Abstract Physical activity (PA) and exercise training (ET) have great potential in the prevention, management, and rehabilitation of a variety of diseases, but this potential has not been fully ...realized in clinical practice. The health care system (HCS) could do much more to support patients in increasing their PA and ET. However, counseling on ET is not used widely by the HCS owing partly to attitudes but mainly to practical obstacles. Extensive searches of MEDLINE, the Cochrane Library, the Database of Abstracts of Reviews of Effects, and ScienceDirect for literature published between January 1, 2000, and January 31, 2013, provided data to assess the critical characteristics of ET counseling. The evidence reveals that especially brief ET counseling is an efficient, effective, and cost-effective means to increase PA and ET and to bring considerable clinical benefits to various patient groups. Furthermore, it can be practiced as part of the routine work of the HCS. However, there is a need and feasible means to increase the use and improve the quality of ET counseling. To include PA and ET promotion as important means of comprehensive health care and disease management, a fundamental change is needed. Because exercise is medicine, it should be seen and dealt with in the same ways as pharmaceuticals and other medical interventions regarding the basic and continuing education and training of health care personnel and processes to assess its needs and to prescribe and deliver it, to reimburse the services related to it, and to fund research on its efficacy, effectiveness, feasibility, and interactions and comparability with other preventive, therapeutic, and rehabilitative modalities. This change requires credible, strong, and skillful advocacy inside the medical community and the HCS.
ABSTRACT
We investigate real effects of a widespread corporate social responsibility (CSR) reporting mandate. In 2014, the European Union (EU) passed Directive 2014/95 (hereafter, “CSR Directive”), ...mandating large listed EU firms to prepare annual nonfinancial reports beginning from fiscal year 2017 onward. We document that firms within the scope of the directive respond by increasing their CSR activities and that they start doing so before the entry‐into‐force of the directive. These real effects are concentrated in firms that are plausibly more strongly affected by the directive, that is, those with previously low levels of both CSR reporting and CSR activities. Using various alternative outcome variables (e.g., new CSR initiatives, improvements in CSR infrastructure, or firm performance), we show that these real effects reflect meaningful increases in CSR beyond firms’ potential attempts to “greenwash” CSR performance. Finally, we conduct tests that increase our confidence that the documented real effects are attributable to the CSR Directive and not general EU trends in CSR.
Background
Many hospitalized adults do not have the capacity to make their own health care decisions and thus require a surrogate decision-maker. While the ethical standard suggests that decisions ...should focus on a patient’s preferences, our study explores the principles that surrogates consider most important when making decisions for older hospitalized patients.
Objectives
We sought to determine how frequently surrogate decision-makers prioritized patient preferences in decision-making and what factors may predict their doing so.
Design and Participants
We performed a secondary data analysis of a study conducted at three local hospitals that surveyed surrogate decision-makers for hospitalized patients 65 years of age and older.
Main Measures
Surrogates rated the importance of 16 decision-making principles and selected the one that was most important. We divided the surrogates into two groups: those who prioritized patient preferences and those who prioritized patient well-being. We analyzed the two groups for differences in knowledge of patient preferences, presence of advance directives, and psychological outcomes.
Key Results
A total of 362 surrogates rated an average of six principles as being extremely important in decision-making; 77.8% of surrogates selected a patient well-being principle as the most important, whereas only 21.1% selected a patient preferences principle. Advance directives were more common to the
patient preferences
group than the
patient well-being
group (61.3% vs. 44.9%; 95% CI: 1.01–3.18;
p
= 0.04), whereas having conversations with the patient about their health care preferences was not a significant predictor of surrogate group identity (81.3% vs. 67.4%; 95% CI: 0.39–1.14;
p
= 0.14). We found no differences between the two groups regarding surrogate anxiety, depression, or decisional conflict.
Conclusions
While surrogates considered many factors, they focused more often on patient well-being than on patient preferences, in contravention of our current ethical framework. Surrogates more commonly prioritized patient preferences if they had advance directives available to them.
•EU policy efforts on energy efficiency in buildings stared in the 1970s in response to the oil crisis.•The first comprehensive EU policy was the SAVE directive in 1992, introducing policy actions ...still relevant today.•A major step forward was the Energy Performance of Buildings Directive in 2002 and its subsequent amendments.•Mandatory energy performance standards are progressively converging towards near zero energy buildings.•Additional policies and financing are needed for the full decarbonisation of the building stock.
The reduction of energy demand in buildings through the adoption of energy efficiency policy is a key pillar of the European Union (EU) climate and energy strategy. Energy efficiency first emerged in the EU energy policy agenda in the 1970s and was progressively transformed with shifting global and EU energy and climate policies and priorities. The paper offers a review of EU energy policies spanning over the last half century with a focus on policy instruments to encourage measures on energy efficiency in new and existing buildings. Starting from early policies set by the EU in response to the Oil Embargo in the 1973, the paper discusses the impact of EU policies in stimulating energy efficiency improvements in the building sector ranging from the SAVE Directive to the recently 2018 updated Energy Performance of Buildings Directive and Energy Efficiency Directive. The review explores the progress made over the last 50 years in addressing energy efficiency in buildings and highlights successes as well as remaining challenges. It discusses the impact of political priorities in reshaping how energy efficiency is addressed by EU policymakers, leading to a holistic approach to buildings, and provides insights and suggestions on how to further exploit the EU potential to save energy from buildings.
Per- and polyfluoroalkyl substances (PFAS) are ubiquitous contaminants which are also found in drinking water. Concentration levels in drinking water vary widely and range from a very low ...contribution to total daily exposure for humans to being the major source of uptake of PFAS. PFAS concentrations in Norwegian drinking water has been rarely reported. We investigated concentrations of 31 PFAS in 164 water samples, representing both source water (i.e., before drinking water treatment) and finished drinking water. Samples were taken from 18 different water bodies across Norway. The 17 waterworks involved supply drinking water to 41 % of the Norwegian population. Only four of the waterworks utilised treatment involving activated carbon which was able to significantly reduce PFAS from the source water. Samples of source water from waterworks not employing activated carbon in treatment were therefore considered to represent drinking water with regards to PFAS (142 samples). All samples from one of the water bodies exceeded the environmental quality standard (EQS) for perfluorooctane sulfonic acid (PFOS) according to the water framework directive (0.65 ng/L). No concentrations exceeded the sum of (20) PFAS (100 ng/L) specified in the EU directive 2020/2184 for drinking water. Several EU countries have issued lower guidelines for the sum of the four PFAS that the European Food Safety Authority (EFSA) has established as the tolerable weekly intake (TWI) for PFOS, perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS). Denmark and Sweden have guidelines specifying 2 and 4 ng/L for the sum of these PFAS. Only one of the 142 drinking water samples exceeded the Danish TWI and contained a sum of 6.6 ng/L PFAS. A population exposure model, for individuals drinking water from the investigated sources, showed that only 0.5 % of the population was receiving PFAS concentrations above the Danish limit of 2 ng/L.
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•Concentrations of 31 PFAS were investigated in 164 samples from 18 water sources.•Treatment using activated carbon showed significant removal rates of some PFAS.•Detection frequency of PFOS was >90 % in drinking water samples.•Drinking water near known sources had higher levels of PFAS.•Only 1 of 142 drinking water samples exceeded the Danish threshold of 2 ng/L of sum EFSA 4 PFAS.
Innovations in European Union (EU) policy making have produced a distinctive, novel mode of policy that combines components of participatory and multi-level governance for policy implementation. In ...this manuscript we provide a conceptualization of what we term the EU's 'mandated participatory planning' (MPP) approach. This approach is increasingly used to implement EU directives, mandating the explicit formulation of certain plans or programmes on mostly subnational or cross-national levels. Drawing on three empirical examples from (mostly) environmental policy, we argue that analysing MPP as such is useful to help identify challenges and possibilities for EU policy making. Our framework provides a means to organize inquiry and compare disparate policies, and to more broadly understand the integration of policy, planning and implementation. This perspective, in turn, sheds fresh light on familiar concepts at the intersections of multi-level governance, policy implementation and participatory governance, namely multilayer implementation, participatory implementation and polycentric governance.
The study of the presence in the aquatic environment of certain substances considered as contaminants of emerging concern (CEC) is a preliminary step to the analysis of the possible harmful effects ...on aquatic ecosystems and the establishment of the corresponding environmental quality standards. In order to monitor the occurrence of CECs in the aquatic environment, the European Commission established in 2015 and 2018 two watch-list of substances for Union-wide monitoring in the field of water policy (Decision (EU) 2015/495 and Decision (EU) 2018/840). In the coast of the Basque Country, southeast of the Bay of Biscay, 19 of these watch list substances were monitored quarterly from May 2017 to March 2019. Water samples were collected at the effluent of three wastewater treatment plants and five control points associated with receiving waters (transitional and coastal water bodies). The most frequently quantified substances were azithromycin (91%), imidacloprid (82%), clarithromycin (80%), diclofenac (78%) and erythromycin (73%), with frequencies of quantification higher in wastewaters (83–100%) than in receiving waters (70–85%). In general, concentrations in wastewater were also higher than in receiving waters, indicating a dilution effect in the environment. In receiving waters, six out of the nineteen substances monitored exceeded their respective Predicted No-Effect Concentrations: azithromycin (34%), imidacloprid (9%), 17β-estradiol (E2) (9%), clarithromycin (7%), ciprofloxacin (7%), and diclofenac (5%); and therefore, their levels could pose an environmental risk.
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•The most frequently quantified substance was azithromycin.•In 34% of the receiving water samples, azithromycin presented high risk.•E1, E2, EHMC, thiacloprid and oxadiazon showed maximum values in receiving waters.•The information here can serve for more efficient monitoring of these substances.
This book was first published in 2005. Copyright 'exceptions' or 'users' rights' have become a highly controversial aspect of copyright law. Most recently, Member States of the European Union have ...been forced to amend their systems of exceptions so as to comply with the Information Society Directive. Taking the newly amended UK legislation as a case study, this book examines why copyright exceptions are necessary and the forces that have shaped the present legislative regime in the UK. It seeks to further our understanding of the exceptions by combining detailed doctrinal analysis with insights gained from a range of other sources. The principal argument of the book is that the UK's current system of 'permitted acts' is much too restrictive and hence is in urgent need of reform, but that paradoxically the Information Society Directive points the way towards a much more satisfactory approach.
This article investigates whether Maritime Spatial Planning (MSP) –which promotes the integrated planning and management of seas and oceans– can play a role in creating increased integration between ...the EU's renewable energy policy and the potentially conflicting rules on the protection of habitats, species and water. The article focuses on innovative ocean energy (tidal stream, wave and salinity gradient energy). It can be said that there is a possible lack of integration between the Renewable Energy Directive and the EU rules on the protection of habitats, species and water: the Habitats Directive, the Birds Directive, the Water Framework Directive and the Marine Strategy Framework Directive. The role that MSP could play in solving this is assessed with regard to the following two legal issues that reflect the said lack of integration: 1) while there are derogation clauses, there is no obligation for Member States to apply these clauses and to undertake a balancing act between ocean energy, on the one hand, and the protection of habitats, species and water, on the other; 2) even if these clauses are applied, it remains unclear how much weight Member States should attach to ocean energy under a subsequent balancing act. The concept of Maritime Spatial Planning in theory is very suitable for guaranteeing that the interests of both renewable energy policy and environmental policy are duly taken into account in licensing procedures and management measures. The contribution that MSP can make towards increased integration is, however, strongly dependent on the way MSP is interpreted on the Member State level. This is illustrated by a discussion of the differences in the current MSP approaches in Scotland and the Netherlands. This article concludes that Maritime Spatial Planning may –if certain conditions are fulfilled– be a suitable way to create a necessity to balance the EU's habitats, species and water protection rules with (ocean) renewable energy projects, on different levels of governance. Nevertheless, it also concludes that MSP alone cannot guarantee a balancing act that represents the goals of the Renewable Energy Directive and those of the aforementioned environmental directives in an equal manner. This article proposes to link MSP to detailed renewable energy plans per Member State in order to solve this issue.
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