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This study was undertaken 6–7 months after the 1999 Athens earthquake with the aim of exploring the differences in post-traumatic stress disorder (PTSD), anxiety and depression symptoms between a group of children exposed to earthquake with a group of children not exposed to it, but with both groups potentially exposed to the same levels of post-earthquake adversities. The study included 2037 children, aged 9–17 years, who were assessed with self-completed questionnaires. The directly exposed group (N = 1752) had significantly higher anxiety and PTSD scores than the indirectly exposed group (N = 284), but no significant group differences were found in depression scores. Girls in both groups reported significantly more PTSD, anxiety and depressive symptoms than boys. Younger children reported significantly more PTSD and anxiety symptoms than the older ones. No significant interactions were found between direct exposure to earthquake, age group and gender. The severity of PTSD symptoms was most strongly predicted by greater perceived threat during the earthquake, whereas depression was most strongly predicted by the level of post-earthquake adversity. The severity of anxiety symptoms was most strongly predicted by female gender. These findings are discussed in relation to the need for screening and intervention following earthquake events.
The mental health of children and young people can be disproportionally affected and easily overlooked in the context of emergencies and disasters. Child and adolescent mental health services can contribute greatly to emergency preparedness, resilience and response and, ultimately, mitigate harmful effects on the most vulnerable members of society.
We explore the potential of mindfulness-based cognitive therapy, a skills-based intervention that provides participants with sustainable tools for adaptive responses to stress and negative mood, for the large group of young people with depression or anxiety who only partially or briefly respond to currently available first-line interventions.
Background: Endovascular thrombectomy (EVT) has shown efficacy in acute ischemic stroke (AIS) patients with infective endocarditis (IE). The possibility to undertake advanced histopathological clot analysis following EVT offers a new avenue to establish the etiological basis of the stroke – which is often labelled “cryptogenic.” In this paper, we present our findings from four consecutive patients with IE who underwent EVT following an AIS at our tertiary referral comprehensive stroke centre. Methods: Comprehensive histopathological analysis of clot retrieved after EVT, including morphology, was undertaken. Results: The consistent observation was the presence of dense paucicellular fibrinoid material mixed/interspersed with clusters of bacterial cocci. This clot morphology may be specific to septic embolus due to IE unlike incidental bacteraemia and could possibly explain the refractoriness of such clots to systemic thrombolysis. Conclusion: Detailed morphological and histopathological analysis of EVT-retrieved clots including Gram staining can assist in etiological classification of the clot. Understanding the composition of the clot may be of clinical value in early diagnostics and mapping treatment planning in IE.
Wind energy is an environmentally sustainable, cost-effective and renewable source of energy with high potential for expansion. As wind energy production expands, turbines are becoming larger, taller and more numerous, covering a larger geographical range and with greater concentration in high resource areas, thereby leading to greater public opposition from those whose interests or values are impacted. Their concerns include impacts on birds and other wildlife, aesthetics and viewsheds, noise and vibrations, human health, property values and the industrialization of rural and pristine landscapes. Due to limited systematic or consensus-based research on several of these topics, the prevalence and severity of the impacts of these are themselves often a source of dispute. Because of the broader political climate, many of the specific concerns about the adverse impacts of wind turbines on nearby residents have been swept up into a broader resistance to wind energy, based in skepticism about climate change, collusion of government and industry, concerns about cost-effectiveness or support for oil and gas development. A highly variable and inconsistent regulatory environment also exacerbates conflicts, with the greatest control sometimes situated at the local level, which leads to case-bycase decision making that suffers from limited technical capacity and is subject to greater local pressure. In many areas, pro-wind and anti-wind advocates have become locked in a fight where both sides ultimately deny the evidence, experiences and realities of the other.
In the face of these growing conflicts, some models for collaborative resolution are emerging. Collaboration between the wind industry and wildlife advocates, such as that pursued by the American Wind Wildlife Institute (see case study) and the Bats and Wind Energy Cooperative, has gone a long way toward understanding, mitigating and reducing wind energy's impact on wildlife. Improved early engagement of stakeholders in state and local siting policy and decision-making, joint fact-finding on areas of uncertainty, clarified regulatory frameworks and expanded public dialogue on energy needs and trade-offs also hold promise for managing wind energy siting disputes.
The Scale of Wind Energy
Wind energy is the fastest growing energy source in the world and has seen enormous growth in the United States over the past few decades.
Electricity and natural gas transmission systems are the backbone needed to deliver energy resources to the distribution systems that provide electricity and natural gas to consumers. They are also the part of our energy infrastructure that affects the most people because electricity transmission and distribution and natural gas pipelines cover millions of miles near homes, along highways, across farms and tribal land and through our parks and cities (see Figures 5.1 and 5.2).
The investment needed to expand and modernize this infrastructure to meet today's and tomorrow's evolving needs is daunting. Almost 50 percent of the existing US natural gas transmission system is more than 50 years old and in imminent need of repair or replacement. Furthermore, new sources of natural gas and oil from the “fracking” boom of the past 15 years have required the construction of new pipelines, and the ongoing shift from coal to natural gas for electricity generation is driving demand for more production and more pipelines. On the transmission side, the Edison Electric Institute estimates that the electricity transmission and distribution system needs $900 billion in new investment by 2030. The need for new transmission lines, in particular, is being driven in part by the growing costeffectiveness of remote renewable energy sources such as wind and solar, from which electricity must be carried over long distances to major population centers.
Different regulatory frameworks govern siting decisions for electricity transmission and for natural gas pipelines. In the case of transmission lines, the overlapping authorities over siting of local, state and federal government have in many cases added to the sources of conflict. In contrast, some cite the more streamlined and clear jurisdiction of the federal government in pipeline siting as a model for resolving siting conflicts more effectively.
The source of some of the most intractable conflicts has been and continues to be the disconnect between the costs and the benefits of interstate transmission and pipeline projects. Those living along the lengthy transmission and pipeline corridors often do not enjoy the benefits of lower cost or cleaner power that is carried by these projects.
This book has sought to offer a snapshot of energy siting conflicts and collaborative opportunities in the United States across gas and oil, wind, transmission and disposal of nuclear waste. While each energy type and its production (or disposal) is governed by various jurisdictions, with different impacts and benefits, they also share commonalities. Our central question has been the following: in what ways can collaboration and conflict resolution be used to ameliorate the conflicts that inevitably arise? In our concluding chapter, we offer some overarching ideas and tools for consideration.
Quasi-judicial Decision Making as the De Facto Method of Dispute Resolution
We recognize that the US system— however much bargaining and collaboration may take place in and between formal processes— is a quasi-judicial system. Most of our present processes seek to adjudicate between competing claims at all levels of government. There are boards, commissions, committees and key decision makers that head up complex agencies with multiple interests even within them. These formal bodies seek to gather evidence, weigh benefits and costs and reach authoritative decisions. For wind siting, local and county boards play an important role, along with statewide energy siting boards of some kind (in many cases). For pipelines across state lines, the Federal Energy Regulatory Commission (FERC) and state utility commissions play a fundamental role, while states alone play a more central role in decision making for high-voltage electricity transmission infrastructure. For oil and gas drilling, private property rights fundamentally determine siting, along with the various ways to adjudicate conflicts that have been created over time. For nuclear waste, while the Department of Energy has an important role, the US Congress is still actively engaged in where, how and when it should be stored. While these adjudicatory systems vary across energy types and jurisdictions, they all share assumptions that key agencies can set the general rules while interveners of various kinds can collectively bring the necessary information, potential impacts and interests to the table to be sorted out by various boards and commissions. And, should these fail to resolve issues, the courts always remain as a backstop to conflict.
Why Is Energy Development and Production Important in Regard to Land Use?
Gas and oil wells dot landscapes from Pennsylvania to Texas, bringing both wealth and controversy around air and water quality, wildlife habitat and community change. The advent of nuclear power in the 1950s started a boom of uranium mining, refining and energy production but brought with it the difficult problem of where and how to safely store potently lethal postenergy production nuclear waste for millennia. Appalachia has been shaped for over a century by coal extraction. More recently, the rapid expansion of wind and solar energy has given rise to host of new companies, beneficiaries and conflicts. Wind development, particularly in the more densely populated landscapes of the northeast, has generated conflicts among environmental groups, local citizens at odds with local impact versus global need. Around the country, there is a raised awareness that “clean” energy has its costs too.
Energy extraction and production have powerfully shaped the US landscape over the last hundred years. Blessed with extraordinary natural resources, the United States built the largest economy in the world. While we think of land use primarily as a local function shaped by the creation of housing, office space, tracks and roads, energy production is also a powerful player in land use.
The United States is one of the largest producers of energy in the world. In 2013, it was the world's largest producer of natural gas (30,005,254 million cubic feet) and oil (2,720,782 thousand barrels) and the second largest producer of coal (nearly 1 billion short tons) and renewable energy (at 9.33 quadrillion Btu). Fossil fuels are the main source of energy in the United States. Fossil fuel resources comprised approximately 82 percent of total US energy consumption in 2013 (with nuclear energy comprising 8 percent and renewable energy 10 percent). Beyond generating energy, these natural resources are essential to creating other products, such as oil to make asphalt and coal for steel. Energy production in its many forms cuts across locales and states, and it affects landscapes substantially, if unevenly, across the United States.
The history of US nuclear waste management has been long, complex and fraught with delays, broken commitments and political gamesmanship. Even though the first nuclear waste was produced in the 1940s, the United States still has no permanent solution to dispose of either spent nuclear fuel (SNF) from commercial nuclear reactors or the high-level waste from defense weapons and DOE-owned research facilities. In January 2012, the Blue Ribbon Commission on America's Nuclear Future (BRC) concluded that there is an “urgent” need for a new strategy to manage our country's high-level nuclear waste. The Blue Ribbon Commission recommended that the United States “commit to a new, more flexible and more adaptive approach to siting and developing [waste disposal] facilities in the future” and recommended the concept of “consentbased siting.” In January 2017, the US Department of Energy (DOE) released a draft proposal for how to implement consent-based siting.
In this chapter, we will review the scope of the nuclear waste problem, the current legislative and regulatory environment for managing our country's nuclear waste and the conflicts that need to be addressed to make progress on consent-based siting.
The inability to find a final repository for the vast build-up of nuclear waste in the United States can be attributed to a number of reasons:
(1) First, as with other energy facilities, siting can become difficult when state and local governments perceive a significant mismatch between the impacts and risks they would bear for hosting nuclear waste disposal sites.
(2) Second, disposal of nuclear waste presents unique challenges because it is a highly complex task, affecting not only those near the disposal facility, but also landowners, communities and businesses along the rail lines and highways that carry waste from the generating source to the storage or disposal facility. And arguably more so than other energy-related facilities, the disposal of nuclear waste will have consequences for thousands of years and will impact many future generations.
(3) Finally, the federal government's history of repeatedly missing timelines and commitments, as well as a perceived lack of fairness and transparency in the decision-making process, has undermined confidence in the agencies and decision makers tasked with designing and implementing current and future siting processes.
A decade ago, natural gas and oil production in the continental United States began dramatically increasing as new technologies allowed for the economically viable extraction of these resources from fields that had previously been left alone or written off. This expansion in oil and gas development has had diverse and significant impacts, ranging from robust economic growth in many production areas, to a precipitous fall in global oil prices in 2015, to the introduction of the word “fracking” and the American public and fears of groundwater contamination and earthquakes that accompany it.
The expansion of production in the United States results from the maturation of two key technologies, horizontal drilling and hydraulic fracturing (colloquially known as “fracking”), that have allowed companies to efficiently produce oil and gas from shale beds and other “unconventional” oil and natural gas fields that standard production techniques could not economically exploit. As a result, natural gas and oil production reemerged in many communities in Pennsylvania, Ohio, North Dakota, and elsewhere that had seen little activity in recent decades. Equally important, however, these same two technologies are increasingly being applied to “conventional” fields to boost production, thereby intensifying development activity in areas that have been steadily producing for years, such as North Texas, Colorado's Western Slope and California's Kern County.
The surge in unconventional oil and gas production in the United States over the past decade has engendered a variety of positive benefits, including economic growth, well-paying jobs and wealth creation for many communities and workers. Significant increases in oil and natural gas production in the United States have also helped to reduce the costs of home heating and of filling a car's gas tank and have contributed to a significant shift of the nation's power generation from coal to natural gas. At the same time, however, the increase in oil and gas development has increased its impacts or potential impacts on water quality, seismic activity, air quality, habitat and the landscape and on socioeconomics. This rapid expansion of development has engendered conflict between a host of different parties, including different residents and property owners in areas hosting oil and gas development; oil and gas development companies; and various levels of government, including state, local, federal and tribal government bodies.
Resolving Land and Energy Conflicts studies energy in the landscape across gas and oil, wind, transmission and nuclear waste disposal. The authors are particularly interested in the conflicts that emerge from specific sites and proposals as well as how this unique land use plays out in terms of conflict and resolution across scales and jurisdictions while touching on broader issues of policy and values. Resolving Land and Energy Conflicts briefly explains the general context around the energy type; the impacts and conflicts that have arisen given this context; the role laws, rules and jurisdictions play in mitigating, resolving or creating more conflict; and the ways in which communication, collaboration and conflict resolution have been or could be used to ameliorate the conflicts that inevitably arise.
Use of ketamine in the prehospital setting may be advantageous due to its potent analgesic and sedative properties and favorable risk profile. Use in the military setting has demonstrated both efficacy and safety for pain relief. The purpose of this study was to assess ketamine training, use, and perceptions in the civilian setting among nationally certified paramedics (NRPs) in the United States.
A cross-sectional survey of NRPs was performed. The electronic questionnaire assessed paramedic training, authorization, use, and perceptions of ketamine. Included in the analysis were completed surveys of paramedics who held one or more state paramedic credentials, indicated “patient care provider” as their primary role, and worked in non-military settings. Descriptive statistics were calculated.
A total of 14,739 responses were obtained (response rate=23%), of which 10,737 (73%) met inclusion criteria and constituted the study cohort. Over one-half (53%) of paramedics reported learning about ketamine during their initial paramedic training. Meanwhile, 42% reported seeking ketamine-related education on their own. Of all respondents, only 33% (3,421/10,737) were authorized by protocol to use ketamine. Most commonly authorized uses included pain management (55%), rapid sequence intubation (RSI; 72%), and chemical restraint/sedation (72%). One-third of authorized providers (1,107/3,350) had never administered ketamine, with another 32% (1,070/3,350) having administered ketamine less than five times in their career. Ketamine was perceived to be safe and effective as the vast majority reported that they were comfortable with the use of ketamine (94%) and would, in similar situations (95%), use it again.
This was the first large, national survey to assess ketamine training, use, and perceptions among paramedics in the civilian prehospital setting. While training related to ketamine use was commonly reported among paramedics, few were authorized to administer the drug by their agency’s protocols. Of those authorized to use ketamine, most paramedics had limited experience administering the drug. Future research is needed to determine why the prevalence of ketamine use is low and to assess the safety and efficacy of ketamine use in the prehospital setting.
BucklandDM, CroweRP, CashRE, GondekS, MalusoP, SirajuddinS, SmithER, DangerfieldP, ShapiroG, WankaC, PanchalAR, SaraniB. Ketamine in the Prehospital Environment: A National Survey of Paramedics in the United States. Prehosp Disaster Med. 2018;33(1):23–28.