Critical Lessons Research Articles

Risks associated with evacuation and disaster-related death after a radiation disaster: summary of research results from Hamadori region, Fukushima.

Radiation disasters can lead to a myriad of direct and indirect health effects. The term 'disaster-related deaths' is commonly used in Japan; however, comprehensive studies in regions severely impacted by nuclear accidents are scarce. Our research primarily focuses on Minamisoma City, situated north of the Fukushima Daiichi Nuclear Power Plant (FDNPP), and aimed to study the risks associated with evacuation and disaster-related death. We introduce the following studies: (1) risks from evacuation in elderly care facilities after the FDNPP accident; (2) detailed case reports on hospital evacuation and (3) detailed reports on disaster-related deaths. A critical lesson from the FDNPP accident is the significant risk to life posed by evacuation actions taken to avoid radiation exposure. Despite evacuation being an effective measure to reduce exposure, our preparation and knowledge are insufficient for safe execution. This paper ensures that the lessons from Fukushima are leveraged in future radiation protection measures.

Managing Angiography Unit Failure in Interventional Radiology: Lessons in Crisis Management and Considerations in Prevention.

Functional and efficient medical equipment is at the core of modern healthcare delivery, particularly in medical imaging. Growing healthcare costs and constrained budgets can delay equipment renewal. Aging equipment risks malfunction, potentially causing injury to patients and staff, and downtimes delaying patient care and impacting departmental revenue. Extensive equipment failure can lead to significant operational disruption which can compromise the delivery of timely and quality healthcare. Although extensive equipment failure is uncommon, 2 interventional radiology divisions at tertiary academic hospitals in Canada and the UK recently faced such a crisis. Their experiences of crisis and recovery inform this review of angiography equipment failure, and the principles learned. The concept of organizational resilience is introduced as a framework through which we review the crises. This concept can be split into successive and cooperative stages of anticipation, coping, and adaptation. Resilient organizations can identify potential threats, cope with unexpected crises, and recover swiftly to ensure future success. The author's experience of critical angiography unit failure, their response, and lessons learned are reviewed. We find these principles are broadly applicable to other medical imaging divisions and relevant to any system reliant on technology for healthcare delivery.

The Politics of Fear and the Experience of Bangladeshi Religious Minority Communities Using Social Media Platforms

Despite significant research on online harm, polarization, public deliberation, and justice, CSCW still lacks a comprehensive understanding of the experiences of religious minorities, particularly in relation to fear, as prominently evident in our study. Gaining faith-sensitive insights into the expression, participation, and inter-religious interactions on social media can contribute to CSCW's literature on online safety and interfaith communication. In pursuit of this goal, we conducted a six-month-long, interview-based study with the Hindu, Buddhist, and Indigenous communities in Bangladesh. Our study draws on an extensive body of research encompassing the spiral of silence, the cultural politics of fear, and communication accommodation to examine how social media use by religious minorities is influenced by fear, which is associated with social conformity, misinformation, stigma, stereotypes, and South Asian postcolonial memory. Moreover, we engage with scholarly perspectives from religious studies, justice, and South Asian violence and offer important critical insights and design lessons for the CSCW literature on public deliberation, justice, and interfaith communication.

Survival in STEMI in resource limited settings - obstacles and potential solutions. Critical lesson learnt thorough a prospective observational study

Abstract Background Early revascularization in ST segment elevation myocardial infarction(STEMI) by Primary Percutaneous coronary Intervention (PPCI) or fibrinolysis, reduces mortality. In the absence of a well-functioning STEMI care system, patients may not get guideline directed revascularisation (GDR). Objective We sought to determine the prevalent mode of revascularisation for STEMI in the community, to discern the factors contributing to lack of GDR during their initial medical encounter, and to investigate the consequences of not getting GDR. Methods Consecutive patients within 24 hours of STEMI from October 2021 to December 2021 in a public hospital from a developing nation, were enrolled. In addition to baseline data, the details of the first medical contact (FMC) and second medical contacts (SMC) before reaching the study site were collected. The hospitals where patients sought care earlier, could be lysis capable hospitals (LCH), PCI/lysis capable hospitals (PLCH) and non-lysis-capable hospitals (NLCH). Medical records related to these visits were scrutinised and in-depth interviews were conducted with patients and their care givers. Details of GDR offered / received during FMC/SMC and the reasons for not receiving GDR were collected. Results 300 patients were enrolled during the study period. 19 reported directly to the study site, while others had visited 1-3 hospitals en route(Figure-1). The 159 who received fibrinolysis in at least one of their medical contacts, had a significantly lower incidence of cardiogenic shock and in-hospital mortality, compared to the rest(Figure-2). 162(54%) patients had had FMC in NLCH and had to be referred to SMC for GDR. Of the 157 visits by a patient with STEMI in a LCH / PLCH within 6 hours’ time window (6HTW), GDR was provided only 44 visits(28%) (Figure-1). The common reason for not receiving GDR was financial. This revascularisation solutions offered were not affordable. These include, PPCI only or pharmaco-invasive package only in PLCH and high cost bolus lytic only in LCH. Of the 132 patients, who had FMC ≤ 12 hours in LCH, only 33 had lysis. Patients who did not receive revascularisation, despite reaching within 6HTW, had adverse in-hospital outcome. (Figure-2) Conclusion The public awareness of the need for early revascularisation in STEMI and the revascularisation solutions available in the neighbourhood hospitals is low. Most patients with STEMI do not receive GDR despite reaching revascularisation capable hospitals within 6HTW. The common reasons for this include, non-availability of low cost fibrinolytics and lack of financial resources. Hospitals should offer fibrinolysis when patients cannot afford PPCI, and low-cost infusion lytics, when patients cannot afford high cost bolus lytics. Provision of GDR in STEMI at the first medical contact, is a social responsibility. Governmental and non-governmental organisations should work in tandem, to ensure 100% GDR at first medical contact.

Application of quality indicators and critical lessons learned assessment as a research approach for the evaluation of rescue missions during terrorist attacks

In Wuerzburg, Germany, a terrorist attack and a killing rampage occurred five years apart (2016 and 2021). Following a structured evaluation of the rescue mission in 2016, a bundle of quality indicators and ten “lessons learned” were defined. Aim of the presented study was to compare the two rescue missions and to critically review the lessons learned from 2016 for their implementation and feasibility. An interdisciplinary and inter-professional group of experts analyzed the data using predefined quality indicators. All lessons defined in 2016 were critically reviewed and qualified as either lessons learned or lessons identified. While seven out of ten lessons were successfully implemented after 2016 (lessons learned), three lessons didn´t work and were recategorized as lessons identified (communication, zoning and the mutual exchange of different tactical approaches). Our results demonstrate that the conclusions drawn in 2016 have helped to improve the performance of the rescue forces in 2021. In addition, the identified lessons are now the basis for further improving emergency and disaster preparedness. It is important to understand, that the process of preparedness improvement is not completed with the definition of lessons identified. These must first be integrated into response plans and then trained intensively. A lesson identified only becomes a lesson learned once it has been successfully applied.

Estimating the impact of vaccination: lessons learned in the first phase of the Vaccine Impact Modelling Consortium.

Estimates of the global health impact of immunisation are important for quantifying historical benefits as well as planning future investments and strategy. The Vaccine Impact Modelling Consortium (VIMC) was established in 2016 to provide reliable estimates of the health impact of immunisation. In this article we examine the consortium in its first five-year phase. We detail how vaccine impact was defined and the methods used to estimate it as well as the technical infrastructure required to underpin robust reproducibility of the outputs. We highlight some of the applications of estimates to date, how these were communicated and what their effect were. Finally, we explore some of the lessons learnt and remaining challenges for estimating the impact of vaccines and forming effective modelling consortia then discuss how this may be addressed in the second phase of VIMC. Modelled estimates are not a replacement for surveillance; however, they can examine theoretical counterfactuals and highlight data gaps to complement other activities. VIMC has implemented strategies to produce robust, standardised estimates of immunisation impact. But through the first phase of the consortium, critical lessons have been learnt both on the technical infrastructure and the effective engagement with modellers and stakeholders. To be successful, a productive dialogue with estimate consumers, producers and stakeholders needs to be underpinned by a rigorous and transparent analytical framework as well as an approach for building expertise in the short and long term.

Scale‐sensitive marine law and policy design: Towards ecosystem‐based management across spatial and temporal scales

AbstractEcosystem‐based management (EBM) is promoted in scholarly literature and international policy as a way to improve marine ecosystem outcomes, through the integration of marine law and policies across sectors, communities, and scales. A legal and policy framework that supports EBM at appropriate temporal and spatial scales is fundamental to the successful deployment of EBM. However, marine management is typically fragmented and misaligned, with a range of laws, policies, governance institutions, and sectoral frameworks applying to different marine spaces and working on varying timescales. In this focus article, we draw on our comprehensive study of Aotearoa New Zealand's marine law and policy to analyze the challenges scale mismatches present for marine law and policy implementation, focusing on key policy areas across fisheries, environment, conservation, and Indigenous rights and interests. We identify key opportunities to better align marine law and policy to ecosystem scale dynamics, revealing critical lessons for the imperative of scale‐sensitive marine law and policy design, globally.This article is categorized under: Policy and Economics > Research and Development Policy and Economics > Governance and Regulation Climate and Environment > Ecosystem Services

Integrating Circular Economy Principles in Urban Development for Sustainable Cities in Nigeria: Lessons from Global and Local Case Studies

Nigeria, Africa's most populous country, faces significant urbanization challenges including waste management, resource scarcity, and environmental degradation. This paper explores the integration of Circular Economy (CE) principles in urban development to foster sustainable cities in Nigeria. By examining case studies and best practices from global and local perspectives, including insights from Lebanon's experiences amid its economic crisis, the paper provides strategic recommendations for policymakers, urban planners, and stakeholders to implement CE principles effectively in Nigerian urban contexts. Lebanon's strategic adaptation of CE principles, particularly in response to its severe economic and energy crises, demonstrates the potential for CE to enhance economic resilience and sustainability under challenging conditions. This experience offers critical lessons for Nigeria, as it also faces similar urbanization and sustainability challenges.

Hitchhiker's Guide to Borrelia burgdorferi.

Don't Panic. In the nearly 50 years since the discovery of Lyme disease, Borrelia burgdorferi has emerged as an unlikely workhorse of microbiology. Interest in studying host-pathogen interactions fueled significant progress in making the fastidious microbe approachable in laboratory settings, including the development of culture methods, animal models, and genetic tools. By developing these systems, insight has been gained into how the microbe is able to survive its enzootic cycle and cause human disease. Here, we discuss the discovery of B. burgdorferi and its development as a model organism before diving into the critical lessons we have learned about B. burgdorferi biology at pivotal stages of its lifecycle: gene expression changes during the tick blood meal, colonization of a new vertebrate host, and developing a long-lasting infection in that vertebrate until a new tick feeds. Our goal is to highlight the advancements that have facilitated B. burgdorferi research and identify gaps in our current understanding of the microbe.

Critical Governance Lessons from a Mining Dam Failure Disaster in Brumadinho, Brazil

Critical Governance Lessons from a Mining Dam Failure Disaster in Brumadinho, Brazil

Learning from the past: Essential knowledge and vigilance for healthcare workers in future pandemics

This paper examines critical lessons from past pandemics and highlights essential knowledge and skills healthcare workers need to prepare for future health crises. By reviewing the Black Death, Spanish Flu, H1N1 Influenza, and COVID-19, we identify key themes such as early detection, rapid response, effective public health communication, and socio-economic impacts. We emphasize continuous education, simulation exercises, interdisciplinary collaboration, and the integration of technology in pandemic response. The roles of AI and data analytics in prediction and management, telemedicine, and innovative diagnostic tools are discussed. Ethical considerations and global cooperation are underscored to ensure equitable and effective responses. Recommendations include enhancing health security, strengthening infrastructure, and fostering a culture of vigilance. Learning from history and proactive preparation can enable healthcare workers to manage future pandemics and ensure healthcare system resilience.

Navigating the politics and processes of food systems transformation: guidance from a holistic framework

The call for transforming food systems from their current unsustainable trajectories toward more desirable, healthy, sustainable, resilient, and equitable outcomes has received unprecedented echoes recently—particularly following the 2021 UN Food Systems Summit. But lack of guidance on how to do so in a comprehensive and integrated manner has left many actors uncertain, skeptical, or even low-spirited about the prospects of delivering such an ambitious task. Through this work, we argue that food systems transformation is not an impossible goal to aspire for; however, whether we achieve any form of transformation is essentially down to how food systems politics are enacted. Politics, we posit, is at the center of creating and maintaining current unsustainable food system trajectories and will also be crucial in guiding change processes toward sustainable goals. In this paper, we explore this argument through a conceptual framework. The framework, which is relevant for both high and lower-income countries, integrates multiple perspectives and practical experiences on transition, transformation and politics to propose a holistic diagnostic and prescriptive tool for food systems transformation. Three critical lessons emerge from this: first, the transformation (of food systems) must be normative, deliberate and goal-oriented—as opposed to driven by technological innovations; second, the process must account for, integrate, and build on the multi-dimensional and multi-procedural nature of the politics that drive (or resist) changes; and third, the transformation needs to build on a strong driving environment, one that transforms not just food systems but also their governance.

The environmental sustainability implications of contrast media supply chain disruptions during the COVID-19 pandemic: A document analysis of international practice guidelines

IntroductionTravel restrictions implemented during the acute phases of the COVID-19 pandemic disrupted supply chain for critical radiology consumables including contrast media (CM) leading to shortages. Consequently, some departments had to restructure their clinical workflows in accordance to recommended guidelines to ensure safe continuity of patient care. This study aimed to summarise the temporary crisis-driven recommendations with implicit environmental sustainability essence and to analyse how these measures might inform the development of a more sustainable, long-term clinical guideline for safer and cost-effective CM usage without compromising diagnostic quality. MethodsDocuments were obtained through an electronic database search together with a relevant manual search in Google Scholar and relevant reference lists. The selected documents were subjected to a pre-defined eligibility criteria for inclusion. The READ approach was employed for document analysis and a thematic analysis of the obtained data was conducted. ResultsOf the 17 documents included, 70% (n = 12) emanate from the United States of America. The summary of the findings relate to minimising CM usage through strategic clinical approaches including optimisation of CM volumes, prioritisation of non-contrast imaging and/or alternative imaging depending on patient need without compromising diagnostic quality. ConclusionCritical lessons of sustainability essence are implicitly embedded in the policy guidelines issued during the periods of acute CM shortage in the COVID-19 pandemic. These lessons were themed around CM conservation based on: type and priority of medical imaging investigation, kind of imaging modality and use of smaller vials over multi-dose vials packaging.Implications for practice: The temporary crisis-driven strategies may offer critical lessons for post-pandemic service delivery to enhance patient safety while saving cost and promoting greener practice via strategic clinical and operational monitoring of CM through policy renewal, education and training and collaboration with industry partners.

Making kin is more than metaphor: Implications of responsibilities toward Indigenous knowledge and artistic traditions for museums

AbstractMany Indigenous communities do not regard objects as inanimate, but rather as animate kin. Based on our work as a collaborative group of museum coordinators and Hopi, Anishinaabe, and Penobscot artists, we explore narratives and kinship concepts emerging from working with collections of baskets and pottery. We question how recent theoretical conceptualizations of kinship have become overly rhetorical and, therefore, risk diminishing the tangible responsibilities that Indigenous knowledge systems teach. We explore how the new social networks forged through collaborative practices implicate museum personnel in kinship‐like relationships, which raises the question: What are the critical lessons museums can learn from the work of making and sustaining kin? Conventional western museology rarely contemplates these imperatives. The implications for museums that come with recognizing such networks are not only about conceptualizing kin in new ways, but also developing shared ethical protocols and responsibilities toward Indigenous knowledge and the environment over multiple generations.

Reimagining hydropower in the United States

AbstractIn this Perspective, we review the clashing narratives around the role of hydropower in the United States' (US) energy future. In doing so, we reveal how hydropower is regarded as a keystone for the renewable energy transition but also viewed as a harmful technology with significant negative environmental and social impacts. These narratives can be seen in the contrasting future renewable energy visions of US government agencies, the hydropower industry, NGOs, and Tribal governments. We review critical lessons learned from past dam‐ and hydropower‐related challenges to reimagine a just energy future for the US that bridges diverse sectors, jurisdictions, and values. We conclude by highlighting some key paths forward that might result in more resilient and adaptive water and energy systems as the country strives to decarbonize.This article is categorized under: Human Water > Human Water Human Water > Water Governance Science of Water > Water and Environmental Change Engineering Water > Planning Water

Unequal Educational Opportunities and Challenges in Online Learning during the Pandemic in India

Enforcing online classes during the lockdown due to the outbreak of the COVID-19 pandemic worsened the living and learning conditions of students from the most marginalised sections in India. Against this backdrop, this study seeks to shed light on the risk of the rapid adaptation of online teaching methods under extremely unfavourable educational conditions and poor educational infrastructure in India. The evolved system was entrenched in the existing social and educational inequalities that were exacerbated by ever-growing private educational providers. This almost limited the vulnerable group in finding choices of learning through the online mode necessitated by the lockdown. Traditional teaching and learning practices were implicated not only due to the existing social arrangements but also due to the shift to the online mode of learning with the adaptation of digital technology during the pandemic crisis, which has deeply disrupted the current educational scenario as well. Critical lessons learned from the recent catastrophic events will provide a political vision to outline an inclusive approach to designing sustainable educational planning and programmes targeting the most vulnerable sections of the population. This also reminds us that hasty and cosmetic solutions would do more harm to the poor than to the rich, thereby leading to everlasting damage to educational and social systems.

Remembering for resilience: nature-based tourism, COVID-19, and green transitions

The COVID-19 pandemic had transformative effects on the tourism sector at an unparalleled scale. With the rapid onset of unprecedented travel restrictions, tourists were abruptly confined to experiences in their regional surroundings that led to new and refreshed relationships with local destinations. This paper draws on qualitative interviews with small tourism businesses in two distinct but proximate nature-based destinations in Ontario, Canada and considers how they responded to the COVID-19 pandemic. Findings are positioned within Holling's Adaptive Cycle to consider implications for ongoing resiliency planning for disturbances relating to climate change. Over a 2-year period (2020–2022), SMEs revealed that after an initially turbulent period they quickly adapted to the absence of international long-haul visitors by embracing a surge in domestic demand for nature-based, outdoor experiences. The paper contributes to the literature on tourism SMEs by connecting experiences of COVID-19 to resiliency planning for future predictable disturbances. Two critical lessons for enhancing destination resiliency are identified: engagement of regional tourism demand, and destination level leadership, through investment in infrastructure and partnerships, can both be harnessed to support SMEs and their communities in transitioning toward a more sustainable, resilient and climate-friendly tourism future. Given the growing demand for tourism businesses to transition away from environmentally harmful practices and a longstanding dependency on economic growth, these resources can help destinations enhance preparedness for future changes to tourism flows driven by decarbonization scenarios and increased climatic impacts.

Barriers to inclusion and equity: a mother-son critical reflection and lessons learned

This study is an exploration of DisCrit Mothering, of education, research, and activism, rooted in our radical love for our children facing barriers and injustices due to intersectional oppressions in schools. We employ critical duoethnography to discuss and analyze our experiences, understandings, and lessons learned in our mother-son educational journey through counter-storytelling of four pivotal events to counter implicit bias and majoritarian narratives. We identify patterns of racism, ableism, and exclusion in our stories and share our lessons learned. We identify the need for a better understanding of dis/ability, timely identification, a rejection of deficit-focused approaches, and student and family involvement in IEPs. We make ourselves vulnerable to share our stories, using our lessons learned to urge educators to question their perceptions of multiply-marginalized students and to focus on care and equity versus discipline.

A Critique of Chinese Loans in Sub-Saharan Africa: A fruitful Prospect or Neo-Colonisation

Abstract Economic development has been on Sub Sahara Africa’s (SSA) agenda for the past two decades. However, the stark reality is that it has been sporadic, slack and slow. One can argue that these nations had a late start due to their economies being controlled by conquerors until the late 20th century. Others might reinforce the idea that the late blooming of SSA was due to their economic development being stifled by the punitive interests levied by the IMF under the guise of reconstruction loans following decolonisation. Thus, in a bid to egress of that vicious circle of debt, another beacon has lit for SSA in the form of Chinese loans. Albeit, an acceptable macro reality that growth can be achieved through loans, this stance has raised moot questions: Is this financial help a strategy that will make SSA beholden to the Chinese government akin to a re-colonisation, or will it propel SSA nations into developed nations by alleviating poverty, creating jobs and promoting growth? The critical lesson of this paper is that confiscation of resources, in the event of non-payment of loans, should be solved with other measures of debt repayment to ensure the continent is not exposed to neo-colonisation.

Entrepreneurial leadership in startups and SMEs: Critical lessons from building and sustaining growth

Entrepreneurial leadership plays a pivotal role in the success of startups and small to medium-sized enterprises (SMEs) by guiding them through the turbulent waters of innovation, risk, and growth. This review explores the critical lessons learned from the experiences of entrepreneurial leaders in building and sustaining growth within these dynamic organizations. In today's competitive business landscape, startups and SMEs face unique challenges, including limited resources, intense competition, and rapid market changes. Effective entrepreneurial leadership entails a visionary mindset, a willingness to take calculated risks, and an ability to adapt to evolving circumstances. This review delves into the fundamental elements of entrepreneurial leadership, such as vision setting, innovation, adaptability, team building, and decision-making, which are essential for navigating the complexities of the startup and SME environment. Furthermore, the review examines strategies for building and sustaining growth, including scalability, financial management, marketing, customer acquisition, and strategic partnerships. Through case studies and practical examples, it illustrates how successful entrepreneurial leaders have implemented these strategies to overcome challenges and achieve sustainable growth. Despite their potential for success, startups and SMEs also face numerous challenges, including regulatory hurdles, technological disruptions, and globalization. By understanding these challenges and embracing emerging trends, entrepreneurial leaders can position their organizations for long-term success in an ever-changing business landscape. In conclusion, this review underscores the importance of entrepreneurial leadership in driving innovation and growth in startups and SMEs. By learning from past experiences and embracing the principles of entrepreneurial leadership, aspiring leaders can chart a course towards success in the dynamic world of entrepreneurship. Keywords: Entrepreneurial Leadership, Startups, SMEs, Sustaining Growth.