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Background In 2018–2019, Canada introduced a Prison Needle Exchange Program (PNEP) across nine federal facilities to mitigate the harms associated with drug injection among incarcerated people. However, program uptake has been limited. We explored the barriers and facilitators to improving PNEP services among key stakeholders in prison. Methods Stakeholders in nine federal prisons with active PNEP participated in focus groups using nominal group technique to achieve rapid consensus. Responses were generated, rank-ordered, and prioritized by each stakeholder group (correctional officers, healthcare workers, and people in prison). We identified the highest-ranking responses to questions about barriers and solutions to PNEP uptake and described them using the five levels of the Socioecological Model: individual, interpersonal, organizational, system, and structural/policy. Results Between September 2023 and February 2024, 34 focus groups were conducted with 215 participants ( n  = 51 correctional officers (24%); n  = 67 healthcare workers (31%); n  = 97 people in prison (45%)). Key barriers identified were lack of confidentiality and privacy across all levels and fear of repercussions from drug use and fear of being targeted at the individual-interpersonal levels. Preferred solutions included comprehensive education across all levels, and establishment of supervised/safe injection sites and external program management, potentially involving peers, at the structural level. Conclusions Several multi-level modifiable barriers to improving PNEP uptake in Canadian federal prisons were shared among key stakeholders. Structural changes to PNEP delivery, including supervised/safe injecting sites and peer-led programs, were proposed as solution-driven enablers to increasing PNEP uptake among incarcerated people who inject drugs. These data will inform Canadian efforts to expand PNEP provision.

Background:In the past 2 decades, many countries have recognized the use of electronic systems for disease surveillance and outbreak response as an important strategy for disease control and prevention. In low- and middle-income countries, the adoption of these electronic systems remains a priority and has attracted the support of global health players. However, the successful implementation and institutionalization of electronic systems in low- and middle-income countries have been challenged by the local capacity to absorb technologies, decisiveness and strength of leadership, implementation costs, workforce attitudes toward innovation, and organizational factors. In November 2019, Ghana piloted the Surveillance Outbreak Response Management and Analysis System (SORMAS) for routine surveillance and subsequently used it for the national COVID-19 response.Objective:This study aims to identify the facilitators of and barriers to the sustainable implementation and operation of SORMAS in Ghana.Methods:Between November 2021 and March 2022, we conducted a qualitative study among 22 resource persons representing different stakeholders involved in the implementation of SORMAS in Ghana. We interviewed study participants via telephone using in-depth interview guides developed consistent with the model of diffusion of innovations in health service organizations. We transcribed the interviews verbatim and performed independent validation of transcripts and pseudonymization. We performed deductive coding using 7 a priori categories: innovation, adopting health system, adoption and assimilation, diffusion and dissemination, outer context, institutionalization, and linkages among the aspects of implementation. We used MAXQDA Analytics Pro for transcription, coding, and analysis.Results:The facilitators of SORMAS implementation included its coherent design consistent with the Integrated Disease Surveillance and Response system, adaptability to evolving local needs, relative advantages for task performance (eg, real-time reporting, generation of case-base data, improved data quality, mobile offline capability, and integration of laboratory procedures), intrinsic motivation of users, and a smartphone-savvy workforce. Other facilitators were its alignment with health system goals, dedicated national leadership, political endorsement, availability of in-country IT capacities, and financial and technical support from inventors and international development partners. The main barriers were unstable technical interoperability between SORMAS and existing health information systems, reliance on a private IT company for data hosting, unreliable internet connectivity, unstable national power supply, inadequate numbers and poor quality of data collection devices, and substantial dependence on external funding.Conclusions:The facilitators of and barriers to SORMAS implementation are multiple and interdependent. Important success conditions for implementation include enhanced scope and efficiency of task performance, strong technical and political stewardship, and a self-motivated workforce. Inadequate funding, limited IT infrastructure, and lack of software development expertise are mutually reinforcing barriers to implementation and progress to country ownership. Some barriers are external, relate to the overall national infrastructural development, and are not amenable even to unlimited project funding.

In view of the high vulnerability of the small islands of the Lesser Antilles to cyclonic hazards, realistic very fine scale numerical simulation of hurricane-induced winds is essential to prevent and manage risks. The present innovative modeling aims at combining the most realistically simulated strongest gusts driven by tornado-scale vortices within the eyewall and the most realistic complex terrain effects. The Weather Research and Forecasting (WRF) model with the nonlinear backscatter and anisotropy (NBA) large eddy simulation (LES) configuration was used to reconstruct the devastating landfall of category 5 Hurricane Irma (2017) on Saint Barthélemy and Saint Martin. The results pointed out that the 30 m scale seems necessary to simulate structures of multiple subtornadic-scale vortices leading to extreme peak gusts of 132 m s−1 over the sea. Based on the literature, such extreme gust values have already been observed and are expected for category 5 hurricanes like Irma. Risk areas associated with terrain gust speed-up factors greater than 1 have been identified for the two islands. The comparison between the simulated gusts and the remote sensing building damage highlighted the major role of structure strength linked with the socio-economic development of the territory. The present modeling method could be easily extended to other small mountainous islands to improve the understanding of observed past damage and to develop safer urban management and appropriate building standards.

PurposeThe purpose of this paper is to identify vulnerable areas for flood hazard and to analyze stakes exposed in touristic valley of Morrocan mountains. The three goals are: methodological (low-cost diagnosis without starting data), operational (to show the risk and identify avenues of prevention in Ourika) and incentive (to reproduce this on other sectors in Morocco).Design/methodology/approachThe vulnerability of three areas of the Ourika valley (the most frequented) was assessed by a hydro-geomorphological study, human frequentation surveys and risk indices at the building scale.FindingsSurveys carried out in the field allowed the identification of areas with high risk, the evaluation of the buildings’ vulnerability and the frequentation of the valley. Evacuation plans, allowing easy access to potential refuges in case of flood, were finally proposed.Originality/valueThe reproducible, inexpensive and relevant nature of the approach (integrated and spatialized) helps in decision making and facilitating dialogue for prevention.

This study aims to better understand coastal processes associated with extreme cyclonic events through the study of the coastal changes, flooding and damage that resulted from the passage of a category 5 hurricane (Irma) on 6 September 2017 over the islands of Saint-Martin and Saint-Barthélemy in the Lesser Antilles. Hurricane Irma was contextualized from tropical cyclone track data and local weather observations collected by Météo-France, as well as high-resolution numerical modelling. Field work involved the study of accretion coasts through qualitative observations, topo-morphological and sedimentary surveys, as well as image acquisition with Unmanned Aerial Vehicle (UAV) surveys during two trips that were made 2 and 8 months after the catastrophe. Wave propagation and flood numerical models are presented and compared to field data. Our field analysis also reports on the devastating impacts of storm surges and waves, which reached 4 and 10 meters height, respectively, especially along east-facing shores. The approaches reveal a variety of morpho-sedimentary responses over both natural and highly urbanized coasts. The analysis shows the effects of coastal structures and streets on flow channeling, on the amplification of some erosion types, and on water level increase. Positive spatial correlation is found between damage intensity and marine flood depth. The signatures of ocean-induced damage are clear and tend to validate the relevance of the intensity scale used in this study.

The Alps are highly impacted by debris flows that cause major problems for companies and transport networks located in the valley bottoms. One such event occurred in the Rif Blanc catchment and affected the road network in the French Alps, as well as adjacent areas across the Italian border, for several days in June 2012. This article presents two independent approaches to vulnerability assessment. Based on investigations conducted during a survey of local authorities following the event, we compared theoretical risk management and real crisis management in terms of decision making and modes of intervention. Functional vulnerability and territorial consequences were analyzed using a best travel time model of accessibility. We show that a bottom-up approach is practiced in case of actual management planning with a central coordination of general council. Conversely theoretical crisis management shows prefect as the key actor supported by several other state institutions. Our analysis also revealed that a debris flow event with a local impact on the road network has territorial consequences at a regional scale. This study contributes to the discussion about how to minimize the vulnerability of alpine transport networks prone to debris flows. Our results could serve as a decision support tool for public authorities.

This paper presents the results from an extensive field data collection effort following the December 26, 2004 earthquake and tsunami in Banda Aceh, Sumatra. The data were collected under the auspices of TSUNARISQUE, a joint French-Indonesian program dedicated to tsunami research and hazard mitigation, which has been active since before the 2004 event. In total, data from three months of field investigations are presented, which detail important aspects of the tsunami inundation dynamics in Banda Aceh. These include measurements of runup, tsunami wave heights, flow depths, flow directions, event chronology and building damage patterns. The result is a series of detailed inundation maps of the northern and western coasts of Sumatra including Banda Aceh and Lhok Nga. Among the more important findings, we obtained consistent accounts that approximately ten separate waves affected the region after the earthquake; this indicates a high-frequency component of the tsunami wave energy in the extreme near-field. The largest tsunami wave heights were on the order of 35 m with a maximum runup height of 51 m. This value is the highest runup value measured in human history for a seismically generated tsunami. In addition, our field investigations show a significant discontinuity in the tsunami wave heights and flow depths along a line approximately 3 km inland, which the authors interpret to be the location of the collapse of the main tsunami bore caused by sudden energy dissipation. The propagating bore looked like a breaking wave from the landward side although it has distinct characteristics. Patterns of building damage are related to the location of the propagating bore with overall less damage to buildings beyond the line where the bore collapsed. This data set was built to be of use to the tsunami community for the purposes of calibrating and improving existing tsunami inundation models, especially in the analysis of extreme near-field events.

Category 5 tropical cyclone Pam hit Vanuatu in March 2015, affecting thousands of people. Three months after the event, this study compared the responses from both external aid agencies and the disaster-affected communities to identify convergences, duplications and gaps. The research relies on 13 interviews with aid agencies and eight focus group discussions with participatory activities at local community level. While aid agencies actively responded during and after Pam, local people too responded to the event with strategies based on livelihoods diversification, food security techniques, traditional knowledge and cooperation intra- and inter-communities. The study emphasizes the need for an integrative approach where disaster responses from the top-down integrate that from the bottom-up. Aid agencies should build on the livelihood mechanisms developed at local level so responses and recovery can be more effective, socioculturally acceptable and may lead to sustainable outcomes of disaster risk reduction including climate change adaptation.

This article provides a spatial and comparative approach to evaluate the territorial accessibility in the event of a volcanic crisis in the French West Indies. A spatial assessment of resources and populations exposed to volcanic hazards is performed, followed by an assessment of the risk of territorial isolation due to lahars. Modelling of the risk of terrestrial isolation builds upon graph-based computations and indices that take into account the specific vulnerability of river-crossing structures and the knowledge of historical lahars. Another application of the graphs concerns scenarios for the evacuation of population, the sole efficient response to an eruption. This results in an optimised division of areas to evacuate in order to assess the potential reduction of the load on the road network. These different results are integrated into a prototype for evacuation maps intended for local authorities. The situation of Guadeloupe is of greater concern than that in Martinique, given the level of exposure, the potential losses of accessibility in case of lahars, and the greater and on-going volcanic unrest of La Soufrière volcano in Guadeloupe.