Journal articles on the topic 'United States. Bureau of Health Planning and Resources Development'

This article argues, based on the author’s research and years of engagement with resettled Karenni refugees in Omaha (U.S.) and illustrated by a characteristic case of a health emergency, that refugees’ religious beliefs and networks can increase access to resources needed to boost their resilience, improve their health, and advance their sense of wellbeing, and subsequently encourages agencies working with refugees and other migrants to pay attention to refugees’ religious beliefs and networks and closely collaborate with religious organizations. The author conceptualizes religious values and networks as social capital and calls for qualitative studies to explore the role of religion in improving resilience, health, and wellbeing of refugees and migrants.

During the COVID-19 pandemic, construction accidents in the United States (US) dropped dramatically compared to previous years. This research uses Saunders’ research onion approach to conduct a deep and systematic analysis of pre- and post-COVID-19 data to understand this phenomenon. The proposed research framework examines safety and prevention measures implemented by the US government, using data collected from various US government agencies, including the Occupational Safety and Health Administration (OSHA), Centers for Disease Control and Prevention (CDC), and US Bureau of Labor Statistics. COVID-19’s effects on construction site health and safety were analyzed and ranked in order of efficacy in a hierarchy of control, and findings reveal a number of safety measures that can potentially be implemented to promote improved construction safety even after COVID-19 is over.

This article explores the programme of national health planning carried out in the 1960s in West and Central Africa by the World Health Organization (WHO), in collaboration with the United States Agency for International Development (USAID). Health plans were intended as integral aspects of economic development planning in five newly independent countries: Gabon, Liberia, Mali, Niger and Sierra Leone. We begin by showing that this episode is treated only superficially in the existing WHO historiography, then introduce some relevant critical literature on the history of development planning. Next we outline the context for health planning, noting: the opportunities which independence from colonial control offered to international development agencies; the WHO’s limited capacity in Africa; and its preliminary efforts to avoid imposing Western values or partisan views of health system organisation. Our analysis of the plans themselves suggests they lacked the necessary administrative and statistical capacity properly to gauge local needs, while the absence of significant financial resources meant that they proposed little more than augmentation of existing structures. By the late 1960s optimism gave way to disappointment as it became apparent that implementation had been minimal. We describe the ensuing conflict within WHO over programme evaluation and ongoing expenditure, which exposed differences of opinion between African and American officials over approaches to international health aid. We conclude with a discussion of how the plans set in train longer processes of development planning, and, perhaps less desirably, gave bureaucratic shape to the post-colonial state.

Several themes run through this consideration of children with special health needs and their families. First, US programs tend to be fragmented in the sense that many geographic areas lack adequate services, and only partial types of family support and treatment services are available despite the relative breadth of family needs. Programs tend to be focused in the sense of separating children based on the specific health condition that they have, despite the similarity of issues for their families that cross diseases. This approach provides focused attention to high quality and high technology medical and surgical care and may lead to better physiologic outcomes, but it lessens attention to the issues that may help the child function effectively in society and grow into a participating young adult. For teenagers, focus on pregnancy prevention may take attention away from other pressing problems, such as substance abuse or sexually transmitted diseases. Hearing screening for school-aged children may take place isolated from intervention programs or from broader preventive health efforts. In Europe, the whole is more than the sum of its parts and the commitment to community-based preventive care assures children and families access to a wide array of preventive efforts. Second, the political will in the US emphasizes freedom of personal choice and individual and family responsibility. This issue of free choice is tempered by restrictions on access to contraceptive education and services for teenagers. But, in general, it limits public support for families with children with special health needs, emphasizing instead the family's responsibility to seek services and provide care, whether for the prevention or management of adolescent pregnancy or for the home and community management of children with complex physical health needs. Programs reflect the belief that families should meet their own needs. In Europe, in distinction, the social contract assumes that families with children with special health needs require additional resources from the community and fosters a broad base of financial support for families. Some conclusions may be drawn about the population of children with special health needs. First, insurance alone will not meet their needs. Other structures (with adequate funding) are needed to insure the development of systems of care, the availability of adequate preventive services, the development and maintenance of regionalized programs where necessary, and the assurance of quality. Second, prevention is relevant for all of these issues of children with special health needs, the prevention of adolescent pregnancy, the prevention of handicap for children with disabilities, or the prevention of dysfunction from a hearing impairment. Much prevention can be carried out at a community level. A broad-based effort reflecting community needs is preferable to fragmented prevention programs for specific issues. Third, a broad notion of children with special health needs is required, rather than a focused campaign on narrow problems. Families' reports of issues in raising children with diverse chronic illnesses and developmental disabilities reflect many similar problems: financing, respite care, physical burdens of care, lack of coordination of services, and limited access to many needed services. Fourth, regulation and regionalization may be necessary to assure access to appropriate services for all children with special health needs. Public planning and regulation are concepts that have been anathema in health policy in the last several years, yet they may be necessary to assure adequate services in all parts of the country.

The availability of fresh water affects public health and living standards around the globe, yet water resources are being rapidly depleted by unsustainable human activities. Strained freshwater resources will perpetuate unless the public is made aware of the severity of water scarcity issues. Audience segmentation, used frequently by environmental communicators to target unreached groups, is a social marketing strategy that segments audiences with shared characteristics to inform the development of effective communication messages. The purpose of this study was to determine characteristics of audience segments based on their level of water conservation behaviors. An online survey of the United States general public captured levels of water conservation behaviors based on how consumers prepare to vote on policy and intent to engage in water conservation behaviors. Cluster analysis resulted in two audience segments: lower water conservation and higher water conservation. Further analysis indicated significant demographic differences between the segments. The lower water segment presented less education, more moderate or conservative political beliefs, and lower family income levels than the higher water segment. Communication messages for the lower water segment should align with these characteristics, including using less scientific verbiage, linking moderate and conservative perspectives with water conservation, and emphasizing economic gain/loss.

The primary objective of this study is to review all Nigerian National Water and Sanitation Policies implemented since 1993. The aim is to assess their performance, efficiency, and alignment with the targets set forth in UN Sustainable Development Goal 6 (SDG 6). This review provides a contextual understanding of the challenges and opportunities for implementing SDG 6 in Nigeria. We conducted a critical appraisal and qualitative analysis of the 2016 Nigerian National Water Resources Policy, the most recently published policy, in relation to the targets of SDG 6. Our findings indicate that seven out of the eight SDG 6 targets are addressed in the policy. These include safe drinking water, sanitation and hygiene, pollution reduction, water-use efficiency, trans-boundary cooperation, and protection of water-related ecosystems. However, the policy falls short in involving local communities in water and sanitation management, which is the eighth requirement of SDG 6. Specifically, only 28 states have a dedicated Rural Water Supply and Sanitation Agency (RUWASSA), and few local government areas have Water Supply and Sanitation Hygiene Departments (WASH) as required by SDG 6. Our assessment of the policy's implementation and practices is based on secondary data sources, notably from the United Nations, the World Health Organization, and the National Bureau of Statistics. We argue that by developing effective implementation strategies that involve local communities, the 2016 National Water Resources Policy can significantly contribute to achieving sustainable water and sanitation management for all Nigerians by 2030.

AbstractEbola is a high consequence infectious disease—a disease with the potential to cause outbreaks, epidemics, or pandemics with deadly possibilities, highly infectious, pathogenic, and virulent. Ebola’s first reported cases in the United States in September 2014 led to the development of preparedness capabilities for the mitigation of possible rapid outbreaks, with the Centers for Disease Control and Prevention (CDC) providing guidelines to assist public health officials in infectious disease response planning. These guidelines include broad goals for state and local agencies and detailed information concerning the types of resources needed at health care facilities. However, the spatial configuration of populations and existing health care facilities is neglected. An incomplete understanding of the demand landscape may result in an inefficient and inequitable allocation of resources to populations. Hence, this paper examines challenges in implementing CDC’s guidance for Ebola preparedness and mitigation in the context of geospatial allocation of health resources and discusses possible strategies for addressing such challenges. (Disaster Med Public Health Preparedness. 2018;12:563–566)

A number of data collection systems designed to monitor selected substance abuse behaviors and consequences are in place in the United States. Some of these systems provide only national-level data, while others provide data disaggregated by state and in some cases by sub-state units such as counties or communities. Less progress has been made in identifying a key set of epidemiologic indicators across the three major substance categories (i.e., alcohol, tobacco, and illicit drugs), and assembling them in a manner designed to effectively support substance abuse prevention planning at the state and local levels. A recent federal initiative funded by the U.S. Center for Substance Abuse Prevention (CSAP) seeks to accelerate progress in this area through its Strategic Prevention Framework (SPF). The framework is intended to stimulate the prudent use of available data, and the development of additional data resources, for: 1) identifying statewide priorities for substance abuse prevention, 2) informing resource allocation decisions, 3) monitoring state and local trends in substance abuse and related consequences, and 4) evaluating state and local prevention efforts. This article describes the underlying rationale and issues considered in developing the database, some of the challenges and limitations in applying the data to prevention planning processes, and current strategies employed by CSAP to guide states and communities in effectively using the data in their substance abuse prevention planning and monitoring efforts.

As the coronavirus disease 2019 (COVID-19) pandemic continues to evolve through the United States and other countries, differing rates of progression and decline are occurring based on varied population densities. While some health systems are reaching a steady state of new patient cases, others are seeing a leveling off or decline, allowing for restoration of normal practices. This “reverse-surge” planning and implementation process is a colossal undertaking for health systems trying to reacquire patient access and financial stability while preserving necessary resources and maintaining precautions for another potential surge. For the otolaryngologist, reverse-surge planning involves additional workflow adjustments in the outpatient and operating room settings given the abundance of COVID-19 virus in the upper aerodigestive tract. As the reverse-surge best practices are still under development, open communication between otolaryngology colleagues and health system leadership is paramount to optimize efficiency and maintain an adequate measure of safety for patients and our health care teams.

The origin of the federal-state partnership in Maternal and Child Health (MCH) can be traced from the Children's Bureau grants of 1912, through the Sheppard-Towner Act, to the creation of Title V and other programs of today that mandate planning, accountability, and systems development. In the past decade with the transformation of the health care system and the emergence of managed care, there has been a resurgence of interest in public, professional, and governmental interest in quality measurement and accountability. Regional perinatal systems have been implemented in all states with varying levels of involvement by state health agencies and the public sector. This historical framework discusses two primary themes: the decades of evolution in the federal-state partnership, and the emergence in the last three decades of perinatal regional system policy, and suggests that the structure of the federal-state partnership has encouraged state variation. A survey of state MCH programs was undertaken to clarify their operational and perceived role in promoting quality improvement in perinatal care. Data and information from the survey, along with five illustrative state case studies, demonstrate great variation in how individual state agencies function. State efforts in quality improvement, a process to make things better, have four arenas of activity: policy development and implementation, definition and measurement of quality, data collection and analysis, and communication to affect change. Few state health agencies (through their MCH programs and perinatal staff) are taking action in all four arenas. This analysis concludes that there are improvements MCH programs could implement without significant expansion in their authority or resources and points out that there is an opportunity for states to be more proactive as they have the legal authority and responsibility for assuring MCH outcomes.

Cardiovascular disease (CVD) is a major public health concern in the United States. In response to the federally sponsored Million Hearts Risk Check Challenge, a team of programmers, software developers, health-information technologists, and clinicians in an integrated healthcare system in Wisconsin collaborated to develop Heart Health MobileTM (HHM), designed to improve awareness of cardiovascular disease risk and promote risk factor control among users. This paper outlines the development processes and highlights key lessons learned for mobile health applications. An agile project management methodology was used to dedicate adequate resources and employ adaptive planning and iterative development processes with a self-organized, cross-functional team. The initial HHM iOS app was developed and tested, and after additional modifications, gamified and HTML 5 versions of the app were released. The development of an iOS app is low in cost and sustainable by a healthcare system. Future app modifications to enhance data security and link self-reported cardiovascular risk assessment data to patient medical records may improve performance, patient relevance, and clinician acceptance of HHM in the primary-care setting. Legal and institutional barriers regarding the capture and analyses of protected health information must be mitigated to fully capture, analyze, and report patient health outcomes for future studies.

Community gardens are often seen as a means for producing sustainable food resources in urban communities. However, the presence of trace metals and metalloids such as lead, arsenic, and cadmium in urban soils poses a health risk to gardeners who participate in urban community gardens. They are exposed to these contaminates through multiple exposure pathways such as inhalation and ingestion directly through soil or through crops grown in the soil. Hot spots of soil contamination are higher in areas of cities with greater minority populations and lower incomes. This paper reviews the state of heavy metal contamination in community garden soils across the United States. This paper outlines the major sources of heavy metals in urban soils, exposure pathways, the ways to reduce heavy metal levels in garden soils, the means to slow down the uptake of heavy metals, and limit the exposure of these contaminates. The application of biochar and compost, implementing raised beds, and maintaining a natural pH are all examples of ways to mitigate heavy metal contaminants.

Attending a scientific conference offers researchers several potential benefits including opportunity to present and receive constructive feedback from professional colleagues. Organizing such conference is also beneficial to the hosts who can acquire skills for coordination, communication and networking. However, the process is fraught with many challenges. One hundred and nine professionals attended the 16th AHILA conference from 22 countries in Africa, Europe and United States of America. The conference agenda was balanced, integrating skills acquisition, information for career development, sources of evidence-based free e-resources, including databases, and e-books for libraries covering health-related topics. This article describes achievement, challenges and lessons learnt in hosting the conference and could serve as a guide for health information professionals planning a similar conference in the future.

Among the impacts of the Coronavirus Disease 2019 (COVID-19) pandemic on the public health system in the United States has been a reevaluation of emergency response systems and procedures. This study uses publicly available literature from government, private sector, and academic sources to identify changes and lessons learned during the COVID-19 pandemic in specific aspects of emergency response, namely human resources, health service delivery, and logistics, determined based on the World Health Organization Health Emergency and Disaster Risk Management (WHO Health EDRM) Framework. Major themes of changes implemented include those intended to increase mobility and flexibility of workforce and resources, integration of various parts of the health system, and effective communication, and are anticipated to be incorporated into response systems going forward.

Single-use plastic waste has become a growing concern in daily life. Community leaders are implementing programs to reduce the use of single-use plastic and change consumer behavior. This study, using the social cognitive theory framework for sustainable consumption, examines the reciprocal relationship among the following three factors: personal (green consumer values), environmental (bans and rebate/reward programs), and behavioral (consumer decision-making related to single-use plastic waste). The study surveyed consumers (N = 330) across the United States who watched a video on the effects of single-use plastic waste on health and well-being. The results indicate that states with bans or rebate/reward programs tend to have higher green consumer values and consumers in those states report less use of single-use plastic waste. Education level also has a significant impact on green consumer values and plastic waste usage. The study provides a resource guide for decision makers to implement programs in five areas: (1) Business Resources, (2) Public Policy Resources, (3) Non-Profit Resources, (4) Education Resources, and (5) Personal Resources. The study also suggests potential areas for future research.

ABSTRACT: The rapid economic progress of Bangladesh is associated with a swiftly rising demand and energy consumption. Future economic growth will undoubtedly require a proportionate increase in energy availability within affordable prices. Bangladesh is inherently energy-scarce and heavily dependent on imported energy, primarily fossil fuels. Several approaches and strategies were attempted over time to mitigate the energy shortage. Some of them were reasonably successful, while others failed. In this study, we first examine the historical developments of the energy sector in Bangladesh since its independence and then use three approaches – triple exponential smoothing, vector autoregression, and the Cochrane-Orcutt AR(1) process to forecast the energy demand. Data for this study were taken from various sources, including British Petroleum, International Gas Union, International Energy Agency, Bangladesh Bureau of Statistics, World Bank, Petrobangla, and Energy Information Agency of the United States. As expected, each model predicts an exponential growth of energy demand in Bangladesh. We then explored the possibilities of mitigating such projected energy demand. Various studies show that Bangladesh has some potential for producing energy from renewable sources, i.e., solar, hydro, wind, wave, and others. However, such possibilities are limited, and many are still in their infancy. Although an increase in renewable energy is desirable from an environmental perspective, it alone will not meet Bangladesh's growing energy demand. At least in the short term, Bangladesh must rely on imported fossil energy. Among the fossil energy sources, LNG is by far the cleanest. With the development of technology, liquefaction, transportation, and regasification, LNG production, transportation, and use are becoming less expensive. Progressively more natural gas-producing countries are joining LNG production and export, contributing to the market's competitiveness. Though historically tied to the oil market, LNG markets are becoming more and more independent because of the increasing number of participants from both the demand and supply sides. Given that both its global price and negative impact on the environment are relatively lower than other fossil fuels, imported LNG should be the fuel of choice for Bangladesh. Government policies should focus on both importing LNG and expanding renewable energy resources.

Professional development in health promotion is fundamental to conduct effective multiyear community-based health promotion programs to address tobacco use. Provided with $15 million over 3 years in new resources from the United States’ Master Tobacco Settlement Agreement, the Tennessee Department of Health organized a longitudinal staff development effort for 95 county health departments using an experiential pedagogy. Through statewide WORKshops, standardized plans, electronic reporting, use of logic modeling, social and behavior theory, and public health terminology were introduced and emphasized. A summative county evaluation document, entitled the Community Health Improvement Plan Against Tobacco Use (CHIPATU), was part of the experiential approach. The report was completed by health department officials from these 95 counites. This report documented tobacco use problem statements, county investments of Tobacco Settlement funds, strategy and project descriptions, and local changes in statewide outcome measures in three focused areas: reducing pregnancy smoking, reducing secondhand smoke exposure for young children, and reducing youth tobacco use initiation. The CHIPATU became a capstone evaluation document that reinforced county-based responsibility for assessment, goal setting, intervention planning, implementation, application of continuous improvement tools, and results. A statewide summary of 3 years’ efforts and outcomes from the 95 county CHIPATUs was included in the state Health Commissioner’s annual budget presentation for the Governor and General Assembly. The results documented the efficacy of the Department’s primary prevention programs, supported by staff development in use of health promotion approaches, to address long-standing public health issues.

Previous research demonstrates that the 1965 American immigration wave has tended to attenuate the obesity pandemic in the United States. Based on a survey carried out by the Israeli Central Bureau of Statistics (ICBS) in 2012 and 2016, we observe the correlation between BMI, age, native language, and years-since-migration to Israel. BMI (=kgm2) is a conventional measure of obesity, where BMI ≥ 25 is considered overweight and BMI ≥ 30 as type I obesity. The results indicate that compared to 11 groups of immigrants, the median BMI among native Israelis is lower. While the prevalence of overweight (BMI ≥ 25) among Hebrew speakers is below 50%, in 11 groups of immigrants, the prevalence of overweight is above 50%. A noteworthy exception is the immigrants from Ethiopia, who exhibit lower overweight prevalence compared to native Israelis and all other population groups. Finally, while male Hebrew and Russian speakers cross the overweight benchmark at the same age (35 years), native Israeli women (Hebrew speakers) cross this benchmark only when they reach 50 years (15 years after the males) and Russian women cross this benchmark only five years after the Russian men. These research findings may be of assistance in public health and culture-oriented medicine.

Alcohol consumption affects the risks of approximately 230 three-digit disease and injury codes in the International Statistical Classification of Diseases and Related Health Problems-10th Revision. The United Nations Sustainable Development Goals comprise 17 challenging goals with 169 targets, which the 193 Member States aim to achieve by 2030. Action to reduce the harmful use of alcohol, especially addressing global health inequalities, will contribute to achieving many of the health-related goals and targets. Alcohol care teams, mainly developed in acute UK hospitals, reduce acute hospital admissions, readmissions and mortality, improve the quality and efficiency of alcohol care, and have 11 key evidence-based, cost-effective and aspirational components. A clinician-led, multidisciplinary team, with integrated alcohol treatment pathways across primary, secondary and community care, coordinated alcohol policies for emergency departments and acute medical units, a 7-day alcohol specialist nurse service, addiction and liaison psychiatry services, an alcohol assertive outreach team, and consultant hepatologists and gastroenterologists with liver disease expertise facilitate collaborative, multidisciplinary, person-centred care. Quality metrics, national indicators, audit, workforce planning, training and accreditation support research and education of the public and healthcare professionals. Hospitals should collaborate with local authorities, public health, clinical commissioning groups, patients and key stakeholders to develop and disseminate cost-effective prevention and treatment strategies. Globally, alcohol care teams can support the achievement of the United Nations Sustainable Development Goals, and should be advocated and implemented through the WHO global alcohol strategy. This requires collaborative care planning by key stakeholders, a skilled workforce, targeted financial resources and dedicated political commitment.

Recent years have seen a paradigm shift from individualistic, market-based models of community development to more sustainable and human-centered approaches that emphasize inclusion and participation. Yet processes of privatization in the era of neoliberalism threaten these efforts by concentrating profits for elites while impoverishing everyday people and the environments they inhabit, resulting in profoundly uneven access to resources, inclusion, and participation. This analysis examines the psychosocial processes that produce and are produced by these unequal and segregated settings, as well as the causes and correlates of this imbalance in the context of the United States. Then, empirical literature is reviewed exploring the harmful consequences that inequality entails for individual and societal wellbeing, arguing that inequality (a) undermines opportunity by limiting access to resources and constraining upward mobility, (b) undermines community by dissolving trust and cohesion, (c) undermines ecosystems health by accelerating environmental degradation, and (d) undermines democracy by reducing the political power of the non-wealthy relative to the wealthy. Finally, four placemaking principles are proposed as a way to promote more sustainable, equitable, and inclusive community development.

North Korea slogged through 2020 in an effort to maintain public health and state power. Kim Jong Un’s hopes for an economic breakthrough were dashed by the COVID-19 outbreak in neighboring China, which posed an existential threat given the DPRK’s limited healthcare resources. Although swift sealing of borders helped prevent a crisis, keeping the country on national quarantine took a heavy toll. Information about internal developments was scarce this year, as demonstrated by the global media’s frenzied speculation in the spring that Kim Jong Un had died. Kim did scale down his public appearances, but convened frequent sessions of the ruling Politburo, often to complain about Party failings, and his sister Kim Yo Jong elevated her profile with tough messages for Seoul and Washington. North Korea remained inwardly focused to the end of the year, rebuffing South Korean entreaties at cooperation and ignoring the presidential election in the United States.

During the COVID-19 pandemic, refugee women in the United States faced significant challenges to sustain their livelihoods, such as losing jobs and health care, becoming essential workers, and finding oneself again in unprecedented situations of limited mobility. These impacts reflect dynamics in migrant health literacy including language proficiency (skills-based approaches) as well as experiences, identities, and power relations in society (socio-cultural approaches). In this article, I explore these dynamics through a gender perspective with a focus on intra-familial health brokering, empowerment-based health education, and health information mapping by drawing on ethnographic research from Portland, Oregon. This includes interviews with 15 refugee women and representatives of organizations working in the context of migration as well as observations of service-providing community efforts. My interviews and observations demonstrate that disruptions in language learning, socio-cultural barriers, and limited access to health-related information resources have posed significant challenges to refugee women’s livelihoods during the pandemic. I suggest that English as a Second Language (ESL) classes can be imperative in addressing these challenges as the classes provide a space for language learning, intercultural dialogue, and information sharing in gender-responsive ways.

The COVID-19 pandemic has and is still adding tremendous morbidity and mortality globally. Although vaccines are a major component in combatting COVID-19 and are widely available in the U.S., vaccine uptake is a major hurdle with 24% of the population having not received any dose of a COVID-19 vaccine. Literature review of reasons for COVID-19 vaccine hesitancy among adults in the United States. 27 articles included from PubMed and analyzed to find date of study, method of survey, population studied and generalization ability, and reasons for vaccine hesitancy or refusal. Most studies were cross-sectional surveys (88.89%) and conducted online (59.25%). Sample size ranged from 58 to 458,235. Populations studied include nationally representative U.S. (25.9%), specific populations within the U.S. (37.0%), specific locations within the U.S. (22.2%), and healthcare workers (14.8%). The most common reason for COVID-19 vaccine hesitancy is concern about side effects and general safety concerns (57.14%). Other significant reasons include: additional information needed (21.42%), distrust (14.28%), no reason/don’t know (3.57%), and antivaccine beliefs (3.57%). Just over half (51.8%) of studies were conducted before the FDA EUA of the Pfizer-BioNTech COVID-19 vaccine, while 37.0% were after, and 11.1% spanned the time period or had follow-up surveys. To increase uptake among those who are still hesitant of COVID-19 vaccines, the American healthcare and education system must go through reform to ensure healthcare for all and address systemic racism. While increasing representation in health fields, already working clinicians can promote vaccinations through strengthening their patient relationships, following up on vaccination status, sharing educational resources and personal stories, and promoting community efforts. Teachers and schools can implement lessons on immunizations and disease. Communication efforts from institutions and local community organizations must work to increase trust, address fear of side effects, and combat misinformation. Promotion of social values and self-efficacy, as well as authentic community investment and engagement, can increase trust and vaccination levels.

An approach to planning, research, and management, that relates people to ecosystems of which they are part, is described and related to the Canada-United States Great Lakes Water Quality Agreements of 1972, 1978, and 1987. Factors favouring the development of an ‘ecosystem approach’ in the Great Lakes Basin include: a shared, highly valued resource; the long residence-times of ‘conservative’ pollutants in the Lakes; use of the Lakes for drinking-water supplies by c. 23 million people; threats to the integrity of the Lakes (pollution, water diversion); advances in ecosystem theory; the rise of voluntary membership associations with interests in the resource; institutional arrangements for managing nationally shared resources; and common economic ties and cultural heritages.The principal obstacle to implementation of an ‘ecosystem’ approach in the Great Lakes Basin is the lack of policies for comparable approaches in the political jurisdictions surrounding the Great Lakes. The principal obstacle to global implementation of an ‘ecosystem’ approach is the lack of international institutional arrangements for joint advice and operational capabilities in respect of the management of nationally shared resources. Another impediment is the widespread egocentricity of governments, corporations, individuals, and the general public.

The application of a geographic information system (GIS) in public health is relatively common in Bangladesh. However, the use of GIS for planning, monitoring and decision-making by local-level managers has not been well documented. This assessment explored how effectively local government health managers used maps with spatial data for planning, resource allocation and programme monitoring. The United States Agency for International Development-funded MaMoni Health Systems Strengthening project supported the introduction of the maps into district planning processes in 2015 and 2016. GIS maps were used to support the prioritisation of underserved unions (the lowest administrative units) and clusters of disadvantaged communities for the allocation of funds. Additional resources from local government budgets were allocated to the lowest performing unions for improving health facility service readiness and supervision. Using a mixed-methods approach, the project evaluated the outputs of this planning process. District planning reports, population-based surveys, local government annual expenditure reports and service availability and utilisation data were reviewed. The goal was to determine the degree to which district planning teams were able to use the maps for their intended purpose. Key informant interviews were conducted with upazila (subdistrict) managers, elected government representatives and service providers to understand how the maps were used, as well as to identify potential institutionalisation scopes. The project observed improvements in health service availability and utilisation in the highest priority unions in 2016. Quick processing of maps during planning sessions was challenging. Nevertheless, managers and participants expressed their satisfaction with the use of spatial analysis, and there was an expressed need for more web-based GIS both for improving community-level service delivery and for reviewing performance in monthly meetings. Despite some limitations, the use of GIS maps helped local health managers identify health service gaps, prioritise underserved unions and monitor results.

Objectives Hypertension affects 1 in 3 adults in the United States and disproportionately affects African Americans. Kaiser Permanente demonstrated that a “bundle” of evidence-based interventions significantly increased blood pressure control rates. This paper describes a multiyear process of developing the protocol for a trial of the Kaiser bundle for implementation in under-resourced urban communities experiencing cardiovascular health disparities during the planning phase of this biphasic award (UG3/UH3). Methods The protocol was developed by a collaboration of faith-based community members, representatives from community health center practice-based research networks, and academic scientists with expertise in health disparities, implementation science, community-engaged research, social care interventions, and health informatics. Scientists from the National Institutes of Health and the other grantees of the Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Alliance also contributed to developing our protocol. Results The protocol is a hybrid type 3 effectiveness-implementation study using a parallel cluster randomized trial to test the impact of practice facilitation on implementation of the Kaiser bundle in community health centers compared with implementation without facilitation. A central strategy to the Kaiser bundle is to coordinate implementation via faith-based and other community organizations for recruitment and navigation of resources for health-related social risks. Conclusions The proposed research has the potential to improve identification, diagnosis, and control of blood pressure among under-resourced communities by connecting community entities and healthcare organizations in new ways. Faith-based organizations are a trusted voice in African American communities that could be instrumental for eliminating disparities.

This article aims to analyze some basic criteria for a sustainable use of water in an international watershed shared by Mexico and the United States. The study area comprises the region of Ambos Nogales, which is located inside the Upper Santa Cruz River Basin. This portion of the watershed represents the main ecosystem and the main source of water for urban and rural populations located in this region. Following criteria of sustainability the authors revise and adapt to the case of Ambos Nogales, a set of guidelines proposed by the Pacific Institute for Studies in Development, Environment, and Security. These guidelines include the following elements: basic water requirements needed to maintain quality of life in the population and the health of ecosystems; water quality that meets certain minimum standards; human actions and their impact on long-term renewability of freshwater stocks and flows; collection of data concerning water resources, use and quality of water; institutional mechanisms to prevent and resolve conflicts; and a democratic process of water-planning and decision-making. These twin cities have a long history of cooperation and conflict linked to water resources, which makes available enough information to create a diagnostic about the water management inside a binational arena, and allowing to explore possibilities for a better water resources management under a sustainable regime and from an international perspective. Keywords: Sustainability, binational water management, ambos Nogales region.

According to the U.S. Green Building Council (USGBC), buildings account for a significant amount of environmental degradation. The building sector is the number one producer of global CO2 emissions in the U.S., followed by the transportation and industrial sectors.1 (See Figure 1 for the environmental impact of all U.S. buildings.) The concept of green buildings represents a major paradigm shift in the architectural, construction, and engineering fields. As society increasingly switches its appreciation of buildings from merely size and aesthetics toward environmental stewardship and efficiency, the USGBC's LEED Green Building Rating System has become increasingly popular to follow. Since its inception in 2000, the LEED system has been promoting and monitoring green building practices throughout the United States. With a four-tiered rating scheme including LEED Certified, LEED Silver, LEED Gold, and LEED Platinum, the system currently has 35,000 projects already on their way toward certification.2 In particular, the LEED for Existing Buildings (LEED-EB) system looks to retrofit existing buildings into those that are more sustainable, efficient, and environmentally friendly. Doing so significantly reduces the demand for new resources, as construction managers can recycle and reuse building materials and incorporate them into new designs. This truly is the definition of green building and is the way of the future. By implementing green building practices, many of the adverse environmental impacts of buildings can be dramatically reduced, often for only a one to two percent initial cost premium over the price of conventional construction practice.3 Several environmental benefits of green buildings include improving air and water quality, conserving natural resources, and becoming more energy efficient. Sudies have shown that green buildings, compared to normal buildings, can reduce energy use by 24–50 percent, CO2 emissions by 33–39 percent, water use by 40 percent, and solid waste by 70 percent.4 (See Figure 2 for the impact of green commercial buildings compared to the average commercial building.) In fact, if half of all new construction within the U.S. were built to match these percentages, it would be the equivalent of taking more than one million cars off of the road every year.5 Economic benefits include reducing operating costs, improving employee productivity and satisfaction, and optimizing economic performance over the life cycle of the structure.6 Additionally, health and community benefits include enhancing occupant comfort and health, and contributing to an overall positive environmentally-conscious reputation.7 Furthermore, Taryn Holowka states, “people in green buildings have 40-60 percent fewer incidents of colds, flu, and asthma; patients in green hospitals are discharged as much as two and a half days earlier; and kids in green schools increase their test scores by as much as 18 percent.”8 The U.S. EPA's Region 10 Park Place office building in Seattle was built in 1970. Its owner, Washington Holdings, and building manager, Wright Runstad & Company, have been encouraged by the EPA to use innovative energy conservation design, water conservation, waste reduction, stormwater management, and other strategies to make the structure more sustainable. Following the EPA's Green Building Strategy, which states that the EPA aims to strengthen the foundations of green building and raise public awareness of building-related impacts and opportunities, the Park Place building has become only the fifteenth LEED-EB Platinum building in the world, and one of the most impressive nearly-forty-year-old buildings in the entire United States. By using the LEED-EB Platinum green building rating system, the Park Place building management team has been able to successfully lower the building's energy consumption rate, improve its water efficiency, and make many other beneficial changes—all of which demonstrate just how effective the LEED system is at producing higher performance buildings.

ObjectiveFamily planning is unique among health interventions in its breadth of health, development and economic benefits. The complexity of formulating effective strategies to promote women’s and girls’ access to family planning calls for closer coordination of resources and attention from all stakeholders. Our objective was to quantify the concordance of two global initiatives: Family Planning 2020’s adding 120 million modern contraceptive users by 2020 (proposed during The London Summit 2012 by Gates Foundation) and satisfying the 75% demand for modern contraceptives by 2030 (proposed by United States Agency for International Development). A demonstration of their concordance, or lack thereof, provides an understanding of the proposed quantitative goals and helps to formulate collective strategies.Design and settingWe applied fixed effects longitudinal models to assess the convergence of the two initiatives. The implications of success in one initiative on achieving the other are simulated to illustrate their shared goals. Publicly available data on contraceptive use, unmet need and met need from national surveys are used. Extensive model validations were conducted to check and confirm models’ predictive performance.ResultsOur results show that the 75% demand satisfied initiative will reach 82 million additional modern users by 2020 and 120 million by early 2023. Following FP2020’s proposed annual increase of modern contraceptive use, 9 of the 41 commitment-making countries will reach the 75% target by 2020; another 8 countries will do so by 2030. Extending FP2020’s proposed contraceptive growth to 2030 implies the achievement of the 75% target in less than half (17) of the 41 commitment-making countries.ConclusionThe results from the statistical exercise demonstrate that the two global initiatives move toward the same goal of promoting access to family planning and overall both are ambitious. Closer coordination between major stakeholders in international family planning may stimulate more efficient mobilisation and utilisation of global sources, which is urgently needed to accelerate the progress toward satisfying women’s need for family planning.

Geographic Response Plans (GRPs) are location-specific plans developed to provide guidance for oil spill responses throughout the United States. Until recently, the majority of crude oil transportation in the United States has occurred via waterways on oil tankers and barges, therefore, most existing GRPs focus on the protection of sensitive biological resources and socio-economic features in near shore environments. The recent development of crude oil extraction from the Bakken formation has resulted in a significant increase in the volume of crude oil being transported via railroads and pipelines and has highlighted the need for inland response planning. Rail cars transporting the volatile and flammable Bakken crude oil now traverse more than 850 miles of New York State on two major Class 1 Railroads. In response, Executive Order 125 was issued by the governor directing state agencies to strengthen the state's preparedness for incidents involving crude oil transportation. New York State's (NYS) Department of Environmental Conservation (DEC), in collaboration with the Department of Homeland Security & Emergency Services and Department of Health, are leading a multi-stakeholder effort to develop Inland GRPs for the 21 NYS counties currently impacted by crude-by-rail transportation. County steering committees were established consisting primarily of local first response agencies, as well as their state and federal partners. Utilizing Sensitive Resource Maps developed by DEC, coupled with the local steering committee input, location-specific response plans were drafted, reviewed, and set as final working “evergreen” documents, which are open for update/refinement at any time in the future. The NYSDEC GRPs are similar to typical GRPs in that they are map-based, location-specific contingency plans that outline response strategies for the protection of sensitive resources. However, the NYSDEC GRPs differ from traditional GRPs in several ways. They extend contingency planning to cover spills on land, in addition to surface water-based spills. Due to the flammability of Bakken crude oil, much more emphasis is placed on the fire risks associated with a train derailment. This is done by mapping sensitive human receptors (e.g., schools, daycare centers, assisted living centers, etc.), critical infrastructure, and identifying fire (and vapor) suppression assets. The NYSDEC GRPs also place more emphasis on the initial response options available to local first responders, options that can be implemented before other response assets may arrive on-scene (State, Federal, and RP). This presentation will discuss the development, structure, proposed implementation, training and exercises associated with this ongoing program.

Currently, no guidelines exist on how to evaluate the performance of health systems fighting the SARS-CoV-2 pandemic. Therefore, this study seeks (1) to develop a conceptual framework that would be helpful in the given context, and (2) to test the feasibility of the proposed approach. The framework is conceptualized based on investigating critical dimensions and indicators for the successful design of a method for evaluating the performance of health systems. Subsequently, the taxonomic measure of development is used and a correlational analysis made in order to run a pilot test of the proposed concept. The finalized conceptual framework has five input dimensions (demographical burden, epidemiological burden, health-related quality of life, financial resources, and access) described by 18 indicators, and two output domains (outcomes, productivity) described by six indicators to monitor system performance under the COVID-19 pandemic. The pilot-test conducted in European Union countries and the United States proved the model to be useful and feasible. The proposed framework can be used to assess the performance of health systems fighting novel pathogens, such as SARS-CoV-2, worldwide. Our methodological approach can be used as a benchmark for international agencies such as the World Health Organization in developing their own frameworks. The paper presents the first research exploring the evaluation of a health system during the COVID-19 pandemic. It has the potential to help monitor a health system’s performance during the pandemic by accounting for specific country-related circumstances. In a broader sense, it can contribute to boosting health market competitiveness in terms of quality.

Community gardens offer broad research opportunities and analytical resources encompassing urban planning to environmental sustainability, food systems, and social capital. However, little is known about the knowledge structure and research development related to community gardens. This study presents an in-depth bibliometric performance analysis and visual scientific mapping analysis of the literature on community gardens by examining 487 published papers selected from the Web of Science database. The results indicated a considerable rise in research papers in this subject area from 2012 onwards, with most contributions from the United States. Studies from high-income countries accounted for 93.22%, and 38 countries have cooperated 167 times in this field. “Health” is the most frequent keyword, and the terms “ecosystem services” has been gaining popularity over the last five years. A combination of co-citation clustering and keyword co-occurrence clustering analysis identified three major research themes in the field of community gardens: “ecosystem services and disservices”, “multidimensional association”, and “sustainable garden systems”. The development of ecosystem value assessment frameworks, the establishment of region-wide soil monitoring databases, accounting for the cost-effectiveness of nature-based solutions, the integration of garden systems into smart cities, and the integration of water management into regulation will be important future research directions regarding community gardens. Overall, this study provides scholars with a systematic and quantitative understanding of community gardens.

Nurses are often the first to recognize and respond to children’s symptoms. This descriptive, exploratory study characterized how pediatric oncology health care providers characterize and assess children’s cancer-related symptoms. The study also explored challenges associated with symptom assessment and information perceived as helpful in planning interventions. The setting was a Children’s Oncology Group–affiliated hospital in the Intermountain West of the United States. Twenty-two pediatric oncology health care providers (95% female; 68% nurses) participated in one of four focus group sessions. Sessions were facilitated by two individuals and included six open-ended questions addressing participants’ perspectives of cancer-related symptoms, approaches to symptom assessment, challenges and frustrations encountered when assessing symptoms, and information needed to plan interventions. Participants identified 75 physical and psychosocial responses that included both subjectively experienced symptoms and other consequences of the cancer experience. Qualitative content analysis procedures organized other responses into categories and subcategories. Participants most frequently reported using observational approaches including physical assessment findings and observation of the child’s behavior to identify symptoms. Strategies that sought the child’s input such as the use of a rating scale or seeking the child’s verbal description were less frequently named. Participants related discerning and interpreting the child’s behaviors as a challenge to symptom assessment. They also reported attention to symptom characteristics as important to planning interventions. Future directions include building capacity to support child-centric symptom assessment. Development of reliable and valid resources for use in clinical settings may support a more child-centric approach to symptom assessment.

104 Background: In 2016, the Association of Community Cancer Centers (ACCC) launched a 3-year initiative to design, test, and refine an OCCM for Medicaid patients with lung cancer. The aim was to help cancer programs identify and reduce the barriers experienced by Medicaid patients by strengthening lung cancer care delivery systems. Methods: Phase I included Model development. Phases II and III included selection of 7 community-based cancer programs as testing sites to implement quality improvement projects, utilizing qualitative and quantitative assessments. Beta testing demonstrated the Model’s ability to offer practical guidance on improving care coordination to achievable target levels in high-impact areas such as patient access to care, prospective multidisciplinary case planning, and tobacco cessation. Opportunities were identified to improve care coordination beyond lung cancer to other tumor sites. Refinements for clarity of intent, ease of use, specificity, and uniformity across assessment areas were implemented, based on feedback from testing sites. Members of the Technical Expert Panel and the Advisory Committee, ACCC staff, and consultants revised the Model using consensus decision-making. Results: The final OCCM is composed of 12 inter-related assessment areas: patient entry into lung cancer program; multidisciplinary treatment planning; clinical trials; supportive care; survivorship care; financial, transportation, and housing needs; tobacco education; navigation; treatment team integration; physician engagement; electronic health records and patient access to information; and quality measurement and improvement. Each assessment area has 5 levels and corresponding metrics—level 1 represents the most basic provision of care, and level 5 represents optimal care coordination, which may be attainable for some cancer programs and aspirational for others. Progress implies cumulative and sustained fulfillment of lower level criteria. The OCCM can be deployed by cancer programs, regardless of size, setting, resource level, or cancer type. Dissemination to promote wider use is planned through an online benchmarking tool, blogs, a brochure, podcasts, and other resources. Conclusions: The OCCM can be utilized by cancer programs for objective self assessments of care delivery capabilities across 12 high-impact areas. Dissemination can advance multidisciplinary coordinated care delivery and improve clinical outcomes for patients nationwide, regardless of cancer type.

In previous papers of this series we have shown how public policies of ‘planned shrinkage’ triggered contagious urban decay and massive destruction of low-income housing within poor minority communities of New York City. The resulting social disintegration exacerbated epidemics of infectious disease, including AIDS (acquired immunodeficiency syndrome) and TB (tuberculosis), and such behavioral pathologies as substance abuse and violence. We extend this work on the neighborhood-level ‘synergism of plagues’ to the metropolitan regional scale for eight US urban areas containing more than 54 million people. Several have central cities, which, like New York, suffer from what Skogan characterized as a relentless ‘hollowing out’ of poor communities. We find AIDS, TB, violent crime, and low birthweight near the worst affected cities to be markers of an accelerating regional synergism of plagues, a diffusing system of interacting and self-reinforcing pathology fueled by, but spreading far beyond, the worst affected inner-city areas. We uncover an apparent threshold condition for regional spread of this synergism, triggered through a stochastic resonance with public policies affecting the distribution of catastrophic events within central-city minority neighborhoods. Control of AIDS, violence, multiple-drug-resistant TB, and other pathologies in the United States will require regional reform and the sharing both of resources and of authority across presently ungovernable systems of fragmented administrative units: the urban centers of the late 19th-century USA, by the late 20th, are vast, tightly coupled urban and/or suburban complexes producing a regional ‘linear chain’ condition for both public health and public order in which the welfare of the whole is increasingly determined by the sickness of the least strong.

Objectives The purpose of this study was to analyze the National Institute of Neurological Disorders and Stroke (NINDS) Request for Information (RFI) input from the public—including health care providers, researchers, patients, patient advocates, caregivers, advocacy organizations, professional societies, and private and academic stakeholders with an interest in health disparities (HDs) in neurologic disease. RFI questions were structured to solicit input on what stakeholders believe are neurologic disease HD research priorities, drivers of health inequity, and potential interventions. Furthermore, these stakeholder insights were examined within the context of contemporary scientific literature and research frameworks on health equity and health disparities. Background The NINDS published a RFI from March 31 to July 15, 2020. The RFI analysis presented here is part of a larger strategic planning process aimed to guide future NINDS efforts in neurologic disorder health equity (HE) research and training. The public commented on facilitators of HDs, populations that experience HDs (HDPs), potential interventions, and research opportunities related to HDs in neurologic disease and/or care in the United States across the lifespan. Responses were analyzed using qualitative methodology. Frequently suggested interventions were thematically clustered using the interpretive phenomenological analysis methodology and are presented in this article to provide a stakeholder-identified roadmap for advancing HE. Results Respondents identified socioecological factors as driving HDs in 89% of determinants reported. Stakeholder-reported HD determinants and subsequent interventions could be classified into the following conceptual categories: HDP neurospecialty care access, innovative HDP engagement and research inclusion strategies, and development of a well-trained clinician-scientist HD workforce. Clustering of the feedback from patient and patient-adjacent respondents (i.e., caretakers and patient advocates) highlighted the prevalence of patient-provider interpersonal factors and limited resources driving access-to-care barriers among their sentiments. Discussion Respondent sentiments suggest prioritization of social determinants of health (SDOH) research, shifting away from the common target of biological and behavioral themes addressed in the existing body of HE research provided by the stakeholder. Overall, respondents suggest focusing research prioritization on access to care, engagement across the HE research and care landscape, and HE workforce development.

AbstractObjectiveIn the 2011 Great East Japan Earthquake, as in Hurricanes Katrina and Rita in the United States, older individuals were at the greatest risk of mortality. Much concern has been raised about developing plans to reduce these risks, but little information has been provided about preparedness, and the key role played by caregivers has been largely unexplored. The aims of this study were thus to examine the preparedness of family caregivers of older adults with long-term care needs and to identify the characteristics of older adults and their caregivers that are associated with poor preparedness and greater concern about disasters.MethodsShortly after the Great East Japan Earthquake, the second wave of the Fukui Longitudinal Caregiver Study was administered to the family caregivers of older Japanese individuals with long-term care needs. The sample included 952 caregivers from 17 municipalities in Fukui prefecture. Logistic regression analyses were used to identify the factors associated with self-assessed preparedness, evacuation planning, and caregivers’ concerns about preparedness.ResultsThe majority (75%) of the caregivers had no concrete plans for evacuation in an emergency, and those caring for persons with dementia were 36% less likely to have any plan. In multivariate models, caregivers who were more experienced and wealthier and who reported more family and community support were more likely to feel well prepared. Caregivers with poor health or limited financial resources or who were responsible for older persons with mobility difficulties reported higher levels of anxiety about their disaster preparedness.ConclusionsThis study indicates that most caregivers are ill prepared to respond in emergencies and that caregiver resources, community support, and the needs of older care recipients influence both preparedness and concern about disasters. Education for caregivers and the development of community support programs could provide important sources of assistance to this vulnerable group. (Disaster Med Public Health Preparedness. 2017;11:31–38)

In this issue of Journal of Disaster Research, we introduce nine papers on societal responses to recent catastrophic disasters with special focus on long-term recovery processes in Japan and the United States. As disaster impacts increase, we also find that recovery times take longer and the processes for recovery become more complicated. On January 17th of 1995, a magnitude 7.2 earthquake hit the Hanshin and Awaji regions of Japan, resulting in the largest disaster in Japan in 50 years. In this disaster which we call the Kobe earthquake hereafter, over 6,000 people were killed and the damage and losses totaled more than 100 billion US dollars. The long-term recovery from the Kobe earthquake disaster took more than ten years to complete. One of the most important responsibilities of disaster researchers has been to scientifically monitor and record the long-term recovery process following this unprecedented disaster and discern the lessons that can be applied to future disasters. The first seven papers in this issue present some of the key lessons our research team learned from the studying the long-term recovery following the Kobe earthquake disaster. We have two additional papers that deal with two recent disasters in the United States – the terrorist attacks on World Trade Center in New York on September 11 of 2001 and the devastation of New Orleans by the 2005 Hurricane Katrina and subsequent levee failures. These disasters have raised a number of new research questions about long-term recovery that US researchers are studying because of the unprecedented size and nature of these disasters’ impacts. Mr. Mammen’s paper reviews the long-term recovery processes observed at and around the World Trade Center site over the last six years. Ms. Johnson’s paper provides a detailed account of the protracted reconstruction planning efforts in the city of New Orleans to illustrate a set of sufficient and necessary conditions for successful recovery. All nine papers in this issue share a theoretical framework for long-term recovery processes which we developed based first upon the lessons learned from the Kobe earthquake and later expanded through observations made following other recent disasters in the world. The following sections provide a brief description of each paper as an introduction to this special issue. 1. The Need for Multiple Recovery Goals After the 1995 Kobe earthquake, the long-term recovery process began with the formulation of disaster recovery plans by the City of Kobe – the most severely impacted municipality – and an overarching plan by Hyogo Prefecture which coordinated 20 impacted municipalities; this planning effort took six months. Before the Kobe earthquake, as indicated in Mr. Maki’s paper in this issue, Japanese theories about, and approaches to, recovery focused mainly on physical recovery, particularly: the redevelopment plans for destroyed areas; the location and standards for housing and building reconstruction; and, the repair and rehabilitation of utility systems. But the lingering problems of some of the recent catastrophes in Japan and elsewhere indicate that there are multiple dimensions of recovery that must be considered. We propose that two other key dimensions are economic recovery and life recovery. The goal of economic recovery is the revitalization of the local disaster impacted economy, including both major industries and small businesses. The goal of life recovery is the restoration of the livelihoods of disaster victims. The recovery plans formulated following the 1995 Kobe earthquake, including the City of Kobe’s and Hyogo Prefecture’s plans, all stressed these two dimensions in addition to physical recovery. The basic structure of both the City of Kobe’s and Hyogo Prefecture’s recovery plans are summarized in Fig. 1. Each plan has three elements that work simultaneously. The first and most basic element of recovery is the restoration of damaged infrastructure. This helps both physical recovery and economic recovery. Once homes and work places are recovered, Life recovery of the impacted people can be achieved as the final goal of recovery. Figure 2 provides a “recovery report card” of the progress made by 2006 – 11 years into Kobe’s recovery. Infrastructure was restored in two years, which was probably the fastest infrastructure restoration ever, after such a major disaster; it astonished the world. Within five years, more than 140,000 housing units were constructed using a variety of financial means and ownership patterns, and exceeding the number of demolished housing units. Governments at all levels – municipal, prefectural, and national – provided affordable public rental apartments. Private developers, both local and national, also built condominiums and apartments. Disaster victims themselves also invested a lot to reconstruct their homes. Eleven major redevelopment projects were undertaken and all were completed in 10 years. In sum, the physical recovery following the 1995 Kobe earthquake was extensive and has been viewed as a major success. In contrast, economic recovery and life recovery are still underway more than 13 years later. Before the Kobe earthquake, Japan’s policy approaches to recovery assumed that economic recovery and life recovery would be achieved by infusing ample amounts of public funding for physical recovery into the disaster area. Even though the City of Kobe’s and Hyogo Prefecture’s recovery plans set economic recovery and life recovery as key goals, there was not clear policy guidance to accomplish them. Without a clear articulation of the desired end-state, economic recovery programs for both large and small businesses were ill-timed and ill-matched to the needs of these businesses trying to recover amidst a prolonged slump in the overall Japanese economy that began in 1997. “Life recovery” programs implemented as part of Kobe’s recovery were essentially social welfare programs for low-income and/or senior citizens. 2. Requirements for Successful Physical Recovery Why was the physical recovery following the 1995 Kobe earthquake so successful in terms of infrastructure restoration, the replacement of damaged housing units, and completion of urban redevelopment projects? There are at least three key success factors that can be applied to other disaster recovery efforts: 1) citizen participation in recovery planning efforts, 2) strong local leadership, and 3) the establishment of numerical targets for recovery. Citizen participation As pointed out in the three papers on recovery planning processes by Mr. Maki, Mr. Mammen, and Ms. Johnson, citizen participation is one of the indispensable factors for successful recovery plans. Thousands of citizens participated in planning workshops organized by America Speaks as part of both the World Trade Center and City of New Orleans recovery planning efforts. Although no such workshops were held as part of the City of Kobe’s recovery planning process, citizen participation had been part of the City of Kobe’s general plan update that had occurred shortly before the earthquake. The City of Kobe’s recovery plan is, in large part, an adaptation of the 1995-2005 general plan. On January 13 of 1995, the City of Kobe formally approved its new, 1995-2005 general plan which had been developed over the course of three years with full of citizen participation. City officials, responsible for drafting the City of Kobe’s recovery plan, have later admitted that they were able to prepare the city’s recovery plan in six months because they had the preceding three years of planning for the new general plan with citizen participation. Based on this lesson, Odiya City compiled its recovery plan based on the recommendations obtained from a series of five stakeholder workshops after the 2004 Niigata Chuetsu earthquake. <strong>Fig. 1. </strong> Basic structure of recovery plans from the 1995 Kobe earthquake. <strong>Fig. 2. </strong> “Disaster recovery report card” of the progress made by 2006. Strong leadership In the aftermath of the Kobe earthquake, local leadership had a defining role in the recovery process. Kobe’s former Mayor, Mr. Yukitoshi Sasayama, was hired to work in Kobe City government as an urban planner, rebuilding Kobe following World War II. He knew the city intimately. When he saw damage in one area on his way to the City Hall right after the earthquake, he knew what levels of damage to expect in other parts of the city. It was he who called for the two-month moratorium on rebuilding in Kobe city on the day of the earthquake. The moratorium provided time for the city to formulate a vision and policies to guide the various levels of government, private investors, and residents in rebuilding. It was a quite unpopular policy when Mayor Sasayama announced it. Citizens expected the city to be focusing on shelters and mass care, not a ban on reconstruction. Based on his experience in rebuilding Kobe following WWII, he was determined not to allow haphazard reconstruction in the city. It took several years before Kobe citizens appreciated the moratorium. Numerical targets Former Governor Mr. Toshitami Kaihara provided some key numerical targets for recovery which were announced in the prefecture and municipal recovery plans. They were: 1) Hyogo Prefecture would rebuild all the damaged housing units in three years, 2) all the temporary housing would be removed within five years, and 3) physical recovery would be completed in ten years. All of these numerical targets were achieved. Having numerical targets was critical to directing and motivating all the stakeholders including the national government’s investment, and it proved to be the foundation for Japan’s fundamental approach to recovery following the 1995 earthquake. 3. Economic Recovery as the Prime Goal of Disaster Recovery In Japan, it is the responsibility of the national government to supply the financial support to restore damaged infrastructure and public facilities in the impacted area as soon as possible. The long-term recovery following the Kobe earthquake is the first time, in Japan’s modern history, that a major rebuilding effort occurred during a time when there was not also strong national economic growth. In contrast, between 1945 and 1990, Japan enjoyed a high level of national economic growth which helped facilitate the recoveries following WWII and other large fires. In the first year after the Kobe earthquake, Japan’s national government invested more than US$ 80 billion in recovery. These funds went mainly towards the repair and reconstruction of infrastructure and public facilities. Now, looking back, we can also see that these investments also nearly crushed the local economy. Too much money flowed into the local economy over too short a period of time and it also did not have the “trickle-down” effect that might have been intended. To accomplish numerical targets for physical recovery, the national government awarded contracts to large companies from Osaka and Tokyo. But, these large out-of-town contractors also tended to have their own labor and supply chains already intact, and did not use local resources and labor, as might have been expected. Essentially, ten years of housing supply was completed in less than three years, which led to a significant local economic slump. Large amounts of public investment for recovery are not necessarily a panacea for local businesses, and local economic recovery, as shown in the following two examples from the Kobe earthquake. A significant national investment was made to rebuild the Port of Kobe to a higher seismic standard, but both its foreign export and import trade never recovered to pre-disaster levels. While the Kobe Port was out of business, both the Yokohama Port and the Osaka Port increased their business, even though many economists initially predicted that the Kaohsiung Port in Chinese Taipei or the Pusan Port in Korea would capture this business. Business stayed at all of these ports even after the reopening of the Kobe Port. Similarly, the Hanshin Railway was severely damaged and it took half a year to resume its operation, but it never regained its pre-disaster readership. In this case, two other local railway services, the JR and Hankyu lines, maintained their increased readership even after the Hanshin railway resumed operation. As illustrated by these examples, pre-disaster customers who relied on previous economic output could not necessarily afford to wait for local industries to recover and may have had to take their business elsewhere. Our research suggests that the significant recovery investment made by Japan’s national government may have been a disincentive for new economic development in the impacted area. Government may have been the only significant financial risk-taker in the impacted area during the national economic slow-down. But, its focus was on restoring what had been lost rather than promoting new or emerging economic development. Thus, there may have been a missed opportunity to provide incentives or put pressure on major businesses and industries to develop new businesses and attract new customers in return for the public investment. The significant recovery investment by Japan’s national government may have also created an over-reliance of individuals on public spending and government support. As indicated in Ms. Karatani’s paper, individual savings of Kobe’s residents has continued to rise since the earthquake and the number of individuals on social welfare has also decreased below pre-disaster levels. Based on our research on economic recovery from the Kobe earthquake, at least two lessons emerge: 1) Successful economic recovery requires coordination among all three recovery goals – Economic, Physical and Life Recovery, and 2) “Recovery indices” are needed to better chart recovery progress in real-time and help ensure that the recovery investments are being used effectively. Economic recovery as the prime goal of recovery Physical recovery, especially the restoration of infrastructure and public facilities, may be the most direct and socially accepted provision of outside financial assistance into an impacted area. However, lessons learned from the Kobe earthquake suggest that the sheer amount of such assistance may not be effective as it should be. Thus, as shown in Fig. 3, economic recovery should be the top priority goal for recovery among the three goals and serve as a guiding force for physical recovery and life recovery. Physical recovery can be a powerful facilitator of post-disaster economic development by upgrading social infrastructure and public facilities in compliance with economic recovery plans. In this way, it is possible to turn a disaster into an opportunity for future sustainable development. Life recovery may also be achieved with a healthy economic recovery that increases tax revenue in the impacted area. In order to achieve this coordination among all three recovery goals, municipalities in the impacted areas should have access to flexible forms of post-disaster financing. The community development block grant program that has been used after several large disasters in the United States, provide impacted municipalities with a more flexible form of funding and the ability to better determine what to do and when. The participation of key stakeholders is also an indispensable element of success that enables block grant programs to transform local needs into concrete businesses. In sum, an effective economic recovery combines good coordination of national support to restore infrastructure and public facilities and local initiatives that promote community recovery. Developing Recovery Indices Long-term recovery takes time. As Mr. Tatsuki’s paper explains, periodical social survey data indicates that it took ten years before the initial impacts of the Kobe earthquake were no longer affecting the well-being of disaster victims and the recovery was completed. In order to manage this long-term recovery process effectively, it is important to have some indices to visualize the recovery processes. In this issue, three papers by Mr. Takashima, Ms. Karatani, and Mr. Kimura define three different kinds of recovery indices that can be used to continually monitor the progress of the recovery. Mr. Takashima focuses on electric power consumption in the impacted area as an index for impact and recovery. Chronological change in electric power consumption can be obtained from the monthly reports of power company branches. Daily estimates can also be made by tracking changes in city lights using a satellite called DMSP. Changes in city lights can be a very useful recovery measure especially at the early stages since it can be updated daily for anywhere in the world. Ms. Karatani focuses on the chronological patterns of monthly macro-statistics that prefecture and city governments collect as part of their routine monitoring of services and operations. For researchers, it is extremely costly and virtually impossible to launch post-disaster projects that collect recovery data continuously for ten years. It is more practical for researchers to utilize data that is already being collected by local governments or other agencies and use this data to create disaster impact and recovery indices. Ms. Karatani found three basic patterns of disaster impact and recovery in the local government data that she studied: 1) Some activities increased soon after the disaster event and then slumped, such as housing construction; 2) Some activities reduced sharply for a period of time after the disaster and then rebounded to previous levels, such as grocery consumption; and 3) Some activities reduced sharply for a while and never returned to previous levels, such as the Kobe Port and Hanshin Railway. Mr. Kimura focuses on the psychology of disaster victims. He developed a “recovery and reconstruction calendar” that clarifies the process that disaster victims undergo in rebuilding their shattered lives. His work is based on the results of random surveys. Despite differences in disaster size and locality, survey data from the 1995 Kobe earthquake and the 2004 Niigata-ken Chuetsu earthquake indicate that the recovery and reconstruction calendar is highly reliable and stable in clarifying the recovery and reconstruction process. <strong>Fig. 3.</strong> Integrated plan of disaster recovery. 4. Life Recovery as the Ultimate Goal of Disaster Recovery Life recovery starts with the identification of the disaster victims. In Japan, local governments in the impacted area issue a “damage certificate” to disaster victims by household, recording the extent of each victim’s housing damage. After the Kobe earthquake, a total of 500,000 certificates were issued. These certificates, in turn, were used by both public and private organizations to determine victim’s eligibility for individual assistance programs. However, about 30% of those victims who received certificates after the Kobe earthquake were dissatisfied with the results of assessment. This caused long and severe disputes for more than three years. Based on the lessons learned from the Kobe earthquake, Mr. Horie’s paper presents (1) a standardized procedure for building damage assessment and (2) an inspector training system. This system has been adopted as the official building damage assessment system for issuing damage certificates to victims of the 2004 Niigata-ken Chuetsu earthquake, the 2007 Noto-Peninsula earthquake, and the 2007 Niigata-ken Chuetsu Oki earthquake. Personal and family recovery, which we term life recovery, was one of the explicit goals of the recovery plan from the Kobe earthquake, but it was unclear in both recovery theory and practice as to how this would be measured and accomplished. Now, after studying the recovery in Kobe and other regions, Ms. Tamura’s paper proposes that there are seven elements that define the meaning of life recovery for disaster victims. She recently tested this model in a workshop with Kobe disaster victims. The seven elements and victims’ rankings are shown in Fig. 4. Regaining housing and restoring social networks were, by far, the top recovery indicators for victims. Restoration of neighborhood character ranked third. Demographic shifts and redevelopment plans implemented following the Kobe earthquake forced significant neighborhood changes upon many victims. Next in line were: having a sense of being better prepared and reducing their vulnerability to future disasters; regaining their physical and mental health; and restoration of their income, job, and the economy. The provision of government assistance also provided victims with a sense of life recovery. Mr. Tatsuki’s paper summarizes the results of four random-sample surveys of residents within the most severely impacted areas of Hyogo Prefecture. These surveys were conducted biannually since 1999,. Based on the results of survey data from 1999, 2001, 2003, and 2005, it is our conclusion that life recovery took ten years for victims in the area impacted significantly by the Kobe earthquake. Fig. 5 shows that by comparing the two structural equation models of disaster recovery (from 2003 and 2005), damage caused by the Kobe earthquake was no longer a determinant of life recovery in the 2005 model. It was still one of the major determinants in the 2003 model as it was in 1999 and 2001. This is the first time in the history of disaster research that the entire recovery process has been scientifically described. It can be utilized as a resource and provide benchmarks for monitoring the recovery from future disasters. <strong>Fig. 4.</strong> Ethnographical meaning of “life recovery” obtained from the 5th year review of the Kobe earthquake by the City of Kobe. <strong>Fig. 5.</strong> Life recovery models of 2003 and 2005. 6. The Need for an Integrated Recovery Plan The recovery lessons from Kobe and other regions suggest that we need more integrated recovery plans that use physical recovery as a tool for economic recovery, which in turn helps disaster victims. Furthermore, we believe that economic recovery should be the top priority for recovery, and physical recovery should be regarded as a tool for stimulating economic recovery and upgrading social infrastructure (as shown in Fig. 6). With this approach, disaster recovery can help build the foundation for a long-lasting and sustainable community. Figure 6 proposes a more detailed model for a more holistic recovery process. The ultimate goal of any recovery process should be achieving life recovery for all disaster victims. We believe that to get there, both direct and indirect approaches must be taken. Direct approaches include: the provision of funds and goods for victims, for physical and mental health care, and for housing reconstruction. Indirect approaches for life recovery are those which facilitate economic recovery, which also has both direct and indirect approaches. Direct approaches to economic recovery include: subsidies, loans, and tax exemptions. Indirect approaches to economic recovery include, most significantly, the direct projects to restore infrastructure and public buildings. More subtle approaches include: setting new regulations or deregulations, providing technical support, and creating new businesses. A holistic recovery process needs to strategically combine all of these approaches, and there must be collaborative implementation by all the key stakeholders, including local governments, non-profit and non-governmental organizations (NPOs and NGOs), community-based organizations (CBOs), and the private sector. Therefore, community and stakeholder participation in the planning process is essential to achieve buy-in for the vision and desired outcomes of the recovery plan. Securing the required financial resources is also critical to successful implementation. In thinking of stakeholders, it is important to differentiate between supporting entities and operating agencies. Supporting entities are those organizations that supply the necessary funding for recovery. Both Japan’s national government and the federal government in the U.S. are the prime supporting entities in the recovery from the 1995 Kobe earthquake and the 2001 World Trade Center recovery. In Taiwan, the Buddhist organization and the national government of Taiwan were major supporting entities in the recovery from the 1999 Chi-Chi earthquake. Operating agencies are those organizations that implement various recovery measures. In Japan, local governments in the impacted area are operating agencies, while the national government is a supporting entity. In the United States, community development block grants provide an opportunity for many operating agencies to implement various recovery measures. As Mr. Mammen’ paper describes, many NPOs, NGOs, and/or CBOs in addition to local governments have had major roles in implementing various kinds programs funded by block grants as part of the World Trade Center recovery. No one, single organization can provide effective help for all kinds of disaster victims individually or collectively. The needs of disaster victims may be conflicting with each other because of their diversity. Their divergent needs can be successfully met by the diversity of operating agencies that have responsibility for implementing recovery measures. In a similar context, block grants made to individual households, such as microfinance, has been a vital recovery mechanism for victims in Thailand who suffered from the 2004 Sumatra earthquake and tsunami disaster. Both disaster victims and government officers at all levels strongly supported the microfinance so that disaster victims themselves would become operating agencies for recovery. Empowering individuals in sustainable life recovery is indeed the ultimate goal of recovery. <strong>Fig. 6.</strong> A holistic recovery policy model.

National security is the primary objective of the state to survive and grow. It can be achieved through the use of economic power, diplomacy, military power projection and political power. The concern for national security is post-World War-II phenomena developed mostly in the United States, initially focusing on military might, and later including other non-military dimensions. In order to ensure national security, a state needs to possess economic, energy, and environmental security etc. Most important challenges which a nation may face include, political instability, threats to territorial integrity, economic weakness, ecological imbalance, socio-cultural disunity etc. Main internal challenges to national security also come from violent groups active within the country; organized crime, drug paddling, extortions, underworld mafias’ etc. These challenges are met through the use of diplomacy to isolate threats; marshal economic power to facilitate or compel cooperation; maintain effective armed forces, implement civil defense and emergency preparedness measures; use intelligence services to detect and defeat or avoid threats and espionage, and to protect classified information; strengthen cybersecurity; and use counterintelligence services. India faces many domestic challenges to its national security such as rising intolerance between the casts and religious communities, dwindling economic development, right and left-wing militancy, rising scarcity of water resources, increasing unemployment, drug and narcotic smuggling, corruption, riots between religious communities etc. India’s poor education and health sectors can pose grave threat to its national security. Other emerging threats include the cyber-crimes such as hacking and online attacks, financial fraud, data theft, espionage etc. This paper focuses on the new emerging domestic challenges to national security and their possible remedy.

The Danjiang River basin is an important water source for the Middle Route of the South-to-North Water Diversion Project. With the shortage of water resources and the increase in pollution pressure, it is of great significance to study the hydrochemical characteristics of surface water in the Danjiang River basin and the risk to human health posed by polluted water bodies for the protection and utilization of water resources. In this paper, 40 surface water samples were collected and analyzed by innovatively adopting the sampling principle of “geological structure unit + landform unit + small watershed unit”. Comprehensive mathematical statistical analysis, Piper trilinear diagrams, Gibbs diagrams, and ion ratio coefficients were used to analyze the hydrochemical composition, spatial distribution characteristics and influencing factors of surface water in the Danjiang River. The entropy weight comprehensive index method (EWQI) and the health risk assessment model recommended by the United States Environmental Protection Agency (HHRA model) were used to evaluate the water quality and potential non-carcinogenic risk of surface water in the Danjiang River source basin. The results showed that the pH of surface water in the study area was 7.02~8.77, with an average value of 8.26; and the TDS was ranged from 134 to 388 mg/L, with an average value of 252.75 mg/L. The main cations in the surface water were Ca2+ and Mg2+, accounting for 71% and 20% of the total cations, respectively, while the main anions were HCO3− and SO42−, accounting for 74% and 19% of the total anions, respectively. The hydrochemical type was HCO3− Ca·Mg. The hydrochemical genesis was mainly controlled by the weathering of carbonate rocks, while some ions were influenced by the weathering of silicate rocks, and human activities were also an important factor affecting the chemical characteristics of the water. The EWQI of surface water in the whole region was 8.95~25.69, and the health risk index (HI) of nitrate pollution ranged from 0.0122 to 0.2118, in which the HI ranges for children and adults were 0.0217~0.2118 and 0.0122~0.1333, respectively, indicating that the water quality of the entire study area met the Class I water standards, and the potential non-carcinogenic risk of nitrate was low. However, its impact on children was significantly higher than on adults, so it is recommended to monitor the water quality downstream of urban areas in the study area to reduce agricultural non-point source pollution and urban domestic sewage discharge and thereby reduce the potential health risks for young populations.

Abstract Abstract 4834 Over the past half century, the course of sickle cell disease has been transformed in the United States through the conduct of rigorous biomedical research and broad application of the results. Universal newborn screening with comprehensive medical care has dramatically reduced death and disability in childhood, and increased the numbers of patients surviving into adulthood. However, access to health care has not kept up with the changing demographics of those affected by sickle cell disease. Health care often becomes fragmented when patients transition from pediatric to adult health care providers. Access to comprehensive care has impeded both conduct of clinical and implementation of research results. To address these needs in this changing environment, HHS Secretary Kathleen Sebelius has charged six agencies of HHS – NIH, CDC, HRSA, FDA, AHRQ and CMS – and the Offices of Minority Health and Planning and Evaluation, to improve the health of people with SCD. The agencies are coordinating their programs and collaborating with the Office of the Secretary, to achieve the following goals:create a comprehensive database of individuals with SCD to facilitate the monitoring of health outcomes and clinical research;improve the care of adults and children through development and dissemination of evidence-based guidelines, which are anticipated in Spring, 2012, with broad implementation plans;identify measures of quality of care for individuals with SCD and incorporate them into quality improvement programs at HHS;increase the availability of medical homes to improve patient access to quality primary and specialty care;provide State Medicaid officials, health care providers, patients, families and advocacy groups with information about resources related to SCD care and treatment;work with the pharmaceutical industry and academic investigators to increase the development of effective treatments for patients with SCD;support research to improve health care for people with SCD;support research to understand the clinical implications of SC trait;engage national and community-based SCD advocacy organizations and experts in ongoing discussions to ensure that issues of importance to persons affected are addressed. Organizational and strategic actions are being taken at each agency to enhance implementation of research advances; provide evidence-based guidelines to families, health care providers, and payers; facilitate new drug development; and provide public health data to impact both the health care delivery and research agendas. The enthusiastic support of the American Society of Hematology and its members is essential for long-term success of this endeavor. Disclosures: No relevant conflicts of interest to declare.

ABSTRACT Major technological disasters, such as oil spills, create many situations that are addressed in typical government and industry contingency plans—for example, how to boom a beach, clean a bird, or lighter a tanker. What is not addressed in contingency plans is how to mitigate the social and psychological impacts of such a disaster on residents of affected communities. Technological disasters have been shown to produce what have come to be known as “corrosive communities” characterized by unusually high levels of tension, conflict, ongoing litigation, and chronic psychological stress. Having experienced a major oil spill firsthand, the members of the Prince William Sound Regional Citizens' Advisory Council (PWS RCAC) initiated a project to fill this large gap in oil spill response planning. In addition to drawing on personal experience, PWS RCAC consulted experts in the fields of socioeconomic and technological disaster research to help in the development of a guidebook titled Coping with Technological Disasters. The guidebook was released in 1999 and contains information to help communities and individuals understand what a technological disaster is, how it differs from a natural disaster, and what to expect during and in the years following the disaster. Information, resources, and proven programs are presented in the guidebook for use by local governments, civic groups, mental health organizations, individuals, or just about anyone responding to a major disaster. Since its release, the guidebook has been requested by communities, state and federal agencies, organizations, and companies throughout Alaska, the United States, and internationally. Community leaders, mental health professionals, and emergency responders have praised the guidebook as an excellent reference and resource. By sharing what the communities of the Exxon Valdez oil spill region have learned, PWS RCAC believes that this guidebook will enhance already existing contingency plans, not only for spill response, but for other emergencies as well.

At the beginning of the 20th century, over 40% by weight of all the materials consumed through the production of goods within the United States were comprised of renewable resources (Matos and Wagner 1998). In contrast, by the end of the 20th century renewable material usage had dropped to less than 8% by weight (Matos and Wagner 1998). Combined with both an increase in the overall rate at which we consume resources as well as growing awareness of the inherently finite availability of nonrenewable resources, the early decades of the 21st century may mark the beginning of a shift back to an increased use of biobased materials. While the relative proportion of the demand for biobased materials has changed over the past century, one factor that has remained constant is that a majority of renewable and nonrenewable resources consumed in the U.S. is used in the construction industry (Matos and Wagner 1998). Although the utilization of biobased products is increasing throughout all sectors, their popularity still lags in the building and construction industry, and they are surpassed by more widely accepted green practices such as the use of pre- and post-consumer recycled materials. There is, however, a great potential benefit to be gained from a resurgence in the use of biobased products, both from general environmental and human health perspectives. Examples of specific sectors that may profit from this include building and construction industries, which account for 40% (Roodman and Lenssen 1995) of global raw material usage, as well as the Federal government, which is the largest real property owner in the U.S. (U.S. General Services Administration 2006). A biobased material is defined as containing some percentage of a biologically renewable resource. According to ASTM E2114-2004, a renewable resource is something “that is grown, naturally replenished, or cleansed, at a rate which exceeds depletion of the usable supply of that resource.” The length of time needed to replace a renewable resource can vary greatly depending upon the resource—for example, it can take 30–100 years for a tree to mature while bamboo can be harvested in as little as 7 years. Rapidly renewable resources are defined, for the purposes of this paper, as those that can be replaced within 10 years. Bamboo, linoleum, and cork are just a few of the more common examples of rapidly renewable resources. The renewable, biobased, component of a material is either derived from a plant or animal, and resource supplies are typically managed in a sustainable fashion, thus ensuring its continued availability. This material may then be used within the product in a fairly unaltered state, it may undergo some chemical or physical transformation, or it may be combined with other products to create an intermediate ingredient in the production or manufacturing process. The decrease in biobased material utilization over the last 100 years has led to an increased use of non-biobased materials, and this development can yield numerous potentially negative impacts that have been fairly well documented in terms of many of their environmental impacts such as eutrophication and air pollution. These, however, only account for a portion of the total sum of potential impacts. In addition to potentially harmful impacts on the exterior environment, various material ingredients and components can negatively affect the interior environment as well through the release of volatile organic compounds (VOCs) and other types of indoor air pollutants. VOCs are a concern because their emissions can be an ongoing problem within an interior space, since in addition to the initial release of compounds, surfaces can continually absorb and re-release the compounds back into the environment where they are absorbed by the inhabitants. If this occurs in combination with other problems, like poor building air circulation, the potential can develop for more serious concerns such as “Sick Building Syndrome” (U.S. Environmental Protection Agency 2010). While some of this can be mitigated through improved ventilation, indoor air quality is still found to be a concern by the U.S. Environmental Protection Agency (Indoor Air Quality, 2010) and other groups. One of the most well known indoor air contaminants is formaldehyde, which is commonly found in the adhesives used in pressed wood products such as furniture, shelving, or particleboard; finishes and coatings on fabrics; paints and coatings; as well as some types of insulation.3 A 2008 study by Papadopoula, Nakos, and Tsiantzi examined the replacement of the formaldehyde-based resins with certain renewably based ones that yielded equivalent, and in some cases superior, performance characteristics in addition to providing a reduction in VOC levels. Another study that investigated school cleaning products found that, on average, the contaminate emission rate for green general cleaners was one fifth that of conventional cleaners (Environmental Working Group 2009). Other studies too, have shown correlations between the use of petroleum-based products and increased VOC levels. A joint report by the Healthy Building Network and Health Care Without Harm (Silas, Hansen, and Lent, 2007) also promotes the use of renewable materials to lessen indoor air quality concerns, and it provides guidelines and information for the health care industry on the benefits of renewable and biobased materials as well as the potential issues associated with petrochemical-based fibers. Additionally, the Healthy Building Network offers biopolymer and bioplastic production and purchasing guidelines. These environmental and health related concerns, as well as the potential market for biobased products, have become the focus of a variety of different areas of legislation and development. In addition to numerous Federal initiatives, an increased awareness of biobased materials and products is also being fostered within the building and construction fields by building rating systems such as Energy Star®, Green Globes, and Leadership in Energy and Environmental Design (LEED®).

Life cycle assessment (LCA) is a powerful tool to evaluate the environmental impacts of domestic wastewater treatment plant (WWTP) operations. It involves a thorough evaluation of the main characteristics or components of the environment, human health, and resources. However, the literature to date is still lacking analysis on the widely varied designs and operational conditions of full-scale WWTPs. The aim here was to integrate analyses such as LCA, greenhouse gas (GHG) emissions, and energy consumption, when considering the environmental impacts of a full-scale WWTP, which can provide practical outputs to aid decision-making on optimum designs and operational conditions. The Russtmiya domestic WWTP, located in Iraq, was considered as the case study. Three operational alternatives were proposed as solutions to improve the WWTP’s performance, as follows: (1) conventional activated sludge with sand filter (CAS), (2) conventional activated sludge with sand filter and nitrogen removal (CAS-N), and (3) membrane bioreactor (MBR). The operation of such alternatives was investigated through modeling and simulation using GPS-X 8.0.1 software. The energy consumption of each alternative was estimated via GPS-X, while the GHG emissions were estimated using three different methods according to the intergovernmental panel on climate change (IPCC), the United States Environmental Protection Agency (USEPA), and GPS-X software. The OpenLCA software (1.10.3) was used to measure all impact categories at both the midpoint and endpoint levels using various methods. As a conclusion, comparing the three proposed alternatives indicated that: (1) the MBR alternative provided the lowest energy consumption and moderate GHG emissions, and (2) the CAS alternative provided the best environmental performance, particularly in aspects such as ozone depletion, global warming, and climate change, where the lowest GHGs emission values had the major contribution.

With the continued influx of Mexican immigrants to the United States, especially to Southern California, health concerns and needs have increased among this population over the last several years. California State Polytechnic University, Pomona (Cal Poly Pomona) obtained a federal grant that provided resources to establish the Community Outreach Partnership Center (COPC). COPC consists of comprehensive efforts to improve the overall well-being of the Angela Chanslor area within the City of Pomona in East Los Angeles. Focus areas of the project include 1) Education and Integrated Services, 2) Community Planning and Capacity Building for Neighborhood Revitalization and Safety, and 3) Job Development and Training. The focus of this paper is health promotion activities within Education and Integrated Services. The primary objective of this portion of the program was to provide residents with physical examinations and health screenings, health education, and medical and social service referrals. Topics discussed are the target community, general overview of COPC, Family Services Information and Referral Program (i.e. health promotion program within Education and Integrated Services), program impact and results, and suggestions for continued implementation and future efforts. / Con la influencia continua de inmigrantes Mexicanos a los Estados Unidos, especialmente al sur de California, ciertas necesidades con respecto a la salud han incrementado en esta poblacion en los ultimos anos. California State Polytechnic University, Pomona (Cal Poly Pomona). Obtuvo ayuda Federal para establecer El Community Outreach Partnership Center (COPC). El centro COPC consiste de esfuerzos conprensivos para mejorar el bienestar del area Angela Chanslor que esta ubicado en la Ciudad de Pomona en la parte Este de Los Angeles. Las partes enfocadas del proyecto incluyen, 1) Educacion y servicios Integrados, 2) Plan para la Comunidad y un Edificio de Capacitacion para la comunidad que dara revitalizacion y seguridad, 3) Y habrira trabajos y entrenamientos. El enfoque de este proyecto es de actividades en Promocion de Salud aliadas con educacion y Servicios Integrados. El objetivo principal de esta porcion del programa era de proveer a los residentes con examinaciones fisicas, educacion para la salud, y eran referidas a servicios medicos y sociales. Los topicos que son tratados son: La comunidad que sera ayudada, El enfoque general de COPC, informacion del programa para referir a servicios familiares, el impacto del programa y resultados, y sugerencias para implementar futuros esfuerzos.

With the continued influx of Mexican immigrants to the United States, especially to Southern California, health concerns and needs have increased among this population over the last several years. California State Polytechnic University, Pomona (Cal Poly Pomona) obtained a federal grant that provided resources to establish the Community Outreach Partnership Center (COPC). COPC consists of comprehensive efforts to improve the overall well-being of the Angela Chanslor area within the City of Pomona in East Los Angeles. Focus areas of the project include 1) Education and Integrated Services, 2) Community Planning and Capacity Building for Neighborhood Revitalization and Safety, and 3) Job Development and Training. The focus of this paper is health promotion activities within Education and Integrated Services. The primary objective of this portion of the program was to provide residents with physical examinations and health screenings, health education, and medical and social service referrals. Topics discussed are the target community, general overview of COPC, Family Services Information and Referral Program (i.e. health promotion program within Education and Integrated Services), program impact and results, and suggestions for continued implementation and future efforts. / Con la influencia continua de inmigrantes Mexicanos a los Estados Unidos, especialmente al sur de California, ciertas necesidades con respecto a la salud han incrementado en esta poblacion en los ultimos anos. California State Polytechnic University, Pomona (Cal Poly Pomona). Obtuvo ayuda Federal para establecer El Community Outreach Partnership Center (COPC). El centro COPC consiste de esfuerzos conprensivos para mejorar el bienestar del area Angela Chanslor que esta ubicado en la Ciudad de Pomona en la parte Este de Los Angeles. Las partes enfocadas del proyecto incluyen, 1) Educacion y servicios Integrados, 2) Plan para la Comunidad y un Edificio de Capacitacion para la comunidad que dara revitalizacion y seguridad, 3) Y habrira trabajos y entrenamientos. El enfoque de este proyecto es de actividades en Promocion de Salud aliadas con educacion y Servicios Integrados. El objetivo principal de esta porcion del programa era de proveer a los residentes con examinaciones fisicas, educacion para la salud, y eran referidas a servicios medicos y sociales. Los topicos que son tratados son: La comunidad que sera ayudada, El enfoque general de COPC, informacion del programa para referir a servicios familiares, el impacto del programa y resultados, y sugerencias para implementar futuros esfuerzos.

The mission of botanical gardens is to work towards the conservation and sustainable use of plant diversity. In the case of gardens established on the premises of former manor estates, actions are also being taken to properly manage existing natural resources, e.g., historic tree stands. This article is based on the case study of the Botanical Garden in Lublin. To assess the health condition of the trees growing in the oldest part of the park—Kościuszko Redoubt—sonic tomography examinations were performed. The article presents the practical application of a newer form of digital imaging, put to the service of assessing the health of old trees in an important public space. The Redoubt is the only work of defense architecture in Poland related to the activity of General Tadeusz Kościuszko, the hero of Poland and the United States of America. It has survived in an excellent condition, preserved without significant changes, as an earth structure with ramparts; an interior, i.e., a yard; a cannon post located on an inaccessible cliff; and a brick basement serving as a shelter for soldiers and a warehouse. The entire surroundings also survived: ravines masked with a wild green, embankments with a safe hidden access road to the Redoubt, and a shaped defense line. The Botanical Garden area is located in the Sławinek district, in the valley of the Czechówka River, and includes a fragment of it and the slope adjacent to the west, cut by three loess ravines. The Botanical Garden was established in 1965, where there was a manor farm earlier, and then in the 19th century, a spa that was destroyed during World War I and II. Good soils and a varied microclimate provide the right ecological conditions for the high biodiversity of plants. With an area of 21.15 ha, the Garden area has the character of a landscape park with the theme of a manor garden from the turn of the 18th/19th century and a spa garden. The primary purpose of the work was to investigate the effectiveness of the use of computer tools in the sustainable management of historical greenery in the Botanical Garden. Research has shown that diagnostics with the use of sound waves allow for an accurate diagnosis and quick protective measures against the tree, improving the safety of visitors to the botanical garden. Moreover, the obtained results and a historical query were used to prepare an application to recognize Redoubt as a monument.

AbstractThe development of databases to track the outcomes of children with cardiovascular disease has been ongoing for much of the last two decades, paralleled by the rise of databases in the intensive care unit. While the breadth of data available in national, regional and local databases has grown exponentially, the ability to identify meaningful measurements of outcomes for patients with cardiovascular disease is still in its early stages.In the United States of America, the Virtual Pediatric Intensive Care Unit Performance System (VPS) is a clinically based database system for the paediatric intensive care unit that provides standardized high quality, comparative data to its participants [https://portal.myvps.org/]. All participants collect information on multiple parameters: (1) patients and their stay in the hospital, (2) diagnoses, (3) interventions, (4) discharge, (5) various measures of outcome, (6) organ donation, and (7) paediatric severity of illness scores. Because of the standards of quality within the database, through customizable interfaces, the database can also be used for several applications: (1) administrative purposes, such as assessing the utilization of resources and strategic planning, (2) multi-institutional research studies, and (3) additional internal projects of quality improvement or research.In the United Kingdom, The Paediatric Intensive Care Audit Network is a database established in 2002 to record details of the treatment of all critically ill children in paediatric intensive care units of the National Health Service in England, Wales and Scotland. The Paediatric Intensive Care Audit Network was designed to develop and maintain a secure and confidential high quality clinical database of pediatric intensive care activity in order to meet the following objectives: (1) identify best clinical practice, (2) monitor supply and demand, (3) monitor and review outcomes of treatment episodes, (4) facilitate strategic healthcare planning, (5) quantify resource requirements, and (6) study the epidemiology of critical illness in children.Two distinct physiologic risk adjustment methodologies are the Pediatric Risk of Mortality Scoring System (PRISM), and the Paediatric Index of Mortality Scoring System 2 (PIM 2). Both Pediatric Risk of Mortality (PRISM 2) and Pediatric Risk of Mortality (PRISM 3) are comprised of clinical variables that include physiological and laboratory measurements that are weighted on a logistic scale. The raw Pediatric Risk of Mortality (PRISM) score provides quantitative measures of severity of illness. The Pediatric Risk of Mortality (PRISM) score when used in a logistic regression model provides a probability of the predicted risk of mortality. This predicted risk of mortality can then be used along with the rates of observed mortality to provide a quantitative measurement of the Standardized Mortality Ratio (SMR). Similar to the Pediatric Risk of Mortality (PRISM) scoring system, the Paediatric Index of Mortality (PIM) score is comprised of physiological and laboratory values and provides a quantitative measurement to estimate the probability of death using a logistic regression model.The primary use of national and international databases of patients with congenital cardiac disease should be to improve the quality of care for these patients. The utilization of common nomenclature and datasets by the various regional subspecialty databases will facilitate the eventual linking of these databases and the creation of a comprehensive database that spans conventional geographic and subspecialty boundaries.

Background:In 2019, EULAR launched the #Time2Work campaign [1] to raise awareness of the impact of rheumatic and musculoskeletal diseases on individuals, society, and the economy. Building on this theme, the Canadian Arthritis Patient Alliance (CAPA) developed a social media campaign and Twitter chat in collaboration with international patient advocates and organizations. The Twitter chat built upon CAPA’s successful development of workplace resources for people living with arthritis [2].Objectives:To deliver an international #ArthritisAtWork social media campaign on Twitter, in support of the #Time2Work campaign.Methods:A one-hour Twitter Chat was held on World Arthritis Day (October 12, 2019) on arthritis in the workplace (#ArthritisAtWork) from 18:00 to 19:00 UTC. The chat was hosted by CAPA and co-hosted by Simon Stones, a patient advocate from the United Kingdom (UK) and CreakyJoints, patient-driven arthritis organization in the United States (US). The Twitter Chat questions were co-developed in advance by the hosts, and blog posts were shared from CAPA’s website. Each host also promoted the Twitter Chat through their websites, newsletters and online communities. A social media analytical tool, Symplur, was used to measure audience engagement using the hashtag #ArthritisAtWork. In addition, pertinent Tweets before, during, and after the chat were obtained. The analysis of themes was undertaken to identify common issues and questions.Results:One hundred and ten users participated in the Twitter chat between 17:20 and 19:20 UTC. Participants included people living with arthritis, researchers, patient organizations, health information outlets and academic institutions. During this period, 565 tweets were shared between participants in Australia, Canada, Ireland, Spain, UK and US. There were 3.352 million Twitter impressions. This represents the number of times a tweet appears to users in either their timeline or search results. Emergent themes of the analysis include:common workplace challenges such as employer attitudes and stigma;effective workplace supports such as prioritizing tasks and requesting workplace accommodations; andareas of improvement such as instituting workplace policies, flexible workplace approaches and education for employees and managers.Conclusion:The social media campaign was successful in reaching a diverse audience and supporting the #Time2Work campaign. Social media tools can provide an important social support for people living with arthritis as they navigate workplace challenges. It also offers a more contemporary platform to engage the international community on issues of common interest. Working together, internationally helps expand reach and reduce barriers in communication. Research can be conducted to measure potential behavior change that leverages digital social support for people living with arthritis.References:[1]EULAR (2019). Press release “EULAR launches Time2Work campaign to highlight the importance of keeping people with rheumatic and musculoskeletal diseases in work. Available from:https://www.eular.org/sysModules/obxContent/files/www.eular.2015/1_42291DEB-50E5-49AE-5726D0FAAA83A7D4/time2work_campaign_press_release_final.pdf2. CAPA (2019). Arthritis in the Workplace: Resources for Patients by Patients. Available from:http://arthritispatient.ca/arthritis-in-the-workplace-resources-for-patients-by-patients/Disclosure of Interests:Laurie Proulx Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma., Speakers bureau: I have provided speaking services to Sanofi and Eli Lilly. These engagements do not relate to this abstract., Simon Stones Consultant of: I have been a paid consultant for Envision Pharma Group and Parexel. This does not relate to this abstract., Speakers bureau: I have been a paid speaker for Actelion and Janssen. These do not relate to this abstract., Joseph Coe: None declared, Dawn Richards Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma., Consultant of: Dawn has done small consulting projects on patient engagement for companies., Speakers bureau: Dawn has been a paid speaker for several companies., Linda Wilhelm Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma., Nathalie Robertson Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma., Janet Gunderson Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma., Alexandra Sirois Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma., Annette McKinnon Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma.