A New Pedagogy to Enhance the Safety and Resilience of Journalists in Dangerous Environments Globally

Risks to journalists are rising with disasters, epidemics, physical, mental and digital harassment all increasing globally. Some 1382 journalists have been killed since 1992 and 246 are imprisoned. However, the threat type has been changing, with the majority of journalists killed annually being ones working in their own country, often who are targeted for assassination. In response, UNESCO and others have called for research into best practice for safety education to halt this and the consequential decline in global media freedom. This five-year award winning project, A Holistic Humanitarian Approach to Enhance the Safety and Resilience of Journalists Globally, tested the hypothesis that a new pedagogy based on a ‘holistic humanitarian’ philosophy would be more effective in protecting journalists working in dangerous domains globally than existing provisions. The little-changed 30-year-old dominant international provision, the ‘military battlefield’ pedagogy, is used by the world’s major news organizations like BBC, CNN and the New York Times. This new pedagogy adapted and customized best practice from other professions and used Taylor’s 2020 Competencies for Disaster Healthcare professionals. A new program was devised and the two international cohorts who took it in 2018 and 2019 judged that it ‘very significantly’ enhanced their resilience and safety skills. Its concentration on group and individual physical and mental resilience building, risk mitigation, psychology, communication, self-defence, and digital security skill acquisition was a paradigm shift in training internationally for news professionals in dangerous environments. The research, thus, proved the study’s hypotheses

Spalling of Concrete - Implications for Structural Performance in Fire

This preliminary paper is a progress report on an analytical investigation into the implications of explosive spalling on the fire performance of reinforced concrete structural elements and whole structures. This study does not attempt to predict whether spalling will occur. For accurate prediction of the occurrence of spalling a complete and fully coupled hygro-thermal-mechanical (HTM) analysis is required, as described by a comprehensive review of current research into the parameters and mechanisms that influence spalling, including a review of physical spalling criteria. This paper describes the structural performance of spalled concrete elements, using finite element analysis where spalling is modelled by removing layers of concrete when a set of spalling criteria are met. The method is presented using a case study of a simply supported reinforced concrete beam, where the analytical results indicate that spalling invariably triggers an early failure (well short of the required FRR rating) of a beam exposed to the standard fire

Effective weakly supervised semantic frame induction using expression sharing in hierarchical hidden Markov models

We present a framework for the induction of semantic frames from utterances in the context of an adaptive command-and-control interface. The system is trained on an individual user's utterances and the corresponding semantic frames representing controls. During training, no prior information on the alignment between utterance segments and frame slots and values is available. In addition, semantic frames in the training data can contain information that is not expressed in the utterances. To tackle this weakly supervised classification task, we propose a framework based on Hidden Markov Models (HMMs). Structural modifications, resulting in a hierarchical HMM, and an extension called expression sharing are introduced to minimize the amount of training time and effort required for the user. The dataset used for the present study is PATCOR, which contains commands uttered in the context of a vocally guided card game, Patience. Experiments were carried out on orthographic and phonetic transcriptions of commands, segmented on different levels of n-gram granularity. The experimental results show positive effects of all the studied system extensions, with some effect differences between the different input representations. Moreover, evaluation experiments on held-out data with the optimal system configuration show that the extended system is able to achieve high accuracies with relatively small amounts of training data

Exercise, APOE, and Working Memory: MEG and Behavioral Evidence for Benefit of Exercise in Epsilon4 Carriers

Performance on the Sternberg working memory task, and MEG cortical response on a variation of the Sternberg task were examined in middle-aged carriers and non-carriers of the APOE ε4 allele. Physical activity was also assessed to examine whether exercise level modifies the relationship between APOE genotype and neurocognitive function. Regression revealed that high physical activity was associated with faster RT in the six- and eight-letter conditions of the Sternberg in ε4 carriers, but not in the non-carriers after controlling for age, gender, and education (N = 54). Furthermore, the MEG analysis revealed that sedentary ε4 carriers exhibited lower right temporal lobe activation on matching probe trials relative to high-active ε4 carriers, while physical activity did not distinguish non-carriers (N = 23). The M170 peak was identified as a potential marker for pre-clinical decline as ε4 carriers exhibited longer M170 latency, and highly physically active participants exhibited greater M170 amplitude to matching probe trials

Structural capacity in fire of laminated timber elements in compartments with exposed timber surfaces

In compartment fires with boundaries consisting of exposed mass timber surfaces – for example in compartments with exposed cross-laminated timber (CLT) walls or floors – the thermal penetration depth, i.e. the depth of timber heated to temperatures significantly above ambient behind the char-timber interface, during fire exposure may have a significant influence on the load bearing capacity of structural mass timber buildings, particularly in the decay phase of a real fire. This paper presents in-depth timber temperature measurements obtained during a series of full-scale fire experiments in compartments with partially exposed CLT boundaries, including decay phases. During experiments in which the timber surfaces achieved auto-extinction after consumption of the compartment fuel load, the thermal penetration depth continued to increase for more than one hour, whilst the progression of the in-depth charring front effectively halted at extinction. A simple calculation model is presented to demonstrate that this ongoing progression of thermal penetration continues to reduce the structural load bearing capacity of the CLT elements, thereby increasing the potential for structural collapse during the decay phase of the fire. This issue is considered to be most important for timber compression elements. Currently utilised structural fire design methods for mass timber generally assume a fixed ‘zero strength layer’ depth to account for thermally affected timber behind the char line; however they make no explicit attempt to account for these decay-phase effects

International comparison of health spending and utilization among people with complex multimorbidity.

OBJECTIVE: The objective of this study was to explore cross-country differences in spending and utilization across different domains of care for a multimorbid persona with heart failure and diabetes. DATA SOURCES: We used individual-level administrative claims or registry data from inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States (US). DATA COLLECTION/EXTRACTION METHODS: Data collected by ICCONIC partners. STUDY DESIGN: We retrospectively analyzed age-sex standardized utilization and spending of an older person (65-90 years) hospitalized with a heart failure exacerbation and a secondary diagnosis of diabetes across five domains of care: hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, and outpatient drugs. PRINCIPAL FINDINGS: Sample sizes ranged from n = 1270 in Spain to n = 21,803 in the United States. Mean age (standard deviation [SD]) ranged from 76.2 (5.6) in the Netherlands to 80.3 (6.8) in Sweden. We observed substantial variation in spending and utilization across care settings. On average, England spent $10,956 per person in hospital care while the United States spent$30,877. The United States had a shorter length of stay over the year (18.9 days) compared to France (32.9) and Germany (33.4). The United States spent more days in facility-based rehabilitative care than other countries. Australia spent $421 per person in primary care, while Spain (Aragon) spent$1557. The United States and Canada had proportionately more visits to specialist providers than primary care providers. Across almost all sectors, the United States spent more than other countries, suggesting higher prices per unit. CONCLUSION: Across 11 countries, there is substantial variation in health care spending and utilization for a complex multimorbid persona with heart failure and diabetes. Drivers of spending vary across countries, with the United States being the most expensive country due to high prices and higher use of facility-based rehabilitative care

Differences in health care spending and utilization among older frail adults in high-income countries: ICCONIC hip fracture persona.

ObjectiveThis study explores differences in spending and utilization of health care services for an older person with frailty before and after a hip fracture.Data sourcesWe used individual-level patient data from five care settings.Study designWe compared utilization and spending of an older person aged older than 65 years for 365 days before and after a hip fracture across 11 countries and five domains of care as follows: acute hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, and outpatient drugs. Utilization and spending were age and sex standardized..Data collection/extraction methodsThe data were compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries as follows: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States.Principal findingsThe sample ranged from 1859 patients in Spain to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia. The majority of patients across countries were female. Relative to other countries, the United States had the lowest inpatient length of stay (11.3), but the highest number of days were spent in post-acute care rehab (100.7) and, on average, had more visits to specialist providers (6.8 per year) than primary care providers (4.0 per year). Across almost all sectors, the United States spent more per person than other countries per unit ($13,622 per hospitalization,$233 per primary care visit, $386 per MD specialist visit). Patients also had high expenditures in the year prior to the hip fracture, mostly concentrated in the inpatient setting.ConclusionAcross 11 high-income countries, there is substantial variation in health care spending and utilization for an older person with frailty, both before and after a hip fracture. The United States is the most expensive country due to high prices and above average utilization of post-acute rehab care

Differences in health outcomes for high-need high-cost patients across high-income countries.

ObjectiveThis study explores variations in outcomes of care for two types of patient personas-an older frail person recovering from a hip fracture and a multimorbid older patient with congestive heart failure (CHF) and diabetes.Data sourcesWe used individual-level patient data from 11 health systems.Study designWe compared inpatient mortality, mortality, and readmission rates at 30, 90, and 365 days. For the hip fracture persona, we also calculated time to surgery. Outcomes were standardized by age and sex.Data collection/extraction methodsData was compiled by the International Collaborative on Costs, Outcomes and Needs in Care across 11 countries for the years 2016-2017 (or nearest): Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States.Principal findingsThe hip sample across ranged from 1859 patients in Aragon, Spain, to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia, and the majority of hip patients across countries were female. The congestive heart failure (CHF) sample ranged from 742 patients in England to 21,803 in the United States. Mean age ranged from 77.2 in the United States to 80.3 in Sweden, and the majority of CHF patients were males. Average in-hospital mortality across countries was 4.1%. for the hip persona and 6.3% for the CHF persona. At the year mark, the mean mortality across all countries was 25.3% for the hip persona and 32.7% for CHF persona. Across both patient types, England reported the highest mortality at 1 year followed by the United States. Readmission rates for all periods were higher for the CHF persona than the hip persona. At 30 days, the average readmission rate for the hip persona was 13.8% and 27.6% for the CHF persona.ConclusionAcross 11 countries, there are meaningful differences in health system outcomes for two types of patients

A methodology for identifying high-need, high-cost patient personas for international comparisons.

ObjectiveTo establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally.Data sourcesLinked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States.Study designWe outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine. We define two patient profiles using accessible patient-level datasets linked across different domains of care-hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, long-term care, home-health care, and outpatient drugs. The personas include a frail older adult with a hip fracture with subsequent hip replacement and an older person with complex multimorbidity, including heart failure and diabetes. We demonstrate their comparability by examining the characteristics and clinical diagnoses captured across countries.Data collection/extraction methodsData collected by ICCONIC partners.Principal findingsAcross 11 countries, the identification of HNHC patient personas was feasible to examine variations in healthcare utilization, spending, and patient outcomes. The ability of countries to examine linked, individual-level data varied, with the Netherlands, Canada, and Germany able to comprehensively examine care across all seven domains, whereas other countries such as England, Switzerland, and New Zealand were more limited. All countries were able to identify a hip fracture persona and a heart failure persona. Patient characteristics were reassuringly similar across countries.ConclusionAlthough there are cross-country differences in the availability and structure of data sources, countries had the ability to effectively identify comparable HNHC personas for international study. This work serves as the methodological paper for six accompanying papers examining differences in spending, utilization, and outcomes for these personas across countries