Interdisciplinary pressure cooker: environmental risk communication skills for the next generation

This article presents a “pressure cooker” approach for building interdisciplinary risk communication capacity in young professionals via an intensive 24 h workshop. The event successfully brought together 35 participants from around the world to work on real-world environmental hazard/risk communication challenges for two areas in Mexico. Participants worked in interdisciplinary teams, following a three-step iterative process, with support from mentors and a range of specialists to develop risk communication outputs. Feedback surveys indicate that the workshop met its goal of improving participants' knowledge of risk communication and interdisciplinary working. The workshop resulted in an interdisciplinary community of researchers and practitioners, including organisers, participants and supporting specialists, which was still active after the event. It is recommended that such interdisciplinary workshops are used to build the capacity to tackle complex challenges, such as risk communication, but they require further testing. Insights into the design and implementation of such interdisciplinary workshops are given (e.g. team design, use of preparatory materials, and engagement of specialists and local stakeholders are presented), including critiques of challenges raised by the workshop participants. Guidance is provided to those interested in applying a pressure cooker approach and further adaptations of the approach are welcomed

Towards an applicable integrated multi-hazard and multi-risk framework

The framework is based on a systemic perspective where a system is a set of (partly) interconnected elements with clear boundaries and which foregrounds interdependencies between elements within a system (elements can be systems themselves). It allows for the assessment and management of both individual risks (risk to individual elements within the system) and systemic risks (risk of the system due to interdependencies). The implementation of the framework is an iterative process, with a possibility of including a range of methodologies, both qualitative and quantitative. As a framework, it does not prescribe methodologies and approaches, but rather provides a frame with which one can work

Science and technology networks: a helping hand to boost implementation of the Sendai Framework for Disaster Risk Reduction 2015–2030?

The Sendai Framework for Disaster Risk Reduction 2015–2030 underlines the importance of Science and Technology (S&T) and S&T networks for effective disaster risk reduction (DRR). The knowledge of existing S&T networks and their exact role in DRR, however, is limited. This opinion piece initiates a discussion on the role of S&T networks in the implementation of the Sendai Framework. The article highlights that current practice is oriented towards a narrative that emphasizes the potential of S&T for DRR and stresses a collaborative approach delivered through networks. But a true understanding of whether and how S&T networks can mobilize and enable S&T for DRR is missing. We call for a review of existing S&T networks for DRR and the development of good practice guidelines on S&T networks for DRR. This review should include knowledge on how to overcome common challenges and maximize the benefits, along with a framework for successful evaluation of such networks. This knowledge would provide much needed guidance for existing and emerging networks

Interdisciplinarity in practice: reflections from early-career researchers developing a risk-informed decision support environment for Tomorrow's cities

The concept of disaster risk is cross-disciplinary by nature and reducing disaster risk has become of interest for various disciplines. Yet, moving from a collection of multiple disciplinary perspectives to integrated interdisciplinary disaster risk approaches remains a fundamental challenge. This paper reflects on the experience of a group of early-career researchers spanning physical scientists, engineers and social scientists from different organisations across the global North and global South who came together to lead the refinement, operationalisation and testing of a risk-informed decision support environment for Tomorrow's Cities (TCDSE). Drawing on the notions of subjects and boundary objects, members of the group reflect on their individual and collective journey of transgressing disciplinary boundaries across three case studies between June–December 2021: operationalisation process of the TCDSE; development of a virtual urban testbed as a demonstration case for the implementation of the TCDSE; and consolidation of frequently asked questions about the TCDSE for communication purposes. The paper argues that (1) the production of boundary objects in interdisciplinary research nurtures relations of reciprocal recognition and the emergence of interdisciplinary subjects; (2) the intrinsic characteristics of boundary objects define the norms of engagement between disciplinary subjects and constrain the expression of interdisciplinary contradictions; and (3) affects and operations of power explain the contingent settlement of interdisciplinary disagreements and the emergence of new knowledge. Activating the interdisciplinary capacities of early-career researchers across disciplines and geographies is a fundamental step towards transforming siloed research practices to reduce disaster risk

Prophylactic Melatonin for Delirium in Intensive Care (Pro-MEDIC): Study protocol for a randomised controlled trial

Background: Delirium is an acute state of brain dysfunction characterised by fluctuating inattention and cognitive disturbances, usually due to illness. It occurs commonly in the intensive care unit (ICU), and it is associated with greater morbidity and mortality. It is likely that disturbances of sleep and of the day-night cycle play a significant role. Melatonin is a naturally occurring, safe and cheap hormone that can be administered to improve sleep. The main aim of this trial will be to determine whether prophylactic melatonin administered to critically ill adults, when compared with placebo, decreases the rate of delirium. Methods: This trial will be a multi-centre, randomised, placebo-controlled study conducted in closed ICUs in Australia. Our aim is to enrol 850 adult patients with an expected ICU length of stay (LOS) of 72h or more. Eligible patients for whom there is consent will be randomised to receive melatonin 4mg enterally or placebo in a 1:1 ratio according to a computer-generated randomisation list, stratified by site. The study drug will be indistinguishable from placebo. Patients, doctors, nurses, investigators and statisticians will be blinded. Melatonin or placebo will be administered once per day at 21:00 until ICU discharge or 14days after enrolment, whichever occurs first. Trained staff will assess patients twice daily to determine the presence or absence of delirium using the Confusion Assessment Method for the ICU score. Data will also be collected on demographics, the overall prevalence of delirium, duration and severity of delirium, sleep quality, participation in physiotherapy sessions, ICU and hospital LOS, morbidity and mortality, and healthcare costs. A subgroup of 100 patients will undergo polysomnographic testing to further evaluate the quality of sleep. Discussion: Delirium is a significant issue in ICU because of its frequency and associated poorer outcomes. This trial will be the largest evaluation of melatonin as a prophylactic agent to prevent delirium in the critically ill population. This study will also provide one of the largest series of polysomnographic testing done in ICU. Trial registration: Australian New Zealand Clinical Trial Registry (ANZCTR) number: ACTRN12616000436471. Registered on 20 December 2015

Comfort and patient-centred care without excessive sedation:the eCASH concept

We propose an integrated and adaptable approach to improve patient care and clinical outcomes through analgesia and light sedation, initiated early during an episode of critical illness and as a priority of care. This strategy, which may be regarded as an evolution of the Pain, Agitation and Delirium guidelines, is conveyed in the mnemonic eCASH—early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as the default presumption for intensive care unit (ICU) patients in the absence of recognised medical requirements for deeper sedation. Effective pain relief is the first priority for implementation of eCASH: we advocate flexible multimodal analgesia designed to minimise use of opioids. Sedation is secondary to pain relief and where possible should be based on agents that can be titrated to a prespecified target level that is subject to regular review and adjustment; routine use of benzodiazepines should be minimised. From the outset, the objective of sedation strategy is to eliminate the use of sedatives at the earliest medically justifiable opportunity. Effective analgesia and minimal sedation contribute to the larger aims of eCASH by facilitating promotion of sleep, early mobilization strategies and improved communication of patients with staff and relatives, all of which may be expected to assist rehabilitation and avoid isolation, confusion and possible long-term psychological complications of an ICU stay. eCASH represents a new paradigm for patient-centred care in the ICU. Some organizational challenges to the implementation of eCASH are identified.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Multi‐risk instruments for emergency response: a multi‐hazard and multi‐risk assessment of the European Union's Solidarity and Emergency Aid Reserve

Natural hazard-related disasters are on the rise and have significant impacts on the public and private sector. Different mechanisms and instruments exist on the pan-European level to deal with them, including the European Union Solidarity Fund (EUSF). Recently, the EUSF expanded its scope to incorporate public health emergencies and merged with the Emergency Aid Reserve to become the Solidarity and Emergency Aid Reserve. It therefore became a multi-hazard and multi-risk instrument to assist countries during the emergency phase of disasters. As different types of hazards and risks are drawing from the same fund there is concern about what capitalisation levels have to be assumed to make it sustainable. Hence, it is important to understand to which hazards and risks the fund is most exposed and whether there are regional differences within Europe. To address these issues, this paper takes a risk-based approach and estimates the capitalisation levels needed for major hazards and risks, noting regional differences across Europe

Rebuild by design in Hoboken: A design competition as a means for achieving flood resilience of urban areas through the implementation of green infrastructure

The Rebuild by Design (RBD) competition was launched after the devastating impact of Hurricane Sandy, and the winning designs have put a significant emphasis on green infrastructure (GI) as a means of achieving flood resilience in urban areas. Previous research in the field of urban stormwater management indicates that wide-spread implementation of GI remains a challenge, largely due to a lack of understanding of the required governance approaches. Therefore, by using a case study of Hoboken, for which the winning design was developed, this paper explores whether RBD provides governance structures and processes needed for the uptake of GI. Semi-structured interviews and desk study provided the data for an analysis of the presence of factors for supporting the transformative governance needed to facilitate the uptake of innovative solutions. Results indicate that RBD brought a greater change in terms of governance processes when compared to governance structures. In Hoboken, RBD created a narrative for long-term change, put GI as a preferred solution for tackling multiple challenges, and strengthened the local political buy-in. However, pitfalls were observed, such as limited funding provision, lack of regulatory compliance, economic justification and large investments required from public and private parties. The absence of these factors can hinder the overall uptake of the GI solution. Even though the design competition presents a novel approach to the field of resilience development, further steps should be made in understanding how the RBD methodology can be adjusted to provide results of equal quality in different settings (e.g., less developed regions, different governance contexts)

Rebuild by design in Hoboken: A design competition as a means for achieving flood resilience of urban areas through the implementation of green infrastructure

The Rebuild by Design (RBD) competition was launched after the devastating impact of Hurricane Sandy, and the winning designs have put a significant emphasis on green infrastructure (GI) as a means of achieving flood resilience in urban areas. Previous research in the field of urban stormwater management indicates that wide-spread implementation of GI remains a challenge, largely due to a lack of understanding of the required governance approaches. Therefore, by using a case study of Hoboken, for which the winning design was developed, this paper explores whether RBD provides governance structures and processes needed for the uptake of GI. Semi-structured interviews and desk study provided the data for an analysis of the presence of factors for supporting the transformative governance needed to facilitate the uptake of innovative solutions. Results indicate that RBD brought a greater change in terms of governance processes when compared to governance structures. In Hoboken, RBD created a narrative for long-term change, put GI as a preferred solution for tackling multiple challenges, and strengthened the local political buy-in. However, pitfalls were observed, such as limited funding provision, lack of regulatory compliance, economic justification and large investments required from public and private parties. The absence of these factors can hinder the overall uptake of the GI solution. Even though the design competition presents a novel approach to the field of resilience development, further steps should be made in understanding how the RBD methodology can be adjusted to provide results of equal quality in different settings (e.g., less developed regions, different governance contexts)