Potential solutions for increasing resilience of the drinking water supply through the public-private partnership in a South African municipality.

There has existed a need to increase the resilience of the drinking water supply in Makana Local Municipality in the scope of the 2018-2019 drought and the municipal water supply outages. A combination of the know-how and mandates of local government and the private water-retail sector could provide solutions. In order to achieve successful imple-mentation, the authors present here tools from the disaster risk management legislation in South Africa for operational-ization of this public-private partnership. These are tools based on Chapter 5, part 1, paragraphs 42 (1d) and Chapter 5, part 2, section/paragraph 47 (1a) i-iv of the Disaster Management Act no. 57 of 2002. Regulations for the recruitment and participation of volunteers in disaster risk management should be applied through the establishment of the volun-teer units and the component for drinking water provision. The use of volunteer units with the engagement of the private sector would provide additional tools for the implementation of the preparedness and mitigation measures for drinking water provision in Makana Local Municipality. Local solutions for increasing the resilience of drinking water provision are available and identified based on the modeling work of a container solution. Potential implementation of that con-tainer solution for increasing resilience of drinking water provision would require an investment of 6.81-13.00 percent of the 2017-2019 annual budget of Makana Local Municipality. At any given time in 2018, the probability of the emergency treatment activation would be about 33.4 percent in Makana Local Municipality. An example of the ad hoc management about the provision of borehole water from 2019 indicates that planning is critical to success of the increased resilience initiatives. Onsite storage of water during the constant supply might be necessary to ensure treatment and drinking water provision.

Health Risk, Inequality Indexes, and Environmental Justice.

Inequality indexes have long been used to analyze distributions of income. Studies have recently begun to use these tools to evaluate the equity of distributions of environmental harm. In response, issues have been raised regarding the appropriateness of using income-based measures in the context of undesirable outcomes. We begin from first principles, identifying a theoretical preference structure under which income-based tools can be appropriate for ranking distributions of "bads." While some critiques of existing applications are valid, they are not a justification for rejecting the approach altogether. Instead, we show how standard income-based measures can be adjusted to accommodate bad outcomes. Rather than inequality indexes, we argue that equally distributed equivalents (EDEs) are well-suited for this purpose since they account for levels and dispersion of outcome distributions. The Kolm-Pollak EDE is particularly useful, having the advantage of consistently evaluating both bads and their complementary goods (e.g., mortality risk and survival probability). As an illustration, we show how these tools can inform an environmental justice analysis of a proposed Environmental Protection Agency (EPA) rule addressing indoor air pollution.

Policy Brief - What's in a Name? A Search for Alternatives to "VSL".

Benefit-cost analyses of environmental, health, and safety regulations often rely on an estimate of the value of statistical life (VSL) to calculate the aggregate benefits of reducing human mortality risk. The VSL represents the marginal rate of substitution between mortality risk and money. Although this concept is well-understood by economists, it is viewed by many non-economists as confusing technical jargon that borders on the immoral. Based on focus groups and a quantitative ranking exercise, this article describes a systematic approach for identifying and testing alternatives to the VSL terminology, with the goal of identifying an alternative term that more clearly communicates the VSL concept to a broad audience.

Urgent Care Center and Emergency Department Utilization for Non-Emergent Health Conditions: Analysis of Managed Care Beneficiaries.

The objective was to identify predictors of utilization for urgent care centers (UCCs), emergency departments (EDs), or for both services for non-emergent health conditions among beneficiaries from a managed care organization (MCO) who resided within a 10-mile radius of UCCs. A cross-sectional design was used to analyze 2016 administrative claims data from an MCO that contracted with a UCC with 12 locations (n = 20,107). Outcome variables were number of visits to UCC, ED, or both. The MCO used the New York University ED algorithm to identify non-emergent health conditions. The Behavioral Model of Health Care Utilization was used as a conceptual framework to identify predictors in the model; age, sex, race/ethnicity, distance to UCC from residence, type of insurance, primary care physician visits, inpatient admissions, chronic conditions, morbid obesity, and smoking behavior. Generalized linear models were used to analyze the association between outcomes and predictors. About 22.7% were UCC users, 66.8% were ED users, and 10.5% used both. African Americans (incident rate ratio [IRR] = 0.95; 95% confidence interval [CI]: 0.91-0.98] were less likely to use UCCs and more likely to use the ED (IRR = 1.10; 95% CI: 1.07-1.13). Beneficiaries with multiple chronic conditions were more likely to use the ED than UCCs. Distance was not a predictor of UCC or ED usage. Utilization of UCC was low for non-emergent health conditions. African Americans and individuals with multiple chronic conditions preferred the ED to UCC for non-emergent health conditions. This study implies that MCO beneficiaries, especially the African American population, need to be informed about UCC locations and services provided.

Valuing Ecological Improvements in the Chesapeake Bay and the Importance of Ancillary Benefits.

Reducing the excess nutrient and sediment pollution that is damaging habitat and diminishing recreational experiences in coastal estuaries requires actions by people and communities that are within the boundaries of the watershed but may be far from the resource itself, thus complicating efforts to understand tradeoffs associated with pollution control measures. Such is the case with the Chesapeake Bay, one of the most iconic water resources in the United States. All seven states containing part of the Chesapeake Bay Watershed were required under the Clean Water Act to submit detailed plans to achieve nutrient and sediment pollution reductions. The implementation plans provide information on the location and type of management practices making it possible to project not only water quality improvements in the Chesapeake Bay but also improvements in freshwater lakes throughout the watershed, which provide important ancillary benefits to people bearing the cost of reducing pollution to the Bay but unlikely to benefit directly. This paper reports the results of a benefits study that links the forecasted water quality improvements to ecological endpoints and administers a stated preference survey to estimate use and nonuse value for aesthetic and ecological improvements in the Chesapeake Bay and watershed lakes. Our results show that ancillary benefits and nonuse values account for a substantial proportion of total willingness to pay and would have a significant impact on the net benefits of pollution reduction programs.

A cross-sectional survey assessing sources of movement-related fear among people with fibromyalgia syndrome.

Fear of movement may contribute to functional limitations and loss of well-being among individuals with fibromyalgia (FM). The objectives of this study were to assess factors contributing to movement-related fear and to explore relationships among these factors, function and wellness, in a widespread population of people with FM. This was an internet survey of individuals with FM. Respondents completed a battery of surveys including the Fibromyalgia Impact Questionnaire--Revised (FIQR), Tampa Scale of Kinesiophobia (TSK), Activities-Specific Balance Confidence Scale (ABC), Primary Care Posttraumatic Stress Disorder screen (PC-PTSD), Vertigo Symptom Scale (VSS-SF), a joint hypermobility syndrome screen (JHS), and screening questions related to obsessive-compulsive personality disorder (OCPD), physical activity, work status, and demographics. Analysis included descriptive statistics, Pearson product-moment correlations, and linear regression. Over a 2-year period, 1,125 people (97.6 % female) completed the survey battery. Kinesiophobia was present in 72.9 % of the respondents, balance confidence was compromised in 74.8 %, PTSD likely in 60.4 %, joint hypermobility syndrome likely in 46.6 %, and OCPD tendencies in 26.8 %. The total FIQR and FIQR perceived function subscores were highly correlated (p < 0.0005, r > 0.4) with pain, kinesiophobia, balance confidence, and vertigo. Reported activity level had poor correlation (r < 0.25) with all measured variables. Pain, ABC, VSS, and TSK predicted FIQR and FIQR-pf, explaining 65 and 48 % of the variance, respectively. Kinesiophobia, balance complaints, vertigo, PTSD, and joint hypermobility were common in this population of people with FM. Sources of movement-related fear correlated to overall wellness and perceived function as measured by the FIQR and FIQR-pf.

Trace detection of meglumine and diatrizoate from Bacillus spore samples using liquid chromatography/mass spectrometry.

Following the September 11, 2001 terrorist attacks, letters containing Bacillus anthracis were distributed through the United States postal system killing five people. A complex forensic investigation commenced to identify the perpetrator of these mailings. A novel liquid chromatography/mass spectrometry protocol for the qualitative detection of trace levels of meglumine and diatrizoate in dried spore preparations of B. anthracis was developed. Meglumine and diatrizoate are components of radiographic imaging products that have been used to purify bacterial spores. Two separate chromatographic assays using multiple mass spectrometric analyses were developed for the detection of meglumine and diatrizoate. The assays achieved limits of detection for meglumine and diatrizoate of 1.00 and 10.0 ng/mL, respectively. Bacillus cereus T strain spores were effectively used as a surrogate for B. anthracis spores during method development and validation. This protocol was successfully applied to limited evidentiary B. anthracis spore material, providing probative information to the investigators.

Comparing distributions of environmental outcomes for regulatory environmental justice analysis.

Economists have long been interested in measuring distributional impacts of policy interventions. As environmental justice (EJ) emerged as an ethical issue in the 1970s, the academic literature has provided statistical analyses of the incidence and causes of various environmental outcomes as they relate to race, income, and other demographic variables. In the context of regulatory impacts, however, there is a lack of consensus regarding what information is relevant for EJ analysis, and how best to present it. This paper helps frame the discussion by suggesting a set of questions fundamental to regulatory EJ analysis, reviewing past approaches to quantifying distributional equity, and discussing the potential for adapting existing tools to the regulatory context.

Does mode matter? A comparison of telephone, mail, and in-person treatments in contingent valuation surveys.

The choice of survey mode in contingent valuation research has long been debated in the literature. However, there is limited evidence as to how mode impacts behavior. Using an identical survey administered with telephone, mail, and in-person interviews, this is the first research to examine mode effects using all three commonly employed modes in contingent valuation research. Results show that there is some evidence of social desirability bias in the telephone survey. In addition, the role of income in the decision-making process is an important consideration.