Temporal vulnerability: historical ecologies of monitoring, memory, and meaning in changing United States floodplain landscapes

This dissertation addresses the relationship between temporality—being bounded in time—and population vulnerability to hazards. Researchers and program managers typically integrate temporality in vulnerability assessments by analyzing either historical change in the level of population vulnerability or the historical (root) causes for disasters. The thesis of this dissertation is that the influence of temporality on population vulnerability is further determined by human relationships to time. In the modern context of fast changing hazardscapes and a diminishing sense of place in a globalizing world, how do temporal reference making practices such as landscape monitoring, memorialization, and meaning attribution influence population-level emergency preparedness? Based on historical ecological fieldwork in four United States floodplains—New Orleans (LA), Savannah (GA), Kinston (NC), and Felton (CA)—the results of this study illustrate how temporal vulnerability, defined as the condition of population surprise, decreases population resilience in the contexts of hazard mitigation, historical preservation, early warning, and disaster evacuation. A dwelling model is constructed that can be used to guide temporal vulnerability assessments, adaptive management, and interventions aimed at increasing hazard resilience

Methodology for assessment of public health emergency preparedness and response synergies between institutional authorities and communities

Background: This paper describes a participatory methodology that supports investigation of the synergistic collaboration between communities affected by infectious disease outbreak events and relevant official institutions. The core principle underlying the methodology is the recognition that synergistic relationships, characterised by mutual trust and respect, between affected communities and official institutions provide the most effective means of addressing outbreak situations. Methods: The methodological approach and lessons learned were derived from four qualitative case studies including (i) two tick-borne disease events (Crimean-Congo haemorrhagic fever in Spain, 2016, and tick-borne encephalitis in the Netherlands, 2016); and (ii) two outbreaks of acute gastroenteritis (norovirus in Iceland, 2017, and verocytotoxin-producing Escherichia coli [VTEC] in Ireland, 2018). An after-event qualitative case study approach was taken using mixed methods. The studies were conducted in collaboration with the respective national public health authorities in the affected countries by the European Centre for Disease Prevention and Control (ECDC). The analysis focused on the specific actions undertaken by the participating countries' public health and other authorities in relation to community engagement, as well as the view from the perspective of affected communities. Results: Lessons highlight the critical importance of collaborating with ECDC National Focal Points during preparation and planning and with anthropological experts. Field work for each case study was conducted over one working week, which although limiting the number of individuals and institutions involved, still allowed for rich data collection due to the close collaboration with local authorities. The methodology enabled efficient extraction of synergies between authorities and communities. Implementing the methodology required a reflexivity among fieldworkers that ackowledges that different versions of reality can co-exist in the social domain. The method allowed for potential generalisability across studies. Issues of extra attention included insider-outsider perspectives, politically sensitivity of findings, and how to deal with ethical and language issues. Conclusions: The overall objective of the assessment is to identify synergies between institutional decision-making bodies and community actors and networks before, during and after an outbreak response to a given public health emergency. The methodology is generic and could be applied to a range of public health emergencies, zoonotic or otherwise

How do people think about interdependence? A multidimensional model of subjective outcome interdependence

Interdependence is a fundamental characteristic of social interactions. Interdependence Theory states that 6 dimensions describe differences between social situations. Here we examine if these 6 dimensions describe how people think about their interdependence with others in a situation. We find that people (in situ and ex situ) can reliably differentiate situations according to 5, but not 6, dimensions of interdependence: (a) mutual dependence, (b) power, (c) conflict, (d) future interdependence, and (e) information certainty. This model offers a unique framework for understanding how people think about social situations compared to another recent model of situation construal (DIAMONDS). Furthermore, we examine factors that are theorized to shape perceptions of interdependence, such as situational cues (e.g., nonverbal behavior) and personality (e.g., HEXACO and Social Value Orientation). We also study the implications of subjective interdependence for emotions and cooperative behavior during social interactions. This model of subjective interdependence explains substantial variation in the emotions people experience in situations (i.e., happiness, sadness, anger, and disgust), and explains 24% of the variance in cooperation, above and beyond the DIAMONDS model. Throughout these studies, we develop and validate a multidimensional measure of subjective outcome interdependence that can be used in diverse situations and relationships-the Situational Interdependence Scale (SIS). We discuss how this model of interdependence can be used to better understand how people think about social situations encountered in close relationships, organizations, and society

Historical waterscape trajectories that need care: the unwanted refurbished flood homes of Kinston's devolved disaster mitigation program

Abstract In 1999 Hurricane Floyd pummeled the eastern portion of North Carolina (NC, U.S.A.), and in its wake many localities participated in federal home acquisition-relocation programs in flood-prone areas, with shared and devolved governance. This article reports on one such program that was conducted in the City of Kinston, where a historical African-American neighborhood called Lincoln City was badly flooded by water containing raw sewage from a compromised wastewater treatment plant upstream. Afterwards, some of the acquired homes were relocated to an adjacent area populated by middle-class, African-American families. The article explores to what extent political devolution of flood mitigation disempowered residents to deal with this crisis in their waterscape. Combining a framework from medical anthropology regarding the logics of choice and care with historical political ecology, it illustrates how devolved government policy led to a continuation of the waterscape's discriminatory history after the buyout program, with no recourse for local citizens as the program worked through a logic of choice that demarcated responsibilities. Understanding this case requires a historically informed assessment of social impact, in which the chosen flood mitigation measures are critically assessed using tools from historically-informed political ecology, leading to a longerterm logic of care where needed. Keywords: Devolution, flooding, path-dependency, waterscape, buyout, mitigation, care, choic

Towards Promotion of Community rewards to Volunteer Community Health Workers? Lessons from Experiences of Village Health Teams in Luwero, Uganda

In the debate regarding volunteer Community Health Workers (CHWs) some argue that lack of remuneration is exploitation while others caution that any promise to pay volunteers will decrease the volunteer spirit. In this paper we discuss the possibility of community rewards for CHWs. Ethnographic fieldwork that lasted 18 months utilised methods including participant observation, FGDs, in-depth interviews and key informant interviews to gain insight into the dynamic relationship between volunteer CHWs known as Village Health Teams (VHTs) and the community. Contextual transcription was done and data was thematically analysed. Findings show that community members are willing to reward volunteer CHWs with cash, material and symbolic rewards in appreciation for their help. Factors crucial for this gesture included: care and recognition of the VHTs’ work by medical staff, fulfilment of the promises made to the community by government and exemplary behaviour by CHWs. Therefore, effort should be made to facilitate volunteer CHWs to be seen as helpful to their communities. Especially, there needs to be a smooth operation at the intersection between the VHTs, local government and medical structures. Community rewards could be a more sustainable way of motivating CHWs while a solution to health personnel shortage is sought

Selection and performance of village health teams (VHTs) in Uganda: lessons from the natural helper model of health promotion

Background: Community health worker (CHW) programmes have received much attention since the 1978 Declaration of Alma-Ata, with many initiatives established in developing countries. However, CHW programmes often suffer high attrition once the initial enthusiasm of volunteers wanes. In 2002, Uganda began implementing a national CHW programme called the village health teams (VHTs), but their performance has been poor in many communities. It is argued that poor community involvement in the selection of the CHWs affects their embeddedness in communities and success. The question of how selection can be implemented creatively to sustain CHW programmes has not been sufficiently explored. In this paper, our aim was to examine the process of the introduction of the VHT strategy in one rural community, including the selection of VHT members and how these processes may have influenced their work in relation to the ideals of the natural helper model of health promotion. Methods: As part of a broader research project, an ethnographic study was carried out in Luwero district. Data collection involved participant observation, 12 focus group discussions (FGDs), 14 in-depth interviews with community members and members of the VHTs and four key informant interviews. Interviews and FGD were recorded, transcribed and coded in NVivo. Emerging themes were further explored and developed using text query searches. Interpretations were confirmed by comparison with findings of other team members. Results: The VHT selection process created distrust, damaging the programme’s legitimacy. While the Luwero community initially had high expectations of the programme, local leaders selected VHTs in a way that sidelined the majority of the community’s members. Community members questioned the credentials of those who were selected, not seeing the VHTs as those to whom they would go to for help and support. Resentment grew, and as a result, the ways in which the VHTs operated alienated them further from the community. Without the support of the community, the VHTs soon lost morale and stopped their work. Conclusion: As the natural helper model recommends, in order for CHW programmes to gain and maintain community support, it is necessary to utilize naturally existing informal helping networks by drawing on volunteers already trusted by the people being served. That way, the community will be more inclined to trust the advice of volunteers and offer them support in return, increasing the likelihood of the sustainability of their service in the community

Repeatability, and Intra-Observer and Interobserver Agreement of Two Dimensional Perfusion Angiography in Patients with Chronic Limb Threatening Ischaemia

Objective. Two dimensional (2D) perfusion angiography is a method that provides quantitative foot perfusion information from standard digital subtraction angiography acquisitions. The aim of this study was to test the reliability of this method in patients with chronic limb threatening ischaemia (CLTI) by investigating repeatability, and intra-observer and interobserver agreement. Methods: Twenty patients with CLTI and a below the knee endovascular revascularisation were included in a prospective clinical study. Prior to treatment two perfusion angiography runs were acquired with a five minute interval without performing an intervention. In these recordings, regions of interest were selected and time density curves and perfusion parameters were determined. To investigate intra-observer agreement one observer performed five measurements on the same acquisition for each patient. To investigate interobserver agreement three observers performed measurements on the same acquisition for each patient. Results were presented in Bland-Altman plots and as the intraclass correlation coefficient per parameter. Results: Two patients were excluded from repeatability analyses because of major motion artefacts. Repeatability analyses of the 18 remaining patients showed excellent correlation for every parameter (> .96). Intra-observer and interobserver agreement for all 20 patients were excellent for all parameters (1.00). Conclusion: Repeatability and intra-observer and interobserver agreement of 2D perfusion angiography in patients with CLTI were found to be excellent. It is therefore a reliable tool when used according to the standardised methods described in this study

CT colonography polyp matching: differences between experienced readers

The purpose of this study was to investigate if experienced readers differ when matching polyps shown by both CT colonography (CTC) and optical colonoscopy (OC) and to explore the reasons for discrepancy. Twenty-eight CTC cases with corresponding OC were presented to eight experienced CTC readers. Cases represented a broad spectrum of findings, not completely fulfilling typical matching criteria. In 21 cases there was a single polyp on CTC and OC; in seven there were multiple polyps. Agreement between readers for matching was analyzed. For the 21 single-polyp cases, the number of correct matches per reader varied from 13 to 19. Almost complete agreement between readers was observed in 15 cases (71%), but substantial discrepancy was found for the remaining six (29%) probably due to large perceived differences in polyp size between CT and OC. Readers were able to match between 27 (71%) and 35 (92%) of the 38 CTC detected polyps in the seven cases with multiple polyps. Experienced CTC readers agree to a considerable extent when matching polyps between CTC and subsequent OC, but non-negligible disagreement exist

Multi-centre, randomised non-inferiority trial of early treatment versus expectant management of patent ductus arteriosus in preterm infants (the BeNeDuctus trial):statistical analysis plan

Abstract Background Controversy exists about the optimal management of a patent ductus arteriosus (PDA) in preterm infants. A persistent PDA is associated with neonatal mortality and morbidity, but causality remains unproven. Although both pharmacological and/or surgical treatment are effective in PDA closure, this has not resulted in an improved neonatal outcome. In most preterm infants, a PDA will eventually close spontaneously, hence PDA treatment potentially increases the risk of iatrogenic adverse effects. Therefore, expectant management is gaining interest, even in the absence of convincing evidence to support this strategy. Methods/design The BeNeDuctus trial is a multicentre, randomised, non-inferiority trial assessing early pharmacological treatment (24–72 h postnatal age) with ibuprofen versus expectant management of PDA in preterm infants in Europe. Preterm infants with a gestational age of less than 28 weeks and an echocardiographic-confirmed PDA with a transductal diameter of > 1.5 mm are randomly allocated to early pharmacological treatment with ibuprofen or expectant management after parental informed consent. The primary outcome measure is the composite outcome of mortality, and/or necrotizing enterocolitis Bell stage ≥ IIa, and/or bronchopulmonary dysplasia, all established at a postmenstrual age of 36 weeks. Secondary short-term outcomes are comorbidity and adverse events assessed during hospitalization and long-term neurodevelopmental outcome assessed at a corrected age of 2 years. This statistical analysis plan focusses on the short-term outcome and is written and submitted without knowledge of the data. Trial registration ClinicalTrials.gov NTR5479. Registered on October 19, 2015, with the Dutch Trial Registry, sponsored by the United States National Library of Medicine Clinicaltrials.gov NCT02884219 (registered May 2016) and the European Clinical Trials Database EudraCT 2017-001376-28

A Cu2+ (S = 1/2) Kagom\'e Antiferromagnet: MgxCu4-x(OH)6Cl2

Spin-frustrated systems are one avenue for inducing macroscopic quantum states in materials. However, experimental realization of this goal has been difficult because of the lack of simple materials and, if available, the separation of the unusual magnetic properties arising from exotic magnetic states from behavior associated with chemical disorder, such as site mixing. Here we report the synthesis and magnetic properties of a new series of magnetically frustrated materials, MgxCu4-x(OH)6Cl2. Because of the substantially different ligand-field chemistry of Mg2+ and Cu2+, site disorder within the kagom\'e layers is minimized, as directly measured by X-ray diffraction. Our results reveal that many of the properties of these materials and related systems are not due to disorder of the magnetic lattice but rather reflect an unusual ground state.Comment: Accepted for publication in J. Am. Chem. Soc