Local Policy Decisions Research Articles

Optimizing China's economic performance through government hierarchy restructuring

AbstractChina's Province‐managing‐county (PMC) reform policy aims to mitigate fiscal stress and augment expenditure autonomy for county governments by eradicating the subordinate fiscal relationship between prefectures and counties. The research augments the time‐varying difference‐in‐difference technique, utilizing a longitudinal dataset at the county level to examine the incentive effects of this reform on economic performance and local government policy decision. The empirical investigation divulges that the local fiscal incentives introduced by this reform through alleviating fiscal stress and providing expenditure autonomy significantly impact economic performance and influence local government policy decisions. The outcomes become more noticeable in economically developed regions and those characterized by enhanced institutional quality and reduced migration barriers. Additionally, the reform encourages counties to adopt a more proactive fiscal policy characterized by increased capital expenditure to promote economic performance while reducing expenditures on social security subsidies and administrative costs affirming that economic performance targets of county governments garbles the composition of public expenditure. These results support positing that a flattened hierarchical structure ameliorates delays in fiscal matters and facilitates communication across various levels of government in the context of improved institutional quality and reduced migration barriers however at the expense of reduced public expenditures. The findings additionally signifies that PMC policy reform become more incentivized in the political competition for economic performance.

Local knowledge, formal evidence, and policy decisions

Local knowledge, formal evidence, and policy decisions

Integrating Water Quality Index (WQI) and Multivariate Statistics for Regional Surface Water Quality Evaluation: Key Parameter Identification and Human Health Risk Assessment

Assessing regional water quality and evaluating the associated risks to human health posed by aquatic contaminants are paramount for conserving and managing surface water resources and formulating effective local policy decisions. This study utilizes 17 water quality parameters collected monthly from nine national monitoring stations in Nanning City, China, from January 2021 to March 2023, i.e., water temperature (WT), pH, dissolved oxygen (DO), permanganate index (CODMn), chemical oxygen demand (COD), five-day biochemical oxygen demand (BOD5), ammonia nitrogen (NH3-N), total phosphorus (TP), copper (Cu), zinc (Zn), fluoride (F-), selenium (Se), arsenic (As), mercury (Hg), cadmium (Cd), chromium (Cr), and lead (Pb). Analyses were performed utilizing the Water Quality Index (WQI) and multiple stepwise regression to ascertain seasonal and spatial variations in water quality and to identify key water quality parameters. Human health risks were evaluated, focusing on eight heavy metals. The results indicated that the average WQI for the designated area was 94.1, with individual monitoring stations displaying WQIs ranging from 93.22 to 96.44, categorizing the water quality as “excellent”. The WQI exhibited seasonal fluctuations, peaking in spring and winter while decreasing in summer and autumn. All measured parameters met national standards for Class I and II surface waters. The stepwise regression analysis facilitated the construction of minimized WQI models (WQImin) derived from three different training and testing datasets, with a WQImin model incorporating six key parameters, i.e., DO, CODMn, NH3-N, Hg, WT, and Se. The concentration of heavy metals in the water exhibited a sequence of Zn (3.35 µg/L) > Cr (2.00 µg/L) > Cu (1.36 µg/L) > As (1.29 µg/L) > Se (0.32 µg/L) > Pb (0.17 µg/L) > Cd (0.03 µg/L) > Hg (0.01 µg/L), with all metals adhering to the Class I standard. Children are more susceptible to the adverse effects of heavy metal contamination than adults, exhibiting a total environmental health risk of 1.28 times greater. Cr was identified as the predominant contributor to the aggregate health risk, accounting for over 80% of the risk in adults and children, followed by As (19.1%). Future protection efforts are recommended to prioritize the control of Cr and As concentrations in Nanning City.

Spatio-temporal variability and trends of air pollutants in the Metropolitan Area of Curitiba

Monitoring air pollutants over time is essential for identifying and addressing trends, which may help improve air quality management and safeguard public health. This study investigates the spatio-temporal variability of air quality in the Metropolitan Area of Curitiba (MAC), Brazil, focusing on six pollutants (SO2, NO2, NOx, O3, CO, and PM10) measured at eight monitoring stations from 2003 to 2017. We conducted statistical analyses, including diurnal cycles, seasonal variability, spatio-temporal correlations, conditional bivariate probability functions, Theil-Sen trend analysis, and comparison with national quality standards (NAQS) and World Health Organization (WHO) guidelines. The analyses revealed large variations in pollutant concentrations across the study area. For instance, stations strongly impacted by industrial emissions presented the highest mean annual SO2 (20–28 μg/m3) and PM10 (32–34 μg/m3) concentrations, while those mostly impacted by traffic showed elevated NO2 (31–39 μg/m3), NOx (63–86 μg/m3) and CO (0.6–0.8 mg/m3) concentrations. The two residential stations recorded the highest O3 concentrations (annual mean of 30–32 μg/m3). Seasonal and diurnal patterns varied by pollutant, with winter experiencing higher concentrations and O3 peaking in spring. SO2 concentrations presented no clear seasonal or diurnal cycle patterns, and showed the highest spatial variability. Significant decreasing annual trends were observed for SO2 (−5.9%), NO2 (−2.6%), NOx (−2.6%), CO (−5.4%), and PM10 (−3.7%), which suggests the success of emission reduction programs implemented in the road transportation and industrial sectors. However, O3 concentrations increased at most stations (+3.3%/yr), likely due to reduced NOx emissions, increased emissions of volatile organic compounds from on-road transport biofuels, and regional O3 transport. Although exceedances of NAQS decreased over time, concentrations of most pollutants remained above WHO guidelines, except for CO. These results highlight the importance of targeted emission control strategies for both industrial and vehicular sources to improve local air quality and inform future policy decisions.

Voice Quality Evaluation in a Mobile Cellular Network: In Situ Mean Opinion Score Measurements.

This article aims to test, measure and evaluate the quality of voice calls made in a mobile cellular network. A set of drive tests were conducted, during which logs were collected using specialized measurement terminals equipped with a dedicated voice evaluation application. Three different scenarios were considered: the first scenario consisted of a series of mobile-to-mobile calls in a circuit-switched (CS) domain over the GSM network, the second scenario involved similar calls using the VoLTE service in a packet-switched (PS) domain of a 4G network, and the third scenario employed an over-the-top (OTT) media service type via the WhatsApp application in the same PS domain of the 4G network. The measurement results highlight the user experience in each scenario and compare the voice quality evaluated through the Mean Opinion Score (MOS) across the CS and PS domains. The originality of this work consists of in situ measurements performed in Bucharest, Romania, providing detailed, context-specific insights regarding the network performance that can drive local improvements and support policy and investment decisions.

The Rise of Xylazine Shows Why Local Data Must Inform Policy and Spending Decisions.

Local governments have been given direct control over a substantial amount of opioid settlement funding. While state-level data sources are valuable inputs, city and county leaders should consider local data sources when making decisions to ensure timely responses to emerging threats, as is exemplified by the rise of xylazine.

Promoting physical activity and healthy diets by modifying the social and/or physical environment at local level: a scoping review of evidence-based policy actions.

Background We aimed to map evidenced-based policy actions proposed by public health institutes or organizations to promote physical activity and healthy diets by modifying the social and/or physical environment at the local level. Methods We conducted a scoping review to identify relevant evidence-based policy actions proposed by public health institutions. We used a two-step strategy to identify government-supported public health institutes or organizations that generate evidence-based recommendations for policy actions. We included policy actions if they 1) aimed at increasing physical activity or improving diet; 2) focused on modifying the physical or social environments; 3) were implemented at the local or community level; 4) were expressed as a concrete action rather than a general aim; and 5) were described explicitly as being based on evidence. Results Starting from 121 public health institutes, we identified 8 relevant organizations and reviewed 63 guidelines or reports that included actions to promote healthy diets and physical activity. Of the 540 proposed actions on diet and 358 on physical activity, 118 met the inclusion criteria. Given that many of the actions were recommended by multiple institutes, we synthesized the information in the infographics to provide recommendations on diet and physical activity in outdoor and indoor settings and schools. Conclusions Public health institutes have generated a wide range of evidence-based recommendations for the promotion of healthy diets and physical activity by modifying the physical and social environment that can be implemented in local settings. Future actions should address barriers to implementing these recommendations and analyze the determinants of local policy decisions.

Change management on the meso-level: Primary mental health care in Pallieterland, supported by Emergo/PANGG 0-18 (Flanders, Belgium)

Introduction: One of the main current challenges for the Belgian primary health care system is the integration of primary mental health care.
 Belgium is known to have a shortage of mental health professionals. Public mental health services are understaffed, resulting in long waiting lists. Private mental health professionals are too expensive for many people in psychological distress.
 Since 2019, a limited number of primary mental health consultations is reimbursed, to lower the financial threshold to access the private mental health sector. Since 2021, the primary mental health convention changed, towards higher renumeration for psychologists working in the convention, and starting more from a public mental health vision.
 This is a Belgian federal action. In Pallieterland and four other primary care zones, this action is coordinated by two mental health networks: Emergo (for adults) and PANNG 0-18 (for minors).
 In this article the focus is on the change management on the meso-level: how did and still does primary care zone Pallieterland help to implement this policy change?
 What we did: The first step was to have a representative of the mental health sector in the board of the primary care zone, a necessary navigator and go-between, facilitating communication efforts of the primary care zone towards the mental health sector.
 The second step was to help founding a local psychologists’ association. After some previous attempts, the start of the new convention showed to be a good momentum for the start of the local psychologists’ association. Their founders are good communicators, representing the local primary mental health professionals in the boards of both the primary care zone, and of the local implementation group of the new primary mental health care convention.
 The third step is to keep monitoring the implementation progress, making sure that all localities in the primary care zone are well served with reimbursed primary health care consultations.
 
 The primary care zone facilitated and still facilitates these processes, by using a diversity of communication platforms:
 - A monthly electronic newsletter, reaching local healthcare and social care professionals;
 - Siilo Connect, a “medical Whatsapp” respecting GDPR legislation and able to send messages both to the whole contact list and to specific professional groups. Sometimes we sent a targeted request to fill a survey related to this topic, whenever we needed input for local policy decisions;
 - Six-monthly platform meetings on relevant interdisciplinary topics, reaching local healthcare and social care professionals: we both gave dedicated time for this project on one platform meeting and gave short follow-up notices on other platform meetings;
 - Six-weekly board meetings and annual general meeting: short notices on the progress of implementation, allowing questions from diverse stakeholders.
 Conclusion: Summarizing the efforts of primary care zone Pallieterland towards the implementation of the new primary mental health convention through the lens of Donabedian’s theory (Structure – Process – Outcome), we found that we spent most energy and time in modelling the structures, and monitoring processes of communication/collaboration. At the moment, primary care zones don’t have access to any outcome indicator.
 

Impact of universal free school meals on health and equity: international policy scoping review

Abstract Issue Every child should have access to healthy foods, engagement with peers, and thrive in educational environments. Universal free school meal policies can address health inequalities and the wider determinants of health. Such policies can impact economic development, community well-being, gender equity, and environmental sustainability. Description The World Health Organization Collaborating Centre on Investment for Health and Well-being undertook an international scoping policy review to identify examples of universal free school meals policy and practice. Resources, including government, public health, and non-governmental organisational websites, were reviewed. Data were extracted on delivery models and outcomes including health, equity, sustainability, and economic well-being. Best practices were summarised. The findings were shared with key Government stakeholders to provide high level overview of the impact of school food programmes and procurement practices on health and wellbeing, wider determinants and social outcomes to inform local policy and practice decisions. Results The report provides evidence on the impacts of universal free school meal programmes as well as promising practices to improve health, equity and well-being. Outcomes explored within the report include inter alia: health and well-being (nutrition, physical health), wider determinants (inequities, educational attainment, poverty, food insecurity) and social outcomes (stigma, social skills, uptake of school food programmes). Taking a global perspective, the report summarises international evidence to support inclusive, sustainable, and equitable solutions, such as improving economic well-being, promoting sustainable procurement practices, and maximising social return on investment. Lessons Mobilising and sharing international evidence and best practice supports equitable, long-term action to improve the health and well-being of children, local economies, and the climate. Key messages • International learning provides key insights to support innovative, equitable and effective policies. • Sustainable policies should address health and social outcomes, and support children and the environment.

Local School Boards and LGBTQ Policy Decisions: A Qualitative Case Study

On 7 September 2022, the Miami-Dade School Board (MDSB), the governing body of one of the largest school districts in the U.S., rejected a resolution requiring the MDSB to observe October 2022 as LGBTQ History Month and directing the district’s superintendent to investigate the feasibility of providing “information and resources” about landmark LGBTQ Supreme Court cases for optional use in high school government classes. The current study coded the transcript of the September 7 meeting utilizing qualitative research protocols based on grounded theory. The resulting analysis identified three themes (curriculum, coercion, and illegality) associated with comments made by members of the public who opposed the resolution and three themes (curriculum, well-being, and anti-LGBTQ bigotry) associated with comments made by members of the public who supported the resolution. Analysis of the September 7 transcript also identified one primary theme (illegality) associated with MDSB members who opposed the resolution and two themes (disinformation and choice) associated with the MDSB member who supported the resolution. In addition to illustrating certain aspects of a contemporary moral panic in the U.S. and other countries, these results provide insights into how the public and U.S. school board members perceive the appropriateness and limitations of addressing the needs of contemporary LGBTQ students.

The Cameroon Health Research and Evidence Database (CAMHRED): tools and methods for local evidence mapping

BackgroundLocal evidence is important for contextualized knowledge translation. It can be used to adapt global recommendations, to identify future research priorities and inform local policy decisions. However, there are challenges in identifying local evidence in a systematic, comprehensive, and timely manner. There is limited guidance on how to map local evidence and provide it to users in an accessible and user-friendly way. In this study, we address these issues by describing the methods for the development of a centralized database of health research evidence for Cameroon and its applications for research prioritization and decision making.MethodsWe searched 10 electronic health databases and hand-searched the archives of non-indexed African and Cameroonian journals. We screened titles, abstracts, and full texts of peer reviewed journal articles published between 1999 and 2019 in English or French that assess health related outcomes in Cameroonian populations. We extracted relevant study characteristics based on a pre-established guide. We developed a coding scheme or taxonomy of content areas so that local evidence is mapped to corresponding domains and subdomains. Pairs of reviewers coded articles independently and resolved discrepancies by consensus. Moreover, we developed guidance on how to search the database, use search results to create evidence maps and conduct knowledge gap analyses.ResultsThe Cameroon Health Research and Evidence Database (CAMHRED) is a bilingual centralized online portal of local evidence on health in Cameroon from 1999 onwards. It currently includes 4384 studies categorized into content domains and study characteristics (design, setting, year and language of publication). The database is searchable by keywords or through a guided search. Results including abstracts, relevant study characteristics and bibliographic information are available for users to download. Upon request, guidance on how to optimize search results for applications like evidence maps and knowledge gap analyses is also available.ConclusionsCAMHRED (https://camhred.org/) is a systematic, comprehensive, and centralized resource for local evidence about health in Cameroon. It is freely available to stakeholders and provides an additional resource to support their work at various levels in the research process.

Using a Multi-Site RCT to Predict Impacts for a Single Site: Do Better Data and Methods Yield More Accurate Predictions?

Multi-site randomized controlled trials (RCTs) provide unbiased estimates of the average impact in the study sample. However, their ability to accurately predict the impact for individual sites outside the study sample, to inform local policy decisions, is largely unknown. To extend prior research on this question, we analyzed six multi-site RCTs and tested modern prediction methods—lasso regression and Bayesian Additive Regression Trees (BART)—using a wide range of moderator variables. The main study findings are that: (1) all of the methods yielded accurate impact predictions when the variation in impacts across sites was close to zero (as expected); (2) none of the methods yielded accurate impact predictions when the variation in impacts across sites was substantial; and (3) BART typically produced “less inaccurate” predictions than lasso regression or than the Sample Average Treatment Effect. These results raise concerns that when the impact of an intervention varies considerably across sites, statistical modeling using the data commonly collected by multi-site RCTs will be insufficient to explain the variation in impacts across sites and accurately predict impacts for individual sites.

Colonized through Art: American Indian Schools and Art Education, 1889–1915 by Marinella Lentis

Reviewed by: Colonized through Art: American Indian Schools and Art Education, 1889–1915 by Marinella Lentis Mackenzie J. Cory Colonized through Art: American Indian Schools and Art Education, 1889–1915. By Marinella Lentis. Lincoln: University of Nebraska Press, 2017. xxvii + 421 pp. Marinella Lentis's Colonized through Art examines how local and federal policy decisions shaped the implementation of art education in Native American boarding schools across the United States in the late nineteenth and early twentieth centuries. At the core of her analysis is Jean and John Comaroff's conception of colonization as both a physical and mental imposition, supported by Gramsci's idea of cultural hegemony, the soft policies used to maintain control across generations without physical violence. This "colonization of consciousness" influenced the actions of boarding school administrators as they sought to create a serving class of Indigenous workers with skills learned in art classrooms (xxi). Throughout the volume, Lentis also relies on Lomawaima and McCarty's "safety zone" to describe how education incorporating traditional Indigenous arts fell in and out of fashion (xxii). This inclusion serves as the keystone explaining the seemingly contradictory policies present in boarding schools and constitutes one of the most groundbreaking aspects of the volume. The volume's chapters first present an overview of the current research regarding art education and Native boarding school policies before demonstrating how these policies were actually implemented at two institutions. These case studies are followed by a broader look at how the works produced by Native students were viewed by audiences from pedagogical backgrounds and the general public, both nationally and internationally. Chapter 1 introduces the reader to the development of art education pedagogy for the lower classes during the nineteenth century. Lentis argues that these efforts to develop the morality and character of children of rural and immigrant workers directly influenced boarding school policies in the last twenty [End Page 322] years of the nineteenth century. Chapter 2 presents a general discussion of how pedagogical models affected boarding school arts education during this time, strengthening Lentis's argument and setting the groundwork for the rest of the volume. These chapters provide excellent overviews of art education both broadly and in the boarding schools and allow scholars lacking familiarity with either field to form an understanding of Lentis's argument. Chapter 3 examines how the beliefs of individual boarding school superintendents influenced the policies identified in the preceding chapter. Though the ultimate goal of the superintendents was to educate Native youth into becoming productive members of industrial society, Lentis discerns considerable disagreement between administrators' opinions of the economic role of art in Native communities, the danger of preserving Native artistic motifs, and the risk of over-homogenization of Native youth. In particular, this chapter does an excellent job of demonstrating how the whiplash between superintendents with relatively short tenures and widely differing pedagogies opened the door for more local control, which is confirmed in the following two chapters. Chapters 4 and 5 present case studies of how these policies were implemented in the Albuquerque Indian School and Sherman Institute, respectively. Though it would be expected that the Albuquerque Indian School would encourage a strong arts program, given the emergence of a local Native art scene in the late nineteenth century, local administrators often defied federal calls for just that due to their belief that Native artisans were preventing the community from integrating into industrial American culture. Conversely, the Sherman Institute in Riverside, California, encouraged art education, going so far as to include regional Native motifs in their lessons and encouraging performance of indigeneity for the local community and tourists. In both cases, Lentis clearly shows the influence of local administrators on their school's art education as well as the impact these choices had on other boarding schools in the region and nationally. Chapter 6 discusses the inclusion of artwork created by boarding school students at international fairs. The artworks and their creators were instrumental in producing a narrative of the United States' success in taming the North American interior while simultaneously allowing foreign visitors to experience the Other. During the early twentieth century, this belief shifted towards one of Native artwork as an essential method...

Comparison of spatial interpolation techniques for innovative air quality monitoring systems

Different integration methods were tested to integrate data from a dynamic road network (ROM) in which pollution measurement sensors were mounted over delivery vans. Two methods were purposely developed, the isoelliptical expansion - ISOE - method accounting for the wind convective transport of pollutants and the modified isoelliptical expansion - MISOE - method in which, furthermore, local specific deviation of the pollution are estimated from historical sequences of pollution levels. The results obtained by these methods were compared with the well-known inverse distance weighted - IDW - method, which is only based on the distance from the interpolation sources. The comparison of the errors between the estimated values and the available measures reveals that the MISOE model provides more accurate estimated values with a low associated error. The ISOE model is more complicate than the IDW but provides better estimations in windy days. The maps of the local adjusting coefficients estimated month by months are able to identify critical areas to address in local environmental policy decisions.

Small Area Estimation of Age-Specific and Total Fertility Rates in Bangladesh

Bangladesh has experienced a rapid national decline in fertility in recent decades, however, fertility rates vary considerably at the sub-national level (i.e., division). These variations are expected to be more pronounced at lower levels of geography (e.g., district level). However, routinely conducted demographic health surveys are designed for national estimates and do not have adequate samples to produce reliable estimate of fertility rates at lower levels of administrative units, particular when considering district level age-specific fertility rates. Data extracted from the Bangladesh Demographic Health Survey 2014 are used to derive direct estimates of age-specific fertility rates and associated smoothed standard errors. These are used as inputs for developing a small area model, which is expressed in a hierarchical Bayesian framework and fitted by Markov Chain Monte Carlo simulation. The model accounts for variation at different levels—women age-group, division, and district. The modeling results show large reductions in the estimated standards errors and provide consistent estimates of fertility at the detailed district age-specific level. There are significant differences in the fertility levels within and between districts and at the division level. Fertility rates are observed to be higher for Sylhet division and for women aged 20–24 years. We use geo-spatial maps of the fertility rates to visualize the variations over districts, and identify hot and cold-spots to have better targeted local level planning and policy decision making for further reductions in fertility rates in Bangladesh.

Effects of local land-use policies and anthropogenic activities on water quality in the upstream Sesan River Basin, Vietnam

Study regionThis study focuses on the upstream Sesan River Basin in the Central Highlands of Vietnam. Study focusLocal land-use policies and human activities can significantly affect hydrology and increase the magnitude of erosion and nutrients in downstream areas. The effects in terrestrial regions on water quality of the target area were evaluated during the 2000–2018 period using the SWAT (Soil and Water Assessment Tool) with updated land-use conditions following the local policy decisions and agricultural practices in different periods. New hydrological insights for the regionsThis study indicates that the implementation of the local land-use policies, along with extensive anthropogenic activities, has had significant effects on the downstream aquatic environment as compared with the period before the implementation of the land-use policies. Higher annual sediment, total nitrogen (TN), and total phosphorus (TP) loadings were found upstream from the Poko Watershed, where range land predominated, and in southern and southwestern Dakbla Watershed, where arable land and permanent cropland predominated. Arable land had the highest proportion of sediment and nutrient loadings into the reach, especially in the 2005–2009 period (conducting afforestation, agricultural expansion, and urbanization) and in the 2010–2014 period (applying crop conversion policy involving a shift from mixed forests to rubber forests). Understanding the watershed characteristics along with the combination of spatial land use, local land-use policies, and agricultural practices will support the implementation of regional land use and water resources management strategies more comprehensively.

Global Value Chains and Local Inter-Industry Linkages: South Africa’s Participation in the Automotive GVC

International trade in the 21st century operates through global value chains (GVCs). There is a growing literature on how the emergence of GVCs has changed the playing field for catch-up industrialization of developing countries. Inter-industry linkages have historically been a central aspect of catch-up industrialization. How such linkages on the country level are affected by the reality that trade is conducted via GVCs is an important research question. This paper synthesizes the theoretical elaborations on inter-industry linkages from the classic development economics literature with secondary empirical data from the East Asian industrialization experience to illustrate the importance of inter-industry linkages for the industrialization process. Using primary data from the South African automotive industry, the paper shows how the dynamics of the automotive GVC have affected domestic inter-industry linkage building in the country. The backward linkages to the domestic component manufacturing industry and to the domestic materials industries from South Africa’s successful integration into the automotive GVC have been disappointing. Both local policy decisions as well as GVC-specific dynamics of follow sourcing and the proliferation of manufacturing technologies and material standards have undermined more substantial backward linkages from exports of automobiles.

Emulation of high-resolution land surface models using sparse Gaussian processes with application to JULES

Abstract. Land surface models are typically integrated into global climate projections, but as their spatial resolution increases the prospect of using them to aid in local policy decisions becomes more appealing. If these complex models are to be used to make local decisions, then a full quantification of uncertainty is necessary, but the computational cost of running just one full simulation at high resolution can hinder proper analysis. Statistical emulation is an increasingly common technique for developing fast approximate models in a way that maintains accuracy but also provides comprehensive uncertainty bounds for the approximation. In this work, we developed a statistical emulation framework for land surface models, enabling fast predictions at a high resolution. To do so, our emulation framework acknowledges, and makes use of, the multitude of contextual data that are often fed into land surface models (sometimes called forcing data, or driving data), such as air temperature or various soil properties. We use The Joint UK Land Environment Simulator (JULES) as a case study for this methodology, and perform initial sensitivity analysis and parameter tuning to showcase its capabilities. The JULES is perhaps one of the most complex land surface models and so our success here suggests incredible gains can be made for all types of land surface model.

COVID-19 data driven planning: The SouthEast Texas approach.

This coautoethnographic case study used the Open-Source Public Health Intelligence process to explore and share the South East Texas Regional Advisory Councils' (SETRAC) experience in collecting, processing, disseminating/visualizing, and analyzing COVID-19 data during the pandemic in the largest national medical setting in the United States. Specifically, it details the production of Business Intelligence reports powered by PowerBI both with general publics and with Regional Healthcare Preparedness Program (HPP) Coalition Coordinators, County Judges and City Mayors, Texas Department of State Health Services (DSHS) executive leadership, the Offices of the Texas Governor, and the Federal Pandemic Task Force led by the US Vice President, in order to provide a foundation for situational awareness, inter-regional collaboration, allocation of scare resources, and local, regional, and state policy decisions. It highlights best practices in risk and crisis communications during the COVID-19 response, underscores cross-sector collaboration and standardization of data collection for effective planning and response, discusses pervasive data revealed during the analysis, and evaluates collaborative and feedback processes that have implications for the Health Care System and Homeland Security Enterprise information sharing.

A retrospective analysis of emergency department usage in rural and semi-urban indigenous Guatemalan populations

Functioning healthcare systems provide emergency medical care. Disparities exist in accessibility and availability of emergency care in low- and middle-income countries. We present a descriptive epidemiologic analysis of Emergency Department (ED) usage in a rural, indigenous Guatemalan population. San Lucas Tolimán is situated in central Guatemala. Hospital Parroquial de San Lucas offers emergency care to San Lucas Tolimán and surrounding villages. All ED visits between January 1st, 2016 and December 31st 2018 were recorded and analyzed. During the study period, 12,229 patient encounters occurred. Almost all patients identified as indigenous. Children comprised 43% of visits. Medical issues represented a majority (83%) of complaints. Respiratory (40%) and gastrointestinal disease (26%) were frequent presenting complaints. Almost all visits (83%) occurred during the day and evening hours. Trauma/surgical complaints were slightly more frequent at night. 93% of patients were discharged, while the rest were admitted or transferred. These data contribute to understanding of disease burden and emergency care needs and capacity in rural areas of low- and middle-income countries. This information may be used to inform local policy decisions, identify research priorities, and create training topics for local health care providers in Guatemala and other countries in this region.