Upholding the World Health Organization: Next steps for the EU

Before the COVID-19 pandemic, the European Union (EU) was neither a strong pro­moter of global health nor a strong supporter of the World Health Organization (WHO). The Global Health Council Conclusions from 2010 were never comprehensively implemented and quickly forgotten. With the pandemic greatly affecting EU member states, the EU is increasingly interested in upholding multilateral cooperation in the global health field. Therefore, the EU should aim for an upgrading of the EU’s status in WHO, the establishment of a global health unit in the European External Action Service (EEAS), and an overhaul of the formal relationship between the European Com­mission and WHO. (Autorenreferat

Unterstützung für die Weltgesundheitsorganisation: welche Schritte die EU als Nächstes einleiten sollte

Vor der Covid‑19-Pandemie galt die Europäische Union (EU) weder als Motor für globale Gesundheit noch als bedeutende Unterstützerin der Weltgesundheits­organisation (WHO). 2010 verabschiedete der Rat der EU Schlussfolgerungen zur Rolle der Union im Bereich globaler Gesundheit; sie gerieten in Vergessenheit und wurden nie umfassend umgesetzt. Da einige EU-Mitglied­staaten zu den besonders von der Pandemie betroffenen Ländern gehören, ist die EU verstärkt an multilateraler Zusammenarbeit auf dem Gebiet der globalen Gesundheit interessiert. Drei Dinge könnten dafür hilfreich sein: eine Auf­wertung ihres Status in der WHO, die Einrichtung eines Referats für globale Gesundheit im Europäischen Auswärtigen Dienst (EAD) sowie eine Überarbeitung der formellen Beziehungen zwischen EU und WHO. (Autorenreferat

The EU as an ‘Intergovernmental’ Actor in Foreign Affairs: Case Studies of the International Criminal Court and the Kyoto Protocol. CEPS Working Documents No. 228, 1 August 2005

This paper examines the relationship between the institutional set-up of the EU policy-making process and the international actorness of the EU in two cases: the establishment of the International Criminal Court (ICC) and the negotiations in the United Nations Framework Convention on Climate Change (UNFCCC) on the implementation details of the Kyoto Protocol. In both cases, the EU policy-making process is distinctly intergovernmental with a limited role for the supranational EU institutions (the European Parliament and the European Commission) and a large role for EU member states and the Council Presidency. Yet, in both cases, the EU operates with a high degree of international actorness. We argue that this is so not only because member states had similar preferences on the issue of climate change and international criminal justice, and because formal rules, legal competences and decision-making procedures had a mediating effect. The high degree of international actorness in both cases can also be explained by processes of social interaction amongst EU member states and between EU member states and non-EU and non-state actors through which preferences converged

A Population Pharmacokinetic Model of Whole-Blood and Intracellular Tacrolimus in Kidney Transplant Recipients

Background and Objective: The tacrolimus concentration within peripheral blood mononuclear cells may correlate better with clinical outcomes after transplantation compared to concentrations measured in whole blood. However, intracellular tacrolimus measurements are not easily implemented in clinical practice. The prediction of intracellular concentrations based on whole-blood concentrations would be a solution for this. Therefore, the aim of this study was to describe the relationship between intracellular and whole-blood tacrolimus concentrations in a population pharmacokinetic (popPK) model. Methods: Pharmacokinetic analysis was performed using non-linear mixed effects modelling software (NONMEM). The final model was evaluated using goodness-of-fit plots, visual predictive checks, and a bootstrap analysis. Results: A total of 590 tacrolimus concentrations from 184 kidney transplant recipients were included in the study. All tacrolimus concentrations were measured in the first three months after transplantation. The intracellular tacrolimus concentrations (n = 184) were best described with an effect compartment. The distribution into the effect compartment was described by the steady-state whole-blood to intracellular ratio (RWB:IC) and the intracellular distribution rate constant between the whole-blood and intracellular compartments. Lean body weight was negatively correlated [delta objective function value (ΔOFV) −8.395] and haematocrit was positively correlated (ΔOFV = − 6.752) with RWB:IC, and both lean body weight and haematocrit were included in the final model. Conclusion: We were able to accurately describe intracellular tacrolimus concentrations using whole-blood concentrations, lean body weight, and haematocrit values in a popPK model. This model may be used in the future to more accurately predict clinical outcomes after transplantation and to identify patients at risk for under- and overexposure

Changes in net ecosystem exchange over Europe during the 2018 drought based on atmospheric observations

The 2018 drought was one of the worst European droughts of the twenty-first century in terms of its severity, extent and duration. The effects of the drought could be seen in a reduction in harvest yields in parts of Europe, as well as an unprecedented browning of vegetation in summer. Here, we quantify the effect of the drought on net ecosystem exchange (NEE) using five independent regional atmospheric inversion frameworks. Using a network of atmospheric CO2 mole fraction observations, we estimate NEE with at least monthly and 0.5° × 0.5° resolution for 2009–2018. We find that the annual NEE in 2018 was likely more positive (less CO2 uptake) in the temperate region of Europe by 0.09 ± 0.06 Pg C yr−1 (mean ± s.d.) compared to the mean of the last 10 years of −0.08 ± 0.17 Pg C yr−1, making the region close to carbon neutral in 2018. Similarly, we find a positive annual NEE anomaly for the northern region of Europe of 0.02 ± 0.02 Pg C yr−1 compared the 10-year mean of −0.04 ± 0.05 Pg C yr−1. In both regions, this was largely owing to a reduction in the summer CO2 uptake. The positive NEE anomalies coincided spatially and temporally with negative anomalies in soil water. These anomalies were exceptional for the 10-year period of our study. This article is part of the theme issue ‘Impacts of the 2018 severe drought and heatwave in Europe: from site to continental scale’

Outcomes of Irish graduate entry medical student engagement with self-directed learning of clinical skills.

no abstract availabl