In the 1960s, Cleveland suffered through racial violence, spiking crime rates, and a shrinking tax base, as the city lost jobs and population. Rats infested an expanding and decaying ghetto, Lake ...Erie appeared to be dying, and dangerous air pollution hung over the city. Such was the urban crisis in the "Mistake on the Lake." When the Cuyahoga River caught fire in the summer of 1969, the city was at its nadir, polluted and impoverished, struggling to set a new course. The burning river became the emblem of all that was wrong with the urban environment in Cleveland and in all of industrial America.
Carl Stokes, the first African American mayor of a major U.S. city, had come into office in Cleveland a year earlier with energy and ideas. He surrounded himself with a talented staff, and his administration set new policies to combat pollution, improve housing, provide recreational opportunities, and spark downtown development. InWhere the River Burned, David Stradling and Richard Stradling describe Cleveland's nascent transition from polluted industrial city to viable service city during the Stokes administration.
The story culminates with the first Earth Day in 1970, when broad citizen engagement marked a new commitment to the creation of a cleaner, more healthful and appealing city. Although concerned primarily with addressing poverty and inequality, Stokes understood that the transition from industrial city to service city required massive investments in the urban landscape. Stokes adopted ecological thinking that emphasized the connectedness of social and environmental problems and the need for regional solutions. He served two terms as mayor, but during his four years in office Cleveland's progress fell well short of his administration's goals. Although he was acutely aware of the persistent racial and political boundaries that held back his city, Stokes was in many ways ahead of his time in his vision for Cleveland and a more livable urban America.
Detractors have called it "The Mistake on the Lake." It was once America's "Comeback City." According to author J. Mark Souther, Cleveland has long sought to defeat its perceived civic malaise. ...Believing in Cleveland chronicles how city leaders used imagery and rhetoric to combat and, at times, accommodate urban and economic decline. Souther explores Cleveland's downtown revitalization efforts, its neighborhood renewal and restoration projects, and its fight against deindustrialization. He shows how the city reshaped its image when it was bolstered by sports team victories. But Cleveland was not always on the upswing. Souther places the city's history in the postwar context when the city and metropolitan area were divided by uneven growth. In the 1970s, the city-suburb division was wider than ever. Believing in Cleveland recounts the long, difficult history of a city that entered the postwar period as America's sixth largest, then lost ground during a period of robust national growth. But rather than tell a tale of decline, Souther provides a fascinating story of resilience for what some folks called "The Best Location in the Nation."
Seeking answers to the question, "Who benefits from homelessness?" this book takes the reader on a sweeping tour of Cleveland's history from the late nineteenthcentury through the early twentyfirst. ...Daniel Kerr shows that homelessness has deep roots in the shifting ground of urban labor markets, social policy, downtown development, the criminal justice system, and corporate power. Rather than being attributable to the illnesses and inadequacies of the unhoused themselves, it is a product of both structural and political dynamics shaping the city. Kerr locates the origins of today's shelter system in the era that followed the massive railroad rebellions of 1877. From that period through the Great Depression, business and political leaders sought to transform downtown Cleveland to their own advantage. As they focused on bringing business travelers and tourists to the city and beckoned upperincome residents to return to its center, they demolished two downtown workingclass neighborhoods and institutionalized a shelter system to contain and control the unhoused and unemployed. The precedents from this period informed the strategies of the post–World War II urban renewal era as the "new urbanism" of the late twentieth century. The efforts of the city's elites have not gone uncontested. Kerr documents a rich history of opposition by people at the margins of whose organized resistance and everyday survival strategies have undermined the grand plans crafted by the powerful and transformed the institutions designed to constrain the lives of the homeless.
•Non-redox factors strongly influence authigenic trace-metal concentrations in sediments.•Diffusion-reaction modelling quantifies watermass chemistry & sedimentation rate effects.•Watermass chemistry ...controls authigenic Mo and U enrichment in modern Black Sea muds.•Sedimentation rate controlled authigenic Mo and U enrichment in Devonian black shales.
Although redox conditions are the dominant control on authigenic enrichment of trace metals in marine sediments, other factors may be important within environments having relatively uniform redox characteristics, such as some anoxic silled basins. Notably, watermass chemistry (specifically, aqueous trace-metal concentrations) and sedimentation rate can also influence the authigenic accumulation of redox-sensitive trace metals such as molybdenum (Mo) and uranium (U) in the sediment, although these effects have received less attention than redox controls to date. Here, we (1) utilize a diffusion-reaction model to evaluate the effects of variations in watermass chemistry and sedimentation rate on authigenic trace-metal enrichment, and (2) present case studies of Mo and U enrichment in modern Black Sea sediments and North American Devonian-Carboniferous boundary (DCB) black shales that illustrate these influences. In both case studies, redox conditions were assessed using non-trace-metal-based proxies (i.e., C-S-Fe, FeT/Al, and Corg:P). Stations 6 and 7 of the modern Black Sea, at water depths of 380 and 1176 m, respectively, exhibit marked differences in authigenic Mo and U enrichment: median Mo/TOC is 13.2 at Station 6 (range 11.5–14.8) versus 5.7 at Station 7 (range 3.7–7.6), and median U/TOC is 2.6 at Station 6 (range 1.5–3.0) versus 1.3 at Station 7 (range 0.7–1.9) (note: units are ppm/% or 10−4, and ranges are 16th-84th percentiles). Given the nearly identical redox conditions and sedimentation rates at these two sites, the most likely cause of the >2× enrichment of Mo and U at Station 6 relative to Station 7 is differences in aqueous Mo and U concentrations, which decline steeply through the upper part of the Black Sea water column, demonstrating the influence of watermass chemistry on patterns of authigenic trace-metal enrichment in the sediment. For the DCB black shales, the median Mo/TOC is 22.2 in the Lower and Upper Bakken (range 15.8–27.0), 28.8 in the Sunbury (range 19.2–37.2), and 14.3 in the Cleveland (range 9.3–22.5), and the median U/TOC is 6.2 in the Lower and Upper Bakken (range 3.5–9.6), 2.6 in the Sunbury (range 1.7–3.4), and 1.2 in the Cleveland (range 0.7–1.7). Differences in Mo and U concentrations between these formations show no relationship to inferred aqueous trace-metal concentrations, Mn–Fe particulate shuttles, or paleoenvironmental redox conditions, but they broadly correlate with variation in sedimentation rates, providing evidence that sedimentation rates can measurably influence the degree of authigenic trace-metal enrichment of marine sediments.
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The aim is to evaluate the utility of transanal irrigation such as treatment of incontinence and severe chronic constipation which is refractory to first-line therapy, and to assess ...its impact into the symptomatology and quality of life.
Observational retrospective study of patients with incontinence and chronic constipation that had initiated transanal irrigation in two hospitals of the region. We collect sociodemographic variables, comorbidity, previous treatments, tests, parameters and incidences during the irrigation, and punctuation in the Cleveland Clinic Incontinence and Constipation Scores and EuroQol-5D Quality Of Life Scale before and after the treatment.
40 patients, 20 with incontinence and 20 with chronic constipation. After an average period of 9 months of treatment, in 14 patients with incontinence we have observed a mean clinical improvement of 7,45 points before-after treatment measured with Cleveland Clinic Incontinence Score, and a mean improvement of 23 points in their quality of life before-after treatment measured with EQ5D Scale (P < .001); and in 16 patients with constipation a mean clinical improvement of 7,6 points before-after treatment measured with Cleveland Clinic Constipation Score, and a mean improvement of 31,5 points in their quality of life before-after treatment measured with EQ5D Scale (P < .001).
Transanal irrigation is an effective therapy for patients with incontinence and chronic constipation that are refractory to first-line therapies. It’s an easy, self-administered and safe procedure. When the patient learns how to use it, the symptomatology and quality of life are improved.
El objetivo es evaluar la utilidad de la irrigación transanal como tratamiento de la incontinencia y estreñimiento crónico severo refractario a primera línea terapéutica, y valorar su impacto en la sintomatología y calidad de vida.
Estudio retrospectivo descriptivo de pacientes con incontinencia y estreñimiento crónico que han iniciado irrigación transanal en dos hospitales de la región. Se recogen variables sociodemográficas, comorbilidades, tratamientos previos, pruebas realizadas, parámetros e incidencias durante la irrigación, puntuación en las escalas de gravedad de incontinencia y estreñimiento de la Cleveland Clinic y calidad de vida EuroQol-5D antes y después del tratamiento.
40 pacientes, 20 con incontinencia y 20 con estreñimiento crónico. Tras una media de 9 meses de tratamiento, en 14 pacientes con incontinencia hemos objetivado una media de mejoría de 7,45 puntos pre-post tratamiento en la escala de gravedad de incontinencia de la Cleveland Clinic, y una media de mejoría en la calidad de vida de 23 puntos pre-post tratamiento en la escala EQ5D (p < 0.001); y en 16 pacientes con estreñimiento una media de mejoría de 7,6 puntos pre-post tratamiento en la escala de gravedad de estreñimiento de la Cleveland Clinic, y una media de mejoría en la calidad de vida de 31,5 puntos pre-post tratamiento en la escala EQ5D (p < 0.001).
La irrigación transanal es una terapia efectiva para pacientes con incontinencia y estreñimiento crónico no respondedores a primera línea terapéutica. Es sencilla, autoadministrable y segura. Cuando el paciente aprende a emplearla, mejora su sintomatología y calidad de vida.
On July 1, 1893, President Grover Cleveland vanished. He boarded a friend's yacht, sailed into the calm blue waters of Long Island Sound, and--poof!-- disappeared. He would not be heard from again ...for five days. What happened during those five days, and in the days and weeks that followed, was so incredible that, even when the truth was finally revealed, many Americans simply would not believe it. The President Is a Sick Man details an extraordinary but almost unknown chapter in American history: Grover Cleveland's secret cancer surgery and the brazen political cover-up by a politician whose most memorable quote was "Tell the truth." When an enterprising reporter named E. J. Edwards exposed the secret operation, Cleveland denied it. The public believed the "Honest President, " and Edwards was dismissed as "a disgrace to journalism." The facts concerning the disappearance of Grover Cleveland that summer were so well concealed that even more than a century later a full and fair account has never been published. Until now.
Green infrastructure installations such as rain gardens and bioswales are increasingly regarded as viable tools to mitigate stormwater runoff at the parcel level. The use of adaptive management to ...implement and monitor green infrastructure projects as experimental attempts to manage stormwater has not been adequately explored as a way to optimize green infrastructure performance or increase social and political acceptance. Efforts to improve stormwater management through green infrastructure suffer from the complexity of overlapping jurisdictional boundaries, as well as interacting social and political forces that dictate the flow, consumption, conservation and disposal of urban wastewater flows. Within this urban milieu, adaptive management—rigorous experimentation applied as policy—can inform new wastewater management techniques such as the implementation of green infrastructure projects. In this article, we present a narrative of scientists and practitioners working together to apply an adaptive management approach to green infrastructure implementation for stormwater management in Cleveland, Ohio. In Cleveland, contextual legal requirements and environmental factors created an opportunity for government researchers, stormwater managers and community organizers to engage in the development of two distinct sets of rain gardens, each borne of unique social, economic and environmental processes. In this article we analyze social and political barriers to applying adaptive management as a framework for implementing green infrastructure experiments as policy. We conclude with a series of lessons learned and a reflection on the prospects for adaptive management to facilitate green infrastructure implementation for improved stormwater management.
•Stormwater governance is difficult due to inherent complexity and high uncertainty.•Adaptive management can address ecological, economic and social stormwater issues.•Adaptive management can increase learning to improve stormwater governance.•Adaptive management to implement green infrastructure for stormwater management.•Governance networks can create space for green infrastructure in urban sewersheds.
Summary Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective ...medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions ( r =0·83), and human resources for health per 1000 ( r =0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Funding Bill & Melinda Gates Foundation.
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