pinecone/core-2020-05-10-deduplication huggingface dataset:
Reconsidering EU Compliance: Implementation performance in the field of environmental policy

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                  166043.pdf (publisher's version ) (Open Access)European Union (EU) environmental policy can only work in practice when it is implemented by and within the member states. Yet, despite its importance, we still lack a solid and cumulative understanding of the practical implementation of EU environmental policies, mainly because of the dominance of case-specific empirical insights and the dichotomous conceptualization of compliant implementation. This paper proposes a conceptual framework for analysing implementation performance, which is built around three dimensions: substance, scope and effort. The framework's relevance and analytical quality are substantiated by a systematic review of empirical studies on practical implementation of 18 EU environmental directives. We find evidence of three types of knowledge deficits: there is neglect of the ‘scope’ and ‘effort’ dimensions of implementation; disproportionate attention to the Water Framework Directive, and the Northern and Western European member states. The proposed conceptual framework aims to inform future research on EU environmental implementation. © 2017 The Authors. Environmental Policy and Governance published by ERP Environment and John Wiley & Sons Ltd13 p
Investigating patterns of local climate governance: How low-carbon municipalities and intentional communities intervene in social practices

The local level has gained prominence in climate policy and governance in recent\ud
years as it is increasingly perceived as a privileged arena for policy experimentation\ud
and social and institutional innovation. However, the success of local climate\ud
governance in industrialized countries has been limited. One reason may be that local\ud
communities focus too much on strategies of technology-oriented ecological modernization\ud
and individual behavior change and too little on strategies that target unsustainable\ud
social practices and their embeddedness in complex socioeconomic\ud
patterns. In this paper we assess and compare the strategies of "low-carbon municipalities"\ud
(top-down initiatives) and those of "intentional communities" (bottom-up initiatives).\ud
We were interested to determine to what extent and in which ways each \ud
community type intervenes in social practices to curb carbon emissions and to explore \ud
the scope for further and deeper interventions on the local level. Using an analytical \ud
framework based on social practice theory we identify characteristic patterns of intervention\ud
for each community type. We find that low-carbon municipalities face difficulties \ud
in transforming carbon-intensive social practices. While offering some\ud
additional low-carbon choices, their ability to reduce carbon-intensive practices is \ud
very limited. Their focus on efficiency and individual choice shows little transformative\ud
potential. Intentional communities, by contrast, have more institutional and organizational \ud
options to intervene in the web of social practices. Finally, we explore to\ud
what extent low-carbon municipalities can learn from intentional communities and \ud
propose strategies of hybridization for policy innovation to combine the strengths\ud
of both models
A blueprint for making the prospective Mediterranean free trade zone an environmental role model

If not accompanied by strong environmental provisions, the prospective Mediterranean Free Trade Zone (MFTZ) is bound to increase existing pressures on scarce natural resources in the region. This article argues that the existing bilateral association agreements between the European Union and Southern Mediterranean countries are clearly insufficient from an environmental perspective. If the MFTZ were to be based upon those agreements, then it would represent a free trade agreement environmentally inferior to the North American Free Trade Agreement and even the World Trade Organization. To turn the MFTZ into an environmental role model instead, a number of provisions are indispensable: environmentally friendly preambular language, upward harmonization of environmental standards, a comprehensive general exceptions clause, a prominent role given to the precautionary principle and the allocation of the burden of proof on the party challenging an environmental measure. Equally importantly, the European Union needs to step up financial, technical and other assistance as part of a wider regional environmental strategy and partnership. Doing so would ensure that the prospective MFTZ becomes a promoter not only of trade and economic growth, but also environmental protection in the Southern Mediterranean region
Environmental issues and the geological storage of CO2 : a discussion document

Increasing CO2 emissions will lead to climate change and ocean acidification with severe consequences for ecosystems and for human society. Strategies are being sought to reduce emissions including the geological storage of CO2. Existing studies operate within existing oil and gas regulatory frameworks, but if other non-oil reservoir geological formations are used these existing regulations may not apply. At UK and European levels the potential environmental impacts of uncontrolled CO2 releases from storage sites have been highlighted to be of significance for regulators. Thus a new regulatory framework may be needed. The precautionary principle is likely to be adopted by regulators, so it is important that the effects of acute and chronic exposures of ecosystems to CO2 leakages are evaluated. Consequently, existing regulations are likely to be developed to include specific recommendations concerning leakages. This review shows that many basic data simply do not exist to assist regulators in this process
Effects of certainty on decision making under uncertainty : using subsidies to reduce production of environmental harmful products

The present thesis investigates the effects of an environmental policy, with the focus on producers’ decision making, which may be used as a means to decrease the production of environmentally harmful products. A subsidy system reimbursing a reduction in sales and/or production is with this aim experimentally investigated by simulating a market. In Study I, a price competition between pairs of participants was designed to test effects of a high and a low level of a subsidy, as compared to no subsidy. It was shown that the subsidy led to higher prices and reduced sales, and also inhibited the start of price wars. The results were dependent on the level of the subsidy, suggesting that participants used the subsidy and the opponent’s previous price as reference values to guide their behavior. Increased risk taking and/or risk aversion may also have influenced the participants’ behavior. In Study II, an experiment was performed to determine whether the subsidy decreased competition. The results showed that participants in competitive conditions did not behave collusive or cooperatively and that the effects f the subsidy were the same, yielding increased prices and reduced sales. Since EU prohibits coalitions or cartels it is important that the subsidy system reduced prices and sales while preserving cometitiveness. To test the hypothesis that a subsidy makes participants more risk taking, in Study III additional experiments were performed focusing on individual production decisions with certain (subsidy) or uncertain sales outcomes. The results showed that participants displayed inconsistent risk taking in that they preferred to diversify between a risky saes prospect and a guaranteed subsidy. Diversifying alternatives were thus rated as more preferable and more attractive, despite not maximizing expected values. The results are explained by that participants make trade‐offs between certainty ‐ a guaranteed outcome, and a potential ‐ the highest possible outcome. Taken together, this thesis suggests that although there is a need for refinements and additional studies of the subsidy system, the results are promising in showing that introducing certainty in decision making under uncertainty may be used as part of a echanism to influence producers to reduce production of environmentally harmful products. 
 
Keywords: Certainty, Environmental Policy, Experiment, Individual Decision Making, Interdependent Decision Making, Risk Taking, Subsidy, Uncertaint
Nature conservation and urban development control in the portuguese planning system: a new impetus against old praxis?

Natura 2000 areas bring a new incentive to assess the performance of land-use planning in protecting environmental values from the impacts of development pressures. In the last decades, urban growth and consequent environmental impacts on natural areas have been a major concern for the Portuguese land-use planning system. Sprawl around sensitive areas has been revealed to be a persistent phenomenon in spite of the increasing challenges underlying land-use plans. This article critically analyses the content of three main documents recently adopted by the Portuguese government – the ‘National Strategy for Sustainable Development’, the ‘National Policy Programme for Spatial Planning’ and the ‘Sector Plan for Natura 2000’ – seeking prospects to innovate future plans at lower levels in order to prevent additional pressures on natural areas. First, the article reviews the recent theoretical debate on planning for the protection of natural areas. Results evidenced by recent EU evaluation reports are used to propose a set of guidelines to evaluate planning guidance at national level. Second, it critically analyses the three planning documents, bearing in mind the main features of the planning system and the proposed guidelines. The article is concluded with a discussion of their potential, exploring whether they bring a new impetus to the role of land-use planning against an outdated and persistent praxis, or whether, on the contrary, further efforts to strengthen planning guidance remain to be formulated. Copyright © 2008 John Wiley & Sons, Ltd and ERP Environment
Chronic hypoxia down-regulates tight junction protein ZO-2 expression in children with cyanotic congenital heart defect

AIMS: Tight junction protein zonula occludens protein 2 (ZO-2) is a member of the membrane-associated guanylate kinases protein family known to be expressed at tight junctions of epithelial and endothelial cells and at adherens junctions (AJs) in cardiomyocytes. Little is known about ZO-2 expression and function in the human heart. Here, we examined the hypothesis that chronic hypoxia down-regulates ZO-2 expression in human myocardium and cultured rat cardiomyocytes. METHODS AND RESULTS: Patients with a diagnosis of cyanotic (n = 10) or acyanotic (n = 10) Tetralogy of Fallot undergoing surgical repair were used to examine ZO-2 messenger RNA and protein expression by real time-PCR, immunohistochemistry, and western blotting. A model of cultured rat cardiomyocytes was used to measure ZO-2 and AJ proteins levels in response to hypoxia and to investigate ZO-2 cellular localization. We showed that ZO-2 is expressed in myocardial tissue in acyanotic and cyanotic children with congenital heart defects. ZO-2 was specifically down-regulated in cyanotic myocardium at both the messenger RNA and protein levels when compared with acyanotic patients. This specific down-regulation can be mimicked in cultured rat cardiomyocytes by treating them with hypoxic conditions confirming that ZO-2 gene down-regulation is specifically due to cyanosis. Furthermore, in addition to its cytoplasmic expression, ZO-2 showed nuclear expression in cultured rat cardiomyocytes suggesting potential role in transcription regulation. CONCLUSIONS: Hypoxia down-regulates ZO-2 expression in both cyanotic patient's myocardium and cultured rat cardiomyocytes. This down-regulation suggest an involvement of ZO-2 in cardiac remodelling of AJs in cyanotic children and may explain the greater susceptibility of cyanotic patients to corrective heart surgery
Red cell distribution width and mortality in acute heart failure patients with preserved and reduced ejection fraction.

Elevated red blood cell distribution width (RDW) is a valid predictor of outcome in acute heart failure (AHF). It is unknown whether elevated RDW remains predictive in AHF patients with either preserved left ventricular ejection fraction (LVEF) ≥50% or reduced LVEF (&lt;50%).
Prospective local registry including 402 consecutive hospitalized AHF patients without acute coronary syndrome or need of intensive care. The primary outcome was all-cause mortality (ACM) at 1 year after admission. Demographic and clinical data derive from admission, echocardiographic examinations (n = 269; 67%) from hospitalization. The Cox proportional hazard model including all patients (P &lt; 0.001) was adjusted for age, gender, and RDW quartiles. Independent predictors of 1-year ACM were cardiogenic shock (HR 2.86; CI: 1.3-6.4), male sex (HR 1.9; CI: 1.2-2.9), high RDW quartile (HR 1.66; CI: 1.02-2.8), chronic HF (HR 1.61; CI: 1.05-2.5), valvular heart disease (HR 1.61; CI: 1.09-2.4), increased diastolic blood pressure (HR 1.02 per mmHg; CI: 1.01-1.03), increasing age (HR 1.04 by year; CI: 1.02-1.07), platelet count (HR 1.002 per G/l; CI: 1.0-1.004), systolic blood pressure (HR 0.99 per mmHg; CI: 0.98-0.99), and weight (HR 0.98 per kg; CI: 0.97-0.99). A total of 114 patients (28.4%) died within the first year; ACM of all patients increased with quartiles of rising RDW (χ(2) 18; P &lt; 0.001). ACM was not different between RDW quartiles of patients with reduced LVEF (n = 153; χ(2) 6.6; P = 0.084). In AHF with LVEF ≥50% the probability of ACM increased with rising RDW (n = 116; χ(2) 9.9; P = 0.0195).
High RDW is associated with increased ACM in AHF patients with preserved but not with reduced LVEF in this study population
Potential role for clinical calibration to increase engagement with and application of home telemonitoring: a report from the HeartCycle programme

Aims: There is a need for alternative strategies that might avoid recurrent admissions in patients with heart failure. Home Telemonitoring (HTM) to monitor patient’s symptoms from a distance may be useful. This study attempts to assess changes in HTM vital signs in response to daily life activities (variations in medication, salt intake, exercise and stress) and to stablish which variations affect weight, blood pressure (BP) and heart rate (HR). Methods and results: We assessed 76 patients with heart failure (mean age 76 ± 10.8 years, 75% male, mainly in NYHA class II/III and from ischaemic etiology cause). Patients were given a calendar of interventions scheduling activities approximately twice-a-week before measuring their vital signs. Eating salty food or a large meal were the activities that had a significant impact on weight gain (+0.3 kg; p<0.001 and p=0.006, respectively). Exercise and skipping a dose of medication other than diuretics increased heart rate (+3 bpm, p=0.001 and almost +2 bpm, p=0.016, respectively). Conclusions: Our HTM system was able to detect small changes in vital signs related to these activities. Further studies should assess if providing such a schedule of activities might be useful for patient education and could improve long-term adherence to recommended lifestyle changes
Dynamic changes of serum microRNA-122-5p through therapeutic courses indicates amelioration of acute liver injury accompanied by acute cardiac decompensation

Aims: Recent studies have shown that serum microRNA (miR) abundance is informative for the diagnosis or prognosis of heart failure. However, the dynamics and kinetics of miRs in acute heart failure are largely unknown. Serial measurement and analysis of serum miRs changes in individuals along their therapeutic course could reduce inter-individual variation and should detect potentially important serum miRs related to disease mechanisms. Based on this concept, we profiled serum miR signatures of blood samples that were obtained sequentially on the day of admission and on hospital Day 7. Methods and results: This prospective, observational study included 42 consecutive acute heart failure patients (74 ± 1 years old, 24 male). From admission to Day 7, most of the patients showed clinical improvement. In such a cohort, we detected several fluctuations of serum miRs by two distinct screening methods (quantitative PCR and high-throughput sequencing). One of these fluctuating serum miRs, miR-122-5p, decreased significantly from Day 1 to Day 7 [median arbitrary unit (1st:3rd quantile value); 4.62 [2.39:12.3] to 3.07 [1.67:5.39], P = 0.007]. This fluctuation was significantly correlated with changes in serum liver function markers (estimated coefficient and 95% confidence interval; vs change in aspartate aminotransferase 1.69, 0.890–2.484, P < 0.001 and r = 0.560, vs change in alanine aminotransferase 1.09, 0.406–1.771, P = 0.007 and r = 0.428). Conclusions: The serum miR signature of patients with acute heart failure might indicate the severity of the disease or patients' response to therapeutic intervention. Notably, serum miR-122-5p levels reflect liver damage in this condition
Kyoto Congestive Heart Failure (KCHF) study: rationale and design

AimsOver the last decade, major developments in medicine have led to significant changes in the clinical management of heart failure patients. This study was designed to evaluate the recent trends in clinical characteristics, management, and short‐term and long‐term prognosis of patients with acute decompensated heart failure (ADHF) in Japan.Methods and resultsThe Kyoto Congestive Heart Failure study is a prospective, observational, multicentre cohort study, enrolling consecutive ADHF patients from 19 participating hospitals in Japan from November 2014 to March 2016. A total of 4000 patients will be enrolled into the study and patients\u27 anthropometric, socio‐economic, and clinical data from hospital admission to discharge will be collected. In addition, in a pre‐determined subgroup of patients (n=1500), a longitudinal follow‐up for 2 years is scheduled.ConclusionsThe Kyoto Congestive Heart Failure study will provide valuable information regarding patients with ADHF in the real‐world clinical practice of Japan and will be indispensable for future clinical and policy decision‐making with respect to heart failure
Right ventricular involvement in cardiac sarcoidosis demonstrated with cardiac magnetic resonance

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                  182911.pdf (publisher's version ) (Open Access)AIMS: Cardiac involvement in sarcoidosis is reported in up to 30% of patients. Left ventricular involvement demonstrated by contrast-enhanced cardiac magnetic resonance has been well validated. We sought to determine the prevalence and distribution of right ventricular late gadolinium enhancement in patients diagnosed with pulmonary sarcoidosis. METHODS AND RESULTS: We prospectively evaluated 87 patients diagnosed with pulmonary sarcoidosis with contrast-enhanced cardiac magnetic resonance for right ventricular involvement. Pulmonary artery pressures were non-invasively evaluated with Doppler echocardiography. Patient characteristics were compared between the groups with and without right ventricular involvement, and right ventricular enhancement was correlated with pulmonary hypertension, ventricular mass, volume, and systolic function. Left ventricular late gadolinium enhancement was demonstrated in 30 patients (34%). Fourteen patients (16%) had right ventricular late gadolinium enhancement, with sole right ventricular enhancement in only two patients. The pattern of right ventricular enhancement consisted of right ventricular outflow tract enhancement in 1 patient, free wall enhancement in 8 patients, ventricular insertion point enhancement in 10 patients, and enhancement of the right side of the interventricular septum in 11 patients. Pulmonary arterial hypertension correlated with the presence of right ventricular enhancement (P < 0.001). Right ventricular enhancement correlated with systolic ventricular dysfunction (P < 0.001), hypertrophy (P = 0.001), and dilation (P < 0.001). CONCLUSIONS: Right ventricular enhancement was present in 16% of patients diagnosed with pulmonary sarcoidosis and in 48% of patients with left ventricular enhancement. The presence of right ventricular enhancement correlated with pulmonary arterial hypertension, right ventricular systolic dysfunction, hypertrophy, and dilation
In-hospital worsening heart failure: a clinically relevant endpoint?

Outcome measures used for the clinical evaluation of patients with acute heart failure differ between studies and may neither adequately address the characteristic presenting symptoms and signs nor reflect the pathophysiological processes involved. In-hospital worsening of heart failure (WHF) is associated with poor outcomes and thus a potential endpoint conveying clinically meaningful prognostic information. Current definitions of WHF are based on the combination of worsening symptoms and signs and the intensification of treatment during admission. Definitions vary across studies and do not fully account for baseline therapy or circumstances in which there is failure to respond to treatment. Further, there are limited data to inform healthcare professionals as to which patients are most at risk of developing in-hospital WHF. In this opinion piece, we review the definitions for WHF used in recent and ongoing clinical trials and propose a novel definition, which captures failure to respond to treatment as well as clinical worsening (deterioration of symptoms and signs) of the patient's condition. Such a definition, applied consistently across studies, would help clarify the characteristics of patients likely to develop in-hospital WHF, allow comparative assessments of the effectiveness of interventions, and help guide appropriate patient management in order to improve outcomes.Peer-reviewedPublisher Versio
Combined heart-liver transplantation for failing Fontan circulation in a late survivor with single-ventricle physiology

Management of adults with failing Fontan physiology poses many challenges, especially as transplantation offers the only realistic alternative to palliative care. We present the first combined heart and liver transplant performed in Europe, for a late survivor of single ventricle palliation with the Fontan circulation. In addition to the conventional medical and surgical challenges posed, we highlight the management of the associated multi-organ failure with focus on the liver and novel strategies for assessment and optimization