Addressing the Challenge of Sustainable Development: The Need for a Global Clean Energy Treaty

If the main road to global environmental law began at Stockholm in 1972, it could be argued it came to an end at the neighbouring Scandinavian city of Copenhagen in 2009. Despite a return from the brink of collapse of the multilateral environmental agreement (MEA) negotiating system in relation to climate change, and possibly more widely, in Cancun in 2010 and Durban in 2011, only tentative, modest steps have been taken towards a post-Kyoto regime at these meetings. The negotiations seem destined to limp slowly forward for some years yet. The failure of the international negotiating process to produce a post-Kyoto regime that embodies commitments on a global scale to the effective reduction of greenhouse gas (GHG) emissions reflects a deeper malaise in global environmental law and governance. Essentially, the global treaty system has failed to establish and implement the concept of sustainable development by establishing appropriate limits on the underlying drivers of unsustainability – namely, unconstrained economic growth, consumption, population growth and poverty. The 2012 Rio + 20 Conference is very much a step in the right direction in addressing this challenge by seeking to focus on two key themes – the “green economy” and global environmental governance. But, just as the original Rio Earth Summit Conference in 1992 saw the substantial diminution of a proposed, binding Earth Charter by producing instead the soft-law Rio Declaration on Environment and Development, there are strong concerns that the Rio +20 conference will fail to achieve a consensus on the kind of path-breaking change in the direction of human civilisation that is needed to avoid a major ecological crisis, or even collapse, within the next one to two generations. Whilst there is no single, simple solution to the challenge of addressing the unsustainability of humanity’s current mode of existence on Earth, there are two aspects of this existence that cry out for urgent attention and which, if effectively addressed, could greatly contribute to the goal of sustainable development, or “sustainability” as it might now be more appropriately termed. The first relates to the production and consumption of energy, which underpins most human activity and particularly represents the single, greatest source of GHG emissions. The second is food production and distribution, where the limits of the Green Revolution are being reached at the same time as current levels of food production are being threatened by the loss of fertile farmlands to urbanisation, degradation and desertification, and through the utilisation of food crops for new generation biofuels. This paper will address the first of these two areas, by exploring the option of developing a new, global treaty on renewable (or “clean”) energy. The proposed treaty would be based on firm commitments by States, in accordance with the principle of common but differentiated responsibility, to achieve a transition from dependence on fossil fuels to a decarbonised, clean energy economy. It would thereby contribute to both of the key goals of Rio + 20 – by enhancing a shift by States to a green economy based firmly on renewable energy and also by providing significant, fresh impetus to the stalled global effort to reduce GHG emissions substantially over the next 10-20 years (thereby restoring or reinforcing confidence in global environmental governance). In proposing a global clean energy treaty, the paper will seek to identify and address the obstacles that quite obviously need to be overcome. These include technical and economic constraints that it is often suggested prevent the uptake of renewable energy on the scale required to replace fossil fuels and to meet ongoing energy demand. It will also address the common excuse of “treaty fatigue” as a reason for not pursuing new MEA’s and focussing instead on enhancing the “synergies” between existing MEA’s. Its conclusion is that these obstacles are surmountable, particularly if the concept of a global clean energy treaty is presented as an opportunity for a positive step forward towards a new, visionary future for humanity, in contrast to the unfortunate depiction of the currently proposed climate change regime, involving targets and timetables for GHG reductions, as a negative and uneconomic constraint on human activity. Environmental psychology is a critical tool in this context. If it were to be adopted, a global clean energy treaty might represent possibly the most promising and feasible pathway to avoiding extreme climate change and achieving the elusive goal of sustainability

Comment on: Randomized controlled trial of plain English and visual abstracts for disseminating surgical research via social media

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Historical flash floods in England:new regional chronologies and database

There is increasing interest in past occurrences of flooding from intense rainfall, commonly referred to as “flash flooding,” and the associated socioeconomic consequences. Historical information can help us to place recent events in context and to understand the effect of low frequency climate variability on changing flash flood frequencies. Previous studies have focussed on fluvial flooding to reconstruct the temporal and spatial patterns of past events. Here, we provide an online flood chronology for the north and south‐west of England for flash floods, including both surface water and fluvial flooding, with coverage from ~1700 to ~2013 (http://ceg-fepsys.ncl.ac.uk/fc). The primary source of documentary material is local newspaper reports, which often give detailed descriptions of impacts. This provides a new resource to inform communities and first responders of flood risks, especially those from rapid rise in water level whose severity may be greater than those of accompanying peak flow. Examples are provided of historical flash floods that exemplify how the chronologies can help to place recent floods in the context of the preinstrumental record for: (a) more robust estimates of event return period, (b) identification of catchment or settlement susceptibility to flash flood events, and (c) characterisation of events in ungauged catchments

Barriers to supportive care during the Ebola virus disease outbreak in West Africa: Results of a qualitative study

© 2018 Loignon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background During the 2013–2016 West Africa Ebola outbreak, supportive care was the only non-experimental treatment option for patients with Ebola virus disease (EVD). However, providing care that would otherwise be routine for most clinical settings in the context of a highly contagious and lethal pathogen is much more challenging. The objective of this study was to document and deepen understanding of barriers to provision of supportive care in Ebola treatment units (ETUs) as perceived by those involved in care delivery during the outbreak. Methods This qualitative study consisted of 29 in-depth semi-structured interviews with stakeholders (decision-makers, physicians, nurses) involved in patient care delivery during the outbreak. Analysis consisted of interview debriefing and team-based transcript coding in NVivo10 software using thematic analysis. Findings Participants emphasized three interconnected barriers to providing high-quality supportive care during the outbreak: 1) lack of material and human resources in ETUs; 2) ETU organizational structure limiting the provision of supportive clinical care; and 3) delayed and poorly coordinated policies limiting the effectiveness of global and national responses. Participants also noted the ethical complexities of defining and enacting best clinical practices in low-income countries. They noted tension between, on one hand, scaling up minimal care and investing in clinical care preparedness to a level sustainable in West Africa and, on the other, providing a higher level of supportive care, which in low-resource health systems would require important investments. Conclusion Our findings identified potentially modifiable barriers to the delivery of supportive care to patients with EVD in West Africa. Addressing these in the inter-outbreak period will be useful to improve patient care and outcomes during inevitable future outbreaks. Promoting community trust and engagement through long-term capacity building of the healthcare workforce and infrastructure would increase both health system resilience and ability to handle other outbreaks of emerging diseases

The effect of duration of antimicrobial treatment for bacteremia in critically ill patients on in-hospital mortality - Retrospective double center analysis.

PURPOSE Excessive duration of antibiotic treatment is a major factor for inappropriate antibiotic consumption. Although in some instances shorter antibiotic courses are as efficient as longer ones, no specific recommendations as to the duration of antimicrobial treatment for bloodstream infections currently exist. In the present study, we investigated the effect of antibiotic treatment duration on in-hospital mortality using retrospective data from two cohorts that included patients with bacteremia at two Swiss tertiary Intensive Care Units (ICUs). MATERIALS AND METHODS Overall 8227 consecutive patients requiring ICU admission were screened for bacteremia between 01/2012-12/2013 in Lausanne and between 07/2016-05/2017 in Bern. Patients with an infection known to require prolonged treatment or having single positive blood culture with common contaminant pathogens were excluded. The primary outcome of interest was the time from start of antimicrobial treatment to in-hospital death or hospital discharge, whichever comes first. The predictor of interest was adequate antimicrobial treatment duration, further divided into shorter (≤10 days) and longer (>10 days) durations. A time-dependent Cox model and a cloning approach were used to address immortality bias. The secondary outcomes were the median duration of antimicrobial treatment for patients with bacteremia overall and stratified by underlying infectious syndrome and pathogens in the case of secondary bacteremia. RESULTS Out of the 707 patients with positive blood cultures, 382 were included into the primary analysis. Median duration of antibiotic therapy was 14 days (IQR, 7-20). Most bacteremia (84%) were monomicrobial; 18% of all episodes were primary bacteremia. Respiratory (28%), intra-abdominal (23%) and catheter infections (17%) were the most common sources of secondary bacteremia. Using methods to mitigate the risk of confounding associated with antibiotic treatment durations, shorter versus longer treatment groups showed no differences in in-hospital survival (time-dependent Cox-model: HR 1.5, 95% CI (0.8, 2.7), p = 0.20; Cloning approach: HR 1.0, 95% CI (0.7,1.5) p = 0.83). Sensitivity analyses showed that the interpretation did not change when using a 7 days cut-off. CONCLUSIONS In this restrospective study, we found no evidence for a survival benefit of longer (>10 days) versus shorter treatment course in ICU patients with bacteremia. TRIAL REGISTRATION The study was retrospectively registered on clinicatrials.gov (NCT05236283), 11 February 2022. The respective cantonal ethics commission (KEK Bern # 2021-02302) has approved the study