Community Ecology and Capacity: Advancing Environmental Communication Strategies among Diverse Stakeholders

1. Introduction Many socioeconomically and geographically diverse communities in the United States have been challenged by occurrences of environmental contamination and the related complex public health issues. The investigations associated with such concerns have traditionally been the responsibility of governmental agencies. Communities facing potential environmental exposures often believe that government-based environmental agencies are not adequately addressing their concerns regarding risk, thus resulting in their misunderstanding and distrust of the regulatory process. A schism develops whereby the community perceives that government is either not doing enough to address their concerns and/or are being influenced by the relevant industry. The governmental agencies involved perceive that the community possesses an inaccurate or irrational perception of the potential risks. As a result, a stressful relationship often arises. Recommendations for effective risk communication have been developed and published (Covello & Sandman, 2001; Hance et al., 1989; Sandman, 1989). Research has also demonstrated the importance of developing relationships among stakeholders and its impact on information delivery and reception (ATSDR, 2004). Given that stakeholder groups perceive risk differently, it is imperative for each group to appreciate the viewpoints of all involved to engage in effective dialog (Park et al., 2001; Tinker et al., 2001). Cox (2006) defines environmental communication as “…the pragmatic and constitutive vehicle for our understanding of the environment as well as our relationships to the natural world; it is the symbolic medium that we use in constructing environmental problems and negotiating society’s different responses to them.” Although opportunities for public participation in environmental assessments have greatly increased, the environmental communication process among key stakeholders needs further evaluation (Charnley & Engelbert, 2005; McKinney & Harmon, 2002). The purpose of this chapter is to describe an evaluative process to develop and propose recommendations that could improve the environmental communication that occurs among diverse stakeholders, such as an environmental regulation and protection agency, waste disposal and energy producing facilities, community activists and the general public. Two case studies will be presented; the first describes the management of environmental permitting decisions in several disparate communities; and the second describes the management and perception of health risks from a single-owner waste-to-energy facility in two distinct communities. To accomplish this goal, this chapter will: 1.) examine how a state environmental agency and waste disposal and energy producing facilities describe their environmental communication experiences regarding various permitting operations and the risk perceptions of the impacted communities; 2.) identify effective communication methods; 3.) discuss the strengths and limitations of these activities; and 4.) propose recommendations for practitioners to advance environmental communication strategies among these key stakeholders

Community Ecology and Capacity: Advancing Environmental Communication Strategies among Diverse Stakeholders

1. Introduction Many socioeconomically and geographically diverse communities in the United States have been challenged by occurrences of environmental contamination and the related complex public health issues. The investigations associated with such concerns have traditionally been the responsibility of governmental agencies. Communities facing potential environmental exposures often believe that government-based environmental agencies are not adequately addressing their concerns regarding risk, thus resulting in their misunderstanding and distrust of the regulatory process. A schism develops whereby the community perceives that government is either not doing enough to address their concerns and/or are being influenced by the relevant industry. The governmental agencies involved perceive that the community possesses an inaccurate or irrational perception of the potential risks. As a result, a stressful relationship often arises. Recommendations for effective risk communication have been developed and published (Covello & Sandman, 2001; Hance et al., 1989; Sandman, 1989). Research has also demonstrated the importance of developing relationships among stakeholders and its impact on information delivery and reception (ATSDR, 2004). Given that stakeholder groups perceive risk differently, it is imperative for each group to appreciate the viewpoints of all involved to engage in effective dialog (Park et al., 2001; Tinker et al., 2001). Cox (2006) defines environmental communication as “…the pragmatic and constitutive vehicle for our understanding of the environment as well as our relationships to the natural world; it is the symbolic medium that we use in constructing environmental problems and negotiating society’s different responses to them.” Although opportunities for public participation in environmental assessments have greatly increased, the environmental communication process among key stakeholders needs further evaluation (Charnley & Engelbert, 2005; McKinney & Harmon, 2002). The purpose of this chapter is to describe an evaluative process to develop and propose recommendations that could improve the environmental communication that occurs among diverse stakeholders, such as an environmental regulation and protection agency, waste disposal and energy producing facilities, community activists and the general public. Two case studies will be presented; the first describes the management of environmental permitting decisions in several disparate communities; and the second describes the management and perception of health risks from a single-owner waste-to-energy facility in two distinct communities. To accomplish this goal, this chapter will: 1.) examine how a state environmental agency and waste disposal and energy producing facilities describe their environmental communication experiences regarding various permitting operations and the risk perceptions of the impacted communities; 2.) identify effective communication methods; 3.) discuss the strengths and limitations of these activities; and 4.) propose recommendations for practitioners to advance environmental communication strategies among these key stakeholders

Hospital Mortality in the United States following Acute Kidney Injury

Acute kidney injury (AKI) is a common reason for hospital admission and complication of many inpatient procedures. The temporal incidence of AKI and the association of AKI admissions with in-hospital mortality are a growing problem in the world today. In this review, we discuss the epidemiology of AKI and its association with in-hospital mortality in the United States. AKI has been growing at a rate of 14% per year since 2001. However, the in-hospital mortality associated with AKI has been on the decline starting with 21.9% in 2001 to 9.1 in 2011, even though the number of AKI-related in-hospital deaths increased almost twofold from 147,943 to 285,768 deaths. We discuss the importance of the 71% reduction in AKI-related mortality among hospitalized patients in the United States and draw on the discussion of whether or not this is a phenomenon of hospital billing (coding) or improvements to the management of AKI

Incidence and In-Hospital Mortality of Acute Kidney Injury (AKI) and Dialysis Requiring AKI (AKI-D) After Cardiac Catheterization in the National Inpatient Sample

Background: Acute kidney injury (AKI) and dialysis‐requiring AKI (AKI‐D) are common, serious complications of cardiac procedures. Methods and Results: We evaluated 3 633 762 (17 765 214 weighted population) cardiac catheterization or percutaneous coronary intervention (PCI) hospital discharges from the nationally representative National Inpatient Sample to determine annual population incidence rates for AKI and AKI‐D in the United States from 2001 to 2011. Odds ratios for both conditions and associated in‐hospital mortality were calculated for each year in the study period using multiple logistic regression. The number of cardiac catheterization or PCI cases resulting in AKI rose almost 3‐fold from 2001 to 2011. The adjusted odds of AKI and AKI‐D per year among cardiac catheterization and PCI patients were 1.11 (95% CI: 1.10–1.12) and 1.01 (95% CI: 0.99–1.02), respectively. Most importantly, in‐hospital mortality significantly decreased from 2001 to 2011 for AKI (19.6–9.2%) and AKI‐D (28.3–19.9%), whereas odds of associated in‐hospital mortality were 0.50 (95% CI: 0.45–0.56) and 0.70 (95% CI: 0.55–0.93) in 2011 versus 2001, respectively. The population‐attributable risk of mortality for AKI and AKI‐D was 25.8% and 3.8% in 2001 and 41.1% and 6.5% in 2011, respectively. Males and females had similar patterns of AKI increase, although males outpaced females. Conclusions: The Incidence of AKI among cardiac catheterization and PCI patients has increased sharply in the United States, and this should be addressed by implementing prevention strategies. However, mortality has significantly declined, suggesting that efforts to manage AKI and AKI‐D after cardiac catheterization and PCI have reduced mortality

The Impact of Star-Formation-Rate Surface Density on the Electron Density and Ionization Parameter of High-Redshift Galaxies

We use the large spectroscopic dataset of the MOSFIRE Deep Evolution Field (MOSDEF) survey to investigate some of the key factors responsible for the elevated ionization parameters (U) inferred for high-redshift galaxies, focusing in particular on the role of star-formation-rate surface density (Sigma_SFR). Using a sample of 317 galaxies with spectroscopic redshifts z~1.9-3.7, we construct composite rest-frame optical spectra in bins of Sigma_SFR and infer electron densities, n_e, using the ratio of the [OII] 3727, 3730 doublet. Our analysis suggests a significant (~3 sigma) correlation between n_e and Sigma_SFR. We further find significant correlations between U and Sigma_SFR for composite spectra of a subsample of 113 galaxies, and for a smaller sample of 25 individual galaxies with inferences of U. The increase in n_e -- and possibly also the volume filling factor of dense clumps in HII regions -- with Sigma_SFR appear to be important factors in explaining the relationship between U and Sigma_SFR. Further, the increase in n_e and SFR with redshift at a fixed stellar mass can account for most of the redshift evolution of U. These results suggest that the gas density, which sets n_e and the overall level of star-formation activity, may play a more important role than metallicity evolution in explaining the elevated ionization parameters of high-redshift galaxies.Comment: 11 pages, 9 figures, 1 table, submitted to Ap

Exploring the Correlation between Hα\rm{H}\alpha-to-UV Ratio and Burstiness for Typical Star-forming Galaxies at z∼2z\sim2

The $\rm{H}\alpha$-to-UV luminosity ratio ($L(\rm H\alpha)/L(\rm UV)$) is often used to probe SFHs of star-forming galaxies and it is important to validate it against other proxies for burstiness. To address this issue, we present a statistical analysis of the resolved distribution of $\Sigma_{\rm{SFR}}$ as well as stellar age and their correlations with the globally measured $L(\rm H\alpha)/L(\rm UV)$ for a sample of 310 star-forming galaxies in two redshift bins of $1.37 < z < 1.70$ and $2.09 < z < 2.61$ observed by the MOSDEF survey. We use the multi-waveband CANDELS/3D-HST imaging of MOSDEF galaxies to construct $\Sigma_{\rm{SFR}}$ and stellar age maps. We analyze the composite rest-frame far-UV spectra of a subsample of MOSDEF targets obtained by the Keck/LRIS, which includes 124 star-forming galaxies (MOSDEF-LRIS) at redshifts $1.4 < z < 2.6$, to examine the average stellar population properties, and the strength of age-sensitive FUV spectral features in bins of $L(\rm H\alpha)/L(\rm UV)$. Our results show no significant evidence that individual galaxies with higher $L(\rm H\alpha)/L(\rm UV)$ are undergoing a burst of star formation based on the resolved distribution of $\Sigma_{\rm{SFR}}$ of individual star-forming galaxies. We segregate the sample into subsets with low and high $L(\rm H\alpha)/L(\rm UV)$. The high-$L(\rm H\alpha)/L(\rm UV)$ subset exhibits, on average, an age of $\log[\rm{Age/yr}]$ = 8.0, compared to $\log[\rm{Age/yr}]$ = 8.4 for the low-$L(\rm H\alpha)/L(\rm UV)$ galaxies, though the difference in age is significant at only the $2\sigma$ level. Furthermore, we find no variation in the strengths of Siiv$\lambda\lambda1393, 1402$ and Civ$\lambda\lambda1548, 1550$ P-Cygni features from massive stars between the two subsamples.Comment: 16 pages, 10 figures, published by the Monthly Notices of the Royal Astronomical Societ

Management of pediatric renal trauma: Results from the American Association for Surgery and Trauma Multi-Institutional Pediatric Acute Renal Trauma Study

BackgroundPediatric renal trauma is rare and lacks sufficient population-specific data to generate evidence-based management guidelines. A nonoperative approach is preferred and has been shown to be safe. However, bleeding risk assessment and management of collecting system injury are not well understood. We introduce the Multi-institutional Pediatric Acute Renal Trauma Study (Mi-PARTS), a retrospective cohort study designed to address these questions. This article describes the demographics and contemporary management of pediatric renal trauma at Level I trauma centers in the United States.MethodsRetrospective data were collected at 13 participating Level I trauma centers on pediatric patients presenting with renal trauma between 2010 and 2019. Data were gathered on demographics, injury characteristics, management, and short-term outcomes. Descriptive statistics were used to report on demographics, acute management, and outcomes.ResultsIn total, 1,216 cases were included in this study. Of all patients, 67.2% were male, and 93.8% had a blunt injury mechanism. In addition, 29.3% had isolated renal injuries, and 65.6% were high-grade (American Association for the Surgery of Trauma Grades III-V) injuries. The mean Injury Severity Score was 20.5. Most patients were managed nonoperatively (86.4%), and 3.9% had an open surgical intervention, including 2.7% having nephrectomy. Angioembolization was performed in 0.9%. Collecting system intervention was performed in 7.9%. Overall mortality was 3.3% and was only observed in patients with multiple injuries. The rate of avoidable transfer was 28.2%.ConclusionThe management and outcomes of pediatric renal trauma lack data to inform evidence-based guidelines. Nonoperative management of bleeding following renal injury is a well-established practice. Intervention for renal trauma is rare. Our findings reinforce differences from the adult population and highlights opportunities for further investigation. With data made available through Mi-PARTS, we aimed to answer pediatric specific questions, including a pediatric-specific bleeding risk nomogram, and better understanding indications for interventions for collecting system injuries.Level of evidencePrognostic and Epidemiological; Level IV

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. METHODS: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING: Bill & Melinda Gates Foundation