Consumption-based carbon accounting: does it have a future?

Internationally, allocation of responsibility for reducing greenhouse gas emissions is currently based on the production-based (PB) accounting method, which measures emissions generated in the place where goods and services are produced. However, the growth of emissions embodied in trade has raised the question whether we should switch to, or amalgamate PB accounting, with other accounting approaches. Consumption-based (CB) accounting has so far emerged as the most prominent alternative. This approach accounts for emissions at the point of consumption, attributing all the emissions that occurred in the course of production and distribution to the final consumers of goods and services. This review has a fourfold objective. First, it provides an account of the logic behind attributing responsibility for emissions on the basis of consumption instead of production. Issues of equity and justice, increased emissions coverage, encouragement of cleaner production practices, and political benefits are considered. Second, it discusses the counterarguments, focusing in particular on issues of technical complexity, mitigation effectiveness, and political acceptability. Third, it presents the spectrum of implementation possibilities—ranging from the status quo to more transformative options—and considers the implications for international climate policy that would accrue under various scenarios of adopting CB accounting in practice. Fourth, it looks at how CB accounting may be adjusted to fit with current political realities and it identifies policy mechanisms that could potentially be utilized to directly or indirectly address CB emissions. Such an approach could unlock new opportunities for climate policy innovation and for climate mitigation

Pulmonary vein reconnection and repeat ablation characteristics following cryoballoon‐compared to radiofrequency‐based pulmonary vein isolation

Background: Despite advances in efficacy and safety of pulmonary vein isolation (PVI), atrial fibrillation (AF) recurrence after PVI remains common. PV‐reconnection is the main finding during repeat PVI procedures performed to treat recurrent AF. Objective: To analyze pulmonary vein (PV) reconnection patterns during repeat ablation procedures in a large cohort of consecutive patients undergoing radio frequency or cryoballoon‐based PVI. Methods: Retrospective analysis of PV‐reconnection patterns and analysis of re‐ablation strategies in consecutive index RF‐ and CB‐based PVI and their respective re‐ablation procedures during concomitant usage of both energy sources at a single high‐volume center in Germany. Results: A total of 610 first (06/2015–10/2022) and 133 s (01/2016–11/2022) repeat ablation procedures after 363 (60%) RF‐ and 247 (40%) CB‐based index PVIs between 01/2015 and 12/2021 were analyzed. PV‐reconnection was found in 509/610 (83%) patients at first and 74/133 (56%) patients at second repeat procedure. 465 of 968 (48%) initially via CB isolated PVs were reconnected at first re‐ablation but 796 of 1422 initially RF‐isolated PV (56%) were reconnected (OR: 0.73 [95% CI: 0.62–0.86]; p < .001). This was driven by fewer reconnections of the left PVs (LSPV: OR: 0.60 [95% CI: 0.42–0.86]; p = .005 and LSPV: 0.67 [0.47–0.95]; p = .026). PV‐reconnection was more likely after longer, RF‐based index PVI and in older females. Repeat procedures were shorter after CB‐compared to after RF‐PVI. Conclusions: Reconnection remains the most common reason for repeat AF ablation procedures after PVI. Our data suggest to preferentially use of the cryoballoon during index PVI, especially in older women

Pulmonary vein reconnection and repeat ablation characteristics following cryoballoon‐compared to radiofrequency‐based pulmonary vein isolation

Background: Despite advances in efficacy and safety of pulmonary vein isolation (PVI), atrial fibrillation (AF) recurrence after PVI remains common. PV‐reconnection is the main finding during repeat PVI procedures performed to treat recurrent AF. Objective: To analyze pulmonary vein (PV) reconnection patterns during repeat ablation procedures in a large cohort of consecutive patients undergoing radio frequency or cryoballoon‐based PVI. Methods: Retrospective analysis of PV‐reconnection patterns and analysis of re‐ablation strategies in consecutive index RF‐ and CB‐based PVI and their respective re‐ablation procedures during concomitant usage of both energy sources at a single high‐volume center in Germany. Results: A total of 610 first (06/2015–10/2022) and 133 s (01/2016–11/2022) repeat ablation procedures after 363 (60%) RF‐ and 247 (40%) CB‐based index PVIs between 01/2015 and 12/2021 were analyzed. PV‐reconnection was found in 509/610 (83%) patients at first and 74/133 (56%) patients at second repeat procedure. 465 of 968 (48%) initially via CB isolated PVs were reconnected at first re‐ablation but 796 of 1422 initially RF‐isolated PV (56%) were reconnected (OR: 0.73 [95% CI: 0.62–0.86]; p < .001). This was driven by fewer reconnections of the left PVs (LSPV: OR: 0.60 [95% CI: 0.42–0.86]; p = .005 and LSPV: 0.67 [0.47–0.95]; p = .026). PV‐reconnection was more likely after longer, RF‐based index PVI and in older females. Repeat procedures were shorter after CB‐compared to after RF‐PVI. Conclusions: Reconnection remains the most common reason for repeat AF ablation procedures after PVI. Our data suggest to preferentially use of the cryoballoon during index PVI, especially in older women

Functional evaluation of the PTPase DEP-1 as a novel regulator of monocytes and macrophages in diabetes and inflammation

Monozyten und Makrophagen spielen im Kontext von Diabetes mellitus und Atherosklerose eine wichtige Rolle. In der vorliegenden Arbeit wurde die Protein-Tyrosin-Phosphatase Density-enhanced phosphatase I (DEP-1) im Kontext von Diabetes in einem Hyperglykaemie- und Inflammationsmodell in Monozyten und Makrophagen charakterisiert. Es konnte gezeigt werden, dass die Expression von DEP-1 in Monozyten von Diabetikern im Vergleich zu Nicht-Diabetikern erhöht ist. In-vitro war DEP-1 in Monozyten unter Stimulation mit TNF-alpha, sowie unter hyperglykaemischen Bedingungen ebenfalls heraufreguliert. M1-Makrophagen zeigten die hoechste Proteinexpression, sowie eine erhoehte DEP-1 Phosphatase-Aktivitaet im Vergleich nicht-aktivierten und M2-aktivierten Makrophagen. siRNA basiertes Silencing von DEP-1 fuehrte zu reduzierter Migration von Makrophagen im Wundheilungsversuch. Die p65-Expression, die p65-Phosphorylierung und die TNF-alpha Expression waren in Makrophagen unter Silencing der Phosphatase erhoeht.Monocytes and macrophages play crucial roles in the pathophysiological context of diabetes mellitus and atherosclerosis. The present work characterizes the protein tyrosine phosphatase Density-enhanced phosphatase 1 (DEP-1) in the context of diabetes by employing a model of hyperglycemia and inflammation in monocytes and macrophages. DEP-1 mRNA expression was upregulated in monocytes from diabetic versus non-diabetic patients. In monocytes, stimulation with TNF-alpha as well as culturing in hyperglycemia led to increased protein expression of DEP-1. M1-activated macrophages showed highest protein expression and a significantly increased phosphatase activity of DEP-1 in comparison with non-activated and alternatively activated M2-macrophages. siRNA-based silencing of DEP-1 led to reduced macrophage migration in a wound-heeling assay. Expression of p65 and p65-phosphorylation, as well as expression of TNF-alpha in macrophages was increased after silencing of the phosphatase

Transcoronary ablation of septal hypertrophy for hypertrophic obstructive cardiomyopathy: feasibility, clinical benefit, and short term results in elderly patients

Objective: To evaluate symptomatic and haemodynamic results of transcoronary ablation of septal hypertrophy for hypertrophic obstructive cardiomyopathy in elderly patients. Setting: Tertiary referral centre for patients with hypertrophic obstructive cardiomyopathy. Design: Retrospective study of two groups of consecutive patients divided at a median age (59 years). Patients: Transcoronary ablation of septal hypertrophy was compared for 80 patients (group 1) < 60 years of age and 77 patients (group 2) ⩾ 60 years of age. At baseline both groups were similar concerning the proportion of familial hypertrophic cardiomyopathy, concomitant moderate hypertension, prior syncope, left ventricular outflow obstruction, left ventricular end diastolic pressure, and left ventricular ejection fraction. Patients in group 2 had a lower interventricular septal thickness and more severe disease as measured by New York Heart Association (NYHA) functional class, exercise capacity, pulmonary artery mean pressure at workload, and cardiac index at peak exercise. Results: Median follow up was seven months after transcoronary ablation of septal hypertrophy. Both groups had a significant and similar improvement in basal and provokable obstruction, septal thickness, NYHA functional class, exercise tolerance, peak oxygen consumption, and pulmonary artery mean pressure at workload. Significant differences, compared with the younger group, were a higher proportion of persistent total atrioventricular block (5% v 17%, p  =  0.015) and a slight decrease in left ventricular ejection fraction (3 (12) v −6 (11)%, p  =  0.001) in the elderly, despite a trend to a lower induced peak creatine kinase activity (596 (339) v 491 (331) U/l, p  =  0.051). Conclusions: Short term results with transcoronary ablation of septal hypertrophy suggest that independent of a patient’s age similar treatment strategies are justified in hypertrophic obstructive cardiomyopathy

Are China’s climate commitments in a post-Paris agreement sufficiently ambitious?

In international climate change negotiations, China’s role is an issue of perennial concern. In particular, the lack of quantitative, absolute emissions commitments from China has been the focus. In line with changing domestic and international contexts, China is recalibrating its stance and strategy. Its participation in international climate change negotiations has evolved from playing a peripheral role to gradually moving to the centre. This article examines China’s stance and role in international climate change negotiations from a historical perspective. In so doing, the article discusses the evolution of international climate negotiations and China’s stance in the lead-up to and at the Paris conference. The focus is now turning to the implementation of the Paris Agreement. The article discusses post-Paris issues in the international context and in particular in China’s context. These affect the post Paris negotiations and hold the key to achieving desired outcomes

An enigmatic case of cortical anopsia: Antemortem diagnosis of a 14-3-3 negative Heidenhain-variant MM1-sCJD

Sporadic Creutzfeldt-Jakob disease is the predominant type of human prion disease. While routine diagnostic in phenotypic cases has advanced considerably, the clinical heterogeneity and rarity of subtypes continue to constitute a major clinical and diagnostic challenge. Here, we report a peculiar case of the Heidenhain-variant of MM1 sporadic Creutzfeldt-Jakob disease presenting as a stroke mimic in an 81-year-old patient with a rapid and clinically distinct course of disease as compared to previously reported cases. While 14-3-3 protein was negative, clinical findings substantiated by 18F-FDG-PET imaging and RT-QuIC-Assay were able to establish the diagnosis. We conclude that in cases presenting with rapid progressive dementia secondary to sudden cortical anopsia the Heidenhain-variant of CJD should be considered