an initial structure to systematically reduce and analyse the data
This study was granted ethics approval by the Wesley Hospital Human Research Ethics Committee, (reference number 1410). All participants were given verbal introduction to the study and provided with an information sheet to read. Participants were asked to sign a consent form if they wanted to proceed with the interviews and FGDs. Pseudonyms have been used and all other identifiable information removed for data storage and reporting.
Communities in regional Queensland faced social, economic and environmental impacts during the development phase of the CSG mine cycle. These factors were perceived to have direct and indirect effects on individual lifestyle factors such as alcohol and drug abuse, family relationships, social capital and mental health; and community-level factors including social connectedness and trust. Participants highlighted concern for sustained impacts on health and wellbeing, including how the community would cope in the 'bust' period; whether the community would regain its identity; how children would grow up following family-related stress during the current mining 'boom'; and how young ex-mine employees would respond to reduced salaries outside of the mining sector.
Socio-economic and environmental conditions
During the study period, participants in regions 1 and 4 were concerned with increasing cost of services in the community and subsequent stress and outmigration, and the perceived burgeoning division between those who benefited economically from the CSG development, and those who didn't.
Residents in all regions commented on development of built infrastructure - most noticeably the increased availability of food outlets, liquor stores and takeaway restaurants. Availability of these options was perceived to cater for the increase in shift workers and temporary residents. Participants were concerned about the increased availability of these services in the community, and thought that young families and time-poor adults might also take advantage of convenience foods, which are often less healthy than home-cooked meals. Air travel was also an issue due to the high costs of airfares during periods when FIFO employment was at its busiest. There was concern for affordability of airfares for both leisure and to attend health and emergency medical appointments in major cities. Participants also commented on the increased number of sporting groups and clubs, but felt they were underutilised due to time constraints of shift workers. Several participants commented on the looming mining downturn and the effects this would have on demand for social and community services that had opened during the 'boom' to meet population growth.
Some young men with higher disposable salaries, both community members who were employed in the CSG industry and those who lived temporarily in the host communities, were often associated with antisocial conduct including alcohol-related behaviour and spending less time with family. This was pertinent in region 4. One participant was concerned for the lifestyle of some shift workers:
"They come home, they spend an hour, have a shower and then they go to sleep because they start again the day after. And again, at the same time, link that to a low level of education and a low level of understanding, and self-awareness… drinking, constantly being with men, and having a lot of disposable income." Service provider, specialised community services, region 4
Participants were concerned for spill over effects in the community and what impact the short-term contracts and uncertainty in employment would have on those who had moved to the community with their families, particularly in regions 1–3. A lack of employment opportunities following the mine downturn was predicted and there was concern for the community's ability to cope in this situation. One participant commented on the influx of people who sought work in the mining sector and remained in the community despite being unsuccessful:
"It normally peaks, it happens in these times. We have a lot of family breakdowns. It's normally because you know… A lot of people are saying we are an industrial city look what is happening. So we get these families who arrive thinking they will be getting these marvellous jobs on a $100,000 a year they get there with their family and realise they can't afford the rent and there is no work for them. The family breaks down… the husband starts drinking... Drugs as well." Service provider, community service, region 4
CSG exploration and drilling occurred on private land and there was concern related to the disruption caused by flares, and the effects of CSG on water bores. There were issues raised relating to the environmental effects on fresh water sources in regions 2–4, which deterred participants from fishing for both recreation and consumption. CSG infrastructure also caused increased noise pollution and traffic, which affected community satisfaction with their environment and perceptions of safety.
High rental prices and poor housing availability was linked to the labour-intensive development stages and subsequent population growth, and forced many community members to move elsewhere, as summarised by this participant:
"Community member (CM): There has been a shift in the community in the last few years around [region 1]… there's been a lot around wellbeing and affordability too. I think there has been a lot of pressure on that just with the CSG industry in [region 1]; it's probably put a bit of pressure on some people's wellbeing, affordability wise… Probably not us specifically, but I have seen a lot of change around that in the community."
Interviewer (I): OK and how has that impacted on people's wellbeing would you say?
CM: I would say, stress.
I: OK. And what are people doing?
CM: "They are moving. They are leaving." Community member, region 1
Housing issues related to both the mining 'boom and bust' were regularly commented on across all regions. Participants commented on the surge of houses and hotels built to meet the demand during the mining boom. However, increased cost of living and housing prices strained the ability of social services to meet housing demand. Participants felt that prices had started to 'return to normal' leading in to the operational phase of CSG. Conversely, there was then great concern for the surplus of housing and the lack of planning by council, as described by this community member during the downturn:
'The councils - they're to blame - they're building it up all the time - how it's going to be the greatest thing to happen to [region 3] and then they… Look at it now they've all left town, it was only going to be short term anyhow until they built everything and it's all been built. There are suburbs out here with houses and houses and there's no one in them but the fact is they're still building them on the flood zones.' Community member, region 3
Service providers and community members discussed the effects of living and working conditions associated with the mining sector in all regions. There was concern for the impact of shift work on families and social behaviour of mine employees in the community. Service providers commented on a marked increase in family disconnection, unbalanced lifestyles, stress and a lack of social networks for newcomers to the communities. These issues were particularly pertinent for the inner regional area 4:
"Mental health is an increasing issue for all regional communities and I think here in particular we have problems with isolation because families move here for work and they aren't supported; or families move here and the husbands are out, or they go out for a week or two weeks at a time, and leave what is essentially a single family, a single parent family." Service provider, community service, region 4
Community members and service providers commented on relationships between male mining employees and their children and felt that a lack of time spent together due to long working hours could have detrimental effects on child development. Long hours and shift work also placed pressure on mothers to carry out dual responsibilities. These issues were traded off against higher wages afforded to shift workers and the benefits of having financial security.
"Shift work. I think that there is some comorbidities that develop amongst the communities that is very much related to long hours, separation from family, unnatural working hours… Even though people who do continual shift work begin to see that as normal, in actual fact it deters that negative impact on us as you know, people. I think you see stress, depression, obesity, diabetes, and dysfunctional relationships." Service provider, tertiary services, region 4
Individual lifestyle factors
Linked to an increase in a male-dominated environment and higher disposable incomes, participants perceived an excessive use of illicit drugs and alcohol in the community. References to drugs and alcohol were particularly salient in region 4, with concerns for the increased availability of drugs in regional communities:
"I: What would be the most pressing health need for the community or for people in your area?"
CM: Probably the drinking would be a big thing.
I: The drinking - ok - and any other things?
CM: Ah in some particular mining camps the drugs are getting in there now.
I: And is that having much sort of spill out into the community?
CM: "From time to time there is and there has been an increase in the drug raids happening in and around town due to mining people getting hold, of bringing in drugs and then selling them." Community member, region 4
All communities were concerned for the effects of excessive drug and alcohol consumption among young mine employees. Service providers in region 4 linked the sudden demand for domestic violence support services to the behaviours of partners' who worked in the mine industry. Participants in region 4 mentioned anti-social behaviour in the town centre and insecurity felt by female residents alone in the town at night. It was perceived that these behaviours in the community were unwelcoming to other newcomers outside of the mine workforce.
"The other thing some of the local ones, I won't say all of them because I know they all don't do it but some of the local ones who have scored jobs in the industry have been on outrageous wages and what are they doing with those wages, I only have to go I won't tell you where I have to go to buy cocaine and methamphetamine and whatever, but it is so easy to get and these people have a disposable income and they're young they've got no common sense that they're not old enough to have that yet." Community member, region 2
Residents in region 4 cited the influx of the mine workforce in pubs and high purchasing rates of alcohol in the community, particularly during poor weather when employees were unable to work. It was felt that workers had little else to do in the community. Participants in regions 2 and 4 felt that the traditional, family-oriented pub culture of the community had dissipated because of expensive prices and over-crowding by the mine workforce. In region 4, participants commented on the cultural changes and the lack of social nightlife in the main town:
"I think probably there are just a number of groups and they interact at different times out of need. I think that springs back to the basic social lifestyle, which is around shift work. Like you know, this town it's really busy, you can go in at 9'o clock on a Friday and everyone is just about disappeared apart from the nightclubs. You know, it's just an unspoken rule because people are up travelling at about 3.30 am/ 4am. So, because of that, it doesn't evoke community as much. People aren't sitting around until late at night, just enjoying themselves down town because people have gone." Service provider, tertiary services, region 4
Social capital and community networks
Communities in each region experienced rapid population growth during the study period. Several references were made to the transient nature of the population –interstate, multi-state and overseas migration led to an impact on community culture, particularly because of the impermanent nature of newcomers and contrast with more traditional and regional community values. One participant recalls the traditional clothing often worn by country Australians, which was associated with farming and agricultural lifestyles, and how this is less prevalent in the community now.
"There is a change in the values. And there is a lower density of Akubra hats and moleskin [trousers] as you go down the street; it's more reflective gear and every second vehicle has a flag on it. And that's a whole different culture to what was here." Community member, region 1
Participants discussed the impact of population growth and CSG related infrastructure on social isolation in regions 1–3. Residents withdrew from services in town because of the changing nature, and this was a particular concern given that many residents lived on rural farms with few socialising opportunities outside of their visits to town.
"I think too, with the influx of the gas, you know we call them 'glow worms' - with the big bright shirts, they are everywhere you go in the coffee shops, in the restaurants, everywhere you go. You walk down the street and the vehicles with their little flags. You think 'ohhh gosh', just from a visual point of view, that just impacts. And the traffic got a lot more. I mean there are positive and there are negatives, but from a community point of view the ones that have been here longer term have probably withdrawn from the services, they don't feel so connected. Like people can say oh it's not the same place I moved to." Service provider, specialised services, region 1
Long-term residents felt that newcomers did not want to contribute to the community. Conversely, newcomers felt isolated and some felt they weren't welcomed in the 'cliquey' town. One participant commented on feeling unwelcome in the community due to temporary residence on a street with other FIFO employees.
"Being isolated as a worker like I'm a – they call workers like myself a townie. A townie is somebody who works in town, they're here for 3-5 years usually or shorter and I'm actually not part of the community, so some community events some church events they don't always make workers like myself feel particularly welcome because they know they're only here for a short period of time. So that's difficult - a bit of a cliquey town. There's lots of wealthy land owners as well as workers in town… that probably comes back to isolation and not having sort of a connection to this community because they don't have family." Community member, region 1
Newcomers were often described as transient people who were 'coming for the economy with no intention to stay'. Community members in region 4 mentioned the under-utilised cemetery as an example of the few people who stayed permanently to retire and live the rest of their life in the region.
Participants in region 1 linked poor community wellbeing to inadequate engagement and communication with the mining sector; Participants were also concerned for the level of community reliance on the mining sector. They felt that the relationship between community members and the sector could be improved, as described by these participants:
"CM 1: You know so we're a corporate town, we've been 'corporatised' and now I think people are getting it in their head that they're de-culturising and that if the town wants something, well the resource company will fork out the money and we'll just leave it up to them and I think a lot of the young people are seeing that. They're seeing that the school - you don't have to work for it. Yeah that's right the money will just come from them. You're not seeing, like I was very offended to see those signs on the school on every side of the school there's a [mining company] sign and I was thinking now hang on when the brothel comes to town, are they going to be allowed to sponsor the school and put their signs up and what about the hundreds and hundreds of parents over the years that have contributed to that school so where's their name around the oval."
I: I'm just trying to make sure we add it to this, what's the wellbeing need there?
CM 1: "To keep more community engagement." Community members, region 2
The findings in this study support anecdotal evidence of broader health concerns arising from nearby CSG development beyond direct physical health impacts. Communities in this study perceived there to be both direct and indirect impacts of CSG development at both an individual and community level. Outer regional communities (regions 1–3) discussed the effects of mining activity on the fabric of their town and community, whereas the inner regional community (region 4) that had a longer history of industrial activity discussed the impacts on families and individual health and wellbeing. Region 1 is much larger than regions 2–4 but with a much smaller population, which could explain the prominence of community-level health and wellbeing impacts of mining. Region 4 had a greater transient and a younger population, which could explain the focus on individual-level health wellbeing needs [19]. Regions 1–3 were predominantly agricultural regions, which could explain why community members were concerned for the stages following construction, when the population would decrease as quickly as it increased, along with employment opportunities and demand for services. Region 1–3 may be more sensitive to the impacts of CSG development because they are smaller and less developed than region 4. The density and geographical size of the community and its previous experience with mining or other industries is predicted to influence the magnitude of impacts felt [20].
The Queensland Government described CSG and LNG development as a 'once in a generation opportunity providing jobs, energy security and prosperity for citizens' [21]. This study demonstrated how the stage of mining activity and subsequent local economic fluctuations affected the social and environmental fabric, which in turn had consequences for health and wellbeing needs at individual and community levels. The 'rapid' nature of CSG development is perhaps a reflection of the labour-intensive development stages, and the short-term impacts this had on the community. It would be valuable to study the effects on health and wellbeing during the consequent stages of mining, to ascertain if the results from this study are unique to the development/pre-construction phase.
A key source of economy for regional Queensland is farming and agriculture. CSG activity commonly occurs on active farms and grazing properties which provides increased opportunity for human interaction and conflict [1]. In the study sites and in the wider literature, CSG development was perceived to disproportionately affect farmers [22]. CSG development involves large water supply usage, environmental disruption and overlap with existing farmland. These conditions could contribute to financial and environmental concerns and influence stress and anxiety levels in an already vulnerable population [23]. Apprehension related to the increased cost of living and uncertainty was thought to force residents out of the communities in search for more affordable living. Economic insecurity can negatively affect mental health [24]. Local mental health services in mining-affected communities need to be aware of the potential triggers during 'boom' periods in order to effectively target services, and monitor and respond to needs.
During the study period, mining communities in regional Queensland experienced significant changes to the built environment and natural landscape, including rapid growth of takeaway and fast food outlets to meet population demands. The public health implications relating to the marked increase in these services is a concern, considering the higher rates of overweight and obesity in rural areas compared to major cities [19]. Increased availability of fast food and takeaway outlets is linked to increased prevalence of obesity in young Australian adults [25]. CSG development utilises a large amount of land due to the multitude of dispersed gas wells, difficult road access, pipelines, and processing plants and dams [1]. In concentrated community centres, this has led to concerns around traffic, volume of activity and destruction to the natural environment, impacting on community wellbeing. Local government is responsible for planning and managing such changes, but unforeseen impacts of the fast-growing and new industry may have contributed to negative community perceptions. Ex-gas mining communities in the US have been branded as 'ghost towns' and 'contaminated communities', reflecting the exodus of people following the mine downturn and little incentive to stay in such altered environments [26]. Evidence-informed planning and communication between local government, mining companies and the public is integral to ensure that long-term effects in the community are mitigated.
Living and working conditions
Social conflict, substance abuse and domestic violence has been linked to the social 'costs' of CSG development and are often considered tertiary socio-economic impacts [12]. These issues were key concerns in the study regions, particularly the social impacts of shift work on families and partners. A lack of understanding of the duration of mine activity led to some tension between longer-term community members and the temporary residents who arrived to work for the mining companies. Some temporary residents felt isolated and unwelcome, feelings of which can lead to poor health and wellbeing and a lack of community cohesion [23].
The communities were concerned that working conditions, particularly for young males, led to anti-social behaviour in the community and excessive drug and alcohol abuse. These risky lifestyle behaviours can have significant impacts on mental health and long-term chronic diseases like lung cancer and liver disease. The working conditions of mine employees and potential for risky lifestyle beahviours is often referred to as a socio-economic product of the 'boom town effect' [12, 27]. There has been little research on the implications of CSG development on women but communities in this study were concerned for the impact of working conditions on families and the effects of social isolation on women. There was an identified need for improved social services to support women in these situations.
Social capital represents social connections and the benefits they generate. Social capital can be sourced at an individual (e.g. family support) or wider collective level (e.g. volunteering) [28]. The framework used in the analysis demonstrated the link between CSG development and community fabric, neighbourhood interactions, community satisfaction, trust and cooperative norms.
It was important to community members to understand what was happening in their communities. As CSG is a relatively new industry there was significant uncertainty and anxiety around the unknown effects. Brashier [2011] stated that community reaction to mining development spans four stages: enthusiasm in the initial stages; followed by uncertainty; then panic and finally, adaptation [29]. The term 'solastalgia' has been coined to describe the melancholy felt following the unwelcome change in one's community and is often used in the CSG development context [30]. At a community level, there is a responsibility of local government to provide evidence, transparency and awareness around the CSG mining process to mitigate negative reactions. It is possible that perceived impacts of CSG development on health and wellbeing may reflect an unavailability of reliable sources, inadequate community consultation and a possible reliance on media for information.
'Community resilience' is a term often used in the context of mining and regional communities, and it is even quoted as a local government objective [31]. Resilience can be defined as responding to changes in one's community with a view to reinstate, maintain and enhance community wellbeing [31]. A key focus of research in this context is being able to provide evidence that supports communities in preparing for the local effects of CSG development rather that experiencing uncertainty and disruption.
Public health and policy implications
Extraction of CSG can occur alongside communities for over a decade. There is obvious concern that a lack of assessment of ongoing and cumulative health impacts leads to mining projects being carried out without a thorough understanding of the consequences for host communities [8]. In Australia, this is evidenced by submissions of concern by leading public health organisations to the NSW independent enquiry and commentaries from prominent academics in the field on NSW CSG development in 2013 [7, 8, 32, 33]. There is currently a lack of cohesion in identifying what health and wellbeing outcomes should be considered when examining population-level impacts of mining, and which stakeholders should be held accountable. Research demonstrates that impacts of CSG development stages relate to social, economic and environmental factors that can affect an individual beyond the state of physical health [12, 34]. Furthermore, evidence points to community—level health and wellbeing impacts that, although harder to measure due to the myriad of possible causes, merit attention (Table 3).
Summary of key findings and recommendations
CSG mining during development stage has implications for the social determinants of health (SDoH) and health and wellbeing outcomes
Direct and indirect impacts both at individual and community level
Potential impacts of CSG mining could incorporate standardised assessment of SDoH at individual and community level, with acknowledgment that setting (e.g. level of remoteness can affect magnitude of outcomes; avoid 'one size fits all' approach
Density and remoteness affects magnitude and type of impacts felt
Inner regional experienced more individual level impacts vs outer regional which experienced more community level impacts
Effects on health and wellbeing may vary with the stages of CSG mining
Lack of assessment of ongoing and cumulative health impacts through the stages
Monitor health and wellbeing over time to enable evidence-informed planning and response to fluctuating demands
Lack of community understanding of CSG timeline and local impacts
Insecurity, lack of trust and concern for the future following completion of CSG mining could exacerbate negative perceptions
Communication of short and long term impacts is imperative alongside effective mitigation and planning
Population level studies are effective to highlight opportunities for targeted research
Groups that might be disproportionately affected by CSG included farmers, young families and women
Targeted research to determine what services are in place or required to meet temporary or longer term needs
Measuring and responding to the impacts of a mining project is not the responsibility of the mining company alone
Assessments should focus on the population, not the project, in order to uncover health and wellbeing outcomes that may not have otherwise been captured
A partnership approach involving local government, communities, research institutes, mining companies and social and health organisations is imperative
There is still much debate and uncertainty around the best tools to measure health and wellbeing impacts in CSG development regions. In the health sector, proxies to determine health impacts include assessing hospitalisation rates and access to health services [6]. Historically, the potential impacts of mining was assessed through health, environmental and/or social impact assessments. According to the International Finance Corporation guidelines, a Health Impact Assessment (HIA) involves the collection and evaluation of baseline data and subsequent risk assessment, and the outcome should include an action plan that addresses the risks previously identified and a monitoring and evaluation strategy [35]. HIAs should incorporate tools to capture broader health and wellbeing outcomes under the social determinants of health framework, and outcomes should be monitored at several points throughout the mining lifecycle.
This study highlights the importance of gaining community views to understand broader health implications of CSG development – the study revealed interesting associations between mining activity and both individual and community level wellbeing. The findings demonstrate the importance of engaging with communities to identify issues throughout the mine cycle, and to use primary qualitative research to gain a deeper understanding of some of the drivers of poor health and wellbeing.
The prevalence of sex work was not mentioned by participants in any of the regions. Sex work in mine settings is a relatively well known occurrence and there are legalised brothels in Queensland, potentially making it a 'non-issue' in these communities [36]. It is also possible that with the discretion around sex work, its occurrence may not have been obvious to participants, or they simply did not consider it as a health or wellbeing need in this region.
This exploratory study highlighted potentially vulnerable groups that may be affected differentially by CSG development, including women and farmers. It is also important to consider whether effects on health and wellbeing differ between migrant populations and permanent residents. Further research could involve assessing health and wellbeing needs of specific groups using the HNA approach. What used to be an 'iron triangle' of government, industry and science needs to incorporate civil society, media and broader stakeholders to enable monitoring, prediction and management of cumulative impacts at a local community-level, and at all stages of mine activity [10].
CSG mining is often referred to as 'rapid' due to the growth of the industry over a short time, labour intensive yet relatively short development phase, and lack of understanding of the possible implications in the local community. It is imperative to understand the context within which CSG mining occurs to predict and control health and wellbeing impacts. More populated communities with existing mining and industry may be less likely to 'feel' impacts of development stages. As our understanding improves of the implications of CSG mining and communities are better prepared for the development stage, effects may become less damaging.
Individually regulating impacts on health and wellbeing is virtually impossible because multiple companies often work in one region and impacts cannot be solely attributed to a particular mining activity [1]. There is also variation in the institutional frameworks that define what health and social assessments must be conducted as part of a mining company's corporate social responsibility, and the findings are often not available in the public domain. HNAs focus on the population rather than a project, and therefore encompass broader health and wellbeing needs and, because of this, HNAs take the responsibility of implementation away from being solely that of the mining sector towards a joint obligation with communities, local government, research institutes and social and health organisations. HNAs are implemented with a partnership approach and significant community involvement, and the outcomes are useful for policy to inform regional and local strategic planning.
It is important to note that the HNA process would not have enabled the possible positive health implications of mining activity to be revealed, because the aim of the assessment was to determine needs. Older women were more likely to take part in the qualitative research and there is a risk of bias and misrepresentation in perceptions because of this. Furthermore, it was known to the research team that the study sites had experienced significant consultation fatigue due to other social, economic and health-related research in the area, which may have contributed to the small population sampled. This corroborates the need for a unified approach to measure, manage and respond to health and wellbeing impacts of CSG development. It is also preferable to gain perceptions from a heterogeneous cross-section of the population with a broader age range than that of this study.
There is evidence of indirect and long-term health and wellbeing implications of living in proximity to CSG development. How communities respond to the boom, post-boom transition and 'bust' of CSG development is important for government, the mining sector and the scientific community. The findings from this study may inform health service planning in regions affected by CSG development and provide the mining sector in regional Queensland with evidence from which to develop social responsibility programs that encompass health, social, economic and environmental assessments that more accurately reflect the needs of the community.
HNAs are a valuable tool for determining cumulative outcomes and needs and operate at population-level rather than project-level. Measuring wellbeing in addition to health provides a more realistic profile of the community. It is recommended that further research is conducted at all stages of the CSG mine cycle to determine trends in health and wellbeing and appropriate responses.
This publication is part of FM's doctorate of public health (DrPH) degree at Berlin University of Technology. We would like to thank all participants in regional Queensland for taking the time to share their insights and experiences with the research team. The authors gratefully acknowledge the contributions of other team members to the broader health needs assessment study.
This work was supported by the Wesley Research Institute through an investigator-initiated grant from Australia Pacific LNG Limited (APLNG). Any opinions, findings and conclusions are those of the authors and do not necessarily reflect the views of the Wesley Research Institute. APLNG had no role in the development or publication of this manuscript. We acknowledge support by the German Research Foundation and the Open Access Publication Funds of Technische Universität Berlin
To maintain the privacy of research participants who reside in small, rural communities, we have not included qualitative data for public review.
CG conceived and designed the Health Needs Assessment study. FM analysed and interpreted the data, which was validated by LM, and wrote the first draft of the manuscript. AT led the research team in the field and AT, LM and CG provided significant input on the structure of the paper and discussion components. All authors read and approved the final manuscript.
This study was granted ethics approval by the Uniting Care Human Research Ethics Committee, (reference number 1410). All participants were given verbal introduction to the study and provided with an information sheet to read. Participants were asked to sign a consent form if they wanted to proceed with the interviews and focus groups. Pseudonyms have been used and all other identifiable information removed for data storage and reporting.
Office of the Chief Economist, Australian Government. Review of the socio-economic impacts of coal seam gas in Queensland 2015. Department of Industry, Innovation and Science. Report. 2015.Google Scholar
Mactaggart F, McDermott L, Tynan A, Gericke C. Examining health and well-being outcomes associated with mining activity in rural communities of high-income countries: a systematic review. Aust J Rural Health. 2016;24(4):230–7.CrossRefPubMedGoogle Scholar
Stephens C, Ahern, M. Worker and community health impacts related to mining operations internationally: A rapid review of the literature. London School of Hygiene and Tropical Medicine. Report. 2002.Google Scholar
Coelho P, Teixeira J, Gonçalves O. Mining activities: health impacts. In: Nriagu JO, editor. Encyclopedia of environmental health. Burlington: Elsevier; 2011. p. 788–802.Google Scholar
Epstein P, Buonocore J, Eckerle K, Hendryx M, Stout B, Heinberg R, Clapp R, May B, Reinhart N, Ahern M, Doshi S, Glustrom L. Full cost accounting for the life cycle of coal in 'Ecological economics Reviews'. Ann NY Acad Sci. 2011;1219:73–98.Google Scholar
Werner A, Vink S, Watt K, Jagals P. Environmental health impacts of unconventional natural gas development: a review of the current strength of evidence. Sci Total Environ. 2015;505:1127–41.Google Scholar
Coram A, Moss J, Blashki G. Harms unknown: health uncertainties cast doubt on the role of unconventional gas in Australia's energy future. Med J Aust. 2014;200(4):210–3.CrossRefPubMedGoogle Scholar
Carey M. Coal seam gas: future bonanza or toxic legacy? Viewpoints. 2012;8:26–31.Google Scholar
Solomon F, Lovel R. Social dimensions of mining: research, policy and practice changes for the minerals industry in Australia. Resourc Policy. 2008;33:142–9.Google Scholar
Kinnear S, Kabir Z, Mann J and Bricknell L. The Need to Measure and Manage the Cumulative Impacts of Resource Development on Public Health: An Australian Perspective. in AJ Rodriguez-Morales (ed). Current Topics in Public Health. Rijeka: Intech Publishers. http://dx.doi.org/10.5772/54297.
Queensland Government. Petroleum and coal seam gas Queensland. 2017.Google Scholar
Measham T, Fleming D, Schandl H. A conceptual model of the socioeconomic impacts of unconventional fossil fuel extraction. Glob Environ Chang. 2016;36:101–10.Google Scholar
House of Representatives; Standing Committee on Regional Australia. Cancer of the bush or salvation for our cities? Fly-in, fly-out and drive-in, drive-out workforce practices in Regional Australia. The Parliament of the Conmonweatlh of Australia, Canberra. Report. 2013.Google Scholar
World Health Organization. WHO definition of health. 1946.Google Scholar
Cavanagh SaC, K. Health Needs Assessment: A Practical Guide. In: National Institute for Health and Clinical Excellence. Report UK 2005.Google Scholar
World Health Organization. Measurement of and target-setting for well-being: an initiative by the WHO regional Office for Europe. Geneva: WHO; 2012.Google Scholar
Australian Bureau of Statistics. Australian Statistical Geography Standard (ASGS) Volume 5 - Remoteness Structure. In: ABS, editor. Canberra 2011.Google Scholar
Australian Institute of Health and Welfare. Rural, regional and remote health: a guide to remoteness classifications. Australian Government. Canberra. 2004.Google Scholar
Australian Institute of Health and Welfare. Rural, regional and remote health: indicators of health status and determinants of health. Australian Government. Report. Canberra. 2008.Google Scholar
Brashier KFM, McLaughlin D, Jacquet J, Stedman R, Kelsey T, Goetz S. Residents' perceptions of community and environmental impacts from development of natural gas in the Marcellus Shale: a comparison of Pennsylvania and New York case. Journal of Rural Social Sciences. 2011;26(1):32–61.Google Scholar
LNG Blueprint: Queensland's LNG industry - a once in a generation opportunity. In: Sub-Committee LC, editor. Queensland: Queensland Government 2010.Google Scholar
Morgan M. HD, Bhullar N. Dunstan D., and Bartik W. Fracked: coal seam gas extraction and farmers' mental health. J Environ Psychol. 2016;47:22–32.CrossRefGoogle Scholar
Hossain D, Gorman D, Chapelle B, Mann W, Saal R, Penton G. Impact of the mining industry on the mental health of landholders and rural communities in southwest Queensland. Australasian Psychiatry. 2013;21(1):32–7.CrossRefPubMedGoogle Scholar
Rohde N. TK, Osberg L., Rao P. The effect of economic insecurity on mental health: recent evidence from Australian panel data. Soc Sci Med. 2016;151:250–8.CrossRefPubMedGoogle Scholar
Smith KJ, McNaughton SA, Gall SL, Blizzard L, Dwyer T, Venn AJ. Takeaway food consumption and its associations with diet quality and abdominal obesity: a cross-sectional study of young adults. International Journal of Behavioural Nutrition and Physical Activity. 2009;6:29.CrossRefGoogle Scholar
Jacquet JB, Stedman RC. The risk of social-pscyhological disruption as an impact of energy development and environmental change. J Environ Plan Manag. 2014;57(9):1285–304.CrossRefGoogle Scholar
Storey K. Fly-in/fly-out: implications for community sustainability. Sustainability. 2010;2(5):1161-81.Google Scholar
Siegler V. Measuring Social Capital. Office for National Statistics. Report. 2014.Google Scholar
Queensland Health. The Health of Queenslanders 2014; Fifth Report of the Chief Health Officer, Queensland. Report. 2014.Google Scholar
Albrecht G, Sartore GM, Connor L, Higginbotham N, Freeman S, Kelly B, et al. Solastalgia: the distress caused by environmental change. Australasian psychiatry. 2007;15(Suppl 1):S95–8.CrossRefPubMedGoogle Scholar
McCrea R, Walton A, Leonard R. A conceptual framework for investigating community wellbeing and resilience. Rural Soc. 2014; 23(3):270–82.Google Scholar
Multiple Public Submissions to the CSG Review, NSW Government. 2013. Available from: http://www.chiefscientist.nsw.gov.au/reports/coal-seam-gas-review/public-submissions.
Kelly B. Industry and rural health: part of the problem or part of the solution? Aust J Rural Health. 2015;23:124–6.CrossRefPubMedGoogle Scholar
Franks DM, Brereton D, Moran CJ. Managing the cumulative impacts of coal mining on regional communities and environments in Australia. Impact Assessment and Project Appraisal. 2010;28(4):299–312.CrossRefGoogle Scholar
Department. EaSD. Introduction to health impact assessment. Washington, DC: International Finance Corporation; 2009.Google Scholar
Laite J. Historical perspectives on industrial development, mining, and prostitution. Hist J. 2009;52(3):739–61.Google Scholar
Public Health Information Development Unit. Social Health Atlas of Australia: Local Government Area. 2015. Available from http://phidu.torrens.edu.au/about-phidu.
1.Department of Health Care ManagementBerlin University of TechnologyBerlinGermany
2.Queensland Centre for Domestic and Family Violence Research, School of Nursing and MidwiferyCQ University AustraliaBrisbaneAustralia
3.University of Queensland School of Public HealthBrisbaneAustralia
4.Anton Breinl Centre for Health Systems Strengthening, Colleges of Medicine and Public HealthJames Cook UniversityCairnsAustralia
Mactaggart, F., McDermott, L., Tynan, A. et al. BMC Public Health (2018) 18: 51. https://doi.org/10.1186/s12889-017-4568-1
First Online 03 August 2017
Publisher Name BioMed Central


NXP Semiconductors, makers of high performance, mixed signal semiconductors, uses PDF FLY Server to convert EPS technical graphics to GIF images for Web viewing.
The Yellow Pages in seven different countries used the FLY SDK to automatically convert print ads received in EPS and PDF formats into crisp PNG images for the Web versions of their Yellow Pages directories. Ads were received from many different sources. Quality needed to be ensured and maintained as part of the workflow. Working together with Visual Integrity, the directories established a workflow process using a watch folder to convert all incoming ads to PNG at the correct size and resolution for high-fidelity Web display.
SDL provides content and document management solutions that streamline the information creation and delivery process. They integrated the PDF SDK into their XML Professional Publisher (XPP) to enable import of PDF pages as EPS files. XPP, an automated XML publishing engine, is widely used in publishing, technical documentation, financial, government, high tech, aerospace and defense industries. XPP is a key component of some of the most sophisticated, high-production publishing systems in the world.
Merck & Co. is a global healthcare company committed to improving health and well-being around the world, They use PDF Server to convert PDF documents into the EPS format as part of their high-volume production system that produces regulatory submissions to the FDA. Over the years that Merck has been a Visual Integrity customer, we have added several custom features and enhancements to our engine in order to ensure absolute conversion accuracy of even the most arcane symbols and equations thus providing the highest fidelity output possible for these critical FDA submissions.
Harris Corporation uses Adobe FrameMaker to produce its technical manuals. The graphics are either produced in CAD applications or stored in legacy systems such as Interleaf. In both cases, they rely on PDF FLY to convert the drawings from EPS into MIF producing graphics that are editable and can be easily imported into their FrameMaker documents.
The world-renowned Swiss Federal Institute of Technology, ETH Zurich, forms a community of 20,000 people from 80 nations with an outstanding research record. Visual Integrity products are at work in several faculties. One professor uses MATLAB to generate sophisticated data plots in EPS. To share these, he needed a solution to publish the EPS files to the Web in a format that people could zoom and pan. SVG was the answer, automatically produced in seconds by invoking PDF FLY via a command line script on UNIX.
Mohawk Industries, the leading producer and distributor of flooring worldwide, relies on PDF FLY to streamline their marketing workflow to move logos, product images, brochures and ads into their XML-based online authoring and publishing system. Files are converted on Linux from EPS into SVG, the XML standard for scaleable vector graphics on the Web.


Hippie tie dye tshirt, trippy, psychedelic style. All sizes available.
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SIZES - XS,S,M,L,XL,XXL - hand dyed to order please state size at checkout.


Generators can be useful to keep the power going in your home during a power outage. They're also handy when you need to power up more tools withour blowing the fuse box! Our customers enjoy renting the 3500w model or the 7000W model for so many different applications! Our fun friends will rent them to set up flood lights and string lights in remote locations for "off the grid" parties! Whatever your unique power needs may be, our knowlegable staff can set you up with the just the right generator!


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UK: PPI, CPI (Dec), SPPI (Q4)
U.K. Inflation Steps Back; COVID-19 Lurks Less Than People Think
by Robert Brusca April 22, 2020
U.K. inflation has remained tame. In December there was a broad-based acceleration, but that has dissipated in February and March. In March and February, only about 21% of the major categories and the headline accelerated month-to-month. In March, the CPIH was flat, the core was up by 0.1%, and the HICP definition for the price index saw prices fall by 0.1%.
The year-on-year graphic for the U.K. shows inflation decelerating rather steadily after peaking in 2017. The diffusion data in the table confirm and underscore that the trends on several annual periods and sub-annual sequential periods as well as over the recent three months largely agree.
Inflation metrics of such different periodicities do not always reveal the same trends; in this case, they do substantially.
Of course, declining prices are now underpinned by dropping oil prices and those prices promise to remain on the weak side of history for some time. Brent crude prices have fallen for three months in a row. Year-on-year Brent prices have fallen for two months in a row as well as in 10 of the last 12 months, leaving a long trail of weak energy prices in the pipeline.
Nonetheless, the CPIH accelerates from three-months to six-months (2.1% vs. 1.3%). Over three months, CPIH categories show acceleration in nearly 79% of the major divisions. However, that was a break from the previous two years and the monthly data make it clear that the price pressures seen in January are now on the run.
With the coronavirus stalking growth and governments throwing up various patchwork arrangements to try to support the out of work who remain substantially unsupportable, there is a large segment of the population at economic risk. Government programs will help some and save some. But there is going to be a lot of pain over this virus given the way it has been handled.
In the U.S., the Federal Reserve has made it clear that it is talking to epidemiologists because economic forecasts cannot be made without their input. So rather than saying "We all Keynesians now," I will say 'we are all epidemiologists now.' And so what does that mean? I'm afraid it means that we are at the whim of what the pandemic specialists want to do and how they view this crisis. And I find this disturbing because they are locked in their own group-think with protocols for action that make NO SENSE TO ME. Maybe they are fans of David Byrne's?
I assume that COVID-19 is COVID-19 is COVID-19. In other words, I assume that the disease 'is the same everywhere' but depending on local demographics and even on how it is approached its impact could play out differently. The table below shows you why I am so upset with how global health authorities have dealt with the virus. Look at the panel under 'Shares.' Here we present the NYC data on COVID-19 deaths by age group and by three categories of heath: (1) those with underlying conditions present, (2) those with no underlying conditions present, and (3) those whose medical history is unknown.
Astonishing facts!
There are two astonishing facts here. (1) One is that the virus preys on the unhealthy. If a person has an underlying health condition, his or her probability of dying is high. 73% of the deaths in NYC are to people in this group. (2) Secondly there is no correlation with age for the healthy. REPEAT: No correlation with age. This is a surprise because so many old people have died, especially in Italy. What is going on? By the time someone is old, they usually have amassed some of the preexisting conditions that make them vulnerable to the virus. Similarly, a Wall Street Journal article (here) explores the reason for their being more Black deaths and traces that back to the prominence of preexisting conditions in the Back community and to a greater incidence of multigenerational households in the Black community.
The bottom line here is pretty clear. If you are healthy, there really is very little risk of death only 1.4% of New York City deaths came to the group reported as having none of the preexisting conditions that the NYC health authorities flag. So why is everyone sheltered? Why not shelter and really protect the at-risk?
The COVID-19 Factor- What to Expect from Policy
Source: NYC COVID-19 Data, NYC Government.
A role for testing
While Boris Johnson is under pressure for how he dealt with the crisis, he may have been on the right track but on the wrong train. The ticket was not to let the virus run rampant but to use some social distancing to slow the spread and to stridently wall off those with preexisting conditions. Sweden has not had a catastrophe by failing to follow the rest of Europe down the rabbit hole of shelter-at-home. But what is also is clear is that health officials and individuals should be taking GREAT CARE to shelter, buffer, and protect people with the preexisting conditions since for them the virus is deadly. Anyone with contact among such people should be tested daily to clear them before they are allowed to have such contact.
In short, in the U.S. and Europe, isolation has been done badly and too broadly. It was too broadly administered to have been done too-well. The attempt to isolate all has greatly impacted economies that did not need to do their imitation of the movie 'The Day the Earth Stood Still.' What was needed was to protect the at-risk population, a much smaller group that I have not been able to put a number on yet.
Knowing nothing about one's health history, an old person should shelter because they are likely to have acquire in the course of their life, a preexisting condition. Certainly, the poor are at greater risk because they are more likely to mingle in multigenerational households putting older peoples with preexisting conditions at risk. There are still clear health challenges, but they can be understood and can be managed far better and more cheaply than sheltering everyone at home-- that is excessive.
An economist's opinion is likely to be as good as anyone else's...
These determinations come from looking at the numbers not from my ability to be a better pandemicist than the pandemicists. A key issue is that they have been given free reign with no push-back from other experts, other scientists/sciences. In the U.S., the 'situation has developed' in which those who argue to open the economy are being accused of being insensitive to human life and are accused of putting the value of the dollar above the value of human lives. In fact, it is the other way around. Recessions, especially deep dark recessions, are a health hazard. When the government blocks people from pursuing their livelihood, there is no entrepreneurial work-around. There is only bankruptcy unless a person has been lucky enough to secure one of the scarce government loans.
The question we need to ask is who are these pandemicists and who gave them absolute authority to make decisions that in retrospect and in PROSPECT seem to be much more damaging and draconian that need be. Someone needs to shift the balance of power here and to change the beat of the dialogue that we have all been catatonically marching to.
There is more than one way to flatten a curve. As the NYC data show…had NYC been able to shelter effectively its at-risk population and its deaths could have been reduced by at least 73%! That'll flatten your curve! NYC does not provide comparable data for hospitalizations. So there is still a potential issue with hospital facilities.
Gentlemen...start your engines
But far from having to wait for a vaccine it may be much safer to open large parts of the economy even NOW if the at-risk population can be identified and protected. Spending public money to do that makes sense. And it will be much cheaper than closing down the bulk of Europe, America, and so on. The solution is found in the numbers, properly arrayed. It is not a matter of politics. It is not a matter of putting money ahead of lives. It is not matter of continuing to follow a bad plan. It is matter of putting understanding and action ahead of doing the things that prove to be very damaging. Policy needs to learn and to change. Restarting growth safely is a closer objective than it seems.

redpajama_set_name: RedPajamaCommonCrawl


Art of Board tiles are hand cut from 100% recycled skate decks and sold by the square foot. Every scratch, scrape and gouge is kept in tact – making them truly original. Each tile has its own story. They're alive with texture, shape and color. Together, they bring that story to life in every space they inhabit – creating a vibrant visual experience in the home, retail or commercial environment.
I wouldn't necessarily use these tiles in my home, but I love the idea of using them in a skate shop or certain retail spaces.
I really do like the creativity of turning something that was broken and destined for the dump into a useful design element.
Love for a retail space or funky basement kitchenette.


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Who is Frank Reich?| Meet the Carolina Panthers' new head coach
IRS now processing tax returns | Part 2
Novant Health spreads awareness on Black maternal health
Novant Health is partnering with a Triad cinema to provide free screening and a panel discussion about childbirth complications.
Author: Sydni Moore
Published: 11:38 AM EST November 29, 2022
Updated: 1:39 PM EST November 29, 2022
GREENSBORO, N.C. — Novant Health is spreading awareness about black maternal health.
They are partnering with a Triad cinema to provide free screening and a panel discussion about a movie focused on childbirth complications.
According to the CDC, Black women are more likely to die from a pregnancy-related cause than White women.
The movie 'Aftershock' focuses on two women that died due to childbirth complications and the community's response to their deaths.
Novant Health Physician, Pam Oliver says through the movie they want to have conversations about the inequities that exist in Black maternal wellness. She says heart conditions are the number 1 cause of death in black mothers and 80% of those deaths are preventable if black women have the access they need for care.
"We know that women of color live in areas more likely in the US that have access gaps and access to care that it said that 6.9 million women in the US live in areas where there's low or no coverage, we had to fix that so that's half a million births in areas where there is low to no coverage," Oliver said.
She also said Tuesday's panel discussion is to not raise fear but to help women understand what they can do to have a safer pregnancy.
"Any woman that is considering starting a family whether she is afraid or not, would benefit from a pre-conception counseling visit with a physician to establish a relationship to develop trust and to get questions answered," Oliver said. "As much as social media can be great in many ways it can also create data points in stories or narratives that people don't give the big picture."
The Aftershock movie and panel discussion begins at 7 p.m. at A/perture Cinema in Winston-Salem.
Giving Tuesday: How to give to nonprofits without pinching your wallet
NC hospitals prepare for potential holiday surge


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Cross Buy could be in Nintendo's Future
It has been quite awhile now since Nintendo released their major Nintendo Network update (which linked 3DS and Wii U eShop accounts), and it seems that Nintendo is finally ready to take things to the next level. If you have access to the EU eShop, then chances are you have heard about Nintendo's new special currently going on. If you buy the RPG "Squids Odyssey" on the 3DS, for a limited time you'll also receive the Wii U copy as well. The game is Nintendo's first "cross buy" title, and although it is a limited offer, this only goes to prove one thing; Nintendo can in fact include cross buy in their future titles.
Up until now, Sony has been one of the only few companies which could provide such a feature (with their PS3, PS4, and Vita), but thanks to Nintendo's new account system, they too can possibly take advantage of this in the future. Currently Nintendo does offer discounts on Wii U Virtual Console games if you owned them on the Wii, but if they could greatly improve on this system. Virtual Console games bought on the 3DS could be played on the Wii U, Wii U Virtual Console titles could be played on 3DS, and eShop titles shared by both consoles could be playable on both with no extra charge. If Nintendo chooses to make full advantage of this system, it would make their fans very happy. Come on Nintendo, go all out with this! No one likes to buy the same game twice on multiple consoles! (Unless, you're me that is...)
Labels: 3DS, eShop, News, Nintendo, Playstation, Wii U


Several types of symmetry have been identified and exploited in Constraint Programming, leading to large reductions in search time. We present a novel application of one such form of symmetry: detecting dynamic value interchangeability in the random variables of a 2-stage stochastic problem. We use a real-world problem from the literature: finding an optimal investment plan to strengthen a transportation network, given that a future earthquake probabilistically destroys links in the network. Detecting interchangeabilities enables us to bundle together many equivalent scenarios, drastically reducing the size of the problem and allowing the exact solution of cases previously considered intractable and solved only approximately.


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What cancer patients need to know about the coronavirus and ways to connect with our experts.
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Advancing pancreatic cancer research for early detection and new therapies through partnerships with internationally renowned organizations.
Diagnose earlier. Live longer.
The Henry Pancreatic Cancer Center aims to do just that by bringing together the world's most innovative minds to accelerate the pace of discovery for early detection and new therapies — all with the goal of reducing the pancreatic cancer mortality (death) rate and, ultimately, offering hope to more patients.
Right now, pancreatic cancer has a five-year survival rate of roughly 9 percent. With no effective screening currently available to detect pancreatic cancer early, most patients are not diagnosed until the cancer has progressed to an advanced stage.
Never has there been a greater opportunity for our research team and international partners to work together to 'raise the floor' for pancreatic cancer research.
Funding from an initial $20 million gift, followed by another $16 million gift, totaling $36 million from an anonymous individual donor — marking one of the largest gifts in the country to a pancreatic cancer center — will bolster the Henry Ford Pancreatic Cancer Center's clinical and translational research endeavors in the fight against this devastating disease.
Our team, led by clinical director David Kwon, M.D., and scientific director Howard Crawford, Ph.D., is working with internationally renowned partners to uncover the early warning signs and biomarkers for pancreatic cancer for earlier diagnosis and improved treatment.
Bring together the best minds in the world to detect pancreatic cancer earlier and help patients live longer.
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Henry Ford Cancer Institute's Precision Medicine Program, the first and most comprehensive in Michigan to offer genomic testing and expertise of a molecular tumor board to all cancer patients.
Henry Ford Health System's participation in All of Us, a National Institutes of Health Precision Medicine research program.
Henry Ford Health System's Department of Public Health Sciences, which conducts and promotes population and clinical research studies to advance biomedical knowledge that will result in disease prevention and overall improved health status.
Precision Medicine works to find targeted treatments custom-fit for each person's unique type of cancer. Discover the advances Henry Ford is bringing to all patients.
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Academic & Professional Books Palaeontology Palaeontology: General
The Second Jurassic Dinosaur Rush Museums and Paleontology in America at the Turn of the Twentieth Century
By: Paul D Brinkman
345 pages, 31 b/w photos, 8 b/w illustrations
ISBN: 9780226074726 Hardback Jul 2010 Temporarily out of stock: order now to get this when available
The so-called "Bone Wars" of the 1880s, which pitted Edward Drinker Cope against Othniel Charles Marsh in a frenzy of fossil collection and discovery, may have marked the introduction of dinosaurs to the American public, but the second Jurassic dinosaur rush, which took place around the turn of the twentieth century, brought the prehistoric beasts back to life. These later expeditions – which involved new competitors hailing from leading natural history museums in New York, Chicago, and Pittsburgh – yielded specimens that would be reconstructed into the colossal skeletons that thrill visitors today in museum halls across the country.
Reconsidering the fossil speculation, the museum displays, and the media frenzy that ushered dinosaurs into the American public consciousness, Paul Brinkman takes us back to the birth of dinomania, the modern obsession with all things Jurassic. Featuring engaging and colorful personalities and motivations both altruistic and ignoble, The Second Jurassic Dinosaur Rush shows that these later expeditions were just as foundational – if not more so – to the establishment of paleontology and the budding collections of museums than the more famous Cope and Marsh treks. With adventure, intrigue, and rivalry, this is science at its most swashbuckling.
1 Scientists Wage Bitter Warfare
2 Osborn's Sorry Valentine
3 Wortman Assumes Charge
4 Most Colossal Animal on Earth
5 An Overconfident Start
6 The Monster of All Ages
7 A Monkey and a Parrot of a Time
8 Fossil Wonders of the West
9 Watch the Dinosaur Shrink!
10 Hatcher Heads West
11 Last Days in the Jurassic
12 Putting Dinosaurs in Their Places
Conclusion: What's the Rush?
Paul Brinkman is a research curator at the North Carolina Museum of Natural Science in Raleigh.
"In the years around 1900, major U.S. museums raced to find the best and biggest dinosaurs and put them on display. It was a decisive decade for paleontology, when the public first got a spectacular view of the strangeness of the prehistoric world, and dinomania first took off. Based on thorough archival research, this is a fascinating story of ambitious administrators and scientists, their moneyed patrons, and the often invisible technicians and fieldworkers on whom the whole project depended."
– Martin Rudwick, author of Worlds Before Adam and Bursting the Limits of Time
"This superbly researched and illustrated book carries the subject of dinosaur paleontology from the end of the much discussed Marsh–Cope era to just short of the discovery of Dinosaur National Monument. It is a period of the establishment of museums in New York, Pittsburgh, and Chicago to exhibit the mounted skeletons. From the archives, including many letters from the field collectors like Hatcher to museum directors like Holland, one learns details of the collecting at major quarries like Bone Cabin Quarry and Sheep Creek, but also of the scientists' often complicated relationships
with one another and with their superiors. At the end, one feels personally acquainted with the personalities in this engaging book."
– John McIntosh, Wesleyan University
Bestsellers in Palaeontology: General
A Guide to Fossil Collecting in England and Wales
Life – An Unauthorised Biography
The Palaeoartist's Handbook
Your Inner Fish
Cowen's History of Life
The Princeton Field Guide to Prehistoric Mammals
Earth History and Palaeogeography
Mesozoic and Tertiary Fossil Mammals and Birds of Great Britain
Browse titles in Palaeontology: General
Other titles from Chicago UP
Neotropical Rainforest Mammals
Phylogeny and Evolution of the Angiosperms
Sewall Wright and Evolutionary Biology
Nature's Engraver
Octopus, Squid & Cuttlefish
Extreme Conservation
The Wild Cat Book
Land Bridges
Messages from Islands
The Trilobite Book
Browse titles from Chicago UP


All GA and VIP tickets have now SOLD OUT!
The Sounds of Summer returns on Saturday February 20th 2016 to the Commons Complex Takapuna beach with a new set up, event style and creation across all of the different venue spaces that this premium seaward side establishment has to offer.
A superb selection of House music, Funk, Soul, old school RnB, Pop party jams and more will be combined with fine food, delicious refreshments and specialised production, giving you a summer party experience in an atmosphere like no other.
The last Sounds of Summer party at this location went off and attracted an exceptional crowd so expect nothing less as we return in 2016 with an even better event!
Tickets for this event are very limited and go on sale Wednesday December 16th.
Purchase a ticket to the Highlife VIP area to enhance your experience at the Sounds of Summer. The VIP area at this event is situated on the second level of the Commons venue and overlooks both the outside and inside main party areas. It is complete with a private bar, serviced toilets, table service, DJ's and seating areas for you to relax in. Complimentary summery fruit platters will be served throughout the night and all VIP guests will be given a tropical summer beverage on arrival.


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Harem Porn Strategy Game: Tactics Elemental
Rastafoo69 March 4, 2019 Harem Porn Strategy Game: Tactics Elemental2019-03-04T09:05:26+00:00 Featured, Reviews No Comment
Hentai Reviews > Featured > Harem Porn Strategy Game: Tactics Elemental
Written by Rastafoo69, edited by Otaku Apologist
Tactics Elemental, a hentai strategy game developed by Fred GD Art. Published by Perry Art Enterprises. Released August 6, 2017. Download on Nutaku.net for $25.00. For PC Windows. No voice acting. Uncensored genitals.
You are the chosen one, hero Eternial. You must defeat the invading alien force all the while building a harem of beautiful women. Gather a group of girlfriends, and sex them up to activate your hidden super powers!
The story can get convoluted at times, but the core narrative is simple: A sage goes on a journey and meets many new companions along the way. His goal is to revive the hero Eternial. After he's resurrected, Eternial must activate his super powers through vaginal sex with women. Once he's fucked his fill of girls, he defeats the alien invasion.
The first two hours you play as Sage Threedle working to resurrect the hero Eternial. Like traditional RPGs, you have a party of characters. The party grows as you explore the world. While Eternial is painted as the main character, he is not always the point-of-view character. In fact, there are segments in the game when you don't play on any guys from your actual party.
The number of characters in the game is so many, many don't get enough characterization to grow beyond their stereotypical portrayal. The dialog is also rife with sex jokes and nonsensical technobabble and words that mean nothing.
The plot is organized into multiple chapters. The first introduces you to Threedle, the Sage of Arach Niac. She and her servant, Chizzle, are the first ones to learn about the alien invasion. Next chapter begins the search for the hero.
If you can look past the bad writing, you'll find the story bursting with personality. The plot goes through highs and lows and keeps you on the edge of your seat. Maybe!
Tactics Elemental is a complex strategy game, but easy to learn. Most actions in game require only a mouse click. Click "continue" during dialogue to progress conversations. Use the mouse wheel to zoom in on the CGs. Use the arrow keys during battle to explore the area. Right click your opponents to see their strengths and weaknesses.
The game includes over 90 levels. There are almost 30 characters you can include in your party. When characters fight together it builds their relationships, similar to Nintendo's Fire Emblem series. When the characters reach the maximum relationship status, you get a unique sex scene. The couple also becomes much more powerful in gameplay.
The combat is a unique kind of turn-based strategy focused on elemental rock-paper-scissors.
There are six elements in the game: Thunder, Fire, Water, Ice, Air, and Earth. Each is strong and weak against another. Choose your team composition to counter-act the elements of the enemy team. You move on a game map and attack enemies with elemental spells. The abilities of your enemies differ. Some will attack you from a long range, while others come at your face. Enemies level up as you battle. If you play too safe, they'll punish you.
The game heavily encourages you to adopt an aggressive playstyle, because all the loot can be destroyed by your enemies. When an enemy lands on a tile with an item, they destroy it.
The game has an in-built tutorial where the characters verbally remind you about the rock-paper-scissor combat mechanics, ie. which element is weak against what. You can also deploy elemental shields to protect against spells of different elements. A water shield will make you immune to fire, for example. These shields can be used offensively by combining elements. For example, using electricity on a water shield will do tons of damage to the opponent!
The combat mechanics are easy to learn, but hard to master. Grind experience points and use boost items to overcome challenges, or play with skill and cunning to progress faster.
The art is a cartoonish style with anime influences. The characters are highly expressive, each guy showing exaggerated features that emphasize their emotions. Their eyes go inhumanly wide when they are surprised. Their long grins stretch across their faces when they're happy. This applies to the CGs only, because the sprite work is not the best. Body proportions are inconsistent, faces look strange, everyone is weirdly colored in unnatural colors.
You can customize your avatar at the end of the first chapter. He appears in that form in all future CGs.
The sheer amount of illustrations in this game is astounding. None of them were generated with 3D models, each of them was hand drawn, one by one. There are too many images to even count! The background art showcases mountain ranges, grassy plains, dark caves, sunset cliffsides, and more.
The CGs are gorgeously colored, but they're hit-or-miss depending on the viewer. Not everyone enjoys this kind of avant-garde style – and that's okay. We can argue about our likes and dislikes. What's objectively bad about the visuals is the terrible user interface. Dialogue boxes cover up images, while the images don't even fit the screen sometimes! The pictures are not wide enough for most monitors. You're forced to zoom in and out trying to get a good look at the scene.
VOICE ACTING AND SOUND EFFECTS (SFX)
Tactics Elemental has no voice acting.
Sound effects are numerous and professionally implemented. You hear everything from sword slashes to punches. Each character comes with their unique set of sounds that compliment their visual design. As the name makes you expect, elemental audio is plentiful in this game. Lightning crackles, fireballs explode. The clips are realistic enough that you're not thrown off, as fantastical as the overall audio is.
The soundtrack has plenty of songs. The track changes when you switch regions, though most of them have the same atmospheric vibe. These songs have a sense of foreboding danger. The intense mood matches the action on screen. The tracks make heavy use of castanets, also known as clackers. When the song playing is dark, the clackers make you dread there's something lurking in the shadows.
You also hear the soft play of drums, with lots of silence between notes. The soundtrack relies heavily on dramatic silence. These songs fill the silence without distracting you from the challenging gameplay.
While the gameplay has lots of exciting features, this hentai title is clearly gameplay first, hentai second.
Almost all scenes jump immediately to vaginal sex, usually in some variation of the missionary position, or doggystyle. The erotic dialogue is decently written, but the dialog box annoyingly covers the imagery. You will struggle to get a good look on either character. On top of that, it's impossible to access all the sex scenes in one playthrough. If you can look past the annoyances, and the artwork excites your genital area, you'll find over 200 sexy images in this game, and over 500 scenes. There's mountains of erotic content to explore. Just pair two people up in battle, build their relationship, and watch them go at it like wild animals!
If you love alien and monster sex, this game is for you. Otherwise, the sex is quite vanilla.
CONCLUDING WORDS
Tactics Elemental is the best hentai strategy game on the market today. The graphics are unique, the story is entertaining, the erotic scenes are numerous, and the gameplay is an exciting brain-puzzler. You're easily getting at least 20 hours of content with this download. The game also includes free DLC that expands the story and adds new characters.
I highly recommend this game to all adult gamers. Download Tactics Elemental.
Graphics - 60%
Gameplay - 100%
Story - 70%
Music - 70%
SFX - 70%
Hentai - 70%
https://hentaireviews.moe/2019/03/04/harem-porn-strategy-game-tactics-elemental/https://hentaireviews.moe/wp-content/uploads/2019/03/Tactics-Elemental-Strategy-Game-Developed-by-Fred-GD-Art-1-1024x802.pnghttps://hentaireviews.moe/wp-content/uploads/2019/03/Tactics-Elemental-Strategy-Game-Developed-by-Fred-GD-Art-1-300x300.png 2019-03-04T09:05:26+00:00 Rastafoo69FeaturedReviewseroge,fantasy,fred gd art,hentai,monster girls,nutaku,romance,rpg,sci fi,strategy,tactics elemental,turn-based strategyWritten by Rastafoo69, edited by Otaku Apologist Tactics Elemental, a hentai strategy game developed by Fred GD Art. Published by Perry Art Enterprises. Released August 6, 2017. Download on Nutaku.net for $25.00. For PC Windows. No voice acting. Uncensored genitals. You are the chosen one, hero Eternial. You must defeat the...Rastafoo69 TELEPHONE2145@gmail.comContributorHentai Reviews
eroge, fantasy, fred gd art, hentai, monster girls, nutaku, romance, rpg, sci fi, strategy, tactics elemental, turn-based strategy
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In QuintaDB you can perform table search and find anything you need easily.
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On a Data Export menu you can automize export to Email or FTP. If you want to automize your data export there is data export scheduling feature available.
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