Some Lessons Learned from Public Health on the Process of Adaptation

Lessons learned from more than 150 years of public health research and intervention can provide insights to guide public health professionals and institutions as they design and implement specific strategies, policies, and measures to increase resilience to climate variability and change. This paper identifies both some modifications to public health systems that may enhance adaptive capacity, and lessons drawn from the history of managing environmental and other threats in the public health sector that may have relevance for other sectors as they design approaches to increase their adaptive capacity to more effectively cope with climate variability and change. The views expressed are the author’s own and do not represent official US EPA policy.     

Cognitive skills underlying driving in patients discharged following self-poisoning with central nervous system depressant drugs

Background: Central nervous system-depressant (CNS-Ds) drugs can impair cognitive functions and driving. They are also the most common drugs taken in overdose in hospital-treated episodes of self-poisoning. In Australia most of these patients are discharged within 48?h, while they still have possible subclinical drug effects. We aimed to determine whether patients treated for self-poisoning with CNS-Ds are impaired in the Trail-Making Test (TMT, parts A and B), a neuropsychological test that is known to correlate with driving performance. Methods: This study was a conducted from November 2008 to April 2011 in a referral center for poisonings in New South Wales, Australia. One hundred seven patients discharged from the clinical toxicology unit following treatment for self-poisoning of CNS-Ds (benzodiazepines, atypical antipsychotics, or opioids) and a control group of 68 discharged following self-poisoning of non-CNS-depressant drugs (acetaminophen or nonsedating antidepressants) were tested with the TMT (parts A and B). Due to the known association of impaired TMT with driving impairment and increased risk of traffic accidents, performance less than the 10th percentile for age was defined as significant impairment in each part of the TMT. The odds ratio (OR) for impairment in each part was calculated in multivariate logistic regression (MLR) models adjusted for gender, education, IQ, and the presence of a major psychiatric illness. A secondary MLR analysis was conducted only for those patients (78 CNS-D and 54 control group participants) who were directly discharged home, after excluding those who were transferred for further psychiatric care. Results: The odds of impairment in the CNS-D group was 2.8?times that of the control group on the TMT-A (38 [35.5%] vs. 11 [16.2%]: adjusted OR = 2.76, 95% confidence interval [CI]: 1.28-5.97), and 4.6?times on the TMT-B (67 [62.6%] vs. 22 [32.4%]: adjusted OR = 4.63, 95% CI: 2.06-10.42). The results were similar in the subgroup of patients discharged home, and the odds of impairment in the CNS-D group was 3.3?times that of the control group on the TMT-A (25 [32.1%] vs. 7 [13.0%]: adjusted OR = 3.30, 95% CI: 1.28-8.52), and 3.6?times on the TMT-B (46 [59.0%] vs. 17 [31.5%]: adjusted OR = 3.64, 95% CI: 1.44-9.20). TMT-B impairment in the CNS-D group remained significant even after adjusting for TMT-A performance. Conclusions: Patients with CNS-D overdose may have significant impairment in cognitive skills underlying driving at the time of discharge from hospitals. Clinicians should warn these patients that their driving skills might still be impaired, even if they are considered clinically recovered and advise them not to drive during the first 1 to 2?days following discharge.     

Flooding and schools: experiences in Hull in 2007

Hull, a city in the East Riding of Yorkshire, United Kingdom, suffered severe flooding in June 2007, affecting some 8,600 households and most schools. Despite the potential for damage in such disasters, no studies of the effects of floods on teachers and schools in the UK appear to have been published previously. This study analysed the impacts of the floods on teachers in Hull in two stages: first through correspondence with Hull City Council and a mailed questionnaire to 91 head teachers of primary, secondary, and special schools; and second, through in‐depth interviews with head teachers from six flooded schools, representing different degrees of flood experience, and a questionnaire completed by eight teachers from the same schools. The findings reveal the importance and the complexity of the role of the school in the wider community in a time of crisis. The study highlights issues concerning preparedness for floods, support for schools, and flood protection for schools.     

The reclamation of worked-out sand and gravel quarries utilising domestic waste — the issue of groundwater pollution

Landfill is the cheapest method of domestic waste disposal but the amount disposed of in this way has declined in recent years. This decline in landfill is due principally to the unavailability of acceptable tipping sites. Up to 30% of land taken for sand and gravel extraction may not be restored to a productive use in the absence of fill material. Domestic waste is often available to reclaim derelict sand and gravel quarries, but unsubstantiated fears of tip leachate polluting groundwaters has prevented its use for this purpose.     

Biorheological properties of intertidal organic fluff on mud flats and its modification of gill ventilation in buried sole <Emphasis Type="Italic">Solea solea</Emphasis>

Intertidal mudflats are important nursery grounds for juveniles of many fish species. However, they are being used increasingly to farm bivalve molluscs, which produce large amounts of organic “fluff”, overlying the mud. Fish such as sole, Solea solea, hide in this fluff from potential predators, but the energy consumed by respiring the fluff may be high due to its biorheological properties. We developed an ichthyoviscometer. It incorporates a freshly killed fish as a viscometer, and we developed it to measure the rheological properties of fluids and suspensions, including fluff, at scales encompassing those in gill ventilation. We have shown that the rheological behaviour of fluff is close to that of a gel with a yield stress strongly dependent on particulate organic matter concentration ([POM]). This has allowed us to model fluff flow through the gill channels in living sole as a function of fish size and [POM], showing that in a 26-g sole, fluff would halve flow at a [POM] value of 3.2 g l⁻¹, and stop it at 3.4.     

Wave Enhancement of Diffusivities within Surficial Sediments

The enhancement of solute diffusivities within coastal surficial sediments as a result of wave action is examined. Fluctuating pressure gradients associated with passing waves cause interstitial water motions leading to enhanced diffusivities through the mechanism of shear dispersion. Wave amplification of diffusivities is likely to be greatest for waves of period 10 s, in shallow water, over a bottom of coarse grain. Diffusivity enhancement of hundreds of times molecular diffusivity is achievable. The mechanism is distinct from, but complements, the mechanism of rotational dispersion which has been previously described. Other mechanisms that enhance solute transport within surficial sediments rely on the interaction between wave-driven or steady flow over bottom obstructions such as biogenic structures or sand ripples. It is suggested that while the resulting advective flows may dominate solute transport within the top few 10 s of centimeters of the sediment column, shear dispersion may be more important deeper within the sediment. In any event, in contrast to these other mechanisms, shear dispersion is operative even when the seabed is flat. Application of the theory to sediments of the South Atlantic Bight would suggest that shear dispersion is capable of explaining a major part of the interstitial transport inferred from measurements.     

Adaptation Options Strategies for Hazards and Vulnerability Mitigation: An International Perspective

The broad objective of this special issue of Mitigation and Adaptation Strategies for Global Change is to address some of the gaps in our knowledge and understanding of the policies, programs, and measures that might be applied to natural hazards and their impacts in an era of climate change. Given the global impacts of climate change and world-wide pattern of increasing losses from natural hazards we necessarily adopt an international perspective. The specific goals of the special issue are to: (a) encompass experiential aspects, emphasizing current practice of mitigation and its associated measures, and their results; and (b) explore primary or root causes of alarming shifts in human and economic costs of environmental extremes. Special emphasis is placed on how human activities are playing a key role in enhancing vulnerability to NTEE (nature-triggered environmental extremes), quite independently from the anthropogenic causes of climate change. The goals are also (c) to examine costs, risks, and benefits (of all kinds including social, political, ecological) of mitigation, and adjustment and adaptation measures; and (d) analyze policy implications of alternative measures. These components are expected to make significant contributions to policy considerations – formulation, implementation and evaluation. There is much uncertainty about the rate of climate change; however, the fact of increase of the atmospheric temperature in the last century is no longer a subject of scientific or policy debate. Due to such changes in the geophysical parameters, certain types of nature-triggered environmental extreme events are likely to continue to increase. How global warming will affect regional climates and pertinent variables is not well known, limiting our ability to predict consequential effects. This factor poses serious constraints against any straightforward policy decisions. Research findings of the work of this volume reaffirm that human dimensions, specifically our awareness and decision-making behavior, are powerful explanatory factors of increasing disaster losses. Disaster mitigation through addressing human, social, and physical vulnerability is one of the best means for contributing to ‘climate change adaptation plans’, and sustainable development goals. Recent lessons from various countries have depicted that the formulation of mitigation strategies cannot be exclusively top-down as it requires social, political, and cultural acceptance and sense of ownership. An interactive, participatory process, involving local communities, produces best expected outcomes concerning mitigation, preparedness, and recovery. An emerging consensus is that there is a need to move towards the ‘mission’ of the International Strategy for Disaster Reduction which aims at building disaster resilient communities by promoting increased awareness of the importance of disaster reduction as an integral component of sustainable development, with the goal of reducing human, social, economic and environmental losses due to natural hazards and related technological and environmental disasters. Sharing of best practices and lessons globally is certain to produce more efficiency and understanding in policy and decision making.     

Horizontal and vertical distribution of organic contaminants in deep-sea fish species

Polychlorobiphenyls (PCBs) and pesticides are persistent, semivolatile contaminants whose global circulation is now well established. One of their ultimate sink is the bio- and geo-phases in the deep-sea. We have investigated the distribution of selected PCBs and pesticides with depth and longitude in various deep-sea fish, namely black scabbardfish (Aphanopus carbo), orange roughy (Hoplostethus atlanticus), roundnose grenadier (Coryphaenoides rupestris) and Bathysaurus ferox from Madeira, Sesimbra, the Meriadzec Terrace and Rockall Trough in the North Eastern Atlantic at 1000 m depth, and at 2000 m depth where available. In most species, males presented higher levels of contamination than females. This pattern was probably due to the females eliminating contaminants through egg production. Roundnose grenadier presented higher levels of contamination (mainly p,p'-DDE, CB 153, 138, 180, sigmaCB(24) and p,p'-DDT) in fish caught at 2000 m than at 1000 m depth. Similarly, B. ferox, which is found deeper than the other species studied, showed much higher levels of most CBs and pesticides (lipid normalised) than the other species. Concentrations were up to 10 times higher, and showed differences between water masses.