Urban Planning & Public Policy

Introduction: The World Health Organization estimates that one million people die by suicide every year. Few studies have looked at factors associated with disposition in patients with chief complaints of depression, suicidal ideation (SI) and suicidal attempts (SA) who present to the emergency department (ED). Our objective was to assess individual determinants associated with ED disposition of patients in depressed patients presenting to the ED.

Methods: We conducted a retrospective study using the National Hospital Ambulatory Medical Care Survey from 2006 to 2008. We used logistic regression to identify factors associated with discharge, in SI, SA and depression patients. Independent variables included socio-demographic information, vital signs, mode of arrival, insurance status, place of residence and concomitant psychiatric diagnosis.

Results: Of the 93,030 subjects, 2,314 met the inclusion criteria (1,362 depression, 353 SI and 599 SA). Patients who arrived by ambulance were less likely to be discharged (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.43-0.92). Hispanic patients and patients age 15 to 29 were likely to be discharged (OR 1.61, 95% CI 1.16-2.24 and OR 1.55, 95% CI 1.15-2.10 respectively). Insurance status and housing status were not significantly associated patient was being discharge from EDs.

Conclusion: The Hispanic population had higher discharge rates, but the reasons are yet to be explored. Patients with SA and SI are discharged less frequently than those with depression, regardless of insurance type or housing status. [West J Emerg Med. 2014;15(2):211–216.]

Introduction: Toxicologic exposures (TE) are a major preventable public health issue, with most cases due to unintentional causes. Although these cases are well documented and reported via the National Poison Data System, there is little information regarding toxicologic exposure cases in the emergency department (ED). The aim of this study was to identify demographic groups at risk for potential poisoning.

Methods: This was a cross-sectional study. We used data from the California State Emergency Department Database (SEDD) 2011 for statistical analysis.

Results: The study included 10,124,598 ED visits in California in 2011. The prevalence of TE was 383.4 (379.6-387.3) per 100,000 visits. Toxicologic exposures were most common among patients aged <10 years (555.4, 95% confidence interval [CI], 544.5-566.5 per 100,000 visits). Overall, TE was more common among males. White patients showed the highest prevalence of TE compared to other racial groups (P <0.001). Subpopulation analysis showed Native American female patients ages 10-19 had a noticeably higher prevalence of TE (1,464.4, 95% CI, 802.9-2444.9 per 100,000). The prevalence of TE was higher in households of higher median income (P <0.001). Prevalence of TE among those with a history of substance use was also elevated. 

Conclusion: Toxicologic exposure cases in the ED are elevated in particular age and race/ethnicity groups, as well as among those with a diagnosis of substance use disorder. The strength of association between these factors and TE in the general population may be different because we examined ED visits only. Further preventive and education strategies are necessary and should target the demographic groups identified in this epidemiological study.

Adaptation to climate change is often conceptualized as a dichotomy, with responses being either planned (formal and structured) or autonomous (organic and self-organized, often known as “everyday adaptation”). Recent literature on adaptation responses has highlighted the existence and importance of the interplay between autonomous and planned adaptation, but examination of this interaction has been limited to date. We use a global database of 1682 peer-reviewed articles on adaptation responses to systematically examine autonomous and planned adaptations, with an emphasis on how these types of adaptations interact with one another. We propose a third category, mixed adaptation, which demonstrates characteristics of both autonomous and planned types, and which recognizes nuances in how organization, external support, formality, and autonomy manifest in the fuzzy space between the two. We find that more than one-third of articles reporting on adaptation responses fall into this mixed category, with cases across sectors and world regions. We develop a qualitative typology of mixed adaptation that identifies nine ways that autonomous and planned adaptation interact and influence each other both positively and negatively. Based on these findings, we argue for more nuanced examinations of the interplay between autonomous and planned adaptation and for conceptualizing adaptation planning as a continuum between the two rather than a dichotomy. Exploring the patterns of interplay from a large database of adaptation responses offers new insights on the relative roles of both autonomous and planned adaptation for mobilizing adaptation pathways in locally relevant, scalable, effective, and equitable ways.

Data for Policy (dataforpolicy.org), a trans-disciplinary community of research and practice, has emerged around the application and evaluation of data technologies and analytics for policy and governance. Research in this area has involved cross-sector collaborations, but the areas of emphasis have previously been unclear. Within the Data for Policy framework of six focus areas, this report offers a landscape review of Focus Area 2: Technologies and Analytics. Taking stock of recent advancements and challenges can help shape research priorities for this community. We highlight four commonly used technologies for prediction and inference that leverage datasets from the digital environment: machine learning (ML) and artificial intelligence systems, the internet-of-things, digital twins, and distributed ledger systems. We review innovations in research evaluation and discuss future directions for policy decision-making.

This article highlights the role of political context in shaping motivation of actors from the public sector, the private sector, and civil society to work together collaboratively. Most studies on motivations for collaborative governance come from Western, democratic contexts, and a comprehensive assessment of motivations in authoritarian contexts is missing. We bring political context in by investigating what motivates state and non-state actors to collaborate in China, a classic example of an authoritarian state. By conducting a systematic review of 264 empirical studies on collaborative governance in China published from 2006 to 2021, this paper reveals prevalent motivators including vertical commands, material-resource dependence, rules and regulations, legitimacy, economic benefits, and political resources; and uncommon motivators including asset specificity and share beliefs for both state and non-state actors in Chinese cases. We conclude by reflecting on the ways common theoretical frameworks, including transaction cost theory, resource dependence theory, the advocacy coalition framework, and social capital theory, explain motivations in China.

BACKGROUND AND OBJECTIVES: Research to identify fetal predictors of infant mortality among singletons born in the United States (US) concludes that poorly understood and unmeasured confounders produce a spurious association between fetal size and infant death. We argue that these confounders include Vanishing Twin Syndrome (VTS)-the clinical manifestation of selection against frail male twins in utero. We test our argument in 276 monthly conception cohorts conceived in the US from January 1995 through December 2017. METHODOLOGY: We use Box-Jenkins transfer function modeling to test the hypothesis that among infants born from 276 monthly conception cohorts conceived in the US from January 1995 through December 2017, the sex ratio of twins born in the 37th week of gestation will correlate inversely with infant mortality among singleton males born at the 40th week of gestation. RESULTS: We find support for our hypothesis and infer that the contribution of survivors of VTS to temporal variation in infant mortality among the hardiest of singleton male infants, those born at 40 weeks gestation, ranged from a decrease of about 7% to an increase of about 5% over our 276 monthly conception cohorts. CONCLUSIONS AND IMPLICATIONS: We conclude that an evolutionary perspective on fetal loss makes a heretofore unmeasured confounder of the relationship between fetal size and infant mortality both explicable and measurable. This finding may help clinicians better anticipate changes over time in the incidence of infant mortality.

OBJECTIVE: Schools play an essential role in providing mental health care for adolescents. School closures during COVID-19, as well as re-opening to remote-only instruction in Fall 2020, may indirectly affect the utilization of emergency psychiatric care. We examine COVID-19-related changes in emergency psychiatric care among youth during the school closure and after school reopening (with remote instruction). METHODS: We use Box-Jenkins interrupted time series methods to analyze psychiatric emergency department (ED) visits among patients 10-19 years at LAC + USC Medical Center (LAC + USC) between January 5th, 2018, and December 31st, 2020. We control for the 1st societal shutdown in LA County (i.e., the nine weeks from March 13 to May 14, 2020) when analyzing the potential return to remote school shock. RESULTS: Youth psychiatric ED visits fell by 15.3 per week during the Spring 2020 school closure (p < .05). The return to remote school coefficient (i.e., August 14th to September 10, 2020), by contrast, is positive but does not reach statistical detection above expected values (p = .11). However, the proportion of psychiatric ED visits rises 38% among youth during the return to remote school period (p = 0.006). CONCLUSION: The initiation of Fall 2020 remote instruction corresponded with a greater proportion of youth ED visits that are classified as psychiatric.

Urban landscapes homogenize our world at global scales, contributing to “extinction of experience”, a progressive decline in human interactions with native greenspace that can disconnect people from the services it provides. College age adults report feeling disconnected from nature more than other demographics, making universities a logical place to explore interventions intended to restore a connection with nature. This study surveyed 1088 students and staff across four university campus communities in Southern California, USA and used multicriteria decision analysis to explore their landscape preferences and the implications of those preferences for combatting extinction of experience. Our results suggest that perspectives of, and preferences for, different greenspace forms vary significantly (i.e., they are not perceived as substitutable). Support for native ecosystems, particularly coastal sage scrub (top ranked landscape) was generally high, suggesting that disaffection with wild nature is not particularly widespread. Programs for replacing turf grass lawns (lowest ranked landscape) with native plants were also well supported, but support for stormwater bioswales was more moderate (and variable). This may reflect their relative newness, both on university campuses and in urban spaces more generally. Not all members of campus communities preferred the same landscapes; preferences differed with degree of pro-environmentalism and university status (undergraduate student, graduate student, staff). Even so, all respondents exhibited landscape preferences consistent with at least one approach for combatting extinction of experience, suggesting that ecologists, engineers and urban planners have a viable set of generalizable tools for reconnecting people with nature.

Recognizing that centuries of mistreatment of low-income and minority communities by governments and corporations have resulted in widespread exposure to environmental harms, academics and policymakers are seeking ways to improve environmental justice. While it is commonly assumed that improved procedural justice (meaningful participation in decision making) should improve distributive justice (equitable distribution of environmental harms and benefits), empirical evidence of this link is nascent. This paper evaluates whether differing approaches to procedural justice shape recognition of distributive injustices by policymakers, focusing on implementation of the National Environmental Policy Act (NEPA) in Puerto Rico. NEPA requires federal agencies to evaluate the potential environmental impacts of projects they implement, fund, or permit; this review commonly includes an assessment of the project's impacts on distributive justice. Drawing on document analysis and interviews with project developers, regulators, and community organizations, we explore how and why four NEPA reviews consider distributional impacts. In all four cases, the community mobilized to voice concerns about the proposed projects' impacts, but the lead agencies and project developers did not always create the space for those voices to collaboratively shape the review. This demonstrates the role of the project developer in how distributive justice considerations are treated, as project leads have discretion on whether and when to provide space for community groups to participate in the process. This research makes two primary contributions. First, by linking features of the decision-making process with environmental justice-related outputs, this research provides practical understanding of ways to support distributive justice and expands knowledge about how participatory governance works within the context of US environmental policy. Second, by studying NEPA's implementation in Puerto Rico, we assess challenges associated with implementing Environmental Impact Assessment in a territorial setting, where the demographics and intensity of environmental problems are distinct from the 'traditional' American context the policies were designed to protect.