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Policy accumulation and the democratic responsiveness trap
The responsiveness to societal demands is both the key virtue and the key problem of modern democracies. On the one hand, responsiveness is a central cornerstone of democratic legitimacy. On the other hand, responsiveness inevitably entails policy accumulation. While policy accumulation often positively reflects modernisation and human progress, it also undermines democratic government in three main ways. First, policy accumulation renders policy content increasingly complex, which crowds out policy substance from public debates and leads to an increasingly unhealthy discursive prioritisation of politics over policy. Secondly, policy accumulation comes with aggravating implementation deficits, as it produces administrative backlogs and incentivises selective implementation. Finally, policy accumulation undermines the pursuit of evidence-based public policy, because it threatens our ability to evaluate the increasingly complex interactions within growing policy mixes. The authors argue that the stability of democratic systems will crucially depend on their ability to make policy accumulation more sustainable.
Book
Circular economy model framework in the European water and wastewater sector
One of the key elements in the transformation towards a circular economy (CE) is providing more sustainable practices for resources and waste management. Improvement actions focused on transformation towards a CE should be targeted at all groups of materials and waste. As water is essential for human survival and well-being and plays a significant role in sustainable development (SD), the actions related to the reuse of water and the recovery of raw materials from wastewater and other water-based waste should be taken. The paper presents a proposition for a new CE model framework in the water and wastewater sector, which includes the six following actions: reduction—prevent wastewater generation in the first place by the reduction of water usage and pollution reduction at source; reclamation (removal)—an application of effective technologies for the removal of pollutants from water and wastewater; reuse—reuse of wastewater as an alternative source of water supply (non-potable usage), recycling—recovery of water from wastewater for potable usage; recovery—recovery of resources such as nutrients and energy from water-based waste, and rethink—rethinking how to use resources to create a sustainable economy, which is `free` of waste and emissions. The novelty of the proposed CE model framework is that it presents possible ways of implementing CE principles in the water and wastewater sector, with a strong emphasis not only technological but also organisational and societal changes. Application of the proposed model may help to further transform the European economy to the CE model. Moreover, the indicated model can be significant tool supporting an assessment of local or regional progress towards CE in the water and wastewater sector and further environmental management and planning.
Journal Article
School's first day of school
\"It's the first day of school at Frederick Douglass Elementary and everyone's just a little bit nervous, especially the school itself\"-- Provided by publisher.
Book
Thermochemical Treatment of Sewage Sludge Ash (SSA)—Potential and Perspective in Poland
Phosphorus (P) recovery from sewage sludge ash (SSA) is one of the most promising approaches of phosphate rock substitution in mineral fertilizers and might be a sustainable way to secure supply of this raw material in the future. In the current investigation, the process of thermochemical treatment of SSA was applied to SSA coming from selected mono-incineration plants of municipal sewage sludge in Poland (Cracow, Gdansk, Gdynia, Lodz, Kielce and Szczecin). The Polish SSA was thermochemically converted in the presence of sodium (Na) additives and a reducing agent (dried sewage sludge) to obtain secondary raw materials for the production of marketable P fertilizers. The process had a positive impact on the bioavailability of phosphorus and reduced the content of heavy metals in the obtained products. The P solubility in neutral ammonium citrate, an indicator of its bioavailability, was significantly raised from 19.7–45.7% in the raw ashes and 76.5–100% in the thermochemically treated SSA. The content of nutrients in the recyclates was in the range of 15.7–19.2% P2O5, 10.8–14.2% CaO, 3.5–5.4% Na2O, 2.6–3.6% MgO and 0.9–1.3% K2O. The produced fertilizer raw materials meet the Polish norms for trace elements covered by the legislation: the content of lead was in the range 10.2–73.1 mg/kg, arsenic 4.8–22.7 mg/kg, cadmium 0.9–2.8 mg/kg and mercury <0.05 mg/kg. Thus, these products could be potentially directly used for fertilizer production. This work also includes an analysis of the possibilities of using ashes for fertilizer purposes in Poland, based on the assumptions indicated in the adopted strategic and planning documents regarding waste management and fertilizer production.
Journal Article
Sensitivity to inhibition of DNA repair by Olaparib in novel oropharyngeal cancer cell lines infected with Human Papillomavirus
The incidence of Human Papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is increasing rapidly in the UK. Patients with HPV-positive OPSCC generally show superior clinical responses relative to HPV-negative patients. We hypothesised that these superior responses could be associated with defective repair of DNA double strand breaks (DSB). The study aimed to determine whether defective DNA repair could be associated with sensitivity to inhibition of DNA repair using the PARP inhibitor Olaparib. Sensitivity to Olaparib, and induction and repair of DNA damage, were assessed in a panel of 8 OPSCC cell-lines, including 2 novel HPV-positive lines. Effects on cell cycle distribution and levels of PARP1 and p53 were quantified. RNA-sequencing was used to assess differences in activity of DNA repair pathways. Two HPV-positive OPSCC lines were sensitive to Olaparib at potentially therapeutic doses (0.1-0.5 μM). Two HPV-negative lines were sensitive at an intermediate dose. Four other lines, derived from HPV-positive and HPV-negative tumours, were resistant to PARP inhibition. Only one cell-line, UPCISCC90, showed results consistent with the original hypothesis i.e. that in HPV-positive cells, treatment with Olaparib would cause accumulation of DSB, resulting in cell cycle arrest. There was no evidence that HPV-positive tumours exhibit defective repair of DSB. However, the data suggest that a subset of OPSCC may be susceptible to PARP-inhibitor based therapy.
Journal Article
Prognostic Significance of Post-Operative Morbidity Severity Score After Potentially Curative D2 Gastrectomy for Carcinoma
Background
Survival and relapse after gastric cancer surgery are largely attributed to tumor biology and surgical radicality; yet, other prognostic factors have been reported, including respiratory sepsis and anastomotic leakage, but not global morbidity severity score (MSS). The hypothesis tested was that MSS would be associated with both disease-free (DFS) and overall survival (OS).
Methods
Consecutive 373 patients undergoing potentially curative surgery for gastric adenocarcinoma between 2004 and 2016 in a UK cancer network were studied. Complications were defined prospectively as any deviation from a pre-determined post-operative course within 30 days of surgery and classified according to the Clavien-Dindo severity classification (CDSC). Primary outcome measures were DFS and OS.
Results
Post-operative complications were identified in 127 (34.0%) patients, which was associated with 9 (2.4%) post-operative deaths. Five-year DFS and OS were 35.9 and 38.5% for patients with a post-operative complication compared with 59.5 and 61.5% in controls (
p
< 0.001,
p
= 0.001, respectively). On multivariable DFS analysis, post-operative morbidity [hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.06–2.50,
p
= 0.026] was independently associated with poor survival. On multivariable OS analysis, post-operative morbidity HR 2.25 (95% CI 1.04–4.85,
p
= 0.039) and CDSC HR 1.76 (95% CI 1.35–2.29,
p
< 0.001) were independently associated with poor survival. These associations were also observed in patients with TNM stage I and II disease with morbidity HR 7.06 (95% CI 1.89–26.38,
p
= 0.004) and CDSC HR 2.93 (95% CI 1.89–4.55,
p
< 0.001) offering independent prognostic value.
Conclusion
Post-operative CDSC was an important independent prognostic factor after potentially curative gastrectomy for carcinoma associated with both DFS and OS. Prehabilitation strategies to minimize complications are warranted.
Journal Article
In a glass Grimmly
Frog joins cousins Jack and Jill in leaving their own stories to seek a magic mirror, encountering such creatures as giants, mermaids, and goblins along the way. Based in part on fairy tales from the Brothers Grimm and Hans Christian Andersen.
Book
Prognostic Significance of Serum Inflammatory Markers in Gastric Cancer
Background
The aim of this study was to assess the relative prognostic value of biomarkers to measure the systemic inflammatory response (SIR) and improve prognostic modeling in a cohort of patients undergoing potentially curative surgery for gastric adenocarcinoma. The hypothesis was that a single SIR biomarker would be associated with the most prognostic value.
Methods
Consecutive 331 patients undergoing surgery for gastric cancer between 2004 and 2016 within a regional UK cancer network were identified. Serum measurements of hemoglobin, C-reactive protein, albumin, modified Glasgow Prognostic Score, and differential white cell counts were obtained before surgery, and correlated with histopathological factors (pTNM stage, differentiation, and vascular invasion) and survival. Primary outcome measures were disease-free (DFS) and overall survival (OS).
Results
Consecutive 331 patients were identified and 291 underwent potentially curative gastrectomy for adenocarcinoma. On univariable DFS analysis, female gender (
p
= 0.027), proximal location (
p
= 0.018), pT stage (
p
< 0.001), pN stage (
p
< 0.001), pTNM stage (
p
< 0.001), vascular invasion (
p
< 0.001), poor differentiation (
p
= 0.001), lymph node ratio (
p
< 0.001), R1 status (
p
< 0.001), platelet count (
p
= 0.038), and mGPS (
p
= 0.001) were significantly associated with poor survival. The mGPS was associated with advanced pT stage (
p
= 0.001), pTNM stage (
p
= 0.013), and poor differentiation (
p
= 0.030). On multivariable DFS analysis, mGPS [hazard ratio (HR) 2.51, 95% confidence interval (CI) 1.35–4.65,
p
= 0.011] was the only inflammatory marker to retain independent significance. Multivariable OS analysis revealed similar findings; mGPS (HR 2.75, (95% CI 1.65–4.59),
p
< 0.001).
Conclusion
mGPS is an important and only SIR-related prognostic biomarker independently associated with both DFS and OS in gastric cancer.
Journal Article