Uncertainty in non-CO2 greenhouse gas mitigation contributes to ambiguity in global climate policy feasibility

Despite its projected crucial role in stringent, future global climate policy, non-CO 2 greenhouse gas (NCGG) mitigation remains a large uncertain factor in climate research. A revision of the estimated mitigation potential has implications for the feasibility of global climate policy to reach the Paris Agreement climate goals. Here, we provide a systematic bottom-up estimate of the total uncertainty in NCGG mitigation, by developing 'optimistic', 'default' and 'pessimistic' long-term NCGG marginal abatement cost (MAC) curves, based on a comprehensive literature review of mitigation options. The global 1.5-degree climate target is found to be out of reach under pessimistic MAC assumptions, as is the 2-degree target under high emission assumptions. In a 2-degree scenario, MAC uncertainty translates into a large projected range in relative NCGG reduction (40-58%), carbon budget (±120 Gt CO 2) and policy costs (±16%). Partly, the MAC uncertainty signifies a gap that could be bridged by human efforts, but largely it indicates uncertainty in technical limitations

Medication effectiveness may not be the major reason for accepting cardiovascular preventive medication: A population-based survey

Background: Shared decision-making and patients’ choice of interventions are areas of increasing importance, not least seen in the light of the fact that chronic conditions are increasing, interventions considered important for public health, and still non-acceptance of especially risk-reducing treatments of cardiovascular diseases (CVD) is prevalent. A better understanding of patients’ medication-taking behavior is needed and may be reached by studying the reasons why people accept or decline medication recommendations. The aim of this paper was to identify factors that may influence people’s decisions and reasoning for accepting or declining a cardiovascular preventive medication offer. Methods: From a random sample of 4,000 people aged 40–59 years in a Danish population, 1,169 participants were asked to imagine being at increased risk of cardiovascular disease and being offered a preventive medication. After receiving ‘complete’ information about effectiveness of the medication they were asked whether they would accept medication. Finally, they were asked about reasons for the decision. Results: A total of 725 (67%) of 1,082 participants accepted the medication offer. Even quite large effects of medication (up to 8 percentage points absolute risk reduction) had a smaller impact on acceptance to medication than personal experience with cardiovascular disease. Furthermore, increasing age of the participant and living with a partner were significantly associated with acceptance. Some 45% of the respondents accepting justified their choice as being for health reasons, and they were more likely to be women, live alone, have higher income and higher education levels. Among those who did not accept the medication offer, 56% indicated that they would rather prefer to change lifestyle. Conclusions: Medication effectiveness seems to have a moderate influence on people’s decisions to accept preventive medication, while factors such as personal experience with cardiovascular disease may have an equally strong or stronger influence, indicating that practitioners could do well to carefully identify the reasons for their patients’ treatment decisions

Evaluation of a patient decision aid for BRCA1/2 pathogenic variant carriers choosing an ovarian cancer prevention strategy

OBJECTIVE: Risk-reducing surgery is advised to BRCA1/2 pathogenic variant (PV) carriers around the age of 40 years to reduce ovarian cancer risk. In the TUBA-study, a multicenter preference study (NCT02321228), BRCA1/2-PV carriers are offered a choice: the standard strategy of risk-reducing salpingo-oophorectomy or the novel strategy of risk-reducing salpingectomy with delayed oophorectomy. We evaluated feasibility and effectiveness of a patient decision aid for this choice. METHODS: Premenopausal BRCA1/2-PV carriers were counselled for risk-reducing surgical options in the TUBA-study; the first cohort was counselled without and the second cohort with decision aid. Evaluation was performed using digital questionnaires for participating women and their healthcare professionals. Outcome measures included actual choice, feasibility (usage and experiences) and effectiveness (knowledge, cancer worry, decisional conflict, decisional regret and self-estimated influence on decision). RESULTS: 283 women were counselled without and 282 women with decision aid. The novel strategy was chosen less frequently in women without compared with women with decision aid (67% vs 78%, p = 0.004). The decision aid was graded with an 8 out of 10 by both women and professionals, and 78% of the women would recommend this decision aid to others. Users of the decision aid reported increased knowledge about the options and increased insight in personal values. Knowledge on cancer risk, decisional conflict, decisional regret and cancer worry were similar in both cohorts. CONCLUSIONS: The use of the patient decision aid for risk-reducing surgery is feasible, effective and highly appreciated among BRCA1/2-PV carriers facing the decision between salpingo-oophorectomy or salpingectomy with delayed oophorectomy

Uncertainty in non-CO2 greenhouse gas mitigation contributes to ambiguity in global climate policy feasibility

Abstract Despite its projected crucial role in stringent, future global climate policy, non-CO2 greenhouse gas (NCGG) mitigation remains a large uncertain factor in climate research. A revision of the estimated mitigation potential has implications for the feasibility of global climate policy to reach the Paris Agreement climate goals. Here, we provide a systematic bottom-up estimate of the total uncertainty in NCGG mitigation, by developing ‘optimistic’, ‘default’ and ‘pessimistic’ long-term NCGG marginal abatement cost (MAC) curves, based on a comprehensive literature review of mitigation options. The global 1.5-degree climate target is found to be out of reach under pessimistic MAC assumptions, as is the 2-degree target under high emission assumptions. In a 2-degree scenario, MAC uncertainty translates into a large projected range in relative NCGG reduction (40–58%), carbon budget (±120 Gt CO2) and policy costs (±16%). Partly, the MAC uncertainty signifies a gap that could be bridged by human efforts, but largely it indicates uncertainty in technical limitations

Medication effectiveness may not be the major reason for accepting cardiovascular preventive medication: A population-based survey

Abstract Background Shared decision-making and patients’ choice of interventions are areas of increasing importance, not least seen in the light of the fact that chronic conditions are increasing, interventions considered important for public health, and still non-acceptance of especially risk-reducing treatments of cardiovascular diseases (CVD) is prevalent. A better understanding of patients’ medication-taking behavior is needed and may be reached by studying the reasons why people accept or decline medication recommendations. The aim of this paper was to identify factors that may influence people’s decisions and reasoning for accepting or declining a cardiovascular preventive medication offer. Methods From a random sample of 4,000 people aged 40–59 years in a Danish population, 1,169 participants were asked to imagine being at increased risk of cardiovascular disease and being offered a preventive medication. After receiving ‘complete’ information about effectiveness of the medication they were asked whether they would accept medication. Finally, they were asked about reasons for the decision. Results A total of 725 (67%) of 1,082 participants accepted the medication offer. Even quite large effects of medication (up to 8 percentage points absolute risk reduction) had a smaller impact on acceptance to medication than personal experience with cardiovascular disease. Furthermore, increasing age of the participant and living with a partner were significantly associated with acceptance. Some 45% of the respondents accepting justified their choice as being for health reasons, and they were more likely to be women, live alone, have higher income and higher education levels. Among those who did not accept the medication offer, 56% indicated that they would rather prefer to change lifestyle. Conclusions Medication effectiveness seems to have a moderate influence on people’s decisions to accept preventive medication, while factors such as personal experience with cardiovascular disease may have an equally strong or stronger influence, indicating that practitioners could do well to carefully identify the reasons for their patients’ treatment decisions.</p

Specific detection of the cleavage activity of mycobacterial enzymes using a quantum dot based DNA nanosensor

We present a quantum dot based DNA nanosensor specifically targeting the cleavage step in the reaction cycle of the essential DNA-modifying enzyme, mycobacterial topoisomerase I. The design takes advantages of the unique photophysical properties of quantum dots to generate visible fluorescence recovery upon specific cleavage by mycobacterial topoisomerase I. This report, for the first time, demonstrates the possibility to quantify the cleavage activity of the mycobacterial enzyme without the pre-processing sample purification or post-processing signal amplification. The cleavage induced signal response has also proven reliable in biological matrices, such as whole cell extracts prepared from Escherichia coli and human Caco-2 cells. It is expected that the assay may contribute to the clinical diagnostics of bacterial diseases, as well as the evaluation of treatment outcomes

Hoe vaak verwijzen richtlijnen naar artikelen in hetNTvG?

OBJECTIVE: For Dutch medical guidelines, Dutch research articles published in the NTvG (NederlandsTijdschriftvoorGeneeskunde) and other medical journals are not searched systematically and are only used sporadically. Using these publications in the process of guideline development can be useful for recommendations regarding the Dutch context of care. In this research, we have investigated how often and in which parts of Dutch guidelines articles published in NTvG are used. DESIGN: We specifically investigated how often articles published in NTvG are mentioned in Dutch medical guidelines published on www.richtlijnendatabase.nl, that were developed in 2019, 2020 and 2021. METHOD: In all parts of new or revised Dutch medical guidelines published in these years on www.richtlijnendatabase.nl, we searched for references of articles published in NTvG. RESULTS: The results show that in 3% of all Dutch medical guidelines a reference to an article published in NTvG is made. These references were made in the literature summaries (21% of the references), the reflections on the literature for the Dutch context of care (48% of the references), or in other areas such as the introduction (10% of the references) or appendices (21% of the references). CONCLUSION: Articles published in NTvG may be relevant for making recommendations in Dutch medical guidelines, as these publications usually reflect the Dutch care context, and may do more so than research published in international journals. The results of this research show that the number of Dutch guidelines where these articles are used is limited. Dutch research articles may be a source of information that is yet to be tapped into