Income disparities and risk: Geographical manifestations of extreme inequities in the United States.

We examined hazard and risk-related metrics of the highest- and lowest-income counties and municipalities in each U.S. state. Indicators of natural and anthropogenic hazards, health outcomes, location of locally unwanted land uses, food insecurity, and other metrics were used to measure social and environmental justice. As expected, the highest-income places have better health outcomes, access to assets that protect health, and high municipal ratings of place quality compared with their poorest counterparts. Yet, they also have higher natural hazard risks and are more likely to live near concentrations of anthropogenic hazards. That is, high-income places have a lot to lose. Although the poorest jurisdictions demonstrate cumulative disadvantages, those in rural areas are exposed to less dense motor vehicle traffic and other hazards and risks associated with urban life. Relationships between income and the geography of hazards and risks are not simple. Even the highest-income areas face challenges. We suggest improvements in databases and tools to increase the focus on and monitoring of the breadth of risks people face in all areas.

Stigma as a multispatial-scale process: Revisiting the worst US Superfund sites.

Areas immediately adjacent to 16 of the first US national priority (NPL) hazardous waste sites that also had pre-superfund emergency actions were examined to measure local stigma. Four decades after their NPL designation, I found marked variation in these areas' social, public health and environmental attributes. About one-third of these small areas fit the stereotype of stressed areas with environmental injustice challenges. Yet, another one-third of these sites have better measurable outcomes than a combination of their host states and counties. For example, they have elevated levels of broadband access and their local jurisdictions are classified as safe and attractive to families. I conclude that long-term stigma around a Superfund site was limited by US EPA actions, as well as by progressive state and local governments, and community groups, in other words, contributions from parties at multiple geographical scales.

Piloting a New Curriculum: Guided At-Home Pediatric Regional Anesthesia Education Using a Portable Ultrasound.

Ultrasound-guided regional anesthesia is the standard of care for most regional blocks in pediatric anesthesiology.Training programs must educate physicians to perform regional blocks safely and efficiently. Hands-on learning with simulation and live models is the gold standard. The coronavirus disease 2019 (COVID-19) pandemic has greatly hampered our ability to safely hold in-person workshops. We describe an at-home, guided virtual workshop using portable ultrasound to safely continue experiential trainee education. The primary objective of this pilot virtual workshop was to develop an effective experiential learning program without the need for live child models. The main goal was to give trainees hands-on experience obtaining anatomical ultrasound images necessary for regional anesthesia blocks in a guided-virtual setting and to evaluate the effectiveness of skills acquisition. This workshop included two pediatric anesthesiology fellows and a pediatric anesthesiologist. Trainees were instructed on ultrasound-guided regional block acquisition. For two weeks, trainees acquired images/movies of regional block anatomy at home using their own children. Virtual video assistance was available. Trainees then used acquired images/movies to discuss needle and local anesthetic placement with a pediatric regional anesthesiologist. Trainees completed pre- and post-workshop surveys assessing attitudes, perceived educational efficacy, and procedural skill acquisition. The faculty member also assessed trainees' skills. The virtual workshop was successful. Trainees expressed successful active learning and increased comfort in performing regional blocks on live patients. They correctly identified relevant anatomy of acquired images/movies, as well as needle and local anesthetic placement at the time of debriefing. Faculty were pleased with trainees' initial performance of regional blocks. Adapting an in-person workshop to an at-home guided experience is a safe, feasible, and well-received method for anesthesiology trainees to obtain experiential learning of ultrasound-guided regional anesthesia. This facilitated at-home learning experience allows for hands-on skill practice while preventing exposure of child models to the hospital setting during a pandemic.

Ports and Environmental Justice in the United States: An Exploratory Statistical Analysis.

A screening environmental justice analysis was conducted of 50 United States ports that manage more than 10 million tons of products. Using the U.S. EPA's EJSCREEN tool, the author examined seven demographic and 11 environmental metrics at distances of 2, 5, and 10 miles from the port centroids. The 2-mile zones were found to have higher values for 13 of the 18 environmental inequity indicators, including all three measures of air toxics, fine particles, proximity to hazardous waste sites, and facilities with risk management plans, as well as indicators of low socioeconomic status and minority populations. With ports expanding, the author discusses the need for maintaining and upgrading EPA's screening tool and considers that alternative futures for port neighborhoods depend upon the strength of their civic groups and elected officials, the role of their government port authorities, and civic values of their commercial users.

Advancing Risk-Informed Decision Making in Managing Defense Nuclear Waste in the United States: Opportunities and Challenges for Risk Analysis.

An omnibus spending bill in 2014 directed the Department of Energy to analyze how effectively Department of Energy (DOE) identifies, programs, and executes its plans to address public health and safety risks that remain as part of DOE's remaining environmental cleanup liabilities. A committee identified two dozen issues and associated recommendations for the DOE, other federal agencies, and the U.S. Congress to consider, as well as other stakeholders such as states and tribal nations. In regard to risk assessment, the committee described a risk review process that uses available data, expert experience, identifies major data gaps, permits input from key stakeholders, and creates an ordered set of risks based on what is known. Probabilistic risk assessments could be a follow-up from these risk reviews. In regard to risk management, the states, in particular, have become major drivers of how resources are driven. States use different laws, different priorities, and challenge DOE's policies in different ways. Land use decisions vary, technology choices are different, and other notable variations are apparent. The cost differences associated with these differences are marked. The net result is that resources do not necessarily go to the most prominent human health and safety risks, as seen from the national level.