The IHR (2005), disease surveillance, and the individual in global health politics

Since the revisions to the International Health Regulations (IHR) in 2005, much attention has turned to two concerns relating to infectious disease control. The first is how to assist states to strengthen their capacity to identify and verify public health emergencies of international concern (PHEIC). The second is the question of how the World Health Organization (WHO) will operate its expanded mandate under the revised IHR. Very little attention has been paid to the potential individual power that has been afforded under the IHR revisions – primarily through the first inclusion of human rights principles into the instrument and the allowance for the WHO to receive non-state surveillance intelligence and informal reports of health emergencies. These inclusions mark the individual as a powerful actor, but also recognise the vulnerability of the individual to the whim of the state in outbreak response and containment. In this paper we examine why these changes to the IHR occurred and explore the consequence of expanding the sovereignty-as-responsibility concept to disease outbreak response. To this end our paper considers both the strengths and weaknesses of incorporating reports from non-official sources and including human rights principles in the IHR framework.

Nowhere to hide: informal disease surveillance networks tracing state behaviour

Since the revisions to the International Health Regulations (IHR) in 2005, much attention has turned to how states, particularly developing states, will address core capacity requirements attached to the revised IHR. Primarily, how will states strengthen their capacity to identify and verify public health emergencies of international concern (PHEIC)? Another important but under-examined aspect of the revised IHR is the empowerment of the World Health Organization (WHO) to act upon non-governmental reports of disease outbreaks. The revised IHR potentially marks a new chapter in the powers of ‘disease intelligence’ and how the WHO may press states to verify an outbreak event. This article seeks to understand whether internet surveillance response programs (ISRPs) are effective in ‘naming and shaming’ states into reporting disease outbreaks.

The challenge to know and control: Disease outbreak surveillance and alerts in China and India

Since the revisions to the International Health Regulations (IHR) in 2005, much attention has been turned to how states, particularly developing states, will address core capacity requirements. The question often examined is how states with poor health systems can strengthen their capacity to identify and verify public health emergencies of international concern. A core capacity requirement is that by 2012 states will have a surveillance and response network that operates from the local community to the national level. Much emphasis has turned to the health system capacity required for this task. In this article, I seek to understand the political capacity to perform this task. This article considers how the world's two most populous states,1 1. For the purposes of this paper, I use the word ‘state’ as a shorthand for the nation-state of China and India, or member state as used by the United Nations. View all notes China and India, have sought to communicate outbreak events in times of crisis and calm. I consider what this reporting performance tells us of their capacity to meet their IHR obligations given the two countries differing political institutions.

The duty to report disease outbreaks : of interest or value? Lessons from H5N1

Since the severe acute respiratory syndrome outbreak in 2003, it has been argued that there has been a substantial revision to the norm dictating the behaviour of states in the event of a disease outbreak. This article examines the evolution of the norm to ‘report and verify’ disease outbreaks and evaluates the extent to which this revised norm has begun to guide state behaviour. Examination of select East Asian countries affected by human infections of the H5N1 (avian influenza) virus strain reveals the need to further understand the mutually constitutive relationship between the value attached to prompt reporting against the capacity to report, and how states manage both in fulfilling their duty to report.

Securitizing infectious disease

Over the past decade there has been an increased awareness in the field of international relations of the potential impact of an infectious disease epidemic on national security. While states’ attempts to combat infectious disease have a long history, what is new in this area is the adoption at the international level of securitized responses regarding the containment of infectious disease. This article argues that the securitization of infectious disease by states and the World Health Organization (WHO) has led to two key developments. First, the WHO has had to assert itself as the primary actor that all states, particularly western states, can rely upon to contain the threat of infectious diseases. The WHO's apparent success in this is evidenced by the development of the Global Outbreak Alert Response Network (GOARN), which has led to arguments that the WHO has emerged as the key authority in global health governance. The second outcome that this article seeks to explore is the development of the WHO's authority in the area of infectious disease surveillance. In particular, is GOARN a representation of the WHO's consummate authority in the area of coordinating infectious disease response or is GOARN the product of the WHO's capitulation to western states’ concerns with preventing infectious disease outbreaks from reaching their borders and as a result, are arguments expressing the authority of the WHO in infectious disease response premature?

The international politics of disease reporting : towards post-Westphalianism?

Since the outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003, there has been much discussion about whether the international community has moved into a new post-Westphalian era, where states increasingly recognize certain shared norms that guide what they ought to do in responding to infectious disease outbreaks. In this article I identify this new obligation as the ‘duty to report’, and examine competing accounts on the degree to which states appreciate this new obligation are considered by examining state behaviour during the H5N1 human infectious outbreaks in East Asia (since 2004). The article examines reporting behaviour for H5N1 human infectious cases in Cambodia, China, Indonesia, Thailand and Vietnam from 2004 to 2010. The findings lend strong support to the claim that East Asian states have come to accept and comply with the duty to report infectious disease outbreaks and that the assertions of sovereignty in response to global health governance frameworks have not systematically inhibited reporting compliance.

Graft versus host disease in oncology nursing practice

INTRODUCTION: Gastrointestinal graft-versus-host disease (GI-GvHD) is extremely debilitating and is multifactorial in its causative factors, management and treatment. It is an exaggeration of normal physiological mechanisms wherein the donor immune system attempts to rid itself of the host. The inflammatory process that follows has the benefit of providing an anti-tumour effect for many diseases, but unfortunately in patients undergoing human stem-cell transplantation, the nature of the inflammation can result in disability, wasting and death. AIM: The aim of this article is to discuss the pathophysiology of this often misunderstood or misdiagnosed condition, as well as its signs and symptoms, management and considerations for nursing care. Considerations for nursing practice: While the medical management is aimed at minimising GvHD through the reduction of T-cell production and proliferation and gastrointestinal decolonisation, the nursing care is often focused on the signs and symptoms that can have the most prominent impact on patients. CONCLUSION: GI-GvHD has serious life-threatening complications, namely wasting syndrome, diarrhoea and dehydration. The basis of signs and symptomology is easily recognisable owing to the stages of progression through the human stem-cell transplantation process. Oncology nurses are in a prime position to identify these serious risks, initiate treatment immediately and collaborate effectively within the multidisciplinary team to minimise GvHD onset and provide expert support to patients, family and caregivers.

Executive function and postural instability in people with Parkinson’s disease

The specific aspects of cognition contributing to balance and gait have not been clarified in people with Parkinson’s disease (PD). Twenty PD participants and twenty age- and gender-matched healthy controls were assessed on cognition and clinical mobility tests. General cognition was assessed with the Mini Mental State Exam and the Addenbrooke’s Cognitive Exam. Executive function was evaluated using the Trail Making Tests (TMT-A and TMT-B) and a computerized cognitive battery which included a series of choice reaction time (CRT) tests. Clinical gait and balance measures included the Tinetti, Timed Up & Go, Berg Balance and Functional Reach tests. PD participants performed significantly worse than the controls on the tests of cognitive and executive function, balance and gait. PD participants took longer on Trail Making Tests, CRT-Location and CRT-Colour (inhibition response). Furthermore, executive function, particularly longer times on CRT-Distracter and greater errors on the TMT-B were associated with worse balance and gait performance in the PD group. Measures of general cognition were not associated with balance and gait measures in either group. For PD participants, attention and executive function were impaired. Components of executive function, particularly those involving inhibition response and distracters, were associated with poorer balance and gait performance in PD.

Control of morphology and nucleation density of iron oxide nanostructures by electric conditions on iron surfaces exposed to reactive oxygen plasmas

The possibility to control the morphology and nucleation density of quasi-one-dimensional, single-crystalline α -Fe2 O3 nanostructures by varying the electric potential of iron surfaces exposed to reactive oxygen plasmas is demonstrated experimentally. A systematic increase in the oxygen ion flux through rf biasing of otherwise floating substrates and then an additional increase of the ion/neutral density resulted in remarkable structural transformations of straight nanoneedles into nanowires with controlled tapering/aspect ratio and also in larger nucleation densities. Multiscale numerical simulations relate the microscopic ion flux topographies to the nanostructure nucleation and morphological evolution. This approach is applicable to other metal-oxide nanostructures.

Deterministic surface growth of single-crystalline iron oxide nanostructures in nonequilibrium plasma

An innovative approach to precise tailoring of surface density, shapes, and sizes of single-crystalline α-Fe 2O 3 nanowires and nanobelts by controlling interactions of reactive oxygen plasma-generated species with the Fe surface is proposed. This strongly nonequilibrium, rapid, almost incubation-free, high-rate growth directly from the solid-solid interface can also be applied to other oxide materials and is based on deterministic control of the density of oxygen species and the surface conditions, which determine the nanostructure nucleation and growth.

Determination of battery storage capacity in energy buffer for wind farm

Design of a battery energy storage system (BESS) in a buffer scheme is examined for the purpose of attenuating the effects of unsteady input power from wind farms. The design problem is formulated as maximization of an objective function that measures the economic benefit obtainable from the dispatched power from the wind farm against the cost of the BESS. Solution to the problem results in the determination of the capacity of the BESS to ensure constant dispatched power to the connected grid, while the voltage level across the dc-link of the buffer is kept within preset limits. A computational procedure to determine the BESS capacity and the evaluation of the dc voltage is shown. Illustrative examples using the proposed design method are included.

Buffer scheme with battery energy storage capability for enhancement of network transient stability and load ride-through

This paper examines a buffer scheme to mitigate the negative impacts of power-conditioned loads on network voltage and transient stabilities. The scheme is based on the use of battery energy-storage systems in the buffers. The storage systems ensure that protected loads downstream of the buffers can ride through upstream voltage sags and swells. Also, by controlling the buffers to operate in either constant impedance or constant power modes, power is absorbed or injected by the storage systems. The scheme thereby regulates the rotor-angle deviations of generators and enhances network transient stability. A computational method is described in which the capacity of the storage systems is determined to achieve simultaneously the above dual objectives of load ride-through and stability enhancement. The efficacy of the resulting scheme is demonstrated through numerical examples.

Contactless and replaceable modularized battery energy storage system for electric vehicles

A novel replaceable, modularized energy storage system with wireless interface is proposed for a battery operated electric vehicle (EV). The operation of the proposed system is explained and analyzed with an equivalent circuit and an averaged state-space model. A non-linear feedback linearization based controller is developed and implemented to regulate the DC link voltage by modulating the phase shift ratio. The working and control of the proposed system is verified through simulation and some preliminary results are presented.

A direct integration scheme for battery-supercapacitor hybrid energy storage systems with the use of grid side inverter

Battery-supercapacitor hybrid energy storage systems are becoming popular in the renewable energy sector due to their improved power and energy performances. These hybrid systems require separate dc-dc converters, or at least one dc-dc converter for the supercapacitor bank, to connect them to the dc-link of the grid interfacing inverter. These additional dc-dc converters increase power losses, complexity and cost. Therefore, possibility of their direct connection is investigated in this paper. The inverter system used in this study is formed by cascading two 3-level inverters, named as the “main inverter” and the “auxiliary inverter”, through a coupling transformer. In the test system the main inverter is connected with the rectified output of a wind generator while the auxiliary inverter is directly attached to a battery and a supercapacitor bank. The major issues with this approach are the dynamic changes in dc-link voltages and inevitable imbalances in the auxiliary inverter voltages, which results in unevenly distributed space vectors. A modified SVM technique is proposed to solve this issue. A PWM based time sharing method is proposed for power sharing between the battery and the supercapacitor. Simulation results are presented to verify the efficacy of the proposed modulation and control techniques.