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The WTO and environment-related international trade disputes : biosecurity and ecosystem services risks
\"We live in a world that is increasingly dependent on international trade in a context of substantial regional/national political tensions. Adding to this is an emerging understanding and concern about the social impact of biosecurity and ecosystem services risks associated with such trade. As the key international trade 'arbiter', the World Trade Organisation (WTO) has never before faced such complexity within its decision-making remit. With increasing numbers of bilateral and regional agreements, as well as new developments emerging such as the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) initiated by multi-national corporations in 2018, the WTO needs to implement ways of reinforcing its legitimacy and enhancing its relevance. This book provides an original analysis of these linked developments and delivers a timely contribution to resolving environment-related international trade disputes. It provides a clear roadmap for improving WTO trade dispute resolution procedures so both biosecurity and ecosystem services risks are considered in evaluating the social, economic and environmental impacts of international trade proposals. In so doing, the WTO should deliver enhanced multilateral social welfare.\"--Back cover.
Book
A time motion study of manual versus artificial intelligence methods for wound assessment
This time-motion study explored the amount of time clinicians spent on wound assessments in a real-world environment using wound assessment digital application utilizing Artificial Intelligence (AI) vs. manual methods. The study also aimed at comparing the proportion of captured quality wound images on the first attempt by the assessment method.
Clinicians practicing at Valley Wound Center who agreed to join the study were asked to record the time needed to complete wound assessment activities for patients with active wounds referred for a routine evaluation on the follow-up days at the clinic. Assessment activities included: labelling wounds, capturing images, measuring wounds, calculating surface areas, and transferring data into the patient's record.
A total of 91 patients with 115 wounds were assessed. The average time to capture and access wound image with the AI digital tool was significantly faster than a standard digital camera with an average of 62 seconds (P<0.001). The digital application was significantly faster by 77% at accurately measuring and calculating the wound surface area with an average of 45.05 seconds (P<0.001). Overall, the average time to complete a wound assessment using Swift was significantly faster by 79%. Using the AI application, the staff completed all steps in about half of the time (54%) normally spent on manual wound evaluation activities. Moreover, acquiring acceptable wound image was significantly more likely to be achieved the first time using the digital tool than the manual methods (92.2% vs. 75.7%, P<0.004).
Using the digital assessment tool saved significant time for clinicians in assessing wounds. It also successfully captured quality wound images at the first attempt.
Journal Article
Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales
Cholera remains a persistent health problem in sub-Saharan Africa and worldwide. Cholera can be controlled through appropriate water and sanitation, or by oral cholera vaccination, which provides transient (∼3 years) protection, although vaccine supplies remain scarce. We aimed to map cholera burden in sub-Saharan Africa and assess how geographical targeting could lead to more efficient interventions.
We combined information on cholera incidence in sub-Saharan Africa (excluding Djibouti and Eritrea) from 2010 to 2016 from datasets from WHO, Médecins Sans Frontières, ProMED, ReliefWeb, ministries of health, and the scientific literature. We divided the study region into 20 km × 20 km grid cells and modelled annual cholera incidence in each grid cell assuming a Poisson process adjusted for covariates and spatially correlated random effects. We combined these findings with data on population distribution to estimate the number of people living in areas of high cholera incidence (>1 case per 1000 people per year). We further estimated the reduction in cholera incidence that could be achieved by targeting cholera prevention and control interventions at areas of high cholera incidence.
We included 279 datasets covering 2283 locations in our analyses. In sub-Saharan Africa (excluding Djibouti and Eritrea), a mean of 141 918 cholera cases (95% credible interval [CrI] 141 538–146 505) were reported per year. 4·0% (95% CrI 1·7–16·8) of districts, home to 87·2 million people (95% CrI 60·3 million to 118·9 million), have high cholera incidence. By focusing on the highest incidence districts first, effective targeted interventions could eliminate 50% of the region's cholera by covering 35·3 million people (95% CrI 26·3 million to 62·0 million), which is less than 4% of the total population.
Although cholera occurs throughout sub-Saharan Africa, its highest incidence is concentrated in a small proportion of the continent. Prioritising high-risk areas could substantially increase the efficiency of cholera control programmes.
The Bill & Melinda Gates Foundation.
Journal Article
A Comprehensive Scoping Review on the Use of Point‐Of‐Care Infrared Thermography Devices for Assessing Various Wound Types
This scoping review investigates the use of point‐of‐care infrared thermography devices for assessing various wound types. A comprehensive search across four databases yielded 76 studies published between 2010 and 2024 that met the inclusion criteria. The review highlights thermography applications in burns, surgical wounds, diabetic foot ulcers, pressure injuries, and other lower limb wounds. Key findings indicate its effectiveness in detecting early signs of inflammation and healing delays, facilitating timely interventions. The technology shows promise in accurately predicting wound healing trajectories and assessing treatment outcomes. Recent advancements have made thermographic devices more affordable and user‐friendly, expanding their clinical potential. However, challenges persist, including reimbursement, training requirements, and integration with electronic medical records (EMRs), with EMR integration identified as a critical barrier to widespread adoption. While preliminary findings are promising, the current evidence base is constrained by small sample sizes, retrospective study designs, and limited consideration of skin tone variability. Large, prospective studies are essential to validate the clinical utility of thermography in wound care and to inform the development of standardised protocols that support equitable, bias‐reduced assessment across diverse populations. Addressing these gaps is critical for advancing research, enhancing clinician training, and improving patient outcomes in wound care. Overall, point‐of‐care thermography demonstrates significant potential to enhance wound assessment and monitoring, thereby elevating care quality and patient outcomes.
Journal Article
Calibrating Satellite-Based Indices of Burn Severity from UAV-Derived Metrics of a Burned Boreal Forest in NWT, Canada
Wildfires are a dominant disturbance to boreal forests, and in North America, they typically cause widespread tree mortality. Forest fire burn severity is often measured at a plot scale using the Composite Burn Index (CBI), which was originally developed as a means of assigning severity levels to the Normalized Burn Ratio (NBR) computed from Landsat satellite imagery. Our study investigated the potential to map biophysical indicators of burn severity (residual green vegetation and charred organic surface) at very high (3 cm) resolution, using color orthomosaics and vegetation height models derived from UAV-based photographic surveys and Structure from Motion methods. These indicators were scaled to 30 m resolution Landsat pixel footprints and compared to the post-burn NBR (post-NBR) and differenced NBR (dNBR) ratios computed from pre- and post-fire Landsat imagery. The post-NBR showed the strongest relationship to both the fraction of charred surface (exponential R2 = 0.79) and the fraction of green crown vegetation above 5 m (exponential R2 = 0.81), while the dNBR was more closely related to the total green vegetation fraction (exponential R2 = 0.69). Additionally, the UAV green fraction and Landsat indices could individually explain more than 50% of the variance in the overall CBI measured in 39 plots. These results provide a proof-of-concept for using low-cost UAV photogrammetric mapping to quantify key measures of boreal burn severity at landscape scales, which could be used to calibrate and assign a biophysical meaning to Landsat spectral indices for mapping severity at regional scales.
Journal Article
Low Sensitivity of Fecal Immunochemical Tests and Blood-Based Markers of DNA Hypermethylation for Detection of Sessile Serrated Adenomas/Polyps
BackgroundEarly detection and removal of precursor lesions reduce colorectal cancer morbidity and mortality. Sessile serrated adenomas/polyps (SSP) are a recognized precursor of cancer, but there are limited studies on whether current screening techniques detect this pathology.AimsTo investigate the sensitivity of fecal immunochemical tests (FIT) and epigenetic biomarkers in blood for detection of SSP.MethodsA prospective study offered FIT and a blood test (Colvera for methylated BCAT1 and IKZF1) to adults referred for colonoscopy. Sensitivity of FIT and the blood test were determined for four types of pathology: low-risk conventional adenoma, high-risk adenoma, SSP, and absence of neoplasia. Comparisons were made for FIT positivity at 10 and 20 μg hemoglobin (Hb)/g feces.ResultsOne thousand eight hundred and eighty-two subjects completed FIT and underwent colonoscopy. One thousand four hundred and three were also tested for methylated BCAT1/IKZF1. The sensitivity of FIT (20 μg Hb/g feces) for SSP was 16.3%. This was lower than the sensitivity for high-risk adenomas (28.7%, p < 0.05), but no different to that for low-risk adenomas (13.1%) or no neoplasia (8.4%). A positive FIT result for SSP was not associated with demographics, morphology, concurrent pathology or intake of medications that increase bleeding risk. FIT sensitivity for SSP did not significantly increase through lowering the positivity threshold to 10 μg Hb/g feces (20.4%, p > 0.05). Sensitivity of the blood test for SSP was 8.8%, and 26.5% when combined with FIT.ConclusionsBoth FIT and blood-based markers of DNA hypermethylation have low sensitivity for detection of SSP. Further development of sensitive screening tests is warranted.
Journal Article