Streams Analysis for Better Air Quality: The German Lead City Program Assessed by the Policy Package Approach and the Multiple Streams Framework

Air pollution caused by traffic and other sources remains a challenge in big cities and urbanized areas in Germany and abroad. Nitrogen dioxide emissions, particulate matter, noise emissions, and ozone are still problematic issues with negative impacts on both the environment and human health. In 2018, the German Federal Government launched the “Lead City Program,” a €130-million fund to support five selected so-called Lead Cities in developing and implementing air quality policies. This article comparatively analyzes the policy-making process and policy content for better air quality in the three (out of five) Lead Cities—Essen, Herrenberg, and Reutlingen. Conceptually, we rely on two theoretical frameworks—the policy package approach (PPA) and the multiple streams framework (MSF). The objective, thus, is an ex-post analysis of policy development by means of two policy science-based concepts. Based on document-based desk research and qualitative interviews with policymakers and stakeholders in each of the three cities, we identified a number of key variables that created a window of opportunity and paved the way for the selection of the policy packages. The resulting five key variables are direct interaction between the different governance levels, long-standing non-compliance with the European Union (EU) NO$_{2}$ limit values in many German cities, the resulting European and national infringement proceedings, the diesel scandal, and the Lead City Program as overall multiple stream-coupling facilitators. The results are then discussed regarding the explanatory power of MSF and PPA and the mutual potential linkages these concepts offer for future research

Sindrome da Encefalopatia Posteriore Reversibile (PRES) in pazienti pediatrici sottoposti a Trapianto di Cellule Staminali Ematopoietiche: esperienza dell'U.O. di Oncoematologia Pediatrica di Pisa e revisione della letteratura.

Il Trapianto di Cellule Staminali Ematopoietiche (TCSE)è una terapia efficace per varie patologie neoplastiche e non. Espone il paziente a complicanze a carico di vari organi tra cui il sistema nervoso centrale ed è causa di morbilità e mortalità. Ciò è legato all’uso di farmaci neurotossici e immunosoppressori, pancitopenia, complicanze infettive, presenza di GVHD o comparsa di secondi tumori.Tra le complicanze neurologiche c’è la Posterior Reversible Encefalopathy Syndrome (PRES).La PRES può presentarsi in ogni epoca del percorso trapiantologico. È caratterizzata da segni e sintomi neurologici focali e/o generalizzati (crisi epilettiche, cefalea,alterazioni della coscienza, disturbi visivi). Le neuroimmagini in genere mostrano edema cerebrale della sostanza grigia e bianca con coinvolgimento delle regioni posteriori cerebrali. La PRES è spesso reversibile anche se più raramente può essere associata a complicazioni potenzialmente letali. La patogenesi della PRES non è chiara. Esistono pochi studi sulla popolazione pediatrica per cui non vi sono a disposizione molti dati per evidenziare eventuali peculiarità cliniche, radiologiche e prognostiche in questa fascia d’età. Non è chiaro inoltre quando sia determinante la presenza di eventuali fattori infettivi (sepsi e/o riattivazioni virali) nella presentazione della PRES.In questo lavoro sono stati raccolti i casi di PRES che si sono presentati tra i pazienti sottoposti a TCSE presso l’U.O. di Oncoematologia Pediatrica di Pisa dal 2003 al 2020.Tali dati sono stati parzialmente utilizzati per uno studio multicentrico sulla PRES in età pediatrica che ha coinvolto altri reparti oncoematologici pediatrici italiani (Bologna, Brescia, Padova, Roma

Streams Analysis for Better Air Quality: The German Lead City Program Assessed by the Policy Package Approach and the Multiple Streams Framework

Air pollution caused by traffic and other sources remains a challenge in big cities and urbanized areas in Germany and abroad. Nitrogen dioxide emissions, particulate matter, noise emissions, and ozone are still problematic issues with negative impacts on both the environment and human health. In 2018, the German Federal Government launched the “Lead City Program,” a €130-million fund to support five selected so-called Lead Cities in developing and implementing air quality policies. This article comparatively analyzes the policy-making process and policy content for better air quality in the three (out of five) Lead Cities—Essen, Herrenberg, and Reutlingen. Conceptually, we rely on two theoretical frameworks—the policy package approach (PPA) and the multiple streams framework (MSF). The objective, thus, is an ex-post analysis of policy development by means of two policy science-based concepts. Based on document-based desk research and qualitative interviews with policymakers and stakeholders in each of the three cities, we identified a number of key variables that created a window of opportunity and paved the way for the selection of the policy packages. The resulting five key variables are direct interaction between the different governance levels, long-standing non-compliance with the European Union (EU) NO2 limit values in many German cities, the resulting European and national infringement proceedings, the diesel scandal, and the Lead City Program as overall multiple stream-coupling facilitators. The results are then discussed regarding the explanatory power of MSF and PPA and the mutual potential linkages these concepts offer for future research

N-3 fatty acids in patients with multiple cardiovascular risk factors

BACKGROUND: Trials have shown a beneficial effect of n-3 polyunsaturated fatty acids in patients with a previous myocardial infarction or heart failure. We evaluated the potential benefit of such therapy in patients with multiple cardiovascular risk factors or atherosclerotic vascular disease who had not had a myocardial infarction. METHODS: In this double-blind, placebo-controlled clinical trial, we enrolled a cohort of patients who were followed by a network of 860 general practitioners in Italy. Eligible patients were men and women with multiple cardiovascular risk factors or atherosclerotic vascular disease but not myocardial infarction. Patients were randomly assigned to n-3 fatty acids (1 g daily) or placebo (olive oil). The initially specified primary end point was the cumulative rate of death, nonfatal myocardial infarction, and nonfatal stroke. At 1 year, after the event rate was found to be lower than anticipated, the primary end point was revised as time to death from cardiovascular causes or admission to the hospital for cardiovascular causes. RESULTS: Of the 12,513 patients enrolled, 6244 were randomly assigned to n-3 fatty acids and 6269 to placebo. With a median of 5 years of follow-up, the primary end point occurred in 1478 of 12,505 patients included in the analysis (11.8%), of whom 733 of 6239 (11.7%) had received n-3 fatty acids and 745 of 6266 (11.9%) had received placebo (adjusted hazard ratio with n-3 fatty acids, 0.97; 95% confidence interval, 0.88 to 1.08; P=0.58). The same null results were observed for all the secondary end points. CONCLUSIONS: In a large general-practice cohort of patients with multiple cardiovascular risk factors, daily treatment with n-3 fatty acids did not reduce cardiovascular mortality and morbidity. Copyright © 2013 Massachusetts Medical Society