Preparedness Plans Research Articles

Evaluation of preparedness and response competency of healthcare administrative staff of the public hospitals during the Covid-19 pandemic and its impact on the resilience of health system in Greece

Introduction: The role of health systems and hospital administrative system in Covid-19 pandemic period is of utmost importance. Objective: The scope of study is to assess the preparedness, response competencies of administrative staff and resilience of health system as well as to highlight the need of modernizing the role of the above three com¬ponents. Methods: 175 executives from public hospitals of the seven Regional Health Authorities in Greece partici¬pated in an online survey. Demographic, occupational data were collected and presented with correlations of individual variables. Results: The mental working condition of staff became much worse. The 96,7% of participants believed that the country does not implement a pandemic preparedness plan while 83,3% think that this plan has not been updated. Also, 38.9% of participants had no idea whether the strengthening of health system resilience is a current preoccu¬pation of health policy makers. Conclusions: Measures of new managements are considered necessary for a suc¬cessful reform effort. The organization of health systems and development of medical countermeasures are suggested as essential for the preparedness and response of Healthcare Administrative Staff of the Public Hospitals as well as the resilience of Greek Health System.

Simulation of large plausible tsunami scenarios associated with the 2019 Durres (Albania) earthquake source and adjacent seismogenic zones

We present an analysis of the hazards of potential earthquake-generated tsunamis along the Albanian–Adriatic coast. The study adopts a case study approach to model plausible tsunamigenic events associated with the 2019 Mw 6.4 Durres (Albania) earthquake source zone. The approach combines current findings on regional tectonics and scenario-based calculations of potential tsunami impacts. The study’s goal is to analyse the propagation of tsunami waves generated by identified seismogenic sources (namely ALCS002 [Lushnje] and ALCS018 [Shijak]) and determine the tsunami risk assessment for Durres City on the Albanian–Adriatic coast. The sources can generate earthquakes with maximum moment magnitudes of Mw 7.5 and Mw 6.8, which are likely to trigger tsunamis that could cause significant impacts in the region. The modelling is performed deterministically with the NAMI DANCE numerical code, including scenarios associated with the largest plausible earthquake. The model integrates bathymetry and topography datasets of large and medium resolutions. Each tsunami scenario simulation is based on the solution of the non-linear shallow water equations used to generate maximum positive wave amplitudes (water elevation), travel time, and tsunami inundation maps. In Durres City, modelling indicates that medium-sized waves could reach up to 2.5 m inland, posing a significant danger to the city’s low-lying areas. The most substantial tsunami waves are expected to impact the area within the first 10 to 20 min. Combining inundation maps and information on exposed assets allows for identifying areas where damages can be expected. In terms of human impact, a preliminary analysis shows that the study area is prone to tsunami threat, with more than 138,000 inhabitants living in vulnerable urban areas of Durres City by 2036. The model’s capacity to capture details related to the presence of buildings is limited due to constraints posed by the resolution of bathymetry and topography datasets available during this study. If refined with high-resolution bathymetry and topography datasets, our results can be considered a backbone for exposure and resilience assessment features to be integrated into preparedness or new urban development plans.

The role of social capital in building community disaster resilience –empirical evidences from rural China

The paper investigates the role of social capital in hazard management in a case area which was overwhelmingly swept by flood in mid-2021. The interplay among social capital, hazard preparedness, response and recovery are explored by using structure equation modeling. Data were gathered from over 413 villages from August 2021 to September 2021, which is one month after the flood occurred. Research findings show that villagers in region with abundant social capital are more likely to contribute to hazard preparedness. We have also confirmed the positive role of social capital in restraining the pursuit of self-interests. Villagers are more willing to help others, and take care of vulnerable population when the hazard strikes. However, it is surprising to note that social capital fails to motivates residents to make preparedness plans for future risks. This retreat effect exists when big loss occurred and failed to meet local people's expectations. Overall, this study implies that the impact of social capital on hazard risk management is extremely complex and such complexity should not be attribute solely to divergent forms of network relationship. The above conclusion enables policy makers to pay attention to the psychological foundation of social capital while cultivating it.

"As I dropped the phone, she slapped me for the first time": Experiences of intimate partner violence among Nigerian men during COVID-19 restrictions.

Limited literature exists on men's experiences with intimate partner violence (IPV) during the COVID-19 lockdown, especially in resource-constrained settings like Nigeria. We investigated the prevalence, risk factors, and lifetime experiences of IPV among men in Nigeria, during COVID-19 restrictions. Using a mixed methods design, we interviewed 420 married men with a structured questionnaire and conducted 20 in-depth interviews. Logistic regression and a framework approach were used for data analysis. Approximately 86.4% of respondents (n=363) experienced IPV at some point in their lifetime. The prevalence of IPV during the COVID-19 restrictions was 76.2% (n=320). Over a lifetime, verbal (67.4%), physical (78.1%), and sexual coercion (81.0%) were the most common forms of IPV. During the COVID-19 lockdown, the corresponding proportions were 48.6%, 69.5%, and 57.4%, respectively. Male- and female-perpetrated IPV over a lifetime (88.3% vs 87.6%) and during COVID-19 restrictions (88.3% vs 81.4%) were similar (p>0.05). Older age, non-Muslim religion, longer marital duration, partner's profession, and no formal education were associated with higher IPV risk. Home confinement, financial stress, childbirth, disrespect towards spouse's parents, emotional detachment, disputes about child discipline, and suspected infidelity contributed to IPV. Men's active involvement in family life, improved communication, and increased transparency emerged as protective factors. Our findings highlight the high rates of IPV during the pandemic, with men as both perpetrators and victims. Future epidemic preparedness plans should prioritize IPV prevention strategies that enhance partner communication, promote male involvement in family life, address the gender education gap, and provide support services.

Rethinking Infection Control: Nursing Home Administrator Experiences during the COVID-19 Pandemic

ObjectiveTo examine nursing home administrator perspectives of infection control practices in nursing homes at the height of the COVID-19 pandemic and characterize lessons learned. DesignDescriptive qualitative study. Setting and ParticipantsAdministrators from 40 nursing homes across 8 diverse health care markets in the United States. MethodsSemistructured interviews were conducted via telephone or Zoom with nursing home administrators. Interviews were repeated at 3-month intervals, for a total of 4 interviews per participant between July 2020 and December 2021 (n = 156). Qualitative analysis of interview transcripts used modified grounded theory and thematic analysis to identify overarching themes. ResultsThree major themes emerged reflecting administrator experiences managing infection control practices and nursing home operations at the height of the COVID-19 pandemic. First, administrators reported that the more stringent infection control protocols implemented to manage and mitigate COVID-19 at their facilities increased awareness and understanding of the importance of infection control; second, administrators reported incorporating higher standards of infection control practices into facility-level policies, emergency preparedness plans, and staff training; and third, administrators said they and their executive leadership were reevaluating and upgrading their facilities’ physical structures and operational processes for better infection control infrastructure in preparation for future pandemics or other public health crises. Conclusions and ImplicationsInsights from this study's findings suggest important next steps for restructuring and improving nursing home infection control protocols and practices in preparation for future pandemics and public health emergencies. Nursing homes need comprehensive, standardized infection control training and upgrading of physical structures to improve ventilation and facilitate isolation practices when needed. Furthermore, nursing home emergency preparedness plans need better integration with local, state, and federal agencies to ensure effective communication, proper resource tracking and allocation, and coordinated, rapid response during future public health crises.

Integrated planning of emergency supply pre-positioning and victim evacuation

Natural disasters such as earthquakes, floods, and storms cause numerous human casualties and economic losses every year. Emergency supply pre-positioning and victim evacuation, as two important emergency relief operations, tend to be separately considered in the literature. However, there are intrinsic correlations between the two operations in reality, which calls for an integrated planning of emergency supply pre-positioning and victim evacuation. In this study, we propose a stochastic programming model to optimize, in an integrated way, the deployment of emergency facilities, pre-stocking and distribution of emergency supplies and management of self-evacuated victims under two planning goals, namely cost effectiveness and evacuation fairness. We also formulate four comparison models to highlight the benefits of our integrated planning model. With a case study on the development of an emergency preparedness and response plan in Sichuan Province, China, we not only demonstrate the effectiveness and benefits of our approach but also obtain key managerial insights and policy suggestions for better emergency management practice.

A practical agenda for incorporating trust into pandemic preparedness and response.

Despite widespread acknowledgement that trust is important in a pandemic, few concrete proposals exist on how to incorporate trust into preparing for the next health crisis. One reason is that building trust is rightly perceived as slow and challenging. Although trust in public institutions and one another is essential in preparing for a pandemic, countries should plan for the possibility that efforts to instil or restore trust may fail. Incorporating trust into pandemic preparedness means acknowledging that polarization, partisanship and misinformation may persist and engaging with communities as they currently are, not as we would wish them to be. This paper presents a practical policy agenda for incorporating mistrust as a risk factor in pandemic preparedness and response planning. We propose two sets of evidence-based strategies: (i)strategies for ensuring the trust that already exists in a community is sustained during a crisis, such as mitigating pandemic fatigue by health interventions and honest and transparent sense-making communication; and (ii)strategies for promoting cooperation in communities where people mistrust their governments and neighbours, sometimes for legitimate, historical reasons. Where there is mistrust, pandemic preparedness and responses must rely less on coercion and more on tailoring local policies and building partnerships with community institutions and leaders to help people overcome difficulties they encounter in cooperating with public health guidance. The regular monitoring of interpersonal and government trust at national and local levels is a way of enabling this context-specific pandemic preparedness and response planning.

Pandemic influenza preparedness plan in Liguria, Italy: a valuable tool for Public Health.

As known, influenza presents a multifaceted challenge to public health, causing disease that ranges from mild cases to severe pandemics with significant morbidity and mortality. Effective pandemic preparedness demands a comprehensive strategy that integrates research, surveillance, response coordination and community engagement, to mitigate the impact of future health emergencies. The pandemic preparedness cycle involves dynamic, cyclical phases of preparation and response aimed at enhancing response capacity. Italy's 2021-2023 National Strategic-Operational Plan for Pandemic Influenza (PanFlu) incorporates lessons learned from past pandemics and serves as a framework for regional plans, such as Liguria's. The Ligurian plan delineates governance structures, surveillance strategies, healthcare services and communication measures necessary for effective pandemic management. It emphasizes the need to strengthen links between emergency structures, to avoid duplication and to adopt flexible approaches to scale actions appropriately and highlights the need for risk/benefit analysis to support evidence-based decision-making as well as clear guidance on data collection and communication activities. By integrating these elements, the region's overall readiness and resilience against influenza pandemics are expected to be reinforced.

Development of a Proof-of-Concept Multi-Method Computer Simulation to Support Rural Healthcare Disaster Preparedness Planning

Due to a lack of resources, rural communities often face challenges when planning catastrophic events. This project involved applying systems thinking and model-based systems engineering to develop a proof-of-concept, multi-method computer simulation and then determining whether the simulation could be used to assess the efficacy of disaster planning approaches on health outcomes in rural communities, as a function of primary healthcare. The project focus was a rural or non-urban healthcare system experiencing a natural hazard. Both system dynamics and discrete event models were incorporated to represent subsystem operations, crucial disaster responses, as well as three key response systems: public health, emergency management, and healthcare. The subsystem models included several components: policies/procedures, communications, resources, exercises/drills/training, healthcare space and staff, and the flow of affected people into and through the system. The combined simulation can serve as a first step to a more comprehensive approach to helping rural communities achieve more efficient and effective healthcare planning for disaster responses.

Crisis preparation for people with multiple sclerosis in Australia: A cross-sectional survey of needs

With increasing prevalence of disasters or crises such as fires, floods, and pandemics globally, people with disabilities are disproportionally at risk for short- and long-term consequences. We surveyed 1479 people with multiple sclerosis (MS) living in Australia to understand their needs for a crisis preparation plan. Only 17.4 % already had a plan that met their needs, 31.0 % and 6.5 % indicated they would find creating or updating a plan helpful (respectively) and 14.1 % were unsure. A third indicated they would need professional assistance with creating or updating their plan. This study shows that people with MS perceive the need to improve their individual preparedness for crises and the need for assistance in doing so. Community disaster preparedness and response plans should consider the particular needs of this patient population, and those living with MS-related disabilities and their carers should be included in the development of these plans.

Experiences of birthing people during the COVID-19 pandemic: Analysis of comments from the 2020 Wisconsin Pregnancy Risk Assessment Monitoring System (PRAMS).

The COVID-19 pandemic has taken a significant toll on the US population, with birthing people having special clinical needs. The Pregnancy Risk Assessment Monitoring System (PRAMS) is a population-based surveillance system for monitoring birthing people's experiences. Comment data from the PRAMS survey can provide further insight into birthing people's experiences. This study aims to use PRAMS data to describe pandemic-related experiences in a representative sample of birthing people in Wisconsin to help inform future emergency preparedness planning. This study analyzed 2020 Wisconsin PRAMS data for births in March or later. Content analysis of pandemic-related comment data was conducted, and quantitative data on demographic characteristics and pandemic-related experiences were examined. Findings from 1406 respondents indicated that many birthing people were affected by the pandemic, including changes in healthcare visits and employment. One hundred respondents commented on pandemic-related experiences; four interrelated themes emerged from content analysis: changed nature and quality of healthcare, limited social support, increased anxiety, stress, or fear, and employment or financial burden. Most comments discussed negative impacts; some expressed positive aspects. Findings suggest opportunities for improving support for birthing people during public health emergencies, for example, through developing healthcare policies and public health guidelines that prioritize the protective mechanisms of social support for birthing people, identifying additional and immediately accessible policy protections to support birthing and postpartum people (e.g., insurance and paid leave) during public health emergencies, and implementing additional screening and support to help address increased mental health needs during public health emergencies.

Integrating Psychological First Aid Into Community Disaster Preparedness Plans: Opportunities And Challenges

Disasters, whether natural or human-made, can have profound and lasting impacts on individuals’ mental health and well-being. In recent years, there has been increasing recognition of the importance of addressing psychological impact of disasters and incorporating psychological first aid (PFA) in disaster preparedness policies and plans. This research paper explores the opportunities and challenges associated with integrating PFA into community disaster preparedness plans. Drawing on a review of existing literature, this paper examines the theoretical underpinnings of PFA, its core principles and components, and its effectiveness in promoting psychological resilience and recovery following disasters. Additionally, this paper explores the practical considerations and logistical challenges involved in implementing PFA within the context of community disaster preparedness, including issues related to training, resource allocation, coordination with existing emergency response systems, and cultural sensitivity. Through a comprehensive analysis of the opportunities and challenges associated with integrating PFA into community disaster preparedness plans, this paper aims to inform policymakers, emergency responders, and mental health professionals about the importance of prioritizing psychological support in disaster preparedness efforts and offers recommendations for enhancing the effectiveness and sustainability of PFA initiatives at the community level.

Long-term wastewater monitoring of SARS-CoV-2 viral loads and variants at the major international passenger hub Amsterdam Schiphol Airport: A valuable addition to COVID-19 surveillance

Wastewater-based epidemiological surveillance at municipal wastewater treatment plants has proven to play an important role in COVID-19 surveillance. Considering international passenger hubs contribute extensively to global transmission of viruses, wastewater surveillance at this type of location may be of added value as well. The aim of this study is to explore the potential of long-term wastewater surveillance at a large passenger hub as an additional tool for public health surveillance during different stages of a pandemic. Here, we present an analysis of SARS-CoV-2 viral loads in airport wastewater by reverse-transcription quantitative polymerase chain reaction (RT-qPCR) from the beginning of the COVID-19 pandemic in Feb 2020, and an analysis of SARS-CoV-2 variants by whole-genome next-generation sequencing from Sep 2020, both until Sep 2022, in the Netherlands. Results are contextualized using (inter)national measures and data sources such as passenger numbers, clinical surveillance data and national wastewater surveillance data. Our findings show that wastewater surveillance was possible throughout the study period, irrespective of measures, as viral loads were detected and quantified in 98.6 % (273/277) of samples. Emergence of SARS-CoV-2 variants, identified in 91.0 % (161/177) of sequenced samples, coincided with increases in viral loads. Furthermore, trends in viral load and variant detection in airport wastewater closely followed, and in some cases preceded, trends in national daily average viral load in wastewater and variants detected in clinical surveillance. Wastewater-based epidemiology at a large international airport is a valuable addition to classical COVID-19 surveillance and the developed expertise can be applied in pandemic preparedness plans for other (emerging) pathogens in the future.

The impact of the COVID-19 pandemic on people who use drugs in three Canadian cities: a cross-sectional analysis

BackgroundThe COVID-19 pandemic had a disproportionate impact on the health and wellbeing of people who use drugs (PWUD) in Canada. However less is known about jurisdictional commonalities and differences in COVID-19 exposure and impacts of pandemic-related restrictions on competing health and social risks among PWUD living in large urban centres.MethodsBetween May 2020 and March 2021, leveraging infrastructure from ongoing cohorts of PWUD, we surveyed 1,025 participants from Vancouver (n = 640), Toronto (n = 158), and Montreal (n = 227), Canada to describe the impacts of pandemic-related restrictions on basic, health, and harm reduction needs.ResultsAmong participants, awareness of COVID-19 protective measures was high; however, between 10 and 24% of participants in each city-specific sample reported being unable to self-isolate. Overall, 3–19% of participants reported experiencing homelessness after the onset of the pandemic, while 20–41% reported that they went hungry more often than usual. Furthermore, 8–33% of participants reported experiencing an overdose during the pandemic, though most indicated no change in overdose frequency compared the pre-pandemic period. Most participants receiving opioid agonist therapy in the past six months reported treatment continuity during the pandemic (87–93%), however, 32% and 22% of participants in Toronto and Montreal reported missing doses due to service disruptions. There were some reports of difficulty accessing supervised consumption sites in all three sites, and drug checking services in Vancouver.ConclusionFindings suggest PWUD in Canada experienced difficulties meeting essential needs and accessing some harm reduction services during the COVID-19 pandemic. These findings can inform preparedness planning for future public health emergencies.

Birth preparedness and pregnancy complication readiness and associated factors among pregnant women in Ethiopia: A multilevel analysis.

Maternal and child deaths occur during pregnancy and delivery. Timely information on signs of pregnancy complications and ways to plan for normal birth is a strategy to reduce maternal and child deaths. The purpose of this study was to assess birth preparedness, and pregnancy complications readiness and identify associated factors in Ethiopia. A cross-sectional study design was used. A total of 1635 weighted samples of pregnant women were included for analysis from the 2016 Ethiopian demographic and health survey data set. Multilevel mixed-effect logistic regression was used to estimate the effects of potential variables on birth preparedness and complication readiness. STATA version 15 software was used for data processing and analysis. A variable with a p-value < 0.05 with a 95% confidence interval was considered a significant factor. Pregnant women were informed about convulsions (8.02%), fever (35.95%), abdominal pain (28.92%), leaking fluid from the vagina (28.21%), and blurred vision (17.98%). Pregnant women prepared for supplies needed for birth (38.70%), transportation (20.04%), money (18.97%), people's support for birth (5.03%), and blood donors (3.11%). Only 56% and 44.91% of pregnant women had good birth preparedness and were informed about pregnancy complications respectively. Educational status, antenatal care visits, and region were significant factors associated with birth preparedness and complication readiness. Distance to health facility and residency were significantly associated with birth and complication readiness, respectively. Birth preparedness and complication readiness among pregnant women were low in Ethiopia. Empowering women with education, installing safe roads, building accessible health facilities, and emphasizing pregnancy complications and birth preparedness plans during antenatal care visits are important interventions to enhance birth preparedness and pregnancy complication readiness.

Health systems challenges, mitigation strategies and adaptations to maintain essential health services during the COVID-19 pandemic: learnings from the six geopolitical regions in Nigeria

BackgroundThe COVID-19 pandemic control strategies disrupted the smooth delivery of essential health services (EHS) globally. Limited evidence exists on the health systems lens approach to analyzing the challenges encountered in maintaining EHS during the COVID-19 pandemic. This study aimed to identify the health system challenges encountered and document the mitigation strategies and adaptations made across geopolitical zones (GPZs) in Nigeria.MethodsThe national qualitative survey of key actors across the six GPZs in Nigeria involved ten states and the Federal Capital Territory (FCT) which were selected based on resilience, COVID-19 burden and security considerations. A pre-tested key informant guide was used to collect data on service utilization, changes in service utilization, reasons for changes in primary health centres’ (PHCs) service volumes, challenges experienced by health facilities in maintaining EHS, mitigation strategies implemented and adaptations to service delivery. Emerging sub-themes were categorized under the appropriate pillars of the health system.ResultsA total of 22 respondents were interviewed. The challenges experienced in maintaining EHS cut across the pillars of the health systems including: Human resources shortage, shortages in the supply of personal protective equipments, fear of contracting COVID-19 among health workers misconception, ignorance, socio-cultural issues, lockdown/transportation and lack of equipment/waiting area (. The mitigation strategies included improved political will to fund health service projects, leading to improved accessibility, affordability, and supply of consumables. The health workforce was motivated by employing, redeploying, training, and incentivizing. Service delivery was reorganized by rescheduling appointments and prioritizing some EHS such as maternal and childcare. Sustainable systems adaptations included IPC and telehealth infrastructure, training and capacity building, virtual meetings and community groups set up for sensitization and engagement.ConclusionThe mitigation strategies and adaptations implemented were important contributors to EHS recovery especially in the high resilience LGAs and have implications for future epidemic preparedness plans.

Comparing the effectiveness of adulticide application interventions on mitigating local transmission of dengue virus

AbstractThe southern US has a large presence of mosquito vector species for dengue virus (DENV) and experiences thousands of DENV importations every year, which have led to several local outbreaks. Adulticide spraying targeting active mosquitoes is one of the most common insecticide strategies used as a response to an outbreak. The aim of this study is to evaluate the effectiveness of adulticide spraying conducted at different times of the day to curb DENV transmission. Based on unique dataset of Aedes aegypti diel activity patterns in Miami-Dade County, Florida, and Brownsville, Texas, we developed a mechanistic model of DENV transmission, which simulates adulticide spraying interventions. We estimated that spraying adulticide for 14 consecutive days at 7am or 8 pm was highly effective in reducing DENV outbreak probability from 10% in the absence of interventions to 0.1% for Miami-Dade County, and from 7.8 to 0.1% for Brownsville. Moreover, in case of a local outbreak in Miami-Dade County, we estimated the median number of symptomatic infections after the identification of a local outbreak to be reduced from 67.0 (IQR: 25.5–103.0) in the absence of interventions to 1.0 (IQR: 0.0–2.0) when spraying adulticide for 14 consecutive days at 8 pm. In Brownsville, the same intervention is estimated to lead to a decrease from 15.0 (IQR: 7.0–33.0) cases to 1.0 (IQR: 0.0–2.0). Our study highlights the importance of considering diel activity patterns of vector mosquito species in arbovirus preparedness and response planning and provide quantitative evidence to guide the decision-making of mosquito control authorities.

Caregivers’ perspectives on disaster preparedness and evacuation plan for children relying on home ventilators or home oxygen

Children with medical complexity (CMC) and their caregivers are particularly vulnerable to the pernicious effects of disasters. This multicenter observational investigation in Ehime Prefecture, Japan, aimed to assess caregivers' perspectives on the disaster preparedness for children relying on home ventilators or home oxygen, determine their inclinations towards evacuation, and identify their concerns regarding a disaster. Caregivers of children receiving home care with a ventilator or oxygen therapy were recruited. Participants were administered multiple-choice questions and requested to provide free-text comments about their concerns. As a result, of 99 participants, 49.5 % (N = 49) reported being well-prepared for a disaster. While 27.3 % (N = 27) stated that they would evacuate, 25.2 % (N = 25) stated never evacuate. Caregivers for totally dependent children were more likely to decline evacuation. 68.7 % (N = 68) reported never having discussed with medical professionals about disaster preparedness. 44.4 % (N = 44) reported not having a backup power supply. 66.7 % (N = 66) expressed concerns about residing in an evacuation shelter. Other concerns included power outages, inadequate resources, and a lack of feasible evacuation options. In conclusion, Many caregivers perceive that they are insufficiently prepared for a disaster. Caregivers have a diverse range of concerns about disasters. Medical professionals and other stakeholders should recognize caregivers’ difficulties and promote communications about disaster preparedness.Practice Implications.Professionals engaged in the care of CMC should acknowledge unique needs of children and their caregivers, assure them of their right to survive during a disaster, and facilitate discussions about preparedness. The viewpoints of children and their caregivers should be taken into consideration when making decisions about policy and infrastructure adjustments.

Soft computing machine learning applications for assessing regional-scale landslide susceptibility in the Nepal Himalaya

PurposeThis research is aimed at preparing landslide susceptibility using spatial analysis and soft computing machine learning techniques based on convolutional neural networks (CNNs), artificial neural networks (ANNs) and logistic regression (LR) models.Design/methodology/approachUsing the Geographical Information System (GIS), a spatial database including topographic, hydrologic, geological and landuse data is created for the study area. The data are randomly divided between a training set (70%), a validation (10%) and a test set (20%).FindingsThe validation findings demonstrate that the CNN model (has an 89% success rate and an 84% prediction rate). The ANN model (with an 84% success rate and an 81% prediction rate) predicts landslides better than the LR model (with a success rate of 82% and a prediction rate of 79%). In comparison, the CNN proves to be more accurate than the logistic regression and is utilized for final susceptibility.Research limitations/implicationsLand cover data and geological data are limited in largescale, making it challenging to develop accurate and comprehensive susceptibility maps.Practical implicationsIt helps to identify areas with a higher likelihood of experiencing landslides. This information is crucial for assessing the risk posed to human lives, infrastructure and properties in these areas. It allows authorities and stakeholders to prioritize risk management efforts and allocate resources more effectively.Social implicationsThe social implications of a landslide susceptibility map are profound, as it provides vital information for disaster preparedness, risk mitigation and landuse planning. Communities can utilize these maps to identify vulnerable areas, implement zoning regulations and develop evacuation plans, ultimately safeguarding lives and property. Additionally, access to such information promotes public awareness and education about landslide risks, fostering a proactive approach to disaster management. However, reliance solely on these maps may also create a false sense of security, necessitating continuous updates and integration with other risk assessment measures to ensure effective disaster resilience strategies are in place.Originality/valueLandslide susceptibility mapping provides a proactive approach to identifying areas at higher risk of landslides before any significant events occur. Researchers continually explore new data sources, modeling techniques and validation approaches, leading to a better understanding of landslide dynamics and susceptibility factors.

The role of palliative care for patients with left ventricular assist devices: a narrative review.

Left ventricular assist devices (LVADs) have revolutionized the care of patients with advanced heart failure (HF). Compared to guideline-directed medical and device therapies, LVAD technology improves quality of life and reduces mortality. Palliative care specialists have an important role to play in the pre-LVAD evaluation phase, in the post-operative longitudinal care phase, and at the end-of-life in patients with LVADs. The objective of this narrative review is to describe the evidence regarding the role of palliative care for patients with LVAD across the care continuum: pre-implantation, post-implantation, and at the end-of-life. Clinical trials relevant to care of patients with HF, LVADs, and the role of palliative care were analyzed for this narrative review. Palliative care involvement in 'preparedness planning' has been described in the literature, though no standardized protocol for preparedness planning exists, to date. In the longitudinal care phase after LVAD implantation, the role of palliative care is less defined; depending on institutional culture and availability of palliative care, patients may be referred based on symptom-management needs or for advance care planning (ACP). At the end-of-life, either due to an acute event or a gradually worsening condition, palliative care is often engaged to participate in discussions regarding treatment preferences and to consider transitions in care from disease-directed treatments to comfort-focused treatments. Given the medical complexity of dying with LVADs, most patients with an LVAD die in hospital with support from palliative care teams for the physical, existential, and psychosocial distress that accompanies end-of-life and LVAD deactivation. In this narrative review, we describe the integral role of palliative care throughout the care continuum of patients living with LVADs and suggest opportunities for further research.