Disturbances of sodium in critically ill adult neurologic patients: A clinical review

Disorders of sodium and water balance are common in critically ill adult neurologic patients. Normal aspects of sodium and water regulation are reviewed. The etiology of possible causes of sodium disturbance is discussed in both the general inpatient and the neurologic populations. Areas of importance are highlighted with regard to the differential diagnosis of sodium disturbance in neurologic patients, and management strategies are discussed. Specific discussions of the etiology, diagnosis, and management of cerebral salt wasting syndrome, the syndrome of inappropriate antidiuretic hormone secretion, and central diabetes insipidus are presented, as well as the problems of overtreatment. The importance of diagnosis at an early stage of these diseases is stressed, with a recommendation for conservative management of milder cases. Copyright © 2005 by Lippincott Williams & Wilkins

Climate change induced socio-economic tipping points: review and stakeholder consultation for policy relevant research

Tipping points have become a key concept in research on climate change, indicating points of abrupt transition in biophysical systems as well as transformative changes in adaptation and mitigation strategies. However, the potential existence of tipping points in socio-economic systems has remained underexplored, whereas they might be highly policy relevant. This paper describes characteristics of climate change induced socio-economic tipping points (SETPs) to guide future research on SETPS to inform climate policy. We review existing literature to create a tipping point typology and to derive the following SETP definition: a climate change induced, abrupt change of a socio-economic system, into a new, fundamentally different state. Through stakeholder consultation, we identify 22 candidate SETP examples with policy relevance for Europe. Three of these are described in higher detail to identify their tipping point characteristics (stable states, mechanisms and abrupt change): the collapse of winter sports tourism, farmland abandonment and sea-level rise-induced migration. We find that stakeholder perceptions play an important role in describing SETPs. The role of climate drivers is difficult to isolate from other drivers because of complex interplays with socio-economic factors. In some cases, the rate of change rather than the magnitude of change causes a tipping point. The clearest SETPs are found on small system scales. On a national to continental scale, SETPs are less obvious because they are difficult to separate from their associated economic substitution effects and policy response. Some proposed adaptation measures are so transformative that their implementations can be considered an SETP in terms of 'response to climate change'. Future research can focus on identification and impact analysis of tipping points using stylized models, on the exceedance of stakeholder-defined critical thresholds in the RCP/SSP space and on the macro-economic impacts of new system states

The Economic Advantage: Assessing the value of climate-change actions in agriculture

This report is aimed at readers who seek to build economic evidence in support of the inclusion of actions on agriculture in climate change plans and programmes, particularly at the national level under the umbrella of nationally determined contributions (NDCs) to the December 2015 Paris Agreement, which aims to restrict a rise in global temperatures and manage risks

An economic way of reducing health, environmental, and other pressures of urban traffic: a decision analysis on trip aggregation

BACKGROUND: Traffic congestion is rapidly becoming the most important obstacle to urban development. In addition, traffic creates major health, environmental, and economical problems. Nonetheless, automobiles are crucial for the functions of the modern society. Most proposals for sustainable traffic solutions face major political opposition, economical consequences, or technical problems. METHODS: We performed a decision analysis in a poorly studied area, trip aggregation, and studied decisions from the perspective of two different stakeholders, the passenger and society. We modelled the impact and potential of composite traffic, a hypothetical large-scale demand-responsive public transport system for the Helsinki metropolitan area, where a centralised system would collect the information on all trip demands online, would merge the trips with the same origin and destination into public vehicles with eight or four seats, and then would transmit the trip instructions to the passengers' mobile phones. RESULTS: We show here that in an urban area with one million inhabitants, trip aggregation could reduce the health, environmental, and other detrimental impacts of car traffic typically by 50–70%, and if implemented could attract about half of the car passengers, and within a broad operational range would require no public subsidies. CONCLUSION: Composite traffic provides new degrees of freedom in urban decision-making in identifying novel solutions to the problems of urban traffic

Parameter and model uncertainty in a life-table model for fine particles (PM2.5): a statistical modeling study

<p>Abstract</p> <p>Background</p> <p>The estimation of health impacts involves often uncertain input variables and assumptions which have to be incorporated into the model structure. These uncertainties may have significant effects on the results obtained with model, and, thus, on decision making. Fine particles (PM_2.5) are believed to cause major health impacts, and, consequently, uncertainties in their health impact assessment have clear relevance to policy-making. We studied the effects of various uncertain input variables by building a life-table model for fine particles.</p> <p>Methods</p> <p>Life-expectancy of the Helsinki metropolitan area population and the change in life-expectancy due to fine particle exposures were predicted using a life-table model. A number of parameter and model uncertainties were estimated. Sensitivity analysis for input variables was performed by calculating rank-order correlations between input and output variables. The studied model uncertainties were (i) plausibility of mortality outcomes and (ii) lag, and parameter uncertainties (iii) exposure-response coefficients for different mortality outcomes, and (iv) exposure estimates for different age groups. The monetary value of the years-of-life-lost and the relative importance of the uncertainties related to monetary valuation were predicted to compare the relative importance of the monetary valuation on the health effect uncertainties.</p> <p>Results</p> <p>The magnitude of the health effects costs depended mostly on discount rate, exposure-response coefficient, and plausibility of the cardiopulmonary mortality. Other mortality outcomes (lung cancer, other non-accidental and infant mortality) and lag had only minor impact on the output. The results highlight the importance of the uncertainties associated with cardiopulmonary mortality in the fine particle impact assessment when compared with other uncertainties.</p> <p>Conclusion</p> <p>When estimating life-expectancy, the estimates used for cardiopulmonary exposure-response coefficient, discount rate, and plausibility require careful assessment, while complicated lag estimates can be omitted without this having any major effect on the results.</p

Green Growth and Equity in the Context of Climate Change: Some Considerations

Green growth entails several different kinds of processes: conversion to low-carbon energy, climate resilience, and response to climate shocks. Equity implies a fair sharing of the costs, within countries and between countries. The authors set out to explore some of the ways that equity has been considered in climate change discussions. They discuss per capita emission right approaches, and highlight key challenges in the application of equity in global climate change negotiations. They provide a brief overview key approaches to carbon financing, focusing on some recent cost estimations of potential climate change impacts, as well as of projected needs for green growth programs. The diversity of estimates and present evidence on the apparent gulf between available public financing and green growth needs are highlighted; and considerations of implementing green growth, focusing on building climate resilience and responding to climate shocks are discussed. In conclusion, the authors present one approach to a global Green Fund to receive assessed contributions of member countries and disburse grant and loan fund to low-income and middle-income countries to pursue green growth programs

The ExternE (Externalities of Energy) study Use of methods and results by the Environment Agency

Research contractor: AEA TechnologySIGLEAvailable from British Library Document Supply Centre-DSC:7218.4741(93) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Gauged and historical abrupt wave front floods (‘walls of water’) in Pennine rivers, northern England

Extremely rapid rates of rise in level and discharge in a subset of flash floods (‘abrupt wave front floods’, AWF) are separate hazards from peak level. Such flood events are investigated for Pennine catchments in northern England using both gauged and historical information. Gauged level and flow digital records at 15‐min intervals provide recent data. Historical information for 122 AWF events is extracted from a chronology of flash floods for Britain. Historical AWF events are mapped and found to occur on every major Pennine catchment; catchment descriptors are derived as a basis for assessing catchment vulnerability. We discuss the disputed origin of AWF. Using gauged data, we contrast the rising limb of AWF and ‘normal’ floods. We investigate time series of historical AWF, noting a puzzling peak in the late 19th century. Current rainfall and river monitoring does not provide a reliable basis for understanding AWF processes or for operational response and we suggest improvements. Similarly, current models for design flood estimation and forecasting do not generate the observed rapid increase in level in AWF floods