As products of the waves of deregulation and liberalization of trade and investments in the region in the 1980s and mid-1990s, special economic zones (SEZs) have emerged as an important tool of ...economic governance in East and Southeast Asia. Recently, governments and investors around the region, have favored multi-purpose SEZs conceived for land and real estate development which exhibit several similarities such as eliciting tourism as the main driver of local development and a declared “eco” and “green” configuration. The Incheon Free Economic Zone (IFEZ) in the Republic of Korea (ROK) and the Van Don SEZ in the Socialist Republic of Vietnam (SRV) are two illustrative cases of urban policy diffusion as a complex phenomenon combining the ROK’s increased international activism and SRV’s own institutional structure and preferences in terms of development goals. Based on a close reading of reports, official documents, qualitative interviews and site visits, this article will further contribute to the debate on the complexity of urban policy diffusion in contemporary East and Southeast Asia.
Since two major earthquakes that hit Central Italy and northeastern Japan in 2009 and 2011 respectively, revisionist plans to make both countries urbanization models and power production and ...distribution systems more sustainable and resilient have emerged. The governments of both Italy (with the support of the European Union) and Japan have invested considerable resources in establishing model smart communities in disaster-hit areas in L'Aquila and Aizuwakamatsu. How has the smart city idea (or ideal) shaped local policies for reconstruction and recovery in disaster-affected areas? Secondly, how have they contributed to informing cooperation at the international level? These questions are relevant in the light of Japan and the European Union's pledges to strengthen their bilateral cooperation in smart cities and communities development in the context of the Covid-19 pandemic and war in Ukraine. With the launch of subsequent overarching strategies both the EU and Japan have shown their resolve to promote structural reforms through digitalization and cutting-hedge technology, in the attempt to foster economic recovery while promoting 'sustainable economic growth'. However, such narrative, common to many advanced capitalist societies, appears instrumental to concealing plans to restructure environments and social arrangements while enhancing for-profit capital restructuring and better surveillance. Keywords: smart city, post-disaster recovery, EU, Italy, Japan, ICT
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In recent years, “smart city” has become a buzzword in discussions about urbanisation. While in Europe and North America the initial utopian optimism has now receded, due to booming implementation ...costs and surveillance concerns, the smart city model has taken root in rapidly urbanising Asia in particular, thanks to the activism of China and Japan. For the latter, smart city technologies and technical know-how represent the new frontier of export goods. In April 2018, the Government of Japan and that of the Socialist Republic of Vietnam announced the construction of a new smart city on the outskirts of the Vietnamese capital Hanoi that is set to become Japan’s largest ODA project to date. Despite changes in the global hegemonic narratives on smart cities, the new project bears the features of an urban settlement that revolves around technological data collection for the sake of perfect efficiency, rather than for its prospective inhabitants. Against this backdrop, how did the Government of Japan succeed in constructing a convincing narrative for made-in-Japan smart cities? Since 2011, thanks to specific initiatives by Japan’s government and investments by Japanese tech companies in the sector, a Japanese discourse on smart cities has emerged. Through an examination of earlier critiques of the smart city model and a close analysis of official policies and books by energy policy intellectuals, this paper will identify the main features of the Japanese discourse on smart cities and place it in the context of an evolving broader global narrative. The study demonstrates how the Japanese discourse on smart cities largely reflects a corporate managerial vision of the city and, at the same time, a “technonationalist” approach that informs the country’s foreign policy.
Objectives
Overdiagnosis, the detection through screening of a breast cancer that would never have been identified in the lifetime of the woman, is an adverse outcome of screening. We aimed to ...determine an estimate range for overdiagnosis of breast cancer in European mammographic service screening programmes.
Methods
We conducted a literature review of observational studies that provided estimates of breast cancer overdiagnosis in European population-based mammographic screening programmes. Studies were classified according to the presence and the type of adjustment for breast cancer risk (data, model and covariates used), and for lead time (statistical adjustment or compensatory drop). We expressed estimates of overdiagnosis from each study as a percentage of the expected incidence in the absence of screening, even if the variability in the age range of the denominator could not be removed. Estimates including carcinoma in situ were considered when available.
Results
There were 13 primary studies reporting 16 estimates of overdiagnosis in seven European countries (the Netherlands, Italy, Norway, Sweden, Denmark, UK and Spain). Unadjusted estimates ranged from 0% to 54%. Reported estimates adjusted for breast cancer risk and lead time were 2.8% in the Netherlands, 4.6% and 1.0% in Italy, 7.0% in Denmark and 10% and 3.3% in England and Wales.
Conclusions
The most plausible estimates of overdiagnosis range from 1% to 10%. Substantially higher estimates of overdiagnosis reported in the literature are due to the lack of adjustment for breast cancer risk and/or lead time.
Summary Background Human papillomavirus (HPV) testing is known to be more sensitive, but less specific than cytology for detecting cervical intraepithelial neoplasia (CIN). We assessed the efficacy ...of cervical-cancer screening policies that are based on HPV testing. Methods Between March, 2004, and December, 2004, in two separate recruitment phases, women aged 25–60 years were randomly assigned to conventional cytology or to HPV testing in combination with liquid-based cytology (first phase) or alone (second phase). Randomisation was done by computer in two screening centres and by sequential opening of numbered sealed envelopes in the remaining seven centres. During phase one, women who were HPV-positive and aged 35–60 years were referred to colposcopy, whereas women aged 25–34 years were referred to colposcopy only if cytology was also abnormal or HPV testing was persistently positive. During phase two, women in the HPV group were referred for colposcopy if the HPV test was positive. Two rounds of screening occurred in each phase, and all women had cytology testing only at the second round. The primary endpoint was the detection of grade 2 and 3 CIN, and of invasive cervical cancers during the first and second screening rounds. Analysis was done by intention to screen. This trial is registered, number ISRCTN81678807. Findings In total for both phases, 47 001 women were randomly assigned to the cytology group and 47 369 to HPV testing. 33 851 women from the cytology group and 32 998 from the HPV-testing group had a second round of screening. We also retrieved the histological diagnoses from screening done elsewhere. The detection of invasive cervical cancers was similar for the two groups in the first round of screening (nine in the cytology group vs seven in the HPV group, p=0·62); no cases were detected in the HPV group during round two, compared with nine in the cytology group (p=0·004). Overall, in the two rounds of screening, 18 invasive cancers were detected in the cytology group versus seven in the HPV group (p=0·028). Among women aged 35–60 years, at round one the relative detection (HPV vs cytology) was 2·00 (95% CI 1·44–2·77) for CIN2, 2·08 (1·47–2·95) for CIN3, and 2·03 (1·60–2·57) for CIN2 and 3 together. At round two the relative detection was 0·54 (0·23–1·28) for CIN2, 0·48 (0·21–1·11) for CIN3, and 0·51 (0·28–0·93) for CIN2 and 3 together. Among women aged 25–34 years, there was significant heterogeneity between phases in the relative detection of CIN3. At round one the relative detection was 0·93 (0·52–1·64) in phase one and 3·91 (2·02–7·57) in phase two. At round two the relative detection was 1·34 (0·46–3·84) in phase one and 0·20 (0·04–0·93) in phase two. Pooling both phases, the detection ratio of CIN2 for women aged 25–34 years was 4·09 (2·24–7·48) at round one and 0·64 (0·23–1·27) at round two. Interpretation HPV-based screening is more effective than cytology in preventing invasive cervical cancer, by detecting persistent high-grade lesions earlier and providing a longer low-risk period. However, in younger women, HPV screening leads to over-diagnosis of regressive CIN2. Funding European Union, Italian Ministry of Health, Regional Health Administrations of Piemonte, Tuscany, Veneto and Emilia-Romagna, and Public Health Agency of Lazio.
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Colorectal cancer (CRC) screening using the fecal occult blood test (FOBT) has been shown to be effective in reducing cause-specific mortality. However, although it detects pre-cancerous adenomas, it ...is uncertain whether FOBT reduces the incidence of invasive cancer. The objective is to evaluate the impact of screening with immunochemical FOBT (FIT) on CRC incidence and mortality.
An organized screening program was implemented in 2005 in the province of Reggio Emilia (Northern Italy). The program invites the resident population aged 50-69 for FIT every 2 years. Subjects who test positive are referred for colonoscopy. Incidence was studied through cancer registry. Person-times of people aged 50-74 from 1997 to 2012 were classified for exposure to screening according to age and period. Furthermore, two open cohorts-one never screened (aged 50-69 in 1997) and one invited for screening (aged 50-69 in 2005)-were followed up for 8 years.
A total of 171,785 people have been invited, and approximately 70% have undergone FIT at least once (272,197 tests). The rate of colonoscopy participation has been about 90%, and 2896 cancers have been recorded (1237 in the screening period). The age-adjusted and sex-adjusted incidence rate ratios as compared with pre-screening were 1.60 (95% confidence interval (CI), 1.43-1.79), 0.86 (95% CI, 0.78-0.94), and 0.59 (95% CI, 0.50-0.69) for the first round, subsequent rounds, and post screening, respectively. Cumulative incidence and incidence-based mortality decreased by 10% (95% CI, 3-17%) and 27% (95% CI, 15-37%), respectively.
FIT screening leads to a decrease in the incidence of CRC and in its mortality.
Background:
Contrast-enhanced intraoperative ultrasonography (CEIOUS) and indocyanine green fluorescence were interesting tool for the visualization of intrahepatic neoplastic nodules. The ...combinations of the 2 technologies could increase tumor detection and the radicality of resection, allowing the use of a pure laparoscopic approach.
Methods:
The patient was an 81-year-old man with a history of hypertension and treated hepatitis C infection, with a sustained serological response from 2018, previously undergoing laparotomic resection for hepatocellular carcinoma (HCC) in segment 8.
During his regular hepatological follow-up, a 25 mm nodule was detected in segment 1, in a retrocaval position. Considering clinical presentation, good liver function (Child A5—MELD 8) and imaging, pure laparoscopic resection of the caudate lobe was performed using fluorescence imaging and CEIOUS navigation guidance.
Results:
The operation last for 205 minutes. Blood loss was 100 mL and no blood transfusion was required. She resumed diet on the next day and was discharged 4 days after the operation. Histopathologic examination showed 27 mm HCC with a clear margin. Contrast computed tomography scan performed 3 months after the operation showed no recurrence of the disease.
Conclusions:
A laparoscopic isolated caudate resection for HCC located in the retrocaval portion of the cirrhotic liver seems to be feasible in selected patients and fluorescence imaging and CEIOUS navigation guidance could guarantee a safe and successful surgery.
In this trial, investigators tested the effect of prostate-specific–antigen testing on the death rate from prostate cancer in more than 162,000 men between the ages of 55 and 69 years in seven ...European countries. A significant reduction in prostate-cancer mortality was found after a median follow-up of 9 years. Overdiagnosis and overtreatment were important limitations of the screening program.
Measurement of serum prostate-specific antigen (PSA), a biomarker for prostate cancer,
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is useful for the detection of early prostate cancer.
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Nevertheless, the effect of PSA-based screening on prostate-cancer mortality remains unclear.
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The European Randomized Study of Screening for Prostate Cancer (ERSPC) was initiated in the early 1990s to determine whether a reduction of 25% in prostate-cancer mortality could be achieved by PSA-based screening.
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Preliminary data from this study have been published and can be accessed at www.erspc.org. Another randomized screening trial in the United States, the Prostate, Lung, Colon, and Ovarian (PLCO) Cancer Screening Trial, was initiated around the same . . .
Abstract Background The European Randomized Study of Screening for Prostate Cancer (ERSPC) has shown a 21% reduction in prostate cancer (PCa) mortality and a 1.6-fold increase in PCa incidence with ...prostate-specific antigen (PSA)-based screening (at 13 yr of follow-up). We evaluated PCa incidence by risk category at diagnosis across the study arms to assess the potential impact on PCa mortality. Design, setting, and participants Information on arm, centre, T and M stage, Gleason score, serum PSA at diagnosis, age at randomisation, follow-up time, and vital status were extracted from the ERSPC database. Four risk categories at diagnosis were defined: 1, low; 2, intermediate; 3, high; 4, metastatic disease. PSA (≤100 or >100 ng/ml) was used as the indicator of metastasis. Outcome measurements and statistical analysis Incidence rate ratios (IRRs) for screening versus control arm by risk category at diagnosis and follow-up time were calculated using Poisson regression analysis for seven centres. Follow-up was truncated at 13 yr. Missing data were imputed using chained equations. The analyses were carried out on an intention-to-treat basis. Results and limitations In the screening arm, 7408 PCa cases were diagnosed and 6107 in the control arm. The proportion of missing stage, Gleason score, or PSA value was comparable in the two arms (8% vs 10%), but differed among centres. The IRRs were elevated in the screening arm for the low-risk (IRR: 2.14; 95% CI, 2.03–2.25) and intermediate-risk (IRR: 1.24; 95% CI, 1.16–1.34) categories at diagnosis, equal to unity for the high-risk category at diagnosis (IRR: 1.00; 95% CI, 0.89–1.13), and reduced for metastatic disease at diagnosis (IRR: 0.60; 95% CI, 0.52–0.70). The IRR of metastatic disease had temporal pattern similar to mortality, shifted forwards an average of almost 3 yr, although the mortality reduction was smaller. Conclusions The results confirm a reduction in metastatic disease at diagnosis in the screening arm, preceding mortality reduction by almost 3 yr. Patient summary The findings of this study indicate that the decrease in metastatic disease at diagnosis is the major determinant of the prostate cancer mortality reduction in the European Randomized study of Screening for Prostate Cancer.
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A decline in breast cancer mortality has been observed in western European Countries since the middle of the 1990s. Different methodological approaches, including case-control studies, ...incidence-based mortality studies, and trend studies, have been used to assess the effectiveness of mammography screening programmes in reducing breast cancer mortality. However, not all methods succeed in distinguishing the relative contributions of service screening and taking correctly into consideration the potential source of bias that might affect the estimate. Recently, a review of six case-control studies confirmed a breast cancer mortality reduction ranging from 38% to 70% among screened women. This figure is in accordance with the estimate obtained from incidence-based mortality studies if screening compliance is taken into account. We will describe the methodological constraints of mortality trend studies in predicting the impact of screening on mortality and the necessary caution that must be applied when interpreting the results of such studies. In conclusion, when appropriate methodological approaches are used, it is evident that mammographic screening programmes have contributed substantially to the observed decline in breast cancer mortality.
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