Governing Climate Change Adaptation in the EU and China: An Analysis of Formal Institutions

Both the European Union (EU) and China are culturally, economically, climatologically and environmentally diverse polities. The EU is a multi-state grouping of economically developed democratic countries, while China is a unitary sovereign state and a developing economy with a strong government bureaucracy. Our hypothesis is that given their diverse political systems, the EU and China would develop different kinds of systems for the governance of adaptation to climate change. We test this hypothesis through a comparative analysis of policy documents from the two study areas,in which we examine framework policies, programmatic actions and specific actions that have been adopted to date in order to address climate change, with a specific focus on the water sector. We find that climate change adaptation began to be addressed through formal policy on a similar timeline in the two regions. The EU and China are also similar in that they use framework laws and existing sectoral policy, such as for the water sector. We find that the EU has primarily relied on integration of climate change adaptation concerns through legal instruments which set a framework for implementation of adaptation policy. In China, specific actions to be incorporated in socio-economic development plans under the existing legislation on adaptation have been the main mode for integrating adaptation into sectoral actions, though the future trend may be to develop more regulations

A Cluster of Vibrio cholerae O1 Infections in French Travelers to Rajasthan (India), May 2006

International audienceThe index case was a female patient aged 60 years. She had a history of ischemic stroke in 2004 (no subsisting defi cit) and convulsive seizures in 2005. She was receiving long-term treatment by acetylsalicylic acid and valproate and did not receive antacids. The patient and her husband participated in a tour to Rajasthan with a group of 25 other persons (12 other couples + 1 solo traveler) in May 2006. All came from Saint-Brieuc, a city of 47,000 inhabitants in Brittany (France). The group left Saint-Brieuc on May 14, 2006, and took off from Paris the following day, arriving in Delhi, India on the evening of May 15. The patient presented the fi rst signs on May 18, on her third day in India: vomiting and fi ve to six stools per day. The stools were mixed neither with blood nor with mucus. She self-treated with loperamide and metronidazole. The group returned on May 24, 2006, by direct fl ight from Delhi to Paris. The patient had no diarrhea and no vomiting during the fl ight to Paris or the ensuing bus trip to Saint-Brieuc. The patient consulted her family physician who referred her to the emergency room at Saint-Brieuc, a secondary care hospital, on the evening of May 25. She presented very liquid stools and vomiting with no abdominal pain. Her temperature was normal. There was marked dehydration with a loss of 6 kg compared to her usual weight. Her arterial blood pressure was 105/60 mm Hg, and pulse rate was 90 bpm. Her blood chemistry showed hypokalemia (1.6 mmol/L) and dehydration (urea = 19 mmol/L, serum creatinine = 99 ␮ mol/L, blood protein = 95 g/L, and C-reactive protein <4 mg/ml). The patient was admitted to the cardiology intensive care unit on May 25 (single room) and was transferred the following day to the reanimation ward (single room). The attending physician there BRIEF COMMUNICATION

Clin Toxicol (Phila)

Introduction: Button battery ingestion in children can be fatal if oesophageal perforation occurs. Such children require chest radiography in the emergency department to determine the button battery position and number. Current guidelines recommend that a button battery impacted in the oesophagus should be removed within two hours. We developed a clinical tool (the button battery impaction score) to estimate the risk of oesophageal impaction and help determine the most appropriate healthcare facility for initial assessment, either a local medical centre or a medical centre with the infrastructure for endoscopic retrieval. Methods: A multicentre retrospective study was conducted over seven years in eight French poison centres. We included patients aged less than 12 years with radiography showing the button battery position and a symptom description before radiography. Button battery impaction scores were calculated using backward stepwise selection. Results and discussion: A total of 1,430 patients were included, of whom 86, 461, and 375 had a button battery in their oesophagus, stomach, and post-pyloric position, respectively. No button batteries were identified by radiography in 508 patients. Sixteen of thirty-five factors independently predicted oesophageal impaction before chest radiography (P = 15 mm. The button battery impaction score showed an area under the curve value of 0.87, a negative predictive value of 0.98, and a sensitivity of 0.86. No cases of death, stricture, or haemorrhage were observed in patients with negative scores, including those with oesophageal impaction. Conclusions: A button battery impaction score used readily available data to predict the risk of oesophageal impaction after button battery ingestion and before chest radiography. When further validated, this rapid tool may be widely applicable in determining an appropriate facility for patient transfer to either a local medical centre or a medical centre with the infrastructure for endoscopic retrieval

Antimicrobial resistance data on 16,756 Streptococcus pneumoniae isolates in 1999: A pan-regional multicenter surveillance study in France

International audienc