Sentinel surveillance for enterovirus 71, Taiwan, 1998.

Outbreaks of enterovirus 71 have been reported around the world since 1969. The most recent outbreak occurred in Taiwan during April-July 1998. This hand, foot, and mouth disease epidemic was detected by a sentinel surveillance system in April at the beginning of the outbreak, and the public was alerted

The capacities of institutions for the integration of ecosystem services in coastal strategic planning: The case of Jiaozhou Bay

This paper explains how the practice of integrating ecosystem-service thinking (i.e., ecological benefits for human beings) and institutions (i.e., organisations, policy rules) is essential for coastal spatial planning. Adopting an integrated perspective on ecosystem services (ESs) both helps understand a wide range of possible services and, at the same time, attune institution to local resource patterns. The objective of this paper is to identify the extent to which ESs are integrated in a specific coastal strategic planning case. A subsequent objective is to understand whether institutions are capable of managing ESs in terms of uncovering institutional strengths and weaknesses that may exist in taking ESs into account in existing institutional practices. These two questions are addressed through the application of a content analysis method and a multi-level analysis framework on formal institutions. Jiaozhou Bay in China is used as an illustrative case. The results show that some ESs have been implicitly acknowledged, but by no means the whole range. This partial ES implementation could result from any of four institutional weaknesses in the strategic plans of Jiaozhou Bay, namely a dominant market oriented interest, fragmented institutional structures for managing ESs, limited ES assessment, and a lack of integrated reflection of the social value of ESs in decision-making. Finally, generalizations of multi-level institutional settings on ES integration, such as an inter-organisational fragmentation and a limited use of ES assessment in operation, are made together with other international case studies. Meanwhile, the comparison highlights the influences of extensive market-oriented incentives and governments' exclusive responsibilities on ES governance in the Chinese context

Dietary modification for women after breast cancer treatment: a narrative review

Diet is thought to account for about 25% of cancers in developed countries. It is well documented that the risks associated with both the breast cancer itself and its treatments are important for women previously treated for breast cancer. Women are at risk of recurrence of the primary disease and prone to develop treatment-induced co-morbidities, some of which are thought to be modified by diet. With a view to making dietary recommendations for the breast cancer patients we encounter in our clinical nursing research, we mined the literature to scope the most current robust evidence concerning the role of the diet in protecting women against the recurrence of breast cancer and its potential to ameliorate some of the longer-term morbidities associated with the disease. We found that the evidence about the role of the diet in breast cancer recurrence is largely inconclusive. However, drawing on international guidelines enabled us to make three definitive recommendations. Women at risk of breast cancer recurrence, or who experience co-morbidities as a result of treatment, should limit their exposure to alcohol, moderate their nutritional intake so it does not contribute to postmenopausal weight gain, and should adhere to a balanced diet. Nursing education planned for breast cancer patients about dietary issues should ideally be individually tailored, based on a good understanding of the international recommendations and the evidence underpinning the

3D inkjet printing of tablets exploiting bespoke complex geometries for controlled and tuneable drug release

A hot melt 3D inkjet printing method with the potential to manufacture formulations in complex and adaptable geometries for the controlled loading and release of medicines is presented. This first use of a precisely controlled solvent free inkjet printing to produce drug loaded solid dosage forms is demonstrated using a naturally derived FDA approved material (beeswax) as the drug carrier and fenofibrate as the drug. Tablets with bespoke geometries (honeycomb architecture) were fabricated. The honeycomb architecture was modified by control of the honeycomb cell size, and hence surface area to enable control of drug release profiles without the need to alter the formulation. Analysis of the formed tablets showed the drug to be evenly distributed within the beeswax at the bulk scale with evidence of some localization at the micron scale. An analytical model utilizing a Fickian description of diffusion was developed to allow the prediction of drug release. A comparison of experimental and predicted drug release data revealed that in addition to surface area, other factors such as the cell diameter in the case of the honeycomb geometry and material wettability must be considered in practical dosage form design. This information when combined with the range of achievable geometries could allow the bespoke production of optimized personalised medicines for a variety of delivery vehicles in addition to tablets, such as medical devices for example

Post-exposure prophylaxis during pandemic outbreaks

<p>Abstract</p> <p>Background</p> <p>With the rise of the second pandemic wave of the novel influenza A (H1N1) virus in the current season in the Northern Hemisphere, pandemic plans are being carefully re-evaluated, particularly for the strategic use of antiviral drugs. The recent emergence of oseltamivir-resistant in treated H1N1 patients has raised concerns about the prudent use of neuraminidase inhibitors for both treatment of ill individuals and post-exposure prophylaxis of close contacts.</p> <p>Methods</p> <p>We extended an established population dynamical model of pandemic influenza with treatment to include post-exposure prophylaxis of close contacts. Using parameter estimates published in the literature, we simulated the model to evaluate the combined effect of treatment and prophylaxis in minimizing morbidity and mortality of pandemic infections in the context of transmissible drug resistance.</p> <p>Results</p> <p>We demonstrated that, when transmissible resistant strains are present, post-exposure prophylaxis can promote the spread of resistance, especially when combined with aggressive treatment. For a given treatment level, there is an optimal coverage of prophylaxis that minimizes the total number of infections (final size) and this coverage decreases as a higher proportion of infected individuals are treated. We found that, when treatment is maintained at intermediate levels, limited post-exposure prophylaxis provides an optimal strategy for reducing the final size of the pandemic while minimizing the total number of deaths. We tested our results by performing a sensitivity analysis over a range of key model parameters and observed that the incidence of infection depends strongly on the transmission fitness of resistant strains.</p> <p>Conclusion</p> <p>Our findings suggest that, in the presence of transmissible drug resistance, strategies that prioritize the treatment of only ill individuals, rather than the prophylaxis of those suspected of being exposed, are most effective in reducing the morbidity and mortality of the pandemic. The impact of post-exposure prophylaxis depends critically on the treatment level and the transmissibility of resistant strains and, therefore, enhanced surveillance and clinical monitoring for resistant mutants constitutes a key component of any comprehensive plan for antiviral drug use during an influenza pandemic.</p

Operating list composition and surgical performance

Background Recent reviews suggest that the way in which surgeons prepare for a procedure (warm up) can affect performance. Operating lists present a natural experiment to explore this phenomenon. The aim was to use a routinely collected large data set on surgical procedures to understand the relationship between case list order and operative performance. Method Theatre lists involving the 35 procedures performed most frequently by senior surgeons across 38 private hospitals in the UK over 26 months were examined. A linear mixed‐effects model and matched analysis were used to estimate the impact of list order and the cost of switching between procedures on a list while controlling for key prognosticators. The influence of procedure method (open versus minimally invasive) and complexity was also explored. Results The linear mixed‐effects model included 255 757 procedures, and the matched analysis 48 632 pairs of procedures. Repeating the same procedure in a list resulted in an overall time saving of 0·98 per cent for each increase in list position. Switching between procedures increased the duration by an average of 6·48 per cent. The overall reduction in operating time from completing the second procedure straight after the first was 6·18 per cent. This pattern of results was consistent across procedure method and complexity. Conclusion There is a robust relationship between operating list composition and surgical performance (indexed by duration of operation). An evidence‐based approach to structuring a theatre list could reduce the total operating time

Enterprise Culture and the Arts: Neo-Liberal Values and British Art Institutions

Neoliberal discourse has spread from the economic realm into all parts of society. This chapter discusses the current situation of neoliberal discourses and their effects on the arts, focusing on the United Kingdom. It also examines the historical development of British cultural policy, highlighting trends toward the marketization of the arts, increasing government intervention, and a growing emphasis on managerialism. The analysis shows that British arts organizations have been deeply affected by state and corporate interests. The chapter draws on the work of Pierre Bourdieu, who describes the field of cultural production as containing two poles that are autonomous or heteronomous. By tracing British cultural policy as it came to favor enterprise culture, the chapter demonstrates an increasing loss of autonomy in the arts

Propaganda in an Age of Algorithmic Personalization: Expanding Literacy Research and Practice

In this commentary, the author considers the rise of algorithmic personalization and the power of propaganda as they shift the dynamic landscape of 21st‐century literacy research and practice. Algorithmic personalization uses data from the behaviors, beliefs, interests, and emotions of the target audience to provide filtered digital content, targeted advertising, and differential product pricing to online users. As persuasive genres, advertising and propaganda may demand different types of reading practices than texts whose purpose is primarily informational or argumentative. Understanding the propaganda function of algorithmic personalization may lead to a deeper consideration of texts that activate emotion and tap into audience values for aesthetic, commercial, and political purposes. Increased attention to algorithmic personalization, propaganda, and persuasion in the context of K–12 literacy education may also help people cope with sponsored content, bots, and other forms of propaganda and persuasion that now circulate online