Managing Tsunami Risk: Social Context Influences on Preparedness

This article describes the testing of a model that proposes that people's beliefs regarding the effectiveness of hazard preparedness interact with social context factors (community participation, collective efficacy, empowerment and trust) to influence levels of hazard preparedness. Using data obtained from people living in coastal communities in Alaska and Oregon that are susceptible to experiencing tsunami, structural equation modelling analyses confirmed the ability of the model to help account for differences in levels of tsunami preparedness. Analysis revealed that community members and civic agencies influence preparedness in ways that are independent of the information provided per se. The model suggests that, to encourage people to prepare, outreach strategies must (a) encourage community members to discuss tsunami hazard issues and to identify the resources and information they need to deal with the consequences a tsunami would pose for them and (b) ensure that the community-agency relationship is complementary and empowering

Preoperative biliary drainage for biliary tract and ampullary carcinomas

We posed six clinical questions (CQ) on preoperative biliary drainage and organized all pertinent evidence regarding these questions. CQ 1. Is preoperative biliary drainage necessary for patients with jaundice? The indications for preoperative drainage for jaundiced patients are changing greatly. Many reports state that, excluding conditions such as cholangitis and liver dysfunction, biliary drainage is not necessary before pancreatoduodenectomy or less invasive surgery. However, the morbidity and mortality of extended hepatectomy for biliary cancer is still high, and the most common cause of death is hepatic failure; therefore, preoperative biliary drainage is desirable in patients who are to undergo extended hepatectomy. CQ 2. What procedures are appropriate for preoperative biliary drainage? There are three methods of biliary drainage: percutaneous transhepatic biliary drainage (PTBD), endoscopic nasobiliary drainage (ENBD) or endoscopic retrograde biliary drainage (ERBD), and surgical drainage. ERBD is an internal drainage method, and PTBD and ENBD are external methods. However, there are no reports of comparisons of preoperative biliary drainage methods using randomized controlled trials (RCTs). Thus, at this point, a method should be used that can be safely performed with the equipment and techniques available at each facility. CQ 3. Which is better, unilateral or bilateral biliary drainage, in malignant hilar obstruction? Unilateral biliary drainage of the future remnant hepatic lobe is usually enough even when intrahepatic bile ducts are separated into multiple units due to hilar malignancy. Bilateral biliary drainage should be considered in the following cases: those in which the operative procedure is difficult to determine before biliary drainage; those in which cholangitis has developed after unilateral drainage; and those in which the decrease in serum bilirubin after unilateral drainage is very slow. CQ 4. What is the best treatment for postdrainage fever? The most likely cause of high fever in patients with biliary drainage is cholangitis due to problems with the existing drainage catheter or segmental cholangitis if an undrained segment is left. In the latter case, urgent drainage is required. CQ 5. Is bile culture necessary in patients with biliary drainage who are to undergo surgery? Monitoring of bile cultures is necessary for patients with biliary drainage to determine the appropriate use of antibiotics during the perioperative period. CQ 6. Is bile replacement useful for patients with external biliary drainage? Maintenance of the enterohepatic bile circulation is vitally important. Thus, preoperative bile replacement in patients with external biliary drainage is very likely to be effective when highly invasive surgery (e.g., extended hepatectomy for hilar cholangiocarcinoma) is planned

Flowcharts for the management of biliary tract and ampullary carcinomas

No strategies for the diagnosis and treatment of biliary tract carcinoma have been clearly described. We developed flowcharts for the diagnosis and treatment of biliary tract carcinoma on the basis of the best clinical evidence. Risk factors for bile duct carcinoma are a dilated type of pancreaticobiliary maljunction (PBM) and primary sclerosing cholangitis. A nondilated type of PBM is a risk factor for gallbladder carcinoma. Symptoms that may indicate biliary tract carcinoma are jaundice and pain in the upper right area of the abdomen. The first step of diagnosis is to carry out blood biochemistry tests and ultrasonography (US) of the abdomen. The second step of diagnosis is to find the local extension of the carcinoma by means of computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiography (PTC), and endoscopic retrograde cholangiopancreatography (ERCP). Because resection is the only way to completely cure biliary tract carcinoma, the indications for resection are determined first. In patients with resectable disease, the indications for biliary drainage or portal vein embolization (PVE) are checked. In those with nonresectable disease, biliary stenting, chemotherapy, radiotherapy, and/or best supportive care is selected

Identifying and Separating Pandora Moth Outbreaks and Climate from A 1500-Year Ponderosa Pine Chronology from Central Oregon

We reconstruct pandora moth (Coloradia pandora Blake) outbreaks and climate from a 1572-year (435-2006 CE) ponderosa pine (Pinus ponderosa Dougl. ex Laws.) chronology from a lava flow in central Oregon. We took samples from 128 living trees and remnant logs and crossdated the samples using skeleton plots and COFECHA for quality control. After cutting out and removing those time periods from the chronology during which insects become the main limiting factor to growth, we examine the response of tree rings to climate. Evidence of species longevity (up to 877 years), presence of periodic pandora moth defoliations (13 total), and a significant relationship with the Palmer Drought Severity Index were observed (R2 = 0.34, p < 0.001). Suppressions related to pandora moth outbreaks were recorded back to 618 CE, with a mean return interval of 104 years. Previous-fall to current-spring PDSI was reconstructed over 1376 years (630-2006 CE), where the most prolonged drought periods were 1136-1166 CE and the Dust Bowl 1924-1941. Our research documents longevity of ponderosa pine, resilience in the presence of multiple disturbances, and demonstrates a technique to separate insect outbreak signals from climate reconstructions in long chronologies while embracing the entire signal available in tree rings. © 2017 by The Tree-Ring Society.This item is part of the Tree-Ring Research (formerly Tree-Ring Bulletin) archive. For more information about this peer-reviewed scholarly journal, please email the Editor of Tree-Ring Research at [email protected]