Large-scale Delivery Research Articles

Understanding and Quantifying the Scale-Up Penalty: a Systematic Review of Early Developmental Preventive Interventions with Criminological Outcomes

This article reviews the process of scaling up early developmental preventive interventions with criminological outcomes over the life-course, with a focus on quantifying the scale-up penalty. The scale-up penalty is an empirically based quantification of the amount of attenuation in the effects of interventions as they move from research and demonstration projects to large-scale delivery systems attempting to achieve population-level impacts. A systematic review was conducted, which included rigorous criteria for inclusion of studies, comprehensive search strategies to identify eligible studies, and a detailed protocol for coding key study characteristics and factors related to the scale-up penalty. A total of six studies met the inclusion criteria, originating in two countries (USA and Norway) and covering a 20-year period (1998 to 2017). Studies showed large variability in the scale-up penalty assigned, ranging from 0 to 50%, with one study reporting scale-up penalties from negative to 71%. A wide range of factors were considered in quantifying the scale-up penalty, including implementation context, heterogeneity in target populations, heterogeneity of service providers, and fidelity to the model. The most recent studies were more comprehensive in their consideration of factors influencing the scale-up penalty. It is important for program developers and policymakers to recognize and account for implementation challenges when scaling up early developmental preventive interventions. Further research in this area is needed to help mitigate attenuation of program effects and aid public investments in early developmental preventive interventions.

Legitimising transgression: design and delivery of a science Work Integrated Learning program that draws on students’ extant work in diverse, non-science fields

ABSTRACTRecent focus on graduate employability has exposed the inadequacies of work preparation for science students, who need an employability toolkit to navigate the modern work landscape. An established mechanism to develop students’ employment awareness is Work Integrated Learning (WIL), but Australian mathematics and science students participate in fewer WIL activities than students in other disciplines. In this article, we present a conceptual discussion around the design of a non-traditional Bachelor of Science WIL program that transcends commonly held perceptions of WIL as primarily discipline-orientated and placement-based. This design dramatically expands the possibilities for WIL in science programs, enabling WIL participation for students unable to engage in a traditional science work placement. The program draws on and legitimises students’ experiences in diverse non-science, part-time workplaces and extra-curricular activities; we term this ‘transgressional learning’. Students engage in reflective and active learning opportunities designed to help them explore and articulate their skill sets in a manner that speaks to multiple future work settings. By drawing on students’ extant work experiences, the program explicitly supports students to foreground and expand on broad skill sets acquired in extra-curricular settings. This article suggests a new conceptual approach and a path forward for large-scale WIL delivery in generalist science degrees. It draws on the reflections of the project team and student participants to outline the goals and design ethos of the program and reflect on the legitimacy of this transgressional program as a science WIL offering.

Capturing implementation knowledge: applying focused ethnography to study how implementers generate and manage knowledge in the scale-up of obesity prevention programs

BackgroundBespoke electronic information management systems are being used for large-scale implementation delivery of population health programs. They record sites reached, coordinate activity, and track target achievement. However, many systems have been abandoned or failed to integrate into practice. We investigated the unusual endurance of an electronic information management system that has supported the successful statewide implementation of two evidence-based childhood obesity prevention programs for over 5 years. Upwards of 80% of implementation targets are being achieved.MethodsWe undertook co-designed partnership research with policymakers, practitioners, and IT designers. Our working hypothesis was that the science of getting evidence-based programs into practice rests on an in-depth understanding of the role programs play in the ongoing system of local relationships and multiple accountabilities. We conducted a 12-month multisite ethnography of 14 implementation teams, including their use of an electronic information management system, the Population Health Information Management System (PHIMS).ResultsAll teams used PHIMS, but also drew on additional informal tools and technologies to manage, curate, and store critical information for implementation. We identified six functions these tools performed: (1) relationship management, (2) monitoring progress towards target achievement, (3) guiding and troubleshooting PHIMS use, (4) supporting teamwork, (5) evaluation, and (6) recording extra work at sites not related to program implementation. Informal tools enabled practitioners to create locally derived implementation knowledge and provided a conduit between knowledge generation and entry into PHIMS.ConclusionsImplementation involves knowing and formalizing what to do, as well as how to do it. Our ethnography revealed the importance of hitherto uncharted knowledge about how practitioners develop implementation knowledge about how to do implementation locally, within the context of scaling up. Harnessing this knowledge for local use required adaptive and flexible systems which were enabled by informal tools and technologies. The use of informal tools also complemented and supported PHIMS use suggesting that both informal and standardized systems are required to support coordinated, large-scale implementation. While the content of the supplementary knowledge required to deliver the program was specific to context, functions like managing relationships with sites and helping others in the team may be applicable elsewhere.

OCD: Online Crowdsourced Delivery for On-Demand Food

Online-to-offline (O2O) commerce connecting service providers and individuals to address daily human needs is quickly expanding. In particular, on-demand food, whereby food orders are placed online by customers and delivered by couriers, is becoming popular. This novel urban food application requires highly efficient and scalable real-time delivery services. However, it is difficult to recruit enough couriers and route them to facilitate such food ordering systems. This paper presents an online crowdsourced delivery (OCD) approach for on-demand food. Facilitated by Internet-of-Things and 3G/4G/5G technologies, public riders can be attracted to act as crowdsourced workers delivering food by means of shared bicycles or electric motorbikes. An online dynamic optimization framework comprising order collection, solution generation, and sequential delivery processes is presented. A hybrid metaheuristic solution process integrating the adaptive large neighborhood search and tabu search approaches is developed to assign food delivery tasks and generate high-quality delivery routes in a real-time manner. The crowdsourced riders are dynamically shared among different food providers. Simulated small-scale and real-world large-scale on-demand food delivery instances are used to evaluate the performance of the proposed approach. The results indicate that the presented crowdsourced food delivery approach outperforms traditional urban logistics. The developed hybrid optimization mechanism is able to produce high-quality crowdsourced delivery routes in less than 120 s. The results demonstrate that the presented OCD approach can facilitate city-scale on-demand food delivery.

Cell Size-Specific Transfection by Micropillar Array Electroporation.

In this study, we reported a new micropillar array electroporation (MAE) platform to accomplish large-scale, size-specific DNA and RNA delivery to mammalian cells for nanomedicine. By introducing well-patterned micropillar array on the electrode surface, the number of micropillars each cell faces varies with the surface area of cell membrane or the size of cells. In this way, cell size-specific electroporation is conveniently done on a large population of cells in despite of their random locations between the two electrodes. The enhancement of this MAE system on the delivery of DNA and RNA probes without sacrifice of cell viability is demonstrated with an average increase of 2.5 to 3-fold on the transfection efficiency of DNA plasmids and additional knockdown of the targeted protein 10-55% more in siRNA delivery when compared to that using a commercial electroporation system. This MAE system works like many single cell electroporation are carried out in parallel, showing potential to bridge the gap between single cell electrophysiology study and in vitro electroporation to a large population of cells.

Model of investment development of beef cattle in the region (on the example of the Voronezh region)

The article describes the state of production of cattle meat on the example of the Voronezh region. It is revealed that the successful overcoming of the crisis period was achieved thanks to the measures taken to enhance investment activity. It was noted that the key condition for increasing the production of cattle meat in the region was the transition to specialized meat cattle breeding. The basis for the development of this subsector was the development of high-tech investment projects, under which the large-scale delivery of highly productive beef cattle from other countries was carried out. Along with this, new livestock complexes were built, advanced technologies were introduced into the production process. One of the stimulating factors was the adoption in the region of state support measures aimed at the development of breeding activities and an increase in the production of high-quality beef. In conclusion, the main problematic issues hindering the effective development of beef cattle breeding in the region are given, and the need to improve existing measures and mechanisms of state support is indicated in order to ensure further intensive development of this sub-sector and increase its investment attractiveness. In particular, a mechanism is presented to stimulate the breeding of beef cattle in households.

Future Directions for Early Childhood Prevention of Mental Disorders: A Road Map to Mental Health, Earlier

Mental disorders are the predominant chronic diseases of youth, with substantial life span morbidity and mortality. A wealth of evidence demonstrates that the neurodevelopmental roots of common mental health problems are present in early childhood. Unfortunately, this has not been translated to systematic strategies for improving population-level mental health at this most malleable neurodevelopmental period. We lay out a translational Mental Health, Earlier road map as a key future direction for prevention of mental disorder. This paradigm shift aims to reduce population attributable risk of mental disorder emanating from early life, by preventing, attenuating, or delaying onset/course of chronic psychopathology via the promotion of self-regulation in early childhood within large-scale health care delivery systems. The Earlier Pillar rests on a “science of when to worry” that (a) optimizes clinical assessment methods for characterizing probabilistic clinical risk beginning in infancy via deliberate incorporation of neurodevelopmental heterogeneity, and (b) universal primary-care-based screening targeting patterns of dysregulated irritability as a robust transdiagnostic marker of vulnerability to life span mental health problems. The core of the Healthier Pillar is provision of low-intensity selective intervention promoting self-regulation for young children with developmentally atypical patterns of irritability within an implementation science framework in pediatric primary care to ensure highest population impact and sustainability. These Mental Health, Earlier strategies hold much promise for transforming clinical outlooks and ensuring young children’s mental health and well-being in a manner that reverberates throughout the life span.

Artificial Intelligence in Global Health

AbstractArtificial intelligence (AI) is reaching into every aspect of global health. In this essay, I examine one example of AI's potential contributions and limitations in global health: the prediction, treatment, and containment of a global influenza outbreak. The potential advantages are clear. AI can aid global influenza surveillance platforms by improving the capacity of organizations to look for novel influenza outbreak strains in the right places, to identify populations most likely to spread influenza, and to produce real-time information about the disease's spread by monitoring social media communications to track outbreak events. There are also very real limitations to what AI can do, and it is crucial that AI not be used as an excuse not to invest in strengthening health systems and other traditional components of global healthcare. AI may also be able to improve our understanding of who should receive a vaccine and what is most effective for large-scale vaccine delivery, but there will always be blind spots that the data cannot fill. Investment in healthcare, with attention to the danger of minimal access to care for minority groups that are at risk and in fragile situations, remains the best chance to prepare communities for outbreak detection, surveillance, and containment.

Paediatric migraine: evidence-based management and future directions

Migraine is prevalent in children and adolescents and constitutes an important cause of disability in this population. Early, effective treatment of paediatric migraine is likely to result in improved outcomes. Findings from the past few years suggest that a biopsychosocial approach that uses interdisciplinary multimodal care is most effective for treatment of migraine in the paediatric population. Key elements of this management include effective and timely acute pharmacological interventions (such as NSAIDs and/or triptans), education of patients regarding self-management techniques, and psychological interventions such as biofeedback, relaxation and cognitive-behavioural therapy. The efficacy of current pharmacological or nutraceutical interventions for migraine prevention in children and adolescents is unclear, although reported placebo response patterns suggest that the effect of pill-taking behaviour is positive. As such, clinicians can consider adding a preventive intervention that involves a daily pill-taking behaviour to evidence-based non-pharmacological first-line preventive interventions (such as cognitive-behavioural therapy). More rigorous research is needed to delineate the role of pharmacological and nutraceutical interventions, the mechanisms of the clinically relevant placebo response, and interventions that enhance this response for migraine prevention in this population. Given the prevalence of migraine, cost-effective and efficacious strategies are needed for the large-scale delivery of interdisciplinary multimodal paediatric migraine care.

Continuous approximation for demand balancing in solving large-scale one-commodity pickup and delivery problems

The one-commodity pickup and delivery problem (1-PDP) has a wide range of applications in the real world, e.g., for repositioning bikes in large cities to guarantee the sustainable operations of bike-sharing systems. It remains a challenge, however, to solve the problem for large-scale instances. This paper proposes a hybrid modeling framework for 1-PDP, where a continuum approximation (CA) approach is used to model internal pickup and delivery routing within each of multiple subregions, while matching of net surplus or deficit of the commodity out of these subregions is addressed in a discrete model with a reduced problem size. The interdependent local routing and system-level matching decisions are made simultaneously, and a Lagrangian relaxation based algorithm is developed to solve the hybrid model. A series of numerical experiments are conducted to show that the hybrid model is able to produce a good solution for large-scale instances in a short computation time.

Data-Driven Diffusion Of Innovations: Successes And Challenges In 3 Large-Scale Innovative Delivery Models.

Failed diffusion of innovations may be linked to an inability to use and apply data, information, and knowledge to change perceptions of current practice and motivate change. Using qualitative and quantitative data from three large-scale health care delivery innovations-accountable care organizations, advanced primary care practice, and EvidenceNOW-we assessed where data-driven innovation is occurring and where challenges lie. We found that implementation of some technological components of innovation (for example, electronic health records) has occurred among health care organizations, but core functions needed to use data to drive innovation are lacking. Deficits include the inability to extract and aggregate data from the records; gaps in sharing data; and challenges in adopting advanced data functions, particularly those related to timely reporting of performance data. The unexpectedly high costs and burden incurred during implementation of the innovations have limited organizations' ability to address these and other deficits. Solutions that could help speed progress in data-driven innovation include facilitating peer-to-peer technical assistance, providing tailored feedback reports to providers from data aggregators, and using practice facilitators skilled in using data technology for quality improvement to help practices transform. Policy efforts that promote these solutions may enable more rapid uptake of and successful participation in innovative delivery system reforms.

Construction of Large-Scale Low-Cost Delivery Infrastructure Using Vehicular Networks

Vehicular ad-hoc networks, as one of the major components of Internet of Things in smart cities, have enormous idle transportation capability due to the huge number of vehicles. This paper argues that it is feasible to employ a large number of mobile vehicles in smart city to construct a large-scale low-cost delivery infrastructure using opportunistic routing to improve the city’s social welfare. To this end, a low-cost good delivery system (LCGDS) with opportunistic relay is proposed to meet the requirements of good delivery. In LCGDS, an enormous number of mobile vehicles constitute a stable, highly reliable, low-cost infrastructure with large transportation capabilities, called the mobile Internet of mission-critical things (M-IoMCT). The main contributions of the LCGDS are: 1) demonstrate the technological feasibility of M-IoMCT for delivering goods through mobile vehicles in a “ride-sharing” fashion with low costs and 2) in order to increase the reliability of goods transmission, the LCGDS proposes mobile vehicle selection algorithm which effectively selects a vehicle with higher probability of arriving at the destination. Both theoretical and experimental simulation results show that the performance of the LCGDS outperforms those of other solutions. Compared with other solutions, our results demonstrate that the costs in the LCGDS are only about 24% of the costs in the origin goods transmission scheme.

Microfinance Institutions' Successful Delivery Of Micronutrient Powders: A Randomized Trial In Rural Haiti.

Globally, two-thirds of child deaths could be prevented by increased provision of health interventions such as vaccines, micronutrient supplements, and water purification tablets. We report the results from a randomized controlled trial in Haiti during 2012 that tested whether microfinance institutions-which reach 200million households worldwide-can effectively deliver health products. These institutions provide loans to underserved entrepreneurs, primarily poor women in rural areas. In the intervention group, micronutrient powders to improve the nutrition of young children were distributed at regularly occurring microfinance meetings by a trained borrower. In both the control and the intervention groups, nurses led seminars on nutrition and extended breastfeeding during microfinance meetings. At three-month follow-up, the mean difference in hemoglobin concentration between children in the intervention group and those in the control group was 0.28 grams per deciliter (g/dL)-with a subsample of younger children (under two years of age) showing greater relative improvement (0.46 g/dL)-and the odds ratio for children in the intervention group meeting the diagnostic criteria for anemia was 0.64. The results are similar to those of previous studies that evaluated micronutrient powder distribution through dedicated health institutions. Our findings suggest that microfinance institutions are a promising platform for the large-scale delivery of health products in low-income countries.

Large-scale delivery of seasonal malaria chemoprevention to children under 10 in Senegal: an economic analysis.

Seasonal Malaria Chemoprevention (SMC) is recommended for children under 5 in the Sahel and sub-Sahel. The burden in older children may justify extending the age range, as has been done effectively in Senegal. We examine costs of door-to-door SMC delivery to children up to 10 years by community health workers (CHWs). We analysed incremental financial and economic costs at district level and below from a health service perspective. We examined project accounts and prospectively collected data from 405 CHWs, 46 health posts, and 4 district headquarters by introducing questionnaires in advance and completing them after each monthly implementation round. Affordability was explored by comparing financial costs of SMC to relevant existing health expenditure levels. Costs were disaggregated by administration month and by health service level. We used linear regression models to identify factors associated with cost variation between health posts. The financial cost to administer SMC to 180 000 children over one malaria season, reaching ∼93% of children with all three intended courses of SMC was $234 549 (constant 2010 USD) or $0.50 per monthly course administered. Excluding research–participation incentives, the financial cost was $0.32 per resident (all ages) in the catchment area, which is 1.2% of Senegal’s general government expenditure on health per capita. Economic costs were 18.7% higher than financial costs at $278 922 or $0.59 per course administered and varied widely between health posts, from $0.38 to $2.74 per course administered. Substantial economies of scale across health posts were found, with the smallest health posts incurring highest average costs per monthly course administered. SMC for children up to 10 is likely to be affordable, particularly where it averts substantial curative care costs. Estimates of likely costs and cost-effectiveness of SMC in other contexts must account for variation in average costs across delivery months and health posts.

HEALTHY AGEING THROUGH INTERNET COUNSELLING IN THE ELDERLY

Cardiovascular disease and dementia share a number of risk factors. It is unknown whether treatment of these risk factors reduces the risk of dementia. eHealth offers great opportunities for large-scale delivery of prevention programs encouraging self-management of risk factors. We aim to investigate whether a multi-domain interactive internet intervention to optimise self-management of cardiovascular risk factors can improve the cardiovascular risk profile and reduce the risk of CVD, cognitive decline and dementia. We developed an interactive internet-intervention with coach-support based on 1) previous experiences in three dementia prevention trials (preDIVA, MAPT and FINGER); 2) existing national and European guidelines on CVRM; 3) focus groups with the target population and nurses involved in CVRM. We currently test this internet-intervention in a multi-national, multi-centre, prospective, randomised, open-label blinded endpoint (PROBE) trial with 18-months intervention in persons >=65 years at increased risk of cardiovascular disease and dementia. The trial runs in the Netherlands, Finland and France. The intervention group uses an interactive internet-platform supported by a coach to stimulate a healthy lifestyle. The control group has access to a static platform with general health information. Primary outcome is a composite score of systolic blood pressure, low-density-lipoprotein and body mass index. Main secondary outcomes include effect on individual cardiovascular risk factors, incident CVD, mortality, cognitive functioning, mood and cost-effectiveness. Between March 2015 and August 2016 we have recruited 2725 persons. Median age is 69 (IQR67–73), 40% has higher education and 30% has a history of cardiovascular disease. During the first 12 months of the trial, adherence to the intervention was good with over 50% logging in at least 5 times per 3 months and only 20% logging in less than 2 times per 3 months. The 18-months follow-up is expected to be complete in December 2017. A large multi-national RCT using an internet intervention to improve the cardiovascular risk profile and prevent cardiovascular disease and cognitive decline is feasible. Whether this leads to a reduction in risk of CVD and dementia is under investigation. Final trial results are expected in mid-2018.

Design Optimization of a Vaneless “Fish-Friendly” Swirl Injector for Small Water Turbines

Large-scale power generation and delivery to remote locales is often prohibitively expensive, due in part to the excessive costs of delivering the materials required to build the necessary infrastructure. In addition, these facilities can have deleterious effects on the local ecosystem. With their reduced physical and environmental footprints, small-scale run-of-river hydroelectric facilities capable of generating power from the modest head provided by streams and rivers are attractive alternatives. Concern remains, however, for the health and safety of the local fish population in these waterways. In order to further reduce the impact of small-scale axial turbine-based hydroelectric facilities on the local fauna, AlfaStar Hydro has proposed a vaneless swirl injector to replace traditional inlet guide vanes (IGVs), as well as a “fish-friendly” rotor designed to rotate relatively slowly and with wide passages between the blades to enable the safe egress of fish drawn into the turbine. Herein, we perform a numerical study of the flow development in the vaneless swirl injector as a function of the number of revolutions and the pitch angle of the rifling in the absence of a rotor toward maximizing turbine efficiency. Swirl intensity, pressure loss in the injector, and axial and circumferential velocity distributions are incorporated as performance metrics into an objective function to optimize the casing design. Results indicate that the number of revolutions of the injector has considerably less influence on overall injector performance than does pitch angle. The casing with the best predicted performance consists of four revolutions at a pitch angle of 25 deg.

The Review of the Impact of Large Scale Photovoltaic Power Generation on Power System

Human concerns energy security and worries environmental deterioration, which makes full use of renewable energy, become a global consensus. Such solar, wind as the representative of the large-scale grid connected power generation with renewable energy has become an irresistible trend of development of new power system, has deep influence on power system, and the academe and engineering give great attention. The purpose of the paper is review of domestic and foreign large-scale photovoltaic research present situation, which is aim to explore the factors on affecting the interaction between solar power generation and power system, refine the academic and engineering problems, and sort out the next step development ideas. From the power system planning, simulation, scheduling and control of angle, this paper lays emphasis on discusses in the modeling and simulation of large-scale PV systems, effects of large-scale photovoltaic (PV) accessed to the dynamic and steady state characteristics and the key technology of large-scale photovoltaic delivery and consumptive analysis.

6-2 放送通信同期合成のための大規模プッシュ配信における配信サーバ選択手法(第6部門 放送方式1(素材の伝送・配信))

6-2 放送通信同期合成のための大規模プッシュ配信における配信サーバ選択手法(第6部門 放送方式1(素材の伝送・配信))

Understanding Performance of Edge Content Caching for Mobile Video Streaming

Today’s Internet has witnessed an increase in the popularity of mobile video streaming, which is expected to exceed 3/4 of the global mobile data traffic by 2019. To satisfy the considerable amount of mobile video requests, video service providers have been pushing their content delivery infrastructure to edge networks—from regional content delivery network (CDN) servers to peer CDN servers (e.g., smartrouters in users’ homes)—to cache content and serve users with storage and network resources nearby. Among the edge network content caching paradigms, Wi-Fi access point caching and cellular base station caching have become two mainstream solutions. Thus, understanding the effectiveness and performance of these solutions for large-scale mobile video delivery is important. However, the characteristics and request patterns of mobile video streaming are unclear in practical wireless network. In this paper, we use real-world data sets containing 50 million trace items of nearly 2 million users viewing more than 0.3 million unique videos using mobile devices in a metropolis in China over two weeks, not only to understand the request patterns and user behaviors in mobile video streaming, but also to evaluate the effectiveness of Wi-Fi and cellular-based edge content caching solutions. To understand the performance of edge content caching for mobile video streaming, we first present temporal and spatial video request patterns, and we analyze their impacts on caching performance using frequency-domain and entropy analysis approaches. We then study the behaviors of mobile video users, including their mobility and geographical migration behaviors, which determine the request patterns. Using trace-driven experiments, we compare strategies for edge content caching, including least recently used (LRU) and least frequently used (LFU), in terms of supporting mobile video requests. We reveal that content, location, and mobility factors all affect edge content caching performance. Moreover, we design an efficient caching strategy based on the measurement insights and experimentally evaluate its performance. The results show that our design significantly improves the cache hit rate by up to 30% compared with LRU/LFU.

Integrated Control and Management of Neglected Tropical Skin Diseases.

Neglected tropical diseases (NTDs) are communicable diseases that occur under conditions of poverty and are concentrated almost exclusively in impoverished populations in the developing world. NTDs affect more than 1000 million people in tropical and subtropical countries, costing developing economies billions of dollars every year. Effective control of NTDs can be achieved with the use of large-scale delivery of single-dose preventive chemotherapy (PC) or intensified disease management (IDM) or both, as is the case for some diseases such as lymphatic filariasis, trachoma, and yaws. Several NTDs exhibit significant cutaneous manifestations that are associated with long-term disfigurement and disability, including Buruli ulcer (BU); cutaneous leishmaniasis (CL); leprosy; mycetoma; yaws; hydrocele and lymphoedema (resulting from lymphatic filariasis); and depigmentation, subcutaneous nodules, severe itching, and hanging groin (resulting from onchocerciasis). Skin examination offers an opportunity to screen people in the communities or children in schools to identify multiple conditions in a single visit. This common approach to skin diseases justifies the integrated delivery of health care interventions to both increase cost-effectiveness and expand coverage. WHO’s Department of Control of NTDs (WHO/NTD) plans to promote an integrated strategy for the skin NTDs requiring IDM. Targeting skin NTDs also provides a platform for treatment of common skin conditions and, therefore, has wider public health benefits. An informal panel of experts (writing this manuscript) was established to help develop guidance in support of the new WHO strategic direction and to develop a proposal for a change in policy for the integrated control and management of the skin NTDs. A symposium at the 2015 ASTMH meeting[1] initiated a discussion of opportunities around integration of surveillance and control of NTDs that affect the skin, but this paper moves these ideas forward and includes some initial recommendations about how these opportunities could be realised. We aim to provide specific pragmatic information and actual recommendations about potential surveillance and management approaches.