Networking Cities after Paris: Weighing the Ambition of Urban Climate Change Experimentation

Over the past few decades, cities have repeatedly demonstrated high levels of ambition with regard to climate action. Global environmental governance has been marked by a proliferation of policy actions taken by local governments around the world to demonstrate their potential to advance climate change mitigation and adaptation. Leading ‘by example’ and demonstrating the extent of action that it is possible to deliver, cities have aspired to raise the ambition of national and international climate governance and put action into practice via a growing number of ‘climate change experiments’ delivered on the ground. Yet accounts of the potential of cities in global environmental governance have often stopped short of a systematic valuation of the nature and impact of the networked dimension of this action. This article addresses this by assessing the nature, and challenges faced by, urban climate governance in the post-Paris era, focusing on the ‘experimentation’ undertaken in cities and the city networks shaping this type of governance. First, we unpack the concept of ‘urban climate change experimentation’, the ways in which it is networked, and the forces driving it. In the second and third parts of the article, we discuss two main pitfalls of networked urban experimentation in its current form, focusing on issues of scaling experiments and the nature of experimentation. We call for increased attention to ‘scaling up’ experiments beyond urban levels of governance, and to transformative experimentation with governance and politics by and in cities. Finally, we consider how these pitfalls allow us to weigh the potential of urban climate ambition, and consider the pathways available for supporting urban climate change experimentation

The Urban Environment and Childhood Asthma (URECA) birth cohort study: design, methods, and study population

<p>Abstract</p> <p>Background</p> <p>The incidence and morbidity of wheezing illnesses and childhood asthma is especially high in poor urban areas. This paper describes the study design, methods, and population of the Urban Environment and Childhood Asthma (URECA) study, which was established to investigate the immunologic causes of asthma among inner-city children.</p> <p>Methods and Results</p> <p>URECA is an observational prospective study that enrolled pregnant women in central urban areas of Baltimore, Boston, New York City, and St. Louis and is following their offspring from birth through age 7 years. The birth cohort consists of 560 inner-city children who have at least one parent with an allergic disease or asthma, and all families live in areas in which at least 20% of the population has incomes below the poverty line. In addition, 49 inner-city children with no parental history of allergies or asthma were enrolled. The primary hypothesis is that specific urban exposures in early life promote a unique pattern of immune development (impaired antiviral and increased Th2 responses) that increases the risk of recurrent wheezing and allergic sensitization in early childhood, and of asthma by age 7 years. To track immune development, cytokine responses of blood mononuclear cells stimulated <it>ex vivo </it>are measured at birth and then annually. Environmental assessments include allergen and endotoxin levels in house dust, pre- and postnatal maternal stress, and indoor air nicotine and nitrogen dioxide. Nasal mucous samples are collected from the children during respiratory illnesses and analyzed for respiratory viruses. The complex interactions between environmental exposures and immune development will be assessed with respect to recurrent wheeze at age 3 years and asthma at age 7 years.</p> <p>Conclusion</p> <p>The overall goal of the URECA study is to develop a better understanding of how specific urban exposures affect immune development to promote wheezing illnesses and asthma.</p

Seasonal risk factors for asthma exacerbations among inner-city children

BACKGROUND: Exacerbations of asthma remain common even in children and adolescents despite optimal medical management. Identification of host risk factors for exacerbations is incomplete, particularly for seasonal episodes. OBJECTIVE: Define host risk factors for asthma exacerbations unique to their season of occurrence. METHODS: This is a retrospective analysis of patients aged 6-20 years who comprised the control groups of the Asthma Control Evaluation trial and the Inner City Anti-IgE Therapy for Asthma trial. Univariate and multivariate models were constructed to determine if patient demographic and historical factors, allergic sensitization, fractional exhaled nitric oxide, spirometric measurements, asthma control, and treatment requirements were associated with seasonal exacerbations. RESULTS: The analysis included 400 patients (54.5% male; 59.0% African American; median age 13 years). Exacerbations occurred in 37.5% of participants over the periods of observation and were most common in the fall (28.8% of participants). In univariate analysis, impaired pulmonary function was significantly associated with greater odds of exacerbations for all seasons, as was an exacerbation in the previous season for all seasons except spring. In multivariate analysis, exacerbation in the previous season was the strongest predictor in fall and winter while a higher requirement for inhaled corticosteroids was the strongest predictor in spring and summer. The multivariate models had the best predictive power for fall exacerbations (30.5% variance attributed). CONCLUSIONS: Among a large cohort of inner city children with asthma, patient risk factors for exacerbations vary by season. Thus, individual patient information may be beneficial in strategies to prevent these seasonal events. CLINICAL IMPLICATIONS: Inner city children remain at risk for asthma exacerbations despite appropriate therapy. Because their risk factors vary by season, strategies to prevent them may need to differ as well. CAPSULE SUMMARY: Risk factors for asthma exacerbations among inner city children varied by season. Fall exacerbations were the most common and the most predictable based on a compilation of historical and clinical variables

Prenatal Maternal Stress and Cord Blood Innate and Adaptive Cytokine Responses in an Inner-City Cohort

Rationale: Stress-elicited disruption of immunity begins in utero

A Computerized Decision Support Tool to Implement Asthma Guidelines for Children and Adolescents.

BACKGROUND: Multi-center randomized controlled trials (RCTs) for asthma management that incorporate usual care regimens could benefit from standardized application of evidence-based guidelines. OBJECTIVE: To evaluate performance of a computerized decision support tool, Asthma Control Evaluation and Treatment (ACET) Program, to standardize usual care regimens for asthma management in RCTs. METHODS: Children and adolescents with persistent, uncontrolled asthma, living in urban census tracts were recruited into 3 multi-center RCTs (each with a usual care arm) between 2004 and 2014. A computerized decision support tool scored asthma control and assigned an appropriate treatment step based on published guidelines. Control level determinants (symptoms, rescue medication use, pulmonary function measure, adherence estimates) were collected at visits and entered into the ACET Program. Changes in control level and treatment steps were examined during the trials. RESULTS: At screening, over half the participants were rated as not or poorly controlled. The proportion of participants who gained good control between screening and randomization increased significantly in all three trials. Between 51% and 70% were well-controlled by randomization. The proportion of well-controlled participants remained constant or improved slightly from randomization until the last post-treatment visit. Night symptoms were the most common control level determinant; there were few ( CONCLUSION: The ACET decision support tool facilitated standardized asthma assessment and treatment in multicenter RCTs and was associated with attaining and maintaining good asthma control in most participants