Why We Can No Longer Ignore Consecutive Disasters

In recent decades, a striking number of countries have suffered from consecutive disasters: events whose impacts overlap both spatially and temporally, while recovery is still under way. The risk of consecutive disasters will increase due to growing exposure, the interconnectedness of human society, and the increased frequency and intensity of nontectonic hazard. This paper provides an overview of the different types of consecutive disasters, their causes, and impacts. The impacts can be distinctly different from disasters occurring in isolation (both spatially and temporally) from other disasters, noting that full isolation never occurs. We use existing empirical disaster databases to show the global probabilistic occurrence for selected hazard types. Current state‐of‐the art risk assessment models and their outputs do not allow for a thorough representation and analysis of consecutive disasters. This is mainly due to the many challenges that are introduced by addressing and combining hazards of different nature, and accounting for their interactions and dynamics. Disaster risk management needs to be more holistic and codesigned between researchers, policy makers, first responders, and companies

Why community-based disaster risk reduction fails to learn from local knowledge? Experiences from Malawi

This contributing paper aims to investigate the extent to which community-based disaster risk reduction (CBDRR) in practice really takes into account local knowledge (LK). It is often taken as given that CBDRR serves as a mechanism for the inclusion of local knowledge (LK) in disaster risk reduction (DRR). But the reality from the ground suggests that this increased attention does not result in practical inclusion of communities nor their LK in DRR. Through in-depth empirical qualitative data from Malawi, the paper explores the dynamics between the inadequate inclusion of LK and approaches to DRR. This study argues that LK is underutilised in CBDRR and finds that current practice provides a limited opportunity for the inclusion of LK, due to five prime obstacles: i) current approach to community participation, ii) financial constraints and capacity of external stakeholders, iii) the donor landscape, iv) information consolidation and sharing, and v) external stakeholders attitudes towards LK. In CBDRR, a strong dichotomy between local and scientific knowledge is maintained, and further re-examination of community-based approaches in practice is needed to make them truly transformative

Early Warning Systems and Their Role in Disaster Risk Reduction

In this chapter, we introduce early warning systems (EWS) in the context of disaster risk reduction, including the main components of an EWS, the roles of the main actors and the need for robust evaluation. Management of disaster risks requires that the nature and distribution of risk are understood, including the hazards, and the exposure, vulnerability and capacity of communities at risk. A variety of policy options can be used to reduce and manage risks, and we emphasise the contribution of early warnings, presenting an eight-component framework of people-centred early warning systems which highlights the importance of an integrated and all-society approach. We identify the need for decisions to be evidence-based, for performance monitoring and for dealing with errors and false information. We conclude by identifying gaps in current early warning systems, including in the social components of warning systems and in dealing with multi-hazards, and obstacles to progress, including issues in funding, data availability, and stakeholder engagement

Why does community-based disaster risk reduction fail to learn from local knowledge? Experiences from Malawi

It is often taken as given that community-based disaster risk reduction (CBDRR) serves as a mechanism for the inclusion of local knowledge (LK) in disaster risk reduction (DRR). In this paper, through in-depth qualitative analysis of empirical data from Malawi, we investigate the extent to which CBDRR in practice really takes into account LK. This research argues that LK is underutilised in CBDRR and finds that current practice provides a limited opportunity for the inclusion of LK, due to five prime obstacles: i) current approach to community participation, ii) financial constraints and capacity of external stakeholders, iii) the donor landscape, iv) information consolidation and sharing, and v) external stakeholders attitudes towards LK. In CBDRR, a strong dichotomy between local and scientific knowledge is maintained, and further re-examination of community-based approaches in practice is needed to make them truly transformative

Appropriate medication use in Dutch terminal care:study protocol of a multicentre stepped-wedge cluster randomized controlled trial (the AMUSE study)

Background: Polypharmacy is common among patients with a limited life expectancy, even shortly before death. This is partly inevitable, because these patients often have multiple symptoms which need to be alleviated. However, the use of potentially inappropriate medications (PIMs) in these patients is also common. Although patients and relatives are often willing to deprescribe medication, physicians are sometimes reluctant due to the lack of evidence on appropriate medication management for patients in the last phase of life. The aim of the AMUSE study is to investigate whether the use of CDSS-OPTIMED, a software program that gives weekly personalized medication recommendations to attending physicians of patients with a limited life expectancy, improves patients’ quality of life. Methods: A multicentre stepped-wedge cluster randomized controlled trial will be conducted among patients with a life expectancy of three months or less. The stepped-wedge cluster design, where the clusters are the different study sites, involves sequential crossover of clusters from control to intervention until all clusters are exposed. In total, seven sites (4 hospitals, 2 general practices and 1 hospice from the Netherlands) will participate in this study. During the control period, patients will receive ‘care as usual’. During the intervention period, CDSS-OPTIMED will be activated. CDSS-OPTIMED is a validated software program that analyses the use of medication based on a specific set of clinical rules for patients with a limited life expectancy. The software program will provide the attending physicians with weekly personalized medication recommendations. The primary outcome of this study is patients’ quality of life two weeks after baseline assessment as measured by the EORTC QLQ-C15-PAL questionnaire, quality of life question.Discussion: This will be the first study investigating the effect of weekly personalized medication recommendations to attending physicians on the quality of life of patients with a limited life expectancy. We hypothesize that the CDSS-OPTIMED intervention could lead to improved quality of life in patients with a life expectancy of three months or less. Trial registration: This trial is registered at ClinicalTrials.gov (NCT05351281, Registration Date: April 11, 2022).</p

Individual Variations in Maternal Care Early in Life Correlate with Later Life Decision-Making and c-Fos Expression in Prefrontal Subregions of Rats

Early life adversity affects hypothalamus-pituitary-adrenal axis activity, alters cognitive functioning and in humans is thought to increase the vulnerability to psychopathology–e.g. depression, anxiety and schizophrenia- later in life. Here we investigated whether subtle natural variations among individual rat pups in the amount of maternal care received, i.e. differences in the amount of licking and grooming (LG), correlate with anxiety and prefrontal cortex-dependent behavior in young adulthood. Therefore, we examined the correlation between LG received during the first postnatal week and later behavior in the elevated plus maze and in decision-making processes using a rodent version of the Iowa Gambling Task (rIGT). In our cohort of male and female animals a high degree of LG correlated with less anxiety in the elevated plus maze and more advantageous choices during the last 10 trials of the rIGT. In tissue collected 2 hrs after completion of the task, the correlation between LG and c-fos expression (a marker of neuronal activity) was established in structures important for IGT performance. Negative correlations existed between rIGT performance and c-fos expression in the lateral orbitofrontal cortex, prelimbic cortex, infralimbic cortex and insular cortex. The insular cortex correlations between c-fos expression and decision-making performance depended on LG background; this was also true for the lateral orbitofrontal cortex in female rats. Dendritic complexity of insular or infralimbic pyramidal neurons did not or weakly correlate with LG background. We conclude that natural variations in maternal care received by pups may significantly contribute to later-life decision-making and activity of underlying brain structures

Acute and constitutive increases in central serotonin levels reduce social play behaviour in peri-adolescent rats

Item does not contain fulltextRATIONALE: Serotonin is an important modulator of social behaviour. Individual differences in serotonergic signalling are considered to be a marker of personality that is stable throughout lifetime. While a large body of evidence indicates that central serotonin levels are inversely related to aggression and sexual behaviour in adult rats, the relationship between serotonin and social behaviour during peri-adolescence has hardly been explored. OBJECTIVE: To study the effect of acute and constitutive increases in serotonin neurotransmission on social behaviour in peri-adolescent rats. MATERIALS AND METHODS: Social behaviour in peri-adolesent rats (28-35 days old) was studied after genetic ablation of the serotonin transporter, causing constitutively increased extra-neuronal serotonin levels, and after acute treatment with the serotonin reuptake inhibitor fluoxetine or the serotonin releasing agent 3,4-methylenedioxymethamphetamine (MDMA). A distinction was made between social play behaviour that mainly occurs during peri-adolescence, and non-playful social interactions that are abundant during the entire lifespan of rats. RESULTS: In serotonin transporter knockout rats, social play behaviour was markedly reduced, while non-playful aspects of social interaction were unaffected. Acute treatment with fluoxetine or MDMA dose-dependently inhibited social play behaviour. MDMA also suppressed non-playful social interaction but at higher doses than those required to reduce social play. Fluoxetine did not affect non-playful social interaction. CONCLUSIONS: These data show that both acute and constitutive increases in serotonergic neurotransmission reduce social play behaviour in peri-adolescent rats. Together with our previous findings of reduced aggressive and sexual behaviour in adult serotonin transporter knockout rats, these data support the notion that serotonin modulates social behaviour in a trait-like manner