Securing circulation pharmaceutically: antiviral stockpiling and pandemic preparedness in the European Union

Governments in Europe and around the world amassed vast pharmaceutical stockpiles in anticipation of a potentially catastrophic influenza pandemic. Yet the comparatively ‘mild’ course of the 2009 H1N1 pandemic provoked considerable public controversy around those stockpiles, leading to questions about their cost–benefit profile and the commercial interests allegedly shaping their creation, as well as around their scientific evidence base. So, how did governments come to view pharmaceutical stockpiling as such an indispensable element of pandemic preparedness planning? What are the underlying security rationalities that rapidly rendered antivirals such a desirable option for government planners? Drawing upon an in-depth reading of Foucault’s notion of a ‘crisis of circulation’, this article argues that the rise of pharmaceutical stockpiling across Europe is integral to a governmental rationality of political rule that continuously seeks to anticipate myriad circulatory threats to the welfare of populations – including to their overall levels of health. Novel antiviral medications such as Tamiflu are such an attractive policy option because they could enable governments to rapidly modulate dangerous levels of (viral) circulation during a pandemic, albeit without disrupting all the other circulatory systems crucial for maintaining population welfare. Antiviral stockpiles, in other words, promise nothing less than a pharmaceutical securing of circulation itself

Antecedents and Consequences of Outward Emotional Reactions in Table Tennis

The purpose of the present study was to shed light on the behavioral component of emotions by investigating antecedents and consequences of outward emotional reactions during table tennis competitions. With regards to the antecedents of outward emotional reactions, in line with appraisal theories, we considered the importance and the controllability of the situation as two important constructs. Fifteen table tennis matches, involving in total 21 players (7 females) with a mean age of 16.71 (SD = 0.70), were video recorded during the finals of the youth National Championship in Greece. Based on the footage, outward emotional reactions after every point were classified as neutral, positive, or negative. Situational factors in relation to the scoring system, bearing the importance and the controllability of the situation, were formed to assess antecedents of outward emotional reactions. To measure the consequences of outward emotional reactions, the impact on the outcome of the next point was assessed. Generalized linear models with a logit link were computed separately for positive outward emotional reactions after having won a point and negative outward emotional reactions after having lost a point. In general, the results show that while situational factors bearing the importance of the situation could predict positive and negative outward emotional reactions, the effects of situational factors bearing the controllability of the situation were less conclusive. In addition, the results also showed interactive effects between the two constructs for both positive and negative outward emotional reactions. With regard to the consequences of outward emotional reactions, negative and positive outward emotional reactions could not predict the outcome of the next point. To conclude, this study highlights the behavioral component of emotions as a viable alternative to enhance our understanding of the role of emotions in sport

Development and characterization of a tamoxifen-resistant breast carcinoma xenograft

A human tamoxifen-resistant mammary carcinoma, MaCa 3366/TAM, originating from a sensitive parental xenograft 3366 was successfully established by treatment of tumour-bearing nude mice with 1–50 mg kg−1tamoxifen for 3 years during routine passaging. Both tumours did not differ significantly in OR- and PR-positivity, however, when compared with the sensitive tumour line, the mean OR content of the TAM-resistant subline is slightly lower. An OR-upregulation following withdrawal of oestradiol treatment was observed in the parental tumours but not in the resistant xenografts. Following long-term treatment with tamoxifen, the histological pattern of the breast carcinoma changed. The more differentiated structures being apparent after treatment with 17β-oestradiol in the original 3366 tumour were not induced in the resistant line. Tamoxifen failed to induce a tumour growth inhibition in comparison to the tamoxifen-sensitive line. The pure anti-oestrogen, ICI 182 780, revealed cross-resistance. Sequence analysis of the hormone-binding domain of the OR of both lines showed no differences, suggesting that either mutations in other regions of the OR are involved in the TAM-resistance phenotype or that mechanisms outside of this protein induced this phenotype. Oestrogen and anti-oestrogen regulate pS2 and cathepsin D expression in 3366 tumours as in the human breast cancer cell line MCF-7. The resistant 3366/TAM tumours have lost this regulation. The established breast cancer xenografts 3366 and 3366/TAM offer the possibility of investigating mechanisms of anti-oestrogen resistance in an in vivo situation. They can be used to test novel approaches to prevent, or to overcome, this resistance in a clinically related manner. © 2000 Cancer Research Campaig

Catching the flu: Syndromic surveillance, algorithmic governmentality and global health security

How do algorithms shape the imaginary and practice of security? Does their proliferation point to a shift in the political rationality of security? If so, what is the nature and extent of that shift? This article explores these questions in relation to global health security. Prompted by an epidemic of new infectious disease outbreaks – from HIV, SARS and pandemic flu, through to MERS and Ebola – many governments are making health security an integral part of their national security strategies. Algorithms are central to these developments because they underpin a number of nextgeneration syndromic surveillance systems now routinely used by governments and international organizations to rapidly detect new outbreaks globally. This article traces the origins, design and evolution of three such internet-based surveillance systems: 1) the Program for Monitoring Emerging Diseases, 2) the Global Public Health Intelligence Network, and 3) HealthMap. The article shows how the successive introduction of those three syndromic surveillance systems has propelled algorithmic technologies into the heart of global outbreak detection. This growing recourse to algorithms for the purposes of strengthening global health security, the article argues, signals a significant shift in the underlying problem, nature, and role of knowledge in contemporary security practices

The race for Ebola drugs: pharmaceuticals, security and global health governance

The international Ebola response mirrors two broader trends in global health governance: (1) the framing of infectious disease outbreaks as a security threat; and (2) a tendency to respond by providing medicines and vaccines. This article identifies three mechanisms that interlink these trends. First, securitisation encourages technological policy responses. Second, it creates an exceptional political space in which pharmaceutical development can be freed from constraints. Third, it creates an institutional architecture that facilitates pharmaceutical policy responses. The ways in which the securitisation of health reinforces pharmaceutical policy strategies must, the article concludes, be included in ongoing efforts to evaluate them normatively and politically

The Political Economy of Non-Traditional Security: Explaining the Governance of Avian Influenza in Indonesia

Given the common association of non-traditional security (NTS) problems with globalisation, surprisingly little attention has been paid to how the political economy context of given NTS issues shape how they are securitised and managed in practice. We argue that security and its governance are always highly contested because different modes of security governance invariably privilege particular interests and normative agendas in state and society, which relate directly to the political economy. Drawing on critical political geography, we argue that, because NTS issues are perceived as at least potentially transnational, their securitisation often involves strategic attempts by actors and coalitions to ‘rescale’ their governance beyond the national political and institutional arenas, into new, expert-dominated modes of governance. Such efforts are often resisted by other coalitions, for which this rescaling is deleterious. As evidenced by a case study of avian influenza in Indonesia, particular governance outcomes depend upon the nature of the coalitions assembled for and against rescaling in specific situations, while these coalitions’ make-up and relative strength is shaped by the political economy of the industries that rescaling would affect, viewed against the broader backdrop of state-society relations

Genomic epidemiology reveals transmission patterns and dynamics of SARS-CoV-2 in Aotearoa New Zealand

New Zealand, a geographically remote Pacific island with easily sealable borders, implemented a nationwide 'lockdown' of all non-essential services to curb the spread of COVID-19. Here, we generate 649 SARS-CoV-2 genome sequences from infected patients in New Zealand with samples collected during the 'first wave', representing 56% of all confirmed cases in this time period. Despite its remoteness, the viruses imported into New Zealand represented nearly all of the genomic diversity sequenced from the global virus population. These data helped to quantify the effectiveness of public health interventions. For example, the effective reproductive number, Re of New Zealand's largest cluster decreased from 7 to 0.2 within the first week of lockdown. Similarly, only 19% of virus introductions into New Zealand resulted in ongoing transmission of more than one additional case. Overall, these results demonstrate the utility of genomic pathogen surveillance to inform public health and disease mitigation

Endoscopic management of enteral tubes in adult patients - Part 1: definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) guideline

Main recommendationsCellular mechanisms in basic and clinical gastroenterology and hepatolog