Greenhouse gas emissions in The Netherlands 1990-2012 : National Inventory Report 2014

In 2012 is de totale uitstoot van broeikasgassen van Nederland, zoals CO2, methaan en lachgas, met ongeveer 1,7 procent gedaald ten opzichte van 2011. Deze daling komt vooral door een lager brandstofgebruik in de energie- en transportsector. Dit lijkt een gevolg van de economische recessie, waardoor emissies door elektriciteitsproductie en het wegtransport in Nederland zijn afgenomen. Cijfers De totale broeikasgasemissie wordt uitgedrukt in CO2-equivalenten en bedraagt in 2012 191,7 teragram (megaton of miljard kilogram) . Ten opzichte van de uitstoot in het Kyoto-basisjaar (213,2 Tg CO2-equivalenten) is dit een afname van ongeveer 10 procent. Het basisjaar, dat afhankelijk van het broeikasgas 1990 of 1995 is, dient voor het Kyoto-protocol als referentie voor de uitstoot van broeikasgassen. De uitstoot van de overige broeikasgassen zoals lachgas en methaan is sinds het basisjaar met 51 procent afgenomen. De CO2-uitstoot daarentegen is in deze periode met 4 procent gestegen. Landen zijn voor het Kyoto-protocol verplicht om de totale uitstoot van broeikasgassen op twee manieren te rapporteren: met en zonder het soort landgebruik en de verandering daarin. Dit is namelijk van invloed op de uitstoot van broeikasgassen. Voorbeelden zijn natuurontwikkeling (dat CO2 bindt) of ontbossing (waardoor CO2 wordt uitgestoten). In bovengenoemde getallen zijn deze zogeheten LULUCF-emissies (Land Use, Land Use Change and Forestry) niet meegenomen. Overige onderdelen inventarisatie Het RIVM stelt jaarlijks op verzoek van het Ministerie van Infrastructuur en Milieu (IenM) de inventarisatie van broeikasgasemissies op. De inventarisatie bevat trendanalyses om ontwikkelingen in de uitstoot van broeikasgassen tussen 1990 en 2012 te verklaren, en een analyse van de onzekerheid in deze getallen. Ook is aangegeven welke bronnen het meest aan deze onzekerheid bijdragen. Daarnaast biedt de inventarisatie documentatie van de gebruikte berekeningsmethoden, databronnen en toegepaste emissiefactoren. Met deze inventarisatie voldoet Nederland aan de nationale rapportageverplichtingen voor 2012 van het Klimaatverdrag van de Verenigde Naties (UNFCCC), van het Kyoto-Protocol en van het Bewakingsmechanisme Broeikasgassen van de Europese Unie.Total greenhouse gas emissions from the Netherlands in 2012 decreased by approximately 1.7 per cent, compared with 2011 emissions. This decrease is mainly the result of decreased fuel combustion in the Energy sector (increased electricity import) and in road transport. In 2012, total direct greenhouse gas emissions (excluding emissions from LULUCF - land use, land use change and forestry) in the Netherlands amounted to 191.7 Tg CO2 eq. This is approximately 10 per cent below the emissions in the base year (213.2 Tg CO2 eq.). The 51% reduction in the non-CO2 emissions in this period is counterbalanced by 4 per cent increase in CO2 emissions since 1990. This report documents the Netherlands' 2014 annual submission of its greenhouse gas emissions inventory in accordance with the guidelines provided by the United Nations Framework Convention on Climate Change (UNFCCC), the Kyoto Protocol and the European Union's Greenhouse Gas Monitoring Mechanism. The report comprises explanations of observed trends in emissions; a description of an assessment of key sources and their uncertainty; documentation of methods, data sources and emission factors applied; and a description of the quality assurance system and the verification activities performed on the data.Ministerie van I&

The impact of diabetes on the pathogenesis of sepsis

Diabetes is associated with an increased susceptibility to infection and sepsis. Conflicting data exist on whether the mortality of patients with sepsis is influenced by the presence of diabetes, fuelling the ongoing debate on the benefit of tight glucose regulation in patients with sepsis. The main reason for which diabetes predisposes to infection appears to be abnormalities of the host response, particularly in neutrophil chemotaxis, adhesion and intracellular killing, defects that have been attributed to the effect of hyperglycaemia. There is also evidence for defects in humoral immunity, and this may play a larger role than previously recognised. We review the literature on the immune response in diabetes and its potential contribution to the pathogenesis of sepsis. In addition, the effect of diabetes treatment on the immune response is discussed, with specific reference to insulin, metformin, sulphonylureas and thiazolidinediones

The effects of long-term total parenteral nutrition on gut mucosal immunity in children with short bowel syndrome: a systematic review

BACKGROUND: Short bowel syndrome (SBS) is defined as the malabsorptive state that often follows massive resection of the small intestine. Most cases originate in the newborn period and result from congenital anomalies. It is associated with a high morbidity, is potentially lethal and often requires months, sometimes years, in the hospital and home on total parenteral nutrition (TPN). Long-term survival without parenteral nutrition depends upon establishing enteral nutrition and the process of intestinal adaptation through which the remaining small bowel gradually increases its absorptive capacity. The purpose of this article is to perform a descriptive systematic review of the published articles on the effects of TPN on the intestinal immune system investigating whether long-term TPN induces bacterial translocation, decreases secretory immunoglobulin A (S-IgA), impairs intestinal immunity, and changes mucosal architecture in children with SBS. METHODS: The databases of OVID, such as MEDLINE and CINAHL, Cochran Library, and Evidence-Based Medicine were searched for articles published from 1990 to 2001. Search terms were total parenteral nutrition, children, bacterial translocation, small bowel syndrome, short gut syndrome, intestinal immunity, gut permeability, sepsis, hyperglycemia, immunonutrition, glutamine, enteral tube feeding, and systematic reviews. The goal was to include all clinical studies conducted in children directly addressing the effects of TPN on gut immunity. RESULTS: A total of 13 studies were identified. These 13 studies included a total of 414 infants and children between the ages approximately 4 months to 17 years old, and 16 healthy adults as controls; and they varied in design and were conducted in several disciplines. The results were integrated into common themes. Five themes were identified: 1) sepsis, 2) impaired immune functions: In vitro studies, 3) mortality, 4) villous atrophy, 5) duration of dependency on TPN after bowel resection. CONCLUSION: Based on this exhaustive literature review, there is no direct evidence suggesting that TPN promotes bacterial overgrowth, impairs neutrophil functions, inhibits blood's bactericidal effect, causes villous atrophy, or causes to death in human model. The hypothesis relating negative effects of TPN on gut immunity remains attractive, but unproven. Enteral nutrition is cheaper, but no safer than TPN. Based on the current evidence, TPN seems to be safe and a life saving solution

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012

OBJECTIVE: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. DESIGN: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. RESULTS: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) 180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5-10 min (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C). CONCLUSIONS: Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients

Emissies van broeikasgassen tussen 1990 en 2016

Total greenhouse gas (GHG) emissions in the Netherlands in 2016 increased by approximately 0.2%, compared with 2015 emissions. This increase was mainly the result of increased natural gasconsumption for space heating. On the other hand, the emission of electricity production has declined. In 2016, total GHG emissions (including indirect CO2 emissions and excluding emissions from Land use, land use change and forestry (LULUCF)) in the Netherlands amounted to 195.2 Tg CO2 eq. This is approximately 12.4% below the emissions in the base year2 (222.9 Tg CO2 eq.). CO2 emissions in 2016 were still above the level in the base year (+1.6%). This increase was offset by the reduction since 1990 in emissions of methane, nitrous oxide and fluorinated gases (CH4, N2O and F-gases). This report documents the Netherlands' annual submission for 2018 of its GHG emissions inventory in accordance with the 2006 IPCC Guidelines for National Greenhouse Gas Inventories (IPCC, 2006) provided by the United Nations Framework Convention on Climate Change (UNFCCC), the Kyoto Protocol (KP) and the European Union's Greenhouse Gas Monitoring Mechanism. The report includes explanations of observed trends in emissions; an assessment of the sources with the highest contribution to total national emissions (key sources) and the uncertainty in their emissions; an itemization of methods, data sources and emission factors (EFs) applied; and a description of the quality assurance system and the verification activities performed on the data.In 2016 is de totale uitstoot van broeikasgassen van Nederland met ongeveer 0,2 procent gestegen ten opzichte van de uitstoot in 2015. Deze stijging komt vooral doordat er meer aardgas is verbruikt om ruimtes te verwarmen. Daarentegen staat dat de uitstoot van de electriciteitsproductie is afgenomen. De totale uitstoot van broeikasgassen naar de lucht wordt uitgedrukt in CO2-equivalenten en bedroeg in 2016 195,2 miljard kilogram. Ten opzichte van het zogeheten Kyoto-basisjaar (222,9 miljard kilogram CO2-equivalenten) is dit een afname van ongeveer 12,4 procent. Dit basisjaar, dat afhankelijk van het broeikasgas 1990 of 1995 is, dient voor het Kyoto Protocol als referentiejaar voor de uitstoot van broeikasgassen. De emissie van CO2 lag in 2014 voor het eerst onder het niveau van het basisjaar 1990. Sindsdien is de CO2-uitstoot toegenomen met circa 5 procent en komt hij boven het niveau van het basisjaar 1990 (+1,6 procent) te liggen. Deze toename werd voor de totale emissie van broeikasgassen ruim gecompenseerd door de lagere emissies van methaan, distikstofoxide en gefluoreerde gassen (CH4, N2O en F-gassen). Dit blijkt uit een inventarisatie van broeikasgasemissies die het RIVM jaarlijks op verzoek van het ministerie van Economische Zaken en Klimaat (EZK) opstelt. Met deze inventarisatie voldoet Nederland aan de nationale rapportageverplichtingen voor 2018 van het Klimaatverdrag van de Verenigde Naties (UNFCCC), van het Kyoto Protocol en van het Bewakingsmechanisme Broeikasgassen van de Europese Unie. De inventarisatie bevat verder trendanalyses voor de uitstoot van broeikasgassen in de periode 1990-2016, een analyse van belangrijkste emissiebronnen ('sleutelbronnen'), evenals de onzekerheid in hun emissies. Daarnaast zijn in de inventarisatie de gebruikte berekeningsmethoden beschreven, evenals databronnen en gebruikte emissiefactoren. Ten slotte bevat het een overzicht van het kwaliteitssysteem en de validatie van de emissiecijfers door de Nederlandse Emissieregistratie.Directorate-General for the Environment and International Affair

Greenhouse gas emissions in the Netherlands 1990-2016

Total greenhouse gas (GHG) emissions in the Netherlands in 2016 increased by approximately 0.2%, compared with 2015 emissions. This increase was mainly the result of increased natural gasconsumption for space heating. On the other hand, the emission of electricity production has declined. In 2016, total GHG emissions (including indirect CO2 emissions and excluding emissions from Land use, land use change and forestry (LULUCF)) in the Netherlands amounted to 195.2 Tg CO2 eq. This is approximately 12.4% below the emissions in the base year2 (222.9 Tg CO2 eq.). CO2 emissions in 2016 were still above the level in the base year (+1.6%). This increase was offset by the reduction since 1990 in emissions of methane, nitrous oxide and fluorinated gases (CH4, N2O and F-gases). This report documents the Netherlands' annual submission for 2018 of its GHG emissions inventory in accordance with the 2006 IPCC Guidelines for National Greenhouse Gas Inventories (IPCC, 2006) provided by the United Nations Framework Convention on Climate Change (UNFCCC), the Kyoto Protocol (KP) and the European Union's Greenhouse Gas Monitoring Mechanism. The report includes explanations of observed trends in emissions; an assessment of the sources with the highest contribution to total national emissions (key sources) and the uncertainty in their emissions; an itemization of methods, data sources and emission factors (EFs) applied; and a description of the quality assurance system and the verification activities performed on the data

Greenhouse gas emissions in the Netherlands 1990-2013 : National Inventory Report 2015

In 2013 is de totale broeikasgasemissie van Nederland met ongeveer 0,2 procent gedaald ten opzichte van de emissie in 2012. Deze daling komt vooral door de afname van brandstofgebruik in de transportsector en de petrochemische industrie. De totale broeikasgasemissie in 2013 bedraagt 195,8 teragram (megaton of miljard kilogram) CO2 equivalenten. Ten opzichte van het basisjaar (221,1 Tg CO2 equivalenten) is dit een afname van ongeveer 11,5 procent. Beide getallen zijn exclusief de emissies afkomstig uit het soort landgebruik en de verandering daarin, zoals natuurontwikkeling of ontbossing (land use, land use change and forestry, LULUCF). Dit blijkt uit een inventarisatie van broeikasgasemissies die het RIVM op verzoek van het ministerie van Infrastructuur en Milieu (IenM) heeft opgesteld. Met deze inventarisatie voldoet Nederland aan de nationale rapportageverplichtingen voor 2015 van het Klimaatverdrag van de Verenigde Naties (UNFCCC)4 en van het Bewakingsmechanisme Broeikasgassen van de Europese Unie. De emissiecijfers zijn in absolute zin gewijzigd ten opzichte van eerdere rapportages omdat de nu gerapporteerde cijfers berekend zijn conform de nieuwste UNFCCC 2006 Guidelines. De inventarisatie bevat verder trendanalyses voor de emissies van broeikasgassen in de periode 1990-2013, een analyse van belangrijkste emissiebronnen (sleutelbronnen) evenals de onzekerheid in hun emissies. Daarnaast biedt de inventarisatie documentatie van de gebruikte berekeningsmethoden, databronnen en toegepaste emissiefactoren. Ten slotte bevat het een overzicht van het kwaliteitssysteem en de validatie van de emissiecijfers door de Nederlandse Emissieregistratie.Total greenhouse gas (GHG) emissions from the Netherlands in 2013 decreased by approximately 0.2%, compared with 2012 emissions. This decrease was mainly the result of decreased fuel combustion in the transport sector and in the petrochemical industry. In 2013, total direct GHG emissions (excluding emissions from Land use, land use change and forestry (LULUCF)) in the Netherlands amounted to 195.8 Tg CO2 eq. This is approximately 12% below the emissions in the base year2 (221.1 Tg CO2 eq). This report documents the Netherlands' 2015 annual submission of its GHG emissions inventory in accordance with the guidelines provided by the United Nations Framework Convention on Climate Change (UNFCCC)3 and the European Union's Greenhouse Gas Monitoring Mechanism. Implementation of the 2006 IPCC Guidelines for National Greenhouse Gas Inventories (IPCC, 2006) meant the presentation of the emissions data changed in comparison with previous submissions. The report includes explanations of observed trends in emissions; an assessment of the sources with the highest contribution to the national emissions (key sources) and the uncertainty in their emissions; an itemization of methods, data sources and emission factors (EFs) applied; and a description of the quality assurance system and the verification activities performed on the data.Ministerie van I&

Emissies van broeikasgassen tussen 1990 en 2014

alleen digitaal verschenenIn 2014 is de totale uitstoot van broeikasgassen van Nederland met ongeveer 4 procent gedaald ten opzichte van de emissie in 2013. Deze daling komt vooral doordat er als gevolg van de relatief warme winter minder brandstof is gebruikt. De totale emissie van broeikasgassen naar de lucht wordt uitgedrukt in CO2-equivalenten en bedroeg in 2014 187,1 miljard kilogram (megaton of teragram). Ten opzichte van het zogeheten Kyoto-basisjaar (223,8 miljard kilogram CO2-equivalenten) is dit een afname van ongeveer 16,4 procent. Dit basisjaar, dat afhankelijk van het broeikasgas 1990 of 1995 is, dient voor het Kyoto-protocol als referentie voor de uitstoot van broeikasgassen. De afname in de broeikasgasemissies wordt voor het grootste deel (78 procent) veroorzaakt doordat de emissies van methaan, distikstofoxide en gefluoreerde gassen (CH4, N2O en F-gassen) afnemen. De CO2-uitstoot is beduidend minder afgenomen (-3 procent ten opzichte van het basisjaar 1990). Dit blijkt uit een inventarisatie van broeikasgasemissies die het RIVM jaarlijks op verzoek van het ministerie van Infrastructuur en Milieu (IenM) opstelt. Met deze inventarisatie voldoet Nederland aan de nationale rapportageverplichtingen voor 2016 van het Klimaatverdrag van de Verenigde Naties (UNFCCC), van het Kyoto Protocol en van het Bewakingsmechanisme Broeikasgassen van de Europese Unie. De emissiecijfers uit brandstoffen zijn in absolute zin gewijzigd ten opzichte van eerdere rapportages om de Nederlandse cijfers beter te laten aansluiten bij de internationale definities. De inventarisatie bevat verder trendanalyses voor de emissies van broeikasgassen in de periode 1990-2014, een analyse van belangrijkste emissiebronnen ('sleutelbronnen'), evenals de onzekerheid in hun emissies. Daarnaast zijn in de inventarisatie de gebruikte berekeningsmethoden beschreven, evenals databronnen en gebruikte emissiefactoren. Ten slotte bevat het een overzicht van het kwaliteitssysteem en de validatie van de emissiecijfers door de Nederlandse Emissieregistratie.Total greenhouse gas (GHG) emissions from the Netherlands in 2014 decreased by approximately 4.1%, compared with 2013 emissions. This decrease was mainly the result of decreased fuel combustion in all sectors as a result of the mild winter. In 2014, total GHG emissions (including indirect CO2 emissions and excluding emissions from Land use, land use change and forestry (LULUCF)) in the Netherlands amounted to 187.1 Tg CO2 eq. This is approximately 16.4% below the emissions in the base year2 (223.8 Tg CO2 eq). This report documents the Netherlands' 2016 annual submission of its greenhouse gas emissions inventory in accordance with the 2006 IPCC Guidelines for National Greenhouse Gas Inventories (IPCC, 2006) provided by the United Nations Framework Convention on Climate Change (UNFCCC), the Kyoto Protocol and the European Union's Greenhouse Gas Monitoring Mechanism. The report includes explanations of observed trends in emissions; an assessment of the sources with the highest contribution to the national emissions (key sources) and the uncertainty in their emissions; an itemization of methods, data sources and emission factors (EFs) applied; and a description of the quality assurance system and the verification activities performed on the data.Directorate-General for the Environment and International Affair