Mycotoxin exposure and human cancer risk : a systematic review of epidemiological studies

In recent years, there has been an increasing interest in investigating the carcinogenicity of mycotoxins in humans. This systematic review aims to provide an overview of data linking exposure to different mycotoxins with human cancer risk. Publications (2019 and earlier) of case–control or longitudinal cohort studies were identified in PubMed and EMBASE. These articles were then screened by independent reviewers and their quality was assessed according to the Newcastle–Ottawa scale. Animal, cross‐sectional, and molecular studies satisfied criteria for exclusion. In total, 14 articles were included: 13 case–control studies and 1 longitudinal cohort study. Included articles focused on associations of mycotoxin exposure with primary liver, breast, and cervical cancer. Overall, a positive association between the consumption of aflatoxin‐contaminated foods and primary liver cancer risk was verified. Two case–control studies in Africa investigated the relationship between zearalenone and its metabolites and breast cancer risk, though conflicting results were reported. Two case–control studies investigated the association between hepatocellular carcinoma and fumonisin B1 exposure, but no significant associations were observed. This systematic review incorporates several clear observations of dose‐dependent associations between aflatoxins and liver cancer risk, in keeping with IARC Monograph conclusions. Only few human epidemiological studies investigated the associations between mycotoxin exposures and cancer risk. To close this gap, more in‐depth research is needed to unravel evidence for other common mycotoxins, such as deoxynivalenol and ochratoxin A. The link between mycotoxin exposures and cancer risk has mainly been established in experimental studies, and needs to be confirmed in human epidemiological studies to support the evidence‐based public health strategies

North American Prairie Wetlands are Important Nonforested Land-Based Carbon Storage Sites

We evaluated the potential of prairie wetlands in North America as carbon sinks. Agricultural conversion has resulted in the average loss of 10.1 Mg ha- of soil organic carbon on over 16 million ha of wetlands in this region. Wetland restoration has potential to sequester 378 Tg of organic carbon over a 10-year period. Wetlands can sequester over twice the organic carbon as no-till cropland on only about 17% of the total land area in the region. We estimate that wetland restoration has potential to offset 2.4% of the annual fossil CO2 emission reported for North America in 1990

Governing shipping externalities : Baltic ports in the process of SOx emission reduction

This paper analyses the debate which has unfolded in the Baltic Sea Region regarding the reduction of sulphur content in vessel fuels, in order to illustrate how tightening environmental regulation challenges traditional forms of maritime governance. Using an interactive governance approach, this study reconstructs the process of sulphur emission reduction as a complex multi-stakeholder interaction in multiple contexts. The empirical investigation has drawn on documentary material from around the Baltic region, including Russia, and has applied the method of qualitative content analysis. The empirical study focuses on two interlinked questions: (1) How sulphur emission reduction policies are being anticipated by maritime industry, in particular by Baltic ports and (2) How port adaptation strategies are tied into Baltic local and energy contexts. Addressing these questions highlights the role of polycentricity in shipping governance and explains how the same universal international regulations can produce varying patterns of governance. The paper concludes that policy-making shall take an account of the fact that the globalized shipping industry is nevertheless locally and sectorally embedded.Peer reviewe

Diabetes self-management arrangements in Europe: a realist review to facilitate a project implemented in six countries

Background: Self-management of long term conditions can promote quality of life whilst delivering benefits to the financing of health care systems. However, rarely are the meso-level influences, likely to be of direct relevance to these desired outcomes, systematically explored. No specific international guidelines exist suggesting the features of the most appropriate structure and organisation of health care systems within which to situate self-management approaches and practices. This review aimed to identify the quantitative literature with regard to diabetes self-management arrangements currently in place within the health care systems of six countries (The United Kingdom, The Netherlands, Norway, Spain, Bulgaria, and Greece) and explore how these are integrated into the broader health care and welfare systems in each country. Methods: The methodology for a realist review was followed. Publications of interest dating from 2000 to 2013 were identified through appropriate MeSH terms by a systematic search in six bibliographic databases. A search diary was maintained and the studies were assessed for their quality and risk of bias. Results: Following the multi-step search strategy, 56 studies were included in the final review (the majority from the UK) reporting design methods and findings on 21 interventions and programmes for diabetes and chronic disease self-management. Most (11/21, 52%) of the interventions were designed to fit within the context of primary care. The majority (11/21, 52%) highlighted behavioural change as an important goal. Finally, some (5/21, 24%) referred explicitly to Internet-based tools. Conclusions: This review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as fundamental principles in the design of relevant programmes. Socio-economic circumstances are relevant to the capacity to self-manage and suggest that any gains and progress will be hard to maintain during economic austerity. This realist review should be interpreted within the wider context of a whole systems approach regarding self-care support and chronic illness management

The financialization of mass wealth, banking crises and politics over the long run

The co-evolution of democratic politics and mass, financialized wealth has destabilized highly integrated financial systems and the socio-political underpinnings of neoliberal policy norms at domestic and global levels. Over the long run, it has increased the political pressure on governments to undertake bailouts during major banking crises and, by raising voters’ attentiveness to wealth losses and distributional inequities, has sharply raised the bar for government performance. The result has been more costly bailouts, greater political instability and the sustained politicization of wealth cleavages in crisis aftermaths. We underline the crucial importance and modernity of this phenomenon by showing how the high concentration of wealth in pre-1914 Britain and America among elites was associated with limited crisis interventions and surprisingly tranquil political aftermaths. By contrast, the 2007–2009 crises in both countries epitomise the political dilemmas facing elected governments in a new world of mass financialized wealth and the impact on political polarization and democratic politics. We show that these dilemmas were embryonic in the interwar period and highlight how the evolutionary forces shaping policy and political outcomes reveal the importance of time, context and the effects of long cycles in the world economy and global politics

The Transitional Justice and Foreign Policy Nexus: The Inefficient Causation of State Ontological Security-Seeking

How does an approach towards transitional justice produce preconditions for a country’s international action, enabling certain policies and practices in the immediate neighborhood and international society at large? This article unpacks ontological security-seeking as a generic social mechanism in international politics which allows to productively conceptualize the connection between a state’s transitional justice and foreign policies. Going beyond the dichotomy of transitional justice compliance and non-compliance by gauging the role of states’ subjective sense of self in driving their behavior, I develop an analytical framework to explain how state ontological security-seeking relates to major transitions and consequent state identity disjuncture, the ensuing politics of truth and justice-seeking, and its international resonance in framing and executing particular foreign policies. I offer a typology of the international consequences of states’ transitional justice politics, distinguishing between reflective and mnemonical security-oriented approaches, spawning cooperative and conflictual foreign policy behavior, respectively. The empirical purchase of the purported nexus is illustrated with the example of post-Soviet Russia’s limited politics of accountability towards the repressions of its antecedent regime and its increasingly self-assertive and confrontational stance in contemporary international politics

Autologous chondrocyte implantation in the knee : systematic review and economic evaluation

Background: The surfaces of the bones in the knee are covered with articular cartilage, a rubber-like substance that is very smooth, allowing frictionless movement in the joint and acting as a shock absorber. The cells that form the cartilage are called chondrocytes. Natural cartilage is called hyaline cartilage. Articular cartilage has very little capacity for self-repair, so damage may be permanent. Various methods have been used to try to repair cartilage. Autologous chondrocyte implantation (ACI) involves laboratory culture of cartilage-producing cells from the knee and then implanting them into the chondral defect. Objective: To assess the clinical effectiveness and cost-effectiveness of ACI in chondral defects in the knee, compared with microfracture (MF). Data sources: A broad search was done in MEDLINE, EMBASE, The Cochrane Library, NHS Economic Evaluation Database and Web of Science, for studies published since the last Health Technology Assessment review. Review methods: Systematic review of recent reviews, trials, long-term observational studies and economic evaluations of the use of ACI and MF for repairing symptomatic articular cartilage defects of the knee. A new economic model was constructed. Submissions from two manufacturers and the ACTIVE (Autologous Chondrocyte Transplantation/Implantation Versus Existing Treatment) trial group were reviewed. Survival analysis was based on long-term observational studies. Results: Four randomised controlled trials (RCTs) published since the last appraisal provided evidence on the efficacy of ACI. The SUMMIT (Superiority of Matrix-induced autologous chondrocyte implant versus Microfracture for Treatment of symptomatic articular cartilage defects) trial compared matrix-applied chondrocyte implantation (MACI®) against MF. The TIG/ACT/01/2000 (TIG/ACT) trial compared ACI with characterised chondrocytes against MF. The ACTIVE trial compared several forms of ACI against standard treatments, mainly MF. In the SUMMIT trial, improvements in knee injury and osteoarthritis outcome scores (KOOSs), and the proportion of responders, were greater in the MACI group than in the MF group. In the TIG/ACT trial there was improvement in the KOOS at 60 months, but no difference between ACI and MF overall. Patients with onset of symptoms < 3 years’ duration did better with ACI. Results from ACTIVE have not yet been published. Survival analysis suggests that long-term results are better with ACI than with MF. Economic modelling suggested that ACI was cost-effective compared with MF across a range of scenarios. Limitations: The main limitation is the lack of RCT data beyond 5 years of follow-up. A second is that the techniques of ACI are evolving, so long-term data come from trials using forms of ACI that are now superseded. In the modelling, we therefore assumed that durability of cartilage repair as seen in studies of older forms of ACI could be applied in modelling of newer forms. A third is that the high list prices of chondrocytes are reduced by confidential discounting. The main research needs are for longer-term follow-up and for trials of the next generation of ACI. Conclusions: The evidence base for ACI has improved since the last appraisal by the National Institute for Health and Care Excellence. In most analyses, the incremental cost-effectiveness ratios for ACI compared with MF appear to be within a range usually considered acceptable. Research is needed into long-term results of new forms of ACI

The Barents and Chukchi Seas: Comparison of two Arctic shelf ecosystems

This paper compares and contrasts the ecosystems of the Barents and Chukchi Seas. Despite their similarity in a number of features, the Barents Sea supports a vast biomass of commercially important fish, but the Chukchi does not. Here we examine a number of aspects of these two seas to ascertain how they are similar and how they differ. We then indentify processes and mechanisms that may be responsible for their similarities and differences.Both the Barents and Chukchi Seas are high latitude, seasonally ice covered, Arctic shelf-seas. Both have strongly advective regimes, and receive water from the south. Water entering the Barents comes from the deep, ice-free and "warm" Norwegian Sea, and contains not only heat, but also a rich supply of zooplankton that supports larval fish in spring. In contrast, Bering Sea water entering the Chukchi in spring and early summer is cold. In spring, this Bering Sea water is depleted of large, lipid-rich zooplankton, thus likely resulting in a relatively low availability of zooplankton for fish. Although primary production on average is similar in the two seas, fish biomass density is an order of magnitude greater in the Barents than in the Chukchi Sea. The Barents Sea supports immense fisheries, whereas the Chukchi Sea does not. The density of cetaceans in the Barents Sea is about double that in the Chukchi Sea, as is the density of nesting seabirds, whereas, the density of pinnipeds in the Chukchi is about double that in the Barents Sea. In the Chukchi Sea, export of carbon to the benthos and benthic biomass may be greater. We hypothesize that the difference in fish abundance in the two seas is driven by differences in the heat and plankton advected into them, and the amount of primary production consumed in the upper water column. However, we suggest that the critical difference between the Chukchi and Barents Seas is the pre-cooled water entering the Chukchi Sea from the south. This cold water, and the winter mixing of the Chukchi Sea as it becomes ice covered, result in water temperatures below the physiological limits of the commercially valuable fish that thrive in the southeastern Bering Sea. If climate change warms the Barents Sea, thereby increasing the open water area via reducing ice cover, productivity at most trophic levels is likely to increase. In the Chukchi, warming should also reduce sea ice cover, permitting a longer production season. However, the shallow northern Bering and Chukchi Seas are expected to continue to be ice-covered in winter, so water there will continue to be cold in winter and spring, and is likely to continue to be a barrier to the movement of temperate fish into the Chukchi Sea. Thus, it is unlikely that large populations of boreal fish species will become established in this Arctic marginal sea. © 2012 Elsevier B.V