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BACKGROUND: The terms syndemic and infodemic have both been applied to the COVID-19 pandemic, and emphasize concurrent socio-cultural dynamics that are distinct from the epidemiological outbreak itself. We argue that the COVID-19 pandemic has exposed yet another important socio-political dynamic that can best be captured by the concept of a quandemic - a portmanteau of "quantification" and "pandemic". MAIN TEXT: The use of quantifiable metrics in policymaking and evaluation has increased throughout the last decades, and is driven by a synergetic relationship between increases in supply and advances in demand for data. In most regards this is a welcome development. However, a quandemic, refers to a situation where a small subset of quantifiable metrics dominate policymaking and the public debate, at the expense of more nuanced and multi-disciplinary discourse. We therefore pose that a quandemic reduces a complex pandemic to a few metrics that present an overly simplified picture. During COVID-19, these metrics were different iterations of case numbers, deaths, hospitalizations, diagnostic tests, bed occupancy rates, the R-number and vaccination coverage. These limited metrics came to constitute the internationally recognized benchmarks for effective pandemic management. Based on experience from the Nordic region, we propose four distinct dynamics that characterize a quandemic: 1) A limited number of metrics tend to dominate both political, expert, and public spheres and exhibit a great deal of rigidity over time. 2) These few metrics crowd-out other forms of evidence relevant to pandemic response. 3) The metrics tend to favour certain outcomes of pandemic management, such as reducing hospitalization rates, while not capturing potential adverse effects such as social isolation and loneliness. 4) Finally, the metrics are easily standardized across countries, and give rise to competitive dynamics based on international comparisons and benchmarking. CONCLUSION: A quandemic is not inevitable. While metrics are an indispensable part of evidence-informed policymaking, being attentive to quandemic dynamics also means identifying relevant evidence that might not be captured by these few but dominant metrics. Pandemic responses need to account for and consider multilayered vulnerabilities and risks, including socioeconomic inequities and comorbidities.
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COVID-19 , Humanos , COVID-19/epidemiología , SARS-CoV-2 , Pandemias/prevención & control , Brotes de Enfermedades , ComorbilidadRESUMEN
This article examines collaborative environmental governance under authoritarian political structures. Building on the theoretical frame of authoritarian environmentalism, it peruses fieldwork material collected during 2009-2019 to determine the most prominent features of recent collaborative governance efforts in the field of water management in Vietnam, a historically seasonal flooding-dependent country. A key feature is technocratisation, where top-down management structures and practices prioritise technocratic solutions to environmental challenges over deliberation, awareness raising, and integration of local knowledge. Another equally important feature is authoritarian intensification, by which increasingly complex environmental management functions, coupled with the state's determination to retain political control, reinforce authoritarian governance. We jointly refer to these features as captured collaboration, signifying a strong authoritarian regime dominance in both vertical and horizontal relations of environmental governance. However, while captured collaboration still appears to be a defining collaborative characteristic, the article acknowledges rising calls for deliberative government in Vietnamese society. This is particularly outspoken in relation to the highly contested issues of hydropower construction and enhanced floods, debates that simultaneously have paved the way for a burgeoning, though much delayed, paradigm shift.
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Conservación de los Recursos Naturales , Ambientalismo , Política Ambiental , Vietnam , Abastecimiento de Agua , Sistemas PolíticosRESUMEN
BACKGROUND AIMS: Several studies report on Good Manufacturing Process (GMP)-compliant manufacturing protocols for the ex vivo expansion of tumor-infiltrating lymphocytes (TILs) for the treatment of patients with refractory melanoma and other solid malignancies. Further opportunities for improvements in terms of ergonomy and operating time have been identified. METHODS: To enable GMP-compliant TILs production for adoptive cell therapy needs, a simple automated and reproducible protocol for TILs manufacturing with the use of a closed system was developed and implemented at the authors' institution. RESULTS: This protocol enabled significant operating time reduction during TILs expansion while allowing the generation of high-quality TILs products. CONCLUSIONS: A simplified and efficient method of TILs expansion will enable the broadening of individualized tumor therapy and will increase patients' access to state-of-the-art TILs adoptive cell therapy treatment.
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Técnicas de Cultivo de Célula/métodos , Hospitales , Linfocitos Infiltrantes de Tumor/citología , Automatización , Recuento de Células , Proliferación Celular , Criopreservación , Femenino , Humanos , Cinética , Fenotipo , Control de CalidadRESUMEN
BACKGROUND: Antimicrobial resistance (AMR) is a growing problem worldwide in need of global coordinated action. With the endorsement of the Global Action Plan (GAP) on AMR in 2015, the 194 member states of the World Health Organization committed to integrating the five objectives and corresponding actions of the GAP into national action plans (NAPs) on AMR. The article analyzes patterns of alignment between existing NAPs and the GAP, bringing to the fore new methodologies for exploring the relationship between globally driven health policies and activities at the national level, taking income, geography and governance factors into account. METHODS: The article investigates the global governance of AMR. Concretely, two proxies are devised to measure vertical and horizontal alignment between the GAP and existing NAPs: (i) a syntactic indicator measuring the degree of verbatim overlap between the GAP and the NAPs; and (ii) a content indicator measuring the extent to which the objectives and corresponding actions outlined in the GAP are addressed in the NAPs. Vertical alignment is measured by the extent to which each NAP overlaps with the GAP. Horizontal alignment is explored by measuring the degree to which NAPs overlap with other NAPs across regions and income groups. In addition, NAP implementation is explored using the Global Database for Antimicrobial Resistance Country Self-Assessment. FINDINGS: We find strong evidence of vertical alignment, particularly among low-income countries and lower-middle-income countries but weaker evidence of horizontal alignment within regions. In general, we find the NAPs in our sample to be mostly aligned with the GAP's five overarching objectives while only moderately aligned with the recommended corresponding actions. Furthermore, we see several cases of what can be termed 'isomorphic mimicry', characterized by strong alignment in the policies outlined but much lower levels of alignment in terms of actual implemented policies. CONCLUSION: To strengthen the alignment of national AMR policies, we recommend global governance initiatives based on individualized responsibilities some of which should be legally binding. Our study provides limited evidence of horizontal alignment within regions, which implies that regional governance institutions (e.g., WHO regional offices) should primarily act as mediators between global and local demands to strengthen a global governance regime that minimizes policy fragmentation and mimicry behavior across member states.
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Farmacorresistencia Bacteriana , Salud Global , Antibacterianos/uso terapéutico , Países en Desarrollo , Gobierno , Política de Salud , Humanos , Organización Mundial de la SaludRESUMEN
Natural hazards not only have socioeconomic ramifications, they also have political repercussions. This paper takes stock of the fast-growing area of research linking disasters triggered by natural hazards to voting behaviour. It is based on the central tenet of voter retrospection: voters place emphasis on past events when making their selection. The study uncovers a great disparity in analysis of electoral outcomes in the wake of disasters, part of which can be explained by the different methodological choices of authors. However, the unpredictability of voting behaviour in the aftermath of disasters also points to the relevance of introducing an intermediate variable when elucidating voter movements. This variable should capture the prevailing political discourses that surround disasters, as these are likely to shape the dynamics of voter retrospection. The paper demonstrates the analytical relevance of such political discourses by contrasting political dynamics in Denmark and Sweden following the Indian Ocean tsunami on 26 December 2004.
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Desastres , Política , Sistemas de Socorro , Tsunamis , Dinamarca , Humanos , Estudios Retrospectivos , SueciaRESUMEN
This brief commentary argues that glocal governance introduces a fruitful new perspective to the global governance debate of AMR, and cautions against too strict a focus on establishing globally binding governance regimes for curbing AMR.
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Programas de Optimización del Uso de los Antimicrobianos/legislación & jurisprudencia , Regulación Gubernamental , Derecho Internacional , HumanosRESUMEN
This paper recommends the incorporation of an additional discursive dimension in famine diagnosis that draws on the number of reports referring to famine in the United Nations Office for the Coordination of Humanitarian Affairs (OCHA)'s ReliefWeb database. Present-day diagnostic tools already apply the principle of triangulation with multiple indicators; the addition of a discursive diagnostic dimension would enable even more refined analysis, allowing more forcefully for the incorporation of the aspect of change. The newly devised discursive famine indices are used both to identify famines--in Ethiopia (2000), Malawi (2002), and Somalia (2011)--and to analyse key socioeconomic determinants of famine. The study finds that income (or poverty) together with state fragility appear to be the major determinants of cross-country variations in famine reporting, while political regimes do not appear to have any independent effect. The indices appear largely robust with regard to concerns about cross-country, semantic, and temporal biases.
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Determinantes Sociales de la Salud , Inanición/diagnóstico , Bases de Datos Factuales , Etiopía , Humanos , Malaui , Política , Pobreza , Factores Socioeconómicos , SomaliaRESUMEN
PURPOSE: The purpose of this paper is to show that 2009 H1N1 "swine" influenza pandemic vaccination policies deviated from predictions established in the theory of political survival, and to propose that pandemic response deviated because it was ruled by bureaucratized experts rather than by elected politicians. DESIGN/METHODOLOGY/APPROACH: Focussing on the 2009 H1N1 pandemic, the paper employs descriptive statistical analysis of vaccination policies in nine western democracies. To probe the plausibility of the novel explanation, it uses quantitative and qualitative content analyses of media attention and coverage in two deviant cases, the USA and Denmark. FINDINGS: Theories linking political survival to disaster responses find little empirical support in the substantial cross-country variations of vaccination responses during the 2009 H1N1 pandemic. Rather than following a political logic, the case studies of media coverage in the USA and Denmark demonstrate that the response was bureaucratized in the public health agencies (CDC and DMHA, respectively). Hence, while natural disaster responses appear to follow a political logic, the response to pandemics appears to be more strongly instituted in the hands of bureaucratic experts. RESEARCH LIMITATIONS/IMPLICATIONS: There is an added value of encompassing bureaucratic dynamics in political theories of disaster response; bureaucratized expertise proved to constitute a strong plausible explanation of the 2009 pandemic vaccination response. PRACTICAL IMPLICATIONS: Pandemic preparedness and response depends critically on understanding the lessons of the 2009 H1N1 pandemic; a key lesson supported by this paper is that expert-based agencies rather than political leaders are the pivotal actors. ORIGINALITY/VALUE: This paper is the first to pinpoint the limitations of political survival theories of disaster responses with respect to the 2009 pandemic. Further, it is among the few to analyze the causes of variations in cross-country pandemic vaccination policies during the 2009 H1N1 pandemic.
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Over two decades, most cancer vaccines failed clinical development. Key factors may be the lack of efficient priming with tumor-specific antigens and strong immunostimulatory signals. MVX-ONCO-1, a personalized cell-based cancer immunotherapy, addresses these critical steps utilizing clinical-grade material to replicate a successful combination seen in experimental models: inactivated patient's own tumor cells, providing the widest cancer-specific antigen repertoire and a standardized, sustained, local delivery over days of a potent adjuvant achieved by encapsulated cell technology. We conducted an open-label, single-arm, first-in-human phase I study with MVX-ONCO-1 in patients with advanced refractory solid cancer. MVX-ONCO-1 comprises irradiated autologous tumor cells coimplanted with two macrocapsules containing genetically engineered cells producing granulocyte-macrophage colony-stimulating factor. Patients received six immunizations over 9 weeks without maintenance therapy. Primary objectives were safety, tolerability, and feasibility, whereas secondary objectives focused on efficacy and immune monitoring. Data from 34 patients demonstrated safety and feasibility with minor issues. Adverse events included one serious adverse event possibly related to investigational medicinal product and two moderate-related adverse events. More than 50% of the patients with advanced and mainly nonimmunogenic tumors showed clinical benefits, including partial responses, stable diseases, and prolonged survival. In recurrent/metastatic head and neck squamous cell carcinoma, one patient achieved a partial response, whereas another survived for more than 7 years without anticancer therapy for over 5 years. MVX-ONCO-1 is safe, well tolerated, and beneficial across several tumor types. Ongoing phase IIa trials target patients with advanced recurrent/metastatic head and neck squamous cell carcinoma after initial systemic therapy. SIGNIFICANCE: This first-in-human phase I study introduces a groundbreaking approach to personalized cancer immunotherapy, addressing limitations of traditional strategies. By combining autologous irradiated tumor cells as a source of patient-specific antigens and utilizing encapsulated cell technology for localized, sustained delivery of granulocyte-macrophage colony-stimulating factor as an adjuvant, the study shows a very good safety and feasibility profile. This innovative approach holds the promise of addressing tumor heterogeneity by taking advantage of each patient's antigenic repertoire.
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Vacunas contra el Cáncer , Inmunoterapia Activa , Neoplasias , Medicina de Precisión , Humanos , Persona de Mediana Edad , Masculino , Femenino , Neoplasias/terapia , Neoplasias/inmunología , Vacunas contra el Cáncer/uso terapéutico , Vacunas contra el Cáncer/administración & dosificación , Anciano , Medicina de Precisión/métodos , Inmunoterapia Activa/métodos , Adulto , Factor Estimulante de Colonias de Granulocitos y Macrófagos/uso terapéuticoRESUMEN
BACKGROUND: Red blood cell-derived microparticles (RMPs) are small phospholipid vesicles shed from RBCs in blood units, where they accumulate during storage. Because microparticles are bioactive, it could be suggested that RMPs are mediators of posttransfusion complications or, on the contrary, constitute a potential hemostatic agent. STUDY DESIGN AND METHODS: This study was performed to establish the impact on coagulation of RMPs isolated from blood units. Using calibrated automated thrombography, we investigated whether RMPs affect thrombin generation (TG) in plasma. RESULTS: We found that RMPs were not only able to increase TG in plasma in the presence of a low exogenous tissue factor (TF) concentration, but also to initiate TG in plasma in absence of exogenous TF. TG induced by RMPs in the absence of exogenous TF was neither affected by the presence of blocking anti-TF nor by the absence of Factor (F)VII. It was significantly reduced in plasma deficient in FVIII or F IX and abolished in FII-, FV-, FX-, or FXI-deficient plasma. TG was also totally abolished when anti-XI 01A6 was added in the sample. Finally, neither Western blotting, flow cytometry, nor immunogold labeling allowed the detection of traces of TF antigen. In addition, RMPs did not comprise polyphosphate, an important modulator of coagulation. CONCLUSIONS: Taken together, our data show that RMPs have FXI-dependent procoagulant properties and are able to initiate and propagate TG. The anionic surface of RMPs might be the site of FXI-mediated TG amplification and intrinsic tenase and prothrombinase complex assembly.
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Conservación de la Sangre , Micropartículas Derivadas de Células/fisiología , Eritrocitos/metabolismo , Plasma/metabolismo , Trombina/metabolismo , Biomarcadores/metabolismo , Pruebas de Coagulación Sanguínea , Western Blotting , Factor XI/metabolismo , Citometría de Flujo , Humanos , Inmunohistoquímica , Tromboplastina/metabolismoRESUMEN
SUMMARY: Microparticles are small phospholipid vesicles of less than 1 µm released into the blood flow by various types of cells such as endothelial, platelet, white or red blood cells. They are involved in many biological and physiological processes including hemostasis. In addition, an elevated number of microparticles in the blood is observed in various pathological situations. In the context of transfusion, erythrocyte-derived microparticles are found in red blood cell concentrates. Their role is not elucidated, and they are considered as a type of storage lesion. The purpose of this review is to present recent data showing that erythrocyte-derived microparticles most likely play a role in transfusion medicine and could cause transfusion complications.
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In this study, we expand on the newly devised sociological concept of pandemic practices that emerged during the COVID-19 outbreak by applying it to the HIV/AIDS pandemic. The analytical heuristic of pandemic practices distinguishes between four kinds of practices: (i) primary practices that encompass the public's direct response to the pandemic, (ii) responsive practices that encompass altered routines and social interactions, (iii) adaptive practices that encompass more elusive organisational and legal legacies and (iv) meta-practices that produce particular narratives about the pandemic dynamics that might lead to lasting socio-cultural behavioural changes. In this paper we probe further into the notion of meta-practices. The results show that the prolonged nature of the HIV/AIDS pandemic combined with the widespread stigmatisation of vulnerable groups has led to distinct social practices that fragment along socio-economic lines both internally in countries but also between high-income and low-income countries. As the COVID-19 pandemic becomes increasingly endemic, lessons learned from HIV/AIDS expose the dangers of similar fragmentations where parts of the population return to normal but where many others continue to suffer not only from adverse health outcomes but also social exclusion and stigmatisation. Thus, we argue that attention to pandemic practices, and how they produce and reinforce underlying socio-economic vulnerabilities would strengthen long-term pandemic responses.
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Síndrome de Inmunodeficiencia Adquirida , COVID-19 , Síndrome de Inmunodeficiencia Adquirida/epidemiología , COVID-19/epidemiología , Brotes de Enfermedades , Humanos , Pandemias , SARS-CoV-2RESUMEN
INTRODUCTION: The exceptional production of research evidence during the COVID-19 pandemic required deployment of scientists to act in advisory roles to aid policy-makers in making evidence-informed decisions. The unprecedented breadth, scale and duration of the pandemic provides an opportunity to understand how science advisors experience and mitigate challenges associated with insufficient, evolving and/or conflicting evidence to inform public health decision-making. OBJECTIVES: To explore critically the challenges for advising evidence-informed decision-making (EIDM) in pandemic contexts, particularly around non-pharmaceutical control measures, from the perspective of experts advising policy-makers during COVID-19 globally. METHODS: We conducted in-depth qualitative interviews with 27 scientific experts and advisors who are/were engaged in COVID-19 EIDM representing four WHO regions and 11 countries (Australia, Canada, Colombia, Denmark, Ghana, Hong Kong, Nigeria, Sweden, Uganda, UK, USA) from December 2020 to May 2021. Participants informed decision-making at various and multiple levels of governance, including local/city (n=3), state/provincial (n=8), federal or national (n=20), regional or international (n=3) and university-level advising (n=3). Following each interview, we conducted member checks with participants and thematically analysed interview data using NVivo for Mac software. RESULTS: Findings from this study indicate multiple overarching challenges to pandemic EIDM specific to interpretation and translation of evidence, including the speed and influx of new, evolving, and conflicting evidence; concerns about scientific integrity and misinterpretation of evidence; the limited capacity to assess and produce evidence, and adapting evidence from other contexts; multiple forms of evidence and perspectives needed for EIDM; the need to make decisions quickly and under conditions of uncertainty; and a lack of transparency in how decisions are made and applied. CONCLUSIONS: Findings suggest the urgent need for global EIDM guidance that countries can adapt for in-country decisions as well as coordinated global response to future pandemics.
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COVID-19 , Pandemias , Política de Salud , Humanos , Formulación de Políticas , Investigación CualitativaRESUMEN
PURPOSE OF REVIEW: The mechanisms involved in the formation of red blood cell (RBC) microparticles in vivo as well as during erythrocyte storage are reviewed, and the potential role of microparticles in transfusion medicine is described. RECENT FINDINGS: Microparticles release is an integral part of the erythrocyte ageing process, preventing early removal of RBCs. Proteomics analyses have outlined the key role of band 3-ankyrin anchoring complex and the occurrence of selective RBC membrane remodelling mechanisms in microparticles formation. The presence of several RBC antigens, expressed on microparticles, has been demonstrated. The potential deleterious effects of RBC microparticles in transfused recipients, including hypercoagulability, microcirculation impairment and immunosuppression, are discussed. SUMMARY: Formation and role of RBC microparticles are far from being completely understood. Combining various approaches to elucidate these mechanisms could improve blood product quality and transfusion safety. Implementation of RBC microparticles as biomarkers in the laboratory routine needs to overcome technical barriers involved in their analysis.
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Micropartículas Derivadas de Células/fisiología , Transfusión de Eritrocitos/métodos , Eritrocitos/citología , Conservación de la Sangre , Envejecimiento Eritrocítico/fisiología , Humanos , MicrocirculaciónRESUMEN
This paper contributes to the debate on race- and gender-based discrimination in grading. We apply a quasi-experimental research design exploiting a shift from open grading in 2018 (examinee's name clearly visible on written assignments), to blind grading in 2019 (only student ID number visible). The analysis thus informs name-based stereotyping and discrimination, where student ethnicity and gender are derived from their names on written assignments. The case is a quantitative methods exam at Roskilde University (Denmark). We rely on OLS regression models with interaction terms to analyze whether blind grading has any impact on the relative grading differences between the sexes (female vs. male examinees) and/or between the two core ethnic groups (ethnic minorities vs. ethnic majority examinees). The results show no evidence of gender or ethnic bias based on names in the grading process. The results were validated by several checks for robustness. We argue that the weaker evidence of ethnic discrimination in grading vis-à-vis discrimination in employment and housing suggests the relevance of gauging the stakes involved in potentially discriminatory activities.
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Éxito Académico , Evaluación Educacional , Etnicidad , Sexismo , Estereotipo , Universidades , Adulto , Dinamarca , Femenino , Humanos , MasculinoRESUMEN
The WHO, FAO, and OIE (the Tripartite) promote One Health (OH) as the guiding frame for national responses to antimicrobial resistance (AMR). Little is known, however, about how much national action plans (NAPs) on AMR actually rely on the OH measures outlined by the Tripartite. The paper investigates attention to OH through a systematic content analysis of 77 AMR NAPs to discern regional and income patterns in the integration of these OH measures. Our findings suggest that (1) AMR NAPs almost universally address the three key sectors of OH, namely, human, animal, and environmental health; (2) AMR NAPs primarily apply OH measures in policies related to human health care, food production, hygiene, and agriculture, whereas the level of attention to OH measures in sanitation, aquaculture, waste management, and water governance is generally low and mainly present in NAPs from low-income countries; (3) AMR NAPs of low-income and lower-middle-income countries' display greater congruence with OH measures than NAPs from upper-middle-income and high-income countries; and (4) the level of OH attention on paper appears to matter little for the extent of multisectoral collaboration in practice.
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Salud Única , Animales , Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana , Humanos , PolíticasRESUMEN
Millions of blood products are transfused every year; many lives are thus directly concerned by transfusion. The three main labile blood products used in transfusion are erythrocyte concentrates, platelet concentrates and fresh frozen plasma. Each of these products has to be stored according to its particular components. However, during storage, modifications or degradation of those components may occur, and are known as storage lesions. Thus, biomarker discovery of in vivo blood aging as well as in vitro labile blood products storage lesions is of high interest for the transfusion medicine community. Pre-analytical issues are of major importance in analyzing the various blood products during storage conditions as well as according to various protocols that are currently used in blood banks for their preparations. This paper will review key elements that have to be taken into account in the context of proteomic-based biomarker discovery applied to blood banking.
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Análisis Químico de la Sangre/métodos , Conservación de la Sangre/métodos , Recolección de Muestras de Sangre/métodos , Proteómica/métodos , Biomarcadores/sangre , HumanosRESUMEN
There is a growing interest in One Health, reflected by the rising number of publications relating to One Health literature, but also through zoonotic disease outbreaks becoming more frequent, such as Ebola, Zika virus and COVID-19. This paper uses bibliometric analysis to explore the state of One Health in academic literature, to visualise the characteristics and trends within the field through a network analysis of citation patterns and bibliographic links. The analysis focuses on publication trends, co-citation network of scientific journals, co-citation network of authors, and co-occurrence of keywords. The bibliometric analysis showed an increasing interest for One Health in academic research. However, it revealed some thematic and disciplinary shortcomings, in particular with respect to the inclusion of environmental themes and social science insights pertaining to the implementation of One Health policies. The analysis indicated that there is a need for more applicable approaches to strengthen intersectoral collaboration and knowledge sharing. Silos between the disciplines of human medicine, veterinary medicine and environment still persist. Engaging researchers with different expertise and disciplinary backgrounds will facilitate a more comprehensive perspective where the human-animal-environment interface is not researched as separate entities but as a coherent whole. Further, journals dedicated to One Health or interdisciplinary research provide scholars the possibility to publish multifaceted research. These journals are uniquely positioned to bridge between fields, strengthen interdisciplinary research and create room for social science approaches alongside of medical and natural sciences.
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This paper investigates the genealogy of social science research into antimicrobial resistance (AMR) by piecing together the bibliometric characteristics of this branch of research. Drawing on the Web of Science as the primary database, the analysis shows that while academic interest in AMR has increased substantially over the last few years, social science research continues to constitute a negligible share of total academic contributions. More in-depth network analysis of citations and bibliometric couplings suggests how the impact of social science research on the scientific discourse on AMR is both peripheral and spread thin. We conclude that this limited social science engagement is puzzling considering the clear academic and practical demand and the many existing interdisciplinary outlets.