Search results

This article was co-published with The Guardian.The United Nations warned that there was "clear evidence" that war crimes may have been committed in "the explosion of violence in Israel and Gaza." Meanwhile, Wall Street is hoping for an explosion in profits.During third-quarter earnings calls this month, analysts from Morgan Stanley and TD Bank took note of this potential profit-making escalation in conflict and asked unusually blunt questions about the financial benefit of the war between Israel and Hamas.The death toll — which so far includes over 7,000 Palestinians and over 1,400 Israelis — wasn't top of mind for TD Cowen's Cai von Rumohr, managing director and senior research analyst specializing in the aerospace industry. His question was about the upside for General Dynamics, an aerospace and weapons company in which TD Asset Management holds over $16 million in stock.Joe Biden has asked Congress for $106 billion in military and humanitarian aid for Israel and Ukraine and humanitarian assistance for Gaza. The money could be a boon to the aerospace and weapons sector which enjoyed a 7-percentage point jump in value in the immediate aftermath of Hamas's October 7 attack on Israel and the beginning of Israel's bombardment of Gaza in response."Hamas has created additional demand, we have this $106 billion request from the president," said von Rumohr, during General Dynamics' earnings call on October 25. "Can you give us some general color in terms of areas where you think you could see incremental acceleration in demand?""You know, the Israel situation obviously is a terrible one, frankly, and one that's just evolving as we speak," responded Jason Aiken, the company's executive vice president of technologies and chief financial officer. "But I think if you look at the incremental demand potential coming out of that, the biggest one to highlight and that really sticks out is probably on the artillery side."That next day, von Rumohr assigned a "buy" rating to General Dynamics' stock.Morgan Stanley's head of aerospace and defense equity research, Kristine Liwag, took a similar approach to the conflict during Raytheon's October 24 earnings call."Looking at [the White House's $106 billion supplemental funding request], you've got equipment for Ukraine, air and missile defense for Israel, and replenishment of stockpiles for both. And this seems to fit quite nicely with the Raytheon Defense portfolio," said Liwag, whose employer holds over $3 billion in Raytheon stock, a 2.1% ownership share of the weapons company."So how much of this opportunity is addressable to the company and if the dollars are appropriated, when would be the earliest you could see this convert to revenue?"Greg Hayes, Raytheon's chairman and executive director, responded: "I think really across the entire Raytheon portfolio, you're going to see a benefit of this restocking … on top of what we think is going to be an increase in the [Department of Defense] top line [budget]."The comments are seemingly in contradiction of each company's "statement on human rights" and explicit endorsements of the Universal Declaration of Human Rights and UN Guiding Principles on Business and Human Rights.Aside from the callousness of casually discussing the financial benefits of far-off armed conflict, the comments raise questions about whether these major institutional shareholders of weapons stocks are abiding by their own human rights policies."We exercise our influence by conducting our business operations in ways that seek to respect, protect and promote the full range of human rights such as those described in the United Nations' Universal Declaration of Human Rights," says Morgan Stanley's "Statement on Human Rights." "Although we believe that governments around the world bear primary responsibility for safeguarding human rights, we acknowledge the corporate responsibility to respect human rights articulated in the United Nations' Guiding Principles on Business and Human Rights.""TD's commitment to respect human rights is made in accordance with the corporate responsibility to respect human rights as set out in the United Nations Guiding Principles on Business and Human Rights (UNGP)," says TD's "Statement on Human Rights." "Since 2018, we have been undertaking a review of current practices and procedures and continue working towards integrating the UNGP across the Bank."But just three days into the Israel-Hamas war, the United Nations' Human Rights Council issued a warning that "there is already clear evidence that war crimes may have been committed in the latest explosion of violence in Israel and Gaza, and all those who have violated international law and targeted civilians must be held accountable for their crimes, the UN Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem and Israel, said today.""The Commission has been collecting and preserving evidence of war crimes committed by all sides since 7 October 2023, when Hamas launched a complex attack on Israel and Israeli forces responded with airstrikes in Gaza," said the Human Rights Council, assessments shared by Amnesty International and Human Rights Watch."[The UN Guiding Principles on Business and Human rights] are clear in their expectation of companies to respect human rights throughout their value chain," said Cor Oudes, programme leader of humanitarian disarmament, business conflict and human rights at PAX for Peace, a Netherland based non-governmental organization advocating for the protection of civilians against acts of war."For banks, this includes ensuring that their clients or companies they otherwise invest in do not cause or contribute to violations of human rights or international humanitarian law," said Oudes. "If a bank invests in an arms producer that supplies weapons to states which use these in serious violations of human rights or IHL, according to the UNGPs, the bank has a responsibility to act to prevent more violations as well as to mitigate the existing impact on human rights."But the UN won't be the legal arbiter of whether US companies have participated in human rights violations, a key loophole for institutional investors and the weapons firms."The Universal Declaration of Human Rights is only as good as how it's interpreted by the host government, which in this case would be the US," Shana Marshall, an expert on finance and arms trade and associate director of the Institute for Middle East Studies at George Washington University explained."These analysts can feel safe in the knowledge that the US government is never going to interpret that law in such a way that they will be prevented from exporting weapons to a country that the US doesn't have an outright embargo on, which probably won't have anything to do with human rights law anyways."Morgan Stanley and TD Bank did not respond to requests for comment.

How might Ukraine's war effort go bankrupt? Developments over the past few weeks recall the words of Ernest Hemingway: "Two ways. Gradually, then suddenly."Should that prove true, it will spell bad news not only for those insisting on an unconditional Ukrainian victory, but also for those pressing for a diplomatic settlement of the conflict. The gradual part is already well underway. The U.S. Congress's decision to pass a "clean" stopgap spending bill over the weekend to fund our government for another 45 days — bowing to pressure from some GOP members to strip Ukraine aid from the bill — is the latest sign of how quickly the political tide has begun to turn. Such a vote would have been unthinkable last December, when Ukrainian President Zelensky addressed a televised joint session of Congress to fawning media reviews, and ceremoniously presented a flag signed by the determined defenders of the besieged city of Bakhmut. Ten months later, Bakhmut has fallen. Ukraine's counteroffensive has sputtered. A series of opinion polls has indicated that most Americans now oppose additional aid to Kyiv. When he arrived in Washington last month, Zelensky was treated more as an interloper than as an inspiring hero. House Speaker McCarthy blocked Zelensky from addressing a joint session of Congress, claiming that there was insufficient time. Signs of "Ukraine fatigue" are appearing in Europe, too. Amid a row over Ukrainian agricultural exports that hurt EU farmers, Polish President Duda compared Ukraine to a drowning victim submerging its would-be rescuers. Hungarian President Orban has said his country will no longer provide any support to Ukraine. Slovakia was the first country to deliver fighter jets to Ukraine after Russia's invasion, but in last weekend's parliamentary elections, its voters opted for the party of ex-prime minister Robert Fico, who had campaigned on ending aid. Meanwhile, the far-right Alternative for Deutschland party, long opposed to breaking with Russia over the Ukraine war, has climbed to second place in German polls. These trends raise the prospect of a vicious circle of mutual intensification. Ukraine's stagnation on the battlefield prompts more Americans to wonder whether billions in aid are being wasted on an unwinnable war. Growing skepticism in Europe reinforces concerns in Washington that our NATO partners will not share the burden of supporting Ukraine. In Washington, the White House's failure to articulate an exit strategy feeds fears of yet another American "forever war," this time a proxy battle against a nuclear power. Worries over Western support undermine Ukraine's military morale and political resolve, leading to further erosion of its position on the battlefield. The combination could produce a tipping point at which the gradual erosion of Western support for Ukraine spills into an abrupt reduction or collapse. What might follow? It is unlikely that this would result, as many claim, in Russia's conquering all Ukrainian territory, incorporating it into the Russian Federation, and turning a resuscitated Russian military toward Poland and the Baltic States. The Kremlin almost certainly recognizes that attempting to conquer and govern the bulk of Ukraine, dominated by a well-armed and anti-Russian populace, would be a self-defeating ambition. Moreover, Russia has demonstrated neither the capability nor the desire to fight a war of choice with the NATO alliance. Rather, Moscow would be far more likely to turn Ukraine into a failed rump state. It would aim to capture the rest of the Donbass and perhaps the Ukrainian Black Sea coast. After creating an extended no-man's land separating Russian forces from Ukraine-controlled territory, it would then declare a unilateral cease-fire and build extensive fortifications against new attacks. Should Kyiv sue for peace under such duress, it could threaten Zelensky's rule. Should it refuse, it could destroy the Ukrainian state. In either case, funding and governing what remains of Ukraine would become the West's problem, not Russia's. Absent an agreed settlement of the war with Russia, few donors would contribute the hundreds of billions of dollars necessary for Ukraine's reconstruction. Prospects for democracy and the rule of law in Ukraine would diminish. Refugee flows into Europe would intensify, fueling more divisions within NATO and the EU. Washington would be racked by debate over who lost Ukraine. In these circumstances, Putin would have few incentives to seek compromise with either Ukraine or the West, leaving the broader East-West relationship in a dangerously unstable state of confrontation, lacking the arms control and conflict-management mechanisms that helped prevent the Cold War from turning hot. Europe would have to contend not with a new Iron Curtain, but rather with a gaping, Libya-like wound that could infect the West for years to come. Russian military cooperation with China, Iran, and North Korea would advance. All this is of course far from inevitable. But those tempted to believe that the United States could end the war by simply ending its aid to Ukraine should think hard about these possibilities. And those insisting that the West can simply double down on delivering aid to Ukraine should recognize that present trends bode ill for the Biden administration's "as long as it takes" strategy, either for winning the war outright or for turning Ukraine into a thriving fortress state, capable of holding off the Russians for many years to come. Avoiding such sobering possibilities will require compromise. The White House will have to compromise with domestic opponents of aid by making clear — at least behind closed doors — its plans for marrying military aid to a viable exit strategy. Opponents of aid will have to compromise with proponents to ensure that Ukraine does not collapse altogether, with all the attendant implications for the West and the world. The West and Russia will each have to compromise – not necessarily over territory, but certainly over the broader architecture of European security and Ukraine's place in it. Compromise is seldom possible unless both sides have cards to play in negotiations. The United States should not remove cards from its hand by ending aid to Ukraine unilaterally or playing them prematurely. But unless it moves quickly to complement aid with diplomacy, it may find that the opportunity to play its cards has suddenly disappeared.

Michael F. Cannon


The Office of Management & Budget (OMB) has announced its approval of a proposed rule on so‐​called "short‐​term limited duration insurance" health plans (STLDI). The administration could release the proposed rule at any time.
Health reporters need to keep in mind when covering Biden's proposed STLDI rule: just about anything the administration proposes would eliminate consumer protections and throw sick people out of their health plans. If the proposed rule shortens STLDI contract terms, limits the number or duration of renewals, and/​or prohibits renewal guarantees, it will gut consumer protections and throw sick patients out of the health insurance that is protecting them and their families.
Some background. Congress exempted STLDI plans from all ObamaCare regulations. Current STLDI rules, which the Trump administration put in place in 2018, allow the initial plan contract to last 12 months and allow consumers to renew the initial contract for up to 36 months. Longer contract terms and renewals protect patients. They shield patients both from losing their coverage and from reunderwriting (read: higher premiums) after they get sick. Current STLDI rules even extend those consumer protections beyond 36 months by recognizing that federal law imposes absolutely no restrictions on insurers selling standalone "renewal guarantees" that allow sick patients to enroll in a new STLDI plan without reunderwriting after 36 months.
The U.S. Court of Appeals for the District of Columbia rejected an attempt by ObamaCare insurers to strip these consumer protections from the STLDI plans with which they compete. (A cheeky move even by DC lobbyist standards.) The court wrote that, were the government to grant the ObamaCare insurers' request, STLDI enrollees "could be 'subject to re‐​underwriting' every three months, could see a 'greatly increased' premium, [and] could be denied a new policy 'based on preexisting medical conditions.'" The court further held, "Nothing in [federal law] prevents insurers from renewing expired STLDI policies."
We don't know the content of Biden's proposal to change current STLDI rules, but OMB writes:
This rule would propose amendments to the definition of 'short‐​term, limited‐​duration insurance' under section 2791(b)(5) of the Public Health Service Act. The rule's proposals would be designed to ensure this type of coverage does not undermine the Affordable Care Act, including its protections for people with pre‐​existing conditions, the Health Insurance Exchanges, or the individual, small group, or large group markets for health insurance in the United States.

That is the ideologically charged, smokescreen rhetoric that ObamaCare supporters use when they want to protect ObamaCare insurers from competition by stripping consumer protections from patients in STLDI plans.
First of all, ObamaCare is the junk coverage here. Economic research shows ObamaCare's preexisting‐​conditions "protections" have eroded coverage at a cost to sick patients of thousands of dollars per year, and even "currently healthy consumers cannot be adequately insured." ObamaCare has caused individual‐​market provider networks to narrow significantly since 2013, when network breadth reflected consumer preferences. ObamaCare premiums are skyrocketing to the point where Congress is offering subsidies to households earning $600,000 per year. STLDI plans offer more flexibility and choice, protect conscience rights, offer broader provider networks, cost up to 70 percent less than ObamaCare plans, and can even reduce ObamaCare premiums by improving ObamaCare's risk pools. ObamaCare supporters criticize STLDI for charging actuarially fair premiums. But federal law allows STLDI plans to do so. Moreover, ObamaCare's risk‐​adjustment program literally tries to emulate actuarially fair premiums because actuarially fair premiums minimize insurers' incentives to avoid or shortchange the sick. If actuarially fair premiums are as bad as ObamaCare supporters say, why are ObamaCare supporters trying to emulate them?
The important thing for health reporters covering the proposed rule to know, however, is that just about any way Biden proposes to limit STLDI plans would in fact strip actual consumer protections from actual sick patients. That includes:
Shortening STLDI contract terms
Limiting the number or duration of renewals
Prohibiting renewal guarantees
Any one of these steps would cause sick patients to lose their coverage and likely leave them unable to purchase an ObamaCare plan. (STLDI plan termination does not trigger an ObamaCare special enrollment period.) We know what happens when restrictions on STLDI plans eliminates these consumer protections, because it happened to Jeanne Balvin. It isn't pretty.
If Biden tries to eliminate standalone renewal guarantees, he may trigger a lawsuit. The Public Health Service Act grants the federal government no authority at all to regulate those novel insurance products.
Additional resources:
Michael F. Cannon, Comments on Short‐​Term, Limited Duration Insurance — CMS-9924‑P, April 2018 (cited in the 2018 final rule)
Michael F. Cannon, "A Chance to Overcome ObamaCare: HHS may soon restore consumer protections for short‐​term plans," Wall Street Journal, May 28, 2018
Michael F. Cannon, Short‐​Term Plans Would Increase Coverage, Protect Conscience Rights & Improve ObamaCare Risk Pools, Cato at Liberty blog, July 2018 (cited in the final rule)
Michael F. Cannon, "ObamaCare is now optional," Washington Examiner, August 01, 2018
Michael F. Cannon, "Californians deserve access to short‐​term health insurance," San Gabriel Valley Tribune, September 2018
Michael F. Cannon, "First, Do No Harm (to ObamaCare): Senate Democrats vote to take away insurance from people with pre‐​existing conditions," Wall Street Journal, October 11, 2018
Michael F. Cannon, "Callous Ideologues: Illinois Legislators Pass Law to Punish Patients with Preexisting Conditions," Cato at Liberty blog, November 2018
Amicus brief by Michael F. Cannon et al., in Association for Community Affiliated Plans v. U.S. Dept. of the Treasury, January 2020
Michael F. Cannon, "In a Win for Consumers, a Court Ruling Affirms the Legality of Short‐​Term Health Insurance Plans," The Hill, July 2020
Michael F. Cannon, "In Which a Lobbyist for Private Insurance Companies Defends Taking Coverage away from the Sick," Cato at Liberty blog, August 4, 2020
Michael F. Cannon, "Obamacare Makes Discrimination against those with Preexisting Conditions Even Worse," Washington Examiner, December 7, 2020
Michael F. Cannon, "Regarding SB199 – Short‐​Term Limited Duration Plans," Testimony before the Committee on Financial Institutions and Insurance, Kansas Senate, March 25, 2021
Michael F. Cannon, "Remarks Regarding Kansas Senate Bill 199 — Short‐​Term Limited Duration Plans," Testimony before the Committee on Insurance and Pensions, Kansas House of Representatives, February 7, 2022

Executive Summary 1 This report analyzes the US Refugee Admissions Program (USRAP), leveraging data from a national survey of resettlement stakeholders conducted in 2020. 2 The survey examined USRAP from the time that refugees arrive in the United States. Its design and questionnaire were informed by three community gatherings organized by Refugee Council USA in the fall and winter of 2019, extensive input from an expert advisory group, and a literature review. This study finds that USRAP serves important purposes, enjoys extensive community support, and offers a variety of effective services. Overall, the survey finds a high degree of consensus on the US resettlement program's strengths and objectives, and close alignment between its services and the needs of refugees at different stages of their settlement and integration. Because its infrastructure and community-based resettlement networks have been decimated in recent years, the main challenges of subsequent administrations, Congresses, and USRAP stakeholders will be to rebuild, revitalize, and regain broad and bipartisan support for the program. This article also recommends specific ways that USRAP's programs and services can be strengthened. Among the study's findings: 3 Most refugee respondents identified USRAP's main purpose(s) as giving refugees new opportunities, helping them to integrate, offering hope to refugees living in difficult circumstances abroad, and saving lives. High percentages of refugees reported that the program allowed them to support themselves soon after arrival (92 percent), helped them to integrate (77 percent), and has a positive economic impact on local communities (71 percent). Refugee respondents also reported that the program encourages them to work in jobs that do not match their skills and credentials (56 percent), does not provide enough integration support after three months (54 percent), does not offer sufficient financial help during their first three months (49 percent), and reunites families too slowly (47 percent). Respondents identified the following main false ideas about the program: refugees pose a security risk (84 percent), use too many benefits and drain public finances (83 percent), and take the jobs of the native-born (74 percent). Refugee respondents reported using public benefits to meet basic needs, such as medical care, food, and housing. Non-refugee survey respondents believed at high rates that former refugees (69 percent) and refugee community advocate groups (64 percent) should be afforded a voice in the resettlement process. Non-refugee respondents indicated at high rates that the program's employment requirements limit the time needed for refugees to learn English (65 percent) and limit their ability to pursue higher education (59 percent). Eighty-six percent of non-refugee respondents indicated that the Reception and Placement program is much too short (56 percent) or a little too short (30 percent). Respondents identified a wide range of persons and institutions as being very helpful to refugees in settling into their new communities: these included resettlement staff, friends, and acquaintances from refugees' country of origin, members of places of worship, community organizations led by refugees or former refugees, and family members. Refugee respondents identified finding medical care (61 percent), housing (52 percent), and a job (49 percent) as the most helpful services in their first three months in the country. Refugees reported that the biggest challenge in their first year was to find employment that matched their educational or skill levels or backgrounds. The needs of refugees and the main obstacles to their successful integration differ by gender, reflecting at least in part the greater childcare responsibilities borne by refugee women. Refugee men reported needing assistance during their first three months in finding employment (68 percent), English Language Learning (ELL) courses (59 percent), and orientation services (56 percent), while refugee women reported needing orientation services (81 percent) and assistance in securing childcare (64 percent), finding ELL courses (53 percent), and enrolling children in school (49 percent). To open-response questions, non-refugee respondents identified as obstacles to the integration of men: digital literacy, (lack of) anti–domestic violence training, the need for more training to improve their jobs, the new public benefit rule, transportation to work, low wages, the need for more mental health services, cultural role adjustment, and lack of motivation. Non-refugee respondents identified as obstacles to the integration of women: lack of childcare and affordable housing, the different cultural roles of women in the United States, lack of affordable driver's education classes, a shortage of ELL classes for those with low literacy or the illiterate, digital literacy challenges, difficulty navigating their children's education and school systems, transportation problems, poorly paying jobs, and lack of friendships with US residents. Non-refugee respondents report that refugee children also face unique obstacles to integration, including limited funding or capacity to engage refugee parents in their children's education, difficulties communicating with refugee families, and the unfamiliarity of teachers and school staff with the cultures and backgrounds of refugee children and families. LGBTQ refugees have many of the same basic needs as other refugees — education, housing, employment, transportation, psychosocial, and others — but face unique challenges in meeting these needs due to possible rejection by refugees and immigrants from their own countries and by other residents of their new communities. Since 2017, the number of resettlement agencies has fallen sharply, and large numbers of staff at the remaining agencies have been laid off. As a result, the program has suffered a loss in expertise, institutional knowledge, language diversity, and resettlement capacity. Resettlement agencies and community-based organizations (CBOs) reported at high rates that to accommodate pre-2017 numbers of refugees, they would need higher staffing levels in employment services (66 percent), general integration and adjustment services (62 percent), mental health care (44 percent) and medical case management (44 percent). Resettlement agencies indicated that they face immense operational and financial challenges, some of them longstanding (like per capita funding and secondary migration), and some related to the Trump administration's hostility to the program. Section I introduces the article and provides historic context on the US refugee program. Section II outlines the resettlement process and its constituent programs. Section III describes the CMS Refugee Resettlement Survey: 2020. Section IV sets forth the study's main findings, with subsections covering USRAP's purpose and overall strengths and weaknesses; critiques of the program; the importance of receiving communities to resettlement and integration; the effectiveness of select USRAP programs and services; integration metrics; and obstacles to integration. The article ends with a series of recommendations to rebuild and strengthen this program.

Genome-wide association studies (GWAS) are not fully comprehensive, as current strategies typically test only the additive model, exclude the X chromosome, and use only one reference panel for genotype imputation. We implement an extensive GWAS strategy, GUIDANCE, which improves genotype imputation by using multiple reference panels and includes the analysis of the X chromosome and non-additive models to test for association. We apply this methodology to 62,281 subjects across 22 age-related diseases and identify 94 genome-wide associated loci, including 26 previously unreported. Moreover, we observe that 27.7% of the 94 loci are missed if we use standard imputation strategies with a single reference panel, such as HRC, and only test the additive model. Among the new findings, we identify three novel low-frequency recessive variants with odds ratios larger than 4, which need at least a three-fold larger sample size to be detected under the additive model. This study highlights the benefits of applying innovative strategies to better uncover the genetic architecture of complex diseases. ; This work has been sponsored by the grant SEV-2011-00067 and SEV2015-0493 of Severo Ochoa Program, awarded by the Spanish Government, by the grant TIN2015- 65316-P, awarded by the Spanish Ministry of Science and Innovation, and by the Generalitat de Catalunya (contract 2014-SGR-1051). This work was supported by an EFSD/Lilly research fellowship. Josep M. Mercader was supported by a Sara Borrell Fellowship from the Instituto Carlos III, Beatriu de Pinós fellowship from the Agency for Management of University and Research Grants (AGAUR) and by the American Diabetes Association Innovative and Clinical Translational Award 1-19-ICTS-068. Sílvia Bonàs was supported by FI-DGR Fellowship from FIDGR 2013 from Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR, Generalitat de Catalunya), and a 'Juan de la Cierva' postdoctoral fellowship (MINECO;FJCI-2017-32090). Cecilia Salvoro received funding from the European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement H2020-MSCA-COFUND-2016- 754433. Cristian Ramon-Cortes pre-doctoral contract is financed by the Spanish Ministry of Science, Innovation, and Universities under contract BES-2016-076791. Elizabeth G. Atkinson was supported by the National Institutes of Mental Health (grants K01MH121659 and T32MH017119). Jose Florez was supported by NIH/NIDDK award K24 DK110550. This study made use of data generated by the UK10K Consortium, derived from samples from UK10K COHORT IMPUTATION (EGAS00001000713). A full list of the investigators who contributed to the generation of the data is available at www.UK10K.org. Funding for UK10K was provided by the Wellcome Trust under award WT091310. This study made use of data generated by the 'Genome of the Netherlands' project, which is funded by the Netherlands Organization for Scientific Research (grant no. 184021007). The data were made available as a Rainbow Project of BBMRI-NL. Samples were contributed by LifeLines (http://lifelines.nl/lifelines-research/general), the Leiden Longevity Study (http://www.healthy-ageing.nl; http://www.langleven.net), the Netherlands Twin Registry (NTR: http://www.tweelingenregister.org), the Rotterdam studies (http://www.erasmus-epidemiology.nl/rotterdamstudy) and the Genetic Research in Isolated Populations program (http://www.epib.nl/research/geneticepi/research. html#gip). The sequencing was carried out in collaboration with the Beijing Institute for Genomics (BGI). This study also made use of data generated by The Haplotype Reference Consortium (HRC) accessed through The European Genome-phenome Archive at the European Bioinformatics Institute with the accession numbers EGAD00001002729, after a form agreed by the Barcelona Supercomputing Center (BSC) with WTSI. This research has been conducted using also the UK Biobank Resource (application number 31063 and 27892). The Genotype-Tissue Expression (GTEx) Project was supported by the Common Fund of the Office of the Director of the National Institutes of Health, and by NCI, NHGRI, NHLBI, NIDA, NIMH, and NINDS. The data used for the analyses described in this manuscript were obtained from the GTEx Portal on 07/16/2019. We acknowledge PRACE for awarding us access to both MareNostrum supercomputer from the Barcelona Supercomputing Center, based in Spain at Barcelona, and the SuperMUC supercomputer of the Leibniz Supercomputing Center (LRZ), based in Garching at Germany (proposals numbers 2016143358 and 2016163985). The technical support group from the Barcelona Supercomputing Center is gratefully acknowledged. Finally, we thank all the Computational Genomics group at the BSC for their helpful discussions and valuable comments on the manuscript. We also acknowledge Elias Rodriguez Fos for designing the GUIDANCE logo. ; Peer Reviewed ; Article signat per 22 autors/autores: Marta Guindo-Martínez 1,18; Ramon Amela 1,18; Silvia Bonàs-Guarch 1,2,3; Montserrat Puiggròs 1; Cecilia Salvoro 1; Irene Miguel-Escalada 1,2,3; Caitlin E. Carey 4,5; Joanne B. Cole 6,7,8,9; Sina Rüeger 10; Elizabeth Atkinson 4,5,11; Aaron Leong 8,12; Friman Sanchez 1; Cristian Ramon-Cortes 1; Jorge Ejarque 1; Duncan S. Palmer 4,5,17; Mitja Kurki 10; FinnGen Consortium*, Krishna Aragam 11,13,14; Jose C. Florez 6,7,15; Rosa M. Badia 1; Josep M. Mercader 1,6,7,15,19✉ & David Torrents 1,16,19✉ *A full list of members and their affiliations appears in the Supplementary Information 1 Barcelona Supercomputing Center (BSC), Barcelona, Spain. 2 Regulatory Genomics and Diabetes, Centre for Genomic Regulation, The Barcelona Institute of Science and Technology, Barcelona, Spain. 3 CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Madrid, Spain. 4 Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA. 5 Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. 6 Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA. 7 Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA. 8 Harvard Medical School, Boston, MA, USA. 9 Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA, USA. 10 Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland. 11 Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA. 12 Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. 13 Cardiology Division, Massachusetts General Hospital, Boston, MA, USA. 14 Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA. 15 Department of Medicine, Harvard Medical School, Boston, MA, USA. 16 Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain. 17 Present address: GENOMICS plc, Oxford, UK. 18 These authors contributed equally: Marta Guindo-Martínez, Ramon Amela. 19 These authors jointly supervised this work: Josep M. Mercader, David Torrents. ; Postprint (published version)

One of the largest costs, and greatest impediments to, recycling any good is that of logistics and transport. Collection, sorting, storage, materials recognition, sampling, pathways, pickups, packaging, manual handling, robotic handling, distances, secure passage, fuel costs, etc. are all components of the heavy logistics burden any recycling system must espouse to be successful.In a study conducted by Cutting and Gietman (2019) for the Victorian Government in Australia, the authors concluded that the economic value of a recycled solar module was $3.41 in reclaimed materials, which may be compared to the price of a new module being between $100 and $300. To alleviate this problem the locations of permanent recycling centres have been researched (Choi & Fthenakis 2014) but the mathematical model developed by those authors require a minimum of 19,000 tons of waste modules per site per annum to make them begin to be economically viable. Furthermore, in a paper introducing an innovative mobile device for recycling silicon modules, Del Pero et. al. (2019) noted that, while the operation of their proposed device was not economically viable, given the glass and other materials recovered from the process, the fact that their device was mobile was a great benefit in the overall economics of recycling solar modules. But while mobile recycling centres can show an improvement in the economics of recycling solar modules, the processes for recycling solar panels are still not a viable economic activity by up to two orders of magnitude. In some countries it may never be possible to assemble 19,000 tons of module recycling in one city and so the above model would mean that those countries may never have a functioning solar module recycling system.In practice, it often falls to the installers to remove and deal with end of life (EoL) solar modules. A practice which delivers varying results such as dumping in landfill, removing the aluminium frames and dumping the remains in landfill, or just warehousing the modules whilst waiting for an industry-wide solution, or formal directions from the Clean Energy Regulator (2021a) or Clean Energy Council (2021), to be made clear.Our model is to make use of the very efficient and secure methods and logistics currently in existence in the solar and electrical industry for the transfer of solar panels from the manufacturer to the end-use site (Clean Energy Regulator 2021b) and to use some stages of this process in reverse.It is a fact that the same class of solar installers who instal solar modules are the ones who remove them from current use. We propose that these electricians would return EoL solar modules to a limited number of solar wholesalers in a city, who would, in turn, return them to a city-wide central logistics centre for processing.Currently all installers must either call or visit wholesalers to get stock for their new jobs on a daily or weekly basis. They have to make this trip, and either go back to the warehouses empty handed, or just take their cardboard and packaging back to the wholesalers for recycling when they collect new stock for their next jobs. We propose that they also take back end-of-life solar modules to the wholesalers, also for recycling, at a nil or small incremental cost. Indeed, the incremental cost may be negative relative to alternatives, if installers were to be removing the EoL modules in any case.Furthermore, we propose that the same information and compliance systems currently in use for installing solar modules, often mandated by the Clean Energy Regulation Offices, through the use of barcodes, serial numbers, geotagged pictures, and mobile phone portals, be used for the verification of collection and processing of EoL solar modules (Clean Energy Regulator 2021b). Then the same system of accountability and information reporting as exists for the installation of new solar systems could also apply for the removal and processing of EoL solar modules.We envisage that this system could be formalised by the Clean Energy authorities and their existing detailed and extensive processes could be enforced on each installer to account for each solar module. The marginal cost to each installer for returning modules to wholesalers is very low as they must return to wholesalers to pick up new stock regularly. Likewise, for the wholesalers, the marginal cost of returning modules from their facilities to a central aggregation centre is minimal as delivery trucks must come from central distribution centres to deliver new modules anyway.Furthermore, by participating in this scheme, the module manufacturers would ensure that their EoL modules would return to just one place in any city and this would streamline and reduce the costs of their warranty processes. In the Victorian context, at least, this scheme should work well as a voluntary scheme where installers, wholesalers, and manufacturers cooperate to provide a cost effective and efficient EoL solution.By using the existing regulated and efficient processes in the electrical and solar industry, with its more than 169,000 nationwide network of electricians and thousands of wholesalers and huge fleets of trucks in Australia alone, the Australian photovoltaics industry could become an even greater facilitator of the clean and circular economy we need (Guterres 2021).Choi, J.-K. & Fthenakis, V. (2014). Crystalline silicon photovoltaic recycling planning: macro and mi-cro perspectives. Journal of Cleaner Production 66, 443-449.Clean Energy Council. (2021). https://www.cleanenergycouncil.org.au/. Melbourne: Clean Energy Council. [Accessed 29 August 2021].Clean Energy Regulator. (2021a). Solar panel serial number ledger, http://www.cleanenergyregulator.gov.au/RET/Scheme-participants-and-industry/solar-panel-serial-number-ledger. Clean Energy Regulator. [Accessed 29 August 2021].Clean Energy Regulator. (2021b). http://cleanenergyregulator.gov.au/. Canberra: Clean Energy Regulator. [Accessed 29 August 2021].Cutting, J. & Gietman, A. (2019). PV Panel Reprocessing: Research into Silicon-Based Photovoltaic Cell Solar Panel Processing Methods, Viable Materials Recovery and Potential End Market Applica-tions. HRL Technology Group Pty Ltd.Del Pero, F., Delogu, M., Berzi, L. & Escamilla, M. (2019). Innovative device for mechanical treat-ment of End of Life photovoltaic panels: Technical and environmental analysis. Waste Management 95, 535- 548.Guterres, A. (2021). Secretary-General's statement on the IPCC Working Group 1 Report on the Physical Science Basis of the Sixth Assessment. New York: United Nations.

It is widely recognised that climate change is having malign effects on human life. Climate change is a global issue, but the political action necessary to address it is inevitably local and national as well as international. The security dilemma is one of the most important theoretical ideas in international relations. The content of security policy is evolving because "security" is a social structure, the content and structure of which is constantly changing depending on the transformation of existing and the emergence of new threats and challenges (climate change, destruction of the ozone layer, desertification, fresh water shortages, etc. - the list of current environmental problems in the XXI century is increasingly supplemented by new threats. Scholars, policy-makers, and activists have proposed broadening use of the concept security beyond its traditional military focus to take into account environmental threats that seriously jeopardize human well-being. This paper explores how ecological and climate problems have fundamentally changed the way we think about security. The non-physical security, diversification of threats, and the salience of identity are key effects of globalization in the security realm. These security effects translate into certain behavioral tendencies in a Germany foreign policy that have thus far not been studied in the literature. The claim that environmental factors should be integrated into the concept of security was first made in the early 1980s. In the late twentieth - early twenty-first century the concept of security has been expanded and applied to address many of the most important issues of international relations theory and security policy. Environmental issues are not only to be treated as non-military threats to the security of societies, but can also work to promote cooperation and peace-building. In modern conditions, the ability of the state system to respond to environmental hazards is criticized, and therefore fundamentally different management structures are proposed as a replacement for it. Therefore, targeted climate protection policies at the international and regional levels, as well as at the national and local levels, are needed to effectively address environmental and climate threats and challenges. Germany positions itself as a regional and world leader in the field of environmental protection and climate. The idea of caring for the environment is gradually becoming an essential element of the value system, legal culture and national identity of German society and the state, which it not only promotes both in the European Communities / European Union and beyond, but also consistently protects. Within the framework of the EU environmental policy, there is room for independent national action by the German government. This guarantees Germany a free choice of national strategies in promoting environmental policy. ; Изменение климата – это глобальная проблема и политические действия, необходимые для ее разрешения, носят как локальный и национальный, так и международный характер. Дилемма безопасности – одна из важнейших теоретических идей в международных отношениях. Содержание политики безопасности эволюционирует, поскольку «безопасность» – это социальная конструкция, содержание и структура которой постоянно меняется в зависимости от трансформации существующих и появления новых угроз и вызовов (изменение климата, разрушение озонового слоя, опустынивание, нехватка пресной воды и др. – перечень актуальных экологических проблем в XXI в. все чаще дополняется новыми угрозами). Ученые, политики и активисты предлагают расширить использование концепции безопасности за пределы ее традиционной военной направленности, чтобы учесть экологические угрозы, которые серьезно угрожают благосостоянию людей. В статье исследуется, как экологические и климатические проблемы принципиально изменили наш взгляд на безопасность. Нефизическая безопасность, диверсификация угроз и выделение личности являются ключевыми эффектами глобализации в сфере безопасности. Эти эффекты безопасности превращаются в определенные поведенческие тенденции во внешней политике Германии, до сих пор не изучались в отечественной литературе. ФРГ позиционирует себя как региональный и мировой лидер в сфере защиты окружающей среды и климата. Идея заботы об окружающей среде становится непременным элементом системы ценностей, правовой культуры и национальной идентичности немецкого общества и государства, которое она не только продвигает как в Европейских сообществах / Европейском Союзе, так и за его пределами, но и последовательно защищает. В рамках законодательной базы экологической политики ЕС сохраняется место для независимых национальных действий немецкого правительства. Это гарантирует ФРГ свободный выбор национальных стратегий при продвижении экологической политики. ; Зміна клімату – це глобальна проблема, але політичні дії, які необхідні для її розв'язання, носять як локальний і національний, так і міжнародний характер. Дилема безпеки – одна з найважливіших теоретичних ідей у міжнародних відносинах. Зміст політики безпеки еволюціонує, оскільки «безпека» – це соціальна конструкція, зміст і структура якої постійно змінюється залежно від трансформації існуючих і появи нових загроз та викликів (зміна клімату, руйнування озонового шару, засухи, нестача прісної води тощо – перелік поточних екологічних проблем в ХХІ ст. все частіше доповнюється новими загрозами). Науковці, політики та активісти пропонують розширити використання концепції безпеки за межі її традиційної військової спрямованості, щоб врахувати екологічні загрози, які серйозно загрожують добробуту людей. У статті досліджено, як екологічні і кліматичні проблеми принципово змінюють наш погляд на безпеку. Нефізична безпека, диверсифікація загроз та виокремлення особистості є ключовими ефектами глобалізації у сфері безпеки. Ці ефекти безпеки перетворюються на певні поведінкові тенденції у зовнішній політиці Німеччини, які досі не вивчались у вітчизняній літературі. Твердження про те, що чинники навколишнього середовища повинні бути інтегровані у концепцію безпеки, вперше озвучене на початку 1980-х років. Наприкінці ХХ – на початку ХХІ ст. концепція безпеки була розширена і застосовується для вирішення багатьох найважливіших питань теорії міжнародних відносин та політики безпеки. Екологічні проблеми слід не лише розглядати як невійськові загрози безпеці суспільств, але вони також можуть сприяти співпраці та побудові миру. У сучасних умовах піддається критиці здатність державної системи реагувати на екологічну небезпеку, а тому запропоновано принципово різні структури управління як заміну їй. Для ефективної протидії екологічним і кліматичним загрозам та викликам потрібна цілеспрямована політика з питань захисту клімату як на міжнародному та регіональному, так і на національному та місцевому рівнях. ФРН позиціонує себе як регіональний і світовий лідер у сфері захисту навколишнього середовища і клімату. Ідея турботи про навколишнє середовище поступово стає неодмінним елементом системи цінностей, правової культури і національної ідентичності німецького суспільства і держави, яку остання не лише просуває як в Європейських співтовариствах/ Європейському Союзі, так і за його межами, але й послідовно захищає. У рамках законодавчої бази екологічної політики ЄС зберігається місце для незалежних національних дій німецького уряду. Це гарантує ФРН вільний вибір національних стратегій при просуванні екологічної політики.

It is widely recognised that climate change is having malign effects on human life. Climate change is a global issue, but the political action necessary to address it is inevitably local and national as well as international. The security dilemma is one of the most important theoretical ideas in international relations. The content of security policy is evolving because "security" is a social structure, the content and structure of which is constantly changing depending on the transformation of existing and the emergence of new threats and challenges (climate change, destruction of the ozone layer, desertification, fresh water shortages, etc. - the list of current environmental problems in the XXI century is increasingly supplemented by new threats. Scholars, policy-makers, and activists have proposed broadening use of the concept security beyond its traditional military focus to take into account environmental threats that seriously jeopardize human well-being. This paper explores how ecological and climate problems have fundamentally changed the way we think about security. The non-physical security, diversification of threats, and the salience of identity are key effects of globalization in the security realm. These security effects translate into certain behavioral tendencies in a Germany foreign policy that have thus far not been studied in the literature. The claim that environmental factors should be integrated into the concept of security was first made in the early 1980s. In the late twentieth - early twenty-first century the concept of security has been expanded and applied to address many of the most important issues of international relations theory and security policy. Environmental issues are not only to be treated as non-military threats to the security of societies, but can also work to promote cooperation and peace-building. In modern conditions, the ability of the state system to respond to environmental hazards is criticized, and therefore fundamentally different management structures are proposed as a replacement for it. Therefore, targeted climate protection policies at the international and regional levels, as well as at the national and local levels, are needed to effectively address environmental and climate threats and challenges. Germany positions itself as a regional and world leader in the field of environmental protection and climate. The idea of caring for the environment is gradually becoming an essential element of the value system, legal culture and national identity of German society and the state, which it not only promotes both in the European Communities / European Union and beyond, but also consistently protects. Within the framework of the EU environmental policy, there is room for independent national action by the German government. This guarantees Germany a free choice of national strategies in promoting environmental policy. ; Изменение климата – это глобальная проблема и политические действия, необходимые для ее разрешения, носят как локальный и национальный, так и международный характер. Дилемма безопасности – одна из важнейших теоретических идей в международных отношениях. Содержание политики безопасности эволюционирует, поскольку «безопасность» – это социальная конструкция, содержание и структура которой постоянно меняется в зависимости от трансформации существующих и появления новых угроз и вызовов (изменение климата, разрушение озонового слоя, опустынивание, нехватка пресной воды и др. – перечень актуальных экологических проблем в XXI в. все чаще дополняется новыми угрозами). Ученые, политики и активисты предлагают расширить использование концепции безопасности за пределы ее традиционной военной направленности, чтобы учесть экологические угрозы, которые серьезно угрожают благосостоянию людей. В статье исследуется, как экологические и климатические проблемы принципиально изменили наш взгляд на безопасность. Нефизическая безопасность, диверсификация угроз и выделение личности являются ключевыми эффектами глобализации в сфере безопасности. Эти эффекты безопасности превращаются в определенные поведенческие тенденции во внешней политике Германии, до сих пор не изучались в отечественной литературе. ФРГ позиционирует себя как региональный и мировой лидер в сфере защиты окружающей среды и климата. Идея заботы об окружающей среде становится непременным элементом системы ценностей, правовой культуры и национальной идентичности немецкого общества и государства, которое она не только продвигает как в Европейских сообществах / Европейском Союзе, так и за его пределами, но и последовательно защищает. В рамках законодательной базы экологической политики ЕС сохраняется место для независимых национальных действий немецкого правительства. Это гарантирует ФРГ свободный выбор национальных стратегий при продвижении экологической политики. ; Зміна клімату – це глобальна проблема, але політичні дії, які необхідні для її розв'язання, носять як локальний і національний, так і міжнародний характер. Дилема безпеки – одна з найважливіших теоретичних ідей у міжнародних відносинах. Зміст політики безпеки еволюціонує, оскільки «безпека» – це соціальна конструкція, зміст і структура якої постійно змінюється залежно від трансформації існуючих і появи нових загроз та викликів (зміна клімату, руйнування озонового шару, засухи, нестача прісної води тощо – перелік поточних екологічних проблем в ХХІ ст. все частіше доповнюється новими загрозами). Науковці, політики та активісти пропонують розширити використання концепції безпеки за межі її традиційної військової спрямованості, щоб врахувати екологічні загрози, які серйозно загрожують добробуту людей. У статті досліджено, як екологічні і кліматичні проблеми принципово змінюють наш погляд на безпеку. Нефізична безпека, диверсифікація загроз та виокремлення особистості є ключовими ефектами глобалізації у сфері безпеки. Ці ефекти безпеки перетворюються на певні поведінкові тенденції у зовнішній політиці Німеччини, які досі не вивчались у вітчизняній літературі. Твердження про те, що чинники навколишнього середовища повинні бути інтегровані у концепцію безпеки, вперше озвучене на початку 1980-х років. Наприкінці ХХ – на початку ХХІ ст. концепція безпеки була розширена і застосовується для вирішення багатьох найважливіших питань теорії міжнародних відносин та політики безпеки. Екологічні проблеми слід не лише розглядати як невійськові загрози безпеці суспільств, але вони також можуть сприяти співпраці та побудові миру. У сучасних умовах піддається критиці здатність державної системи реагувати на екологічну небезпеку, а тому запропоновано принципово різні структури управління як заміну їй. Для ефективної протидії екологічним і кліматичним загрозам та викликам потрібна цілеспрямована політика з питань захисту клімату як на міжнародному та регіональному, так і на національному та місцевому рівнях. ФРН позиціонує себе як регіональний і світовий лідер у сфері захисту навколишнього середовища і клімату. Ідея турботи про навколишнє середовище поступово стає неодмінним елементом системи цінностей, правової культури і національної ідентичності німецького суспільства і держави, яку остання не лише просуває як в Європейських співтовариствах/ Європейському Союзі, так і за його межами, але й послідовно захищає. У рамках законодавчої бази екологічної політики ЄС зберігається місце для незалежних національних дій німецького уряду. Це гарантує ФРН вільний вибір національних стратегій при просуванні екологічної політики.

This project report contains research conducted by senior undergraduate students in a university capstone course, from January to April, 2021. The course invites students to conduct original research as an integrative experience for a degree in the Faculty of Agricultural, Life & Environmental Sciences, University of Alberta. All student authors were completing their degrees in Environment and Conservation Sciences, with majors in Human Dimensions, Environmental Economics and Policy, or Environmental Studies. At the beginning of each chapter, the names of student authors are listed. The final report was modified by the editors for clarity and consistency. This research is focused on the social context of flood risk in Alberta, with an emphasis on understanding the evolving challenges of urban residential flooding. This interest arose from interactions with faculty members at the University of Alberta, representatives from TD Insurance and researchers at the Institute for Catastrophic Loss Reduction, who were focused on understanding why homeowners in urban areas are not implementing measures on their properties to reduce the risk and impacts from stormwater flood events. Challenges homeowners face include the increasing frequency of surface flooding and how the media reports on these events over time. We also observe divergent perspectives on how to mitigate flood risk and who is responsible for these actions. These differences are noted in the information gathered from municipal planners and insurance brokers. The social context of flood risk also includes public perspectives of flooding and how these perspectives might be impacted by recent experiences with flooding and political ideology. Through a better understanding of these issues, we hope that key decision makers, such as municipal planners and insurance brokers, as well as homeowners, can better understand this social context and design programs or undertake activities to assist with flood risk reduction. In chapter one, the authors review 37 media articles on flooding in Alberta. Analysis indicates that topics in the media were associated with three broad factors: lack of awareness, socioeconomic concerns and concern for ongoing flooding. The two most frequently proposed solutions to flood risk were homeowners improving their homes to mitigate against flood risks or damages, and major infrastructural improvements or developments to withstand flood 10 | P a g e damages. Results showed that there were more articles that placed the onus on governments to do more in both fixing flooding problems and in accepting responsibility for allowing flooding to occur in the first place. Researchers also found that climate change is slowly starting to become part of the discussion surrounding urban flooding. With a focus on municipal planners (i.e., Edmonton, Calgary and St. Albert), chapter 2 investigates how planners understand flood risk, and their perceptions of collaboration and community engagement in flood risk management decision-making processes. Based on 12 in-depth interviews, this research revealed that there is considerable contention around the roles and responsibilities of homeowners, municipalities, and the provincial government. For example, there are different perspectives on who should be responsible for overland flooding within municipalities, with evolving expectations for governments and homeowners. Emerging perspectives on these roles and responsibilities is precipitated by large disaster events such as the 2013 fluvial floods in southern Alberta. The chapter also identifies emerging approaches to flood mitigation in municipalities, with distinct approaches to new versus old neighbourhoods, and ongoing challenges of flood mitigation as it relates to municipal versus private land. Chapter 3 involves in-depth interviews with 15 insurance brokers who work for TD Insurance. These individuals were identified for the students through prior contacts between university faculty members and the insurance company. Key questions in this study include the following: What do insurance adjusters see as the biggest barriers for customers to invest in flood prevention measures for their homes? With these barriers in mind, what can insurance companies and local governments do to encourage homeowners to invest in flood prevention measures? The largest barrier identified was homeowners not being able to understand their insurance policy, and the solutions to these problems centred on educational programming that is targeted at homeowners. In chapter 4, students shifted their focus to the perspectives of households. By comparing survey data from 2007 and 2021, the authors identified shifting patterns of public perception. Regarding perceptions of future flood risks, 10% of homeowners in 2021 rated the chance of a stormwater flood in the next 10 years as very or somewhat likely. This statistic 11 | P a g e indicates a drop of 38% in the perception of flood risk when compared to the 2007. his statistic compares to 38% in 2007, indicating a drop in the perception of flood risk. Other key differences in perception are compared in this study. But authors caution that while such differences may be a result of changing perceptions in the general population, they may also result from different survey research methods used in the 2007 and 2021 studies. Looking more deeply at public perceptions, Chapter 5 introduces the concept of moral framing and nudges as a way to understand flood risk through a political lens. The authors hypothesized that conservatives are more likely to undertake flood mitigation efforts when influenced by authority, loyalty, and sanctity framing. Liberals were expected to be more influenced by moral frames such as care, fairness and reciprocity. Although the theory of moral framing would suggest these outcomes to be observed in the dataset, results from this study show that morally framed statements did not produce statistically significant differences between liberal and conservative-oriented respondents. These results may challenge some of the thinking behind moral framing theory, but may also indicate some weaknesses in the quality of survey data. Finally, in chapter 6, students utilize pre-existing national survey data to examine differences in perceived versus objective flood risk and its impact on mitigation measures. Objective risk was measured using a GIS method of flood risk analysis for the Edmonton region. Using multivariate analysis, results indicate that objective risk has no impact on perceived risk of basement flooding. This conclusion was counter to that found in Chapter 4 with the more recent Edmonton homeowner survey. However, the students in this present chapter note that several socio-demographic variables are statistically significant in predicting perceived risk of basement flooding. These results (and those in Chapter 4) suggest a complex interaction between objective and perceived risks

BACKGROUND: There is growing interest in paying for performance (P4P) as a means to align the incentives of healthcare providers with public health goals. Rigorous evidence on the effectiveness of these strategies in improving health care and health in low‐ and middle‐income countries (LMICs) is lacking; this is an update of the 2012 review on this topic. OBJECTIVES: To assess the effects of paying for performance on the provision of health care and health outcomes in low‐ and middle‐income countries. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and 10 other databases between April and June 2018. We also searched two trial registries, websites, online resources of international agencies, organizations and universities, and contacted experts in the field. Studies identified from rerunning searches in 2020 are under 'Studies awaiting classification.' SELECTION CRITERIA: We included randomized or non‐randomized trials, controlled before‐after studies, or interrupted time series studies conducted in LMICs (as defined by the World Bank in 2018). P4P refers to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. To be included, a study had to report at least one of the following outcomes: patient health outcomes, changes in targeted measures of provider performance (such as the delivery of healthcare services), unintended effects, or changes in resource use. DATA COLLECTION AND ANALYSIS: We extracted data as per original review protocol and narratively synthesised findings. We used standard methodological procedures expected by Cochrane. Given diversity and variability in intervention types, patient populations, analyses and outcome reporting, we deemed meta‐analysis inappropriate. We noted the range of effects associated with P4P against each outcome of interest. Based on intervention descriptions provided in documents, we classified design schemes and explored variation in effect by scheme design. MAIN RESULTS: We included 59 studies: controlled before‐after studies (19), non‐randomized (16) or cluster randomized trials (14); and interrupted time‐series studies (9). One study included both an interrupted time series and a controlled before‐after study. Studies focused on a wide range of P4P interventions, including target payments and payment for outputs as modified by quality (or quality and equity assessments). Only one study assessed results‐based aid. Many schemes were funded by national governments (23 studies) with the World Bank funding most externally funded schemes (11 studies). Targeted services varied; however, most interventions focused on reproductive, maternal and child health indicators. Participants were predominantly located in public or in a mix of public, non‐governmental and faith‐based facilities (54 studies). P4P was assessed predominantly at health facility level, though districts and other levels were also involved. Most studies assessed the effects of P4P against a status quo control (49 studies); however, some studies assessed effects against comparator interventions (predominantly enhanced financing intended to match P4P funds (17 studies)). Four studies reported intervention effects against both comparator and status quo. Controlled before‐after studies were at higher risk of bias than other study designs. However, some randomised trials were also downgraded due to risk of bias. The interrupted time‐series studies provided insufficient information on other concurrent changes in the study context. P4P compared to a status quo control: For health services that are specifically targeted, P4P may slightly improve health outcomes (low certainty evidence), but few studies assessed this. P4P may also improve service quality overall (low certainty evidence); and probably increases the availability of health workers, medicines and well‐functioning infrastructure and equipment (moderate certainty evidence). P4P may have mixed effects on the delivery and use of services (low certainty evidence) and may have few or no distorting unintended effects on outcomes that were not targeted (low‐certainty evidence), but few studies assessed these. For secondary outcomes, P4P may make little or no difference to provider absenteeism, motivation or satisfaction (low certainty evidence); but may improve patient satisfaction and acceptability (low certainty evidence); and may positively affect facility managerial autonomy (low certainty evidence). P4P probably makes little to no difference to management quality or facility governance (low certainty evidence). Impacts on equity were mixed (low certainty evidence). For health services that are untargeted, P4P probably improves some health outcomes (moderate certainty evidence); may improve the delivery, use and quality of some health services but may make little or no difference to others (low certainty evidence); and may have few or no distorting unintended effects (low certainty evidence). The effects of P4P on the availability of medicines and other resources are uncertain (very low certainty evidence). P4P compared to other strategies: For health outcomes and services that are specifically targeted, P4P may make little or no difference to health outcomes (low certainty evidence), but few studies assessed this. P4P may improve service quality (low certainty evidence); and may have mixed effects on the delivery and use of health services and on the availability of equipment and medicines (low certainty evidence). For health outcomes and services that are untargeted, P4P may make little or no difference to health outcomes and to the delivery and use of health services (low certainty evidence). The effects of P4P on service quality, resource availability and unintended effects are uncertain (very low certainty evidence). Findings of subgroup analyses: Results‐based aid, and schemes using payment per output adjusted for service quality, appeared to yield the greatest positive effects on outcomes. However, only one study evaluated results‐based aid, so the effects may be spurious. Overall, schemes adjusting both for quality of service and rewarding equitable delivery of services appeared to perform best in relation to service utilization outcomes. AUTHORS' CONCLUSIONS: The evidence base on the impacts of P4P schemes has grown considerably, with study quality gradually increasing. P4P schemes may have mixed effects on outcomes of interest, and there is high heterogeneity in the types of schemes implemented and evaluations conducted. P4P is not a uniform intervention, but rather a range of approaches. Its effects depend on the interaction of several variables, including the design of the intervention (e.g., who receives payments ), the amount of additional funding, ancillary components (such as technical support) and contextual factors (including organizational context).

Penelitian ini bertujuan untuk menguji dan menganalisis pengaruh financial distress, komite audit, dan leverage terhadap agresivitas pajak. Pengukuran agresivitas pajak dalam penelitian ini menggunakan tarif pajak efektif (ETR). Model penelitian yang digunakan adalah metode kuantitatif. Data yang digunakan dalam penelitian ini adalah laporan keuangan. Populasi dalam penelitian ini menggunakan perusahaan real estate yang terdaftar di Bursa Efek Indonesia (BEI) 2016-2019. Jumlah sampel penelitian sebanyak 31 perusahaan dengan jumlah sampel sebanyak 124 yang diperoleh dengan metode purposive sampling. Metode Penelitian yang digunakan adalah metode analisis deskriptif dengan analisis regresi berganda. Hasil analisis menunjukkan bahwa financial distress, komite audit, dan leverage berpengaruh signifikan terhadap agresivitas pajak.Kata kunci: Kesulitan Keuangan, Komite Audit, Leverage, Agresivitas Pajak. DAFTAR PUSTAKA Windaswari, K. A., & Merkusiwati, N. K. L. A. (2018). Pengaruh Koneksi Politik, Capital Intensity, Profitabilitas, Leverage dan Ukuran Perusahaan Pada Agresivitas Pajak. E-Jurnal Akuntansi, 23, 1980. https://doi.org/10.24843/eja.2018.v23.i03.p1 Maulana, I. (2020) Faktor-Faktor Yang Mempengaruhi Agresivitas Pajak Pada Perusahaan Properti Dan Real Estate, Krisna: Kumpulan Riset Akuntansi, 12, 13-14. Yunanto. F; Januarti, I (2017). Analisis Pengaruh Financial Distress, Komisaris Independen Dan Struktur Kepemilikan Terhadap Agresivitas Pajak. P. Ariyani, S. Lestari, D. Pratomo et al (2019) Pengaruh Koneksi Politik dan Capital Intensity Terhadap Agresivitas Pajak, JURNAL ASET (Akuntansi Riset), 11, 41- 54. Kandaka, R. Pratiwi (2019) Pengaruh Komite Audit, Leverage, dan Provitabilitas Terhadap Agresivitas Pajak (Studi Pada Perusahaan Sektor Industri Barang Konsumsi Yang Terdaftar Di Bursa Efer Periode 2014-2017): STIE Multi Data Palembang,3 ,57-73 C. Swingly, I. Sukartha (2015) Pengaruh Karakteristik Eksekutif, Komite Audit, Ukuran Perusahaan, Leverage, dan Sales Growth pada Tax Avoidance, E- Jurnal Akuntansi Universitas Udayana, 1, 47-62 Independen, Komite Audit, Preferensi Risiko Eksekutif Dan Ukuran Perusahaan Pada Penghindaran Pajak, E-Jurnal Akuntansi, 1, 72-100 Vol. 5, No. 2 (Oktober 2015) E S E N S I Jurnal Bisnis dan Manajemen, 5, 187-206 P. Diantari, I. Ulupui (2016) Pengaruh Komite Audit, Proporsi Komisaris Independen, Dan Proporsi Kepemilikan Institulional Terhadap Tax Avoidance, E-Jurnal Akuntansi, 16, 702-732 M. Hernawati (2018) Analisis Kepemilikan Manajerial, Kepemilikan Institutional, Komite Audit, Manajemen Laba Dan Ukuran perusahaan terhadap Tindakan Tindakan Agresivitas Pajak (Studi Empiris pada Perusahaan Manufaktur yang terdaftar di Bursa Efek Indonesia tahun 2014-2017), Skripsi Ekonomi Universitas Islam Indonesia. Jamaludin. A (2020) Pengaruh Profitabilitas (ROA), Leverage (Ltder) Dan Intensitas Aktiva Tetap Terhadap Penghindaran Pajak (Tax Avoidance) Pada Perusahaan Subsektor Makanan Dan Minuman Yang Terdaftar Di Bei Periode 2015- 2017, Eqien: Jurnal Ekonomi dan Bisnis, 7, 85-92.Dharma. I, Ardiana. P (2016) Pengaruh Leverage, Intensitas Aset Tetap, Ukuran Perusahaan, Dan Koneksi Politik Terhadap Tax Avoidance, E-Jurnal Akuntansi,15, 584-613.Hidayat. A, Fitria, E (2018) Pengaruh Capital Intensity, Inventory Intensity, Provitabilitas dan Leverage Terhadap agresivitas Pajak, Eksis: Jurnal RisetEkonomi dan Bisnis, 13, 157-168Kristanto Budi. A, (2015) Faktor finansial dan non finansial yang mempengaruhi agresivitas pajak di Indonesia, Media Riset Akuntansi, Auditing & Informasi, 15,31-48.K. Subagiastra, I. Arizon, I. Mahaputra (2017) Pengaruh Profitabilitas, Kepemilikan Keluarga Dan Good Corporate Governance Terhadap Penghidaran Pajak, JurnalIlmiah Akuntansi, 1, 167-193.S. Purnawati, L. Sugiarti (2017) Pengaruh Intensitas Aset Tetap, Pertumbuhan Penjualandan Koneksi Politik Terhadap Tax Avoidance, Jurnal Riset Akuntansi & Keuangan,5, 1625-1641.M. Alam, Fidiana (2019) Pengaruh Manajemen Laba, Likuiditas, Leverage dan Corporate Governance Terhadap Penghindaran Pajak, Jurnal Ilmu dan RisetAkuntansi, 8, 1-22.W. Valentinus (2015) Pengaruh Proporsi Komisaris Independen, Komite Audit, Manajemen Laba, Likuiditas, Ukuran Perusahaan dan Profitabilitas TerhadapAgresivitas Pajak, Universidad Nacional de Colombia. Laporan Keuanga atau anuual Report dari IDXhttps://www.idx.co.id/en-us/listed-companies/financial-statements-annual- report/ Alifianti, R., Putri, H., & Chariri, A. (2017). Pengaruh Financial Distress Dan Good Corporate Governance Terhadap Praktik Tax Avoidance Pada Perusahaan M Anufaktur. Diponegoro Journal of Accounting, 6(2), 56–66.Ardyansah, D. (2014). Pengaruh Size, Leverage, Profitability, Capital Intensity Ratio Dan Komisaris Independen Terhadap Effective Tax Rate (Etr). Diponegoro Journal of Accounting, 3(2), 371–379.Empiris, S., Di, T., & Selama, B. E. I. (2014). Pengaruh Size, Leverage, Profitability, Capital Intensity Ratio Dan Komisaris Independen Terhadap Effective Tax Rate (Etr). Diponegoro Journal of Accounting, 3(2), 371–379.Han, E. S., & goleman, daniel; boyatzis, Richard; Mckee, A. (2019). 済無No Title No Title. Journal of Chemical Information and Modeling, 53(9), 1689– 1699.Khairuzzaman, M. Q. (2016). No Title血清及尿液特定蛋白检测在糖尿病肾病早期诊断中的意义. 4(1), 64–75.Larasati, O. (2018). Jurnal Mitra Manajemen ( JMM Online ). Jurnal Mitra Manajemen, 2(4), 273–285. http://e- jurnalmitramanajemen.com/index.php/jmm/article/view/125/69 Nugraha, M. (2015). Diponegoro Journal of Accounting. Diponegoro Journal of Accounting, Vol. 4 No.(PENGARUH CORPORATE SOCIAL RESPONSIBILITY, UKURAN PERUSAHAAN, PROFITABILITAS, LEVERAGE DAN CAPITAL INTENSITY TERHADAP AGRESIVITASPAJAK), 1–14. http://ejournal-s1.undip.ac.id/index.php/accountingNugroho, S. A., & Firmansyah, A. (2018). Pengaruh Financial Distress, Real Earnings Management Dan Corporate Governance Terhadap Tax Aggressiveness. Journal of Applied Business Administration, 1(2), 163– 182. https://doi.org/10.30871/jaba.v1i2.616Nurjanah, N., Abdullah, A., & Nufus, C. (2018). Karakteristik Sediaan Garam Ulva lactuca dari Perairan Sekotong Nusa Tenggara Barat bagi Pasien Hipertensi. Jurnal Pengolahan Hasil Perikanan Indonesia, 21(1), 109. https://doi.org/10.17844/jphpi.v21i1.21455Selviani, R., Supriyanto, J., & Fadillah, H. (2018). Pengaruh Ukuran Perusahaan dan Leverage terhadap Penghindaran Pajak Studi Kasus Empiris Pada Perusahaan Sub Sektor Kimia di Bursa Efek Indonesia Periode 2013 – 2017. Jurnal Online Mahasiswa Bidang Akuntansi, 2(5), 1–15.Setiawan, A., & Al-ahsan, M. K. (2016). Pengaruh Size, Leverage, Profitability , Komite Audit, Komisaris Independen dan Investor Konstitusional Terhadap Effective Tax Rate ( ETR ). Jurnal EKA CIDA, 1(2), 1–16.Turyatini, T. (2017). The Analysis of Tax Avoidance Determinant on The Property and Real Estate Companies. Jurnal Dinamika Akuntansi, 9(2), 143–153. https://doi.org/10.15294/jda.v9i2.10385Windaswari, K. A., & Merkusiwati, N. K. L. A. (2018). Pengaruh Koneksi Politik, Capital Intensity, Profitabilitas, Leverage dan Ukuran Perusahaan Pada Agresivitas Pajak. E-Jurnal Akuntansi, 23, 1980.https://doi.org/10.24843/eja.2018.v23.i03.p14

Email



Share

Tweet

Share


Comment










Image



Nurses in Sri Lanka attend to their work. Photo: Dominic Sansoni/World Bank






















The COVID-19 pandemic is prompting a fresh look at options to ensure reliable power for health facilities , including the Vavuniya General Hospital in Sri Lanka's Northern Province. In line with an overall push to boost the share of renewables, the government of Sri Lanka is pursuing new power solutions for Vavuniya and about 20 other hospitals across the nation.

The World Bank is assisting as part of a multi-sectoral pandemic response in Sri Lanka. Similar initiatives are underway in other countries around the world, including Afghanistan, Madagascar, and Nigeria, to name a few.

Parts of a solution

Distributed photovoltaics (DPV), installed on rooftops or open spaces near buildings, are proliferating as a low-cost option for emergency power supplies. Many developing countries already use DPV as a long-term primary or secondary power source for health care facilities in rural and urban settings. While operating costs are minimal, average investment costs are dramatically lower today than even a few years ago, making DPV more economically attractive. When coupled with batteries, which are also becoming cheaper, DPV systems can contribute to reliable power around the clock.

With these solutions, diesel generators can become more of a last resort, instead of being the main or only source of essential back-up power when the grid is unavailable. Less use of diesel generators helps avoid the high cost of fuel, vulnerability to shortages, and toxic emissions.

Diverse technology options are available for distributed renewables. They range from individual components to pre-packaged "box" solutions which combine DPV, batteries and generators of varying sizes, including up to mini-grid level for larger sites. Under the auspices of the Energy Storage Partnership facilitated by the World Bank, a survey of suppliers has found that significant inventory is available despite logistics disruptions.

Electrical devices are also increasingly available in more energy efficient models, which can help avoid oversized power systems in new health care units. Correct system sizing is crucial where financial resources are limited, but many variables need to be considered.

For example, the electricity needs of intensive care units (ICU) differ greatly depending on how many beds are occupied: temporary ICU wards need significant power, but only for a limited time period. Another key factor to consider is that electricity demand from certain medical services may drop while stay-at-home measures are in force. For instance, some hospitals are deferring elective surgeries during the crisis. System sizing strategies need to examine such factors when addressing the health care sector's power needs in response to the pandemic.

Bringing the parts together

Given all the options, what tools are available to design power solutions for hospitals without full grid electricity? One resource is the HOMER Powering Health Tool, a free online model to help simplify the design process for distributed generation systems for health care facilities. Standing for Hybrid Optimization Model for Multiple Energy Resources, HOMER is a leading resource for mini-grid analyses.

Originally commissioned for USAID's Powering Health program, the HOMER Powering Health Tool has recently been updated to reflect typical COVID-19 response needs with support from the World Bank's Energy Sector Management Assistance Program (ESMAP). Users enter the electrical needs manually or select default values for pre-listed devices from one of four health facility tiers as a starting point. The tiers include, for example, a small rural dispensary that would typically screen and refer serious cases to larger facilities such as a district hospital. Based on user inputs, the tool calculates least-cost combinations of batteries, PV, and diesel generators sets – including as back-up to grid electricity if this is available for some hours each day.

The tool runs entirely online and can be used an unlimited number of times with no need to sign in or to download a software. It's kept simple for non-specialists to use without requiring special training. This comes with limitations, of course. For certain advanced needs, other products are available, such as the full, licensed software of HOMER Energy by UL or the free System Advisor Model (SAM) of the U.S. National Renewable Energy Laboratory (NREL). The latter is especially useful for systems that may feed DPV power to the grid when it is not needed on site. In Sri Lanka, the World Bank is applying these tools to optimize solutions to strengthen power for Vavuniya and other hospitals.

From one to many

With a standard lifetime of 20 years, DPV systems can supply clean energy to the national grid. They can also become the backbone of community mini-grids. The value of both options goes well beyond the pandemic. DPV can help not only the consumers who host the systems but also a power system that it feeds. DPV can reduce grid congestion and energy losses for utilities. It can also displace more costly generation from wholesale sources while promoting resilience.

Sri Lanka has already been promoting DPV such as through its Rooftop Solar Power Generation Project, in partnership with the Asian Development Bank. Nationwide, rooftop installations are on track to reach a total of 200 megawatts capacity by the end of 2020, equivalent to around 7 percent of system peak demand. Northern Province alone has added over 3 megawatts since 2017, including 17 projects in Vavuniya for businesses and households. Consumers with DPV can choose to feed some or all the power generated into the national grid through the utility providers. In all cases, the DPV significantly reduces consumers' bills while providing clean energy to the system at a lower cost than fuel-based generation for grid.

Sri Lanka's initiative shows that solutions to the current crisis can also address longer-term challenges. With a strategic approach, health care facilities can be well-positioned to combat COVID-19 while preparing for the "new normal."

Subscribe here to stay up to date with the latest Energy blogs.











Topics

Energy
Health









Regions

South Asia









Series

COVID-19 (coronavirus)
















Authors













https://www.linkedin.com/in/alandlee/




Alan David Lee
Senior Energy and Climate Change Specialist
More Blogs By Alan

































https://www.linkedin.com/in/andrea-arricale/




Andrea Arricale
Energy Access Consultant
More Blogs By Andrea









































0

Publisher's version (útgefin grein) ; Smoking is a potentially causal behavioral risk factor for type 2 diabetes (T2D), but not all smokers develop T2D. It is unknown whether genetic factors partially explain this variation. We performed genome-environment-wide interaction studies to identify loci exhibiting potential interaction with baseline smoking status (ever vs. never) on incident T2D and fasting glucose (FG). Analyses were performed in participants of European (EA) and African ancestry (AA) separately. Discovery analyses were conducted using genotype data from the 50,000-single-nucleotide polymorphism (SNP) ITMAT-Broad-CARe (IBC) array in 5 cohorts from from the Candidate Gene Association Resource Consortium (n = 23,189). Replication was performed in up to 16 studies from the Cohorts for Heart Aging Research in Genomic Epidemiology Consortium (n = 74,584). In meta-analysis of discovery and replication estimates, 5 SNPs met at least one criterion for potential interaction with smoking on incident T2D at p<1x10-7 (adjusted for multiple hypothesis-testing with the IBC array). Two SNPs had significant joint effects in the overall model and significant main effects only in one smoking stratum: rs140637 (FBN1) in AA individuals had a significant main effect only among smokers, and rs1444261 (closest gene C2orf63) in EA individuals had a significant main effect only among nonsmokers. Three additional SNPs were identified as having potential interaction by exhibiting a significant main effects only in smokers: rs1801232 (CUBN) in AA individuals, rs12243326 (TCF7L2) in EA individuals, and rs4132670 (TCF7L2) in EA individuals. No SNP met significance for potential interaction with smoking on baseline FG. The identification of these loci provides evidence for genetic interactions with smoking exposure that may explain some of the heterogeneity in the association between smoking and T2D. ; WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201100046C, HSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C. The grant funding of WHI are R21 HL123677, R56 DK104806 and R01 MD012765 to NF. The FamHS was funded by R01HL118305 and R01HL117078 NHLBI grants, and 5R01DK07568102 and 5R01DK089256 NIDDK grant." and "The Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study was supported by the Intramural Research Program of the National Institute on Aging, National Institutes of Health (project # Z01-AG000513 and human subjects protocol number 09-AGN248). Support for GENOA was provided by the National Heart, Lung and Blood Institute (HL119443, HL087660, HL054464, HL054457, and HL054481) of the National Institutes of Health. Ruth loos is supported by the NIH (R01DK110113, U01HG007417, R01DK101855, R01DK107786). The Rotterdam Study GWAS datasets are supported by the Netherlands Organisation of Scientific Research NWO Investments (nr. 175.010.2005.011, 911-03-012), the Research Institute for Diseases in the Elderly (014-93-015; RIDE2), and the Netherlands Genomics Initiative (NGI)/Netherlands Organisation for Scientific Research (NWO) Netherlands Consortium for Healthy Aging (NCHA), project nr. 050-060-810. The ERF study as a part of EUROSPAN (European Special Populations Research Network) was supported by European Commission FP6 STRP grant number 018947 (LSHG-CT-2006- 01947) and also received funding from the European Community's Seventh Framework Programme (FP7/2007-2013)/grant agreement HEALTH-F4-2007-201413 by the European Commission under the programme "Quality of Life and Management of the Living Resources" of 5th Framework Programme (no. QLG2-CT-2002- 01254). The ERF study was further supported by ENGAGE consortium and CMSB. Highthroughput analysis of the ERF data was supported by joint grant from Netherlands Organisation for Scientific Research and the Russian Foundation for Basic Research (NWORFBR 047.017.043).ERF was further supported by the ZonMw grant (project 91111025), and this work was partially supported by the National Heart, Lung and Blood Institute's Framingham Heart Study (Contract No. N01-HC25195) and its contract with Affymetrix, Inc for genotyping services (Contract No. N02-HL-6- 4278). This study is also supported by National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) R01 DK078616 to Drs. Meigs, Dupuis and Florez, NIDDK K24 DK080140 to Dr. Meigs, and a Doris Duke Charitable Foundation Clinical Scientist Development Award to Dr. Florez. The HERITAGE Family Study was supported by National Heart, Lung, and Blood Institute grant HL-45670. The Women's Genome Health Study is supported by the National Heart, Lung, and Blood Instutute (HL043851 and HL080467) and the National Cancer Institute (CA047988 and UM1CA182913). Additional support for endpoint collection was provided by the National Heart, Lung, and Blood Institute under ARRA funding (HL099355). HyperGEN (Hypertension Genetic Epidemiology Network): The hypertension network is funded by cooperative agreements (U10) with NHLBI: HL54471, HL54472, HL54473, HL54495, HL54496, HL54497, HL54509, HL54515, and 2 R01 HL55673- 12. The AGES study has been funded by NIH contracts N01-AG-1-2100 and 271201200022C. Caroline Hayward is supported by an MRC University Unit Programme Grant MC_UU_00007/10 (QTL in Health and Disease)"and "Generation Scotland received core funding from the Chief Scientist Office of the Scottish Government Health Directorate CZD/16/6, the Scottish Funding Council HR03006 and the Wellcome Trust through a Strategic Award (reference 104036/Z/14/Z) for Stratifying Resilience and Depression Longitudinally (STRADL). Genotyping was funded by the UK's Medical Research Council. Jose C. Florez, NIDDK K24 DK110550 The MESA project is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with MESA investigators. Support for MESA is provided by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169, UL1-TR-000040, UL1-TR-001079, UL1-TR-001420, UL1-TR-001881, and DK063491. Additionally, one or more authors are affiliated with the following commercial entities: Interleukin Genetics, GlaxoSmithKline, Daiichi-Sankyo, AstraZeneca, Data Tecnica International LLC, Illumina Inc., University of California Healthcare, Janssen Pharmaceuticals, Goldfinch Bio, and Novo Nordisk. Please see the Competing Interests Statement for additional details. The funders provided support in the form of salaries for authors but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the 'author contributions' section. ; Peer Reviewed

Background: Pollution – unwanted waste released to air, water, and land by human activity – is the largest environmental cause of disease in the world today. It is responsible for an estimated nine million premature deaths per year, enormous economic losses, erosion of human capital, and degradation of ecosystems. Ocean pollution is an important, but insufficiently recognized and inadequately controlled component of global pollution. It poses serious threats to human health and well-being. The nature and magnitude of these impacts are only beginning to be understood.Goals: (1) Broadly examine the known and potential impacts of ocean pollution on human health. (2) Inform policy makers, government leaders, international organizations, civil society, and the global public of these threats. (3) Propose priorities for interventions to control and prevent pollution of the seas and safeguard human health.Methods: Topic-focused reviews that examine the effects of ocean pollution on human health, identify gaps in knowledge, project future trends, and offer evidence-based guidance for effective intervention.Environmental Findings: Pollution of the oceans is widespread, worsening, and in most countries poorly controlled. It is a complex mixture of toxic metals, plastics, manufactured chemicals, petroleum, urban and industrial wastes, pesticides, fertilizers, pharmaceutical chemicals, agricultural runoff, and sewage. More than 80% arises from land-based sources. It reaches the oceans through rivers, runoff, atmospheric deposition and direct discharges. It is often heaviest near the coasts and most highly concentrated along the coasts of low- and middle-income countries. Plastic is a rapidly increasing and highly visible component of ocean pollution, and an estimated 10 million metric tons of plastic waste enter the seas each year. Mercury is the metal pollutant of greatest concern in the oceans; it is released from two main sources – coal combustion and small-scale gold mining. Global spread of industrialized agriculture with increasing use of chemical fertilizer leads to extension of Harmful Algal Blooms (HABs) to previously unaffected regions. Chemical pollutants are ubiquitous and contaminate seas and marine organisms from the high Arctic to the abyssal depths.Ecosystem Findings: Ocean pollution has multiple negative impacts on marine ecosystems, and these impacts are exacerbated by global climate change. Petroleum-based pollutants reduce photosynthesis in marine microorganisms that generate oxygen. Increasing absorption of carbon dioxide into the seas causes ocean acidification, which destroys coral reefs, impairs shellfish development, dissolves calcium-containing microorganisms at the base of the marine food web, and increases the toxicity of some pollutants. Plastic pollution threatens marine mammals, fish, and seabirds and accumulates in large mid-ocean gyres. It breaks down into microplastic and nanoplastic particles containing multiple manufactured chemicals that can enter the tissues of marine organisms, including species consumed by humans. Industrial releases, runoff, and sewage increase frequency and severity of HABs, bacterial pollution, and anti-microbial resistance. Pollution and sea surface warming are triggering poleward migration of dangerous pathogens such as the Vibrio species. Industrial discharges, pharmaceutical wastes, pesticides, and sewage contribute to global declines in fish stocks.Human Health Findings: Methylmercury and PCBs are the ocean pollutants whose human health effects are best understood. Exposures of infants in utero to these pollutants through maternal consumption of contaminated seafood can damage developing brains, reduce IQ and increase children's risks for autism, ADHD and learning disorders. Adult exposures to methylmercury increase risks for cardiovascular disease and dementia. Manufactured chemicals – phthalates, bisphenol A, flame retardants, and perfluorinated chemicals, many of them released into the seas from plastic waste – can disrupt endocrine signaling, reduce male fertility, damage the nervous system, and increase risk of cancer. HABs produce potent toxins that accumulate in fish and shellfish. When ingested, these toxins can cause severe neurological impairment and rapid death. HAB toxins can also become airborne and cause respiratory disease. Pathogenic marine bacteria cause gastrointestinal diseases and deep wound infections. With climate change and increasing pollution, risk is high that Vibrio infections, including cholera, will increase in frequency and extend to new areas. All of the health impacts of ocean pollution fall disproportionately on vulnerable populations in the Global South – environmental injustice on a planetary scale.Conclusions: Ocean pollution is a global problem. It arises from multiple sources and crosses national boundaries. It is the consequence of reckless, shortsighted, and unsustainable exploitation of the earth's resources. It endangers marine ecosystems. It impedes the production of atmospheric oxygen. Its threats to human health are great and growing, but still incompletely understood. Its economic costs are only beginning to be counted.Ocean pollution can be prevented. Like all forms of pollution, ocean pollution can be controlled by deploying data-driven strategies based on law, policy, technology, and enforcement that target priority pollution sources. Many countries have used these tools to control air and water pollution and are now applying them to ocean pollution. Successes achieved to date demonstrate that broader control is feasible. Heavily polluted harbors have been cleaned, estuaries rejuvenated, and coral reefs restored.Prevention of ocean pollution creates many benefits. It boosts economies, increases tourism, helps restore fisheries, and improves human health and well-being. It advances the Sustainable Development Goals (SDG). These benefits will last for centuries.Recommendations: World leaders who recognize the gravity of ocean pollution, acknowledge its growing dangers, engage civil society and the global public, and take bold, evidence-based action to stop pollution at source will be critical to preventing ocean pollution and safeguarding human health.Prevention of pollution from land-based sources is key. Eliminating coal combustion and banning all uses of mercury will reduce mercury pollution. Bans on single-use plastic and better management of plastic waste reduce plastic pollution. Bans on persistent organic pollutants (POPs) have reduced pollution by PCBs and DDT. Control of industrial discharges, treatment of sewage, and reduced applications of fertilizers have mitigated coastal pollution and are reducing frequency of HABs. National, regional and international marine pollution control programs that are adequately funded and backed by strong enforcement have been shown to be effective. Robust monitoring is essential to track progress.Further interventions that hold great promise include wide-scale transition to renewable fuels; transition to a circular economy that creates little waste and focuses on equity rather than on endless growth; embracing the principles of green chemistry; and building scientific capacity in all countries.Designation of Marine Protected Areas (MPAs) will safeguard critical ecosystems, protect vulnerable fish stocks, and enhance human health and well-being. Creation of MPAs is an important manifestation of national and international commitment to protecting the health of the seas.

Laut der Weltgesundheitsorganisation WHO sind 10% aller Arzneimittel weltweit minderwertig oder gefälscht, wobei Länder mit niedrigem oder mittlerem Einkommen besonders betroffen sind. Gründe dafür sind mangelhafte oder fehlende Pharmakovigilanz, Arzneimittelüberwachung und Berichterstattung sowie Menschen, die in ärmlichen Verhältnissen leben und keinerlei Zugang zum Gesundheitssystem haben. Darüber hinaus steigt die Anzahl der vom Pharmaceutical Security Institute veröffentlichten Vorfälle, die im Zusammenhang mit minderwertigen, gefälschten, nachgemachten oder nicht registrierten Medikamenten stehen, weltweit an. Das ist auf die steigende Komplexität der pharmazeutischen Lieferkette und die Tatsache zurückzuführen, dass sich Menschen in vielen Regionen legale Arzneiwaren nicht leisten könne. Sowohl Rohstoffe als auch Fertigprodukte werden heutzutage rund um den Globus transportiert, wodurch Fälschern und Menschen mit kriminellen Absichten zahlreiche Möglichkeiten geboten werden, um nicht legale Arzneimittel einzuschleusen. Diese Vermarktung von illegalen Produkten kann in weiterer Folge zu ernsten gesundheitlichen Problemen bis hin zum Tod des Patienten führen. Um die Unterwanderung der pharmazeutischen Lieferkette mit jeglicher Art von gefälschten Arzneimitteln und in weiterer Folge deren Distribution zu unterbinden beziehungsweise zu bekämpfen, wurden in den letzten Jahren in einigen Ländern und Regionen, wie etwa in der EU, in Russland und den USA, Rechtsvorschriften erlassen. Diese beinhalten unter anderem die Implementierung von Maßnahmen zur Serialisierung jeder Einzelpackung eines Medikaments und eines Rückverfolgungssystems, um Arzneimittelfälschungen von Originalen unterscheiden und jede Einzelpackung innerhalb der Lieferkette verfolgen und orten zu können. Ziel dieser Masterarbeit ist die Gegenüberstellung der Fälschungsrichtlinie 2011/62 und der Delegierten Verordnung 2016/161 der Kommission der EU, des russischen Bundesgesetzes 425-FZ inklusive dessen Erweiterungen und des amerikanischen Drug Supply Chain Security Act bezüglich der Anforderungen zur Kennzeichnung, Ortung und Rückverfolgbarkeit von Arzneimitteln und das Aufzeigen von Gemeinsamkeiten und Unterschieden der drei Gesetze. Basierend auf diesem Vergleich wird unter Verwendung des Tools der multikriteriellen Entscheidungsanalyse, genauer gesagt der Methode SMART, die beste Performance der 3 regulatorischen Modelle unter Berücksichtigung von Kriterien, wie Verbesserung der Sicherheit der Lieferkette, des Patienten und des Produkts, Kosten für Implementierung der Kennzeichnungsanforderungen und des Rückverfolgungssystems sowie die Struktur, Verwaltung und Handhabung des Rückverfolgungssystems evaluiert und diskutiert. Die ausgewählten Kriterien wurden dabei verschieden gereiht und in 3 Fällen unterschiedlich gewichtet . Im ersten Fall wurden alle Kriterien gleich stark gewichtet, während im zweiten Fall der Fokus auf den ersten vier Eigenschaften lag, deren Gewichtung insgesamt 75% ausmachte. Im dritten Fall wurden sogenannte ROD-Gewichte angewendet, wo die Gewichtung gemäß der Verteilung der Rangordnungen der Kriterien unter Verwendung der direkten Bewertungsmethode erfolgte. Bei der Auswertung von 15 möglichen Kombinationen aus 3 Fällen und 7 unterschiedlichen Anordnungen der Kriterien erreichte das russische Modell einmal den höchsten Nutzen, nämlich für die Gewichtung gemäß Fall 2, wenn die Attribute, die in Verbindung mit der Verbesserung der Sicherheit stehen, als wichtigste und Kosten als unwichtigste Kriterien gereiht waren. Im Vergleich dazu wurden das europäische und das amerikanische Modell jeweils siebenmal als die zu favorisierende Alternative identifiziert. Dabei erzielte die europäische Lösung für Fall 1 bei Gleichgewichtung der Kriterien und für Fall 2 und 3, wenn der Fokus auf Anforderungen und Kosten der Serialisierung gelegt wurde, die beste Performance. Im Gegensatz dazu erreichte die amerikanische Lösung für Fall 2 und 3 den höchsten Nutzen, wenn einerseits Kriterien, die im Zusammenhang mit dem Rückverfolgungssystem standen, und andererseits Kosten für die Implementierung sämtlicher Maßnahmen als wichtigste Attribute eingestuft wurden. Gleiches gilt für Fall 2 und 3 wenn die Kriterien zur Verbesserung der Sicherheit im Fokus standen. Die Ergebnisse dieser Evaluierung legen einerseits den Schluss nahe, die Anzahl der zur Auswahl stehenden regulatorischen Modelle von 3 auf 2 zu reduzieren, sodass sich Entscheidungsträger nur mehr zwischen dem europäischen und amerikanischen Modell entscheiden müssen. Andererseits zeigte diese Analyse, dass die Festlegung der Reihenfolge der Wichtigkeit der Kriterien in manchen Situationen eine entscheidende Rolle spielt, welches Modell als jenes mit der besten Performance aus der Berechnung hervorgeht. Daher bietet eine Verfeinerung der Definition der Kriterien, der Gewichtung und der Bewertung Raum für zukünftige Untersuchungen der Performance der drei regulatorischen Modelle. ; According to the WHO, 10% of all pharmaceuticals are substandard or falsified especially in low- and middle-income countries, where pharmacovigilance, drug monitoring and reporting is not executed properly, people live in poor conditions and do not have the access to the health care system. Moreover, the numbers of incidents worldwide published by the Pharmaceutical Security Institute in connection with fake medicine, i.e. sub-standard, falsified, counterfeited or unregistered pharmaceuticals, are on the rise all over the planet. One major factor for an increasing number of such incidents besides the unaffordability of pharmaceuticals in many regions of the world is the gaining complexity of the pharmaceutical supply chain. Nowadays, raw materials and the finished product take on a long journey all around the world. This global approach offers counterfeiters and people with criminal intentions the possibility of marketing illegitimate pharmaceuticals which in turn could lead to serve health issues or even to death of people. In order to combat the infiltration of the legal supply chain with any kind of fake medicine and subsequently inhibit the distribution, the European Union, the Russian Federation and the United States of America, among others, enacted legislations in the last years dealing with development and implementation of means of serialisation and aggregation of every single unit packaging and of a traceability system for pharmaceuticals. Those measurements shall help to identify fake from genuine medicine and to track and trace each pack along its journey in the pharmaceutical supply chain. This master thesis aims to compare requirements connected to the marking and the tracking and tracing of pharmaceuticals and to state major differences and similarities of the 3 legislations, i.e. the Falsified Medicine Directive 2011/62 and the Commission Delegated Regulation 2016/161 in the EU, Federal Law 425-FZ and corresponding amendments in the Russian Federation and the Drug Supply Chain Security Act in the USA. Building on this comparison, this master thesis further discusses which of these three surrogate regulatory models offers the best performance by application of a multi-criteria decision analysis (MCDA). More precisely, the MCDA-method SMART is applied to 7 different options of ranking of attributes like improvement of the security of the supply chain, the patient and the product, cost for implementing the marking requirements and the system, the structure, management and handling of the traceability system, in combination with 3 cases of weighting like equally weighting of all objectives (case 1), focusing on the top 4 objectives that account 75% in total in weights (case 2) and the use of rank order distribution weights (case 3). By evaluating 15 possible combinations of cases and options, only one time the Russian model did receive the highest utility when the attributes related to the improvement of the security are ranked as most important and costs as least important in case 2. The American and the European model both were identified 7 times each as the favoured solution, whereas the European solution did receive the highest utility in case 1 of equally weighting of all objectives and in case 2 and 3 when the focus is laid on requirements and costs for serialisation. In contrast, if attributes related to costs are of higher priority on one hand and in connection with the traceability system on the other hand, the American model scored the highest utility for both cases 2 and 3. Based on this evaluation, decision makers have to select their appropriate model out of a pool made up of the European and American model, on the one hand. On the other hand, for some options one has to carefully define the order of importance of the criteria as the final decision highly depends on the ranking of the attributes in some cases. Further research regarding the performance of these 3 regulatory models by refining the objectives, their weighting and scoring could be done in the future. ; Abweichender Titel laut Übersetzung der Verfasserin/des Verfassers ; Arbeit an der Bibliothek noch nicht eingelangt - Daten nicht geprüft ; Wien, FH Campus Wien, Masterarb., 2020 ; (VLID)5660619