A Rapid Segmentation-Insensitive "Digital Biopsy" Method for Radiomic Feature Extraction: Method and Pilot Study Using CT Images of Non-Small Cell Lung Cancer.

Quantitative imaging approaches compute features within images' regions of interest. Segmentation is rarely completely automatic, requiring time-consuming editing by experts. We propose a new paradigm, called "digital biopsy," that allows for the collection of intensity- and texture-based features from these regions at least 1 order of magnitude faster than the current manual or semiautomated methods. A radiologist reviewed automated segmentations of lung nodules from 100 preoperative volume computed tomography scans of patients with non-small cell lung cancer, and manually adjusted the nodule boundaries in each section, to be used as a reference standard, requiring up to 45 minutes per nodule. We also asked a different expert to generate a digital biopsy for each patient using a paintbrush tool to paint a contiguous region of each tumor over multiple cross-sections, a procedure that required an average of <3 minutes per nodule. We simulated additional digital biopsies using morphological procedures. Finally, we compared the features extracted from these digital biopsies with our reference standard using intraclass correlation coefficient (ICC) to characterize robustness. Comparing the reference standard segmentations to our digital biopsies, we found that 84/94 features had an ICC >0.7; comparing erosions and dilations, using a sphere of 1.5-mm radius, of our digital biopsies to the reference standard segmentations resulted in 41/94 and 53/94 features, respectively, with ICCs >0.7. We conclude that many intensity- and texture-based features remain consistent between the reference standard and our method while substantially reducing the amount of operator time required

What makes an acute emergency? Temporal manifestation patterns and global health emergencies

In this article, we consider the role that onset patterns play in shaping how acute global events are taken to be, drawing on illustrative cases from the field of global health emergencies. We identify four temporal manifestation patterns that we argue display distinct political dynamics. First, an emergent onset pattern (e.g. the H1N1 health emergency), with political dynamics dominated by novelty-induced uncertainty and lack of information as well as familiar analogies. Second, an anticipatory onset pattern (e.g. the risk of a global avian flu health emergency), with a political dynamic characterised by dread of an as-of-yet unrealised high-consequence risk. Third, a cyclical onset pattern (e.g. Ebola), with a political dynamic characterised by a sense of familiarity and expectedness, unless eventual ‘unexpected’ or ‘unprecedented’ aspects manifest themselves. Lastly, a perpetual onset pattern (e.g. antimicrobial resistance), with political dynamics characterised by incrementalism and low political salience. We argue that acuteness is often associated with a departure from expected manifestation patterns, such as an escalation or other traits that make events appear unfamiliar. Whilst drawing on global health emergences in this paper, the four categories theorised here may also be used on a range of other adversities at the global or local level

Expert-Led Securitization:The Case of the 2009 Pandemic in Denmark and Sweden

This article goes beyond the study of speech acts to investigate the process of securitization during a health crisis. The article introduces the concept of ‘expert-led securitization’ to account for situations when experts dominate the administrative process that translates a securitizing speech act into extraordinary public policy. Expert-led securitization was particularly salient during the 2009 pandemic flu in Denmark and Sweden. Autonomous public health expert agencies led the national securitization processes, and these never included intense political battles or extensive public debates. In turn, the respective processes resulted in different policies: Sweden’s main response to the pandemic was an extraordinary push to vaccinate its whole population, while Denmark’s was a one-off offer of vaccination to about twenty percent of its people. Hence, the 2009 pandemic example illustrates the added value of investigating the administrative dynamics of securitization when seeking to understand differences in extraordinary policies

Policy termination made easy?:The emerging trend towards sunsetting antimicrobial resistance national action plans

While policy termination is usually more difficult than continuity in domestic policymaking, the international process for addressing antimicrobial resistance (AMR) shows that sustaining commitments can be the more difficult path. Addressing persistent crises requires persistent policy responses across multiple countries. Policy coordination among many countries has gained significant scholarly attention whereas analyses of continuing, longer-term commitments of many countries to crisis response are less common. This paper remedies this shortfall by analysing the commitments of different countries to the international policy process against AMR. It triangulates novel evidence in the form of distinct indicators based on global surveys, content analysis of national action plans (NAPs), and publication patterns of second-generation NAPs. The findings suggest that national commitments to the international process initially reached high levels but are now in decline. Countries are effectively ‘sunsetting’ their NAPs, and thereby ending commitments to the international process for addressing AMR. Many have refrained from renewing their NAPs, and those that do renew rarely show signs of learning or adaptation from previous NAPs. Hence, even in the AMR case, where a global and persistent threat rose high on the international political agenda, long-term commitment to the international response policy process is by no means assured

Challenges Associated with Creeping Disasters in Disaster Risk Science and Practice: Considering Disaster Onset Dynamics

In this article, we set out to reconcile a general conceptualization of disaster temporalities by drawing on the epitome example of a creeping disaster, namely famine. Our argument is driven by the recognition that slowly manifesting disaster impacts pose distinct challenges for decision makers and researchers while there is a tendency for the disaster literature to overlook the role of disaster onset dynamics. More specifically and as a starting point, we identify four key themes that merit particular attention when dealing with creeping disasters: (1) our understanding of disaster as a phenomenon; (2) measurement and operationalization; (3) early warning and response; and (4) disaster management and termination. By integrating conceptual discussions of disaster with famine scholarship—a phenomenon often excluded from mainstream disaster research—this article provides fresh perspectives on disaster science as well as a number of implications for how we think about disaster risk reduction.publishedVersio

Living through and with the global HIV/AIDS pandemic:Distinct ‘pandemic practices’ and temporalities

In this study, we expand on the newly devised sociological concept of pandemic practices that emerged during the COVID-19 outbreak by applying it to the HIV/AIDS pandemic. The analytical heuristic of pandemic practices distinguishes between four kinds of practices: (i) primary practices that encompass the public's direct response to the pandemic, (ii) responsive practices that encompass altered routines and social interactions, (iii) adaptive practices that encompass more elusive organisational and legal legacies and (iv) meta-practices that produce particular narratives about the pandemic dynamics that might lead to lasting socio-cultural behavioural changes. In this paper we probe further into the notion of meta-practices. The results show that the prolonged nature of the HIV/AIDS pandemic combined with the widespread stigmatisation of vulnerable groups has led to distinct social practices that fragment along socio-economic lines both internally in countries but also between high-income and low-income countries. As the COVID-19 pandemic becomes increasingly endemic, lessons learned from HIV/AIDS expose the dangers of similar fragmentations where parts of the population return to normal but where many others continue to suffer not only from adverse health outcomes but also social exclusion and stigmatisation. Thus, we argue that attention to pandemic practices, and how they produce and reinforce underlying socio-economic vulnerabilities would strengthen long-term pandemic responses

A media visibility analysis of public leadership in Scandinavian responses to pandemics

This paper analyses public leadership in Scandinavia during thelatest two pandemics, the swine flu pandemic in 2009 and thecoronavirus pandemic in 2020, by compiling and contrastingnational proxies of media visibility among pandemic responseactors. Concretely, the paper taps into key media databases todevelop indicators of how often national leaders and leadinghealth experts are mentioned in Danish, Norwegian, and Swedishmedia reports about the 2009 and 2020 pandemics.The study reveals a high degree of continuity of public leadershipin Sweden during the two pandemics. In contrast, Norway and inparticular Denmark both moved from a predominately expertdriven media presence in 2009 to a much stronger top-downministerial leadership presence during the 2020 coronavirus pandemic. In addition, Sweden also displays the most balancedmedia representation of health experts and cabinet ministers during both pandemics. The paper concludes by discussing the prosand cons of the outlined differences in public leadership and thepossible practical implications with regards public debateand trust.Expert Government Agencies' contribution to public deliberation: balancing the need for expertise with political equalit