Team dynamics in emergency surgery teams: results from a first international survey

Background: Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma\u2019s causes or the patient\u2019s personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods: An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients\u2019 and stakeholders\u2019 engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion: Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey\u2019s participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions

Climate-proofing spatial planning and water management projects: an analysis of 100 local and regional projects in the Netherlands

Since the turn of the century, an increasing number of local and regional authorities in Europe started making their city or region resilient to climate change, or ‘climate-proof’. Publications about the actual experiences with implementing these adaptation policies are as yet anecdotal, determined by the local context and the methods applied. In order to identify common processes and characteristics, moving beyond individual cases, this paper systematically assesses 100 spatial planning and water management projects in the Netherlands that included climate resilience as one of their objectives. We derive eight defining characteristics that not only increase climate resilience, but are also found to lead to a greater ‘quality’ of the project area. We structure these properties into a stylized sequence: (i) a longer timeframe, (ii) an integrative and sustainable approach, (iii) consideration of new spatial functions, (iv) a broader spatial context, (v) participation of multiple stakeholders, (vi) new opportunities for entrepreneurs, (vii) increased cost-effectiveness, and (viii) enhanced quality of the project area. The assessment also suggests four process-related conditions that contribute to the success of a project: early incorporation of adaptation; multi-actor collaboration and co-creation of knowledge; integrated, multifunctional and forward-looking solutions; and early political commitment

Steden en gemeenten adapteren

Cities and municipalities in Flanders will increasingly be confronted with the impacts of climate change. TheDepartment of LNE intends to support them by the prevention of and adaptation to these impacts by offeringan easily accessible toolbox with which local authorities can decrease their vulnerability. This toolbox will helpthe local authorities to ease, in an ‘automatic’ way, to develop a local adaptation plan. This report proposes thecharacteristics of such a toolbox. It is based on (i) an analysis of different steps in the adaptation decision-makingprocesses, (ii) a mapping of adaptation support needs of municipalities, (iii) an inventory and evaluation of existinginstruments for adaptation, (iv) the demonstration and testing existing instruments that meets the adaptationsupport needs of local authorities and (v) a description of the Adaptation Toolbox for Flanders, based on thefindings.Analysis of steps in adaptation processes. Based on an analysis of national and international adaptation processessix steps are distinguished that shape the decision-making process of climate change adaptation at the local level:fostering political commitment, climate impact and vulnerability analysis, identification of adaptation measures,prioritizing and choosing adaptation measures, implementing measures, and monitoring and evaluation. In practice,these steps will not always be taken subsequently but sometimes also in parallel. Stakeholder engagement isrelevant for all steps.Adaptation support needs of local authorities. Information on adaptation support needs of local authorities wasanalysed through a number of interviews with different types of municipalities across Flanders. Needs and desiresdepend on factors such as the size of a municipality, the available staff and funds, the motivation of staff involvedand the progress made in developing climate plans. The willingness of a wide variety of municipalities to participateand the interest in the issue appeared to be large, which also led to a very wide diversity of needs and wishes as tothe characteristics of a toolbox.Analysis of existing methods and tools. An inventory resulted in about 89 existing methods and tools that couldbe relevant for a Flemish toolbox, from Belgium, the Netherlands, and other Western countries. The tools wereorganized and evaluated according to a number of aspects, such as their specific purposes, the accessibility, therequired level of expertise, the type of climate effects, the ease or complexity of application, the level of scale, thetype of output and the potential for transfer to an application in Flanders. Furthermore, benefits and pitfalls areidentified. The 89 instruments were structured in a decision tree to ease the search for the most appropriate tool.Playzone. In a workshop, instruments that fit to the adaptation support needs were demonstrated and testedby the participants for their applicability in the Flemish context. This exercise made clear that many of the toolshave potential, but need to be translated to the Flemish situation, and for non-Dutch tools, translated. Many ofthem also require Flemish data. It is important that detailed data and other relevant information on climate risksand vulnerabilities will become available for Flanders, where this is currently sometimes the cases for Antwerpand a limited number of other cities and regions. This should preferably be at one location and compatible withsoftware systems used by Flemish municipalities. The toolbox should take the level of available knowledge andhuman resources into account as well as the need to integrate climate change adaptation with other policy areas.Participants confirmed the urgency of such a toolbox and also the feasibility.Describing the Adaptation Toolbox. Based on the inteviews, the steering group consultations, the analyses and theplayzone activity recommendations are formulated for the Adaptation Toolbox for Flemish municipalities and cities.Adaptation support needs and instrument specifications are fully considered. Recommendations are made on theAdaptation Toolbox, including: (a) bringing together information on climate impact and vulnerability in a GIS viewer;(b) a climate test for new and ongoing projects; (c) a database of adaptation measures, including informationon vulnerabilities, costs and effects; (d) a Climate Cuisine – a workshop to involve stakeholders in identifyingadaptation measures and developing an adaptation plan; (g) financial support on synergies in local budgets andhelp to find national and European subsidies to finance adaptation measures. In addition to an online toolbox, werecommend the development of an Adaptation Community where a lively dialogue will take place between localauthorities, provinces, companies, citizens, NGO’s and the Flemish authorities on adaptation practices and how todevelop than as efficient as possible

Climate adaptation services for the Netherlands: An operational approach to support spatial adaptation planning

There is a growing availability of climate change information, offered to scientists and policy makers through climate services. However, climate services are not well taken up by the policy-making and planning community. Climate services focus on primary impacts of climate change, e.g., the disclosure of precipitation and temperature data, and this seems insufficient in meeting their needs. In this paper, we argue that, in order to reach the spatial planning community, climate services should take on a wider perspective by translating climate data to policy-relevant indicators and by offering support in the design of adaptation strategies. We argue there should be more focus on translating consequences of climate change to land-use claims and subsequently discuss the validity, consequences and implications of these claims with stakeholders, so they can play a role in spatial planning processes where much of the climate adaptation takes place. The term Climate Adaptation Services is introduced as being a stepwise approach supporting the assessment of vulnerability in a wider perspective and include the design and appraisal of adaptation strategies in a multi-stakeholder setting. We developed the Climate Adaptation Atlas and the Climate Ateliers as tools within the Climate Adaptation Services approach to support decision-making and planning processes. In this paper, we describe the different steps of our approach and report how some of the challenges were addresse

Steden en gemeenten adapteren

Cities and municipalities in Flanders will increasingly be confronted with the impacts of climate change. TheDepartment of LNE intends to support them by the prevention of and adaptation to these impacts by offeringan easily accessible toolbox with which local authorities can decrease their vulnerability. This toolbox will helpthe local authorities to ease, in an ‘automatic’ way, to develop a local adaptation plan. This report proposes thecharacteristics of such a toolbox. It is based on (i) an analysis of different steps in the adaptation decision-makingprocesses, (ii) a mapping of adaptation support needs of municipalities, (iii) an inventory and evaluation of existinginstruments for adaptation, (iv) the demonstration and testing existing instruments that meets the adaptationsupport needs of local authorities and (v) a description of the Adaptation Toolbox for Flanders, based on thefindings.Analysis of steps in adaptation processes. Based on an analysis of national and international adaptation processessix steps are distinguished that shape the decision-making process of climate change adaptation at the local level:fostering political commitment, climate impact and vulnerability analysis, identification of adaptation measures,prioritizing and choosing adaptation measures, implementing measures, and monitoring and evaluation. In practice,these steps will not always be taken subsequently but sometimes also in parallel. Stakeholder engagement isrelevant for all steps.Adaptation support needs of local authorities. Information on adaptation support needs of local authorities wasanalysed through a number of interviews with different types of municipalities across Flanders. Needs and desiresdepend on factors such as the size of a municipality, the available staff and funds, the motivation of staff involvedand the progress made in developing climate plans. The willingness of a wide variety of municipalities to participateand the interest in the issue appeared to be large, which also led to a very wide diversity of needs and wishes as tothe characteristics of a toolbox.Analysis of existing methods and tools. An inventory resulted in about 89 existing methods and tools that couldbe relevant for a Flemish toolbox, from Belgium, the Netherlands, and other Western countries. The tools wereorganized and evaluated according to a number of aspects, such as their specific purposes, the accessibility, therequired level of expertise, the type of climate effects, the ease or complexity of application, the level of scale, thetype of output and the potential for transfer to an application in Flanders. Furthermore, benefits and pitfalls areidentified. The 89 instruments were structured in a decision tree to ease the search for the most appropriate tool.Playzone. In a workshop, instruments that fit to the adaptation support needs were demonstrated and testedby the participants for their applicability in the Flemish context. This exercise made clear that many of the toolshave potential, but need to be translated to the Flemish situation, and for non-Dutch tools, translated. Many ofthem also require Flemish data. It is important that detailed data and other relevant information on climate risksand vulnerabilities will become available for Flanders, where this is currently sometimes the cases for Antwerpand a limited number of other cities and regions. This should preferably be at one location and compatible withsoftware systems used by Flemish municipalities. The toolbox should take the level of available knowledge andhuman resources into account as well as the need to integrate climate change adaptation with other policy areas.Participants confirmed the urgency of such a toolbox and also the feasibility.Describing the Adaptation Toolbox. Based on the inteviews, the steering group consultations, the analyses and theplayzone activity recommendations are formulated for the Adaptation Toolbox for Flemish municipalities and cities.Adaptation support needs and instrument specifications are fully considered. Recommendations are made on theAdaptation Toolbox, including: (a) bringing together information on climate impact and vulnerability in a GIS viewer;(b) a climate test for new and ongoing projects; (c) a database of adaptation measures, including informationon vulnerabilities, costs and effects; (d) a Climate Cuisine – a workshop to involve stakeholders in identifyingadaptation measures and developing an adaptation plan; (g) financial support on synergies in local budgets andhelp to find national and European subsidies to finance adaptation measures. In addition to an online toolbox, werecommend the development of an Adaptation Community where a lively dialogue will take place between localauthorities, provinces, companies, citizens, NGO’s and the Flemish authorities on adaptation practices and how todevelop than as efficient as possible

Endoplasmic Reticulum Dynamics, Inheritance, and Cytoskeletal Interactions in Budding Yeast

The endoplasmic reticulum (ER) in Saccharomyces cerevisiae consists of a reticulum underlying the plasma membrane (cortical ER) and ER associated with the nuclear envelope (nuclear ER). We used a Sec63p-green fluorescent protein fusion protein to study motility events associated with inheritance of cortical ER and nuclear ER in living yeast cells. During M phase before nuclear migration, we observed thick, apparently rigid tubular extensions emanating from the nuclear ER that elongate, undergo sweeping motions along the cell cortex, and shorten. Two findings support a role for microtubules in this process. First, extension of tubular structures from the nuclear ER is inhibited by destabilization of microtubules. Second, astral microtubules, structures that undergo similar patterns of extension, cortical surveillance and retraction, colocalize with nuclear ER extensions. During S and G(2) phases of the cell cycle, we observed anchorage of the cortical ER at the site of bud emergence and apical bud growth. Thin tubules of the ER that extend from the anchored cortical ER display undulating, apparently random movement and move into the bud as it grows. Finally, we found that cortical ER morphology is sensitive to a filamentous actin–destabilizing drug, latrunculin-A, and to mutations in the actin-encoding ACT1 gene. Our observations support 1) different mechanisms and cytoskeletal mediators for the inheritance of nuclear and cortical ER elements and 2) a mechanism for cortical ER inheritance that is cytoskeleton dependent but relies on anchorage, not directed movement