Integrating Recovery within a Resilience Framework: Empirical Insights and Policy Implications from Regional Australia

"Within Australia's federal system, responsibility for preventing, preparing for, responding to and recovering from natural disasters is shared between the three tiers of government. Intergovernmental policy and funding arrangements are premised on shared responsibility and aim to foster individual, business and community resilience. These arrangements underpin Australia's international reputation for effectiveness in its management of natural disasters. The capacity of the diverse networks that comprise the disaster management system to coordinate and deliver in the preparedness and response phases of a disaster, and to provide relief in the immediate aftermath, has been developed over time and tested and refined through the experience of frequent, severe disaster events over recent decades. Less well developed is the system's ability to support economic recovery in disaster-affected communities over the longer term. This paper presents case studies of regional communities affected by two of Australia's most expensive and deadly natural disasters - the 2009 Victorian bushfires and the cyclones and floods that struck the state of Queensland in 2010-2011. It highlights significant gaps in policy and funding arrangements to support recovery and offers lessons for aligning recovery within a resilience framework." (author's abstract

Exploring the relationship between groundwater geochemical factors and denitrification potentials on a dairy farm in southeast Ireland

NOTICE: this is the author’s version of a work that was accepted for publication in the journal Ecological Engineering. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Ecological Engineering, volume 37, issue 9, September 2011, 1304-1313. DOI: 10.1016/j.ecoleng.2011.03.025peer-reviewedNitrate (NO3−) loss from agriculture to shallow groundwater and transferral to sensitive aquatic ecosystems is of global concern. Denitrifying bioreactor technology, where a solid carbon (C) reactive media intercepts contaminated groundwater, has been successfully used to convert NO3− to di-nitrogen (N2) gas. One of the challenges of groundwater remediation research is how to track denitrification potential spatially and temporally within reactive media and subsoil. First, using δ15N/δ18O isotopes, eight wells were divided into indicative transformational processes of ‘nitrification’ or ‘denitrification’ wells. Then, using N2/argon (Ar) ratios these wells were divided into ‘low denitrification potential’ or high denitrification potential’ categories. Secondly, using falling head tests, the saturated hydraulic conductivity (Ksat) in each well was estimated, creating two groups of ‘slow’ (0.06 m day−1) and ‘fast’ (0.13 m day−1) wells, respectively. Thirdly, two ‘low denitrification potential’ wells (one fast and one slow) with high NO3− concentration were amended with woodchip to enhance denitrification. Water samples were retrieved from all wells using a low flow syringe to avoid de-gassing and analysed for N2/Ar ratio using membrane inlet mass spectrometry. Results showed that there was good agreement between isotope and chemical (N2/Ar ratio and dissolved organic C (DOC)) and physio-chemical (dissolved oxygen, temperature, conductivity and pH) parameters. To explain the spatial and temporal distribution of NO3− and other parameters on site, the development of predictive models using the available datasets for this field site was examined for NO3−, Cl−, N2/Ar and DOC. Initial statistical analysis was directed towards the testing of the effect of woodchip amendment. The analysis was formulated as a repeated measures analysis of the factorial structure for treatment and time. Nitrate concentrations were related to Ksat and water level (p < 0.0001 and p = 0.02, respectively), but did not respond to woodchip addition (p = 0.09). This non-destructive technique allows elucidation of denitrification potential over time and could be used in denitrifying bioreactor technology to assess denitrification hotspots in reactive media, while developing a NO3− spatial and temporal predictive model for bioreactor site specific conditions

The HubBLe trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for haemorrhoids

BACKGROUND:Haemorrhoids (piles) are a very common condition seen in surgical clinics. After exclusion of more sinister causes of haemorrhoidal symptoms (rectal bleeding, perianal irritation and prolapse), the best option for treatment depends upon persistence and severity of the symptoms. Minor symptoms often respond to conservative treatment such as dietary fibre and reassurance. For more severe symptoms treatment such as rubber band ligation may be therapeutic and is a very commonly performed procedure in the surgical outpatient setting. Surgery is usually reserved for those who have more severe symptoms, as well as those who do not respond to non-operative therapy; surgical techniques include haemorrhoidectomy and haemorrhoidopexy. More recently, haemorrhoidal artery ligation has been introduced as a minimally invasive, non destructive surgical option.There are substantial data in the literature concerning efficacy and safety of ’rubber band ligation including multiple comparisons with other interventions, though there are no studies comparing it to haemorrhoidal artery ligation. A recent overview has been carried out by the National Institute for Health and Clinical Excellence which concludes that current evidence shows haemorrhoidal artery ligation to be a safe alternative to haemorrhoidectomy and haemorrhoidopexy though it also highlights the lack of good quality data as evidence for the advantages of the technique. METHODS/DESIGN:The aim of this study is to establish the clinical effectiveness and cost effectiveness of haemorrhoidal artery ligation compared with conventional rubber band ligation in the treatment of people with symptomatic second or third degree (Grade II or Grade III) haemorrhoids.Design: A multi-centre, parallel group randomised controlled trial.Outcomes: The primary outcome is patient-reported symptom recurrence twelve months following the intervention. Secondary outcome measures relate to symptoms, complications, health resource use, health related quality of life and cost effectiveness following the intervention.Participants: 350 patients with grade II or grade III haemorrhoids will be recruited in surgical departments in up to 14 NHS hospitals.Randomisation: A multi-centre, parallel group randomised controlled trial. Block randomisation by centre will be used, with 175 participants randomised to each group. DISCUSSION:The results of the research will help inform future practice for the treatment of grade II and III haemorrhoids.TRIAL REGISTRATION:ISRCTN4139471

Burnout Among Surgeons in the UK During the COVID-19 Pandemic: A Cohort Study

BackgroundSurgeon burnout has implications for patient safety and workforce sustainability. The aim of this study was to establish the prevalence of burnout among surgeons in the UK during the COVID-19 pandemic.MethodsThis cross-sectional online survey was set in the UK National Health Service and involved 601 surgeons across the UK of all specialities and grades. Participants completed the Maslach Burnout Inventory and a bespoke questionnaire. Outcome measures included emotional exhaustion, depersonalisation and low personal accomplishment, as measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS).ResultsA total of 142 surgeons reported having contracted COVID-19. Burnout prevalence was particularly high in the emotional exhaustion (57%) and depersonalisation (50%) domains, while lower on the low personal accomplishment domain (15%). Burnout prevalence was unrelated to COVID-19 status; however, the greater the perceived impact of COVID-19 on work, the higher the prevalence of emotional exhaustion and depersonalisation. Degree of worry about contracting COVID-19 oneself and degree of worry about family and friends contacting COVID-19 was positively associated with prevalence on all three burnout domains. Across all three domains, burnout prevalence was exceptionally high in the Core Trainee 1–2 and Specialty Trainee 1–2 grades.ConclusionsThese findings highlight potential undesirable implications for patient safety arising from surgeon burnout. Moreover, there is a need for ongoing monitoring in addition to an enhanced focus on mental health self-care in surgeon training and the provision of accessible and confidential support for practising surgeons

Identification of Surgeon Burnout via a Single-Item Measure

BackgroundBurnout is endemic in surgeons in the UK and linked with poor patient safety and quality of care, mental health problems, and workforce sustainability. Mechanisms are required to facilitate the efficient identification of burnout in this population. Multi-item measures of burnout may be unsuitable for this purpose owing to assessment burden, expertise required for analysis, and cost.AimsTo determine whether surgeons in the UK reporting burnout on the 22-item Maslach Burnout Inventory (MBI) can be reliably identified by a single-item measure of burnout.MethodsConsultant (n = 333) and trainee (n = 217) surgeons completed the MBI and a single-item measure of burnout. We applied tests of discriminatory power to assess whether a report of high burnout on the single-item measure correctly classified MBI cases and non-cases.ResultsThe single-item measure demonstrated high discriminatory power on the emotional exhaustion burnout domain: the area under the curve was excellent for consultants and trainees (0.86 and 0.80), indicating high sensitivity and specificity. On the depersonalisation domain, discrimination was acceptable for consultants (0.76) and poor for trainees (0.69). In contrast, discrimination was acceptable for trainees (0.71) and poor for consultants (0.62) on the personal accomplishment domain.ConclusionsA single-item measure of burnout is suitable for the efficient assessment of emotional exhaustion in consultant and trainee surgeons in the UK. Administered regularly, such a measure would facilitate the early identification of at-risk surgeons and swift intervention, as well as the monitoring of group-level temporal trends to inform resource allocation to coincide with peak periods

A novel fluorescent c-met targeted imaging agent for intra-operative colonic tumour mapping: Translation from the laboratory into a clinical trial

Background The c-Met protein is overexpressed in many gastrointestinal cancers. We explored EMI-137, a novel c-Met targeting fluorescent probe, for application in fluorescence-guided colon surgery, in HT-29 colorectal cancer (CRC) cell line and an in vivo murine model. Methods HT-29 SiRNA transfection confirmed specificity of EMI-137 for c-Met. A HT-29 CRC xenograft model was developed in BALB/c mice, EMI-137 was injected and biodistribution analysed through in vivo fluorescent imaging. Nine patients, received a single intravenous EMI-137 bolus (0.13 mg/kg), 1–3 h before laparoscopic-assisted colon cancer surgery (NCT03360461). Tumour and LN fluorescence was assessed intraoperatively and correlated with c-Met expression in eight samples by immunohistochemistry. Findings c-Met expression HT-29 cells was silenced and imaged with EMI-137. Strong EMI-137 uptake in tumour xenografts was observed up to 6 h post-administration. At clinical trial, no serious adverse events related to EMI-137 were reported. Marked background fluorescence was observed in all participants, 4/9 showed increased tumour fluorescence over background; 5/9 had histological LN metastases; no fluorescent LN were detected intraoperatively. All primary tumours (8/8) and malignant LN (15/15) exhibited high c-Met protein expression. Interpretation EMI-137, binds specifically to the human c-Met protein, is safe, and with further refinement, shows potential for application in fluorescence-guided surgery