Cold chains in Hanoi and Bangkok : Changing systems of provision and practice

We know that patterns of domestic consumption are situated within broader systems of provision and that home appliances like the fridge freezer bridge between practices of cooking, shopping and eating, on one hand, and increasingly global systems of food production, distribution and diet on the other. In analysing the uses of fridge freezers in Hanoi and Bangkok as expressions, in microcosm, of complex and evolving processes of urbanisation and food provisioning, this article provides new insight into how specific configurations, dependencies and patterns of consumption take hold and how they vary and change. Our analysis of systems and practices in flux has the dual function of showing how household strategies reflect and contribute to more extensive transformations, and of demonstrating how these are shaped by ongoing tensions and relations between new and established forms of urban food supply and associated concepts of freshness and safety. The result is a subtle account of the multiple routes through which consumer 'needs' evolve.Peer reviewe

Cold chains in Hanoi and Bangkok:changing systems of provision and practice

We know that patterns of domestic consumption are situated within broader systems of provision and that home appliances like the fridge freezer bridge between practices of cooking, shopping and eating, on the one hand, and increasingly global systems of food production, distribution and diet on the other. In analysing uses of fridge freezers in Hanoi and Bangkok as expressions, in microcosm, of complex and evolving processes of urbanisation and food provisioning this paper provides new insight into how specific configurations, dependencies and patterns of consumption take hold and how they vary and change. Our analysis of systems and practices in flux has the dual function of showing how household strategies reflect and contribute to more extensive transformations, and of demonstrating how these are shaped by ongoing tensions and relations between new and established forms of urban food supply and associated concepts of freshness and safety. The result is a subtle account of the multiple routes through which consumer ‘needs’ evolve

Holmium-166 radioembolization for the treatment of patients with liver metastases: design of the phase I HEPAR trial

<p>Abstract</p> <p>Background</p> <p>Intra-arterial radioembolization with yttrium-90 microspheres ( ⁹⁰Y-RE) is an increasingly used therapy for patients with unresectable liver malignancies. Over the last decade, radioactive holmium-166 poly(L-lactic acid) microspheres ( ¹⁶⁶Ho-PLLA-MS) have been developed as a possible alternative to ⁹⁰Y-RE. Next to high-energy beta-radiation, ¹⁶⁶Ho also emits gamma-radiation, which allows for imaging by gamma scintigraphy. In addition, Ho is a highly paramagnetic element and can therefore be visualized by MRI. These imaging modalities are useful for assessment of the biodistribution, and allow dosimetry through quantitative analysis of the scintigraphic and MR images. Previous studies have demonstrated the safety of ¹⁶⁶Ho-PLLA-MS radioembolization ( ¹⁶⁶Ho-RE) in animals. The aim of this phase I trial is to assess the safety and toxicity profile of ¹⁶⁶Ho-RE in patients with liver metastases.</p> <p>Methods</p> <p>The HEPAR study (Holmium Embolization Particles for Arterial Radiotherapy) is a non-randomized, open label, safety study. We aim to include 15 to 24 patients with liver metastases of any origin, who have chemotherapy-refractory disease and who are not amenable to surgical resection. Prior to treatment, in addition to the standard technetium-99m labelled macroaggregated albumin ( ^99mTc-MAA) dose, a low radioactive safety dose of 60-mg ¹⁶⁶Ho-PLLA-MS will be administered. Patients are treated in 4 cohorts of 3-6 patients, according to a standard dose escalation protocol (20 Gy, 40 Gy, 60 Gy, and 80 Gy, respectively). The primary objective will be to establish the maximum tolerated radiation dose of ¹⁶⁶Ho-PLLA-MS. Secondary objectives are to assess tumour response, biodistribution, performance status, quality of life, and to compare the ¹⁶⁶Ho-PLLA-MS safety dose and the ^99mTc-MAA dose distributions with respect to the ability to accurately predict microsphere distribution.</p> <p>Discussion</p> <p>This will be the first clinical study on ¹⁶⁶Ho-RE. Based on preclinical studies, it is expected that ¹⁶⁶Ho-RE has a safety and toxicity profile comparable to that of ⁹⁰Y-RE. The biochemical and radionuclide characteristics of ¹⁶⁶Ho-PLLA-MS that enable accurate dosimetry calculations and biodistribution assessment may however improve the overall safety of the procedure.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT01031784</p

Quantitative Evaluation of Scintillation Camera Imaging Characteristics of Isotopes Used in Liver Radioembolization

Scintillation camera imaging is used for treatment planning and post-treatment dosimetry in liver radioembolization (RE). In yttrium-90 (90Y) RE, scintigraphic images of technetium-99m (99mTc) are used for treatment planning, while 90Y Bremsstrahlung images are used for post-treatment dosimetry. In holmium-166 (166Ho) RE, scintigraphic images of 166Ho can be used for both treatment planning and post-treatment dosimetry. The aim of this study is to quantitatively evaluate and compare the imaging characteristics of these three isotopes, in order that imaging protocols can be optimized and RE studies with varying isotopes can be compared.Phantom experiments were performed in line with NEMA guidelines to assess the spatial resolution, sensitivity, count rate linearity, and contrast recovery of 99mTc, 90Y and 166Ho. In addition, Monte Carlo simulations were performed to obtain detailed information about the history of detected photons. The results showed that the use of a broad energy window and the high-energy collimator gave optimal combination of sensitivity, spatial resolution, and primary photon fraction for 90Y Bremsstrahlung imaging, although differences with the medium-energy collimator were small. For 166Ho, the high-energy collimator also slightly outperformed the medium-energy collimator. In comparison with 99mTc, the image quality of both 90Y and 166Ho is degraded by a lower spatial resolution, a lower sensitivity, and larger scatter and collimator penetration fractions.The quantitative evaluation of the scintillation camera characteristics presented in this study helps to optimize acquisition parameters and supports future analysis of clinical comparisons between RE studies

The association between medically unexplained physical symptoms and health care use over two years and the influence of depressive and anxiety disorders and personality traits: a longitudinal study

Background Medically unexplained physical symptoms (MUPS) are highly prevalent and are associated with frequent health care use (HCU). MUPS frequently co-occur with psychiatric disorders. With this study we examined the longitudinal association between MUPS and HCU over 2 years and the influence of depressive and anxiety disorders and personality traits on this association. Methods We analysed follow-up data from 2045 to 2981 participants from the Netherlands Study of Depression and Anxiety (NESDA), a multisite cohort study. The study population included participants with a current depressive and/or anxiety disorder, participants with a lifetime risk and/or subthreshold symptoms for depressive and/or anxiety disorders and healthy controls. HCU, measured with the Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness (TIC-P), was operationalized as the number of used medical services and the number of associated contacts. MUPS were measured with the Four Dimensional Symptoms Questionnaire, depressive and anxiety disorders with the Composite International Diagnostic Interview and personality traits with the NEO Five-Factory Inventory. Measurements were taken at baseline, 1 and 2 years follow-up. We used generalized estimating equations (GEE), using HCU at all three measurements as (multivariate) outcome. GEE also takes into account the dependency of observations within participants. Results MUPS were positively associated with HCU over 2 years (medical services: RR 1.020, 95 % CI 1.017–1.022; contacts: RR 1.037, 95 % CI 1.030–1.044). Neuroticism and depression had the strongest influence on the associations. After adjustment for these factors, the associations between MUPS and HCU weakened, but remained significant (services: RR 1.011, 95 % CI 1.008–1.014; contacts: RR 1.023, 95 % CI 1.015–1.032). Conclusions Our results show that MUPS were positively associated with HCU over 2 years, even after adjusting for depressive and anxiety disorders and personality traits

The new (Fragmented) geography of carbon market mechanisms : Governance challenges from Thailand and Vietnam

Countries in the Global South—which are contributing an increasing share of global greenhouse gas emissions—are actively developing carbon market mechanisms, including emissions trading systems and (voluntary) offset mechanisms. This article analyzes past and emerging experiments with carbon market mechanisms in Thailand and Vietnam, in the context of their domestic political economies and the shifting dynamics of the global climate governance regime. Drawing from thirty-three in-depth interviews and document analysis, I show the changing roles of government, the private sector, civil society, and donor and multilateral actors in these countries. Moreover, the article identifies key factors that may play roles in the further—and more synergistic—development of carbon market mechanisms: the generation of domestic demand for carbon credits; building and keeping human capacity and adequate data; creating space for civil society; ensuring coordination within the government and between sectors, notably the energy sector; and establishing further linkages with regional (Asian) and global carbon market mechanisms, such as those in China, Japan, and South Korea. These findings suggest that market-based mechanisms with high social and environmental integrity are one of the options that countries in the Global South have to achieve low-carbon development in the post-Paris climate change regime

Illiberalism and Energy Transitions in Myanmar and Thailand

Over the next century most states are likely to face momentous and potentially catastrophic environmental impacts due to climate change. This has made managing energy policy – traditionally focused on delivering energy security and equitable access – much more strenuous. Governments now face an energy policy trilemma: delivering both traditional energy goals while also minimizing greenhouse gas emissions. Most governments have found it difficult to achieve high levels of all three goals at any one time, particularly within the developing countries of Southeast Asia