Assessing socio-economic vulnerability to climate change impacts and environmental hazards in New South Wales and Queensland, Australia

This article systematically reviews and synthesises academic, peer-reviewed literature to assess the state of knowledge concerning socio-economic vulnerability to climate change impacts and environmental hazards in New South Wales and Queensland, Australia. It focuses upon empirical research that identifies socio-economic factors associated with vulnerable subpopulations. Using systematic review methods, 35 articles met the inclusion criteria. These articles are analysed according to their general characteristics, the methods used, and the factors reported to be associated with socio-economic vulnerability. This body of evidence reveals that (1) the majority of the knowledge about socio-economic vulnerability in New South Wales and Queensland has only recently emerged; (2) more knowledge has been published about Queensland; and (3) extreme temperature is the most researched environmental hazard. Despite increased research activity over time, the number of factors repeatedly demonstrated to influence socio-economic vulnerability is small. Age, gender, place of residence, and pre-existing illness were the most commonly reported factors, although the influence of these factors upon socio-economic vulnerability is complex. There is scope to extend the empirical research base across a broader range of climate-related hazards and to better link findings from the domains of climate change vulnerability and population health

The Vehicle, Spring 2010

Table of Contents ForgettingRashelle McNairpage 34 MuseMary Lieskepage 35 My CompulsionAshton Tembypage 38 MemoryKate Vandermeerpage 41 Killmercialize MeGreg Petersonpage 42 PenJake Smithpage 46 GrassKate Vandermeerpage 48 Character CreationMary Lieskepage 52 Ring Around TheKim Hunter-Perkinspage 54 The Great Cursive ScareJake Smithpage 55 OpiateDoug Urbanskipage 61 What Happens to Little Girls...Jennifer O\u27Neilpage 63 Poetry Sunny DaysRyan Poolpage 2 AtlantisDoug Urbanskipage 4 Garbage CityKate Vandermeerpage 6 Fat Girl ThongsKim Hunter-Perkinspage 7 MercilessRosalia Pecorapage 19 ChemistryMary Lieskepage 20 He-Who-Stopped-TalkingJustin Sudkamppage 22 In Which Iris Contemplates a Barren EarthSean Slatterypage 24 At the Bottom of the WorldNick Canadaypage 27 Dogma: Mush!Scott Maypage 28 ThiefMary Lieskepage 29 Prose Coming HomeDoug Urbanskipage 8 DodoDan Davispage 31 The Poet in the PedestrianScott Maypage 37 Toxic RainJacob Swansonpage 40 What\u27s Your Greatest Fear?Justine Fittonpage 43 Soul VoiceHolly Thomaspage 49 Conversations with a SniperKim Hunter-Perkinspage 56 LettersDaniel Paquinpage 65 Art San Marcos, MexicoKate Vandermeercover Contemplation of the World\u27s EndNicholas Giffordpage 18 Little Lady SitsSarah Hadwigerpage 26 MoodAlycia Rockeypage 30 Four Ducks in a RowMegan Mathypage 36 The Daily EasternBen Tillerypage 39 BirdsAlycia Rockeypage 45 March of the BugsMegan Mathypage 47 Mexico Work ExperienceKate Vandermeerpage 53 Feather and JewelsAlycia Rockeypage 60 The ForgottenMegan Mathypage 64 Special Features Fall 2009-Spring 2010 Vehicle Award Winnerspage 1 James K. Johnson Creative Writing Awardpage 74 Kim Hunter-PerkinsWinning Entries (Poetry)page 75 Clint WalkerWinning Entry (Fiction)page 86 Faculty Spotlight: Professor Jason Brownpage 99 About the Contributorspage 106 About the Editorspage 110https://thekeep.eiu.edu/vehicle/1093/thumbnail.jp

Protocol for the development and validation of a risk prediction model for stillbirths from 35 weeks gestation in Australia

Abstract: Background: Despite advances in the care of women and their babies in the past century, an estimated 1.7 million babies are born still each year throughout the world. A robust method to estimate a pregnant woman’s individualized risk of late-pregnancy stillbirth is needed to inform decision-making around the timing of birth to reduce the risk of stillbirth from 35 weeks of gestation in Australia, a high-resource setting. Methods: This is a protocol for a cross-sectional study of all late-pregnancy births in Australia (2005–2015) from 35 weeks of gestation including 5188 stillbirths among 3.1 million births at an estimated rate of 1.7 stillbirths per 1000 births. A multivariable logistic regression model will be developed in line with current TransparentReporting of a multivariable prediction model forIndividualPrognosis orDiagnosis (TRIPOD) guidelines to estimate the gestation-specific probability of stillbirth with prediction intervals. Candidate predictors were identified from systematic reviews and clinical consultation and will be described through univariable regression analysis. To generate a final model, elimination by backward stepwise multivariable logistic regression will be performed. The model will be internally validated using bootstrapping with 1000 repetitions and externally validated using a temporally unique dataset. Overall model performance will be assessed with R2, calibration, and discrimination. Calibration will be reported using a calibration plot with 95% confidence intervals (α = 0.05). Discrimination will be measured by the C-statistic and area underneath the receiver-operator curves. Clinical usefulness will be reported as positive and negative predictive values, and a decision curve analysis will be considered. Discussion: A robust method to predict a pregnant woman’s individualized risk of late-pregnancy stillbirth is needed to inform timely, appropriate care to reduce stillbirth. Among existing prediction models designed for obstetric use, few have been subject to internal and external validation and many fail to meet recommended reporting standards. In developing a risk prediction model for late-gestation stillbirth with both providers and pregnant women in mind, we endeavor to develop a validated model for clinical use in Australia that meets current reporting standards

Protocol for the development and validation of a risk prediction model for stillbirths from 35 weeks gestation in Australia

Abstract: Background: Despite advances in the care of women and their babies in the past century, an estimated 1.7 million babies are born still each year throughout the world. A robust method to estimate a pregnant woman’s individualized risk of late-pregnancy stillbirth is needed to inform decision-making around the timing of birth to reduce the risk of stillbirth from 35 weeks of gestation in Australia, a high-resource setting. Methods: This is a protocol for a cross-sectional study of all late-pregnancy births in Australia (2005–2015) from 35 weeks of gestation including 5188 stillbirths among 3.1 million births at an estimated rate of 1.7 stillbirths per 1000 births. A multivariable logistic regression model will be developed in line with current TransparentReporting of a multivariable prediction model forIndividualPrognosis orDiagnosis (TRIPOD) guidelines to estimate the gestation-specific probability of stillbirth with prediction intervals. Candidate predictors were identified from systematic reviews and clinical consultation and will be described through univariable regression analysis. To generate a final model, elimination by backward stepwise multivariable logistic regression will be performed. The model will be internally validated using bootstrapping with 1000 repetitions and externally validated using a temporally unique dataset. Overall model performance will be assessed with R2, calibration, and discrimination. Calibration will be reported using a calibration plot with 95% confidence intervals (α = 0.05). Discrimination will be measured by the C-statistic and area underneath the receiver-operator curves. Clinical usefulness will be reported as positive and negative predictive values, and a decision curve analysis will be considered. Discussion: A robust method to predict a pregnant woman’s individualized risk of late-pregnancy stillbirth is needed to inform timely, appropriate care to reduce stillbirth. Among existing prediction models designed for obstetric use, few have been subject to internal and external validation and many fail to meet recommended reporting standards. In developing a risk prediction model for late-gestation stillbirth with both providers and pregnant women in mind, we endeavor to develop a validated model for clinical use in Australia that meets current reporting standards

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Ecological and Cultural Understanding as a Basis for Management of a Globally Significant Island Landscape

Islands provide the opportunity to explore management regimes and research issues related to the isolation, uniqueness, and integrity of ecological systems. K’gari (Fraser Island) is an Australian World Heritage property listed based on its outstanding natural value, specifically, the unique wilderness characteristics and the diversity of ecosystem types. Our goal was to draw on an understanding of the natural and cultural environment of K’gari as a foundation on which to build a management model that includes First Nations Peoples in future management and research. Our research involved an analysis of papers in the peer-reviewed scientific literature, original reports, letters, and other manuscripts now housed in the K’gari Fraser Island Research Archive. The objectives of the research were: (1) to review key historical events that form the cultural, social, and environmental narrative; (2) review the major natural features of the island and threats; (3) identify the gaps in research; (4) analyse the management and conservation challenges associated with tourism, biosecurity threats, vegetation management practices, and climate change and discuss whether the requirements for sustaining island ecological integrity can be met in the future; and (5) identify commonalities and general management principles that may apply globally to other island systems and other World Heritage sites listed on the basis of their unique natural and cultural features. We found that the characteristics that contribute to island uniqueness are also constraints for research funding and publication; however, they are important themes that warrant more investment. Our review suggests that K’gari is a contested space between tourist visitation and associated environmental impacts, with an island that has rich First Nations history, extraordinary ecological diversity, and breathtaking aesthetic beauty. This juxtaposition is reflected in disparate views of custodianship and use, and the management strategies are needed to achieve multiple objectives in an environmentally sustainable way whilst creating cultural equity in modern times. We offer a foundation on which to build a co-management model that includes First Nations Peoples in governance, management, research, and monitoring

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe