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Human rights and environmental protection are closely intertwined, and both are critically dependent on supportive legal opportunity structures. These legal structures consist of access to the courts; 'legal stock' or the set of available standards and precedents on which to base litigation; and institutional receptiveness to potential litigation. These elements all depend on a variety of social, political, and economic variables. This book critically analyses the complexities of uniting human rights advocacy and environmental protection. Bringing together international experts in the field, it documents the current state of our environmental human rights knowledge, strategically critical questions that remain unanswered, and the initiatives required to develop those answers. It is ideal for researchers in environmental governance and law, as well as interested practitioners and advanced students working in public policy, political science and environmental studies.
The opioid epidemic in the United States is getting worse: in 2020 opioid overdose deaths hit an all-time high of 92,183. This underscored the need for more effective and readily available treatments for patients with opioid use disorder (OUD). Prescription digital therapeutics (PDTs) are FDA-authorized treatments delivered via mobile devices (eg, smartphones). A real-world pilot study was conducted in an outpatient addiction treatment program to evaluate patient engagement and use of a PDT for patients with OUD. The objective was to assess the ability of the PDT to improve engagement and care for patients receiving buprenorphine medication for opioid use disorder (MOUD).
Patients with OUD treated at an ambulatory addiction treatment clinic were invited to participate in the pilot. The reSET-O PDT is comprised of 31 core therapy lessons plus 36 supplementary lessons, plus contingency management rewards. Patients were asked to complete at least 4 lessons per week, for 12-weeks. Engagement and use data were collected via the PDT and rates of emergency room data were obtained from patient medical records. Data were compared to a similar group of 158 OUD patients treated at the same clinic who did not use the PDT. Abstinence data were obtained from deidentified medical records.
Pilot participants (N = 40) completed a median of 24 lessons: 73.2% completed at least 8 lessons and 42.5% completed all 31 core lessons. Pilot participants had significantly higher rates of abstinence from opioids in the 30 days prior to discharge from the program than the comparison group: 77.5% vs 51.9% (P < .01). Clinician-reported treatment retention for pilot participants vs the comparison group was 100% vs 70.9% 30 days after treatment initiation (P < .01), 87.5% vs 55.1% at 90 days post-initiation (P < .01), and 45.0% vs 38.6% at 180 days post-initiation (P = .46). Emergency room visits within 90 days of discharge from the addiction program were significantly reduced in pilot participants compared to the comparison group (17.3% vs 31.7%, P < .01).
These results demonstrate substantial engagement with a PDT in a real-world population of patients with OUD being treated with buprenorphine. Abstinence and retention outcomes were high compared to patients not using the PDT. These results demonstrate the potential value of PDTs to improve outcomes among patients with OUD, a population for which a significant need for improved treatments exists.
Trinity Health Innovation and Pear Therapeutics Inc.
Sudden hearing loss, or progressive hearing loss occurring over months to years, are well-established presentations. However, little is described in the medical literature on how to approach patients presenting with a rapidly progressive hearing loss occurring over weeks. This study aimed to evaluate the clinical significance of patients presenting with rapidly progressive hearing loss.
A case of rapidly progressive hearing loss occurring over 12 weeks is presented. A PubMed literature review was performed to determine the evidence-based differential diagnoses for rapidly progressive hearing loss.
Fifteen causes were identified for rapidly progressive hearing loss: intracranial aetiologies (meningioma, lymphoma, metastatic deposit, cavernous angioma, meningitis, superficial siderosis); paraneoplastic syndrome (small cell lung carcinoma, thymoma); inflammatory or autoimmune disorders (autoimmune inner-ear disease, sarcoidosis, vasculitis, Sjögren's syndrome); infective disorders (syphilis, human immunodeficiency virus); and medication-induced causes.
Rapidly progressive hearing loss should be considered a ‘red flag’ symptom that warrants urgent action. Most causes are systemic or sinister in nature, and the patient's hearing loss can potentially be reversed.
This manuscript details the strategy employed for categorising food items based on their processing levels into the four NOVA groups. Semi-quantitative food frequency questionnaires (FFQs) from the Nurses’ Health Studies (NHS) I and II, the Health Professionals Follow-up Study (HPFS) and the Growing Up Today Studies (GUTS) I and II cohorts were used. The four-stage approach included: (i) the creation of a complete food list from the FFQs; (ii) assignment of food items to a NOVA group by three researchers; (iii) checking for consensus in categorisation and shortlisting discordant food items; (iv) discussions with experts and use of additional resources (research dieticians, cohort-specific documents, online grocery store scans) to guide the final categorisation of the short-listed items. At stage 1, 205 and 315 food items were compiled from the NHS and HPFS, and the GUTS FFQs, respectively. Over 70 % of food items from all cohorts were assigned to a NOVA group after stage 2. The remainder were shortlisted for further discussion (stage 3). After two rounds of reviews at stage 4, 95⋅6 % of food items (NHS + HPFS) and 90⋅7 % items (GUTS) were categorised. The remaining products were assigned to a non-ultra-processed food group (primary categorisation) and flagged for sensitivity analyses at which point they would be categorised as ultra-processed. Of all items in the food lists, 36⋅1 % in the NHS and HPFS cohorts and 43⋅5 % in the GUTS cohorts were identified as ultra-processed. Future work is needed to validate this approach. Documentation and discussions of alternative approaches for categorisation are encouraged.
Recent progress has been made in quantifying snowmelt in the Himalaya. Although the conditions are favorable for refreezing, little is known about the spatial variability of meltwater refreezing, hindering a complete understanding of seasonal snowmelt dynamics. This study aims to improve our understanding about how refreezing varies in space and time. We simulated refreezing with the seNorge (v2.0) snow model for the Langtang catchment, Nepalese Himalaya, covering a 5-year period. Meteorological forcing data were derived from a unique elaborate network of meteorological stations and high-resolution meteorological simulations. The results show that the annual catchment average refreezing amounts to 122 mm w.e. (21% of the melt), and varies strongly in space depending on elevation and aspect. In addition, there is a seasonal altitudinal variability related to air temperature and snow depth, with most refreezing during the early melt season. Substantial intra-annual variability resulted from fluctuations in snowfall. Daily refreezing simulations decreased by 84% (annual catchment average of 19 mm w.e.) compared to hourly simulations, emphasizing the importance of using sub-daily time steps to capture melt–refreeze cycles. Climate sensitivity experiments revealed that refreezing is highly sensitive to changes in air temperature as a 2°C increase leads to a refreezing decrease of 35%.
Infant neurodevelopment is a complex process which may be affected by different events during pregnancy, such as hypertensive disorders of pregnancy (HDP). We conducted a prospective cohort study to compare the prevalence of neurodevelopmental disorders in infants born to mothers with and without HDP at six months of age. Participants attended the Health Observatory of Instituto de Desarrollo e Investigaciones Pediátricas “Prof. Dr. Fernando E. Viteri” during 2018 and 2019. Infant neurodevelopment was assessed with the Bayley Scales of Infant and Toddler Development—Third Edition (Bayley-III). Data were analyzed using Chi-square, Student’s t-test and Mann–Whitney test. Of the 132 participating infants, 68 and 64 were born to mothers with and without HDP, respectively. At six months, the prevalence of risk of neurodevelopmental delay was significantly higher in infants born to mothers with than without HDP (27.9% vs. 9.4%; p = 0.008) (odds ratio, 3.71; 95% confidence interval, 1.30; 12.28). In conclusion, infants born to mothers with HDP had three times increased risk of neurodevelopmental delay at six months of age.
The essentially open-textured quality of political discourse that an equivocal (equi-vocal) norm suggests does not simply allow for many voices to be heard – it mandates it. Likewise, governance benefits from the pragmatism inherent in a norm that eschews absolutes and formulaic solutions in favor of bespoke designs, tailormade for environmental problems that vary in character by location and time. The forces of globalization make legislative oversight of administrative action difficult, if not impossible, by multiplying accountability challenges across multiple governance levels and processes. Using existing administrative competencies, a deliberative model of transnational democratic accountability can build on the functions that intergovernmental organizations already perform tolerably well without relying on new legislative inputs or continuous monitoring by elected officials. Two features of democratic deliberation – its tendency to reduce moral disputes and to promote consensus – can reduce the costs of organization maintenance in stakeholder communities that offer non-legislative alternatives for administrative oversight. The EU is a pioneer of transnational democratic oversight and administrative accountability, and its incremental and trial and error innovations, as inadequate as they still are, offer lessons for the problem of accountability in the absence of effective legislative authority.
Over the course of a little more than a decade, an unusually coherent and comprehensive literature has emerged on the demands of effective earth system governance. Informed by the insight that humanity is no longer (and can no longer be) a spectator with respect to global environmental change, the concept of earth system governance recognizes that human actions have had an impact on our planet that has driven, and is driving, its primary ecological systems beyond the range of their natural variability. As a result, humans face a challenge like no other – the necessity to actively and self-consciously govern the environment that sustains us.
Deliberative democracy is well-suited to the challenges of governing in the Anthropocene. But deliberative democratic practices are only suited to these challenges to the extent that five prerequisites - empoweredness, embeddedness, experimentality, equivocality, and equitableness - are successfully institutionalized. Governance must be: created by those it addresses, applicable equally to all, capable of learning from (and adapting to) experience, rationally grounded, and internalized by those who adopt and experience it. This book analyzes these five major normative principles, pairing each with one of the Earth System Governance Project's analytical problems to provide an in-depth discussion of the minimal conditions for environmental governance that can be truly sustainable. It is ideal for scholars and graduate students in global environmental politics, earth system governance, and international environmental policy. This is one of a series of publications associated with the Earth System Governance Project. For more publications, see www.cambridge.org/earth-system-governance.
In the Anthropocene, earth system governance must be effective both within and across identities, and the inescapable equivocality of democratic governance means that discussions can never be closed but merely transformed as old problems and concerns give way to new. The experimental quality that effective environmental governance must possess cannot be a transient quality but, rather, must be a permanent feature of the landscape of democratic decision-making, in which success is realized in a context of identity politics. To take place without distortion and without posing systemic disadvantage, and for intergroup differences to be accommodated, substantial equality of access to decision-making and equitable allocation of fundamental capabilities are essential prerequisites. Institutional arrangements must provide for empowerment of those whose identities are otherwise ill-favored and the embeddedness of environmental decision-making in the communities of fate where people actually determine their shared life experiences.
More than just democracy in the form of aggregation of votes, deliberative democratic practice makes possible the learning, local knowledge, and engagement required by enlightened environmental governance under the conditions associated with the concept of the Anthropocene.
In the context of earth system governance today, experimentation is no longer merely a virtue but a basic survival skill. Administrative professionals – understood to include administrators national, international, and subnational, both governmental and nongovernmental, across the entire range of policy arenas – are in a position to engage in this best practice for learning from experience, perhaps to a greater degree than any other agents of governance. Protected by both their relative anonymity and their institutional affiliations, they enjoy the dual benefits of relative invisibility and administrative discretion. Administrative professionals can experiment with social and political arrangements that are not only adaptive but are also democratic and effective in reconciling humans to their environment. The volatility of their environments has meant that they face devolved responsibility in governance for both acquiring resources and achieving results. Administrative professionals succeed by being scavengers par excellence, such that approaches that work well anywhere are destined eventually to be tried everywhere.
To endure, policies and institutions that both protect the environment and promote human security must have an architecture based on principles that lead to creation and maintenance of a rational relationship between human places and human practices. Flexibility and open texture allow meaning to change and endure over time, as both times and people change, and to remain embedded in its cultural context. In every corner of the globe, people have devised small pieces of institutional architecture that show remarkable creativity and potential for expansion. The objective should not be replicating these experiences at grander and higher scales, nor achieving greater levels of consistency or integration in governance architecture. Instead, consilience is what should be sought in our environmental governance architecture – a greater level of coherence in our knowledge. This is the level of democratic discourse, which depends on a more solid and substantive level of explanation – grounded in holistic social experimentation – for both its subject matter and its evaluative criteria.
If there is no corner of the natural world that is beyond human influence, then no corner of the world lies beyond the human responsibility implied by our moral agency. The question of agency is critical to any strategy of global political transformation one might imagine. Agency is not merely a matter of knowledge (beginning with self-knowledge) or autonomy (as the absence of restraint or coercion) or both. Effective practice presumes capability. For an agent to be held responsible, the capability of effective action must exist. Agents of governance are not merely political actors. They are, rather, any authoritative actors who have both the legitimacy and capacity to act. The agency of those outside of the core governance institutions and processes should not be limited to a support role. Doing so both degrades the quality of decision-making and marginalizes those whose agency should be enhanced by self-governance.
Access and allocation firmly ground the concept of human security in the larger context of social justice, posing serious challenges for equitable earth system governance. The focus on capabilities brings together a range of ideas addressed inadequately in traditional approaches to the economics of welfare. The capabilities approach highlights the importance of real freedoms in the assessment of persons’ relative level of advantage, promoting a more realistic balance of materialistic and non-materialistic factors in evaluating human welfare and a concern for the distribution of substantive opportunities within society. Research on access to and allocation of environmental resources in a deliberative system of democratic governance builds on and extends an existing limited research literature on the implications of deliberative democratic practices for environmental justice policy and governance. More equitable access to and allocation of environmental “goods” should be a focus for a next generation of environmental research characterized by improved normative understanding as well as more meaningful and reflexive potential for sustainability transformation.