Benzo[a]pyrene (BaP) has been proven to be toxic and carcinogenic. Since 2010, the European Union officially established target values for BaP concentrations in ambient air. In this study BaP concentrations over Europe have been modelled using a modified version of the chemistry transport model Community Multiscale Air Quality (CMAQ) which includes the relevant reactions of BaP. CMAQ has been run using different emission datasets for the years 1980, 2000, and 2020 as input data. In this study, the changes in BaP concentrations between 1980 and 2020 are evaluated and regions which exceed the European annual target value of 1 ng/m3 are identified, i.e. the Po Valley, the Paris metropolitan area, the Rhine-Ruhr area, Vienna, Madrid, and Moscow. Additionally, the impact of emission reductions on atmospheric concentrations of BaP is investigated. Between 1980 and 2000, half of the BaP emission reductions are due to lower emissions from industrial sources. These emission reductions, however, only contribute to one third of the total ground-level BaP concentration reduction. Further findings are that between 2000 and 2020, a large part (40%) of the BaP concentration reduction is not due to changes in BaP emissions but caused by changes in emissions of criteria pollutants which have an impact on the formation of ozone.
In central Europe, ammonium sulphate and ammonium nitrate make up a large fraction of fine particles which pose a threat to human health. Most studies on air pollution through particulate matter investigate the influence of emission reductions of sulphur- and nitrogen oxides on aerosol concentration. Here, we focus on the influence of ammonia (NH3) emissions. Emission scenarios have been created on the basis of the improved ammonia emission parameterization implemented in the SMOKE for Europe and CMAQ model systems described in part I of this study. This includes emissions based on future European legislation (the National Emission Ceilings) as well as a dynamic evaluation of the influence of different agricultural sectors (e.g. animal husbandry) on particle formation. The study compares the concentrations of NH3, View the MathML sourceNH4+, NO3 -, sulphur compounds and the total concentration of particles in winter and summer for a political-, technical- and behavioural scenario. It was found that a reduction of ammonia emissions by 50% lead to a 24% reduction of the total PM2.5 concentrations in northwest Europe. The observed reduction was mainly driven by reduced formation of ammonium nitrate. Moreover, emission reductions during winter had a larger impact than during the rest of the year. This leads to the conclusion that a reduction of the ammonia emissions from the agricultural sector related to animal husbandry could be more efficient than the reduction from other sectors due to its larger share in winter ammonia emissions.
'Enabling Social Europe' examines how the paradigm of the 'enabling welfare state' might offer a new perspective for European social policy in the decades to come. The 'enabling' concept is perceived as going beyond that of mere 'activation', thus also embracing policies aimed at increasing personal autonomy, individual responsibility and social inclusion by endowing individuals with the resources and capabilities needed to manage and balance their life courses in a better way.The study is distinguished by a unique collaboration of social and economic policy experts coming from a wide range of disciplines: economics, law, sociology, political science, and philosophy. The authors seek to shed new light on whether European social policy ought to play a role in the future and, if so, what sort of role that could be. They convincingly argue that despite an implicit normative consensus on the 'European social model', there is still room for a multifaceted world in which welfare regimes can maintain their own path-dependent ways of achieving a fair and just society with a high level of welfare for all.The empirical part of the book contains an appraisal of policies and reforms with a view to the 'enabling welfare state' approach in four important policy areas: health care, old-age security, family policy, and poverty prevention. Within each sector, the authors compare the policies and practices of two countries attributable to different regime types: Germany and the United Kingdom, Poland and Germany, Finland and Estonia, and Belgium and Denmark.This book is highly recommendable not only for scholars and policymakers active in this field, but also for students of welfare and labour economics, sociology, social policy, political science and law.
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Der Bericht stellt die Resultate einer multikriteriellen Bewertung verschiedener Szenarien eines Kohleausstiegs in Deutschland vor. Die exemplarischen Politikszenarien basieren auf unterschiedlich umfassenden politischen Maßnahmenbündeln und bewegen sich im Spannungsfeld zwischen Ordnungsrecht und Markt. Der transdisziplinäre Bewertungsprozess wurde parallel zur Kohlekommission im Rahmen des Kopernikus-Projektes "Energiewende-Navigationssystem" (ENavi) erprobt. Hierbei schätzten die Wissenschaftlerinnen und Wissenschaftler des Konsortiums die Folgen der Maßnahmenbündel ab und bewerteten diese anhand von zehn Nachhaltigkeitskriterien. Die so entstandenen Bewertungsvorschläge wurden mit Stakeholdern aus Zivilgesellschaft, Industrie, Wirtschaft und Politik geprüft, diskutiert und verfeinert. Der Bericht gibt einen Überblick zu Prozess, Methodik sowie Ergebnissen der Bewertung. Zudem zeigt er, unter anderem anhand eines Vergleichs mit der Kohlekommission, Verbesserungspotentiale des realisierten Bewertungsverfahrens auf. Die Erfahrungen, Empfehlungen und identifizierten Forschungsbedarfe bieten wertvolle Gestaltungshinweise für zukünftige Projekte mit einer ähnlichen inter- und transdisziplinären Herangehensweise.
Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.