1,097 research outputs found

    Analysis of the Copenhagen Accord pledges and its global climatic impacts‚ a snapshot of dissonant ambitions

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    This analysis of the Copenhagen Accord evaluates emission reduction pledges by individual countries against the Accord's climate-related objectives. Probabilistic estimates of the climatic consequences for a set of resulting multi-gas scenarios over the 21st century are calculated with a reduced complexity climate model, yielding global temperature increase and atmospheric CO2 and CO2-equivalent concentrations. Provisions for banked surplus emission allowances and credits from land use, land-use change and forestry are assessed and are shown to have the potential to lead to significant deterioration of the ambition levels implied by the pledges in 2020. This analysis demonstrates that the Copenhagen Accord and the pledges made under it represent a set of dissonant ambitions. The ambition level of the current pledges for 2020 and the lack of commonly agreed goals for 2050 place in peril the Accord's own ambition: to limit global warming to below 2 °C, and even more so for 1.5 °C, which is referenced in the Accord in association with potentially strengthening the long-term temperature goal in 2015. Due to the limited level of ambition by 2020, the ability to limit emissions afterwards to pathways consistent with either the 2 or 1.5 °C goal is likely to become less feasibl

    Evaluating a person-centred chronic pain service using indices of reliable and clinically significant change

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    Background: Psychological interventions for chronic pain often require substantial individualisation, which can undermine links with the research evidence on which treatment is based. To ensure patients receive effective therapy, evaluation is needed. This paper demonstrates the use of individual level change indices, which may be more appropriate for assessing effectiveness of person-centred treatment than traditional group-level statistics. Aims: To evaluate the efficacy of a psychological chronic pain service at individual level and to recommend improvements for future service evaluation. Method: Indices of reliable and clinically significant change were used to assess outcomes on the HADS, CORE-10 andPSEQ. Results: Fifty-six out of 83 patients had usable outcome data. On the most widely administered outcome measure, the CORE-10, n=15 met reliable change and n=22 met clinically significant change criteria. Eighteen showed no reliable change. Only one person deteriorated. Conclusions: The person-centred treatment provided by this service was effective and achieved outcomes similar to published data from a structured group programme. However, missing data reduced the reliability of these conclusions andled to reduced usefulness of the evaluation for service planning. Recommendations for future evaluation are made

    Reduced regional brain cortical thickness in patients with heart failure.

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    AimsAutonomic, cognitive, and neuropsychologic deficits appear in heart failure (HF) subjects, and these compromised functions depend on cerebral cortex integrity in addition to that of subcortical and brainstem sites. Impaired autoregulation, low cardiac output, sleep-disordered-breathing, hypertension, and diabetic conditions in HF offer considerable potential to affect cortical areas by loss of neurons and glia, which would be expressed as reduced cortical thicknesses. However, except for gross descriptions of cortical volume loss/injury, regional cortical thickness integrity in HF is unknown. Our goal was to assess regional cortical thicknesses across the brain in HF, compared to control subjects.Methods and resultsWe examined localized cortical thicknesses in 35 HF and 61 control subjects with high-resolution T1-weighted images (3.0-Tesla MRI) using FreeSurfer software, and assessed group differences with analysis-of-covariance (covariates; age, gender; p<0.05; FDR). Significantly-reduced cortical thicknesses appeared in HF over controls in multiple areas, including the frontal, parietal, temporal, and occipital lobes, more markedly on the left side, within areas that control autonomic, cognitive, affective, language, and visual functions.ConclusionHeart failure subjects show reduced regional cortical thicknesses in sites that control autonomic, cognitive, affective, language, and visual functions that are deficient in the condition. The findings suggest chronic tissue alterations, with regional changes reflecting loss of neurons and glia, and presumably are related to earlier-described axonal changes. The pathological mechanisms contributing to reduced cortical thicknesses likely include hypoxia/ischemia, accompanying impaired cerebral perfusion from reduced cardiac output and sleep-disordered-breathing and other comorbidities in HF
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