Environmental justice in the Israeli context

The ideal of environmental justice is a far reach for Israel, a country with severely limited land area, an overriding concern with security, and a significant minority population. Nevertheless, it is urgent that policy makers take steps in that direction, both for the health of the nation and for moral rightness. After a survey of theoretical approaches to environmental justice, the author offers an operative definition and theory appropriate to the Israeli situation. This approach, embodying all facets of the theory, is applied to a case study of the Arab town of Sachnin, and the policy implications that it indicates are explored. Specific steps that could help progress toward the ultimate goal of environmental justice are suggested.

Collaborative Planning Principles for Disaster Preparedness

Natural and technological hazards can have consequences of a scale and severity far exceeding most human experience. Massive earthquakes predicted as imminent for some regions of the world, fires engulfing large tracts of land and the global COVID-19 pandemic of 2020 illustrate several key preparedness challenges. The hazards literature stresses the importance of involving communities in decisions before, during and after calamitous events occur. Currently, community planning and hazard risk management planning are largely carried out in separate tracks that seldom intersect. We propose that hazard risk managers may benefit from integrating in their approaches collaborative planning principles, especially at the pre-disaster stage. We further propose that community planners deliberately consider hazards and integrate the potential consequences of a disaster into routine plan-making, boosting communities’ resilience. Finally, since citizen involvement is necessary but burdensome in both planning and hazards management, we suggest a set of criteria for considering who—from among the many community and public stakeholders—should be involved, when, and how

Collaborative Planning Principles for Disaster Preparedness

Natural and technological hazards can have consequences of a scale and severity far exceeding most human experience. Massive earthquakes predicted as imminent for some regions of the world, fires engulfing large tracts of land and the global COVID-19 pandemic of 2020 illustrate several key preparedness challenges. The hazards literature stresses the importance of involving communities in decisions before, during and after calamitous events occur. Currently, community planning and hazard risk management planning are largely carried out in separate tracks that seldom intersect. We propose that hazard risk managers may benefit from integrating in their approaches collaborative planning principles, especially at the pre-disaster stage. We further propose that community planners deliberately consider hazards and integrate the potential consequences of a disaster into routine plan-making, boosting communities’ resilience. Finally, since citizen involvement is necessary but burdensome in both planning and hazards management, we suggest a set of criteria for considering who—from among the many community and public stakeholders—should be involved, when, and how

Process Design Decisions in Community-Based Collaboration: Implications for Implementation and Collateral Social Benefits

Collaborative decision-making processes are conducted widely in public affairs at various scales, from community to metropolitan, regional and national. They vary from highly formalized and prescribed processes, such as “regulatory negotiations”, to collaborative planning processes directed by urban planners or other public agency staff, to rather informal processes within community-based organizations. While substantial effort has been invested in identifying the benefits of collaboration, we ask; do the benefits materialize in each case? We researched one ad hoc community collaborative in Oregon, USA, widely considered a success in the aftermath of agreement. We were interested in the implementation of agreement provisions, as well as in any social benefits from the process. Relying on published documents, surveys and interviews one year after the process ended, and additional interviews and on-site observations five years later, we found that despite the initial enthusiasm and confidence in actions proposed in the final report and social relationships strengthened during the process, evidence of long-term success on these two dimensions was mixed. This case provides a cautionary note to process facilitators, urban planners, public administrators and stakeholder and citizen participants. Participants face many strategic and process design decisions. Among these are choices about institutional linkages, stakeholders, the decision rule, and clarity about the purpose and goal of the process. While the degree of “success” of any collaborative may not be our call as observers, we contend that implementation and social impacts are critical to assessing the value of these processes. Consequently, we propose that participants and facilitators alike should understand and consider appropriately the micro-decisions that can and do add to critical implications on these two important dimensions

Pretreatment prediction of response to ursodeoxycholic acid in primary biliary cholangitis: development and validation of the UDCA Response Score.

BACKGROUND Treatment guidelines recommend a stepwise approach to primary biliary cholangitis: all patients begin treatment with ursodeoxycholic acid (UDCA) monotherapy and those with an inadequate biochemical response after 12 months are subsequently considered for second-line therapies. However, as a result, patients at the highest risk can wait the longest for effective treatment. We determined whether UDCA response can be accurately predicted using pretreatment clinical parameters. METHODS We did logistic regression analysis of pretreatment variables in a discovery cohort of patients in the UK with primary biliary cholangitis to derive the best-fitting model of UDCA response, defined as alkaline phosphatase less than 1·67 times the upper limit of normal (ULN), measured after 12 months of treatment with UDCA. We validated the model in an external cohort of patients with primary biliary cholangitis and treated with UDCA in Italy. Additionally, we assessed correlations between model predictions and key histological features, such as biliary injury and fibrosis, on liver biopsy samples. FINDINGS 2703 participants diagnosed with primary biliary cholangitis between Jan 1, 1998, and May 31, 2015, were included in the UK-PBC cohort for derivation of the model. The following pretreatment parameters were associated with lower probability of UDCA response: higher alkaline phosphatase concentration (p<0·0001), higher total bilirubin concentration (p=0·0003), lower aminotransferase concentration (p=0·0012), younger age (p<0·0001), longer interval from diagnosis to the start of UDCA treatment (treatment time lag, p<0·0001), and worsening of alkaline phosphatase concentration from diagnosis (p<0·0001). Based on these variables, we derived a predictive score of UDCA response. In the external validation cohort, 460 patients diagnosed with primary biliary cholangitis were treated with UDCA, with follow-up data until May 31, 2016. In this validation cohort, the area under the receiver operating characteristic curve for the score was 0·83 (95% CI 0·79-0·87). In 20 liver biopsy samples from patients with primary biliary cholangitis, the UDCA response score was associated with ductular reaction (r=-0·556, p=0·0130) and intermediate hepatocytes (probability of response was 0·90 if intermediate hepatocytes were absent vs 0·51 if present). INTERPRETATION We have derived and externally validated a model based on pretreatment variables that accurately predicts UDCA response. Association with histological features provides face validity. This model provides a basis to explore alternative approaches to treatment stratification in patients with primary biliary cholangitis. FUNDING UK Medical Research Council and University of Milan-Bicocca

Pretreatment prediction of response to ursodeoxycholic acid in primary biliary cholangitis: development and validation of the UDCA Response Score.

BACKGROUND: Treatment guidelines recommend a stepwise approach to primary biliary cholangitis: all patients begin treatment with ursodeoxycholic acid (UDCA) monotherapy and those with an inadequate biochemical response after 12 months are subsequently considered for second-line therapies. However, as a result, patients at the highest risk can wait the longest for effective treatment. We determined whether UDCA response can be accurately predicted using pretreatment clinical parameters. METHODS: We did logistic regression analysis of pretreatment variables in a discovery cohort of patients in the UK with primary biliary cholangitis to derive the best-fitting model of UDCA response, defined as alkaline phosphatase less than 1·67 times the upper limit of normal (ULN), measured after 12 months of treatment with UDCA. We validated the model in an external cohort of patients with primary biliary cholangitis and treated with UDCA in Italy. Additionally, we assessed correlations between model predictions and key histological features, such as biliary injury and fibrosis, on liver biopsy samples. FINDINGS: 2703 participants diagnosed with primary biliary cholangitis between Jan 1, 1998, and May 31, 2015, were included in the UK-PBC cohort for derivation of the model. The following pretreatment parameters were associated with lower probability of UDCA response: higher alkaline phosphatase concentration (p<0·0001), higher total bilirubin concentration (p=0·0003), lower aminotransferase concentration (p=0·0012), younger age (p<0·0001), longer interval from diagnosis to the start of UDCA treatment (treatment time lag, p<0·0001), and worsening of alkaline phosphatase concentration from diagnosis (p<0·0001). Based on these variables, we derived a predictive score of UDCA response. In the external validation cohort, 460 patients diagnosed with primary biliary cholangitis were treated with UDCA, with follow-up data until May 31, 2016. In this validation cohort, the area under the receiver operating characteristic curve for the score was 0·83 (95% CI 0·79-0·87). In 20 liver biopsy samples from patients with primary biliary cholangitis, the UDCA response score was associated with ductular reaction (r=-0·556, p=0·0130) and intermediate hepatocytes (probability of response was 0·90 if intermediate hepatocytes were absent vs 0·51 if present). INTERPRETATION: We have derived and externally validated a model based on pretreatment variables that accurately predicts UDCA response. Association with histological features provides face validity. This model provides a basis to explore alternative approaches to treatment stratification in patients with primary biliary cholangitis. FUNDING: UK Medical Research Council and University of Milan-Bicocca