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The MHRA is a comprehensive form on our electronic patient records system. It includes 11 sections assessing different risk categories, with tick boxes to evidence input from various members of the MDT. Anecdotal experience suggested that these forms were sometimes incomplete and often lacked input from MDT members other than nursing staff. We aimed to increase the completion rate and multidisciplinary team (MDT) involvement, particularly doctor involvement, in the electronic MHRA documentation on an acute inpatient psychiatric assessment ward at the Royal Edinburgh Hospital.
Methods
• Baseline survey (November cohort of 12 patients): data collection on number of sections completed (total number = 11) and whether the ‘psychiatrist’ box was ticked, indicating medical input.
• Intervention: doctors on the ward reviewed all inpatient MHRAs, added additional assessments if appropriate, and ticked ‘psychiatrist’ involvement in the MHRA.
• Repeat survey (February cohort of 11 patients): data collection as before and review of findings.
Results
In our baseline survey (November 2021), 75% (9/12) of patients had all sections of the MHRA completed. 33% (4/12) had the ‘psychiatrist’ box ticked. In our repeat survey (February 2022), 91% (10/11) of patients had all sections of the MHRA completed. 100% (11/11) had the ‘psychiatrist’ box ticked.
Conclusion
Accurate assessment and management of risk is an important factor in the safety of patients and staff on acute psychiatric wards. Our baseline data showed that risk assessments had limited medical input and at times had sections which were not filled in at all. Review of the MHRA by medical staff improved this, and in some cases found and added relevant information which had been missed. As a person dependent intervention, this may not be a sustainable change. As a first step to introduce a sustainable system change, a visual prompt has been introduced, in the form of a blue triangle icon in the duty room whiteboard to highlight whether each patient has a complete and up to date MHRA. Further interventions could include integrating a review of the MHRA in weekly ward rounds. This audit also raised the issue of some relevant information having been missed from risk assessments and showed that further audit of the quality of risk assessments is indicated.
The rapid popularization of unmanned aerial vehicles (UAVs; also referred to as drones), in both the recreational and industrial sectors, has paved the way for rapid developments in drone capabilities. Although the threat of UAVs used by terrorists has been recognized by specialists in both Counter-Terrorism and Counter-Terrorism Medicine (CTM), there are limited data on the extent and characteristics of drone use by terrorist organizations.
Methods:
Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database search functions for all terrorist attacks using UAVs from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. Primary weapon type, number and type of UAVs used, related attacks, location (country, world region), and number of deaths and injuries were collated. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.
Results:
There were 76 terrorist attacks using UAVs. The first attack occurred in 2016, and the number of attacks per year varied considerably (range: 4-36). Forty-seven of the 76 attacks (70%) were successful. Twenty-seven individually listed events (36%) were related and part of nine coordinated, multi-part incidents. A total of 50 deaths and 132 injuries were recorded, which equated to 1.09 deaths (range: 0-6) and 2.89 injuries (range: 0-20) per successful attack. The mean number of UAVs used in an attack was 1.28 (range: 1-5) and multiple UAVs were used in 22% of attacks.
Conclusion:
The use of UAVs to carry out terrorist attacks is on the rise. Seventy-six terrorist attacks using this novel method were recorded since 2016, killing 50 and injuring 132 people. While the use of UAV-related explosives appears less lethal than traditional explosive attacks, advancing technologies and swarming capabilities, increasing ability to carry larger payloads, and the possibility of UAVs to disperse chemical, biological, radiological, and nuclear (CBRN) weapons will likely increase UAV lethality in the future, requiring CTM specialists be more proactive.
The production of three-dimensional (3D) digital meshes of surface and computed tomographic (CT) data has become widespread in morphometric analyses of anthropological and archaeological data. Given that processing methods are not standardized, this leaves questions regarding the comparability of processed and digitally curated 3D datasets. The goal of this study was to identify those processing parameters that result in the most consistent fit between CT-derived meshes and a 3D surface model of the same human mandible. Eight meshes, each using unique thresholding and smoothing parameters, were compared to assess whole-object deviations, deviations along curves, and deviations between specific anatomical features on the surface model when compared with the CT scans using a suite of comparison points. Based on calculated gap distances, the mesh that thresholded at “0” with an applied smoothing technique was found to deviate least from the surface model, although it is not the most biologically accurate. Results have implications for aggregated studies that employ multimodal 3D datasets, and caution is recommended for studies that enlist 3D data from websites and digital repositories, particularly if processing parameters are unknown or derived for studies with different research foci.
Due to lack of data on the epidemiology, cardiac, and neurological complications among Ontario visible minorities (Chinese and South Asians) affected by coronavirus disease (COVID-19), this population-based retrospective study was undertaken to study them systematically.
Methods:
From January 1, 2020 to September 30, 2020 using the last name algorithm to identify Ontario Chinese and South Asians who were tested positive by PCR for COVID-19, their demographics, cardiac, and neurological complications including hospitalization and emergency visit rates were analyzed compared to the general population.
Results:
Chinese (N = 1,186) with COVID-19 were found to be older (mean age 50.7 years) compared to the general population (N = 42,547) (mean age 47.6 years) (p < 0.001), while South Asians (N = 3,459) were younger (age of 42.1 years) (p < 0.001). The 30-day crude rate for cardiac complications among Chinese was 169/10,000 (p = 0.069), while for South Asians, it was 64/10,000 (p = 0.008) and, for the general population, it was 112/10,000. For neurological complications, the 30-day crude rate for Chinese was 160/10,000 (p < 0.001); South Asians was 40/10,000 (p = 0.526), and general population was 48/10,000. The 30-day all-cause mortality rate was significantly higher for Chinese at 8.1% vs 5.0% for the general population (p < 0.001), while it was lower in South Asians at 2.1% (p < 0.001).
Conclusions:
Chinese and South Asians in Ontario affected by COVID-19 during the first wave of the pandemic were found to have a significant difference in their demographics, cardiac, and neurological outcomes.
The Subglacial Antarctic Lakes Scientific Access (SALSA) Project accessed Mercer Subglacial Lake using environmentally clean hot-water drilling to examine interactions among ice, water, sediment, rock, microbes and carbon reservoirs within the lake water column and underlying sediments. A ~0.4 m diameter borehole was melted through 1087 m of ice and maintained over ~10 days, allowing observation of ice properties and collection of water and sediment with various tools. Over this period, SALSA collected: 60 L of lake water and 10 L of deep borehole water; microbes >0.2 μm in diameter from in situ filtration of ~100 L of lake water; 10 multicores 0.32–0.49 m long; 1.0 and 1.76 m long gravity cores; three conductivity–temperature–depth profiles of borehole and lake water; five discrete depth current meter measurements in the lake and images of ice, the lake water–ice interface and lake sediments. Temperature and conductivity data showed the hydrodynamic character of water mixing between the borehole and lake after entry. Models simulating melting of the ~6 m thick basal accreted ice layer imply that debris fall-out through the ~15 m water column to the lake sediments from borehole melting had little effect on the stratigraphy of surficial sediment cores.
Ecosystem modeling, a pillar of the systems ecology paradigm (SEP), addresses questions such as, how much carbon and nitrogen are cycled within ecological sites, landscapes, or indeed the earth system? Or how are human activities modifying these flows? Modeling, when coupled with field and laboratory studies, represents the essence of the SEP in that they embody accumulated knowledge and generate hypotheses to test understanding of ecosystem processes and behavior. Initially, ecosystem models were primarily used to improve our understanding about how biophysical aspects of ecosystems operate. However, current ecosystem models are widely used to make accurate predictions about how large-scale phenomena such as climate change and management practices impact ecosystem dynamics and assess potential effects of these changes on economic activity and policy making. In sum, ecosystem models embedded in the SEP remain our best mechanism to integrate diverse types of knowledge regarding how the earth system functions and to make quantitative predictions that can be confronted with observations of reality. Modeling efforts discussed are the Century ecosystem model, DayCent ecosystem model, Grassland Ecosystem Model ELM, food web models, Savanna model, agent-based and coupled systems modeling, and Bayesian modeling.
The systems ecology paradigm (SEP) is presented as the right science and analytical approach at the right time for resolving many of the Earth’s natural resource, environmental, and societal challenges. SEP embodies two major parts. One, the systems ecology approach, which is the holistic, systems thinking perspective and methodology developed for the rigorous study of ecosystems, including humans. Two, the use of ecosystem science, the vast body of scientific knowledge, much of which has been assembled using the ecosystem and systems ecology approaches. The fundamental philosophy, evolution, and application of the SEP are defined in this chapter. The organizing principles of the SEP include: many problems are complex and complicated and may have multiple causes; precise definitions of problems and their spatial, temporal, and organizational hierarchical scales are critical; collaborative decision making including scientists, technical and administrative staff members, and essential stakeholders is essential; transparent, honest, and effective communication is required; globalization of collaboration within interdisciplinary networks has been a hallmark of the paradigm; and integration of simulation modeling, field and laboratory studies has proven indispensable for many scientific breakthroughs. A call for integration of transdisciplinary science, policy making, and management is presented.
The evolution of ecosystem science and systems ecology as legitimate branches of science has occurred since the late 1960s. They have flourished because of their essential contributions to understanding and management of natural resources and the environment. Scientific knowledge about the structure and functioning of ecosystems, the services ecosystems provide to people, and the roles people play therein, have become commonplace. Scientists know what challenges face Earth’s environments and they know many of the solutions available to resolve them. But scientific knowledge alone is insufficient to implement change. Knowledge transfer to people who manage our lands, waters, and other natural resources is essential and they must become engaged in implementing solutions to major natural resource and environmental challenges. Adoption of new concepts and technologies is critical. Overcoming the barriers to adoption of best management practices is critically needed. Many of the barriers are created by adherence to dogmatic cultural norms and ideologies by landowners, managers, and policy makers. Behavioral, organizational, learning, and marketing professionals study behavioral change. The systems ecology paradigm must incorporate behavioral, organizational, learning, and marketing professionals as partners in implementing concepts of adoption cycles and community-based social marketing to solve wicked problems.
The systems ecology paradigm (SEP) emerged in the late 1960s at a time when societies throughout the world were beginning to recognize that our environment and natural resources were being threatened by their activities. Management practices in rangelands, forests, agricultural lands, wetlands, and waterways were inadequate to meet the challenges of deteriorating environments, many of which were caused by the practices themselves. Scientists recognized an immediate need was developing a knowledge base about how ecosystems function. That effort took nearly two decades (1980s) and concluded with the acceptance that humans were components of ecosystems, not just controllers and manipulators of lands and waters. While ecosystem science was being developed, management options based on ecosystem science were shifting dramatically toward practices supporting sustainability, resilience, ecosystem services, biodiversity, and local to global interconnections of ecosystems. Emerging from the new knowledge about how ecosystems function and the application of the systems ecology approach was the collaboration of scientists, managers, decision-makers, and stakeholders locally and globally. Today’s concepts of ecosystem management and related ideas, such as sustainable agriculture, ecosystem health and restoration, consequences of and adaptation to climate change, and many other important local to global challenges are a direct result of the SEP.
National and international agencies and organizations have published reports outlining critical natural resource, environmental, and societal challenges facing global inhabitants. These reports include the UN Sustainability Goals, Future Earth, Global Land Project, and the Resilience Alliance. Recognizing many of the topics listed in these reports are broad and aspirational, the authors of this chapter have disaggregated many topics into research and management challenges for which the systems ecology paradigm is well suited. Disaggregation is based on challenges at different spatial hierarchical scales: organisms/populations; ecological sites; landscapes; small regions/watersheds; regions/nations; continents; and the globe. Emphasis is placed on research needs at landscape and larger hierarchical levels. Biophysical knowledge acquired during the past 50 years about organism/population and ecological site levels is available now to better manage ecosystems and natural resources. However, research blending the ecosystem knowledge base with behavioral, learning, organizational, and marketing sciences is vitally needed to affect management practice change at scales where people manage land and waters. The goal is to engage managers, policy makers, thought leaders, and concerned citizens to resolve critical problems and adopt best management practices to meet current and future environmental challenges (e.g., provision of ecosystem services and climate change effects on ecosystem).