Uncompensated claims to fair emission space risk putting Paris Agreement goals out of reach

Addressing questions of equitable contributions to emission reductions is important to facilitate ambitious global action on climate change within the ambit of the Paris Agreement. Several large developing regions with low historical contributions to global warming have a strong moral claim to a large proportion of the remaining carbon budget (RCB). However, this claim needs to be assessed in a context where the RCB consistent with the long-term temperature goal (LTTG) of the Paris Agreement is rapidly diminishing. Here we assess the potential tension between the moral claim to the remaining carbon space by large developing regions with low per capita emissions, and the collective obligation to achieve the goals of the Paris Agreement. Based on scenarios underlying the IPCC's 6th Assessment Report, we construct a suite of scenarios that combine the following elements: (a) two quantifications of a moral claim to the remaining carbon space by South Asia, and Africa, (b) a 'highest possible emission reduction' effort by developed regions (DRs), and (c) a corresponding range for other developing regions (ODR). We find that even the best effort by DRs cannot compensate for a unilateral claim to the remaining carbon space by South Asia and Africa. This would put the LTTG firmly out of reach unless ODRs cede their moral claim to emissions space and, like DRs, pursue highest possible emission reductions, which would also constitute an inequitable outcome. Furthermore, regions such as Latin America would need to provide large-scale negative emissions with potential risks and negative side effects. Our findings raise important questions of perspectives on equity in the context of the Paris Agreement including on the critical importance of climate finance. A failure to provide adequate levels of financial support to compensate large developing regions to emit less than their moral claim will put the Paris Agreement at risk

Uncompensated claims to fair emission space risk putting Paris Agreement goals out of reach

Addressing questions of equitable contributions to emission reductions is important to facilitate ambitious global action on climate change within the ambit of the Paris Agreement. Several large developing regions with low historical contributions to global warming have a strong moral claim to a large proportion of the remaining carbon budget (RCB). However, this claim needs to be assessed in a context where the RCB consistent with the long-term temperature goal (LTTG) of the Paris Agreement is rapidly diminishing. Here we assess the potential tension between the moral claim to the remaining carbon space by large developing regions with low per capita emissions, and the collective obligation to achieve the goals of the Paris Agreement. Based on scenarios underlying the IPCC's 6th Assessment Report, we construct a suite of scenarios that combine the following elements: (a) two quantifications of a moral claim to the remaining carbon space by South Asia, and Africa, (b) a 'highest possible emission reduction' effort by developed regions (DRs), and (c) a corresponding range for other developing regions (ODR). We find that even the best effort by DRs cannot compensate for a unilateral claim to the remaining carbon space by South Asia and Africa. This would put the LTTG firmly out of reach unless ODRs cede their moral claim to emissions space and, like DRs, pursue highest possible emission reductions, which would also constitute an inequitable outcome. Furthermore, regions such as Latin America would need to provide large-scale negative emissions with potential risks and negative side effects. Our findings raise important questions of perspectives on equity in the context of the Paris Agreement including on the critical importance of climate finance. A failure to provide adequate levels of financial support to compensate large developing regions to emit less than their moral claim will put the Paris Agreement at risk

Perinatal and 2-year neurodevelopmental outcome in late preterm fetal compromise: the TRUFFLE 2 randomised trial protocol

Introduction Following the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years. Methods and analysis Women with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the estimated fetal weight or abdominal circumference is <10th percentile or has decreased by 50 percentiles since 18–32 weeks will be included for observational data collection. Participants will be randomised if cerebral blood flow redistribution is identified, based on umbilical to middle cerebral artery pulsatility index ratio values. Computerised cardiotocography (cCTG) must show normal fetal heart rate short term variation (≥4.5 msec) and absence of decelerations at randomisation. Randomisation will be 1:1 to immediate delivery or delayed delivery (based on cCTG abnormalities or other worsening fetal condition). The primary outcome is poor condition at birth and/or fetal or neonatal death and/or major neonatal morbidity, the secondary non-inferiority outcome is 2-year infant general health and neurodevelopmental outcome based on the Parent Report of Children’s Abilities-Revised questionnaire. Ethics and dissemination The Study Coordination Centre has obtained approval from London-Riverside Research Ethics Committee (REC) and Health Regulatory Authority (HRA). Publication will be in line with NIHR Open Access policy. Trial registration number Main sponsor: Imperial College London, Reference: 19QC5491. Funders: NIHR HTA, Reference: 127 976. Study coordination centre: Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS with Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University. IRAS Project ID: 266 400. REC reference: 20/LO/0031. ISRCTN registry: 76 016 200

Monitoring fetal maturation-objectives, techniques and indices of autonomic function.

Monitoring the fetal behavior does not only have implications for acute care but also for identifying developmental disturbances that burden the entire later life. The concept, of 'fetal programming', also known as 'developmental origins of adult disease hypothesis', e.g. applies for cardiovascular, metabolic, hyperkinetic, cognitive disorders. Since the autonomic nervous system is involved in all of those systems, cardiac autonomic control may provide relevant functional diagnostic and prognostic information. The fetal heart rate patterns (HRP) are one of the few functional signals in the prenatal period that relate to autonomic control and, therefore, is predestinated for its evaluation. The development of sensitive markers of fetal maturation and its disturbances requires the consideration of physiological fundamentals, recording technology and HRP parameters of autonomic control. Based on the ESGCO2016 special session on monitoring the fetal maturation we herein report the most recent results on: (i) functional fetal autonomic brain age score (fABAS), Recurrence Quantitative Analysis and Binary Symbolic Dynamics of complex HRP resolve specific maturation periods, (ii) magnetocardiography (MCG) based fABAS was validated for cardiotocography (CTG), (iii) 30 min recordings are sufficient for obtaining episodes of high variability, important for intrauterine growth restriction (IUGR) detection in handheld Doppler, (iv) novel parameters from PRSA to identify Intra IUGR fetuses, (v) evaluation of fetal electrocardiographic (ECG) recordings, (vi) correlation between maternal and fetal HRV is disturbed in pre-eclampsia. The reported novel developments significantly extend the possibilities for the established CTG methodology. Novel HRP indices improve the accuracy of assessment due to their more appropriate consideration of complex autonomic processes across the recording technologies (CTG, handheld Doppler, MCG, ECG). The ultimate objective is their dissemination into routine practice and studies of fetal developmental disturbances with implications for programming of adult diseases