A short history of the successes and failures of the international climate change negotiations.

The last 35 years have been a period of intense and continuous international negotiations to deal with climate change. During the same period of time humanity has doubled the amount of anthropogenic carbon dioxide in the atmosphere. There has, however, been progress and some notable successes in the negotiations. In 2015, at COP21 of the United Nations Framework Convention on Climate Change, 196 countries adopted the Paris Agreement stating that they would limit global temperatures to well below 2°C above pre-industrial levels and would pursue efforts to limit the temperature increase to 1.5°C above pre-industrial levels. The first review of the Paris Agreement was at COP26 in Glasgow with many countries pledging to go to net zero emissions by the middle of the century. But currently these pledges, if fulfilled, will only limit the global average temperature to between 2.4°C and 2.8°C. At COP27 in Egypt the core agreements from the Glasgow Climate Pact were maintained and countries finally agreed to set up a loss and damage facility - although details of who will provide the finance and who can claim are still be to be worked out. This article reviews the key moments in the history of international climate change negotiations and discusses what the key objectives are for future COP meetings.

Patient preference for bra or binder after breast surgery.

BACKGROUND: No data are currently available to assess the relative merits of breast binder or bra following breast surgery. METHODS: A randomized controlled study was undertaken to compare a breast binder with a bra postoperatively for patients undergoing lumpectomies, partial mastectomies and total mastectomies. RESULTS: Fifty-eight patients were included in the study. Six different parameters were compared and the bra was found better on all criteria; a small group of patients who initially used a binder and then, for a second procedure, used a bra, found the bra more comfortable. CONCLUSION: Postoperative discomfort can be decreased by using a well-fitting bra rather than a breast binder.

Design, methods, and evaluation directions of a multi-access service for the management of diabetes mellitus patients.

Recent advances in information and communication technology allow the design and testing of new models of diabetes management, which are able to provide assistance to patients regardless of their distance from the health care providers. The M2DM project, funded by the European Commission, has the specific aim to investigate the potential of novel telemedicine services in diabetes management. A multi-access system based on the integration of Web access, telephone access through interactive voice response systems, and the use of palmtops and smart modems for data downloading has been implemented. The system is based on a technological platform that allows a tight integration between the access modalities through a middle layer called the multi-access organizer. Particular attention has been devoted to the design of the evaluation scheme for the system: A randomized controlled study has been defined, with clinical, organizational, economic, usability, and users' satisfaction outcomes. The evaluation of the system started in January 2002. The system is currently used by 67 patients and seven health care providers in five medical centers across Europe. After 6 months of usage of the system no major technical problems have been encountered, and the majority of patients are using the Web and data downloading modalities with a satisfactory frequency. From a clinical viewpoint, the hemoglobin A1c (HbA1c) of both active patients and controls decreased, and the variance of HbA1c in active patients is significantly lower than the control ones. The M2DM system allows for the implementation of an easy-to-use, user-tailored telemedicine system for diabetes management. The first clinical results are encouraging and seem to substantiate the hypothesis of its clinical effectiveness.

District nurses' referrals to home-based palliative nursing services.

This study investigated district nurses' considerations of the Marie Curie Nursing Service. Most saw the primary service as respite care and referred patients to it during late stages of illness rather than palliative phases. The MCNS is valued, but confusion exists about appropriate referral times and the services provided. Improvement in communication and education is needed. The provision of this home palliative nursing service helps to promote the principle of palliative care in optimising the quality of life of patients who have life-limiting diseases and their families.