Conflicting world views: disjuncture between climate change knowledge, land use planning and disaster resilience in remote Indigenous communities in northern Australia

This paper examines the links between emergency management and land use planning in four remote Indigenous communities in tropical northern Australia and the extent to which such linkages produced better disaster resilience in these communities. The case study communities were chosen because they are in locations likely to experience increased frequency and/or intensity of extreme weather events, both slow (sea level rise, drought) and rapid onset (storm surges, cyclones, floods) as a consequence of climate change. We compared land use planning legislation, state level planning policies, statutory planning schemes, property registration systems and emergency management systems. We found a clear disjuncture between understanding the likely impacts of climate change and the collection of emergency management data and the consideration of hazards and risks in land use planning systems. We conclude that the land use planning systems in tropical northern Australia are still geared toward promoting and facilitating development and have not evolved sufficiently to take account of climate change impacts, including sea level rise. This disjuncture is particularly evident in the context of remote Indigenous communities in Australia and reforms to land use planning systems are urgently required to address this disjuncture.Copyright Information: Copyright the author

The Role of Children in Adapting to Climate Change

Children’s voices on disaster risk reduction (DRR) have been sidelined by disaster management and relief efforts targeted at adults. The latest collaborative research by IDS and Plan International addresses this imbalance. It examines how children’s views can be heard within different policy spaces and challenges assumptions about their lack of agency. Understanding the benefits of child-centred DRR approaches is informing further research into the role children might play in addressing the multiple threats to their futures posed by climate change

Children as Agents for Disaster Risk Reduction: Lessons from El Salvador and The Philippine

This paper explores children’s voices in disaster risk reduction (DRR) policy spaces and their capacity to communicate disaster risk to their parents and larger community. It challenges the traditional development approaches which perceive children as passive victims during and after disasters. The argument is supported by field research in El Salvador and Philippines conducted by Plan International, which highlights the contribution of children to minimising risks in disaster–prone developing countries

Factors influencing the uptake and use of nicotine replacement therapy and e-cigarettes in pregnant women who smoke: a qualitative evidence synthesis

Background: Nicotine replacement therapy (NRT) delivers nicotine without the toxic chemicals present in tobacco smoke. It is an effective smoking cessation aid in non‐pregnant smokers, but there is less evidence of effectiveness in pregnancy. Systematic review evidence suggests that pregnant women do not adhere to NRT as prescribed, which might undermine effectiveness. Electronic cigarettes (e‐cigarettes) have grown in popularity, but effectiveness and safety in pregnancy are not yet established. The determinants of uptake and use of NRT and e‐cigarettes in pregnancy are unknown.Objectives: To explore factors affecting uptake and use of NRT and e‐cigarettes in pregnancy.Search methodsWe searched MEDLINE(R), CINAHL and PsycINFO on 1 February 2019. We manually searched OpenGrey database and screened references of included studies and relevant reviews. We also conducted forward citation searches of included studies.Selection criteria: We selected studies that used qualitative methods of data collection and analysis, included women who had smoked in pregnancy, and elicited participants' views about using NRT/e‐cigarettes for smoking cessation or harm reduction (i.e. to smoke fewer cigarettes) during pregnancy.Data collection and analysis: We identified determinants of uptake and use of NRT/e‐cigarettes in pregnancy using a thematic synthesis approach. Two review authors assessed the quality of included studies with the Wallace tool. Two review authors used the CERQual approach to assess confidence in review findings. The contexts of studies from this review and the relevant Cochrane effectiveness review were not similar enough to fully integrate findings; however, we created a matrix to juxtapose findings from this review with the descriptions of behavioural support from trials in the effectiveness review.Main results: We included 21 studies: 15 focused on NRT, 3 on e‐cigarettes, and 3 on both. Studies took place in five high‐income countries. Most studies contributed few relevant data; substantially fewer data were available on determinants of e‐cigarettes. Many studies focused predominantly on issues relating to smoking cessation, and determinants of NRT/e‐cigarette use was often presented as one of the themes.We identified six descriptive themes and 18 findings within those themes; from these we developed three overarching analytical themes representing key determinants of uptake and adherence to NRT and/or e‐cigarettes in pregnancy. The analytical themes show that women's desire to protect their unborn babiesfrom harm is one of the main reasons they use these products. Furthermore, women consider advice from health professionals when deciding whether to use NRT or e‐cigarettes; when health professionals tell women that NRT or e‐cigarettes are safer than smoking and that it is okay for them to use these in pregnancy, women report feeling more confident about using them. Conversely, women who are told that NRT or e‐cigarettes are as dangerous or more dangerous than smoking and that they should not use them during pregnancy feel less confident about using them. Women's past experiences with NRT can also affect their willingness to use NRT in pregnancy; women who feel that NRT had worked for them (or someone they know) in the past were more confident about using it again. However, women who had negative experiences were more reluctant to use NRT.No trials on e‐cigarette use in pregnancy were included in the Cochrane effectiveness review, so we considered only NRT findings when integrating results from this review and the effectiveness review. No qualitative studies were conducted alongside trials, making full integration of the findings challenging. Women enrolled in trials would have agreed to being allocated to NRT or control group and would have received standardised information on NRT at the start of the trial. Overall, the findings of this synthesis are less relevant to women's decisions about starting NRT in trials and more likely to help explain trial participants' adherence to NRT after starting it.We considered most findings to be of moderate certainty; we assessed findings on NRT use as being of higher certainty than those on e‐cigarette use. This was mainly due to the limited data from fewer studies (only in the UK and USA) that contributed to e‐cigarette findings. Overall, we judged studies to be of acceptable quality with only minor methodological issues.Authors' conclusions: Consistent messages from health professionals, based on high‐quality evidence and clearly explaining the safety of NRT and e‐cigarettes compared to smoking in pregnancy, could help women use NRT and e‐cigarettes more consistently/as recommended. This may improve their attitudes towards NRT or e‐cigarettes, increase their willingness to use these in their attempt to quit, and subsequently encourage them to stay smoke‐free

Attitudes to E-Cigarettes and Cessation Support for Pregnant Women from English Stop Smoking Services: A Mixed Methods Study

Smoking in pregnancy remains a public health problem. In the UK e-cigarettes are the most popular aid to quitting smoking outside of pregnancy, but we don’t know the extent of e-cigarette use in pregnancy or how English Stop Smoking Services (SSS) respond to pregnant women who vape. In 2015 we surveyed SSS managers about cessation support for pregnant women and responses to clients who vaped. Subsequently we interviewed a sub-sample of managers to seek explanations for the SSS’ position on e-cigarettes; interviews were thematically analysed. Survey response rate was 67.8% (72/106); overall managers reported 2.2% (range 1.4–4.3%) of pregnant clients were using e-cigarettes. Most SSS reported supporting pregnant women who already vaped, but would not recommend e-cigarette use; for women that were still smoking and not using e-cigarettes, 8.3% of SSS were likely/very likely to advise using e-cigarettes, with 56.9% of SSS unlikely/very unlikely to advise using them. Fifteen respondents were interviewed; interviewees were generally positive about the potential of e-cigarettes for cessation in pregnancy although concerns about perceived lack of evidence for safety were expressed and most wanted research on this. Clear guidance on e-cigarette use informed by pregnancy specific research will assist SSS to provide consistent evidence-based support

High Antibody Titer against Apical Membrane Antigen-1 Is Required to Protect against Malaria in the Aotus Model

A Plasmodium falciparum 3D7 strain Apical Membrane Antigen-1 (AMA1) vaccine, formulated with AS02A adjuvant, slowed parasite growth in a recent Phase 1/2a trial, however sterile protection was not observed. We tested this AS02A, and a Montanide ISA720 (ISA) formulation of 3D7 AMA1 in Aotus monkeys. The 3D7 parasite does not invade Aotus erythrocytes, hence two heterologous strains, FCH/4 and FVO, were used for challenge, FCH/4 AMA1 being more homologous to 3D7 than FVO AMA1. Following three vaccinations, the monkeys were challenged with 50,000 FCH/4 or 10,000 FVO parasites. Three of the six animals in the AMA+ISA group were protected against FCH/4 challenge. One monkey did not become parasitemic, another showed only a short period of low level parasitemia that self-cured, and a third animal showed a delay before exhibiting its parasitemic phase. This is the first protection shown in primates with a recombinant P. falciparum AMA1 without formulation in Freund's complete adjuvant. No animals in the AMA+AS02A group were protected, but this group exhibited a trend towards reduced growth rate. A second group of monkeys vaccinated with AMA+ISA vaccine was not protected against FVO challenge, suggesting strain-specificity of AMA1-based protection. Protection against FCH/4 strain correlated with the quantity of induced antibodies, as the protected animals were the only ones to have in vitro parasite growth inhibitory activity of >70% at 1∶10 serum dilution; immuno-fluorescence titers >8,000; ELISA titers against full-length AMA1 >300,000 and ELISA titer against AMA1 domains1+2 >100,000. A negative correlation between log ELISA titer and day 11 cumulative parasitemia (Spearman rank r = −0.780, p value = 0.0001), further confirmed the relationship between antibody titer and protection. High titers of cross-strain inhibitory antibodies against AMA1 are therefore critical to confer solid protection, and the Aotus model can be used to down-select future AMA1 formulations, prior to advanced human trials

Empowering young people and strengthening resilience: Youth-centred participatory video as a tool for climate change adaptation and disaster risk reduction

Young people regularly face great hurdles to get their voices heard, while research and practice in the disaster and climate change community commonly represent young people as passive victims requiring protection. Consequently, their capacities to inform decision-making processes, communicate risks to their communities and take direct action to reduce risks have been neglected. This paper presents empirical data from participatory video (PV) methods with groups of young people in three communities in Eastern Samar, the Philippines. Producing these videos enabled groups to research, document and raise awareness of disaster risk, and use screening events to mobilise and advocate for risk reduction measures in their communities. The results suggest that the PV process was an effective tool for empowering young people to raise important issues with decision-makers and advocate change on behalf of their communities.15 page(s

Exploring the circumstances surrounding flood fatalities in Australia—1900–2015 and the implications for policy and practice

This paper documents the analysis of the circumstances surrounding fatalities due to flooding in Australia between 1900 and 2015. This longitudinal investigation is important to understand changing trends in social vulnerability and to inform efficient and strategic risk reduction strategies. The basis of this analysis was PerilAUS, Risk Frontiers’ database of historical natural hazard impacts in Australia. This data was augmented and verified using coronial inquest records which provide detailed data concerning the social, demographic and environmental circumstances of each fatality. A statistical analysis of the data was undertaken, examining demographics (age, gender), location (state), seasonality, circumstances surrounding the fatality, environmental factors (e.g. the event intensity) and social factors (e.g. the decisions or actions which led to death). Overall there have been 1859 fatalities identified, with distinct trends in relation to gender, age, activity and reason behind the activity. Flood deaths have been declining. The majority of the fatalities are male (79.3%): however, since the 1960s the proportion of female to male fatalities has increased. Children and young adults (<29 years) make up the greatest proportion of the fatalities (53.8% of cases where age is known). The highest proportions of fatalities occurred while victims attempted to cross a flood-impacted bridge or road. The recommendations for emergency management policy and practice are discussed, outlining the need for a new approach that accounts for a continuum of measures including regulation and incentive, education and structural intervention.This research was funded by a research grant from the Bushfire and Natural Hazards Cooperative Research Centre (BNHCRC). Ethical approval for the project was granted from the Macquarie University Human Research Ethics Committee, reference no. 5201400073.Peer Reviewe

High Multiplicity Infection by HIV-1 in Men Who Have Sex with Men

Elucidating virus-host interactions responsible for HIV-1 transmission is important for advancing HIV-1 prevention strategies. To this end, single genome amplification (SGA) and sequencing of HIV-1 within the context of a model of random virus evolution has made possible for the first time an unambiguous identification of transmitted/founder viruses and a precise estimation of their numbers. Here, we applied this approach to HIV-1 env analyses in a cohort of acutely infected men who have sex with men (MSM) and found that a high proportion (10 of 28; 36%) had been productively infected by more than one virus. In subjects with multivariant transmission, the minimum number of transmitted viruses ranged from 2 to 10 with viral recombination leading to rapid and extensive genetic shuffling among virus lineages. A combined analysis of these results, together with recently published findings based on identical SGA methods in largely heterosexual (HSX) cohorts, revealed a significantly higher frequency of multivariant transmission in MSM than in HSX [19 of 50 subjects (38%) versus 34 of 175 subjects (19%); Fisher's exact p = 0.008]. To further evaluate the SGA strategy for identifying transmitted/founder viruses, we analyzed 239 overlapping 5′ and 3′ half genome or env-only sequences from plasma viral RNA (vRNA) and blood mononuclear cell DNA in an MSM subject who had a particularly well-documented virus exposure history 3–6 days before symptom onset and 14–17 days before peak plasma viremia (47,600,000 vRNA molecules/ml). All 239 sequences coalesced to a single transmitted/founder virus genome in a time frame consistent with the clinical history, and a molecular clone of this genome encoded replication competent virus in accord with model predictions. Higher multiplicity of HIV-1 infection in MSM compared with HSX is consistent with the demonstrably higher epidemiological risk of virus acquisition in MSM and could indicate a greater challenge for HIV-1 vaccines than previously recognized