Impact of individual and work factors on the heat-related consequences among power plant workers in a hot region.

Prolonged exposure to hot environments increases the probability of heat load that may cause occupational heat strain to workers. This study investigates the impact of individual and work-related factors on the heat-related consequences among power plant workers in a hot region. This cross-sectional study was conducted in 2020. The collecting data tool was a validated self-reported 26 item questionnaire and completed in 534 individuals. We used logistic regression, Adjusted odds ratio (AOR) and maximum likelihood evaluations for data analysis. The findings indicated that age, work environment, physical work demands and drinking fluids during work hours are significant with heat exposure perception, heat-related symptoms, and work performance (P-value<0.05). Further, the male workers aged 40-49 are more prone to heat-related symptoms (AOR 1.34, 95% CI 1.18-2.13). The importance of addressing heat stress in occupational settings is necessary and informing strategies to help workers adapt to heat in hot workplaces.

Main social vulnerability indicators in the COVID-19 pandemic in Iran.

Background: Social factors play the main role in the vulnerability of exposed countries to disasters. The COVID-19 pandemic as a disaster is not an exception to this fact. This study aimed to determine the main social vulnerability indicators in the COVID-19 pandemic in Iran. Methods: This study was conducted during the period of 2021-2022 in three phases, including a systematic review, a virtual panel expert, and the Analytical Hierarchy Process. First, the draft of social vulnerability indicators in COVID-19 was extracted through a systematic review. Then, the extracted indicators were finalized and prioritized by the expert panel and the AHP, respectively. Results: Initially, the literature review found five domains and 38 indicators of social vulnerability in COVID-19. The outcome of the expert panel increased the related domains to six but decreased the indicators to 31. The three prioritized social vulnerability indicators that were determined by the AHP were population density, accessibility to healthcare facilities, and relevant services and vulnerable groups. Conclusion: Measuring social vulnerability with the identified indicators is valuable for addressing high COVID-19 incidence among socially vulnerable hotspot areas. Regarding the result of this study, further research should be conducted to validate the identified indicators.

Investigating the impacts of socio-economic vulnerability indicators on COVID-19: A case study of Yazd, Iran.

Socio-economic vulnerability plays a major role in affected countries by disasters and emergencies. This study aims to identify the most effective socio-economic vulnerability indicators on COVID-19 cases and severity in the Yazd city. This study was conducted in 2022. Regarding purpose of study, different methods were applied during this research. They were including reviewing scientific research, expert panel sessions, weighting the socio-economic vulnerability indicators by Analytic Hierarchy Process (AHP) and examining the spatially relationships between vulnerability indicators and COVID-19. Excel and GIS software were applied for data analysis using local correlation coefficient. AHP analysis showed that employment, population density, buildings quality and distance from hospitals were obtained the most weight in the related indicators of socio-economic vulnerability. GIS mapping overlying showed that four socio-economic vulnerability sub indicators including percentage of immigrants, age, population density and distance from health centers had spatially relationships with COVID-19 cases and severity. Western, northern and some central regions of Yazd were identified as the COVID-19 hot spots. Local officials and health authorities should pay immediate attention to the most influential socio-econimic vulnerability indicators that are dominant in the Yazd city. They incorporate measures to the regions identified as hot spots because people who located in these areas are more vulnerable to COVID-19 and the other future natual or man-made disasters.

Occupational health risk assessment of airborne formaldehyde in medical laboratories.

The professional use of formaldehyde is a major occupational health concern in medical laboratory operations. Quantification of various risks associated with chronic exposure to formaldehyde may help in understanding the related hazards. This study designed to assess the health risks associated with inhalation exposure to formaldehyde involving biological, cancer, and non-cancer risks in medical laboratories. This study was performed in the hospital laboratories at Semnan Medical Sciences University. Risk assessment was performed in pathology, bacteriology, hematology, biochemistry, and serology laboratories with 30 employees, using formaldehyde in their daily routine operations. We determined area and personal exposures to airborne contaminant, applied standard air sampling, and analytical method recommended by National Institute of Occupational Safety and Health (NIOSH). We addressed formaldehyde-specific hazard by estimating peak blood level, life cancer risk, and the hazard quotient of non-cancer risks, adapted from Environmental Protection Agency (EPA) assessment method. The airborne formaldehyde concentrations in the laboratory personal samples ranged 0.0156-0.5940 ppm (mean = 0.195 ppm, SD = 0.048) and area exposure ranged 0.0285-1.0810 ppm (mean = 0.462 ppm, SD = 0.087). Based on workplace exposure, peak blood levels of formaldehyde were estimated at minimum 0.0026 mg/l to maximum 0.152 mg/l (mean = 0.015 mg/l, SD = 0.016). The mean cancer risk levels in terms of area and personal exposures were estimated respectively at 3.93 E - 8 µg/m3 and 1.84 E - 4 µg/m3, and for the non-cancer risk levels of the same exposures measured respectively at 0.03 µg/m3 and 0.07 µg/m3. Formaldehyde levels were significantly higher among laboratory employees, especially bacteriology workers. Exposure and risk could be minimized by strengthening control measures including the use of management controls, engineering controls, and respiratory protection equipment to reduce exposure levels of all workers to less than the allowed exposure limits and improve indoor air quality in the workplace.

Prediction of time in industrial chemical accidents: A survival analysis.

BACKGROUND: Chemical accidents have imposed casualties and high economic and social consequences to Iranian industries and society. OBJECTIVE: This study investigated the effect of risk factors involved in occurrences of the chemical accidents and predicted the time of occurrences in Iranian chemical factories. METHODS: A cross-sectional study was implemented in 574 chemical facilities with more than 25 employees from 2018 to 2020. Collecting data instruments were 2 checklists with 15 and 25 three-point Likert scale questions, respectively. Chi square and Monte Carlo tests assessed the relationships between independent risk factors and dependent hazardous chemical accidents. Cox semi-parametric and log-normal parametric models were used to predict the upcoming time of chemical accidents based on the impacts of risk factors understudy. Data analyses were performed using Stata and R software. RESULTS: The results showed that safety data sheets, labeling, fire extinguishing system, safe chemicals storage, separation, loading, transportation and training were statistically significant with occurrences of the chemical accidents (P-value < 0.05). Loading and transportation were mostly related to chemical incidents and reduced significantly the expected time of chemical events (P-value = 0.028). CONCLUSION: Establishing a comprehensive chemical accidents dataset and strict governmental supervision on chemical safety regulations are suggested to decrease the chemical accidents at regional and local levels in chemical plants.

Impact of social and cultural factors on incidence, transmission and control of Coronavirus disease in Iran: a qualitative study.

INTRODUCTION: COVID-19 pandemic has had mixed reactions from nations, people and governments about ways to cope with, prevent and control the disease. The current study identifies social, cultural and policy factors affecting the incidence and control of Coronavirus disease in Iran. METHODS: A qualitative study consists of content analysis as well as the views of 20 experienced and knowledgeable subjects specialized in social and cultural health management. The data were gathered using three semi-structured interviews and then continued by 17 semi-structured interviews. Data analysis was done using Graneheim approach. After each interview, the recorded audio files transcript and reviewed. Then codes extracted and divided to categories and sub-categories. RESULTS: There are distinct social and cultural factors in coping with Coronavirus disease. These consisted of three categories of governance, individual and community related factors. A total of 17 subcategories and 215 primary codes that were extracted from the text of interviews as variables of the study and in relation to the research question. Ten subdomains of governance including vaccination, political issues, knowledge, support services, administrative services, transportation, health and treatment, culturalization, legislation and, managerial and financial policies impacted the spread and mitigation of the pandemic at various levels. CONCLUSION: The management of pandemics requires a comprehensive capacity for identifying and determining social and cultural criteria. A healthy partnership between governments and the community may be required to remove unnecessary obstacles that hinder public health attempt to alleviate the risk. The obtained criteria and indicators from this study may be utilized by policy makers in an attempt to strengthen protocols for mitigating pandemics. Further studies may be warranted to confirm these findings.

Impacts of climate change on occupational health indicators in the three climatic regions of Iran.

Climate change has increased the exposure risk of workers to occupational health risk factors and diseases. This study aims to investigate the impacts of climate change on the occupational health indicators at the workplaces in Iran. This study was conducted during 2021 in three climatic regions of Iran. Required data was collected from Health Deputies of Medical Universities and Iran Meteorological Organization. Stepwise linear regression model used for data analysis and predictions were done based on three scenarios of SSP1-2.6, SSP3-7.0, and SSP5-8.5 during the period of 2021-2100. This indicated 2.6 and 2.9 times higher percentage of workers who were exposed to heat stress and Ultra Violet (UV) radiation, respectively, in the provinces understudy. This study suggests a holistic approach to address potential impacts of climate change on workers' health and safety that would benefit in making decisions on climate-related planning and developing the adaptation strategies at workplaces.

Working conditions and stressors data during Covid-19 and mental well-being in Iranian healthcare workers.

The current Covid-19 pandemic has affected the physical and mental stressors of hospital-based healthcare workers, but the extent of such effects are required to be quantified. This survey looked at data on nurses' perception across teaching hospitals to assess the impacts of Covid-19 on working conditions, exposure to stressors, and mental health symptoms. We implemented a population survey with a cross-sectional design in teaching hospitals affiliated with Medical Sciences Universities in Iran from April to November 2021. Participants were about 1200 health care workers, including hospital nursing staff, assistants, and technicians. Final data were assembled from 831 hospital nurses across surgery, dialysis, intensive care, emergency care, cardiac care, internal medicine, gynecology, and pediatric wards. Self-reported data were collected directly from survey participants. We collected information on variables including gender, marital status, employment status, occupational health training, evaluation of work environment stressors, fear of Covid-19, and occupational burnout constructs, specifically reflecting emotional exhaustion, depersonalization, and personal accomplishment. Focus groups of faculties evaluated and edited items to test the content wording and to define the content that are valid measures of the variables. The questionnaires were assessed for their reliability. Manual data entries were double-checked for errors. Data were recorded and categorized consistently to ensure the replicability of the data in the future. Statistical descriptive and analytical analyses were performed on the data. Data reported on the frequencies and mean values of responses and the variations of mental health in terms of worktime schedules. Chi- square, ANOVA, and correlation analyses determined relations between variables. The compiled data shed light on the exposure and response to physical and psychosocial factors and mental health symptoms among nurses during the pandemic. The data files detailed in this article can be further reused to inform workplace determinants of health in hospital settings. The obtained scores and existing dataset on mental health outcomes can help future studies to consider resilience strategies that should be provided among nurses.

Implementation of Chemical Health, Safety, and Environmental Risk Assessment in Laboratories: A Case-Series Study.

Introduction: Characterizing risks associated with laboratory activities in universities may improve health, safety, and environmental management and reduce work-related diseases and accidents. This study aimed to develop and implement a chemical risk assessment method to determine and prioritize more hazardous chemicals in the academic laboratories. Methods: A case-series study was conducted at five academic laboratories and research facilities of an Iranian medical sciences university in 2021. A risk assessment was developed and implemented in three phases to identify, evaluate, and classify potential risks and hazards. The approach provided an innovative tool for evaluating and prioritizing risks in chemical laboratories. Hazards were classified on a five-level scale. The technique reviewed both quantitative and qualitative data and pieces of evidence using Laboratory Safety Guidance (OSHA), Occupational Hazard Datasheet (ILO), the standards of the American Conference of Governmental Industrial Hygienists (ACGIH), International Agency for Research on Cancer (IARC), and National Fire Protection Agency (NFPA) codes. Results: Overall, the frequency of risks rated from "moderate" to "very high" levels was determined for the health hazards (9.3%), environmental hazards (35.2%), and safety hazards (20.4%). Hydrochloric acid had a high consumption rate in laboratory operations and received the highest risk levels in terms of potential hazards to employees' health and the environment. Nitric acid, Sulfuric acid, Formaldehyde, and Sodium hydroxide were assessed as potential health hazards. Moreover, Ethanol and Sulfuric acid were recognized as safety hazards. We observed adequate security provisions and procedures in academic laboratory operations. However, the lack of awareness concerning health, safety, environmental chemical hazards, and inappropriate sewage disposal systems contributed to the increasing levels of laboratory risk. Conclusions: Chemicals used in laboratory activities generate workplace and environmental hazards that must be assessed, managed, and risk mitigated. Developing a method of rating health, safety, and environmental risks related to laboratory chemicals may assist in defining and understanding potential hazards. Our assessment suggested the need for improving the risk perception of individuals involved in handling chemicals to prevent exposure from workplace duties and environmental pollution hazards.

Occupational Burnout Symptoms and Its Relationship With Workload and Fear of the SARS-CoV-2 Pandemic Among Hospital Nurses.

Introduction: The pandemic has intensified physical and psychological work demands experienced by nurses in a hospital environment. The purpose of this study was to examine personal and work environmental risk factors associated with occupational burnout among hospital nurses. Methods: We conducted a cross-sectional from April to November 2020. Data from 831 nurses who worked professionally in four educational hospitals were compiled through survey questionnaires to report the prevalence of burnout, occupational and individual factors. Independent t-test and Mann-Whitney test measured the link between the scopes of occupational burnout and risk factors. Results: About half of the participants indicated moderate symptoms of burnout. The fear of the nurses correlated significantly with emotional exhaustion (r = 0.71, p = 0.001), depersonalization (r = 0.67, p = 0.02), and personal accomplishment (r = 0.63, p = 0.05). Mental demand (r = 0.74, p = 0.01) and effort at work (r = 0.68, 0.001) correlated significantly with emotional exhaustion (r = 0.51, p = 0.03). Conclusion: The findings indicated a high prevalence of burnout symptoms, particularly emotional exhaustion, among hospital nursing professionals. Occupational health services should consider burnout as an occupational-related condition and provide interventions to reduce workplace chronic stressors and burnout in hospitals.

Challenges and Barriers of Humanitarian Hygiene Items Management in Recent Disasters in Iran.

OBJECTIVE: The provision and continuation of the basic needs of affected communities, including water, food, and shelter remain the most important priorities in responding to disasters. In this regard, this study sought to investigate the management challenges of humanitarian hygiene items in recent disasters in Iran. METHODS: This qualitative study was conducted through a semi-structured interview. Nineteen participants with different experiences, roles, and responsibilities in the recent disaster of Iran and experiences of various events in the national and international arenas were included in the study. A thematic analysis was used, and an initial conceptual framework was defined based on the study aim. The relationship between the components was compared and interpreted in this framework and the main and subthemes were extracted accordingly. RESULTS: Six main themes and 21 subthemes were extracted based on the results. The main challenges in recent disasters were the lack of protocols and standard guidelines, inappropriate selection of items in each hygiene kit, the lack of standard distribution of hygiene kits, and the lack of attention to the affected population's culture. CONCLUSIONS: Overall, it is necessary to define a system for preparation, supply, storage, and timely distribution of hygiene. Finally, it is suggested that an organization should be appointed for this purpose.

Social vulnerability indicators in pandemics focusing on COVID-19: A systematic literature review.

INTRODUCTION: Social factors can affect the vulnerability of disaster-prone communities. This review aimed to identify and categorize social vulnerability indicators in the COVID-19 pandemic. METHODS: This systematic review was conducted in February 2021. Bibliographies, citation databases, and other available records were investigated based on the aim of the study. The Joanna Briggs Institute (JBI) critical appraisal tools were applied for assessing the included articles retrieved through the comprehensive and systematic literature search. Descriptive and thematic analyses were done to extract the indicators affecting social vulnerability in the COVID-19 pandemic. RESULTS: Thirty-one eligible articles were included and 85 indicators of social vulnerability were extracted. The indicators were categorized in seven main categories, including; Household, community composition; Race, minority status and language; Socioeconomic status; Community health status; Public health infra-structures; Education; Information, technology and communication. CONCLUSION: Regions with higher social vulnerability experienced greater mortality rates during the COVID-19 pandemic. Additional research is needed to measure the social vulnerability index in pandemics to prioritize distribution of scarce resources and ensure effectiveness and equity for all regions of countries.

Assessing the Preparedness of Healthcare Facilities for Disasters and Emergencies in Damghan, Iran.

OBJECTIVES: Iran is exposed to a wide range of natural and man-made hazards. Health-care facilities can play a significant role in providing life-saving measures in the minutes and hours immediately following the impact or exposure. The aim of this study was to determine the preparedness of health-care facilities in disasters and emergencies. METHODS: This cross-sectional study was conducted in Damghan, Semnan Province, in 2019. The samples consisted of all the 11 health-care facilities located in Damghan County. A developed checklist was used to collect the data, including 272 questions in 4 sections: understanding threatening hazards, functional, structural, and nonstructural vulnerability of health-care facilities. The data were analyzed using SPSS 21. RESULTS: The results revealed that the health-care facilities were exposed to 22 different natural and man-made hazards throughout the county. The total level of preparedness of the health-care centers under assessment was 45.8%. The average functional, structural, and nonstructural vulnerability was assessed at 49.3%, 31.6%, and 56.4%, respectively. CONCLUSIONS: Conducting mitigation measures is necessary for promoting the functional and structural preparedness. Disaster educational programs and exercises are recommended among the health staff in health-care facilities.

Challenges of Reproductive Health Management in the Camps of Internally Displaced Persons: A Systematic Review.

BACKGROUND: Internally Displaced Persons (IDPs) in the camps face many reproductive health challenges. They should meet their needs timely to save their lives. This paper outlines a systematic review to discuss the challenges of reproductive health management in the camps of internally displaced persons. METHODS: For this research, electronic databases including PubMed, Science Direct, Scopus, Pro Quest, Google Scholar and Cochrane Library till January 1, 2020 were searched. A threestage screening process was used for the selection of literature due to PRISMA checklist. Finally, a thematic synthesis approach was applied to analyze the data. RESULTS: In total, 133 articles were identified; 11 articles met the inclusion criteria for entering the process of final analysis. The findings were demonstrated in six main categories of availability and accessibility of reproductive health services, sexual and gender-based issues, human rights, social and cultural issues, coordination and collaboration, and mental health issues. The remarkable result of this study highlighted that the main challenges are lack of access to health services, violence against women and lack of household education. CONCLUSION: Results of this systematic review present valuable advice for policy makers and managers to prepare and respond effectively and timely to reproductive health challenges of internally displaces persons. Disaster preparedness plans and contingency plans for maintaining and developing reproductive health in IDPs camps are recommended.

Disaster safety assessment of primary healthcare facilities: a cross-sectional study in Kurdistan province of Iran.

BACKGROUND: Kurdistan province of Iran is among disaster prone areas of the country. The Primary Health Care facilities in Iran deliver health services at all levels nationwide. Resiliency and flexibility of such facilities is important when a disaster occurs. Thus, evaluating functional, structural, and non-structural aspects of safety of such facilities is essential. METHODS: In this cross-sectional study, the instrument used to evaluate four sections of functional, structural, non-structural, and total safety of 805 healthcare facilities in Kurdistan Province was the safety evaluation checklist of primary healthcare centers, provided by the Iranian Ministry of Health and Medical Education. Each section scored from 0 to 100 points, and each section of the safety was classified to three safety classes according to their total score: low (≤34.0), average (34.01-66.0) and high (> 66.0). RESULTS: The levels of functional, structural, non-structural and total safety were equal to 23.8, 20.2, 42.3 and 28.7, out of 100, respectively. Regarding the functional safety, rapid response team scored the highest, while financial affairs scored the lowest. Nevertheless, in structural and non-structural sections, the scores of different items were almost similar. CONCLUSIONS: The results of the study revealed that safety score of primary healthcare facilities in general was unsatisfactory. Thus, promoting preparedness, resilience and continuity of service delivery of these facilities are essential to response to disasters and emergencies. The finding of this study could be beneficial for national and provincial decision-makers and policymakers in this regard.

Emergency food aid challenges in natural and man-made disasters: A systematic review.

BACKGROUND: Emergency food aid is the most essential response of the international community to natural disasters and complex emergencies. The humanitarian aid organizations sometimes have been encountered with different challenges during the feeding process to target groups. OBJECTIVE: The aim of this article is to review the food aid challenges in receiving countries of humanitarian food assistance during disasters and emergencies. METHODS: This systematic review was conducted in August 2019, and the search was limited to published evidence before July 1, 2019. Through this systematic review, the international electronic databases such as PubMed, Web of Science, Scopus, ProQuest, and Google Scholar were investigated for the studies published in English. The articles were assessed based on title, abstract, and full text by Joanna Briggs Institute critical appraisal tools. Then, descriptive and thematic analyses were done to extract the most relevant food challenges in recipient countries of humanitarian food assistance. RESULTS: A total of 179 studies were found. Of which, 34 and 118 were excluded because of duplication and quality appraisal, respectively. Finally, 27 eligible articles and reports were included in this study, and 30 main challenges were determined during the international humanitarian food assistance in receiving countries. The challenges were categorized in seven main category of availability (two subcategories), access (six subcategories), utilization (three subcategories), coordination and collaboration (eight subcategories), political and legal issues (three subcategories), monitoring and assessment (six subcategories), and human rights (two subcategories). CONCLUSION: The most repeated challenges were related to access and monitoring. Most of the extracted food aid challenges allocated to time after occurring the disasters. Regarding to the result of this study, further research should be conducted to suggest the practical approaches for solving the mentioned challenges and increase the effectiveness of such aids.

Data of risk analysis management in university campuses.

OBJECTIVES: This data paper aims to provide the data set of a practical method to health, safety, and environmental risk assessment to assess and rank potential threats/hazards and to prevent and decrease the accidents and harmful consequences at an academic setting. Descriptive data on type of hazards, places, and persons at risk were collected. Quantitative data on risk probability and severity of identified hazards were determined. Additionally, the descriptive statistics and analytical tests were applied to create a concise perspective on health, safety and environmental hazards/threats situation in research location under study. The dataset further provides information on the prioritization of determined risks according to the relevant scores and levels for doing the relevant control measures to remove and mitigate the related risks. DATA DESCRIPTION: This paper provides data of comprehensive risk assessment of health, safety and, environmental hazards of academic setting. For each identified hazard, the descriptive and numeric data are available. The information about the risk level and prevention or mitigation measure related to each hazard is provided. Additionally, the statistical tests are applied for determining the relations among the variables under study. The data and methodology on risk assessment in this article may be used to manage variety of risks in higher education institutions.

Applying health, safety, and environmental risk assessment at academic settings.

BACKGROUND: Students, staff, and faculties are involved in activities that exposed them to a range of minor to severe or even fatal accidents in academic settings. Managing work environment risks is crucial to any safety and health prevention program. This study developed a risk assessment using combinations of hazards and risk factors to establish a scale of measures in a risk reduction action plan. METHODS: This cross-sectional study was conducted in an Iranian medical sciences university in 2018. A structured method of risk assessment was developed, applying a three-step procedure to identify hazards, consequences, and risk evaluation. Data were collected through detailed health, safety, and environment checklist in 38 different sites. Finally, the risks quantified, prioritized, and control measures proposed accordingly. Chi-square and correlation tests assessed how environmental factors were associated with hazard consequences. The analysis results were evaluated at the significance level of 0.05. RESULTS: The frequencies of moderate and high-risk levels were 22.7 and 2.9%, respectively. Thus, corrective measures should be considered as soon as possible and immediately for these risk groups. Facilities and functions within laboratories, library, and powerhouse were more vulnerable to serious risks. The type of hazard had associated with the sites and total risk score at the significance level of 0.05 (P-value = 0.017). Similarly, risk severity was significantly related to the sites (P-value = 0.003). Safety hazards had a statistically higher contribution to the total risk score when compared to health and environmental hazards. CONCLUSION: The study revealed complex risks and hazardous circumstances with significant variances in academic sites and activities. Universities should provide training in risk reduction programs to increase the awareness of students, staff, and faculties, which can improve life safety in a university environment.

Towards developing a model for the evaluation of hospital disaster resilience: a systematic review.

BACKGROUND: Hospitals play a vital role in disaster stricken regions. The resilient hospitals will be able to provide essential services to affected people and it can mitigate the risk of injuries during and after disasters. This study aimed to obtain the indicators required for the evaluation of hospital resilience. METHODS: This systematic review was conducted in 2018. Through this systematic review, international electronic databases were investigated for the research studies published in English. The exclusion and inclusion criteria were determined to extract the hospital resilience indicators. These indicators will be used in order to develop a model to keep the system performance at an acceptable level during disasters. RESULTS: Out of 1794 research studies published until September 2018, 89 articles and guidelines with full text were surveyed. Thirty-two articles and guidelines were then selected and analyzed to collect the indicators related to hospital disaster resilience (HDR). The domains and the indicators were extracted from these selected research studies. The authors collected and categorized them into three domains and twenty seven subdomains. The three domains included constructive, infrastructural, and administrative resilience. The relevant indicators were designed for each subdomain to assess HDR. CONCLUSION: Since diverse indicators affect hospital resilience, other studies should be conducted to propose some models or tools to quantify the hospital resilience in different countries and scopes with an all hazards approach.