Coastal natural and nature-based features: international guidelines for flood risk management

Natural and nature-based features (NNBF) have been used for more than 100 years as coastal protection infrastructure (e.g., beach nourishment projects). The application of NNBF has grown steadily in recent years with the goal of realizing both coastal engineering and environment and social co-benefits through projects that have the potential to adapt to the changing climate. Technical advancements in support of NNBF are increasingly the subject of peer-reviewed literature, and guidance has been published by numerous organizations to inform technical practice for specific types of nature-based solutions. The International Guidelines on Natural and Nature-Based Features for Flood Risk Management was recently published to provide a comprehensive guide that draws directly on the growing body of knowledge and practitioner experience from around the world to inform the process of conceptualizing, planning, designing, engineering, and operating NNBF. These Guidelines focus on the role of nature-based solutions and natural infrastructure (beaches, dunes, wetlands and plant systems, islands, reefs) as a part of coastal and riverine flood risk management. In addition to describing each of the NNBF types, their use, design, implementation, and maintenance, the guidelines describe general principles for employing NNBF, stakeholder engagement, monitoring, costs and benefits, and adaptive management. An overall systems approach is taken to planning and implementation of NNBF. The guidelines were developed to support decision-makers, project managers, and practitioners in conceptualizing, planning, designing, engineering, implementing, and maintaining sustainable systems for nature-based flood risk management. This paper summarizes key concepts and highlights challenges and areas of future research

Enhancing structural measures for environmental, social, and engineering benefits

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The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine