Suchergebnisse

AbstractThe progress in chemical analytics and understanding of pesticide dynamics in surface waters allows establishing robust data on compounds with frequent exceedances of quality standards. The current chemical, temporal, and spatial coverage of the pesticide monitoring campaigns differs strongly between European countries. A questionnaire revealed differences in monitoring strategies in seven selected European countries; Nordic countries prioritize temporal coverage, while others focus on spatial coverage. Chemical coverage has increased, especially for non-polar classes like synthetic pyrethroids. Sweden combines monitoring data with agricultural practices for derived quantities, while the Netherlands emphasizes spatial coverage to trace contamination sources. None of the EU member states currently has established a process for linking chemical surface water monitoring data with regulatory risk assessment, while Switzerland has recently established a legally defined feedback loop. Due to their design and objectives, most strategies do not capture concentration peaks, especially 2-week composite samples, but also grab samples. Nevertheless, for substances that appear problematic in many data sets, the need for action is evident even without harmonization of monitoring programs. Harmonization would be beneficial, however, for cross-national assessment including risk reduction measures.

Chronic hepatitis C (HCV) is a public health priority in the European Union/European Economic Area (EU/EEA) and is a leading cause of chronic liver disease and liver cancer. Migrants account for a disproportionate number of HCV cases in the EU/EEA (mean 14% of cases and > ; 50% of cases in some countries). We conducted two systematic reviews (SR) to estimate the effectiveness and cost-effectiveness of HCV screening for migrants living in the EU/EEA. We found that screening tests for HCV are highly sensitive and specific. Clinical trials report direct acting antiviral (DAA) therapies are well-tolerated in a wide range of populations and cure almost all cases (> ; 95%) and lead to an 85% lower risk of developing hepatocellular carcinoma and an 80% lower risk of all-cause mortality. At 2015 costs, DAA based regimens were only moderately cost-effective and as a result less than 30% of people with HCV had been screened and less 5% of all HCV cases had been treated in the EU/EEA in 2015. Migrants face additional barriers in linkage to care and treatment due to several patient, practitioner, and health system barriers. Although decreasing HCV costs have made treatment more accessible in the EU/EEA, HCV elimination will only be possible in the region if health systems include and treat migrants for HCV.

Chronic hepatitis C (HCV) is a public health priority in the European Union/European Economic Area (EU/EEA) and is a leading cause of chronic liver disease and liver cancer. Migrants account for a disproportionate number of HCV cases in the EU/EEA (mean 14% of cases and >50% of cases in some countries). We conducted two systematic reviews (SR) to estimate the effectiveness and cost-effectiveness of HCV screening for migrants living in the EU/EEA. We found that screening tests for HCV are highly sensitive and specific. Clinical trials report direct acting antiviral (DAA) therapies are well-tolerated in a wide range of populations and cure almost all cases (>95%) and lead to an 85% lower risk of developing hepatocellular carcinoma and an 80% lower risk of all-cause mortality. At 2015 costs, DAA based regimens were only moderately cost-effective and as a result less than 30% of people with HCV had been screened and less 5% of all HCV cases had been treated in the EU/EEA in 2015. Migrants face additional barriers in linkage to care and treatment due to several patient, practitioner, and health system barriers. Although decreasing HCV costs have made treatment more accessible in the EU/EEA, HCV elimination will only be possible in the region if health systems include and treat migrants for HCV.

The Naval Postgraduate School embarked this year on a quest to imagine the future and what its place might be in that future. While currently an acknowledged expert in national security, to excel even more in the years to come, NPS must study current trends, estimate the future ones and determine its path. Given sufficient flexibility, NPS has the opportunity to create a future where the talents of faculty, students and staff are fully realized; where the education is unquestionably the best and where research impacts every facet of the security of the world in which we live. In preparation for updating its strategic plan in 2012, the Naval Postgraduate School established a Committee on the Future to assess national security and academic trends, define future challenges, and recommend actions to ensure continued mission success. Committee members representing industry,academia, government and the NPS Board of Advisors divided their effort into nine working groups: Trends, Education and Research, Faculty, Students, Organization, Funding, Facilities, Information Technology, and Partnerships. The yearlong effort included extensive reviews of government, public policy research groups, and academic studies, as well as interviews with a broad range of military and civilian officials in Washington, D.C., Pacific area commands and locally in California. Each working group developed a report and submitted it to the whole Committee and NPS for review. The report chapters share a common organization and include sections on background, method, observations, considerations, and recommendations. Across the working groups, Committee members identified several major trends that will require institutional change by the Defense and Navy Departments as well as NPS. Of greatest concern is increasing instability in the geostrategic landscape, growing complexity stemming from globalization, rapidly changing and proliferating technology, significant natural and financial resource constraints, and environmental challenges. All of these contribute to extreme levels of uncertainty in multiple dimensions, and are likely to change organizational planning assumptions as well as the cause and nature of future conflicts. The implications for defense and national security are the same as for NPS: large bureaucratic institutions will need to become more flexible and responsive to emerging requirements, while continuously working to improve the efficiency of their operations. Operating effectively in this emerging world will require institutions to engage people who are intellectually curious, tolerate ambiguity, embrace abstraction and lifelong learning, and are creative. Those skills will influence curricula development and organizational processes, as well as change the way the military, government, industry and academic institutions select their leaders. Future success must also acknowledge cultural changes that demand near-continuous access to information, and collaboration among internal and external entities. This change in the way people communicate necessitates a robust and secure cyber infrastructure that will be as fundamental to the NPS mission as buildings and classrooms. In addition to actions implied by these contextual trends, the working groups identified 45 specific recommendations in their areas of expertise, including many internal actions NPS can take immediately. Of greater importance are recommendations for more comprehensive change that may require additional study and liaison with external organizations. The following recommendations distill the most important themes of the Committee's deliberations and imperatives for action that include an external reach with actions that require DoN engagement: 1. Implement a special charter status for NPS with the Department of the Navy that provides flexibility in hiring faculty and staff, funding and fund-raising, facilities, student markets, advertising/recruitment, and partnerships. 2. Capitalize on the need for innovation across capabilities, operational concepts, personnel policies and organizational structures. 3. Continue NPS' responsiveness to national security priorities and accelerate development of hybrid resident/ distant programs to improve responsiveness to DoD/DoN and federal agency requirements. Investments in this area should consider the establishment of conference facilities. 4. Make the following visible and aggressive institutional priorities: classified research and education capabilities, energy, government acquisition, cyber, modeling and simulation, regional studies, and unmanned systems. Investments will have to include expansion of classified facilities. 5. Expand the NPS research portfolio and rebalance to increase 6.1/6.2 research. 6. Maintain technological flexibility with a robust cyberinfrastructure and services. 7. Consolidate base operations with local community and other local Department of Defense assets. 8. Work with SECNAV to modify promotion board precepts to value quality graduate education in the selection process. Request the CNO designate NPS and NWC as the major contributers to the Navy's Graduate Education Strategy with objectives that place them at the core of providing graduate education for the Navy and other Services (and civilians). 9. Promote the NPS value proposition with DoD, DoN and federal agency leaders through programs, events, publications, and media. The overwhelming message in each of the chapters is flexibility. NPS requires flexibility for its future. • Enrollment Flexibility Include civilians and more international students to maximize existing capacity in selected programs • Curriculum Flexibility Expansion of hybrid programs that include resident and non-resident elements • Revenue Flexibility The ability to do fund-raising, accept and keep tuition and accept GI Bill support for veterans and spouses • Hiring Flexibility Ensure hiring the best faculty and staff talent to continue quality improvement in all areas of NPS • Technological Flexibility Maintain a robust cyberinfrastructure and services including the .edu capability • Facility Flexibility The ability to lease property, build and renovate facilities • Communication and Outreach Flexibility The ability to engage in recruiting and advertising and more expansive outreach to increase NPS visibility • Partnership Flexibility Make it easier for NPS to engage in strategic partnerships with other universities, laboratories, and industry • Organizational Flexibility Having the flexibility, where appropriate, to adapt to the most cost efficient and effective organization as significant changes occur in the world or the Department of Defense Like the Defense and Navy Departments it serves, NPS faces a future defined by complexity and uncertainty. Its mission and the tools it uses to educate students and conduct research are likely to change more rapidly than ever before, and its sponsors will be relentless in their search for operating efficiencies. These macro trends have implications for nearly every aspect of NPS operations. The next Strategic Plan will have to account for specific adjustments related to the above. More difficult perhaps will be the need to assess carefully some fundamental but difficult changes in organization and leadership selection, so that NPS has the agility and flexibility to meet 21st century challenges. The crucial element for the future is flexibility — not continued requests for additional resources or building on existing programs using the same historical patterns for program growth. The successful institutions of the future will be adaptable to changing conditions or newly discovered information. Speed of responsiveness will be another defining factor. Both require the flexibility to recruit and retain the best talent, expand and reduce physical capacity as needed, raise funds, reallocate resources, publicly communicate intentions and accomplishments, expand student markets, maintain technological currency and flexibility, increase international enrollments and engage in partnerships with other institutions and industry. NPS cannot rely solely on the unique nature of its operations to obtain the much-needed regulatory relief the Committee recommends. Rather, it will have to take persistent action to demonstrate the cost savings and related advantages of implementing them. However, there is cause for optimism because maintaining the status quo will not allow Defense and Navy Department leaders to achieve their objectives — they will have to seek alternative solutions. NPS possesses an abundance of talent among its faculty, staff and students — it has the proven capability not only to adapt to current trends, but also to become a leader among the Navy's flagship institutions as it prepares for the next five years. The Naval Postgraduate School is a superb institution which provides a unique and valuable education to future leaders in the national security arena. It contributes significantly to scientific and scholarly inquiry that addresses the most difficult of national and international problems. NPS and the Navy have a responsibility to ensure NPS' future vitality and contributions by taking the actions the committee has recommended.-- Executive Summary ; Committee on the Future