Variation in risk seeking behaviour following large losses : a natural experiment

This study explores people's risk taking behaviour after having suffered large real-world losses following a natural disaster. Using the margins of the 2011 Australian floods (Brisbane) as a natural experimental setting, we find that homeowners who were victims of the floods and face large losses in property values are 50% more likely to opt for a risky gamble -- a scratch card giving a small chance of a large gain ($500,000) -- than for a sure amount of comparable value ($10). This finding is consistent with prospect theory predictions regarding the adoption of a risk-seeking attitude after a loss.

Creating regional resilience in Australia

This paper explores the impact that extreme weather events can have on communities. Using the Brisbane floods of 2011 to examine the recovery operations, the paper highlights the effectiveness of recovery and rebuilding in already strong and resilient communities. Our research has shown that communities which have a strong sense of identity, as well as organized places to meet, develop resilient networks that come into play in times of crisis. The increasing trend of the fly-in/fly-out (FIFO) or drive-in/drive-out (DIDO) workforce to service regional areas has undermined the resilience of existing communities. The first hint of this occurs with community groups not knowing who their neighbours are. The paper is based on research examining the needs of groups in regional communities with the goal to better equip regional communities with the capacity to respond positively to change (and crisis) through in-novative, evidence-based policies, resilience strategies and tools. Part of this process was to build an evidence-base to address a range of challenges associated with the place-based environments and the sharing of information systems within communities and decision makers. The first part of the paper explores the context in which communities have been required to mobilize in response to crises; the issues that have galvanized a common purpose; and the methods by which these communities shared their knowledge. The second part of the paper examines how communities could plan for and mitigate natural disasters in the future by developing better decision making tools. The paper defines the requirements for information systems that will link data models of built infrastruc-ture with data from the disaster and response plans. These will then form the basis for the use of social media to coordinate activities between official crews and the public to improve response coordination and provide the technology that could reduce the time required to allow communities to resume some semblance of normality.

Expanding Emergency Department capacity : a multisite study

Objectives: To i) identify predictors of admission, and ii) describe outcomes for patients who arrived via ambulance to three Australian public Emergency Departments (EDs), before and after the opening of 41 additional ED beds within the area. Methods: A retrospective, comparative, cohort study using deterministically linked health data collected between 3 September 2006 and 2 September 2008. Data included ambulance offload delay, time to see doctor, ED length of stay (ED LOS), admission requirement, access block, hospital length of stay and in-hospital mortality. Logistic regression analysis was undertaken to identify predictors of hospital admission. Results: One third of all 286,037 ED presentations were via ambulance (n= 79,196) and 40.3% required admission. After increasing emergency capacity, the only outcome measure to improve was in-hospital mortality. Ambulance offload delay, time to see doctor, ED length of stay (ED LOS), admission requirement, access block, hospital length of stay did not improve. Strong predictors of admission before and after increased capacity included: age over 65 years, Australian Triage Scale (ATS) category 1-3, diagnoses of circulatory or respiratory conditions and ED LOS > 4 hours. With additional capacity the odds ratios for these predictors increased for age >65 and ED LOS > 4 hours and decreased for triage category and ED diagnoses. Conclusions: Expanding ED capacity from 81 to 122 beds within a health service area impacted favourably on mortality outcomes but not on time-related service outcomes such as ambulance offload time, time to see doctor and ED LOS. To improve all service outcomes, when altering (increasing/decreasing) ED bed numbers, the whole healthcare system needs to be considered.

Groundwater table response to sea level rise and its impact on pavement structure

It has been predicted that sea level will rise about 0.8 m by 2100. Consequently, seawater can intrude into the coastal aquifers and change the level of groundwater table. A raise in groundwater table due to seawater intrusion threats the coastal infrastructure such as road pavements. The mechanical properties of subgrade materials will change due to elevated rise of groundwater table, leading to pavement weakening and decreasing the subgrade strength and stiffness. This paper presents an assessment of the vulnerability of subgrade in coastal areas to change in groundwater table due to sea-level rise. A simple bathtub approach is applied for estimating the groundwater level changes according to sea-level rise. Then the effect of groundwater level changes on the soil water content (SWC) of a single column of fine-sand soil is simulated using MIKE SHE. The impact of an increase in moisture content on subgrade strength/stiffness is assessed for a number of scenarios.

The Arab Spring and its social media audiences : English and Arabic Twitter users and their networks

2011 ‘Arab Spring’ are likely to overstate the impact of Facebook and Twitter on these uprisings, it is nonetheless true that protests and unrest in countries from Tunisia to Syria generated a substantial amount of social media activity. On Twitter alone, several millions of tweets containing the hashtags #libya or #egypt were generated during 2011, both by directly affected citizens of these countries, and by onlookers from further afield. What remains unclear, though, is the extent to which there was any direct interaction between these two groups (especially considering potential language barriers between them). Building on hashtag datasets gathered between January and November 2011, this paper compares patterns of Twitter usage during the popular revolution in Egypt and the civil war in Libya. Using custom-made tools for processing ‘big data’, we examine the volume of tweets sent by English-, Arabic-, and mixed-language Twitter users over time, and examine the networks of interaction (variously through @replying, retweeting, or both) between these groups as they developed and shifted over the course of these uprisings. Examining @reply and retweet traffic, we identify general patterns of information flow between the English- and Arabic-speaking sides of the Twittersphere, and highlight the roles played by users bridging both language spheres.

Calculate excess mortality during heatwaves using Hilbert-Huang transform algorithm

Background Heatwaves could cause the population excess death numbers to be ranged from tens to thousands within a couple of weeks in a local area. An excess mortality due to a special event (e.g., a heatwave or an epidemic outbreak) is estimated by subtracting the mortality figure under ‘normal’ conditions from the historical daily mortality records. The calculation of the excess mortality is a scientific challenge because of the stochastic temporal pattern of the daily mortality data which is characterised by (a) the long-term changing mean levels (i.e., non-stationarity); (b) the non-linear temperature-mortality association. The Hilbert-Huang Transform (HHT) algorithm is a novel method originally developed for analysing the non-linear and non-stationary time series data in the field of signal processing, however, it has not been applied in public health research. This paper aimed to demonstrate the applicability and strength of the HHT algorithm in analysing health data. Methods Special R functions were developed to implement the HHT algorithm to decompose the daily mortality time series into trend and non-trend components in terms of the underlying physical mechanism. The excess mortality is calculated directly from the resulting non-trend component series. Results The Brisbane (Queensland, Australia) and the Chicago (United States) daily mortality time series data were utilized for calculating the excess mortality associated with heatwaves. The HHT algorithm estimated 62 excess deaths related to the February 2004 Brisbane heatwave. To calculate the excess mortality associated with the July 1995 Chicago heatwave, the HHT algorithm needed to handle the mode mixing issue. The HHT algorithm estimated 510 excess deaths for the 1995 Chicago heatwave event. To exemplify potential applications, the HHT decomposition results were used as the input data for a subsequent regression analysis, using the Brisbane data, to investigate the association between excess mortality and different risk factors. Conclusions The HHT algorithm is a novel and powerful analytical tool in time series data analysis. It has a real potential to have a wide range of applications in public health research because of its ability to decompose a nonlinear and non-stationary time series into trend and non-trend components consistently and efficiently.

Emergency healthcare of the future

Emergency healthcare is a high profile component of modern healthcare systems, which over the past three decades has fundamentally transformed in many countries. However, despite this rapid development, and associated investments in service standards, there is a high level of concern with the performance of emergency health services relating principally to system wide congestion. The factors driving this problem are complex but relate largely to the combined impact of growing demand, expanded scope of care and blocked access to inpatient beds. These factors are unlikely to disappear in the medium term despite the National Emergency Access Target. The aim of this article is to stimulate a conversation about the future design and functioning of emergency healthcare systems; examining what we understand about the problem and proposing a rationale that may underpin future strategic approaches. This is also an invitation to join the conversation.

Conceptual framework for understanding the demand for emergency health services

Background & Objectives Emergency health services (EHS) throughout the world are increasingly congested. As more people use EHS, factors such as population growth and aging cannot fully explain this increase. Also, focus on patients’ clinical characteristics ignores the role that attitudinal and perceptual factors and motivations play in directing their decisions and actions. The aim of this study is to review and synthesize an integrated conceptual framework for understanding social psychological factors underpinning demand for EHS. Methodology A comprehensive search and review of empirical and theoretical studies about the utilization of EHS was conducted using major medical, health, social and behavioral sciences databases. Results A small number of studies used a relevant conceptual framework (e.g. Health Services Utilization Model or Health Belief Model) or their components to analyze patients’ decision to use EHS. The studies evidenced that demand was affected by perceived severity of the condition; perceived costs and benefits (e.g. availability, accessibility and affordability of alternative services); experience, preference and knowledge; perceived and actual social support; and demographic characteristics (e.g. age, sex, socioeconomic status, ethnicity, marital and living circumstances, place of residence). Conclusions Conceptual models that are commonly used in areas like social and behavioral sciences have rarely been applied in the EHS utilization field. Understanding patients’ decision-making and associated factors will lay the groundwork for identification of the evidence to inform improved policy responses and the development of demand management strategies. An integrated conceptual framework will be introduced as part of this study.

Duty in the time of epidemics : what China and Zimbabwe teach us

In November 2002, a man with ‘atypical pneumonia’ treated in Foshan hospital, Guangdong Province, in the People's Republic of China, was the first known case of Severe Acute Respiratory Syndrome (SARS). However, it was not until April 2003 that the Chinese government admitted to the full scale of ‘atypical pneumonia’ cases infected with SARS, two months after the disease had rapidly spread across the world with initial infections in Hong Kong and Vietnam sourced to Guangdong. In 2008, Zimbabwe experienced one of the biggest outbreaks of cholera ever recorded. By February 2009, the disease had spread across all of Zimbabwe's 10 provinces and to neighbouring countries—Botswana, South Africa, Zambia and Mozambique—causing thousands of infections amongst their populations. This article seeks to examine what duties the Chinese and Zimbabwe states had to protect their citizens and the international community from these outbreaks. The article refers to the findings of the International Law Commission's study into the role of states and international organisations in protecting persons in the event of a disaster to consider whether there is an international duty to protect persons from epidemics. The article concludes that both cases reveal a growing concept of protection that entails an international duty to assist individuals when an affected state proves unwilling or unable to assist its own population in the event of a disease outbreak.

Is there an international duty to protect persons in the event of an epidemic?

In 2006, the International Law Commission began a study into the role of states and international organizations in protecting persons in the event of a disaster. Special Rapporteur Mr. Eduardo Valencia-Ospina was appointed to head the study, and in 2011 the findings of the study will be presented to the United Nations General Assembly. Of interest to this paper has been the inclusion of “epidemics” under the natural disaster category in all of the reports detailing the Commission’s program of work on the protection of persons. This paper seeks to examine the legal and political ramifications involved in including “epidemic” into the concept of protection by exploring where sovereign responsibility for epidemic control begins and ends, particularly in light of the revisions to the International Health Regulations by the World Health Assembly in 2005. The paper will first analyze the findings already presented by the Special Rapporteur, examining the existing “responsibilities” of both states and international organizations. Then, the paper will consider to what extent the concept of protection entails the duty to assist individuals when an affected state proves unwilling or unable to assist their own population in the event of a disease outbreak. In an attempt to answer this question, the third part of the paper will examine the recent cholera outbreak in Zimbabwe.

Caring for emergency service personnel : does what we do work?

Most emergency service organisations have some form of staff support program that share general aims of promoting and maintaining the mental health of their workforce. Yet few of these services have been subject to evaluation and fewer still have commissioned external professional researchers to scrutinise their programs. The Queensland Ambulance (QAS) Service provides a comprehensive and multifaceted program that is both proactive and reactive in design and with the support of the Commissioner, was the subject of a rigorous evaluation throughout 2013. In this paper the program services are briefly outlined and the considered approach to the evaluation is presented within the context of existing scientific literature. Using focus groups, information regarding the uptake of the program’s various ‘arms’, and survey data, results suggest the program is widely used and that staff are very satisfied with the services provided. Further, analysis of established psychometric measures demonstrated organisational and interpersonal factors that are important in the promotion of mental health and in warding off the deleterious impacts that frontline emergency service staff can endure. Data presented in this paper indicate how best to ensure a professional quality of life for ambulance personnel, how to promote resilience to the sometimes extremely challenging aspects of the work role, and ways in which difficulties such as depression may be minimised.

Promoting posttraumatic growth in police recruits : preliminary results of a randomised controlled resilience intervention trial

Recent research has demonstrated that the same experiences that may elicit symptoms of post-traumatic stress disorder (PTSD) in emergency service personnel can also provide a catalyst for positive personal changes such as posttraumatic growth (PTG). In this research newly recruited police officers (N = 412) participated in a randomised control trial of a program specifically designed to promote mental health. On entry to the academy, new recruits were randomly allocated, by classrooms, to either a treatment as usual condition (i.e., existing psychoeducation program) or to the intervention group. The Promoting Resilient Officers (PRO) program is a resilience building intervention adapted from an earlier resilience building program in collaboration with the police service. The PRO program also includes additional components on trauma and PTG. The current research included the participants who had experienced trauma prior to or during the research period (N = 246). It was hypothesised that participation in the PRO program would increase levels of PTG and lower levels of PTSD when compared to recruits in the control condition. Using multilevel modelling and post-hoc analyses, results indicated there were significantly higher levels of PTG across multiple dimensions when compared to the control group. There was no effect on PTSD symptoms with both conditions showing a floor effect. The research indicated the potential value of developing interventions that elicit reflections on the potential for positive as well as negative outcomes of experiencing traumatic and other highly challenging events.

Institutional response and Indigenous experiences of Cyclone Tracy

Early on Christmas morning 1974 Tropical Cyclone Tracy, a Category 4 storm, devastated the Northern Territory city of Darwin leaving only 6% of the city’s housing habitable. The extent of the disaster was largely the result of unregulated and poorly constructed buildings, predominantly housing. While the engineering and reconstruction process demonstrated a very successful response and adaptation to an existing and future risk, the impact of the cyclone of the local community and its Indigenous population in particular, had not been well recorded. NCCARF therefore commissioned a report on the Indigenous experience of Cyclone Tracy to document how Indigenous people were impacted by, responded to, and recovered from Cyclone Tracy in comparison to non-Indigenous groups. The report also considers the research literature on disasters and Indigenous people in the Northern Territory, with a specific focus on cyclones, and considers the socio-political context of Indigenous communities in Darwin prior to Cyclone Tracy.

Cyclone Tracy and the road to improving wind-resistant design

Early on Christmas morning 1974, tropical cyclone Tracy devastated the city of Darwin leaving only 6 per cent of the city’s housing habitable and instigating the evacuation of 75 per cent of its population. The systematic failure of so much of Darwin’s building stock led to a humanitarian disaster that proved the impetus for an upheaval of building regulatory and construction practices throughout Australia. Indeed, some of the most enduring legacies of Tracy have been the engineering and regulatory steps taken to ensure the extent of damage would not be repeated. This chapter explores these steps and highlights lessons that have led to a national building framework and practice at the fore of wind-resistant design internationally.