International regulatory responses to global challenges in marine pollution and climate change

Marine pollution, also referred to as \u27pollution of the marine environment\u27, may occur as a result of different activities. Examples are land-based activities, vessel-related activitiese, dumping at sea, atmospheric and offshore hydrocarbon exploration, seabed mining, and so on. As discussed in Chapter 4, these types of marine pollution are often transboundary in nature and are harmful to human health and marine ecosystem. Similarly, climate change is a global issue involving the interests of all States. The Fifth Assessment Report of the Intergovernmental Panel on Climate Change (IPCC), finalized and published in 2014, has further confirmed the existence of global warming when compared with the previous IPCC reports. It indicates that climate change has negatively affected natural and human systems on all continents and across the oceans, and asserts that 280substantial and sustained reduction of greenhouse gas (GHG) emissions would contribute to the tackling of climate change. 1 International issues need international responses. Both the marine pollution and climate change are issues with international dimensions, and thus require the global regulation by the international community

Death in hospital following ICU discharge : insights from the LUNG SAFE study

Altres ajuts: Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic); Science Foundation Ireland Future Research Leaders Award; European Society of Intensive Care Medicine (ESICM), Brussels; St Michael's Hospital, Toronto; University of Milan-Bicocca, Monza, Italy.Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments ('treatment limitations'), and the subpopulations with treatment limitations. Results: 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. Trial Registration: ClinicalTrials.gov NCT02010073