Managing CO2 storage resources in a mature CCS future

This paper summarises the potential for surface and subsurface interactions which might occur during CO2 storage operations. We discuss possible options for managing these interactions to provide timely storage capacity, illustrated with a regional case study from the Southern North Sea. The case study evaluates storage site options to provide storage capacity for CO2 supplied to the region until 205

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The IEA CCS Technology Roadmap: One Year On

AbstractIn October 2009, the International Energy Agency’s CCS Technology Roadmap was launched at the Carbon Sequestration Leadership forum (CSLF) Ministerial Meeting in London. The Roadmap builds on the IEA BLUE Map scenario that leads to the stabilisation of CO2 emissions at 450 ppm by 2050. Achieving this scenario will require an energy technology revolution involving a portfolio of solutions: greater energy efficiency, increased renewable energy technologies and nuclear power, and the near decarbonisation of fossil fuel-based power generation via carbon capture and storage (CCS). In this scenario CCS contributes almost 20% to the total emissions reductions required in 2050. Recommendations are made in the IEA CCS Roadmap on what is required to achieve this level of deployment not only technically, but also from a financial and regulatory point of view as well as in terms of public engagement and international collaboration, including the sharing of knowledge. This paper looks at progress made against these recommendations in the 12 months since the release of the roadmap. •Analysis undertaken by the IEA consistently identifies a significant role for CCS in mitigating global CO2 emissions. IEA analysis suggests that there will be a need to capture and store 10 Gt CO2 per year in 2050, from 3400 projects globally to achieve the BLUE Map emissions reduction targets.•Significant progress is being made to launch large-scale demonstration facilities across the globe, with some 80 large-scale integrated demonstration projects identified. As of April 2010, public funding commitments were in the range of USD 26.6 billion to USD 36.1 billion.•While 5500 km of CO2 pipelines already exist and further infrastructure development is planned, it is however clear that to enable large-scale deployment of CCS, more joint planning of CO2 transportation infrastructure is required globally.•The status and availability of data on CO2 storage varies significantly around the world and is potentially a major constraint to rapid, widespread CCS deployment. In regions with the potential to store large volumes of CO2, a concerted effort will be required to characterise the basins in sufficient detail.•Much progress has been achieved in the legal and regulatory area. The first movers in establishing legal frameworks have generally been OECD countries. It is now important that the large emerging economies start developing their legal and regulatory frameworks.•Public awareness and acceptance is a key element in making CCS possible. Public concerns are legitimate and require a close dialogue and sharing of information with the local population. While companies developing transport and storage will need to lead on the engagement processes, governments and politicians have a vital role to play.•Several initiatives are in place for international dialogue and collaboration on the development and deployment of CCS.•While much progress has been made, many challenges still remain if CCS is to deliver at the scale required. The challenges are well-known and require concerted action by industry, governments, international organisations and civil society. Continued political leadership remains absolutely essential

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc