Explore the vast range of titles available.

In many regions and at the planetary scale, human pressures on the environment exceed levels that natural systems can sustain. These pressures are caused by networks of human activities, which often extend across countries and continents due to global trade. This has led to an increasing requirement for methods that enable absolute environmental sustainability assessment (AESA) of anthropogenic systems and which have a basis in life cycle assessment (LCA). Such methods enable the comparison of environmental impacts of products, companies, nations, etc, with an assigned share of environmental carrying capacity for various impact categories. This study is the first systematic review of LCA-based AESA methods and their applications. After developing a framework for LCA-based AESA methods, we identified 45 relevant studies through an initial survey, database searches and citation analysis. We characterized these studies according to their intended application, impact categories, basis of carrying capacity estimates, spatial differentiation of environmental model and principles for assigning carrying capacity. We then characterized all method applications and synthesized their results. Based on this assessment, we present recommendations to practitioners on the selection and use of existing LCA-based AESA methods, as well as ways to perform assessments and communicate results to decision-makers. Furthermore, we identify future research priorities intended to extend coverage of all components of the proposed method framework, improve modeling and increase the applicability of methods.

Carbon stock estimates based on land cover type are critical for informing climate change assessment and landscape management, but field and theoretical evidence indicates that forest fragmentation reduces the amount of carbon stored at forest edges. Here, using remotely sensed pantropical biomass and land cover data sets, we estimate that biomass within the first 500 m of the forest edge is on average 25% lower than in forest interiors and that reductions of 10% extend to 1.5 km from the forest edge. These findings suggest that IPCC Tier 1 methods overestimate carbon stocks in tropical forests by nearly 10%. Proper accounting for degradation at forest edges will inform better landscape and forest management and policies, as well as the assessment of carbon stocks at landscape and national levels. Forest fragmentation is thought to reduce carbon storage at forest edges. Here, using remote sensing datasets, the authors show that biomass is 25% lower within 500 m of the forest edge, and suggest that fragmentation results in a global reduction in tropical forest carbon stocks by nearly 10%.

Aim To examine self‐reported exposure and experiences of negative workplace behaviour and ways of coping of nursing staff before and after educational workshops. Design A Quasi‐experimental design. Method/Setting/Participants Data were collected pre‐ /postworkshops using a structured questionnaire. Nurses (N = 230) from 12 units in four regional acute care hospitals were invited to complete a pre‐intervention survey. Educational workshops were then implemented by the organization at two of the hospitals, after which, follow‐up surveys were undertaken. Results There were 74 responses in the pre‐intervention and 56 responses in the postintervention time period. There were 111 participants who attended the educational intervention, 20% (n = 22) completed the follow‐up survey. Participants were more likely exposed to work‐related bullying acts and they used problem‐focused coping strategies and sought social support as a way of coping when exposed to the negative behaviours. Overall, there was a decrease in both bullying and incivility experienced by participants; however, our findings were unable to establish that a statistically significant difference was made due to the implementation of the intervention. Study Registration Australian New Zealand Clinical Trials Registry (Registration No. ACTRN12618002007213; December 14, 2018).

International corporations in an increasingly globalized economy exert a major influence on the planet’s land use and resources through their product design and material sourcing decisions. Many companies use life cycle assessment (LCA) to evaluate their sustainability, yet commonly-used LCA methodologies lack the spatial resolution and predictive ecological information to reveal key impacts on climate, water and biodiversity. We present advances for LCA that integrate spatially explicit modelling of land change and ecosystem services in a Land-Use Change Improved (LUCI)-LCA. Comparing increased demand for bioplastics derived from two alternative feedstock-location scenarios for maize and sugarcane, we find that the LUCI-LCA approach yields results opposite to those of standard LCA for greenhouse gas emissions and water consumption, and of different magnitudes for soil erosion and biodiversity. This approach highlights the importance of including information about where and how land-use change and related impacts will occur in supply chain and innovation decisions. Life cycle assessments are used by corporations to determine the sustainability of raw source materials. Here, Chaplin-Kramer et al . develop an improved life cycle assessment approach incorporating spatial variation in land-use change, and apply this framework to a bioplastic case study.

The agricultural expansion and intensification required to meet growing food and agri-based product demand present important challenges to future levels and management of biodiversity and ecosystem services. Influential actors such as corporations, governments, and multilateral organizations have made commitments to meeting future agricultural demand sustainably and preserving critical ecosystems. Current approaches to predicting the impacts of agricultural expansion involve calculation of total land conversion and assessment of the impacts on biodiversity or ecosystem services on a per-area basis, generally assuming a linear relationship between impact and land area. However, the impacts of continuing land development are often not linear and can vary considerably with spatial configuration. We demonstrate what could be gained by spatially explicit analysis of agricultural expansion at a large scale compared with the simple measure of total area converted, with a focus on the impacts on biodiversity and carbon storage. Using simple modeling approaches for two regions of Brazil, we find that for the same amount of land conversion, the declines in biodiversity and carbon storage can vary two- to fourfold depending on the spatial pattern of conversion. Impacts increase most rapidly in the earliest stages of agricultural expansion and are more pronounced in scenarios where conversion occurs in forest interiors compared with expansion into forests from their edges. This study reveals the importance of spatially explicit information in the assessment of land-use change impacts and for future land management and conservation.

Pharmacogenetics affects both pharmacokinetics and pharmacodynamics, thereby influencing an individual's response to drugs, both in terms of response and adverse reactions. Within the area of pharmacogenetics, findings of genetic variation influencing drug levels have been more prevalent, and variation in the cytochrome P450 (CYP) enzymes is one of the most common causes. Much of the work concerning sequence variations in CYPs aims at finding biomarkers of use for individualised treatment, thereby increasing the treatment response, lowering the number of side effects and decreasing the overall cost of treatment regimens. For over ten years, the Human Cytochrome P450 Allele Nomenclature (CYP-allele) website ( http://www.cypalleles.ki.se/ ) has offered a database of genetic information on CYP variants, along with effects at the molecular as well as clinical level. Thus, this database serves as an assembly of past, current and soon-to-be published information on CYP alleles and their outcome effects. The website is used by academic researchers and companies (eg as a tool in drug development and for outlining new research projects). By providing peer-reviewed genetic information on CYP enzymes, the CYP-allele website has become increasingly popular and widely used. Recently, NADPH cytochrome P450 oxidoreductase (POR), the electron donor for CYP enzymes, was included on the website, which already contains 29 CYP genes, hence POR alleles are now also designated using the star allele ( POR *) nomenclature. Although most CYPs on the CYP-allele website are involved in the metabolism of xenobiotics, polymorphic enzymes with endogenous functions are also included. Each gene on the CYP-allele website has its own webpage that lists the different alleles with their nucleotide changes, their functional consequences and links to publications in which the allele has been identified and/or characterised. Thus, the CYP-allele website offers a rapid online publication of new alleles, as well as providing an overview of peer-reviewed data.

The production of palm oil, soy, beef and timber are key drivers of global forest loss. For this reason, over 470 companies involved in the production, processing or distribution of these commodities have issued commitments to eliminate or reduce deforestation from their supply chains. However, the effectiveness of these commitments is uncertain since there is considerable variation in ambition and scope and there are no globally agreed definitions of what constitutes a forest. Many commitments identify high conservation value forests (HCVFs), high carbon stock forests (HCSFs) and forests on tropical peatland as priority areas for conservation. This allows for mapping of the global extent of forest areas classified as such, to achieve an assessment of the area that may be at reduced risk of development if companies comply with their zero deforestation commitments. Depending on the criteria used, the results indicate that between 34% and 74% of global forests qualify as either HCVF, HCSF or forests on tropical peatland. However, we found that the total extent of these forest areas varies widely depending on the choice of forest map. Within forests which were not designated as HCVF, HCSF or forests on tropical peatland, there is substantial overlap with areas that are highly suitable for agricultural development. Since these areas are unlikely to be protected by zero-deforestation commitments, they may be subject to increased pressure resulting from leakage of areas designated as HCVF, HCSF and tropical peatland forests. Considerable uncertainties around future outcomes remain, since only a proportion of the global market is currently covered by corporate commitments. Further work is needed to map the synergies between corporate commitments and government policies on land use. In addition, standardized criteria for delineating forests covered by the commitments are recommended.

Background Achieving health equity is important to improve population health; however, health equity is not typically well defined, integrated, or measured within health service and delivery systems. To improve population health, it is necessary to understand barriers and facilitators to health equity integration within health service and delivery systems. This study aimed to explore health equity integration among health systems workers and identify key barriers and facilitators to implementing health equity strategies within the health service and delivery system in Nova Scotia, ahead of the release of a Health Equity Framework, focused on addressing inequities within publicly funded institutions. Methods Purposive sampling was used to recruit individuals working on health equity initiatives including those in high-level leadership positions within the Nova Scotia health system. Individual interviews and a joint interview session were conducted. Topics of discussion included current integration of health equity through existing strategies and perceptions within participant roles. The Consolidated Framework for Implementation Research (CFIR) was used to guide coding and analysis, with interviews transcribed and deductively analyzed in NVivo. Qualitative description was employed to describe study findings as barriers and facilitators to health equity integration. Results Eleven individual interviews and one joint interview ( n  = 5 participants) were conducted, a total of 16 participants. Half ( n  = 8) of the participants were High-level Leaders (i.e., manager or higher) within the health system. We found that existing strategies within the health system were inadequate to address inequities, and variation in the use of indicators of health equity was indicative of a lack of health equity integration. Applying the CFIR allowed us to identify barriers to and facilitators of health equity integration, with the power of legislation to implement a Health Equity Framework, alongside the value of partnerships and engagement both being seen as key facilitators to support health equity integration. Barriers to health equity integration included inadequate resources devoted to health equity work, a lack of diversity among senior system leaders and concerns that existing efforts to integrate health equity were siloed. Conclusion Our findings suggest that health equity integration needs to be prioritized within the health service and delivery system within Nova Scotia and identifies possible strategies for implementation. Appropriate measures, resources and partnerships need to be put in place to support health equity integration following the introduction of the Health Equity Framework, which was viewed as a key driver for action. Greater diversity within health system leadership was also identified as an important strategy to support integration. Our findings have implications for other jurisdictions seeking to advance health equity across health service and delivery systems.

Background Telephone support services are a viable means of providing population-level support to reduce health risk behaviours. While research exists on the effectiveness of Quitlines to reduce smoking, there is limited other research investigating whether telephone services can provide effective behaviour change support for people with a mental health condition for behaviours including physical activity, healthy eating, and weight management. The aims of this trial were to evaluate the effectiveness of referral of people with a mental health condition to a population-level telephone coaching service to improve health risk behaviours and increase attempts to do so. Methods A parallel-group randomised controlled trial was conducted. Participants with a mental health condition ( N  = 681) were assigned to a control (health information pack) or intervention group (information pack and referral by the research team to a coaching program). Data were collected via telephone surveys at baseline and six months post-recruitment. Primary outcomes were: (1) weekly minutes of moderate-to-vigorous physical activity, (2) daily fruit serves, (3) daily vegetable serves, and (4) attempted behaviour change/weight loss (yes/no; composite measure). Secondary outcomes included weight, Body Mass Index (BMI), and attempts to change each health behaviour individually. Results Intention-to-treat analyses found no significant differential change between groups from baseline to six months for primary or secondary outcomes. By follow-up, 242/549 (44%) of intervention participants had enrolled in coaching and completed at least one call, with 16/242 having completed the program, 79 ongoing, and 147 withdrawn. Per-protocol analyses found attempting to improve at least one health behaviour/lose weight was significantly greater in enrolees (OR = 3.7, 95% CI 1.03—13.23) than the control group. Conclusions Referral to the program did not improve risk behaviours or weight/BMI but did support behaviour change attempts. Contributing factors may include low program completion by follow-up and impact of COVID-19. Further research is required to better understand participation in and benefits of telephone coaching services for people with a mental health condition. Trial registration Registered retrospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12620000351910).

Background Improving palliative and end-of-life care for people with dementia is a growing priority globally. This study aimed to integrate multiple perspectives on end-of-life care for people with dementia and carers, to identify clinically relevant areas for improvement. Methods The mixed-methods study involved surveys, interviews, and workshops with two participant groups: healthcare professionals and carers (individuals who provided care and support to a family member or friend). Healthcare professionals were invited to complete an online adapted version of the Australian Commission on Safety and Quality in Health Care, End-of-Life Care Toolkit: Clinician Survey Questions. Carers completed a hard copy or online adapted version of the Views of Informal Carers—Evaluation of Services (Short form) (VOICES-SF) questionnaire. Interview schedules were semi-structured, and workshops followed a co-design format. Findings were integrated narratively using a weaving approach. Results Five areas in which we can improve care for people with dementia at the end of life, were identified: 1) Timely recognition of end of life; 2) Conversations about palliative care and end of life; 3) Information and support for people with dementia and carers; 4) Person-and-carer-centred care; 5) Accessing quality, coordinated care. Conclusions There are multiple areas where we can improve the quality of end-of-life care people with dementia receive. The findings demonstrate that the heterogeneous and challenging experiences of living with and caring for people with dementia necessitate a multidisciplinary, multifaceted approach to end-of-life care. The identified solutions, including care coordination, can guide local development of co-designed models of end-of-life care for people with dementia.