A Framework for Identification, Assessment and Prioritization of Climate Change Adaptation Measures for Roads and Railways

Severe accidents and high costs associated with weather-related events already occur in today’s climate. Unless preventive measures are taken, the costs are expected to increase in future due to ongoing climate change. However, the risk reduction measures are costly as well and may result in unwanted impacts. Therefore, it is important to identify, assess and prioritize which measures are necessary to undertake, as well as where and when these are to be undertaken. To be able to make such evaluations, robust (scientifically based), transparent and systematic assessments and valuations are required. This article describes a framework to assess the cause-and-effect relationships and how to estimate the costs and benefits as a basis to assess and prioritize measures for climate adaptation of roads and railways. The framework includes hazard identification, risk analysis and risk assessment, identification, monetary and non-monetary evaluation of possible risk reduction measures and a step regarding distribution-, goal- and sensitivity analyses. The results from applying the framework shall be used to prioritize among potential risk reduction measures as well as when to undertake them.

Aggregated Risk Assessment and Survey for Risk Reduction in Oil Terminals

One of the goals of any oil terminal is to make a business while avoiding hazardous events and harmful effects for both humans and the environment. This can be achieved by creating a safe working place as well as by performing safe and acceptable activities regarding the impact on surrounding objects, including residential and industrial areas. The aim of the hazard analysis of the oil terminal is to assess the risks related to hazardous events or phenomena and to evaluate whether the assessed risks are acceptable. The hazard analysis and assessment of risk are also used for risk reduction while examining and limiting hazardous scenarios that, for instance, involve the loss-of-containment of flammable or combustible material. In this paper, the authors aim to contribute to risk research by providing a comprehensive methodology of risk assessment for oil terminals with case study results and discussion on features of the methodology, risk aggregation, its applicability for risk reduction, and industrial interests. The performed study considered the “Klaipedos Nafta AB” (an operator of the Klaipeda Oil Terminal, Lithuania) case study regarding hazardous materials that might be released from various tanks, devices, and associated pipelines. The performed quantitative risk assessment has enabled the determination of the probability regarding whether releases would ignite and, for instance, cause explosion. In the case study, the estimate of probability, i.e., the frequency, and the possible consequences of the hazardous events were evaluated, and both mitigation and risk reduction measures were also considered.

Frequency, etiologies, risk factors, and sequelae of falls among patients with brain metastases: a population- and institutional-level analysis

Background Falls in patients with cancer harbor potential for serious sequelae. Patients with brain metastases (BrM) may be especially susceptible to falls but supporting investigations are lacking. We assessed the frequency, etiologies, risk factors, and sequelae of falls in patients with BrM using two data sources. Methods We identified 42,648 and 111 patients with BrM utilizing Surveillance, Epidemiology, and End Results (SEER)-Medicare data (2008-2016) and Brigham/Dana Farber (BWH/DFCI) institutional data (2015), respectively, and characterized falls in these populations. Results Among SEER-Medicare patients, 10,267 (24.1%) experienced a fall that prompted medical evaluation, with cumulative incidences at 3, 6, and 12 months of 18.0%, 24.3%, and 34.1%, respectively. On multivariable Fine/Gray’s regression, older age (>81 or 76-80 vs. 66-70 years, hazard ratio [HR] 1.18 [95% CI, 1.11-1.25], p<0.001 and HR 1.10 [95% CI, 1.04-1.17], p<0.001, respectively), Charlson comorbidity score of >2 vs. 0-2 (HR 1.08 [95% CI, 1.03-1.13], p=0.002) and urban residence (HR 1.08 [95% CI, 1.01-1.16], p=0.03) were associated with falls. Married status (HR 0.94 [95% CI, 0.90-0.98], p=0.004) and Asian vs. white race (HR 0.90 [95% CI, 0.81-0.99], p=0.03) were associated with reduced fall-risk. Identified falls were more common among BWH/DFCI patients (N=56, 50.4% of cohort), resulting in emergency department visits, hospitalizations, fractures, and intracranial hemorrhage in 33%, 23%, 11%, and 4% of patients, respectively. Conclusions Falls are common among patients with BrM, especially older/sicker patients, and can have deleterious consequences. Risk-reduction measures, such as home safety checks, physical therapy, and medication optimization, should be considered in this population.

Using Climate Information for Building Smallholder Resilience in India

Intra-seasonal and inter-annual climate variability is the specific climate-related production risk faced by smallholder rainfed farmers in India. For small holding rainfed farmers, access to reliable extended range and seasonal climate forecast (SCF) information could induce a set of adaptive risk reduction measures. The paper is an attempt to capture the experience of a pilot research study to understand the utility of SCF in generating risk-reducing decisions by players across the agricultural value chain in a semi-arid rainfed agroecosystem in Tamil Nadu, India. The results show that to realise the desired societal benefit of SCF, in addition to forecasts with improved predictive skills, appropriate spatial and temporal scale of the climate variables and effectiveness of the communication process is essential. Social equity in access to climate information across the agricultural value chain and ability and flexibility to adopt by the end users are also decisive factors that determine the effectiveness of climate information in reducing risk in farming. The experience also emphasises the need for strong institutional support to improve resource access and build the capacities of smallholders to translate informed decisions to actions at field level on risk-reducing responses.

Societal and equity challenges for Brain Health Services. A user manual for Brain Health Services—part 6 of 6

Brain Health Services are a novel approach to the personalized prevention of dementia. In this paper, we consider how such services can best reflect their social, cultural, and economic context and, in doing so, deliver fair and equitable access to risk reduction. We present specific areas of challenge associated with the social context for dementia prevention. The first concentrates on how Brain Health Services engage with the “at-risk“ individual, recognizing the range of factors that shape an individual’s risk of dementia and the efficacy of risk reduction measures. The second emphasizes the social context of Brain Health Services themselves and their ability to provide equitable access to risk reduction. We then elaborate proposals for meeting or mitigating these challenges. We suggest that considering these challenges will enable Brain Health Services to address two fundamental questions: the balance between an individualized “high-risk” and population focus for public health prevention and the ability of services to meet ethical standards of justice and health equity.