Year In Asia Research Articles

Digital Healthcare Innovations and Idea Management

The aim of the paper is to analyse the global demand development and funding of digital healthcare innovations and also characterise idea management trends in the digital healthcare context. Web-based idea management systems (IMS) fall in line with the growing importance of information communication technologies, the spread of open innovation and co-innovation, etc. Especially systems, which are based on the Internet during COVID-19 have become important tools in all sectors. Plus, over the last few years the changes related to digital healthcare have taken place and now in this context the questions have been raised. How could they be linked with a web-based IMS? What are digital healthcare innovation demands and funding trends? The changes in search habits for health information over the last three years have become statistically significant. The growth of funding volumes has followed these changes because both digital health care and digital therapeutics have increased much faster during pandemic times than before. The growth in 2020 compared to 2019 reached 53.9%, but in 2021 compared to 2020 it even accounted 74.7%. The Asian region and Europe have also seen a sharp increase in the leverage over the past two years, but pre-pandemic levels were significantly lower than in the United States. Average annual volumes of investments in digital health have increased by about 4.2 Bn$ per year in the USA, by about 1.2 Bn$ per year in Asia, by about 0.83 Bn$ per year in Europe and by about 0.15 Bn$ per year in other regions. Such demand and funding could boost new innovations in healthcare with web-based idea management systems by internal, external, and mixed approaches in organisations with active and passive IMS. Plus, IMS could become a tool to create innovations in product or organisational innovation.

The impact of internal climate variability on OH trends between 2005 and 2014

The hydroxyl radical (OH) lies at the nexus of climate and air quality as the primary oxidant for both reactive greenhouse gases and many hazardous air pollutants. To better understand the role of climate variability on spatiotemporal patterns of OH, we utilize a 13-member ensemble of the Community Earth System Model version 2-Whole Atmosphere Community Climate Model version 6 (CESM2-WACCM6), a fully coupled chemistry-climate model, spanning the years 1950–2014. Ensemble members vary only in their initial conditions of the climate state in 1950. We focus on the final decade of the simulation, 2005–2014, when prior studies disagree on the signs of the global OH trends. The ensemble mean global airmass-weighted mean tropospheric column OH ( ΩTOH ), which is an estimate of the forced signal, increases by 0.06%/year between 2005 and 2014 while regional ΩTOH trends range from −0.56%/year over Southern Europe to +0.64%/year over South America. We show that ten-year ΩTOH trends are strongly affected by internal climate variability, as the spread of ΩTOH trends across the ensemble varies between 0.23%/year in Asia and 1.53%/year in South America. We train a fully connected neural network to emulate the ΩTOH simulated by the CESM2-WACCM6 model and combine it with satellite observations to interpret the role of OH chemical proxies. While the OH chemical proxies are subject to internal variability, the impact of internal variability on ΩTOH trends is primarily due to the meteorological parameters except for South America. Forced trends in global mean ΩTOH do not unambiguously emerge from trends driven by internal variability over the 2005–2014 period. The observation-constrained ΩTOH presents opposite trends due to climate variability, resulting in varying conclusions on the attribution of OH to CH4 trends.

Prediction of Thrips Damage Distribution in Mango Orchards Using a Novel Maximum Likelihood Classifier

Thrips constitute the primary pest responsible for reducing mango yield and quality every year in Asia. Therefore, the efficient monitoring of thrips damage across mango orchards on a large scale to aid farmers in devising rational pesticide application strategies poses a significant challenge within the current mango industry. This study designs a mango thrips damage inversion prediction method based on the maximum likelihood classifier (MLC). Initially, drone multispectral remote sensing technology is utilized to acquire multispectral data from mango orchards, which are then combined with ground hyperspectral information to identify sensitive bands indicative of mango leaf damage caused by thrips. Subsequently, correlation analysis is conducted on various vegetation indices, leading to the selection of the Greenness Normalized Difference Vegetation Index (GNDVI), which exhibits a strong correlation coefficient of 0.82, as the spectral characteristic parameter for the inversion prediction model. The construction of a remote sensing prediction model for thrips damage distribution in mango orchards is then undertaken based on the MLC. Acknowledging the bias-variance trade-off inherent in the MLC when processing spectral data and its potential limitations in feature extraction and robustness, this study proposes a modification wherein neighboring pixels are weighted differently to enhance the model’s feature extraction capabilities. Experimental results show that the novel MLC maintains stable estimation levels across various numbers of domain pixels, achieving an inversion accuracy of 91.23%. Through the reconstruction of the pixel matrix, the damage distribution of thrips in mango orchards can be swiftly and comprehensively visualized over extensive areas.

P1082 A comparative analysis of persistence of advanced therapies among patients with Inflammatory Bowel Disease in Taiwan

Abstract Background The prevalence of inflammatory bowel disease (IBD) has been rapidly increasing in Asia. Advanced therapies have significantly improved outcomes for moderate to severe cases of IBD. With the expanding availability of advanced therapies, the selection of the most suitable treatment option has become crucial. Among various factors, treatment persistence holds paramount importance. We present the first study in Asia that compares real-world persistence rates among advanced therapies in IBD patients in Taiwan. Methods In this retrospective cohort study, we enrolled patients with IBD who were treated with five advanced therapies: infliximab (IFX), adalimumab (ADA), vedolizumab (VDZ), ustekinumab (UST), and tofacitinib (TOF) at Linkou Chang Gung Memorial Hospital between October 2017 and April 2023. UST followed a standard maintenance dosing frequency of every 12 weeks, while TOF was permitted for use only as a second-line treatment option for UC in Taiwan. We compared baseline data and drug persistence rates within the first 52 weeks for the overall group, biologic-naïve patients, and biologic-experienced patients. Results A total of 432 IBD patients were included, with 173 (40%) having ulcerative colitis (UC) and 259 (60%) having Crohn's disease (CD). The majority of patients were male, with a mean age of 43.6 years and a mean BMI of 22.6. UST showed the highest rate of dose escalation (22%). Across all five drugs, the primary reason of discontinuation was secondary loss of response, with IFX having the highest discontinuation rate due to side effects (20%). Other baseline characteristics were presented in Table 1. Kaplan-Meier analysis revealed that all biologics exhibited a persistence rate of over 50% within the initial 52 weeks. UST demonstrated the highest 52-week persistence rates in overall (87.88%, p < 0.001, Figure 1a), biologic-naïve (96.55%, p = 0.002, Figure 1b) and biologic-experienced CD patients (80.56%, p=0.043, Figure 1c). Although no statistically significant differences were observed between advanced therapies in overall UC patients and other subgroup analyses (Figure 1d-1f). VDZ showed highest 52-week persistence in overall (69.05%, p=0.078, Figure 1d) and biologic-experienced (60.87%, p=0.751, Figure 1f) UC patients. UST had highest 52-week persistence in biologic-naïve UC patients (100%, p=0.329, Figure 1e). Conclusion In this pioneering real-world comparison of advanced therapies across one year in Asia, UST exhibited superior 52-week persistence rates in CD patients. However, the rate of dose escalation in UST was also the highest among these therapies. The study's limitations include its single-center nature and relatively small sample size.

Pandemic potential of henipaviruses

Introduction and purpose. Hendra and Nipah are two highly dangerous zoonotic viruses belonging to the group of henipaviruses. Although they have been known for more than 20 years, no human drug or vaccine has been invented for them. The aim of this paper is to describe the epidemiology of the reported paramyxoviruses, the pandemic potential of henipaviruses and a standardised action plan to counter their spread. This paper is a review of scientific articles from 2012-2023 published in the scientific databases such as Pubmed, Researchgate and Google Scholar. The following keywords were used: pandemic potential of henipaviruses, Hendra virus, Nipah virus, henipavirus epidemics. Description of the state of knowledge. The mortality rate of henipaviruses varies between 50-100%. The Nipah virus is particularly dangerous, with epidemics recurring virtually every year in Asia since 1998. The Hendra virus situation is more manageable because there is an effective vaccine for horses, which are most vulnerable to infection. Through anthropogenic changes, the terrain and climate where the animals that are the reservoir of the virus are found are changing. Due to the numerous outbreaks of henipaviruses in areas of Asia and Australia, great care is being taken to quickly neutralise the outbreaks that occur. Conclusions. Due to the high pandemic threat from henipaviruses, more research into drugs and vaccines is required. It is also important to develop effective bio-assurance plans, introduce controls on their operation and educate the population on the issue. Reservoir animals, through anthropogenic changes in the environment, are changing habitats and feeding sites, making more and more territories vulnerable to the disease. New species of henipaviruses are emerging all the time, posing an epizootic challenge to public health, so a key action is to increase the amount of research into the epidemic development of the virus and to conduct it as widely as possible.

Medical populism and the politics of dengue epidemics in the Global South

ABSTRACT With millions of cases and thousands of deaths every year in Asia and Latin America, dengue fever continues to be of global public health significance. This article uses the concept of ‘medical populism’ to analyse the political construction of the 2019 dengue epidemics in Bangladesh, the Philippines, and Honduras. Through this framework, we examine the narratives of these outbreaks by reconstructing how political actors simplified the discourse, spectacularised the crises, offered multiple knowledge claims, and forged divisions between the people and ‘dangerous others’. Taken together, our case studies, obtained through government, journalistic, and scholarly sources, illuminate the role of medical populists (who are almost always politicians) in defining and responding to public health emergencies, underscoring the performative dimension of disease outbreaks. By detracting attention from less spectacular but more substantive policies and programs, these ‘performances’ of health crises perpetuate health inequities, especially in fragile democracies like the aforementioned Global South countries. We conclude by reflecting on the implications of medical populism to public health, health communications, and the inevitable recurrence of epidemics.

Estimates of temporal-spatial variability of wildfire danger across the Pan-Arctic and extra-tropics

Satellite-based hot-spot analysis for the Pan-Arctic, shows that Asia experiences a greater number of fires compared to North America and Europe. While hot spots are prevalent through the year in Asia, Europe (North America) exhibits marked annual (semi-annual) variability. The Potential Fire Danger index (PFIv2) demonstrates increased fire incidence vulnerability across the Arctic and extra-tropics. Though not significant in northwestern North America and eastern Asia, significant-positive trends across the mid-latitudes of Eurasia and Siberia are clear. PFIv2 accurately matches the regional distribution of observed fires, while the worldwide used Fire Weather Index does not. Fire danger has evolved as distributions of short-interval precipitation events and background vegetation characteristics change. In conjunction with increased population and expanded infrastructure, frequent extreme events may increase pressure for new settlements that lead to greater fire exposure across the Pan-Arctic. Thus, PFIv2 may be useful for decision planners and danger managers to anticipate and minimize the adverse effects of indiscriminate fire use.

Relationship between Particulate Matter (PM10) and Airway Inflammation Measured with Exhaled Nitric Oxide Test in Seoul, Korea.

Purpose Particulate matter (PM) is increasing every year in Asia. It is not fully understood how the airway is affected when inhaling PM. We investigated the correlation between particulate matter with a diameter of less than 10 μm (PM10) and fractional exhaled nitric oxide (FeNO) to determine whether PM causes airway inflammation. Material and Methods. We analyzed patients who visited our outpatient clinic and tested FeNO from January 2016 to December 2017 at the Korea University Guro Hospital. PM10 data were provided by the government of the Republic of South Korea, and measuring station of PM10 is located 800 meters from the hospital. We analyzed the correlation between PM10 and FeNO by a Pearson correlation analysis and by a multivariate linear regression analysis. To identify the most correlated times, we analyzed the correlation between the FeNO and PM10 daily average from the day of visit to 4 days before visit. Results FeNO positively correlated with PM10 at two days before hospital visit in the Pearson correlation (Pearson correlation coefficient = 0.057; P-value = 0.023) and in the multivariate linear regression analysis (B = 0.051, P-value = 0.026). If the PM10 increased by 100 μg/m3, the FeNO result was expected to rise to 8.3 ppb in healthy people without respiratory disease. Conclusion The positive correlation was found in both healthy people and asthmatic patients. Therefore, PM10 can increase airway inflammation.

Dementia Around the World and the Latin America and Mexican Scenarios.

Dementia has become a major public health concern around the world. Dementia risk factors are significantly different among countries. The number of new cases of dementia anticipated each year worldwide is almost 7.7 million, one new case every four seconds. There are 3.6 million (46%) new cases per year in Asia, 2.3 million (31%) in Europe, 1.2 million (16%) in the Americas, and 0.5 million (7%) in Africa. Latin American and Caribbean low and middle-income countries are at high risk. Air pollution is an important risk modifiable factor for dementia across the world, and the recent report of the Alzheimer's disease continuum in children and young adults residing in Metropolitan Mexico City along with the presence of cognitive impairment in 55% of the young adult population residing in Mexican cities with fine particulate matter concentrations above the current USEPA annual standard of 12 μg/m3 makes this a severe public health problem in progress. It is imperative to keep generating epidemiological data on dementia worldwide and their relationship with air pollutants to improve the strategies to face all the challenges associated with dementia and Alzheimer's disease in particular. Alzheimer's disease is a fatal disease, we have no cure, and we ought to invest in protecting our citizens by intervening in modifiable environmental factors.

“Trump’s First Year in Asia: Accelerating a Long-term Trend”

What has been the impact of Donald J. Trump’s presidency on the place of the United States in East Asia? Trump already has shown a proclivity for upending the mainstream American consensus about grand strategy to East Asia, with the real possibility of a trade war with China or a shooting war with North Korea on the horizon. However, this article will place President Trump’s first year in office into a larger context of long-term decline of U.S. leadership and influence in East Asia, arguing that this trend has been underway for quite some time, and that Trump has not altered fundamentally this trajectory. Some of Trump’s actions may accelerate a decline in U.S. leadership, but by no means was Trump the first nor will he be the last U.S. president to deal with a swiftly changing East Asia. The region has been changing rapidly for decades, and there are no indications that this will stop anytime soon. However, continuing and gradual U.S. withdrawal from leadership does not mean less American-East Asia interaction. East Asia will remain the most important trading and investment region for the U.S. for the foreseeable future.

Structural basis for neutralization of Japanese encephalitis virus by two potent therapeutic antibodies.

Japanese encephalitis virus (JEV), closely related to dengue, Zika, yellow fever and West Nile viruses, remains neglected and not well characterized 1 . JEV is the leading causative agent of encephalitis, and is responsible for thousands of deaths each year in Asia. Humoral immunity is essential for protecting against flavivirus infections and passive immunization has been demonstrated to be effective in curing disease2,3. Here, we demonstrate that JEV-specific monoclonal antibodies, 2F2 and 2H4, block attachment of the virus to its receptor and also prevent fusion of the virus. Neutralization of JEV by these antibodies is exceptionally potent and confers clear therapeutic benefit in mouse models. A single 20 μg dose of these antibodies resulted in 100% survival and complete clearance of JEV from the brains of mice. The 4.7 Å and 4.6 Å resolution cryo-electron microscopy structures of JEV-2F2-Fab and JEV-2H4-Fab complexes, together with the crystal structure of 2H4 Fab and our recent near-atomic structure of JEV 4 , unveil the nature and location of epitopes targeted by the antibodies. Both 2F2 and 2H4 Fabs bind quaternary epitopes that span across three adjacent envelope proteins. Our results provide a structural and molecular basis for the application of 2F2 and 2H4 to treat JEV infection.

Near-atomic structure of Japanese encephalitis virus reveals critical determinants of virulence and stability

Although several different flaviviruses may cause encephalitis, Japanese encephalitis virus is the most significant, being responsible for thousands of deaths each year in Asia. The structural and molecular basis of this encephalitis is not fully understood. Here, we report the cryo-electron microscopy structure of mature Japanese encephalitis virus at near-atomic resolution, which reveals an unusual “hole” on the surface, surrounded by five encephalitic-specific motifs implicated in receptor binding. Glu138 of E, which is highly conserved in encephalitic flaviviruses, maps onto one of these motifs and is essential for binding to neuroblastoma cells, with the E138K mutation abrogating the neurovirulence and neuroinvasiveness of Japanese encephalitis virus in mice. We also identify structural elements modulating viral stability, notably Gln264 of E, which, when replaced by His264 strengthens a hydrogen-bonding network, leading to a more stable virus. These studies unveil determinants of neurovirulence and stability in Japanese encephalitis virus, opening up new avenues for therapeutic interventions against neurotropic flaviviruses.

The First to Leave Is the Winner

The First to Leave Is the Winner Becky Mandelbaum (bio) Click for larger view View full resolution Photo by Anna and John Wilderson [End Page 132] For a brief period in my late twenties, I lived alone on a horse ranch at 9,500 feet in the San Juan Mountains. The closest human heartbeat was thirteen miles away, the nearest airport two hundred. The altitude gave me vertigo [End Page 133] and headaches and months of spectacular, disturbing dreams, but it was worth it for the sky, which was grandiose and constantly changing, a lava lamp let loose of its goblet. Never had I seen a sky like that, and I haven’t seen one since. Granted, I haven’t been looking. The ranch belonged to an ex-boyfriend of mine who was spending the year in Asia to find himself. From his itinerary, I concluded that finding oneself was best achieved in boutique hotels, five-star resorts, and spas named after rare tropical plants. To be fair, his beautiful young wife had just died from a brain bleed. One moment she was chopping a sweet onion, saying she felt funny, and the next she was dead. Just like that, an opening in the earth. “I’m so sorry, Ellison,” was what I told him when I got there. I was in a mild state of shock at the beauty of the place. Not only had he left me for another woman, but he’d been out here, living with her in paradise. There were mountains and fields of desert lupine and, just across the gravel road, the Rio Grande, which shone in the sun like a great diamond necklace cast down by a jilted lover. This was autumn, the aspens dripping with pompous starlight. Not to mention the house, which was something from a page of Country Living. The kitchen was all blond wood and chrome, multicolored vases filled with dried baby’s breath and sage. My own kitchen, in the little apartment I’d left behind in Denver, had stacks of bills and boxes of Grape Nuts from 2004. The only decoration was a plaque above the stove that read live, love, laugh, a mantra that made me genuinely gag if I read it after having a bad day, which, at this particular juncture in my life, could be any day. Once, I smashed a pregnant spider on the plaque and the babies went everywhere; instead of trying to kill all one thousand of them, I went out for a cheeseburger. I was surprised and a little annoyed to find that, despite his dead wife, Ellison looked as handsome as ever. He had always been like a human cinnamon roll, bronzed and sweet. Standing in the ranch kitchen, he wore his grief like a glaze that made you want to put your tongue against his neck and keep it there. I thought of the time, early in our relationship, when I was trying to decide what to eat for dinner and the thought legitimately crossed my mind that I was hungry for him, Ellison—that I wanted to put him in a bowl and eat him like soup. I made the mistake of telling him about it. “That’s the creepiest thing I’ve ever heard,” he said and refused to kiss me for a week. It had disappointed me that he mistook my romance for cannibalism and also made me wonder if there was something wrong with the way I loved. [End Page 134] “You don’t have to pretend to be sad,” he said. “I know you never liked Gloria.” “To be fair, I never knew her—you never gave us the chance.” As far as I knew, nobody from our old life had met her. Their wedding was a small, Pinterest-inspired affair that took place primarily on Instagram. “Maybe you would have liked her, then. Everybody liked her. She was one of those people.” “Well,” I said, astounded that there was still a part of my heart he could break, “it’s possible she wouldn’t have liked me. But I guess we’ll never know now, will we?” Once he was gone, without...

Ecosystem Service Changes and Livelihood Impacts in the Maguri-Motapung Wetlands of Assam, India

Wetlands provide a diverse range of ecosystem services supporting livelihoods of many people. Despite their value, wetlands are continuously being degraded. There is scant information on individual wetlands, people’s dependency and their exploitation at a local scale. We therefore assessed wetland ecosystem services, the drivers of change and impacts of those drivers on ecosystem services and people’s dependency through a case study of the Maguri-Motapung Beel wetlands of Assam, India. Both qualitative and quantitative data were collected through household surveys, focus group discussions, key informant interviews and community workshops. The analyses showed a total of 29 ecosystem services, and high dependency on these with five out of seven livelihood strategies sourced from ecosystem services. Over-exploitation of wetland resources and siltation were reported as the major direct drivers of change with impacts on both ecosystem services and people’s livelihoods. Drastic decreases in availability of thatch, fish stocks, fodder and tourism were observed. This suggests that there is an urgent need for a comprehensive participatory management plan. Actions are needed to maintain the Maguri-Motapung Beel wetlands and the flow of services in order to sustain people’s livelihoods in the area. With an estimated 50% global loss of wetlands in the last century and the loss of 5,000 square kilometers a year in Asia alone, the loss of ecosystem services and livelihood impacts shown in our study may be typical of what is occurring in the region and perhaps globally.

An outbreak of cholera in Medipally village, Andhra Pradesh, India, 2013.

BackgroundCholera continues to remain endemic in over 50 countries and has caused large epidemics with around 3–5 million cases occurring every year in Asia alone. In India, cholera is endemic in many states. However, etiological information and age-specific incidence related to cholera outbreaks is limited. In November 2013, district authorities reported a cluster of diarrheal disease among residents of Medipally to the state surveillance unit. We investigated this cluster to confirm its etiology, describe its magnitude, identify potential risk factors, and make recommendations for control.FindingsA house-to-house active search was conducted to identify cases of acute diarrhea and collect information on drinking water source. Drinking water samples were collected from common water sources and sampled households to test for bacteriological quality. Ten stool samples were collected for culture. A matched case–control study was conducted to identify the risk factors. A total of 138 case-patients of diarrhea (Attack rate: 11.5/100; Population: 15 1,200) and 1 death (Case Fatality Ratio: 0.72/100) were identified. Five of the 10 stool samples were culture positive for V. cholerae, serogroup O1 El Tor. Drinking water from the overhead tank [Adjusted OR (AOR): 31.94, 95 % CI: 7.3-139.5] was associated with risk of developing illness.ConclusionsThis outbreak affected nearly 11% of the village population and was due to contamination of the main drinking water source. Outbreaks such as this can be prevented by constructing the drain away from the water pipelines and by monitoring regular chlorination of drinking water source and inspection of pipelines for damage.

A systems thinking approach to address the complex issue of plastic surgery in South Korea

Bodily shape and facial appearances which do not remain the same with aging varies across culture and continents and these are impacted by racism, class prejudice and ableism. As a result many people with less self-esteem resort to varying beauty therapy including plastic surgery. More than 5.8 million enhancements with photos of celebrities to emulate them are done by people every year in Asia. But people who are dissatisfied request repeat procedures or experience depression and adjustment problems, social isolation, family problems, self-destructive behaviours and anger toward the surgeon and staffs. To date, no solution has been put into place to reduce the number of plastic surgeries. This study therefore uses a systems thinking approach to identify the key variables that are affecting this trend. Casual loop diagrams developed reveal and foster integrated planning for governments to intervene the lustic interest in plastic surgery to minimise negative consequences and reduce impersonations and the wrong motives such as; undergoing plastic surgery to achieve success in life. The Bayesian models developed will help decision makers anticipate the long-term consequences of their decisions and actions, as well as avoid the unintended consequences of plastic surgery on the health system.

Expanding Poliomyelitis and Measles Surveillance Networks to Establish Surveillance for Acute Meningitis and Encephalitis Syndromes—Bangladesh, China, and India, 2006-2008

Quality surveillance is critical to the control and elimination of vaccine-preventable diseases (VPDs). A key strategy for enhancing VPD surveillance, outlined in the World Health Organization (WHO) Global Framework for Immunization Monitoring and Surveillance (GFIMS), is to expand and link existing VPD surveillance systems (particularly those developed for polio eradication and measles elimination) to include other priority VPDs. Since the launch of the Global Polio Eradication Initiative in 1988, the incidence of polio has decrease by 99% worldwide. A cornerstone of this success is a sensitive surveillance system based on the rapid and timely reporting of all acute flaccid paralysis (AFP) cases in children aged <15 years, with confirmatory diagnostic testing performed by laboratories that are part of a global network. As countries achieve polio-free status, many have expanded syndromic surveillance to include persons with rash and fever, and have built measles diagnostic capacity in existing polio reference laboratories. Acute meningitis/encephalitis syndrome (AMES) and acute encephalitis syndrome (AES) are candidates for expanded surveillance because they are most often caused by VPDs of public health importance for which confirmatory laboratory tests exist. Vaccine-preventable cases of encephalitis include approximately 68,000 Japanese encephalitis (JE) cases, resulting in 13,000-20,000 deaths each year in Asia. Moreover, although bacterial meningitis incidence in Asia is not as well-documented, pneumococcal and meningococcal meningitis outbreaks have been reported in Bangladesh and China, and the incidence of Haemophilus influenzae type b (Hib) meningitis in children aged <5 years in India has been estimated to be 7.1 per 100,000 population, similar to that in European countries before the introduction of vaccine. This report describes a prototype for expanding existing polio and measles surveillance networks in Bangladesh, China, and India to include surveillance for viral and bacterial vaccine-preventable causes of AMES and AES and presents data from 2006-2008.

PIN6 Japanese Encephalitis in Asia: Clinical Burden and Cost-Effectiveness of Vaccination Program

To report clinical burden of Japanese encephalitis (JE) in Asia and cost-effectiveness of JE vaccination program. Systematic literature searches were conducted using Embase®, MEDLINE®, WHO, and Google scholar platforms to identify relevant studies in patients with JE. Eligibility of trials was assessed by two reviewers with any discrepancy reconciled by a third, independent reviewer. A total of 10 studies out of 41 retrieved, met the inclusion criteria for the clinical review. Approximately 35,000-50,000 JE cases and 10,000–15,000 deaths due to JE were reported every year in Asia. Incidence of JE was high in China and India, with China accounting for 50% of the JE cases reported worldwide. The incidence of JE in China was reported to be 0.01-1.53 residents/year/100,000. The number of JE cases reported in China, India, Nepal, Sri Lanka, and Bangladesh were 5,000-10,000, 1,500-4,000, 1,000-3,000, 100-200, and 56, respectively. JE caused 12,038 and 2,496 deaths in Southeast Asia and Western Pacific, respectively (2008). JE was associated with 491,797 disability-adjusted life years (DALYs) in the Southeast Asia and 185,573 DALYs in the Western Pacific region (2004). Four studies out of 59 retrieved, met the eligibility criteria for evaluating cost-effectiveness of JE vaccination. JE vaccination prevented 117 cases and 12 deaths (Vietnam), 103 cases and 18 deaths (Thailand), 420 cases and 105 deaths (China), and 175-316 cases and 36-65 deaths (India). Total savings in the direct medical costs witnessed as a consequence of JE vaccination were $51,122 (Vietnam), $58,776 (Thailand), $614,762 (China), and $178,558-$319,627 (India). JE has lead to significant morbidity in survivors and mortality in Asian countries. Existing evidence from cost-effectiveness studies demonstrated that vaccination program markedly reduced the burden of JE in Asia.

Burden of rotavirus gastroenteritis and distribution of rotavirus strains in Asia: A systematic review

Rotavirus is the leading cause of severe diarrhea in children worldwide. We systematically reviewed the burden of rotavirus gastroenteritis (RVGE) and distribution of rotavirus strains in Asia. We searched MEDLINE, EMBASE and the World Health Organization (WHO) website for the term "rotavirus" and the name of each country. We included studies that were conducted in children between 2000 and 2011 and that examined the epidemiology, health and/or economic burden of RVGE, and G and P-type distribution in Eastern, South East, Southern and Central Asia. Random effects models were used to pool the proportions of RVGE. We also estimated child mortality due to RVGE using the updated WHO and United Nations Children's Fund's mortality estimates in 2008. The search identified 113 eligible articles. The incidence rates of rotavirus-related hospitalizations in children under 5 years of age ranged from 2.1 to 20.0 cases per 1000 children per year with the highest rates reported in Bangladesh, South Korea, Taiwan, Thailand, and Vietnam. Rotavirus accounted for 37.5% of year-round hospitalized gastroenteritis cases, with higher proportions reported in South East Asia. Rotavirus was associated with approximately 145,000 deaths every year in Asia, with the greatest numbers occurring in India, Pakistan, and Indonesia. The highest annual societal costs of treating RVGE were reported in China (US$365 million), followed by Japan (US$254 million) and India (US$41-72 million). A diversity of rotavirus G and P-types was observed across Asia and the distribution of strains differed by country and year. The most common strains were G1P[8] (23.6%), G2P[4] (11.8%), G3P[8] (18.9%), and G9P[8] (7.4%). Rotavirus is associated with substantial hospitalizations and deaths among children and causes large healthcare expenditures throughout Asia. Safe and effective rotavirus vaccines could substantially reduce the burden of disease.

The Perennial Reform: Fixing School Time

In the past quarter century, reformers have repeatedly urged schools to fix their use of time, even though it is a solution that is least connected to what happens in classrooms or what Americans want from public schools. Since A Nation at Risk in 1983, Prisoners of Time in 1994, and the latest blue-ribbon recommendations in Tough Choices, Tough Times in 2007, both how much time and how well students spend it in school has been criticized no end. (2) Business and civil leaders have been critical because they see U.S. students stuck in the middle ranks on international tests. These leaders believe that the longer school year in Asia and Europe is linked to those foreign students scoring far higher than U.S. students on those tests. Employers criticize the amount of time students spend in school because they wonder whether the limited days and hours spent in classes are sufficient to produce the skills that employees need to work in a globally competitive economy. Employers also wonder whether our comparatively short school year will teach the essential workplace behaviors of punctuality, regular attendance, meeting deadlines, and following rules. Parents criticize school schedules because they want schools to be open when they go to work in the morning and to remain open until they pick up their children before dinner. Professors criticize policy makers for allotting so little time for teachers to gain new knowledge and skills during the school day. Other researchers want both policy makers and practitioners to distinguish between requiring more time in school and academic learning time, academic jargon for those hours and minutes where teachers engage students in learning content and skills or, in more jargon, time on task. (3) Finally, cyberschool champions criticize school schedules because they think it's quaint to have students sitting at desks in a building with hundreds of other students for 180 days when a revolution in communication devices allows children to learn the formal curriculum in many places, not just in school buildings. Distance learning advocates, joined by those who see cyberschools as the future, want children and youths to spend hardly any time in K-12 schools. (4) TIME OPTIONS Presidential commissions, parents, academics, and employers have proposed the same solutions, again and again, for fixing the time students spend in school: Add more days to the annual school calendar. Change to year-round schools. Add instructional time to the daily schedule. Extend the school day. What has happened to each proposal in the past quarter century? Longer School Year. Recommendations for a longer school year (from 180 to 220 days) came from A Nation at Risk (1983) and Prisoners of Time (1994) plus scores of other commissions and experts. In 2008, a foundation-funded report, A Stagnant Nation: Why American Students Are Still at Risk, found that the 180-day school year was intact across the nation and only Massachusetts had started a pilot program to help districts lengthen the school year. The same report gave a grade of F to states for failing to significantly expand student learning time. (5) Year-Round Schools. Ending the break is another way to maximize student time in school. There is a homespun myth, treated as fact, that the annual school calendar, with three months off for both teachers and students, is based on the rhythm of 19th-century farm life, which dictated when school was in session. Thus, planting and harvesting chores accounted for long breaks, an artifact of agrarian America. Not so. Actually, vacations grew out of early 20th-century urban middle-class parents (and later lobbyists for camps and the tourist industry) pressing school boards to release children to be with their families for four to eight weeks or more. By the 1960s, however, policy maker and parent concerns about students losing ground academically during the vacation months--in academic language, summer loss--gained support for year-round schooling. …