Since 1990, natural hazards have led to over 1.6 million fatalities globally, and economic losses are estimated at an average of around USD 260–310 billion per year. The scientific and policy communities recognise the need to reduce these risks. As a result, the last decade has seen a rapid development of global models for assessing risk from natural hazards at the global scale. In this paper, we review the scientific literature on natural hazard risk assessments at the global scale, and we specifically examine whether and how they have examined future projections of hazard, exposure, and/or vulnerability. In doing so, we examine similarities and differences between the approaches taken across the different hazards, and we identify potential ways in which different hazard communities can learn from each other. For example, there are a number of global risk studies focusing on hydrological, climatological, and meteorological hazards that have included future projections and disaster risk reduction measures (in the case of floods), whereas fewer exist in the peer-reviewed literature for global studies related to geological hazards. On the other hand, studies of earthquake and tsunami risk are now using stochastic modelling approaches to allow for a fully probabilistic assessment of risk, which could benefit the modelling of risk from other hazards. Finally, we discuss opportunities for learning from methods and approaches being developed and applied to assess natural hazard risks at more continental or regional scales. Through this paper, we hope to encourage further dialogue on knowledge sharing between disciplines and communities working on different hazards and risk and at different spatial scales.
SummarySocial impact assessment (SIA) developed alongside EIA in the early 1970s as a mechanism to consider the social impacts of planned interventions. The early understanding tended to limit the practical application of SIA to the project level, usually within the context of regulatory frameworks, and primarily considered only the direct negative impacts. However, like other types of impact assessment, SIA has evolved over time and has diverged considerably from EIA. Nowadays, SIA has widened its scope to become a“philosophy about development and democracy”. Ideally SIA considers the pathologies, goals, and processes of development. In this broad understanding, it now focuses on the management of all social issues, intending to bring about a more sustainable and equitable biophysical and human environment.The SIA field defines “social” very broadly, as “anything that affects people and their communities”. Thus,for example, all environmental impacts are also social impacts because people depend on the environment for their livelihoods as well as their physical and spiritual well-being. Social impact concepts include people’s way of life, their culture, community, political systems, environment, health and wellbeing, personal and property rights, and their fears and aspirations.Formerly seen as a regulatory tool required by regulatory agencies but resented by proponents, SIA, for a variety of reasons, is now increasingly being embraced by corporations and used as an internal process for managing social issues. Such a shift towards corporate acceptance, of course, does not guarantee that SIA will always be done properly, or that it is able to adequately influence company operations.Several other shifts have been observed: greater consideration of benefits; moving towards developing and implementing Social Impact Management Plans; communities themselves actively commissioning, or doing, their own SIA studies; SIA playing an important part in ensuring “free, prior and informed consent” and gaining a “sociallicense to operate”.Health issues have a central place in SIA. Many of the social impacts of projects could also be described as health impacts, and all health impacts would be regarded as social impacts in SIA. In SIA, health impacts are considered amongst a wide range of impacts on people and communities. SIA practitioners are supposed to look from an integrated perspective. Arguably, this means that the determinants of health should be addressed when SIA is carried out properly. Nevertheless, SIA guidelines do not typically require a detailed analysis of the origins of, or pathways to, specific health conditions. There is, however, a strong awareness of indirect effects and cumulative effects.In actual practice, the SIA approach used highly depends on the type of policy, plan or project being considered, as well as on the legal and cultural context, on client requirements, and on the commitment of the individual practitioner or consultancy. The SIA case studies considered in this chapter usually discussed the broader determinants of health but did not necessarily recognize them as such. The pathways from social impacts to health, and the linkages between health and social impacts, were not explicitly part of the analysis. Overall, the input of health expertise into SIAs seemed to be lacking. However, given the close connections between the HIA and SIA approaches, more cooperation and crossfertilization between these two types of impact assessment can be expected in the future.
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BackgroundFluid therapy is a common intervention in critically ill patients. It is increasingly recognised that deresuscitation is an essential part of fluid therapy and delayed deresuscitation is associated with longer invasive ventilation and length of intensive care unit (ICU) stay. However, optimal timing and rate of deresuscitation remain unclear. Lung ultrasound (LUS) may be used to identify fluid overload. We hypothesise that daily LUS-guided deresuscitation is superior to deresuscitation without LUS in critically ill patients expected to undergo invasive ventilation for more than 24 h in terms of ventilator free-days and being alive at day 28.MethodsThe “effect of lung ultrasound-guided fluid deresuscitation on duration of ventilation in intensive care unit patients” (CONFIDENCE) is a national, multicentre, open-label, randomised controlled trial (RCT) in adult critically ill patients that are expected to be invasively ventilated for at least 24 h. Patients with conditions that preclude a negative fluid balance or LUS examination are excluded. CONFIDENCE will operate in 10 ICUs in the Netherlands and enrol 1000 patients. After hemodynamic stabilisation, patients assigned to the intervention will receive daily LUS with fluid balance recommendations. Subjects in the control arm are deresuscitated at the physician’s discretion without the use of LUS. The primary endpoint is the number of ventilator-free days and being alive at day 28. Secondary endpoints include the duration of invasive ventilation; 28-day mortality; 90-day mortality; ICU, in hospital and total length of stay; cumulative fluid balance on days 1–7 after randomisation and on days 1–7 after start of LUS examination; mean serum lactate on days 1–7; the incidence of reintubations, chest drain placement, atrial fibrillation, kidney injury (KDIGO stadium ≥ 2) and hypernatremia; the use of invasive hemodynamic monitoring, and chest-X-ray; and quality of life at day 28.DiscussionThe CONFIDENCE trial is the first RCT comparing the effect of LUS-guided deresuscitation to routine care in invasively ventilated ICU patients. If proven effective, LUS-guided deresuscitation could improve outcomes in some of the most vulnerable and resource-intensive patients in a manner that is non-invasive, easy to perform, and well-implementable.Trial registrationClinicalTrials.gov NCT05188092. Registered since January 12, 2022
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