Urban Studies

Free clinics are an important part of the US health care safety net and their numbers are rising. This article offers a critical analysis of the politics of free health clinics in Milwaukee, WI. It uses the geographies of resistance literature to assess free clinics as a response to the neoliberalization of health care delivery. It underlines the multiple political spaces free clinics occupy as a result of the entanglements of a diverse range of identities and practices within the clinic space. In Milwaukee, the primary entanglement occurs between the progressive Christian identity inspiring the practices of the free clinic’s volunteers and the commodified identity of the corporate non-profit health care systems that dominate health care delivery in the city. This research suggests that understanding the transition from oppositional identities, such as progressive Christianity, to resistance is an important next step in constructing more robust responses to neoliberal capitalism and other exploitive social relations.

This essay takes the 25th Anniversary of Neil Smith’s Uneven Development: Nature, Capital and the Production of Space as an opportunity to consider the seminal contributions the books has
made for pushing scholars to more deeply consider the connections between the persistence of capitalism and social reproduction. Furthermore, we move on from this connection to consider the emancipatory ideas within Uneven Development and their connection to prompting new forms of revolutionary imagination and political possibility.

Social science researchers interested in human health have generally neglected the production of health care spaces and the experience of medical workers, particularly physicians. Health care researchers have contributed to our knowledge of the discursive and material construction of disease and ill health, the
embodied experience of ill-health, and the socio-spatial relations of care networks. Yet, similar developments have been relatively absent in spatialities of medical services. This is particularly true if one looks beyond a few key sites in New Zealand, Canada, and England. This project reviews the geographies of medical services literature and then identifies three key areas which would benefit from greater engagement: macro- and micro-scale interactions, primary care spaces, and a greater range of places. I then use
a case study of the privatization of a primary care space in Milwaukee, Wisconsin to illustrate the usefulness of geographic approaches for medical service research.

Blight in urban America has often been cited as a major concern for residents, politicians, and academics alike.  Unfortunately, gentrification in which higher income residents move in and displace the indigenous residents has become the contemporary fallback process for remediating urban blight.  However, four strategies—the gentrification with justice model, asset based community development, urban renewal, and adaptive reuse of industrial brownfields—can remediate and reimagine urban blight, especially when working in tandem with one another.  This paper seeks to explain these alternative strategies as well as provide precedent examples from projects around the United States.  This paper will then apply these methods in theoretical practice to the Water Tower Landing, an emerging community in Memphis, Tennessee.  Taking its name from the area’s vertical landmark, “the Landing” has potential to unify several smaller neighborhoods around an underdeveloped commercial corridor.  With the right stakeholders in development, government, and community leadership applying the four strategies for blight remediation, in 10 to 20 years the Water Tower Landing could provide national precedent for reimagining a blighted neighborhood without displacing the existing residents.

Churches in the South have long been segregated by race, and many still are.  According to my pastor at Fellowship Memphis during a sermon, only 3% of churches in the nation have a multi-racial congregation.  However, during the Civil Rights Movements and even since that time, many churches have come together over issues of social justice.  Though they may not pray in the same building, religious groups will picket together, march together, and host dialogues together.  Both Idlewild Presbyterian Church and Clayborn Temple provided essential leadership for the city during times of racial hardship.  Dr. Paul Tudor Jones, especially, vocalized a need for increased integration on Sunday mornings.  Yet, the question remains, were advocates and opponents more inspired by the leadership in the church or by the positions of their lay-peers?  Certainly grassroots movements are carried by the potency of both individual charismatic leadership and congregational mobilization as a means of promoting, enforcing, and boycotting various policies.  To that extent, Memphis area churches boasted both powerful displays of charismatic leadership and congregational groupthink during the peak of the city’s engagement in the Civil Rights Movement and integration efforts.

He was, is, and will always be a soldier.  However, the cause he fights for is varying with the time and with his social perspective.  Dennis “Cutty” Wise is a somewhat minor character on the hit television series The Wire who tries to make a major impact in his community.  A middle-aged man by the time Season 3 debuts him in a state prison befriended by his friend and gang leader Avon Barksdale, Dennis underestimated the effect 14 years would have on his life outlook as well as on the social structure he returned to in the real world.  However, some things never change.  Learning from his experiences before, during, and after prison, Dennis seeks to capitalize on his disadvantaged situation by empowering youth in his community with an outlet.  To him because of first hand experience, and to many others indirectly effected, disenfranchisement following a release from prison is a major urban social problem.

Background Excess mortality from cardiovascular disease during the COVID‐19 pandemic has been reported. The mechanism is unclear but may include delay or deferral of care, or differential treatment during hospitalization because of strains on hospital capacity. Methods and Results We used emergency department and inpatient data from a 12‐hospital health system to examine changes in volume, patient age and comorbidities, treatment (right‐ and left‐heart catheterization), and outcomes for patients with acute myocardial infarction (AMI) and heart failure (HF) during the COVID‐19 pandemic compared with pre‐COVID‐19 (2018 and 2019), controlling for seasonal variation. We analyzed 27 427 emergency department visits or hospitalizations. Patient volume decreased during COVID‐19 for both HF and AMI, but age, race, sex, and medical comorbidities were similar before and during COVID‐19 for both groups. Acuity increased for AMI as measured by the proportion of patients with ST‐segment elevation...

Background: The COVID-19 pandemic was associated with a worrisome decrease in acute coronary syndrome (ACS) cases. We sought to investigate the trajectory of ACS following the relaxation of isolation orders and public service education. Hypothesis: We hypothesized that during the COVID-19 pandemic, ACS cases would decrease during the period of strict isolation and thereafter increase, illustrating a “rebound effect”, during the period of relaxed isolation. Methods: All adults with concern for ACS requiring cardiac catheterization at one academic center from 22 December 2019 to 13 June 2020 were included. Cases were designated as ST-elevation myocardial infarction (STEMI), STEMI activation, out-of-hospital cardiac arrest (OHCA), Non-STEMI/unstable angina (NSTEMI/UA), and/or total ACS. 18 December - 14 March, 15 March - 9 May, and 10 May - 13 June were designated as pre-isolation COVID-19 (piC), strict isolation COVID-19 (siC), and relaxed isolation COVID-19 (riC), respectively. Fisher’s exact test was used to compare average cases per week in piC vs. siC and siC vs. riC. One-way ANOVA was used to compare cases across piC, siC, and riC together. Analysis was completed with STATA/MP 16.1. Results: 315 cases concerning for ACS requiring cardiac catherization lab activation were included. When comparing piC with siC and siC with riC, there were no significant differences in STEMI, STEMI activation, OHCA, NSTEMI/UA, or total ACS. When compared across piC, siC, and riC simultaneously there were no significant differences in STEMI (p=0.426), STEMI activation (p=0.172), OHCA (p=0.167), NSTEMI/UA (p=0.362), and total ACS (p=0.219). Total ACS, STEMI activation, NSTEMI/UA, and OHCA exhibited a trend towards a rebound effect (Graph). Conclusions: There were no significant changes in the incidence of total ACS, OHCA, STEMI, STEMI activation, or NSTEMI/UA between pre-isolation, strict isolation, and relaxed isolation periods of the COVID-19 pandemic.

Introduction: In October 2018, the heart allocation policy for adult heart transplant (OHTx) in the United States was changed, with the goal of reducing waitlist mortality and providing broader sharing of donor organs within the United States. The aim of this study was to assess the effect of this policy change on access to OHTx vs LVAD, overall and among key sociodemographic subgroups, in the US from 2016 to 2019. Hypothesis: We hypothesized that the UNOS heart allocation policy would increase OHTx volume overall as well as use of temporary mechanical circulatory support. Methods: We identified all patients receiving OHTx or LVAD between 2016-2019 using the National Inpatient Sample. Controlling for medical comorbidities, trends over time, and within hospital-year effects, we fit a dynamic logistic regression model to evaluate patient and hospital factors associated with receiving OHTx vs LVAD pre- versus post-policy change. Results: We identified 2264 patients who received OHTx an...

Introduction: Therapeutic hypothermia is a guideline-recommended treatment for certain unresponsive patients after a cardiac arrest. However, the degree to which patients with cardiac arrest have access to this therapy on a national level is unknown. Understanding hospital- and patient-level factors associated with receipt of hypothermia could inform interventions to improve access to this treatment among appropriate patients. Methods: This was a retrospective analysis using National Inpatient Sample data from 2016-2019. We used ICD10 diagnosis and procedure codes to identify adult patients with in-hospital and out-of-hospital cardiac arrest and receipt of therapeutic hypothermia. We used logistic regression with GEE clustering on hospital-year, and controlling for medical comorbidities, to evaluate patient and hospital factors associated with receiving therapeutic hypothermia. Results: We identified 478,419 patients (unweighted) with cardiac arrest. Of those, 4088 (0.85%) received ...