A framework for evaluating the effectiveness of flood emergency management systems in Europe

Calls for enhancing societal resilience to flooding are echoed across Europe alongside mounting evidence that flood risk will increase in response to climate change amongst other risk-enhancing factors. At a time where it is now widely accepted that flooding cannot be fully prevented, resilience discourse in public policy stresses the importance of improving societal capacities to absorb and recover from flood events. Flood emergency management has thus emerged as a crucial strategy in flood risk management. However, the extent to which emergency management supports societal resilience is dependent on the effectiveness of governance and performance in practice. Drawing from the extensive body of literature documenting the success conditions of so-called effective emergency management more broadly, this study formulates an evaluation framework specifically tailored to the study of Flood Emergency Management Systems (FEMS) in Europe. Applying this framework, this research performs a cross-country comparison of FEMS in the Netherlands, England, Poland, France, and Sweden. Important differences are observed in how FEMS have evolved in relation to differing contextual backgrounds (political, cultural, administrative and socio-economic) and exposures to flood hazard. Whereas the organization and coordination of actors are functioning effectively, other aspects of effective FEMS are relatively under-developed in several countries, such as provisions for institutional learning, recovery-based activities and community preparedness. Drawing from examples of good practice, this paper provides a critical reflection on the opportunities and constraints to enhancing the effectiveness of FEMS in Europe

Medical students’ personal experiences, religion, and spirituality explain their (dis)comfort with a patient’s religious needs

Background: Physicians often avoid discussing patients’ religious and spiritual concerns, even though most patients (i.e., 50-94%) want integrated care.  To address this gap, medical students interviewed a Standardized Patient (SP) who was upset because the daughter did not confront her fiancée about converting to Orthodox Judaism.  Students reflected on how their own religion and spirituality affected engaging with their patient. Methods: With a 97% response rate, 231 first-year medical students responded to open-ended questions about their patient encounter.  For this quantitative content analysis, we used inductive reasoning, identifying three themes:  (1) impact of students’ own religion on their comfort, (2) change in comfort, and (3) their learning. We used deductive reasoning to compare qualitative results from half of the students who began the curriculum with a questionnaire about their own spirituality with the other students completing afterwards. Results: Most students said being religious positively influenced their comfort, whether they were also Orthodox Jewish or from a different religion. Among uncomfortable students (6.5%), some attributed this to not being religious. Some students (4.8%) grew more comfortable discussing the religious issue, and 18.2% became uncomfortable due to lacking knowledge of Orthodox Judaism and the awkwardness of the topic.  Students who had completed the questionnaire beforehand gave more comments about connecting with their patients than students who completed the questionnaire afterwards (X2=11.047, p<.001). Conclusions: Students’ own religion influenced their comfort with discussing religious concerns, with some feeling more connected and others becoming uncomfortable. This finding helps inform medical educators about teaching mind-body-spirit care

Bone Fractures With and Without Sickle Cell Disease in the Pediatric Population

Background: Individuals with sickle cell disease are restricted from certain physical activities due to the increased risk of complications including fractures secondary to osteopenia. However the exact incidence and outcomes of fractures amongst these patients is unknown. Objectives: (1) describe the incidence, epidemiology, and outcomes of fractures in patients with SCD. (2) to compare fracture patterns and outcomes in patients with and without SCD. Methods: This is a retrospective, cohort study of patients aged 0-25 years old with HbSS, HbSC, or HbS-β-thalassemia with a fracture evaluated at a pediatric emergency department from April 2009-April 2022. Eligible patients were identified using a combination of ICD billing codes and a preexisting hematology clinic database. Patients were age/gender matched with non-SCD patients with fractures. Data on demographics, number and types of fractures and outcomes were collected. Results: 753 patients with SCD were identified during the study period. SCD patients with fractures were more likely to have multiple comorbidities, lower mean vitamin D levels and were less likely to be on vitamin D supplementation compared to those without fractures. The most common etiology was fall and carpal bones were most commonly fractured. Non-SCD patients with fractures were more likely to be obese and require surgical repair compared to their SCD peers. Conclusions: Fracture incidence among SCD patients is low. Male gender, multiple comorbidities, and lack of vitamin D supplementation are associated with increased risk of fracture. SCD patients with a fracture were less likely to require surgical treatment compared to their non-SCD counterparts

Shaping flood risk governance through science-policy interfaces: insights from England, France and The Netherlands

In the face of increasing threats from flooding, there are growing calls to strengthen and improve arrangements of flood risk governance (FRG). This endeavour requires an appreciation of the multitude of factors stabilising and driving governance dynamics. So-called catalyst flood events, policy champions and advocacy coalitions have tended to dominate this study to date, whilst the potential role played by Science Policy Interfaces (SPIs) has been somewhat neglected and often approached in a reductionist and fragmented way. This paper addresses this gap by drawing from in-depth policy analysis and stakeholder interviews conducted within England, France and the Netherlands under the auspices of the EU-FP7 STAR-FLOOD project. The analysis reveals four prominent ways in which SPIs shape FRG, by i) facilitating the diversification of Flood Risk Management (FRM) strategies; ii) increasing their connectivity, iii) facilitating a decentralisation of FRM and iv) fostering inter-country learning. It identifies different roles of specific interfaces (structures) and interfacing mechanisms (processes) in shaping governance dynamics. This way, the analysis reveals various ‘entry points’ through which SPIs can steer FRG, either along existing pathways, or towards new and potentially transformative change. The study shows that SPIs are a hitherto underexposed factor explaining dynamics in flood risk governance which merits additional systematic empirical study