Sending a message: How significant events have influenced the warnings landscape in Australia

Publisher's version (útgefin grein)The Bureau of Meteorology has a mandate to issue warnings for weather and climate events that are likely to result in harm and loss. This service has been delivered in an end-to-end (science to service) context and warnings messages have typically been crafted to describe the current and predicted future state of the environment and recommended protective actions. However, the warnings landscape is evolving and Australian governments and emergency management agencies are adopting rapidly diversifying roles in a range of warnings processes. This evolution coincides with the shift in international strategies: from the mitigation and crisis management approach to the emphasis on building community resilience. Following a number of severe weather-related events that resulted in serious losses a series of Australian inquiries, reviews and social research investigated warnings efficacy. This included the National Review of Warnings and Information for Australia, with a recommendation suggesting that a Total Warning System concept be more formally considered across multiple hazards, rather than just flood, as it currently stands. Consequently, Australian warnings agencies are embracing a more people-centred approach recognising the need for messages to include detail of likely impact alongside an implied level of risk. Thus, developing capability to deliver impact forecasting and risk-based warnings services in a multi (natural) hazard context. With a key focus on flood, fire and tropical cyclone, this paper reviews international and national warnings policy documents and social research and explores the evidence-based evolution of warning services with respect to the Total Warning System concept.Deanne Bird has been supported by the Nordic Centre of Excellence for Resilience and Societal Security – NORDRESS, which is funded by the Nordic Societal Security Programme.Peer Reviewe

What is the role of single-stage oral mucosa graft urethroplasty in the surgical management of lichen sclerosus-related stricture disease in men? A systematic review

Purpose The benefits and harms of the available types of surgical management for lichen sclerosus-related (LS) strictures remain unclear and, thus, clear and robust clinical practice recommendations cannot be given. Materials and methods To assess the role of single-stage OMGU in the management of LS strictures and explore how its benefits and harms compare with the alternative management options. Medline, Embase and Cochrane controlled trial databases (CENTRAL, CDSR) were systematically searched. Randomized (RCTs) and nonrandomized studies (NRCSs) comparing single-stage OMGU with other surgical management options for LS strictures and single-arm studies on single-stage OMGU were included. Risk of bias (RoB) was assessed. Results Of the 1912 abstracts identified, 15 studies (1 NRCS and 14 single-arm studies) were included, recruiting in total 649 patients. All studies were at high RoB. In the only NRCS available, stricture-free rate (SFR) for single-stage and staged OMGU was 88% vs 60%, respectively (p = 0.05), at a mean follow-up of 66.5 months. SFR range for single-stage OMGU in single-arm studies was 65-100% (mean/median follow-up, 12-59 months). Single-stage OMGU had low complication rates and beneficial impact on LUTS and QoL. Conclusions The present SR highlights the methodological limitations of the available literature. In the absence of adverse local tissue conditions, and taking into consideration benefit-harm balance and surgeon's skills and expertise, single-stage OMGU can be justified in patients with LS strictures

Is a Course of Intermittent Self-dilatation with Topical Corticosteroids Superior at Stabilising Urethral Stricture Disease in Men and Improving Functional Outcomes over a Course of Intermittent Self-dilatation Alone? A Systematic Review and Meta-analysis

Context: Intermittent self-dilatation (ISD) is a therapeutic strategy used to stabilise a urethral stricture and postpone or avoid further treatment. Adding corticosteroids to this mode of management might further enhance its outcomes by downregulation of collagen deposition and excessive scar tissue formation. Objective: To explore whether a course of ISD with topical corticosteroids is superior at stabilising urethral stricture disease in men and improving functional outcomes over a course of ISD alone. Evidence acquisition: This systematic review and meta-analysis was undertaken by the European Association of Urology Urethral Strictures Guideline Panel according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines (CRD42021256744). The primary benefit outcome was successful stabilisation of the urethral stricture. Treatment-related complications were the primary harm outcome. Evidence synthesis: In total, 978 records were screened for eligibility, ultimately leading to five included studies, all randomised controlled trials, comprising 250 patients, of whom 124 underwent a course of ISD with corticosteroids and 126 underwent a course of ISD alone, all after direct vision internal urethrotomy (DVIU). Successful stabilisation of the stricture was achieved in 77% and 64% of patients in the group with and without corticosteroids, respectively (p = 0.04). No extra complications related to the addition of corticosteroids to the ISD regimen were reported. The risk of bias of the included studies was generally unclear to high. Conclusions: Based on the currently available data, a course of ISD with topical corticosteroids appears to be safe and superior at stabilising a urethral stricture after DVIU in the short term to a course of ISD alone. However, given the unclear to high risk of bias in the included studies, further high-quality studies are needed to fully underpin this. Patient summary: This study shows that addition of topical corticosteroids to intermittent self-dilatation after direct vision internal urethrotomy can better stabilise the stricture in the short term