Citizen repertoires of smart urban safety: Perspectives from Rotterdam, the Netherlands

This article provides empirical research about the perspectives of citizens of Rotterdam, the Netherlands, on the emergent phenomenon of ‘smart urban safety’, which advocates advanced uses of digital technologies and data for urban safety management, and is gaining currency in thinking about urban futures. While smart cities affect many dimensions of city management, applications to safety management belong to the most controversial, revealing important tensions between disparate perspectives on technology and society in the context of urban living environments. Despite their influence, the concepts of smart cities and smart urban safety are largely unknown to the public. To gain insights into citizens’ perspectives, this study uses smart urban safety vignettes to which participants are invited to respond. Using discourse analytical techniques, their interpretations of safety in the smart city are described, which center on functional designs, express lacking influence over technological developments, and reflect on benefits and risks and on their civic roles vis-à-vis technologically mediated urban safety management. Our article concludes by arguing how these findings complement, but also show limitations to traditional technology acceptance models that are as of yet dominant in research of smart urban safety specifically, and smart cities more generally

Exploring the feasibility of introducing triple artemisinin-based combination therapy in the malaria treatment policy in Vietnam

BACKGROUND: This study investigates the processes regarding changing malaria treatment policies in Vietnam. Moreover, it explores the feasibility of introducing triple artemisinin-based combination therapy (TACT) in Vietnam to support the national malaria control and elimination plan. METHODS: Data were collected via 12 in-depth interviews with key stakeholders, combined with a review of policy documents. RESULTS: TACT is considered as a useful backup strategy in case future treatment failures with current artemisinin-based combination therapy (ACT) would occur. Moreover, TACT is also considered as a promising strategy to prevent the re-establishment of malaria. However, regulatory procedures and implementation timelines for TACT were expected to be lengthy. Therefore, strategies to engage national decision-makers, regulators, and suppliers should be initiated soon, stipulating the benefits of TACT deployment. In Vietnam, a procedure to apply for an import permit without registration that has previously been applied to the introduction of artesunate-pyronaridine was proposed to accelerate the introduction of TACT. Global-level support through the World Health Organization recommendations and prequalification were considered critical for supporting the introduction of TACT in Vietnam. CONCLUSIONS: Appropriate approach strategies and early stakeholder engagement will be needed to accelerate the introduction of TACT in Vietnam

Strategies for deploying triple artemisinin-based combination therapy in the Greater Mekong Subregion

Background This is a qualitative study to identify implementation challenges for deploying triple artemisinin-based combination therapy (TACT) in the Greater Mekong Subregion (GMS) of Southeast Asia and to explore strategies to overcome these challenges. Methods In-depth interviews were conducted in three countries that have repeatedly been confronted with ACT failures: Cambodia, Vietnam, and Lao PDR. Thirty-nine key stakeholders in the healthcare systems in these countries were interviewed. One participatory workshop was conducted in Cambodia, where scenarios for potential TACT deployment were discussed. Results The results section is organized around four strategic themes that emerged from the data: policy support, data and evidence, logistics and operation, and downstream engagement. The study revealed that countries in the GMS currently rely on ACT to eliminate Plasmodium falciparum malaria by 2025. TACT is, however, considered to be a useful backup strategy in case of future treatment failures and to prevent the re-establishment of malaria. The study showed that a major challenge ahead is to engage decision makers and healthcare providers into deploying TACT, given the low case incidence of falciparum malaria in the GMS. Interview respondents were also skeptical whether healthcare providers would be willing to engage in new therapies for a disease they hardly encounter anymore. Hence, elaborate information dissemination strategies were considered appropriate and these strategies should especially target village malaria workers. Respondents proposed several regulatory and programmatic strategies to anticipate the formation of TACT markets in the GMS. These strategies include early dossier submission to streamline regulatory procedures, early stakeholder engagement strategies to shorten implementation timelines, and inclusion of TACT as second-line therapy to accelerate their introduction in case they are urgently needed. Conclusions This paper presents a qualitative study to identify implementation challenges for deploying TACT in the GMS and to explore strategies to overcome these challenges. The findings could benefit researchers and decision makers in strategizing towards potential future deployment of TACT in the GMS to combat artemisinin and partner drug resistance

The impact of anti-malarial markets on artemisinin resistance: perspectives from Burkina Faso

Background: Widespread artemisinin resistance in Africa could be catastrophic when drawing parallels with the failure of chloroquine in the 1970s and 1980s. This article explores the role of anti-malarial market characteristics in the emergence and spread of arteminisin resistance in African countries, drawing on perspectives from Burkina Faso. Methods: Data were collected through in-depth interviews and focus group discussions. A representative sample of national policy makers, regulators, public and private sector wholesalers, retailers, clinicians, nurses, and community members were purposively sampled. Additional information was also sought via review of policy publications and grey literature on anti-malarial policies and deployment practices in Burkina Faso. Results: Thirty seven in-depth interviews and 6 focus group discussions were conducted. The study reveals that the current operational mode of anti-malarial drug markets in Burkina Faso promotes arteminisin resistance emergence and spread. The factors are mainly related to the artemisinin-based combination therapy (ACT) supply chain, to ACT quality, ACT prescription monitoring and to ACT access and misuse by patients. Conclusion: Study findings highlight the urgent requirement to reform current characteristics of the anti-malarial drug market in order to delay the emergence and spread of artemisinin resistance in Burkina Faso. Four recommendations for public policy emerged during data analysis: (1) Address the suboptimal prescription of anti-malarial drugs, (2) Apply laws that prohibit the sale of anti-malarials without prescription, (3) Restrict the availability of street drugs, (4) Sensitize the population on the value of compliance regarding correct acquisition and intake of anti-malarials. Funding systems for anti-malarial drugs in terms of availability and accessibility must also be stabilized

Market Formation in an Era of Drug Resistant Malaria: Understanding the formation of markets for (triple) artemisinin-based combination therapies

This thesis explores the formation of markets for antimalarial therapies under the pressure of drug resistance. Part 1 maps the innovation system of antimalarial therapies and identifies systemic failures that jeopardize the formation of markets for new therapies. This is done by investigating in retrospect the antimalarial drug transition from conventional monotherapies to artemisinin-based combination therapies (ACTs), which is done in Chapters 2 and 3. Part 2 investigates the prospects of market formation for triple artemisinin-based combination therapies (TACTs) in African countries, where current ACTs are still effective. Introducing TACTs would therefore not directly benefit individual patients but instead they would mitigate the risks of future antimalarial drug resistance. Considering the introduction of TACTs in this context raises important ethical and practical questions which are discussed in Chapters 4 and 5. Part 3 investigates the market formation prospects of TACTs in Southeast Asia, where current ACTs are increasingly failing and where TACTs can provide direct clinical relief and can protect drug compounds

Practices of politicizing gentrification: The emergence organization and governance of an urban issue in three European neighborhoods

For some, political issues are to be found in a particular place, like a parliament. For others, the political is 'everywhere'. From a pragmatic perspective, however, both seem rather unrealistic. In terms of 'practices of politicizing', which make things political (cf. Çaliskan and Callon 2009 on 'practices of economization' making things economic), there are many ways of finding and handling political issues, from a Deweyan formation of a public to a Machiavellian power play to a Foucauldian governmentality (Latour, 2007). As a political issue, gentrification is also dealt with in many different political practices enacted by different communities and states. Although recent overviews of global urbanisms and gentrifications sometimes seem to imply so (e.g. Lees et al. 2015), not all of these practices of politicizing are in any straightforward sense 'neoliberal' (or 'depoliticized'). To explore the rich multiplicity of practices of politicizing gentrification, three neighborhoods in Vienna (AT), Istanbul (TR) and Arnhem (NL) will be compared in terms of how the matter of concern emerges and is processed politically in ways more or less institutionalized

Expert perspectives on the introduction of Triple Artemisinin-based Combination Therapies (TACTs) in Southeast Asia: a Delphi study

BACKGROUND: Triple Artemisinin-based Combination Therapies (TACTs) are being developed as a response to artemisinin and partner drug resistance in Southeast Asia. However, the desirability, timing and practical feasibility of introducing TACTs in Southeast Asia is subject to debate. This study systematically assesses perspectives of malaria experts towards the introduction of TACTs as first-line treatment for uncomplicated falciparum malaria in Southeast Asia. METHODS: A two-round Delphi study was conducted. In the first round, 53 malaria experts answered open-ended questions on what they consider the most important advantages, disadvantages, and implementation barriers for introducing TACTs in Southeast Asia. In the second round, the expert panel rated the relevance of each statement on a 5-point Likert scale. RESULTS: Malaria experts identified 15 advantages, 15 disadvantages and 13 implementation barriers for introducing TACTs in Southeast Asia in the first round of data collection. In the second round, consensus was reached on 13 advantages (8 perceived as relevant, 5 as not-relevant), 12 disadvantages (10 relevant, 2 not-relevant), and 13 implementation barriers (all relevant). Advantages attributed highest relevance related to the clinical and epidemiological rationale of introducing TACTs. Disadvantages attributed highest relevance related to increased side-effects, unavailability of fixed-dose TACTs, and potential cost increases. Implementation barriers attributed highest relevance related to obtaining timely regulatory approval, timely availability of fixed-dose TACTs, and generating global policy support for introducing TACTs. CONCLUSIONS: The study provides a structured oversight of malaria experts' perceptions on the major advantages, disadvantages and implementation challenges for introducing TACTs in Southeast Asia, over current practices of rotating ACTs when treatment failure is observed. The findings can benefit strategic decision making in the battle against drug-resistant malaria