Overcoming failure in infrastructure risk governance implementation: large dams journey

[EN] There is ample recognition of the risk inherent in our very existence and modes of social organization, with a reasonable expectation that implementing risk governance will result in enhanced resilience as a society. Despite this, risk governance is not a mainstream approach in the infrastructure sector, regardless of the increasing number of peer-reviewed published conceptualizations, mature procedures to support its application, or public calls to cope with systemic risks in our modern societies. This paper aims to offer a different view on the issue of risk governance, with focus in the analysis of the root causes of its relatively low degree of implementation in the infrastructure sector. We later analyze the impact of such essential causes, which we have grouped and labeled as the ontology, the concerns, the anathemas, and the forgotten, in the specific field of large dams. 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Risk-informed local action planning against flooding: lessons learnt and way forward for a case study in Spain

After 29 years of the largest flood event in modern times (with the highest recorded rainfall rate at the Iberian Peninsula with 817 mm in 24 hours), the municipality of Oliva faces the challenge of mitigating flood risk through the development and implementation of a local action plan, in line with other existent and ongoing structural measures for flood risk reduction. Located 65 km from Valencia, on the South-Eastern coast of Spain, Oliva is affected by pluvial, river and coastal flooding and it is characterized by a complex and wide-ranging geography and high seasonal variation in population. A quantitative flood risk analysis has been performed to support the definition of flood risk management strategies. This paper shows how hazard, exposure and vulnerability analyses provide valuable information for the development of a local action plan against flooding, for example by identifying areas with highest societal and economic risk levels. It is concluded that flood risk management actions, such as flood warning and monitoring or evacuation, should not be applied homogenously at local scale, but instead actions should be adapted based on spatial clustering. Implications about the impact of education and training on flood risk reduction are also addressed and discuss

Risk-informed local action planning against flooding: lessons learnt and way forward for a case study in Spain

After 29 years of the largest flood event in modern times (with the highest recorded rainfall rate at the Iberian Peninsula with 817 mm in 24 hours), the municipality of Oliva faces the challenge of mitigating flood risk through the development and implementation of a local action plan, in line with other existent and ongoing structural measures for flood risk reduction. Located 65 km from Valencia, on the South-Eastern coast of Spain, Oliva is affected by pluvial, river and coastal flooding and it is characterized by a complex and wide-ranging geography and high seasonal variation in population. A quantitative flood risk analysis has been performed to support the definition of flood risk management strategies. This paper shows how hazard, exposure and vulnerability analyses provide valuable information for the development of a local action plan against flooding, for example by identifying areas with highest societal and economic risk levels. It is concluded that flood risk management actions, such as flood warning and monitoring or evacuation, should not be applied homogenously at local scale, but instead actions should be adapted based on spatial clustering. Implications about the impact of education and training on flood risk reduction are also addressed and discuss

An integrated approach of flood risk assessment in the eastern part of Dhaka City

The flood risk is a function of the flood hazard, the exposed values, and their vulnerability. In addition to extreme hydrological events, different anthropogenic activities such as extensive urbanization and land use play an important role in producing catastrophic floods. Considerations of both physical and social dimensions are therefore equally important in flood risk assessment. However, very often the risk assessment studies focus either on physical or social dimensions. In addition, the available studies often focus on economic valuation of only direct tangible costs. In this study, we provide an integrated flood risk assessment approach that goes beyond the valuation of direct tangible costs, through incorporating physical dimensions in hazard and exposure and social dimensions in vulnerability. The method has been implemented in the Dhaka City, Bangladesh, an area internationally recognized as hot spot for flood risk. In this study, flood hazards for different return periods are calculated in spatial environment using a hydrologic model, HEC-RAS. Vulnerability is assessed through aggregation of various social dimensions, i.e., coping and adaptive capacities, and susceptibility. We assess vulnerability for both baseline and improved scenarios. In the baseline scenario, current early warning for study area is considered. In the alternative scenario, the warning system is expected to improve. Aggregating hazard, exposure and vulnerability, risk maps (in terms of both tangible and intangible costs) of several return period floods are produced for both baseline and improved scenarios. Compared to traditional assessments, the integrated assessment approach used in this study generates more information about the flood risk. Consequently, the results are useful in evaluating policy alternatives and minimizing property loss in the study area.The flood risk is a function of the flood hazard, the exposed values, and their vulnerability. In addition to extreme hydrological events, different anthropogenic activities such as extensive urbanization and land use play an important role in producing catastrophic floods. Considerations of both physical and social dimensions are therefore equally important in flood risk assessment. However, very often the risk assessment studies focus either on physical or social dimensions. In addition, the available studies often focus on economic valuation of only direct tangible costs. In this study, we provide an integrated flood risk assessment approach that goes beyond the valuation of direct tangible costs, through incorporating physical dimensions in hazard and exposure and social dimensions in vulnerability. The method has been implemented in the Dhaka City, Bangladesh, an area internationally recognized as hot spot for flood risk. In this study, flood hazards for different return periods are calculated in spatial environment using a hydrologic model, HEC-RAS. Vulnerability is assessed through aggregation of various social dimensions, i.e., coping and adaptive capacities, and susceptibility. We assess vulnerability for both baseline and improved scenarios. In the baseline scenario, current early warning for study area is considered. In the alternative scenario, the warning system is expected to improve. Aggregating hazard, exposure and vulnerability, risk maps (in terms of both tangible and intangible costs) of several return period floods are produced for both baseline and improved scenarios. Compared to traditional assessments, the integrated assessment approach used in this study generates more information about the flood risk. Consequently, the results are useful in evaluating policy alternatives and minimizing property loss in the study area

An international assessment of the adoption of enhanced recovery after surgery (ERAS®) principles across colorectal units in 2019–2020

AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units.MethodAn online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted.ResultsOf hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from ‘rarely’ to ‘always’ in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017.ConclusionsUptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation.AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units.MethodAn online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted.ResultsOf hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from ‘rarely’ to ‘always’ in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017.ConclusionsUptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation.A

An international assessment of the adoption of enhanced recovery after surgery (ERAS®) principles across colorectal units in 2019–2020

Aim: The Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units. Method: An online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted. Results: Of hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from ‘rarely’ to ‘always’ in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017. Conclusions: Uptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation

An international assessment of the adoption of enhanced recovery after surgery (ERAS®) principles across colorectal units in 2019–2020

Aim: The Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units. Method: An online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted. Results: Of hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from ‘rarely’ to ‘always’ in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017. Conclusions: Uptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation

The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit.

This is the peer reviewed version of the following article: The and E. S. o. C. c. groups (2018). "The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit." Colorectal Disease 20(S6): 69-89., which has been published in final form at https://doi.org/10.1111/codi.14371. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.BACKGROUND: Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice. METHODS: Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30-day major complication rate, defined as Clavien-Dindo grade III-V. RESULTS: Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, P < 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27-2.11, P < 0.001). CONCLUSIONS: Appropriate laparoscopic conversion should not be considered a treatment failure in modern practice. Conversion does not appear to place patients at increased risk of complications vs planned open surgery, supporting broadening of selection criteria for attempted laparoscopy in elective colonic resection