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Resilient organizations contribute significantly to resilient communities. However, the task of building more resilient organizations is complicated by an inability to translate the concept of resilience into tangible working constructs for organizations. In addition, resilience is often considered to be a crisis or emergency management issue. The link between creating resilient day-today operations and having a resilient crisis response and recovery is typically not well understood by organizations. Resilience for organizations is found to have three principal attributes. Situation awareness, management of keystone vulnerabilities, and adaptive capacity. A facilitated process is introduced that assists organizations to enhance their performance in relation to these attributes. This process is called resilience management and was developed and tested with 10 case study organizations selected specifically to represent a wide range of industry sectors, business types, and sizes in New Zealand. Some of the preliminary resilience issues to arise from this study are also briefly discussed.

Background Evaluation of indeterminate biliary strictures typically involves collection and analysis of tissue or cells. Brush cytology and intraductal biopsies that are routinely performed during ERCP to assess malignant-appearing biliary strictures are limited by relatively low sensitivity. Objective To study the comparative effectiveness of brushings for cytology and intraductal biopsies in the etiology of biliary strictures. Design Meta-analysis. Setting Referral center. Patients PUBMED and Embase databases were reviewed for studies published to April 2014 where diagnostic correlation of histology was available. Intervention Database and review of study findings. Main Outcome Measurements Sensitivity and specificity. Results The pooled sensitivity and specificity of brushings for the diagnosis of malignant biliary strictures was 45% (95% confidence interval [CI], 40%–50%) and 99% (95% CI, 98%–100%), respectively. The pooled diagnostic odds ratio to detect malignant biliary strictures was 33.43 (95% CI, 14.29–78.24). For intraductal biopsies, the pooled sensitivity and specificity were 48.1% (95% CI, 42.8%–53.4%) and 99.2% (95% CI, 97.6%–99.8%), respectively. The pooled diagnostic odds ratio to detect malignant biliary strictures was 43.18 (95% CI, 19.39–95.83). A combination of both modalities only modestly increased the sensitivity (59.4%; 95% CI, 53.7%–64.8%) with a specificity of 100% (95% CI, 98.8%–100.0%). The Begg-Mazumdar and Egger tests indicated a low potential for publication bias. Limitations Inclusion of low-quality studies. Conclusion Our study suggests that both brushings and biopsy are comparable and have limited sensitivity for the diagnosis of malignant biliary strictures. A combination of both only modestly increases the sensitivity.

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