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This book explores the benefits of using risk analysis techniques in the evaluation of flood protection structures, and examines the results of the environmental impact assessment for selected planned flood protection projects. The objective of the book is to propose a methodology for environmental impact assessment in water management. In more detail, flood mitigation measures are investigated with the aim of selecting the best option for the approval process. This methodology is intended to streamline the process of environmental impact assessment for structures in the field of the water management. The book?s environmental impact assessment system for water management structures analyzes the respective risks for different options. The results are intended to support the selection of future projects that pose minimum risks to the environment. Comparison of alternatives and designation of the optimal variant are implemented on the basis of selected criteria that objectively describe the characteristics of the planned alternatives and their respective impacts on the environment. The proposed Guideline for environmental impact assessment of flood protection objects employs multi-parametric risk analysis, a method intended to not only enhance the transparency and sensitivity of the evaluation process, but also successfully addresses the requirements of environmental impact assessment systems in the European Union. These modifications are intended to improve the outcomes of the environmental impact assessment, but may also be applied to other infrastructure projects. The case study proves that the primary aim? to improve transparency and minimize subjectivity in the environmental impact assessment process specific to flood protection structure projects? is met for the planned project in Kruézlov, Slovakia.

Background, aim and scope In 2005, a comprehensive comparison of life cycle impact assessment toxicity characterisation models was initiated by the United Nations Environment Program (UNEP)–Society for Environmental Toxicology and Chemistry (SETAC) Life Cycle Initiative, directly involving the model developers of CalTOX, IMPACT 2002, USES-LCA, BETR, EDIP, WATSON and EcoSense. In this paper, we describe this model comparison process and its results—in particular the scientific consensus model developed by the model developers. The main objectives of this effort were (1) to identify specific sources of differences between the models’ results and structure, (2) to detect the indispensable model components and (3) to build a scientific consensus model from them, representing recommended practice. Materials and methods A chemical test set of 45 organics covering a wide range of property combinations was selected for this purpose. All models used this set. In three workshops, the model comparison participants identified key fate, exposure and effect issues via comparison of the final characterisation factors and selected intermediate outputs for fate, human exposure and toxic effects for the test set applied to all models. Results Through this process, we were able to reduce inter-model variation from an initial range of up to 13 orders of magnitude down to no more than two orders of magnitude for any substance. This led to the development of USEtox, a scientific consensus model that contains only the most influential model elements. These were, for example, process formulations accounting for intermittent rain, defining a closed or open system environment or nesting an urban box in a continental box. Discussion The precision of the new characterisation factors (CFs) is within a factor of 100–1,000 for human health and 10–100 for freshwater ecotoxicity of all other models compared to 12 orders of magnitude variation between the CFs of each model, respectively. The achieved reduction of inter-model variability by up to 11 orders of magnitude is a significant improvement. Conclusions USEtox provides a parsimonious and transparent tool for human health and ecosystem CF estimates. Based on a referenced database, it has now been used to calculate CFs for several thousand substances and forms the basis of the recommendations from UNEP-SETAC’s Life Cycle Initiative regarding characterisation of toxic impacts in life cycle assessment. Recommendations and perspectives We provide both recommended and interim (not recommended and to be used with caution) characterisation factors for human health and freshwater ecotoxicity impacts. After a process of consensus building among stakeholders on a broad scale as well as several improvements regarding a wider and easier applicability of the model, USEtox will become available to practitioners for the calculation of further CFs.

Policies that stimulate active transportation (walking and bicycling) have been related to heath benefits. This study aims to assess the potential health risks and benefits of promoting active transportation for commuting populations (age groups 16-64) in six European cities. We conducted a health impact assessment using two scenarios: increased cycling and increased walking. The primary outcome measure was all-cause mortality related to changes in physical activity level, exposure to fine particulate matter air pollution with a diameter <2.5 μm, as well as traffic fatalities in the cities of Barcelona, Basel, Copenhagen, Paris, Prague, and Warsaw. All scenarios produced health benefits in the six cities. An increase in bicycle trips to 35% of all trips (as in Copenhagen) produced the highest benefits among the different scenarios analysed in Warsaw 113 (76-163) annual deaths avoided, Prague 61 (29-104), Barcelona 37 (24-56), Paris 37 (18-64) and Basel 5 (3-9). An increase in walking trips to 50% of all trips (as in Paris) resulted in 19 (3-42) deaths avoided annually in Warsaw, 11(3-21) in Prague, 6 (4-9) in Basel, 3 (2-6) in Copenhagen and 3 (2-4) in Barcelona. The scenarios would also reduce carbon dioxide emissions in the six cities by 1,139 to 26,423 (metric tonnes per year). Policies to promote active transportation may produce health benefits, but these depend of the existing characteristics of the cities. Increased collaboration between health practitioners, transport specialists and urban planners will help to introduce the health perspective in transport policies and promote active transportation.

Multiple Coronavirus Disease 2019 (COVID-19) vaccines appear to be safe and efficacious, but only high-income countries have the resources to procure sufficient vaccine doses for most of their eligible populations. The World Health Organization has published guidelines for vaccine prioritisation, but most vaccine impact projections have focused on high-income countries, and few incorporate economic considerations. To address this evidence gap, we projected the health and economic impact of different vaccination scenarios in Sindh Province, Pakistan (population: 48 million). We fitted a compartmental transmission model to COVID-19 cases and deaths in Sindh from 30 April to 15 September 2020. We then projected cases, deaths, and hospitalisation outcomes over 10 years under different vaccine scenarios. Finally, we combined these projections with a detailed economic model to estimate incremental costs (from healthcare and partial societal perspectives), disability-adjusted life years (DALYs), and incremental cost-effectiveness ratio (ICER) for each scenario. We project that 1 year of vaccine distribution, at delivery rates consistent with COVAX projections, using an infection-blocking vaccine at $3/dose with 70% efficacy and 2.5-year duration of protection is likely to avert around 0.9 (95% credible interval (CrI): 0.9, 1.0) million cases, 10.1 (95% CrI: 10.1, 10.3) thousand deaths, and 70.1 (95% CrI: 69.9, 70.6) thousand DALYs, with an ICER of $27.9 per DALY averted from the health system perspective. Under a broad range of alternative scenarios, we find that initially prioritising the older (65+) population generally prevents more deaths. However, unprioritised distribution has almost the same cost-effectiveness when considering all outcomes, and both prioritised and unprioritised programmes can be cost-effective for low per-dose costs. High vaccine prices ($10/dose), however, may not be cost-effective, depending on the specifics of vaccine performance, distribution programme, and future pandemic trends. The principal drivers of the health outcomes are the fitted values for the overall transmission scaling parameter and disease natural history parameters from other studies, particularly age-specific probabilities of infection and symptomatic disease, as well as social contact rates. Other parameters are investigated in sensitivity analyses. This study is limited by model approximations, available data, and future uncertainty. Because the model is a single-population compartmental model, detailed impacts of nonpharmaceutical interventions (NPIs) such as household isolation cannot be practically represented or evaluated in combination with vaccine programmes. Similarly, the model cannot consider prioritising groups like healthcare or other essential workers. The model is only fitted to the reported case and death data, which are incomplete and not disaggregated by, e.g., age. Finally, because the future impact and implementation cost of NPIs are uncertain, how these would interact with vaccination remains an open question. COVID-19 vaccination can have a considerable health impact and is likely to be cost-effective if more optimistic vaccine scenarios apply. Preventing severe disease is an important contributor to this impact. However, the advantage of prioritising older, high-risk populations is smaller in generally younger populations. This reduction is especially true in populations with more past transmission, and if the vaccine is likely to further impede transmission rather than just disease. Those conditions are typical of many low- and middle-income countries.

The potential impacts of coal mining on health have been addressed by the application of impact assessment methodologies that use the results of qualitative and quantitative analyses to support their conclusions and recommendations. Although human epidemiological analyses can provide the most relevant measures of risk of health outcomes in populations exposed to coal mining by-products, this kind of studies are seldom implemented as part of the impact assessment methods. To review the use of human epidemiological analyses in the methods used to assess the impacts of coal mining, a systematic search in the peer review literature was implemented following the PRISMA protocol. A synthesis analysis identified the methods and the measures used in the selected publications to develop a thematic review and discussion. The major methodological approaches to assess the impacts of coal mining are environmental impact assessment (EIA), health impact assessment (HIA), social impact assessment (SIA) and environmental health impact assessment (EHIA). The measures used to assess the impacts of coal mining on health were classified as the estimates from non-human-based studies such as health risk assessment (HRA) and the measures of risk from human epidemiological analyses. The inclusion of human epidemiological estimates of the populations exposed, especially the general populations in the vicinity of the mining activities, is seldom found in impact assessment applications for coal mining. These methods rather incorporate HRA measures or other sources of evidence such as qualitative analyses and surveys. The implementation of impact assessment methods without estimates of the risk of health outcomes relevant to the potentially exposed populations affects their reliability to address the environmental and health impacts of coal mining. This is particularly important for EIA applications because these are incorporated in regulatory frameworks globally. The effective characterization of the impacts of coal mining on health requires quantitative estimates of the risk, including the risk measures from epidemiological analyses of relevant human health data.

We present an exposure analysis of infrastructure and lifeline to tephra fallout for a future large-scale explosive eruption of Sakurajima volcano. An eruption scenario is identified based on the field characterization of the last subplinian eruption at Sakurajima and a review of reports of the eruptions that occurred in the past six centuries. A scenario-based probabilistic hazard assessment is performed using the Tephra2 model, considering various eruption durations to reflect complex eruptive sequences of all considered reference eruptions. A quantitative exposure analysis of infrastructures and lifelines is presented primarily using open-access data. The post-event impact assessment of Magill et al. (Earth Planets Space 65:677–698, 2013) after the 2011 VEI 2 eruption of Shinmoedake is used to discuss the vulnerability and the resilience of infrastructures during a future large eruption of Sakurajima. Results indicate a main eastward dispersal, with longer eruption durations increasing the probability of tephra accumulation in proximal areas and reducing it in distal areas. The exposure analysis reveals that 2300 km of road network, 18 km 2 of urban area, and 306 km 2 of agricultural land have a 50% probability of being affected by an accumulation of tephra of 1 kg/m 2 . A simple qualitative exposure analysis suggests that the municipalities of Kagoshima, Kanoya, and Tarumizu are the most likely to suffer impacts. Finally, the 2011 VEI 2 eruption of Shinmoedake demonstrated that the already implemented mitigation strategies have increased resilience and improved recovery of affected infrastructures. Nevertheless, the extent to which these mitigation actions will perform during the VEI 4 eruption presented here is unclear and our hazard assessment points to possible damages on the Sakurajima peninsula and the neighboring municipality of Tarumizu.

In the advanced cancer setting, patients, families, and clinicians are often confronted with an uncertain future regarding treatment outcomes and survival. Greater certainty on what to expect can enhance decision-making for many personal and healthcare issues. Although 70–90% of patients with advanced cancer desire open and honest prognostic disclosure, a small proportion do not want to know. Approximately half of patients with advanced cancer have an inaccurate understanding of their illness, which could negatively impact their decision-making. In this review, we use a conceptual framework to highlight 5 key steps along the prognostic continuum, including (1) prognostic formulation, (2) prognostic disclosure, (3) prognostic awareness, (4) prognostic acceptance, and (5) prognosis-based decision-making. We shall summarize the impact of prognostic predictions, disclosure, awareness, and acceptance on various patient and caregiver outcomes, such as hope, trust, anxiety, depression, chemotherapy use, and care planning. Based on where the patient is at along the prognostic continuum, we propose 5 different subgroups (avoidance: “I don’t want to know”; discordant, “I never wanted to know”; anxious, “I don’t know what’s happening”; concerned, “I don’t like this”; acceptance, “I know how to plan ahead”). Although prognostication is not necessarily a linear process, recognizing where the patient is at cognitively and emotionally along the prognostic continuum may allow clinicians to provide personalized interventions, such as specialist palliative care and psychology referral, towards personalizing prognostic disclosure, enhancing prognostic awareness, increasing prognostic acceptance, and supporting decision-making and, ultimately, improving patient outcomes.

Several recent publications reflect debate on the issue of “endocrine disrupting chemicals” (EDCs), indicating that two seemingly mutually exclusive perspectives are being articulated separately and independently. Considering this, a group of scientists with expertise in basic science, medicine and risk assessment reviewed the various aspects of the debate to identify the most significant areas of dispute and to propose a path forward. We identified four areas of debate. The first is about the definitions for terms such as “endocrine disrupting chemical”, “adverse effects”, and “endocrine system”. The second is focused on elements of hormone action including “potency”, “endpoints”, “timing”, “dose” and “thresholds”. The third addresses the information needed to establish sufficient evidence of harm. Finally, the fourth focuses on the need to develop and the characteristics of transparent, systematic methods to review the EDC literature. Herein we identify areas of general consensus and propose resolutions for these four areas that would allow the field to move beyond the current and, in our opinion, ineffective debate.

Background Health Impact Assessment (HIA) advances Health in All Policies by identifying impacts of proposed actions on health and equity and recommending changes to address these impacts. Since the Gothenburg Consensus Statement in 1999, HIA has been applied to policies, plans, programmes and projects in multiple sectors and settings across the world. Despite demonstrated effectiveness, its use across the world is inconsistent with few nations systematically using HIA. In a global context of increasing health inequities, pandemics, climate change, and economic crises, HIA can help integrate health and equity into decision making. There is a need for research to support the ongoing evolution and development of HIA. This paper presents a research agenda for the field of HIA. Methods We used a mixed method approach utilising insights of approximately 280 participants through an international online survey and participatory workshops. We compared priority areas of research identified through the survey, workshops, and literature review to inform the development of a research agenda. The team drew on their own positioning and experience as HIA practitioners and researchers to shape this agenda. Results We identified four research priorities: (1) Institutionalisation - Sustaining and institutionalising HIA in varying contexts and levels. (2) Influence - Identifying mechanisms and strategies that can be employed to effectively influence stakeholders and decision making. (3) Equity and Participation - Analysing the role of equity, justice, power and participation in HIA, and (4) Methodology - Improving HIA Methods to understand the complex relationships between proposed actions, health and health equity outcomes and identifying what to do. We developed research questions for each theme. Conclusions The research agenda advocates for sustained research and practice to strengthen impact and address knowledge gaps in the field. Functioning as a roadmap for both researchers and funders, it aims to contribute to a healthier and more equitable world. Recognising the valuable role of HIA in addressing global health challenges, the agenda encourages researchers to investigate, develop, and advance the field of HIA.

Over 150 forms of impact assessment can be identified using Google searches, with several new forms appearing since 2003. Since then, the popularity of the various members of the impact assessment family has changed, partly in response to legislative and regulatory changes, and general trends in society. The information explosion and expansion of the internet has resulted in a 32 fold increase in the number of hits for \"impact assessment\", now over 12 million. The conventional methods most frequently mentioned in 2003 had relatively low proportional change over the last 10 years but remain amongst the most frequently mentioned in 2014: risk assessment, public participation, cost-benefit analysis, public involvement, environmental monitoring, and project evaluation. The terms with highest proportional change (i.e. the super-hot topics) were primarily social concerns, including: equality impact assessment, welfare impact assessment, mental health impact assessment, disability impact assessment, human impact assessment, social impact assessment, and social risk assessment. Other terms that had high proportional change included life cycle impact assessment. Information about the relative popularity of the various forms of impact assessment is used in this paper to discuss issues and trends in the broad field of impact assessment.