Making our children pay for mitigation

Investments in mitigating climate change have their greatest environmental impact over the long term. As a consequence the incentives to invest in cutting greenhouse gas emissions today appear to be weak. In response to this challenge, there has been increasing attention given to the idea that current generations can be motivated to start financing mitigation at much higher levels today by shifting these costs to the future through national debt. Shifting costs to the future in this way benefits future generations by break- ing existing patterns of delaying large-scale investment in low-carbon energy and efficiency. As we will see in this chapter, it does appear to be technically feasible to transfer the costs of investments made today to the future in such a way that people alive today do not incur any net cost. the aim of this chapter is to take seriously the possibility that climate change has produced an extremely intractable political problem and that we must now consider strong measures that can break existing patterns of delaying mitigation. I defend the claim that if climate change involves a stark conflict of interests between current and future generations, then borrowing from the future would be both strategically and normatively much better than the status quo. Nevertheless, I challenge the borrowing from the future proposal on the grounds that it is not in fact the powerful tool for motivating existing agents that its proponents imagine it to be. The purpose of developing this critical argument is not, however, simply to throw doubt onto the idea of borrowing from the future. If we really do find ourselves in a political context where the prospects for effective action are very poor then strategic forms of buck-passing may make an important positive contribution to avoiding dangerous global cli- mate change. Consequently, if debt financing is not as powerful of a motivational tool as imagined we still have strong reasons, I will argue, to identify other strategies that will change agents’ incentive structures. To this end, I propose an alternative form of passing on the costs of mitigation to the future that warrants consideration

A Climate of Disorder: What to do About the Obstacles to Effective Climate Politics

The emphasis on general distributive principles in the climate justice literature has left significant gaps regarding the problem of weak climate governance. The main contribution of this chapter is to show how normative theory can contribute to addressing the apparent political incapacity to respond to the threat of climate disruption. The chapter argues that a set of six underlying obstacles to effective climate change politics can serve as a framework around which ‘non-ideal’ normative theorizing about climate politics can be organized. Policies and other tactics to mediate the six obstacles are shown to raise distinct normative issues in need of deeper analysis

Global Warming and Our Natural Duties of Justice

Compelling research in international relations and international political economy on global warming suggests that one part of any meaningful effort to radically reverse current trends of increasing green house gas (GHG) emissions is shared policies among states that generate costs for such emissions in many if not most of the world’s regions. Effectively employing such policies involves gaining much more extensive global commitments and developing much stronger compliance mechanism than those currently found in the Kyoto Protocol. In other words, global warming raises the prospect that we need a global form of political authority that could coordinate the actions of states in order to address this environmental threat. This in turn suggests that any serious effort to mitigate climate change will entail new limits on the sovereignty of states. In this book I focus on the normative question of whether or not we have clear moral reasons to bind ourselves together in such a supranational form of political association. I argue that one can employ familiar liberal arguments for the moral legitimacy of political order at the state level to show that we do have a duty to support such a global political project. Even if one adopts the premises employed by the most influential forms of liberal scepticism to the ideas of global political and distributive justice, such as those advanced by John Rawls and Thomas Nagel, it is clear that the threat of global warming has expanded the scope of justice. We now have a global and demanding duty of justice to create the political conditions that would allow us to collectively address our impact on the Earth’s atmosphere

Political obligations in a sea of tyranny and crushing poverty

Christopher Wellman is the strongest proponent of the natural-duty theory of political obligations and argues that his version of the theory can satisfy the key requirement of “particularity”; namely, justifying to members of a state the system of political obligationstheyshare in. Critics argue that natural-duty theories like Wellman's actually require well-ordered states and/or their members to dedicate resources to providing the goods associated with political order to needy outsiders. The implication is that natural-duty approaches weaken the particularity requirement and cannot justify to citizens the systems of political obligation they share in. I argue that the critics’ diagnosis of natural-duty approaches is correct, whereas the proposed implication is false. I maintain that 1) only natural-duty approaches can justify political obligations, and that 2) weakening the particularity requirementcontributesto the theory's ability to justify a range-limited system of political obligationsamongcompatriots.</jats:p

Multi-center, randomized, placebo-controlled trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease: a study protocol for the INOX trial

Abstract\ud \ud Background\ud Long-term oxygen therapy (LTOT) is the only component of the management of chronic obstructive pulmonary disease (COPD) that improves survival in patients with severe daytime hypoxemia. LTOT is usually provided by a stationary oxygen concentrator and is recommended to be used for at least 15–18 h a day. Several studies have demonstrated a deterioration in arterial blood gas pressures and oxygen saturation during sleep in patients with COPD, even in those not qualifying for LTOT. The suggestion has been made that the natural progression of COPD to its end stages of chronic pulmonary hypertension, severe hypoxemia, right heart failure, and death is dependent upon the severity of desaturation occurring during sleep. The primary objective of the International Nocturnal Oxygen (INOX) trial is to determine, in patients with COPD not qualifying for LTOT but who present significant nocturnal arterial oxygen desaturation, whether nocturnal oxygen provided for a period of 3 years decreases mortality or delay the prescription of LTOT.\ud \ud \ud Methods\ud The INOX trial is a 3-year, multi-center, placebo-controlled, randomized trial of nocturnal oxygen therapy added to usual care. Eligible patients are those with a diagnosis of COPD supported by a history of past smoking and obstructive disease who fulfill our definition of significant nocturnal oxygen desaturation (i.e., ≥ 30% of the recording time with transcutaneous arterial oxygen saturation < 90% on either of two consecutive recordings). Patients allocated in the control group receive room air delivered by a concentrator modified to deliver 21% oxygen. The comparison is double blind. The primary outcome is a composite of mortality from all cause or requirement for LTOT. Secondary outcomes include quality of life and utility measures, costs from a societal perspective and compliance with oxygen therapy. The follow-up period is intended to last at least 3 years.\ud \ud \ud Discussion\ud The benefits of LTOT have been demonstrated whereas those of nocturnal oxygen therapy alone have not. The INOX trial will likely determine whether supplemental oxygen during sleep is effective in reducing mortality, delaying the need for LTOT and improving health-related quality of life in patients with COPD who desaturate overnight.\ud \ud \ud Trial registration\ud Current Controlled Trials \ud ISRCTN50085100\ud \ud ; ClinicalTrials.gov \ud NCT01044628\ud \ud (date of registration: January 6, 2010)

Global warming and the cosmopolitan political conception of justice

Within the literature in green political theory on global environmental threats one can often find dissatisfaction with liberal theories of justice. This is true even though liberal cosmopolitans regularly point to global environmental problems as one reason for expanding the scope of justice beyond the territorial limits of the state. One of the causes for scepticism towards liberal approaches is that many of the most notable anti-cosmopolitan theories are also advanced by liberals. In this paper, I first explain why one of the strongest expressions of liberal anti-cosmopolitanism cannot simply be dismissed because it may fail to support desired environmental ends. The political conception of justice represents one of the most important challenges to cosmopolitanism generally and is thus a serious challenge to viewing global environmental problems in terms of cosmopolitan justice. Second, I will show through the case of anthropogenic global warming that the political conception of justice under current conditions does have clear cosmopolitan implications despite its proponents' claims

Budesonide/formoterol as effective as prednisolone plus formoterol in acute exacerbations of COPD A double-blind, randomised, non-inferiority, parallel-group, multicentre study

<p>Abstract</p> <p>Background</p> <p>Oral corticosteroids and inhaled bronchodilators with or without antibiotics represent standard treatment of COPD exacerbations of moderate severity. Frequent courses of oral steroids may be a safety issue. We wanted to evaluate in an out-patient setting whether a 2-week course of inhaled budesonide/formoterol would be equally effective for treatment of acute COPD exacerbations as standard therapy in patients judged by the investigator not to require hospitalisation.</p> <p>Methods</p> <p>This was a double-blind, randomised, non-inferiority, parallel-group, multicentre study comparing two treatment strategies; two weeks' treatment with inhaled budesonide/formoterol (320/9 μg, qid) was compared with prednisolone (30 mg once daily) plus inhaled formoterol (9 μg bid) in patients with acute exacerbations of COPD attending a primary health care centre. Inclusion criteria were progressive dyspnoea for less than one week, FEV₁30–60% of predicted normal after acute treatment with a single dose of oral corticosteroid plus nebulised salbutamol/ipratropium bromide and no requirement for subsequent immediate hospitalisation, i.e the clinical status after the acute treatment allowed for sending the patient home.</p> <p>A total of 109 patients (mean age 67 years, 33 pack-years, mean FEV₁45% of predicted) were randomized to two weeks' double-blind treatment with budesonide/formoterol or prednisolone plus formoterol and subsequent open-label budesonide/formoterol (320/9 μg bid) for another 12 weeks. Change in FEV₁was the primary efficacy variable. Non-inferiority was predefined.</p> <p>Results</p> <p>Non-inferiority of budesonide/formoterol was proven because the lower limit of FEV₁-change (97.5% CI) was above 90% of the efficacy of the alternative treatment. Symptoms, quality of life, treatment failures, need for reliever medication (and exacerbations during follow-up) did not differ between the groups. No safety concerns were identified.</p> <p>Conclusion</p> <p>High dose budesonide/formoterol was as effective as prednisolone plus formoterol for the ambulatory treatment of acute exacerbations in non-hospitalized COPD patients. An early increase in budesonide/formoterol dose may therefore be tried before oral corticosteroids are used.</p> <p>Clinical trial registration</p> <p>NCT00259779</p

COPD exacerbations in general practice: variability in oral prednisolone courses

<p>Abstract</p> <p>Background</p> <p>The use of oral corticosteroids as treatment of COPD exacerbations in primary care is well established and evidence-based. However, the most appropriate dosage regimen has not been determined and remains controversial. Corticosteroid therapy is associated with a number of undesirable side effects, including hyperglycaemias, so differences in prescribing might be relevant. This study examines the differences between GPs in dosage and duration of prednisolone treatment in patients with a COPD exacerbation. It also investigates the number of general practitioners (GPs) who adjust their treatment according to the presence of diabetic co-morbidity.</p> <p>Methods</p> <p>Cross-sectional study among 219 GPs and 25 GPs in training, located in the Northern part of the Netherlands.</p> <p>Results</p> <p>The response rate was 69%. Nearly every GP prescribed a continuous dose of prednisolone 30 mg per day. Among GPs there were substantial differences in treatment duration. GPs prescribed courses of five, seven, ten, or fourteen days. A course of seven days was most common. The duration of treatment depended on exacerbation and disease severity. A course of five days was especially prescribed in case of a less severe exacerbation. In a more severe exacerbation duration of seven to fourteen days was more common. Hardly any GP adjusted treatment to the presence of diabetic co-morbidity.</p> <p>Conclusion</p> <p>Under normal conditions GPs prescribe prednisolone quite uniformly, within the range of the current Dutch guidelines. There is insufficient guidance regarding how to adjust corticosteroid treatment to exacerbation severity, disease severity and the presence of diabetic co-morbidity. Under these circumstances, there is a substantial variation in treatment duration.</p

Psychological distress is related to poor health behaviours in COPD and non-COPD patients: Evidence from the CanCOLD study

Background Patients with psychiatric disorders (depression, anxiety) are more likely to have poor health behaviours, including higher smoking and lower physical activity (PA) levels. Smoking is a major risk factor for Chronic Obstructive Pulmonary Disease (COPD), and PA is critical for COPD management. However, no studies have assessed associations between psychological distress and these behaviours among patients with vs without COPD. This is a sub-analysis of the CanCOLD study that assessed the relationships between psychological disorders (depression, anxiety) and poor health behaviours (smoking, PA). Methods 717 COPD and 797 matched non-COPD individuals from the CanCOLD study, completed the Hospital Anxiety Depression Scale (HADS) to assess anxiety and depression. Smoking behaviour was self-reported pack-years smoking. The CHAMPS PA questionnaire determined calorific expenditure as a PA measure. Regressions determined relationships between anxiety/depression and health behaviours, adjusting for age, sex, BMI, GOLD stage and COPD status. Results Across the whole sample, we observed relationships between depression (β = 1.107 ± 0.197; 95%CI = 0.691–1.462; p < .001) and anxiety (β = 0.780 ± 0.170; 95%CI = 0.446–1.114; p < .001) and pack years. Higher depression (β = −0.220 ± 0.028; 95%CI = −0.275 to −0.165; p < .001) and anxiety (β = −0.091 ± 0.025; 95%CI = −0.139 to −0.043; p < .001) scores were related to lower PA. These associations were comparable across COPD and non-COPD patients. Conclusions Results showed that higher levels of anxiety and depression were related to higher cumulative smoking and lower levels of PA in patients with and without COPD, suggesting symptoms of psychological distress is similarly associated with poorer health behaviours in COPD and non-COPD individuals. Future studies need to determine if treating symptoms of psychological distress can improve health behaviours and outcomes in this population

Ten new insights in climate science 2022

Non-technical summary We summarize what we assess as the past year's most important findings within climate change research: limits to adaptation, vulnerability hotspots, new threats coming from the climate–health nexus, climate (im)mobility and security, sustainable practices for land use and finance, losses and damages, inclusive societal climate decisions and ways to overcome structural barriers to accelerate mitigation and limit global warming to below 2°C. Technical summary We synthesize 10 topics within climate research where there have been significant advances or emerging scientific consensus since January 2021. The selection of these insights was based on input from an international open call with broad disciplinary scope. Findings concern: (1) new aspects of soft and hard limits to adaptation; (2) the emergence of regional vulnerability hotspots from climate impacts and human vulnerability; (3) new threats on the climate–health horizon – some involving plants and animals; (4) climate (im)mobility and the need for anticipatory action; (5) security and climate; (6) sustainable land management as a prerequisite to land-based solutions; (7) sustainable finance practices in the private sector and the need for political guidance; (8) the urgent planetary imperative for addressing losses and damages; (9) inclusive societal choices for climate-resilient development and (10) how to overcome barriers to accelerate mitigation and limit global warming to below 2°C. Social media summary Science has evidence on barriers to mitigation and how to overcome them to avoid limits to adaptation across multiple fields