Lateral Epicondylitis: Critical Analysis Review of Current Nonoperative Treatments.

¼: Lateral epicondylitis (LE) or tennis elbow is a common cause of elbow pain in the general population, especially women in the fourth and fifth decades of life who participate in repetitive forceful movements involving the wrist and forearm. ¼: The pathogenesis of this overuse injury is believed to start from an overload event leading to a microtear in or near the origin of the extensor carpi radialis brevis that is subsequently prone to additional injury and structural weakness over time. ¼: Treatment of LE often begins with a wide variety of nonoperative modalities including rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy. For recalcitrant symptoms, additional nonoperative therapies are implemented; however, there remains a lack of comparative efficacy between these adjunct treatments. ¼: In this article, we examine the available literature regarding nonoperative management of LE and provide supplementary insight into the effectiveness of current modalities.

Moving beyond the Technology: A Socio-technical Roadmap for Low-Cost Water Sensor Network Applications.

In this paper, we critically review the current state-of-the-art for sensor network applications and approaches that have developed in response to the recent rise of low-cost technologies. We specifically focus on water-related low-cost sensor networks, and conceptualize them as socio-technical systems that can address resource management challenges and opportunities at three scales of resolution: (1) technologies, (2) users and scenarios, and (3) society and communities. Building this argument, first we identify a general structure for building low-cost sensor networks by assembling technical components across configuration levels. Second, we identify four application categories, namely operational monitoring, scientific research, system optimization, and community development, each of which has different technical and nontechnical configurations that determine how, where, by whom, and for what purpose low-cost sensor networks are used. Third, we discuss the governance factors (e.g., stakeholders and users, networks sustainability and maintenance, application scenarios, and integrated design) and emerging technical opportunities that we argue need to be considered to maximize the added value and long-term societal impact of the next generation of sensor network applications. We conclude that consideration of the full range of socio-technical issues is essential to realize the full potential of sensor network technologies for society and the environment.

Buying time: Drug repurposing to treat the host in COVID-19H.

In 2016 Fedson stated …. "For almost two decades, leading scientists and health officials have warned that we must prepare for a potentially devastating global pandemic of an infectious disease. Initial concern was focused on …H5N1…. More recently…a devastating outbreak of Ebola virus..(and) several other emerging viruses are believed to seriously threaten global health and global security. To prepare, scientists have been urged to discover new vaccines and treatments for these emerging viruses. At the same time, political leaders have been urged by global health experts to invest millions in a "top down" restructuring of the global health system. This article takes a different view. It focuses on an alternative approach to the scientific discovery of treatments for individual patients, reviews the mechanisms of action and clinical experience with specific drugs that might be useful, and considers whether or not recent lessons regarding this "bottom up" approach to treatment have been learned". Now with a new virus and pandemic upon us, Fedson's 2016 comments appear chilling, are cause for reflection on what we have learnt and importantly offer focus on an immediate opportunity in the area of treating the host (Fedson DS, Ann Transl Med, 2016;4:421).

Preparing for genomic medicine: a real world demonstration of health system change.

Organisations and governments seeking to implement genomics into clinical practice face numerous challenges across multiple, diverse aspects of the health care system. It is not sufficient to tackle any one aspect in isolation: to create a system that supports genomic medicine, they must be addressed simultaneously. The growing body of global knowledge can guide decision-making, but each jurisdiction or organisation needs a model for genomic (or personalised) medicine that is tailored to its unique context, its priorities and the funds available. Poor decisions could greatly reduce the benefits that could potentially arise from genomic medicine. Demonstration projects enable models to be tested, providing valuable evidence and experience for subsequent implementation. Here, we present the Melbourne Genomics Health Alliance demonstration project as an exemplar of a collaborative, holistic approach to phased implementation of genomics across multiple autonomous institutions. The approach and lessons learned may assist others in determining how best to integrate genomics into their healthcare system.

Erratum: Preparing for genomic medicine: a real world demonstration of health system change.

[This corrects the article DOI: 10.1038/s41525-017-0017-4.].

Probabilistic modelling of prospective environmental concentrations of gold nanoparticles from medical applications as a basis for risk assessment.

BACKGROUND: The use of gold nanoparticles (Au-NP) based medical applications is rising due to their unique physical and chemical properties. Diagnostic devices based on Au-NP are already available in the market or are in clinical trials and Au-NP based therapeutics and theranostics (combined diagnostic and treatment modality) are in the research and development phase. Currently, no information on Au-NP consumption, material flows to and concentrations in the environment are available. Therefore, we estimated prospective maximal consumption of Au-NP from medical applications in the UK and US. We then modelled the Au-NP flows post-use and predicted their environmental concentrations. Furthermore, we assessed the environment risks of Au-NP by comparing the predicted environmental concentrations (PECs) with ecological threshold (PNEC) values. RESULTS: The mean annual estimated consumption of Au-NP from medical applications is 540 kg for the UK and 2700 kg for the US. Among the modelled concentrations of Au-NP in environmental compartments, the mean annual PEC of Au-NP in sludge for both the UK and US was estimated at 124 and 145 µg kg(-1), respectively. The mean PEC in surface water was estimated at 468 and 4.7 pg L(-1), respectively for the UK and US. The NOEC value for the water compartment ranged from 0.12 up to 26,800 µg L(-1), with most values in the range of 1000 µg L(-1). CONCLUSION: The results using the current set of data indicate that the environmental risk from Au-NP used in nanomedicine in surface waters and from agricultural use of biosolids is minimal in the near future, especially because we have used a worst-case use assessment. More Au-NP toxicity studies are needed for the soil compartment.

Evaluating adaptive governance approaches to sustainable water management in north-west Thailand.

Adaptive governance is advanced as a potent means of addressing institutional fit of natural resource systems with prevailing modes of political-administrative management. Its advocates also argue that it enhances participatory and learning opportunities for stakeholders over time. Yet an increasing number of studies demonstrate real difficulties in implementing adaptive governance 'solutions'. This paper builds on these debates by examining the introduction of adaptive governance to water management in Chiang Mai province, north-west Thailand. The paper considers, first, the limitations of current water governance modes at the provincial scale, and the rationale for implementation of an adaptive approach. The new approach is then critically examined, with its initial performance and likely future success evaluated by (i) analysis of water stakeholders' opinions of its first year of operation; and (ii) comparison of its governance attributes against recent empirical accounts of implementation difficulty and failure of adaptive governance of natural resource management more generally. The analysis confirms the potentially significant role that the new approach can play in brokering and resolving the underlying differences in stakeholder representation and knowledge construction at the heart of the prevailing water governance modes in north-west Thailand.