The appropriateness of patients' visits to an emergency department.

Aim: The appropriateness of patient visits to an emergency unit was investigated in this study. Method: This descriptive study included 2968 patient cards from the National District Hospital, Bloemfontein emergency unit during 2003. Patient information was evaluated according to predetermined criteria to determine whether a visit was appropriate or not. Results: The patient's ages varied between 0 to 97 years (median 29 year) and 50.8% was female. Informal residencies presented 26.4% of patient's neighbourhoods. The most common chronic condition was hypertension (7.9%). Only 8.4% of patients already used medication for their presenting condition. Most (72.4%) patients presented after hours and 36.6% presented during weekends. The total number of injuries was 22.9% and 75.6% were examined for medical or surgical problems. The criterion with the most visits was the trauma category (21.8%). The criterion with the least patients (0.3%) was the criterion for significant bleeding. According to the results more than a third (35.4% ; 95% CI 33.7% ; 37.2%) of the patient visits can be seen as inappropriate. Conclusion: The emergency unit is used inappropriately South African Family Practice Vol. 49 (4) 2007: pp. 1

Non-compliance with treatment by epileptic patients at George Provincial Hospital

Non-compliance with anti-epileptic drug treatment in the George area, resulting in recurrent seizures and visits to the emergency department of the George Provincial Hospital, has been identified as a social and economic problem. The aim of this study was to determine the socio-economic and medical factors, the information given to patients by healthcare workers, and the understanding of patients living with epilepsy who presented to the emergency department with seizures. Methods A descriptive study design was employed and the data-collection tools were a questionnaire and structured interview. Results The median age of the study population was 32 years. The patients had suffered from epilepsy for a median of two years and visited a clinic for a median of seven times a year. The median education level was primary school and three quarters had no employment or government grant. The majority did not understand the disease, the side effects of the medication and why they should be on medication. In addition, it became apparent from patient reports that healthcare workers showed a lack of counselling skills, time and appropriate knowledge. Conclusions There is a general lack of understanding of epilepsy by the patient. Not only were the patients uninformed, but they also showed apathy towards the management of their condition.South African Family Practice Vol. 49 (9) 2007: pp. 1

How Low Can We Go? The Implications of Delayed Ratcheting and Negative Emissions Technologies on Achieving Well Below 2 °C

Pledges embodied in the nationally determined contributions (NDCs) represent an interim step from a global “no policy” path towards an optimal long-term global mitigation path. However, the goals of the Paris Agreement highlight that current pledges are insufficient. It is, therefore, necessary to ratchet-up parties’ future mitigation pledges in the near-term. The ambitious goals of remaining well below 2 °C and pursuing reductions towards 1.5 °C mean that any delay in ratcheting-up commitments could be extremely costly or may even make the targets unachievable. In this chapter, we consider the impacts of delaying ratcheting until 2030 on global emissions trajectories towards 2 °C and 1.5 °C, and the role of offsets via negative emissions technologies (NETs). The analysis suggests that delaying action makes pursuing the 1.5 °C goal especially difficult without extremely high levels of negative emissions technologies (NETs), such as carbon capture and storage combined with bioenergy (BECCS). Depending on the availability of biomass, other NETs beyond BECCS will be required. Policymakers must also realise that the outlook for fossil fuels are closely linked to the prospects for NETs. If NETs cannot be scaled, the levels of fossil fuels suggested in this analysis are not compatible with the Paris Agreement goals i.e. there are risks of lock-in to a high fossil future. Decision makers must, therefore, comprehend fully the risks of different strategies

An energy vision for a planet under pressure

Worldwide, global energy systems face an array of challenges, from access for the poor to reliability and security. Meanwhile, the provision of energy creates local human and ecological health impacts as well as dangerous global climate change. Addressing these issues simultaneously will require a fundamental transformation of the energy system. Recent assessments show that such a transformation is achievable in technological and economic terms, but it will present formidable supply- and demand-side challenges as well as problems of governance, transparency and reliability across scales. This policy brief presents a long-term vision for the energy system and describes the elements required for the transition towards this vision. To succeed, this transformation must integrate several key components, including a focus on high levels of energy efficiency and the scale up of investments in technology deployment as well as research, development and demonstration (RD&D)

Locked into Copenhagen pledges - Implications of short-term emission targets for the cost and feasibility of long-term climate goals

This paper provides an overview of the AMPERE modeling comparison project with focus on the implications of near-term policies for the costs and attainability of long-term climate objectives. Nine modeling teams participated in the project to explore the consequences of global emissions following the proposed policy stringency of the national pledges from the Copenhagen Accord and Cancun Agreements to 2030. Specific features compared to earlier assessments are the explicit consideration of near-term 2030 emission targets as well as the systematic sensitivity analysis for the availability and potential of mitigation technologies. Our estimates show that a 2030 mitigation effort comparable to the pledges would result in a further "lock-in" of the energy system into fossil fuels and thus impede the required energy transformation to reach low greenhouse-gas stabilization levels (450 ppm CO2e). Major implications include significant increases in mitigation costs, increased risk that low stabilization targets become unattainable, and reduced chances of staying below the proposed temperature change target of 2 degrees C in case of overshoot. With respect to technologies, we find that following the pledge pathways to 2030 would narrow policy choices, and increases the risks that some currently optional technologies, such as carbon capture and storage (CCS) or the large-scale deployment of bioenergy, will become "a must" by 2030

Global implications of crop-based bioenergy with carbon capture and storage for terrestrial vertebrate biodiversity

Bioenergy with carbon capture and storage (BECCS) based on purpose-grown lignocellulosic crops can provide negative CO 2 emissions to mitigate climate change, but its land requirements present a threat to biodiversity. Here, we analyse the implications of crop-based BECCS for global terrestrial vertebrate species richness, considering both the land-use change (LUC) required for BECCS and the climate change prevented by BECCS. LUC impacts are determined using global-equivalent, species–area relationship-based loss factors. We find that sequestering 0.5–5 Gtonne of CO 2 per year with lignocellulosic crop-based BECCS would require hundreds of Mha of land, and commit tens of terrestrial vertebrate species to extinction. Species loss per unit of negative emissions decreases with: (i) longer lifetimes of BECCS systems, (ii) less overall deployment of crop-based BECCS and (iii) optimal land allocation, that is prioritizing locations with the lowest species loss per negative emission potential, rather than minimizing overall land use or prioritizing locations with the lowest biodiversity. The consequences of prevented climate change for biodiversity are based on existing climate response relationships. Our tentative comparison shows that for crop-based BECCS considered over 30 years, LUC impacts on vertebrate species richness may outweigh the positive effects of prevented climate change. Conversely, for BECCS considered over 80 years, the positive effects of climate change mitigation on biodiversity may outweigh the negative effects of LUC. However, both effects and their interaction are highly uncertain and require further understanding, along with the analysis of additional species groups and biodiversity metrics. We conclude that factoring in biodiversity means lignocellulosic crop-based BECCS should be used early to achieve the required mitigation over longer time periods, on optimal biomass cultivation locations, and most importantly, as little as possible where conversion of natural land is involved, looking instead to sustainably grown or residual biomass-based feedstocks and alternative strategies for carbon dioxide removal

Limited emission reductions from fuel subsidy removal except in energy exporting regions

Hopes are high that removing fossil fuel subsidies could help to mitigate climate change by discouraging inefficient energy consumption and levelling the playing field for renewables1–3. In September 2016, the G20 countries re-affirmed their 2009 commitment (at the G20 Leaders’ Summit) to phase out fossil fuel subsidies4,5 and many national governments are using today’s low oil prices as an opportunity to do so6–9. In practical terms, this means abandoning policies that decrease the price of fossil fuels and electricity generated from fossil fuels to below normal market prices10,11. However, whether the removal of subsidies, even if implemented worldwide, would have a large impact on climate change mitigation has not been systematically explored. Here we show that fossil fuel subsidy removal would have a small impact on global energy demand and carbon dioxide emissions and would not increase renewable energy use by 2030. Subsidy removal would reduce the carbon price necessary to stabilize greenhouse gas concentration at 550 parts per million by only 2–12 per cent under low oil prices. Removing subsidies in most regions would deliver smaller emission reductions than the Paris Agreement (2015) climate pledges and in some regions global subsidy removal may actually lead to an increase in emissions, owing to either coal replacing subsidized oil and natural gas or natural-gas use shifting from subsidizing, energy-exporting regions to non-subsidizing, importing regions. Our results show that subsidy removal would result in the largest CO2 emission reductions in oil- and gas-exporting regions, where reductions would exceed their climate pledges and where subsidy removal would also affect fewer people below the poverty line than in lower-income regions