Operationalizing risk perception and preparedness behavior research for a multi-hazard context

Increasingly, citizens are being asked to take a more active role in disaster risk reduction (DRR), as decentralization of hazard governance has shifted greater responsibility for hazard preparedness actions onto individuals. Simultaneously, the taxonomy of hazards considered for DRR has expanded to include medical and social crises alongside natural hazards. Risk perception research emerged to support decision-makers with understanding how people characterize and evaluate different hazards to anticipate behavioral response and guide risk communication. Since its inception, the risk perception concept has been incorporated into many behavioral theories, which have been applied to examine preparedness for numerous hazard types. Behavioral theories have had moderate success in predicting or explaining preparedness behaviors; however, they are typically applied to a single hazard type and there is a gap in understanding which theories (if any) are suited for examining multiple hazard types simultaneously. This paper first reviews meta-analyses of behavioral theories to better understand performance. Universal lessons learnt are summarized for survey design. Second, theoretically based preparedness studies for floods, earthquakes, epidemics, and terrorism are reviewed to assess the conceptual requirements for a ‘multi-hazard’ preparedness approach. The development of an online preparedness self-assessment and learning platform is discussed

Adopt-an-Apprentice Teacher: Re-Inventing Early Field Experiences

The goal of this chapter was to explore the impact of a field-centric, grade-band, and subject-area specific field experience model that is linked to corresponding coursework on novice teacher candidates\u27 conceptions of what it means to be a teacher. Grounded in the work of scholars such as Dewey, Piaget, and Vygotsky, this study explores three questions: What aspects of the Adopt-an-Apprentice program do teacher candidates view as beneficial to their understanding of the profession and their development as teachers? What benefits, if any, do classroom teachers derive from hosting teacher candidates in the Adopt-an-Apprentice program? What is the impact of grade band/subject-area field experiences on teacher candidates\u27 conceptions of being a teacher? Using quantitative and qualitative surveys, the study illustrates how coursework linked to authentic application in clinical settings empowered novice teacher candidates to understand and engage content, pedagogy, and standards

Altruism, Scepticism, and Collective Decision-Making in Foreign-Born U.S. Residents in a Tuberculosis Vaccine Trial

Background: The current vaccine against tuberculosis, BCG, is effective when given in most TB-endemic countries at birth but has diminished efficacy against pulmonary TB after 15–20 years. As a result, new booster vaccines for adolescents and adults are being developed to realize the World Health Organization target of global elimination of TB by 2035. Multiple TB candidates thus are in active clinical development. Methods: One of these, DAR-901, is advancing in human clinical trials. These clinical trials are conducted in BCG immunized adults with and without HIV infection in order to assess safety and efficacy among the people most in need of a new vaccine. A Phase I dose escalation trial of DAR-901 in BCG-immunized adults with or without HIV infection was conducted between 2014 and 2016. This offered an unusual opportunity to qualitatively examine why foreign-born adults living in the United States – a poorly studied population – decide to participate, or not, in clinical trials. Results: We conducted a qualitative study of individuals who were recruited to participate in this Phase I vaccine trial, interviewing those who agreed and declined to participate. We found diverse motivations for participation or refusal; varied understandings of tuberculosis and vaccines; and complex views about how ‘informed consent’ can be at odds with cultural understandings of power, authority, and medical decision-making. These dynamics included: knowledge (direct or indirect) of tuberculosis, a desire to be altruistic and simultaneous hopes for personal gain as well as concerns over what remuneration for participation could mean, the importance of personal relationships with care providers in shaping volunteerism, concerns over privacy, and evidence of how culture and history shape medical decision-making. Conclusions: This US-based trial, aimed at addressing a crucible global health issue, raises productive questions about the interface between altruism and scepticism regarding clinical research participation

Clinical and Epidemiological Correlates of Genotypes within the Mycobacterium avium Complex Defined by Restriction and Sequence Analysis of hsp65

Species identification of isolates of the Mycobacterium avium complex (MAC) remains a difficult task. Although M. avium and Mycobacterium intracellulare can be identified with expensive, commercially available probes, many MAC isolates remain unresolved, including those representing Mycobacterium lentiflavum as well as other potentially undefined species. PCR restriction analysis (PRA) of the hsp65 gene has been proposed as a rapid and inexpensive approach. We applied PRA to 278 MAC isolates, including 126 from blood of human immunodeficiency virus (HIV)-infected patients, 59 from sputum of HIV-negative patients with chronic obstructive pulmonary disease, 88 from environmental sources, and 5 pulmonary isolates from a different study. A total of 15 different PRA patterns were observed. For 27 representative isolates, a 441-bp fragment of the hsp65 gene was sequenced; based on 54 polymorphic sites, 18 different alleles were defined, including 12 alleles not previously reported. Species and phylogenetic relationships were more accurately defined by sequencing than by PRA or commercial probe. The distribution of PRA types and, by implication, phylogenetic lineages among blood isolates was significantly different from that for pulmonary and environmental isolates, suggesting that particular lineages have appreciably greater virulence and invasive potential

Communication With Children and Families About Disaster: Reviewing Multi-disciplinary Literature 2015-2017

PURPOSE OF REVIEW: To identify strategies for communicating with youth and children pre- and post-disaster in the context of a broader survey of child participation in disaster risk reduction as well as methods for communication with children. RECENT FINDINGS: Youth and children are capable of peer and community education and activism concerning disaster issues and such participation benefits the young actors. Family and sibling support are important in easing the impact of trauma on children. Contemporary forms of psychological first aid appear to do no harm and in line with current evidence. Generally, more evidence from evaluations is necessary to guide the development of communication strategies. Children are growing up in increasingly urban environments with less contact with nature and greater reliance on techno-social systems. Thus, young people may misunderstand natural hazards. Schools and conscious parenting can play important roles in building understanding and psychological resilience

Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness

Introduction Adrenal incidentalomas are lesions that are incidentally identified while scanning for other conditions. While most are benign and hormonally non-functional, around 20% are malignant and/or hormonally active, requiring prompt intervention. Malignant lesions can be aggressive and life-threatening, while hormonally active tumours cause various endocrine disorders, with significant morbidity and mortality. Despite this, management of patients with adrenal incidentalomas is variable, with no robust evidence base. This project aimed to establish more effective and timely management of these patients. Methods We developed a web-based, electronic Adrenal Incidentaloma Management System (eAIMS), which incorporated the evidence-based and National Health Service–aligned 2016 European guidelines. The system captures key clinical, biochemical and radiological information necessary for adrenal incidentaloma patient management and generates a pre-populated outcome letter, saving clinical and administrative time while ensuring timely management plans with enhanced safety. Furthermore, we developed a prioritisation strategy, with members of the multidisciplinary team, which prioritised high-risk individuals for detailed discussion and management. Patient focus groups informed process-mapping and multidisciplinary team process re-design and patient information leaflet development. The project was partnered by University Hospital of South Manchester to maximise generalisability. Results Implementation of eAIMS, along with improvements in the prioritisation strategy, resulted in a 49% reduction in staff hands-on time, as well as a 78% reduction in the time from adrenal incidentaloma identification to multidisciplinary team decision. A health economic analysis identified a 28% reduction in costs. Conclusions The system’s in-built data validation and the automatic generation of the multidisciplinary team outcome letter improved patient safety through a reduction in transcription errors. We are currently developing the next stage of the programme to proactively identify all new adrenal incidentaloma cases

The cost of treating diabetic ketoacidosis in an adolescent population in the UK: a national survey of hospital resource use

Aims: Adolescents with Type 1 diabetes commonly experience episodes of ketoacidosis. In 2014, we conducted a nationwide survey on the management of diabetic ketoacidosis in young people. The survey reported how individual adolescents with diabetes were managed. However, the costs of treating diabetic ketoacidosis were not reported. Methods: Using this mixed population sample of adolescents, we took a ‘bottom-up’ approach to cost analysis aiming to determine the total expense associated with treating diabetic ketoacidosis. The data were derived using the information from the national UK survey of 71 individuals, collected via questionnaires sent to specialist paediatric diabetes services in England and Wales. Results: Several assumptions had to be made when analysing the data because the initial survey collection tool was not designed with a health economic model in mind. The mean time to resolution of diabetic ketoacidosis was 15.0 h [95% confidence interval (CI) 13.2, 16.8] and the mean total length of stay was 2.4 days (95% CI 1.9, 3.0). Based on data for individuals and using the British Society of Paediatric Endocrinology and Diabetes (BSPED) guidelines, the cost analysis shows that for this cohort, the average cost for an episode of diabetic ketoacidosis was £1387 (95% CI 1120, 1653). Regression analysis showed a significant cost saving of £762 (95% CI 140, 1574; P = 0.04) among those treated using BSPED guidelines. Conclusion: We have used a bottom-up approach to calculate the costs of an episode of diabetic ketoacidosis in adolescents. These data suggest that following treatment guidelines can significantly lower the costs for managing episodes of diabetic ketoacidosis

Polyclonal Infections Due to Mycobacterium Avium Complex in Patients with AIDS Detected by Pulsed-field Gel Electrophoresis of Sequential Clinical Isolates.

Invasive infection with organisms of the Mycobacterium avium complex (MAC) is common among patients with advanced human immunodeficiency virus infection. In previous studies, we analyzed multiple individual colonies of MAC isolated from specimens obtained at the same time and observed that 14 to 20% of patients are simultaneously infected with more than one strain. In this study, we examined sequential isolates from 12 patients with AIDS who had two or more MAC isolates available from clinical specimens collected more than 1 week apart; the intervals between the first and last specimens ranged from 8 to 192 (median, 46) days. For each isolate, restriction digests of genomic DNA were analyzed by pulsed-field gel electrophoresis; DNA was prepared by using a protocol, described here in detail, which had been optimized for conditions of bacterial growth and lysis. The pulsed-field gel electrophoresis analysis identified four patients (33%) infected with two different MAC strains. Both M. avium and M. intracellulare were cultured from blood specimens from two patients. In each of the four patients, the second strain was identified from a culture taken within 14 days of the initial study isolate, and in three of these patients, the first strain was detected again in a subsequent culture. These observations suggest that the presence of two different strains among isolates from sequential cultures may reflect ongoing polyclonal infection. We conclude that polyclonal infection with MAC is common among patients with AIDS. The identification of such infections may be critical in the development of effective treatments