Arctic Standards: Recommendations on Oil Spill Prevention, Response, and Safety in the U.S. Arctic Ocean

Oil spilled in Arctic waters would be particularly difficult to remove. Current technology has not been proved to effectively clean up oil when mixed with ice or when trapped under ice. An oil spill would have a profoundly adverse impact on the rich and complex ecosystem found nowhere else in the United States. The Arctic Ocean is home to bowhead, beluga, and gray whales; walruses; polar bears; and other magnificent marine mammals, as well as millions of migratory birds. A healthy ocean is important for these species and integral to the continuation of hunting and fishing traditions practiced by Alaska Native communities for thousands of years.To aid the United States in its efforts to modernize Arctic technology and equipment standards, this report examines the fierce Arctic conditions in which offshore oil and gas operations could take place and then offers a summary of key recommendations for the Interior Department to consider as it develops world-class, Arctic-specific regulatory standards for these activities. Pew's recommendations call for improved technology,equipment, and procedural requirements that match the challenging conditions in the Arctic and for full public participation and transparency throughout the decision-making process. Pew is not opposed to offshore drilling, but a balance must be achieved between responsible energy development and protection of the environment.It is essential that appropriate standards be in place for safety and for oil spill prevention and response in this extreme, remote, and vulnerable ecosystem. This report recommends updating regulations to include Arctic specific requirements and codifying temporary guidance into regulation. The appendixes to this report provide substantially more detail on the report's recommendations, including technical background documentation and additional referenced materials. Please refer to the full set of appendixes for a complete set of recommendations. This report and its appendixes offer guidelines for responsible hydrocarbon development in the U.S. Arctic Ocean

Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes

BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo