Pursuing More Sustainable Consumption by Analyzing Household Metabolism in European Countries and Cities

Bringing about more sustainable consumption patterns is an important challenge for society and science. In this article the concept of household metabolism is applied to analyzing consumption patterns and to identifying possibilities for the development of sustainable household consumption patterns. Household metabolism is determined in terms of total energy requirements, including both direct and indirect energy requirements, using a hybrid method. This method enables us to evaluate various determinants of the environmental load of consumption consistently at several levels—the national level, the local level, and the household level. The average annual energy requirement of households varies considerably between the Netherlands, the United Kingdom, Norway, and Sweden, as well as within these countries. The average expenditure level per household explains a large part of the observed variations. Differences between these countries are also related to the efficiency of the production sectors and to the energy supply system. The consumption categories of food, transport, and recreation show the largest contributions to the environmental load. A comparison of consumer groups with different household characteristics shows remarkable differences in the division of spending over the consumption categories. Thus, analyses of different types of households are important for providing a basis for options to induce decreases of the environmental load of household consumption. At the city level, options for change are provided by an analysis of the city infrastructure, which determines a large part of the direct energy use by households (for transport and heating). At the national level, energy efficiency in production and in electricity generation is an important trigger for decreasing household energy requirements.

Review: Consumption-stage food waste reduction interventions - What works and how to design better interventions

Food waste prevention has become an issue of international concern, with Sustainable Development Goal 12.3 aiming to halve per capita global food waste at the retail and consumer levels by 2030. However there is no review that has considered the effectiveness of interventions aimed at preventing food waste in the consumption stages of the food system. This significant gap, if filled, could help support those working to reduce food waste in the developed world, providing knowledge of what interventions are specifically effective at preventing food waste. This paper fills this gap, identifying and summarizing food-waste prevention interventions at the consumption/consumer stage of the supply chain via a rapid review of global academic literature from 2006 to 2017. We identify 17 applied interventions that claim to have achieved food waste reductions. Of these, 13 quantified food waste reductions. Interventions that changed the size or type of plates were shown to be effective (up to 57% food waste reduction) in hospitality environments. Changing nutritional guidelines in schools were reported to reduce vegetable waste by up to 28%, indicating that healthy diets can be part of food waste reduction strategies. Information campaigns were also shown to be effective with up to 28% food waste reduction in a small sample size intervention. Cooking classes, fridge cameras, food sharing apps, advertising and information sharing were all reported as being effective but with little or no robust evidence provided. This is worrying as all these methods are now being proposed as approaches to reduce food waste and, except for a few studies, there is no reproducible quantified evidence to assure credibility or success. To strengthen current results, a greater number of longitudinal and larger sample size intervention studies are required. To inform future intervention studies, this paper proposes a standardised guideline, which consists of: (1) intervention design; (2) monitoring and measurement; (3) moderation and mediation; (4) reporting; (5) systemic effects. Given the importance of food-waste reduction, the findings of this review highlight a significant evidence gap, meaning that it is difficult to make evidence-based decisions to prevent or reduce consumption-stage food waste in a cost-effective manner

Policy to practice: impact of GeneXpert MTB/RIF implementation on the TB spectrum of care in Lilongwe, Malawi

While previous research has provided evidence of the diagnostic accuracy of the GeneXpert MTB/RIF (GeneXpert), further information is needed about implementation in the real-world. This study evaluated the impact of the introduction of GeneXpert testing in a tertiary medical center according to the testing algorithm proposed by the National TB Control Program (NTP) guidelines

A flood damage allowance framework for coastal protection with deep uncertainty in sea-level rise

Future projections of Antarctic ice sheet (AIS) mass loss remain characterized by deep uncertainty (i.e., behavior is not well understood or widely agreed upon by experts). This complicates decisions on long-lived projects involving the height of coastal flood protection strategies that seek to reduce damages from rising sea levels. If a prescribed margin of safety does not properly account for sea-level rise and its uncertainties, the effectiveness of flood protection will decrease over time, potentially putting lives and property at greater risk. We develop a flood damage allowance framework for calculating the height of a flood protection strategy needed to ensure that a given level of financial risk is maintained (i.e., the average flood damage in a given year). The damage allowance framework considers decision-maker preferences such as planning horizons, preferred protection strategies (storm surge barrier, levee, elevation, and coastal retreat), and subjective views of AIS stability. We use Manhattan (New York City)\textemdash with the distribution of buildings, populations, and infrastructure fixed in time\textemdash as an example to show how our framework could be used to calculate a range of damage allowances based on multiple plausible AIS outcomes. Assumptions regarding future AIS stability more strongly influence damage allowances under high greenhouse gas emissions (Representative Concentration Pathway [RCP] 8.5) compared to those that assume strong emissions reductions (RCP2.6). Design tools that specify financial risk targets, such as the average flood damage in a given year, allow for the calculation of avoided flood damages (i.e., benefits) that can be combined with estimates of construction cost and then integrated into existing financial decision-making tools, like benefit-cost or cost-effectiveness analyses

Effect of oral fluconazole 1200 mg/day on QT interval in African adults with HIV-associated cryptococcal meningitis.

We assessed the effect of fluconazole 1200 mg/day on the QT interval in cryptococcal meningitis patients. Mean corrected QT (QTc) change from baseline to day 7 was 10.1 ms (IQR: -28 to 46 ms) in the fluconazole treatment group and -12.6 ms (IQR: -39 to 13.5 ms) in those not taking fluconazole (P = 0.04). No significant increase in QTc measurements over 500 ms was observed with fluconazole. Nevertheless, it remains important to correct any electrolyte imbalance and avoid concomitant drugs that may increase QTc

Altered mental status is an indicator of mortality and associated with both infectious and non-communicable disease in Lilongwe, Malawi

Little is known about diseases associated with Altered Mental Status in resource-poor settings. We studied adult medicine patients presenting with AMS in Lilongwe, Malawi and found that AMS and HIV infection were each significantly associated with mortality. It is therefore critical that evaluation and management in this patient population is improved

Healthcare Costs and Life-years Gained From Treatments Within the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) Trial on Cryptococcal Meningitis: A Comparison of Antifungal Induction Strategies in Sub-Saharan Africa

Background. Mortality from cryptoccocal meningitis remains high. The ACTA trial demonstrated that, compared with 2 weeks of amphotericin B (AmB) plus flucystosine (5FC), 1 week of AmB and 5FC was associated with lower mortality and 2 weeks of oral flucanozole (FLU) plus 5FC was non-inferior. Here, we assess the cost-effectiveness of these different treatment courses. Methods. Participants were randomized in a ratio of 2:1:1:1:1 to 2 weeks of oral 5FC and FLU, 1 week of AmB and FLU, 1 week of AmB and 5FC, 2 weeks of AmB and FLU, or 2 weeks of AmB and 5FC in Malawi, Zambia, Cameroon, and Tanzania. Data on individual resource use and health outcomes were collected. Cost-effectiveness was measured as incremental costs per life-year saved, and non-parametric bootstrapping was done. Results. Total costs per patient were US $1442 for 2 weeks of oral FLU and 5FC,$1763 for 1 week of AmB and FLU, $1861 for 1 week of AmB and 5FC,$2125 for 2 weeks of AmB and FLU, and $2285 for 2 weeks of AmB and 5FC. Compared to 2 weeks of AmB and 5FC, 1 week of AmB and 5FC was less costly and more effective and 2 weeks of oral FLU and 5FC was less costly and as effective. The incremental cost-effectiveness ratio for 1 week of AmB and 5FC versus oral FLU and 5FC was US$208 (95% confidence interval $91–1210) per life-year saved

Current knowledge on the Cuvette Centrale peatland complex and future research directions

CongoPeat Early Careers Researchers Group is a group of early career researchers who work directly or in partnership with the NERC funded CongoPeat project (NERC reference no.: NE/R016860/1; https://congopeat.net), which has provided the authors with full or partial financial and academic support.The Cuvette Centrale is the largest tropical peatland complex in the world, covering approximately 145,000 km2 across the Republic of Congo and the Democratic Republic of Congo. It stores ca. 30.6 Pg C, the equivalent of three years of global carbon dioxide emissions and is now the first trans-national Ramsar site. Despite its size and importance as a global carbon store, relatively little is known about key aspects of its ecology and history, including its formation, the scale of greenhouse gas flows, its biodiversity and its history of human activity. Here, we synthesise available knowledge on the Cuvette Centrale, identifying key areas for further research. Finally, we review the potential of mathematical models to assess future trajectories for the peatlands in terms of the potential impacts of resource extraction or climate change.Publisher PDFPeer reviewe

Short-term Mortality Outcomes of HIV-Associated Cryptococcal Meningitis in Antiretroviral Therapy–Naïve and –Experienced Patients in Sub-Saharan Africa

Background: An increasing proportion of patients with HIV-associated cryptococcal meningitis have received antiretroviral therapy (ART) before presentation. There is some evidence suggesting an increased 2-week mortality in those receiving ART for 14 days. However, presentation and outcomes for cryptococcal meningitis patients who have recently initiated ART, and those with virologic failure and/or nonadherence, are not well described. / Methods: Six hundred seventy-eight adults with a first episode of cryptococcal meningitis recruited into a randomized, noninferiority, multicenter phase 3 trial in 4 Sub-Saharan countries were analyzed to compare clinical presentation and 2- and 10-week mortality outcomes between ART-naïve and -experienced patients and between patients receiving ART for varying durations before presentation. / Results: Over half (56%; 381/678) the study participants diagnosed with a first episode of cryptococcal meningitis were ART-experienced. All-cause mortality was similar at 2 weeks (17% vs 20%; hazard ratio [HR], 0.85; 95% CI, 0.6–1.2; P = .35) and 10 weeks (38% vs 36%; HR, 1.03; 95% CI, 0.8–1.32; P = .82) for ART-experienced and ART-naïve patients. Among ART-experienced patients, using different cutoff points for ART duration, there were no significant differences in 2- and 10-week mortality based on duration of ART. / Conclusions: In this study, there were no significant differences in mortality at 2 and 10 weeks between ART-naïve and -experienced patients and between ART-experienced patients according to duration on ART