A Multi-model Analysis of Post-2020 Mitigation Efforts of Five Major Economies

This paper looks into the regional mitigation strategies of five major economies (China, EU, India, Japan and USA) in the context of the 2 degrees C target, using a multi-model comparison. In order to stay in line with the 2 degrees C target, a tripling or quadrupling of mitigation ambitions is required in all regions by 2050, employing vigorous decarbonization of the energy supply system and achieving negative emissions during the second half of the century. In all regions looked at, decarbonization of energy supply (and in particular power generation) is more important than reducing energy demand. Some differences in abatement strategies across the regions are projected: In India and the USA the emphasis is on prolonging fossil fuel use by coupling conventional technologies with carbon storage, whereas the other main strategy depicts a shift to carbon-neutral technologies with mostly renewables (China, EU) or nuclear power (Japan). Regions with access to large amounts of biomass, such as the USA, China and the EU, can make a trade-off between energy related emissions and land related emissions, as the use of bioenergy can lead to a net increase in land use emissions. After supply-side changes, the most important abatement strategy focuses on enduse efficiency improvements, leading to considerable emission reductions in both the industry and transport sectors across all regions. Abatement strategies for non-CO2 emissions and land use emissions are found to have a smaller potential. Inherent model, as well as collective, biases have been observed affecting the regional response strategy or the available reduction potential in specific (end-use) sectors

Coupling circularity performance and climate action: from disciplinary silos to transdisciplinary modelling science

Technological breakthroughs and policy measures targeting energy efficiency and clean energy alone will not suffice to deliver Paris Agreement-compliant greenhouse gas emissions trajectories in the next decades. Strong cases have recently been made for acknowledging the decarbonisation potential lying in transforming linear economic models into closed-loop industrial ecosystems and in shifting lifestyle patterns towards this direction. This perspective highlights the research capacity needed to inform on the role and potential of the circular economy for climate change mitigation and to enhance the scientific capabilities to quantitatively explore their synergies and trade-offs. This begins with establishing conceptual and methodological bridges amongst the relevant and currently fragmented research communities, thereby allowing an interdisciplinary integration and assessment of circularity, decarbonisation, and sustainable development. Following similar calls for science in support of climate action, a transdisciplinary scientific agenda is needed to co-create the goals and scientific processes underpinning the transition pathways towards a circular, net-zero economy with representatives from policy, industry, and civil society. Here, it is argued that such integration of disciplines, methods, and communities can then lead to new and/or structurally enhanced quantitative systems models that better represent critical industrial value chains, consumption patterns, and mitigation technologies. This will be a crucial advancement towards assessing the material implications of, and the contribution of enhanced circularity performance to, mitigation pathways that are compatible with the temperature goals of the Paris Agreement and the transition to a circular economy

Demand-side approaches for limiting global warming to 1.5 °C

The Paris Climate Agreement defined an ambition of limiting global warming to 1.5 °C above preindustrial levels. This has triggered research on stringent emission reduction targets and corresponding mitigation pathways across energy economy and societal systems. Driven by methodological considerations, supply side and carbon dioxide removal options feature prominently in the emerging pathway literature, while much less attention has been given to the role of demand-side approaches. This special issue addresses this gap, and aims to broaden and strengthen the knowledge base in this key research and policy area. This editorial paper synthesizes the special issue’s contributions horizontally through three shared themes we identify: policy interventions, demand-side measures, and methodological approaches. The review of articles is supplemented by insights from other relevant literature. Overall, our paper underlines that stringent demand-side policy portfolios are required to drive the pace and direction of deep decarbonization pathways and keep the 1.5 °C target within reach. It confirms that insufficient attention has been paid to demand-side measures, which are found to be inextricably linked to supply-side decarbonization and able to complement supply-side measures. The paper also shows that there is an abundance of demand-side measures to limit warming to 1.5 °C, but it warns that not all of these options are “seen” or captured by current quantitative tools or progress indicators, and some remain insufficiently represented in the current policy discourse. Based on the set of papers presented in the special issue, we conclude that demand-side mitigation in line with the 1.5 °C goal is possible; however, it remains enormously challenging and dependent on both innovative technologies and policies, and behavioral change. Limiting warming to 1.5 °C requires, more than ever, a plurality of methods and integrated behavioral and technology approaches to better support policymaking and resulting policy interventions

A strategy to enhance the safety and efficiency of handovers of ICU patients: study protocol of the pICUp study

Contains fulltext : 118558.pdf (publisher's version ) (Open Access)BACKGROUND: To use intensive care unit (ICU) facilities efficiently and ensure high quality of care, an optimal patient flow is necessary. Discharging patients relieves the pressure on ICU beds but the risk of premature discharge must be managed carefully. Suboptimal patient discharge may result in ICU readmissions and in patients' death.The aim of this study is to obtain insight into the safety and efficiency of current ICU discharge practices and into barriers and facilitators to the implementation of effective ICU discharge interventions, and to develop an implementation strategy tailored to the barriers and facilitators identified. METHODS/DESIGN: This study exists of five phases. Phase A: analysis of routinely registered data on variation in ICU readmissions and hospital mortality after ICU discharge of all ICUs participating in the Dutch National Intensive Care Evaluation registry (n=83). Phase B: systematic review of effective interventions aiming to improve the efficiency and safety of the ICU discharge process. Phase C: assessing the intervention adherence with a questionnaire survey among all Dutch ICUs (n=90). Phase D: assessing barriers and facilitators to the implementation of effective ICU discharge interventions with a questionnaire survey among all Dutch intensivists (n=700). The questionnaire will be based on barriers and facilitators identified by focus groups (n=4) and individual interviews with professionals of ICUs and general wards and adult discharged ICU patients (n=25 to 30). Phase E: systematic development of an implementation strategy based on the sampled data in phase A to D, and effective implementation strategies from the literature using the intervention mapping method. DISCUSSION: Using theory and empirical data, an implementation strategy will be developed to improve the safety and efficiency of the ICU discharge process. The developed strategy will be evaluated in a subsequent study. The knowledge obtained in this study should be used for further implementation of ICU discharge interventions, and can be used for implementation of handover interventions in other healthcare transition settings

Screening en diagnostiek van diabetes tijdens de zwangerschap

Hoe om te gaan met zwangerschapsdiabetes is een onderwerp van veel discussie. In Nederland, maar ook internationaal. De herziene CBO richtlijn geeft een advies voor het vaststellen van zwangerschaps- diabetes mellitus. De Jonge ea beschrijven relevante achtergrond- informatie bij de aanbevelingen over screening en diagnostiek

Simple fitness testing for individual and team sports : Part.1 body composition and endurance

BACKGROUND: There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with. METHODS: This was an explorative, descriptive study using qualitative methods (individual and focus group interviews). We conducted 19 individual interviews and 4 focus group interviews with nurses and physicians working in the ICU or the general ward of 10 Dutch hospitals. RESULTS: The ethical problems in the context of ICU admission and discharge can be divided into problems concerning full bed occupancy and problems related to treatment decisions. The gap between the high level of care the ICU can provide and the lower care level in the general ward sometimes leads to mutual misunderstandings. Our results indicate that when professionals of different wards feel there is a collective responsibility and effort to solve a problem, this helps to prevent or alleviate moral distress. ICU patients' wishes are often unknown, causing healthcare professionals to err on the side of more treatment. Additionally, the highly technological nature of intensive care appears to encourage over-treatment. CONCLUSIONS: It is important for ICUs and general wards to communicate and cooperate well, since there is a mutual dependency for optimal patient flow between the different departments. Interventions that improve the understanding and cooperation between these wards may help mitigate ethical problems. The nature of the ICU environment makes it important for healthcare professionals to be aware of the risk of over-treatment, reflect on why they do what they do, and be mindful of a possible negative impact of over-treatment on their patients. Early discussion of a patient's wishes with regard to treatment options is important in preventing over-treatment

Rationing in the intensive care unit in case of full bed occupancy: a survey among intensive care unit physicians

BACKGROUND: Internationally, there is no consensus on how to best deal with admission requests in cases of full ICU bed occupancy. Knowledge about the degree of dissension and insight into the reasons for this dissension is lacking. Information about the opinion of ICU physicians can be used to improve decision-making regarding allocation of ICU resources. The aim of this study was to: Assess which factors play a role in the decision-making process regarding the admission of ICU patients; Assess the adherence to a Dutch guideline pertaining to rationing of ICU resources; Investigate factors influencing the adherence to this guideline. METHODS: In March 2013, an online questionnaire was sent to all ICU physician members (n = 761, in 90 hospitals) of the Dutch Society for Intensive Care. RESULTS: 166 physicians (21.8 %) working in 64 different Dutch hospitals (71.1 %) completed the questionnaire. Factors associated with a patient's physical condition and quality of life were generally considered most important in admission decisions. Scenario-based adherence to the Dutch guideline "Admission request in case of full ICU bed occupancy" was found to be low (adherence rate 50.0 %). There were two main reasons for this poor compliance: unfamiliarity with the guideline and disagreement with the fundamental approach underlying the guideline. CONCLUSIONS: Dutch ICU physicians disagree about how to deal with admission requests in cases of full ICU bed occupancy. The results of this study contribute to the discussion about the fundamental principles regarding admission of ICU patients in case of full bed occupancy

Improving clinical handover between intensive care unit and general ward professionals at intensive care unit discharge

PURPOSE: To systematically review and evaluate the effectiveness of interventions in order to improve the safety and efficiency of patient handover between intensive care unit (ICU) and general ward healthcare professionals at ICU discharge. METHODS: PubMed, CINAHL, PsycINFO, EMBASE, Web of Science, and the Cochrane Library were searched for intervention studies with the aim to improve clinical handover between ICU and general ward healthcare professionals that had been published up to and including June 2013. The methods for article inclusion and data analysis were pre-specified and aligned with recommendations outlined in the PRISMA guideline. Two reviewers independently extracted data (study purpose, setting, population, method of sampling, sample size, intervention characteristics, outcome, and implementation activities) and assessed the quality of the included studies. RESULTS: From the 6,591 citations initially extracted from the six databases, we included 11 studies in this review. Of these, six (55 %) reported statistically significant effects. Effective interventions included liaison nurses to improve communication and coordination of care and forms to facilitate timely, complete and accurate handover information. Effective interventions resulted in improved continuity of care (e.g., reduced discharge delay) and in reduced adverse events. Inconsistent effects were observed for use of care, namely, reduction of length of stay versus increase of readmissions to higher care. No statistically significant effects were found in the reduction of mortality. The overall methodological quality of the 11 studies reviewed was relatively low, with an average score of 4.5 out of 11 points. CONCLUSIONS: This review shows that liaison nurses and handover forms are promising interventions to improve the quality of patient handover between the ICU and general ward. More robust evidence is needed on the effectiveness of interventions aiming to improve ICU handover and supportive implementation strategies