The vulnerability of World Heritage seagrass habitats to climate change.

Seagrass is an important natural attribute of 28 World Heritage (WH) properties. These WH seagrass habitats provide a wide range of services to adjacent ecosystems and human communities, and are one of the largest natural carbon sinks on the planet. Climate change is considered the greatest and fastest-growing threat to natural WH properties and evidence of climate-related impacts on seagrass habitats has been growing. The main objective of this study was to assess the vulnerability of WH seagrass habitats to location-specific key climate stressors. Quantitative surveys of seagrass experts and site managers were used to assess exposure, sensitivity and adaptive capacity of WH seagrass habitats to climate stressors, following the Climate Vulnerability Index approach. Over half of WH seagrass habitats have high vulnerability to climate change, mainly from the long-term increase in sea-surface temperature and short-term marine heatwaves. Potential impacts from climate change and certainty scores associated with them were higher than reported by a similar survey-based study from 10 years prior, indicating a shift in stakeholder perspectives during the past decade. Additionally, seagrass experts' opinions on the cumulative impacts of climate and direct-anthropogenic stressors revealed that high temperature in combination with high suspended sediments, eutrophication and hypoxia is likely to provoke a synergistic cumulative (negative) impact (p < .05). A key component contributing to the high vulnerability assessments was the low adaptive capacity; however, discrepancies between adaptive capacity scores and qualitative responses suggest that managers of WH seagrass habitats might not be adequately equipped to respond to climate change impacts. This thematic assessment provides valuable information to help prioritize conservation actions, monitoring activities and research in WH seagrass habitats. It also demonstrates the utility of a systematic framework to evaluate the vulnerability of thematic groups of protected areas that share a specific attribute.

Ecosystem services at risk from disturbance in Europe's forests.

Global change impacts on disturbances can strongly compromise the capacity of forests to provide ecosystem services to society. In addition, many ecosystem services in Europe are simultaneously provided by forests, emphasizing the importance of multifunctionality in forest ecosystem assessments. To address disturbances in forest ecosystem policies and management, spatially explicit risk analyses that consider multiple disturbances and ecosystem services are needed. However, we do not yet know which ecosystem services are most at risk from disturbances in Europe, where the respective risk hotspots are, nor which of the main disturbance agents are most detrimental to the provisioning of multiple ecosystem services from Europe's forests. Here, we quantify the risk of losing important ecosystem services (timber supply, carbon storage, soil erosion control and outdoor recreation) to forest disturbances (windthrows, bark beetle outbreaks and wildfires) in Europe on a continental scale. We find that up to 12% of Europe's ecosystem service supply is at risk from current disturbances. Soil erosion control is the ecosystem service at the highest risk, and windthrow is the disturbance agent posing the highest risk. Disturbances challenge forest multifunctionality by threatening multiple ecosystem services simultaneously on 19.8 Mha (9.7%) of Europe's forests. Our results highlight priority areas for risk management aiming to safeguard the sustainable provisioning of forest ecosystem services.

Effects of delay and error in the feedback structure of ecological management.

Ecosystems face various emergent uncertainties owing to factors such as climate change and accelerating anthropogenic impacts. Uncertainty is a major challenge and a barrier that ecosystem management faces, because it is difficult to precisely predict a priori risks that can have significant impacts on ecosystems. Hence, management with adaptive capacity is recommended to deal with such uncertainties, and feedback structures are central mechanisms for such flexible management. This study used mathematical models to clarify the specific impacts of feedback structures on ecosystem management, such as resource and wildlife management. In particular, the impact of errors in estimating ecosystem status when providing feedback and the impact of the time lag before feedback effects were implemented into management were examined. Overestimation of ecosystem status or a large time lag led to undesirable temporal oscillations in ecosystem status. However, these scenarios can be avoided when combined with management practices that limit the impact of management on the ecosystem, such as input control. Ecosystem management tends to have a large spatiotemporal scale, and implementing highly accurate monitoring and sophisticated feedback structures is difficult. However, the results suggest that effective ecosystem management with a simple feedback structure can be achieved through such complementary institutional design.

Exploring homecare leaders' risk perception and the link to resilience and adaptive capacity: a multiple case study.

BACKGROUND: Home-based healthcare is considered crucial for the sustainability of healthcare systems worldwide. In the homecare context, however, adverse events may occur due to error-prone medication management processes and prevalent healthcare-associated infections, falls, and pressure ulcers. When dealing with risks in any form, it is fundamental for leaders to build a shared situational awareness of what is going on and what is at stake to achieve a good outcome. The overall aim of this study was to gain empirical knowledge of leaders' risk perception and adaptive capacity in homecare services. METHODS: The study applied a multiple case study research design. We investigated risk perception, leadership, sensemaking, and decision-making in the homecare services context in three Norwegian municipalities. Twenty-three leaders were interviewed. The data material was analyzed using thematic analysis and interpreted in a resilience perspective of work-as-imagined versus work-as-done. RESULTS: There is an increased demand on homecare services and workers' struggle to meet society's high expectations regarding homecare's responsibilities. The leaders find themselves trying to maneuver in these pressing conditions in alignment with the perceived risks. The themes emerging from analyzed data were: 'Risk and quality are conceptualized as integral to professional work', 'Perceiving and assessing risk imply discussing and consulting each other- no one can do it alone' and 'Leaders keep calm and look beyond the budget and quality measures by maneuvering within and around the system'. Different perspectives on patients' well-being revealed that the leaders have a large responsibility for organizing the healthcare soundly and adequately for each home-dwelling patient. Although the leaders did not use the term risk, discussing concerns and consulting each other was a profound part of the homecare leaders' sense of professionalism. CONCLUSIONS: The leaders' construction of a risk picture is based on using multiple signals, such as measurable vital signs and patients' verbal and nonverbal expressions of their experience of health status. The findings imply a need for more research on how national guidelines and quality measures can be implemented better in a resilience perspective, where adaptive capacity to better align work-as-imagined and work-as-done is crucial for high quality homecare service provision.

Climate shock effects and mediation in fisheries.

Climate shocks can reorganize the social-ecological linkages in food-producing communities, leading to a sudden loss of key products in food systems. The extent and persistence of this reorganization are difficult to observe and summarize, but are critical aspects of predicting and rapidly assessing community vulnerability to extreme events. We apply network analysis to evaluate the impact of a climate shock-an unprecedented marine heatwave-on patterns of resource use in California fishing communities, which were severely affected through closures of the Dungeness crab fishery. The climate shock significantly modified flows of users between fishery resources during the closures. These modifications were predicted by pre-shock patterns of resource use and were associated with three strategies used by fishing community member vessels to respond to the closures: temporary exit from the food system, spillover of effort from the Dungeness crab fishery into other fisheries, and spatial shifts in where crab were landed. Regional differences in resource use patterns and vessel-level responses highlighted the Dungeness crab fishery as a seasonal "gilded trap" for northern California fishing communities. We also detected disparities in climate shock response based on vessel size, with larger vessels more likely to display spatial mobility. Our study demonstrates the importance of highly connected and decentralized networks of resource use in reducing the vulnerability of human communities to climate shocks.

Perspectives of nature-based tourism-dependent communities on climate change in the Okavango Delta, Botswana.

The intensity and frequency of climate extremes such as heat waves, droughts and extreme rainfall events are projected to rise. This will increase the severity of their impacts across socio-ecological systems. Economic sectors such as nature-based tourism become more vulnerable because of their reliance on climate and natural capital as key resources. While attempts have been made to understand how climate change may impact tourists and the industry itself, little is known about the same on tourism-dependent communities. This paper determines the extent to which tourism-dependent communities are vulnerable to climate change in the Okavango Delta, Botswana, to enhance their wider livelihood the development of strategies for improving adaptive capacity, resilience, and reduced exposure sensitivities. A household survey of 172 households was conducted in three purposively selected villages of Mababe, Sankuyo and Khwai, actively involved in community-based tourism for their socio-economic development. Information sourced related to livelihood options, peoples' resilience, local risks, and hazards. The data was analysed using descriptive statistics and thematic analysis. The results indicate that respondents have observed climatic changes over the years such as increased temperatures, decreased rainfall, and increased frequencies of extreme events. The respondents attributed changes in natural capital to these observed climatic conditions in the form of desiccation, dwindling populations of some wildlife species, decreased fish stocks and reduced vegetation cover. This renders the tourism-dependent communities vulnerable as their livelihood is threatened. The paper thus concludes that climate change adaptation is an urgent priority for local communities who are already exposed to existing climatic and non-climatic stresses.

Examining the role of community health workers amid extreme weather events in low- and middle-income countries: a scoping review.

OBJECTIVES: The increased frequency and severity of extreme weather events (EWEs) have underscored the need to strengthen climate-resilient health systems and capacity. Community health workers (CHWs) are integral health systems actors with the potential to protect and improve population health in a changing climate. The aim of this review was to synthesize the literature on the roles of CHWs amid EWEs in low- and middle-income countries, the barriers and facilitators to implement these roles, and program supports to strengthen CHW capacity and health system functions. STUDY DESIGN: Scoping review. METHODS: Four academic databases and gray literature published between January 2000 and June 2023 were searched. Data were thematically analyzed using a deductive-inductive approach guided by the World Health Organization's (WHO's) Operational framework for building climate-resilient health systems. RESULTS: Thirty sources were included. Amid EWEs, CHW roles included: 1) delivery of diagnostic, treatment, and other clinical services; 2) support with access, utilization, or navigation of health services and/or referrals; 3) community education and health promotion; 4) data collection and health surveillance; 5) psychosocial supports; and 6) weather-related health emergency response. Facilitators and barriers to the provision of CHW supports amid EWEs were categorized within WHO's building blocks of health systems. Considerations for strengthening CHW programs to enhance climate-resilient health systems are also discussed. CONCLUSIONS: CHWs are uniquely positioned to provide health-related supports amid EWEs that extend to emergency preparedness and response to climate-health challenges. These efforts can contribute to the community and health systems resilience to climate change.

Smallholder farmers' challenges and opportunities: Implications for agricultural production, environment and food security.

In an era of growing environmental, socioeconomic, and market uncertainties, understanding the adaptive strategies of smallholder farmers is paramount for sustainable agricultural productivity and environmental management efforts. We adopted a mixed-methods approach to investigate the adaptive strategies of smallholders in Northwest Cambodia. Our methodology included downscaled climate projections to project future climate conditions and scenarios, household surveys to collect detailed demographic and socioeconomic data, crop monitoring and record-keeping to gather data on productivity and profitability, and semi-structured interviews to obtain qualitative insights on constraints and adaptation. Our analyses revealed that all smallholders are increasingly vulnerable to climate change which projections reveal will result in more intense and extreme weather events. Specifically, 92% of respondents reported reductions in household income, and 63% indicated the necessity to cut household expenses, which negatively affect agricultural productivity, as evidenced by 33% of respondents reporting declining crop yields and 10% experiencing food shortages. We also uncovered significant differences in farming strategies to mitigate vulnerability among distinct household clusters. Some households prioritise maximising yields through high-expense production strategies, while others focus on optimising inputs to enhance profit-margins, indirectly minimising their environmental impact. These varying strategies have different implications for poverty, food security, and the environment, but were doing very little to mitigate overall vulnerability. To enhance the adaptive capacity of smallholders, policies should target interventions that balance economic growth with environmental sustainability, tailored to the specific needs of different farmer and household types. Promoting the adoption of climate-resilient agricultural practices, investing in water management infrastructure, enhancing access to timely and accurate climate information, and implementing social protection measures are strongly recommended.

Operationalizing a fisheries social-ecological system through a Bayesian belief network reveals hotspots for its adaptive capacity in the southern North sea.

Fisheries social-ecological systems (SES) in the North Sea region confront multifaceted challenges stemming from environmental changes, offshore wind farm expansion, and marine protected area establishment. In this paper, we demonstrate the utility of a Bayesian Belief Network (BN) approach in comprehensively capturing and assessing the intricate spatial dynamics within the German plaice-related fisheries SES. The BN integrates ecological, economic, and socio-cultural factors to generate high-resolution maps of profitability and adaptive capacity potential (ACP) as prospective management targets. Our analysis of future scenarios, delineating changes in spatial constraints, economics, and socio-cultural aspects, identifies factors that will exert significant influence on this fisheries SES in the near future. These include the loss of fishing grounds due to the installation of offshore wind farms and marine protected areas, as well as reduced plaice landings due to climate change. The identified ACP hotspots hold the potential to guide the development of localized management strategies and sustainable planning efforts by highlighting the consequences of management decisions. Our findings emphasize the need to consider detailed spatial dynamics of fisheries SES within marine spatial planning (MSP) and illustrate how this information may assist decision-makers and practitioners in area prioritization. We, therefore, propose adopting the concept of fisheries SES within broader integrated management approaches to foster sustainable development of inherently dynamic SES in a rapidly evolving marine environment.

Vulnerability of barley yields in Québec.

Climate projections across Québec indicate increased water stress and recurrent vulnerability of cropping systems. In recent years, reports of droughts and water stress have been recorded across the province. Many parts of Québec have experienced droughts in the past few years, which have had uninvestigated impacts on crops. These droughts have been described as some of the most significant in the last 80 years. On the positive side, climate change is likely to trigger shorter winters and therefore longer growing seasons for several crops. However, for crops like maple syrup, the regions suitable for their cultivation will shift northwards. Despite these projections, studies monitoring the susceptibility of barley to environmental changes, climate variability, and adaptive capacity across Québec are still limited. This study aims to provide a provincial-scale portrait of vulnerability of barley in Québec based on historical growing season precipitation, barley yield, and socioeconomic data (literacy and poverty rates) using a composite statistical model. Growing season precipitation data were downloaded from Ouranos. Barley yield data were collected from the Institut de la Statistique du Québec, and the socio-demographic data were collected from the Advisory Council of Poverty and the Institut de la Statistique du Québec. A vulnerability index with sub-indices (sensitivity, exposure, and adaptive capacity) is deployed. It is hypothesised that (1) vulnerability is inversely associated with adaptive capacity, and (2) the peripheral regions of Québec are more vulnerable and less adaptive to climate stressors. Initial results show that when the vulnerability index for barley is more prominent, the associated index of adaptive capacity is relatively lower. A significant gradient between the peripheral and southern regions of Québec is observed, with vulnerability lowest around Montreal/Laval and gradually increasing towards the peripheral regions. A better understanding of vulnerability warrants a change in approach from focusing solely on climate-related variables to integrating socioeconomic proxies. The challenge, however, has been how to introduce these socioeconomic proxies into empirical and process-based crop models.

Comparative transcriptomes reveal geographic differences in the ability of the liver of plateau zokors (Eospalax baileyi) to respond and adapt to toxic plants.

BACKGROUND: Environmental changes are expected to intensify in the future. The invasion of toxic plants under environmental changes may change herbivore feeding environments. Herbivores living long-term in toxic plant-feeding environments will inevitably ingest plant secondary metabolites (PSMs), and under different feeding environments are likely to have unique protection mechanisms that support improved adaptation to PSMs in their habitat. We aimed to compare different subterranean herbivore population responses and adaptations to toxic plants to unveil their feeding challenges. RESULTS: Here, we investigated the adaptive capacity of the liver in two geographically separated populations of plateau zokors (Eospalax baileyi) before and after exposure to the toxic plant Stellera chamaejasme (SC), at the organ, biochemical, and transcriptomic levels. The results showed no significant liver granules or inflammatory reactions in the Tianzhu (TZ) population after the SC treatment. The transaminase level in the TZ population was significantly lower than that in the Luqu population. Transcriptome analysis revealed that the TZ population exhibited interactions with other detoxification metabolic pathways by oxytocin pathway-associated genes, including diacylglycerol lipase alpha (Dagla), calcium/calmodulin dependent protein kinase II Alpha (Camk2a), and CD38 molecule (Cd38). The phase II process of liver drug metabolism increased to promote the rate of metabolism. We found that alternative splicing (AS) and the expression of the cyclin D (Ccnd1) gene interact-a TZ population hallmark-reduced liver inflammatory responses. CONCLUSION: Our study supports the detoxification limitation hypothesis that differences in liver detoxification metabolism gene expression and AS are potential factors in herbivore adaptation to PSMs and may be a strategy of different herbivore populations to improve toxic plant adaptability.

Is the future female for turtles? Climate change and wetland configuration predict sex ratios of a freshwater species.

Climate change and land-use change are leading drivers of biodiversity decline, affecting demographic parameters that are important for population persistence. For example, scientists have speculated for decades that climate change may skew adult sex ratios in taxa that express temperature-dependent sex determination (TSD), but limited evidence exists that this phenomenon is occurring in natural settings. For species that are vulnerable to anthropogenic land-use practices, differential mortality among sexes may also skew sex ratios. We sampled the spotted turtle (Clemmys guttata), a freshwater species with TSD, across a large portion of its geographic range (Florida to Maine), to assess the environmental factors influencing adult sex ratios. We present evidence that suggests recent climate change has potentially skewed the adult sex ratio of spotted turtles, with samples following a pattern of increased proportions of females concomitant with warming trends, but only within the warmer areas sampled. At intermediate temperatures, there was no relationship with climate, while in the cooler areas we found the opposite pattern, with samples becoming more male biased with increasing temperatures. These patterns might be explained in part by variation in relative adaptive capacity via phenotypic plasticity in nest site selection. Our findings also suggest that spotted turtles have a context-dependent and multi-scale relationship with land use. We observed a negative relationship between male proportion and the amount of crop cover (within 300 m) when wetlands were less spatially aggregated. However, when wetlands were aggregated, sex ratios remained consistent. This pattern may reflect sex-specific patterns in movement that render males more vulnerable to mortality from agricultural machinery and other threats. Our findings highlight the complexity of species' responses to both climate change and land use, and emphasize the role that landscape structure can play in shaping wildlife population demographics.

Are Mediterranean marine threatened species at high risk by climate change?

Rapid anthropogenic climate change is driving threatened biodiversity one step closer to extinction. Effects on native biodiversity are determined by an interplay between species' exposure to climate change and their specific ecological and life-history characteristics that render them even more susceptible. Impacts on biodiversity have already been reported, however, a systematic risk evaluation of threatened marine populations is lacking. Here, we employ a trait-based approach to assess the risk of 90 threatened marine Mediterranean species to climate change, combining species' exposure to increased sea temperature and intrinsic vulnerability. One-quarter of the threatened marine biodiversity of the Mediterranean Sea is predicted to be under elevated levels of climate risk, with various traits identified as key vulnerability traits. High-risk taxa including sea turtles, marine mammals, Anthozoa and Chondrichthyes are highlighted. Climate risk, vulnerability and exposure hotspots are distributed along the Western Mediterranean, Alboran, Aegean, and Adriatic Seas. At each Mediterranean marine ecoregion, 21%-31% of their threatened species have high climate risk. All Mediterranean marine protected areas host threatened species with high risk to climate change, with 90% having a minimum of 4 up to 19 species of high climate risk, making the objective of a climate-smart conservation strategy a crucial task for immediate planning and action. Our findings aspire to offer new insights for systematic, spatially strategic planning and prioritization of vulnerable marine life in the face of accelerating climate change.

Coral adaptive capacity insufficient to halt global transition of coral reefs into net erosion under climate change.

Projecting the effects of climate change on net reef calcium carbonate production is critical to understanding the future impacts on ecosystem function, but prior estimates have not included corals' natural adaptive capacity to such change. Here we estimate how the ability of symbionts to evolve tolerance to heat stress, or for coral hosts to shuffle to favourable symbionts, and their combination, may influence responses to the combined impacts of ocean warming and acidification under three representative concentration pathway (RCP) emissions scenarios (RCP2.6, RCP4.5 and RCP8.5). We show that symbiont evolution and shuffling, both individually and when combined, favours persistent positive net reef calcium carbonate production. However, our projections of future net calcium carbonate production (NCCP) under climate change vary both spatially and by RCP. For example, 19%-35% of modelled coral reefs are still projected to have net positive NCCP by 2050 if symbionts can evolve increased thermal tolerance, depending on the RCP. Without symbiont adaptive capacity, the number of coral reefs with positive NCCP drops to 9%-13% by 2050. Accounting for both symbiont evolution and shuffling, we project median positive NCPP of coral reefs will still occur under low greenhouse emissions (RCP2.6) in the Indian Ocean, and even under moderate emissions (RCP4.5) in the Pacific Ocean. However, adaptive capacity will be insufficient to halt the transition of coral reefs globally into erosion by 2050 under severe emissions scenarios (RCP8.5).

Adaptive capacity of high- and low dyke farmers to hydrological changes in the Vietnamese Mekong delta.

This research assesses the adaptive capacity of farmers in the Vietnamese Mekong Delta's floodplains (VMD) with respect to hydrological changes. Currently, climate change and socio-economic developments induce extreme- and diminishing floods, which in turn increase farmers' vulnerability. This research assesses farmers' adaptive capacity to hydrological changes using two prevalent farming systems: high dykes featuring triple-crop rice farming and low dykes where fields are left fallow during the flood season. We examine (1) farmers' perceptions on a changing flood regime and their current vulnerabilities and (2) farmers' adaptive capacity through five sustainability capitals. Methods include a literature review and qualitative interviews with farmers. Results show that extreme floods are becoming less frequent and damaging, depending on arrival time, depth, residence time, and flow velocity. In extreme floods, farmers' adaptive capacity is generally strong, and only low dyke farmers experience damage. As for diminishing floods, which is an emerging phenomenon, the overall adaptive capacity of farmers is remarkably weaker and varies between high- and low dyke farmers. Financial capital is lower for low dyke farmers due to their double-crop rice system, and natural capital is low for both farmer groups due to a decrease in soil- and water quality, affecting yields and increasing investment costs. Farmers also struggle with an unstable rice market due to strong fluctuating prices for seeds, fertilizers, and other inputs. We conclude that both high- and low dyke farmers have to cope with new challenges, including fluctuating flood patterns and the depletion of natural resources. Increasing farmers resilience should focus on exploring better crop varieties, adjusting crop calendars, and shifting to less water-intensive crops.

Genetic diversity goals and targets have improved, but remain insufficient for clear implementation of the post-2020 global biodiversity framework.

Genetic diversity among and within populations of all species is necessary for people and nature to survive and thrive in a changing world. Over the past three years, commitments for conserving genetic diversity have become more ambitious and specific under the Convention on Biological Diversity's (CBD) draft post-2020 global biodiversity framework (GBF). This Perspective article comments on how goals and targets of the GBF have evolved, the improvements that are still needed, lessons learned from this process, and connections between goals and targets and the actions and reporting that will be needed to maintain, protect, manage and monitor genetic diversity. It is possible and necessary that the GBF strives to maintain genetic diversity within and among populations of all species, to restore genetic connectivity, and to develop national genetic conservation strategies, and to report on these using proposed, feasible indicators.

Factors contributing to healthcare professionals' adaptive capacity with hospital standardization: a scoping review.

BACKGROUND: Certain factors contribute to healthcare professionals' adaptive capacities towards risks, challenges, and changes such as attitudes, stress, motivation, cognitive capacity, group norms, and teamwork. However, there is limited evidence as to factors that contribute to healthcare professionals' adaptive capacity towards hospital standardization. This scoping review aimed to identify and map the factors contributing to healthcare professionals' adaptive capacity with hospital standardization. METHODS: Scoping review methodology was used. We searched six academic databases to September 2021 for peer-reviewed articles in English. We also reviewed grey literature sources and the reference lists of included studies. Quantitative and qualitative studies were included if they focused on factors influencing how healthcare professionals adapted towards hospital standardization such as guidelines, procedures, and strategies linked to clinical practice. Two researchers conducted a three-stage screening process and extracted data on study characteristics, hospital standardization practices and factors contributing to healthcare professionals' adaptive capacity. Study quality was not assessed. RESULTS: A total of 57 studies were included. Factors contributing to healthcare professionals' adaptive capacity were identified in numerous standardization practices ranging from hand hygiene and personal protective equipment to clinical guidelines or protocols on for example asthma, pneumonia, antimicrobial prophylaxis, or cancer. The factors were grouped in eight categories: (1) psychological and emotional, (2) cognitive, (3) motivational, (4) knowledge and experience, (5) professional role, (6) risk management, (7) patient and family, and (8) work relationships. This combination of individual and group/social factors decided whether healthcare professionals complied with or adapted hospital standardization efforts. Contextual factors were identified related to guideline system, cultural norms, leadership support, physical environment, time, and workload. CONCLUSION: The literature on healthcare professionals' adaptive capacity towards hospital standardization is varied and reflect different reasons for compliance or non-compliance to rules, guidelines, and protocols. The knowledge of individual and group/social factors and the role of contextual factors should be used by hospitals to improve standardization practices through educational efforts, individualised training and motivational support. The influence of patient and family factors on healthcare professionals' adaptive capacity should be investigated. TRIAL REGISTRATION: Open Science Framework ( https://osf.io/ev7az ) https://doi.org/10.17605/OSF.IO/EV7AZ .

Exploring everyday work as a dynamic non-event and adaptations to manage safety in intraoperative anaesthesia care: an interview study.

BACKGROUND: Safety has been described as a dynamic non-event and as constantly present in professionals' work processes. Investigating management of complex everyday situations may create an opportunity to elucidate safety management. Anaesthesia has been at the frontline of enhancing patient safety - testing and implementing knowledge from other high-reliability industries, such as aviation, in the complex, adaptive system of an operating room. The aim of this study was to explore factors supporting anaesthesia nurses and anaesthesiologists in managing complex everyday situations during intraoperative anaesthesia care processes. METHODS: Individual interviews with anaesthesia nurses (n = 9) and anaesthesiologists (n = 6) using cognitive task analysis (CTA) on case scenarios from previous prospective, structured observations. The interviews were analysed using the framework method. RESULTS: During intraoperative anaesthesia care, management of everyday complex situations is sustained through preparedness, support for mindful practices, and monitoring and noticing complex situations and managing them. The prerequisites are created at the organization level. Managers should ensure adequate resources in the form of trained personnel, equipment and time, team and personnel sustainability and early planning of work. Management of complex situations benefits from high-quality teamwork and non-technical skills (NTS), such as communication, leadership and shared situational awareness. CONCLUSION: Adequate resources, stability in team compositions and safe boundaries for practice with shared baselines for reoccurring tasks where all viewed as important prerequisites for managing complex everyday work. When and how NTS are used in a specific clinical context depends on having the right organizational prerequisites and a deep expertise of the relevant clinical processes. Methods like CTA can reveal the tacit competence of experienced staff, guide contextualized training in specific contexts and inform the design of safe perioperative work practices, ensuring adequate capacity for adaptation.

A resilience perspective on healthcare personnels' experiences of managing the COVID-19 pandemic: a qualitative study in Norwegian nursing homes and come care services.

BACKGROUND: The COVID-19 pandemic led to new and unfamiliar changes in healthcare services globally. Most COVID-19 patients were cared for in primary healthcare services, demanding major adjustments and adaptations in care delivery. Research addressing how rural primary healthcare services coped during the COVID-19 pandemic, and the possible learning potential originating from the pandemic is limited. The aim of this study was to assess how primary healthcare personnel (PHCP) working in rural areas experienced the work situation during the COVID-19 outbreak, and how adaptations to changes induced by the pandemic were handled in nursing homes and home care services. METHOD: This study was conducted as an explorative qualitative study. Four municipalities with affiliated nursing homes and homecare services were included in the study. We conducted focus group interviews with primary healthcare personnel working in rural nursing homes and homecare services in western Norway. The included PHCP were 16 nurses, 7 assistant nurses and 2 assistants. Interviews were audio recorded, transcribed and analyzed using thematic analysis. RESULTS: The analysis resulted in three main themes and 16 subthemes describing PHCP experience of the work situation during the COVID-19 pandemic, and how they adapted to the changes and challenges induced by the pandemic. The main themes were: "PHCP demonstrated high adaptive capacity while being put to the test", "Adapting to organizational measures, with varying degree of success" and "Safeguarding the patient's safety and quality of care, but at certain costs". CONCLUSION: This study demonstrated PHCPs major adaptive capacity in response to the challenges and changes induced by the covid-19 pandemic, while working under varying organizational conditions. Many adaptations where long-term solutions improving healthcare delivery, others where short-term solutions forced by inadequate management, governance, or a lack of leadership. Overall, the findings demonstrated the need for all parts of the system to engage in building resilient healthcare services. More research investigating this learning potential, particularly in primary healthcare services, is needed.

Monsoon flood risks in urban areas of Pakistan: A way forward for risk reduction and adaptation planning.

Climate change poses a significant threat to sustainable urban development. Heavy rainfall has led to severe urban flooding, disrupting human life and causing widespread damage. This study aims to examine the impacts, preparedness, and adaptation strategies related to monsoon flooding in Lahore, Pakistan's second-most populous metropolitan area. Using Yamane's sampling method, a total of 370 samples were surveyed and analyzed using descriptive analysis and chi-square tests. The results indicate that houses and parks were the most commonly damaged properties, with common impacts including roof collapse, house fires, seepage, and wall dampness. These impacts not only caused physical damage but also disrupted basic amenities and damaged roads, resulting in significant socioeconomic costs. Despite these challenges, residents adopted a variety of adaptation strategies such as the use of temporary tarps, moving household appliances to upper floors, and shifting to tiled floors and wall paneling to mitigate damage. However, the study highlights the need for further measures to reduce flood risks and promote adaptation planning in order to effectively address the ongoing challenges posed by climate change and urban flooding.