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Determinations of significance play a pivotal role in environmental impact assessments because they point decision makers to the predicted effects of an action most deserving of attention and further study. Impact predictions are always subject to uncertainty because they rely on estimates of future consequences. Yet uncertainty is often neglected or treated in a perfunctory manner as part of the characterization, evaluation, and communication of anticipated consequences and their significance. Proposals to construct fossil fuel pipelines in North America provide a highly visible example; casual treatment of how uncertainty affects significance determinations has resulted in poorly informed stakeholders, frustrated industry proponents, and inconsistent choices on the part of public decision makers. Using environmental assessments for recent pipeline proposals as examples, we highlight five ways in which uncertainty is often neglected when determining impact significance and suggest that a mix of known methods, new guidelines, and appropriate oversight could greatly improve current practices.

Close to two thousand environmental human rights defenders have been killed in 57 countries since 2002, with about four losing their lives every week in 2019. Many of these defenders represent Indigenous Peoples and local communities protecting ecosystems from large‐scale environmentally destructive projects. As the positive contributions of Indigenous and local communities to biodiversity conservation become better recognized, so should the losses and risks that they face. Despite major efforts at documenting abuses and protecting defenders, many blind spots and gaps remain. Here, we call for the conservation community to put the protection of defenders at the heart of its strategy to slow down and reverse the current onslaught on the environment. The conservation community can respond in a number of ways including reaching out to its constituencies, working together with the human rights community, and mobilizing its networks, field offices, and presence in remote areas to denounce abuses and counter isolation. In doing so the conservation community can advance the collective agenda bringing together conservation and environment‐related human rights through the Post‐2020 Global Biodiversity Framework.

Sustainably managed wild fisheries support food and nutritional security, livelihoods, and cultures (1). Harmful fisheries subsidies—government payments that incentivize overcapacity and lead to overfishing—undermine these benefits yet are increasing globally (2). World Trade Organization (WTO) members have a unique opportunity at their ministerial meeting in November to reach an agreement that eliminates harmful subsidies (3). We—a group of scientists spanning 46 countries and 6 continents—urge the WTO to make this commitment...

Humanity is on a deeply unsustainable trajectory. We are exceeding planetary boundaries and unlikely to meet many international sustainable development goals and global environmental targets. Until recently, there was no broadly accepted framework of interventions that could ignite the transformations needed to achieve these desired targets and goals. As a component of the IPBES Global Assessment, we conducted an iterative expert deliberation process with an extensive review of scenarios and pathways to sustainability, including the broader literature on indirect drivers, social change and sustainability transformation. We asked, what are the most important elements of pathways to sustainability? Applying a social–ecological systems lens, we identified eight priority points for intervention (leverage points) and five overarching strategic actions and priority interventions (levers), which appear to be key to societal transformation. The eight leverage points are: (1) Visions of a good life, (2) Total consumption and waste, (3) Latent values of responsibility, (4) Inequalities, (5) Justice and inclusion in conservation, (6) Externalities from trade and other telecouplings, (7) Responsible technology, innovation and investment, and (8) Education and knowledge generation and sharing. The five intertwined levers can be applied across the eight leverage points and more broadly. These include: (A) Incentives and capacity building, (B) Coordination across sectors and jurisdictions, (C) Pre-emptive action, (D) Adaptive decision-making and (E) Environmental law and implementation. The levers and leverage points are all non-substitutable, and each enables others, likely leading to synergistic benefits. Transformative change towards sustainable pathways requires more than a simple scaling-up of sustainability initiatives—it entails addressing these levers and leverage points to change the fabric of legal, political, economic and other social systems. These levers and leverage points build upon those approved within the Global Assessment's Summary for Policymakers, with the aim of enabling leaders in government, business, civil society and academia to spark transformative changes towards a more just and sustainable world. A free Plain Language Summary can be found within the Supporting Information of this article. Fil: Chan, Kai M. A.. University of British Columbia; Canadá Fil: Boyd, David R.. University of British Columbia; Canadá Fil: Gould, Rachelle. University of Vermont; Estados Unidos Fil: Jetzkowitz, Jens. Staatliches Museum fur Naturkunde Stuttgart; Alemania Fil: Liu, Jianguo. Michigan State University; Estados Unidos Fil: Muraca, Bárbara. University of Oregon; Estados Unidos Fil: Naidoo, Robin. University of British Columbia; Canadá Fil: Beck, Paige. University of British Columbia; Canadá Fil: Satterfield, Terre. University of British Columbia; Canadá Fil: Selomane, Odirilwe. Stellenbosch University; Sudáfrica Fil: Singh, Gerald G.. University of British Columbia; Canadá Fil: Sumaila, Rashid. University of British Columbia; Canadá Fil: Ngo, Hien T.. Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services; Alemania Fil: Boedhihartono, Agni Klintuni. University of British Columbia; Canadá Fil: Agard, John. The University Of The West Indies; Trinidad y Tobago Fil: de Aguiar, Ana Paula D.. Stockholms Universitet; Suecia Fil: Armenteras, Dolors. Universidad Nacional de Colombia; Colombia Fil: Balint, Lenke. BirdLife International; Reino Unido Fil: Barrington-Leigh, Christopher. Mcgill University; Canadá Fil: Cheung, William W. L.. University of British Columbia; Canadá Fil: Díaz, Sandra Myrna. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; Argentina Fil: Driscoll, John. University of British Columbia; Canadá Fil: Esler, Karen. Stellenbosch University; Sudáfrica Fil: Eyster, Harold. University of British Columbia; Canadá Fil: Gregr, Edward J.. University of British Columbia; Canadá Fil: Hashimoto, Shizuka. The University Of Tokyo; Japón Fil: Hernández Pedraza, Gladys Cecilia. The World Economy Research Center; Cuba Fil: Hickler, Thomas. Goethe Universitat Frankfurt; Alemania Fil: Kok, Marcel. PBL Netherlands Environmental Assessment Agency; Países Bajos Fil: Lazarova, Tanya. PBL Netherlands Environmental Assessment Agency; Países Bajos Fil: Mohamed, Assem A. A.. Central Laboratory for Agricultural Climate; Egipto Fil: Murray-Hudson, Mike. University Of Botswana; Botsuana Fil: O'Farrell, Patrick. University of Cape Town; Sudáfrica Fil: Palomo, Ignacio. Basque Centre for Climate Change; España Fil: Saysel, Ali Kerem. Boğaziçi University; Turquía Fil: Seppelt, Ralf. Martin-universität Halle-wittenberg; Alemania Fil: Settele, Josef. German Centre for Integrative Biodiversity Research-iDiv; Alemania Fil: Strassburg, Bernardo. International Institute for Sustainability, Estrada Dona Castorina; Brasil Fil: Xue, Dayuan. Minzu University Of China; China Fil: Brondízio, Eduardo S.. Indiana University; Estados Unidos

There is little to no written information in the literature regarding the origin of the trauma flow sheet. This vital document allows programs to evaluate initial processes of trauma care. This information populates the trauma registry and is reviewed in nearly every Trauma Process Improvement and Patient Safety conference when discerning the course of patient care. It is so vital, a scribe is assigned to complete this documentation task for all trauma resuscitations, and there are continual process improvement efforts in trauma centers across the nation to ensure complete and accurate data collection. Indeed, it is the single most important document reviewed by the verification committee when evaluating processes of care at site visits. Trauma surgeons often overlook its importance during resuscitation, as recording remains the domain of the trauma scribe. Yet it is the first document scrutinized when the outcome is less than what is expected. The development of the flow sheet is not a result of any consensus statement, expert work group, or mandate, but a result of organic evolution due to the need for relevant and better data. The purpose of this review is to outline the origin, importance, and critical utility of the trauma flow sheet.

Do people have a right to clean air, safe drinking water, and a healthy environment? Fifty years ago, the concept of a human right to a healthy environment was viewed as a novel, even radical, idea...

The right to a healthy environment has rapidly gained constitutional protection around the world. In at least twenty countries, recognition of the right to a healthy environment first occurred through court decisions determining that it is implicit in other constitutional provisions, primarily the right to life. The right is now recognized explicitly in the constitutions of 90 countries spanning Europe, Asia, Latin America, the Caribbean and Africa, and is recognized as an implicit and enforceable constitutional right in at least twelve additional countries. The decisions of international courts and tribunals provide further support for concluding that the right to life necessarily includes the right to a healthy environment.

The origins of the US Civilian Trauma and Emergency Medical Services Systems (EMSS) started in the 1970s are presented. The conceptual basis, strategic, and tactical implementation approaches used to establish the national program are described. The trauma and other clinical systems were extensions of proven clinical methods initially from cardiac and trauma units and deployed in new settings. The overall systems design was regionalization. Professionals, governmental agents, the public, and politicians all worked together to establish local, regional, state, and a nationwide comprehensive trauma/EMSS program that touch every state, territory, and community. A historical narrative is presented.

This invited commentary summarizes the need for stronger Canadian environmental laws and policies. The environmental burden of disease in Canada is substantial. In part this is due to environmental laws and policies that are significantly weaker and less effective than corresponding rules in other wealthy industrialized nations. One promising approach is recognition of the right to live in a healthy environment. In particular, constitutional recognition of this right in 100 nations has led to stronger environmental laws, better enforcement of those laws, enhanced public participation in environmental decision-making, and superior environmental outcomes (e.g., faster progress in reducing air pollution and greenhouse gas emissions). In light of Canada's weak environmental record, this potentially transformative approach is particularly promising.

La semaine prochaine, quelques fonctionnaires canadiens iront a Rome assister a la 4e reunion de la Conference des parties a la Convention de Rotterdam, traite regissant le commerce des substances qui causent un prejudice a la sante humaine et a l'environnement. Leur mission? Si le pass

Next week, a handful of Canadian bureaucrats will fly to Rome for the 4th Conference of the Parties to the Rotterdam Convention, a treaty governing trade in substances that harm human health and the environment. Their mission? If past experience provides an accurate guide, they will be there, on

Background Exposure to environmental hazards contributes to many chronic diseases, yet the magnitude of their contribution to the total disease burden in Canada is not well understood. Objectives To estimate the environmental burden of disease (EBD) in Canada for respiratory disease, cardiovascular disease, cancer, and congenital affliction. Quantifying the contribution of environmental exposures to the overall burden of disease could play an important role in shaping public health and environmental policy priorities. Methods The World Health Organization (WHO) recently estimated the environmental burden of disease globally by using a combination of comparative risk assessment data and expert judgment to develop environmentally attributable fractions (EAFs) of mortality and morbidity for 85 categories of disease. We use the EAFs developed by the WHO, EAFs developed by other researchers, and data from Canadian public health institutions to provide an initial estimate of the environmental burden of disease in Canada for four major categories of disease. Results Our results indicate that: 10,000–25,000 deaths; 78,000–194,000 hospitalizations; 600,000–1.5 million days spent in hospital; 1.1 million–1.8 million restricted activity days for asthma sufferers; 8000–24,000 new cases of cancer; 500–2500 low birth weight babies; and between $3.6 billion and $9.1 billion in costs occur in Canada each year due to respiratory disease, cardiovascular illness, cancer, and congenital affliction associated with adverse environmental exposures. Conclusions The burden of illness in Canada resulting from adverse environmental exposures is significant. Stronger efforts to prevent adverse environmental exposures are warranted, including research, education, and regulation.

The incidence of minor burn injuries has been determined for the Commonwealth of Virginia during a 17-month period. The data set included all patients with burn injuries receiving treatment in the emergency department that did not require hospitalization. The risk of burn injury was calculated by age, race and sex. Examination of the data revealed large differences in the magnitude of age-specific incidence rates between men and women and the white and non-white population. Differences in the economic status of the population may explain a large proportion of the variation in the crude burn rates.

The osmometer (cryoscope) measures the tonicity of body fluids accurately and rapidly, even when operated by a relatively untrained technician or house physician, and provides specific information necessary for physiologic monitoring of solute disturbances.

Twenty-seven patients had penetrating chest trauma that involved the heart during a 21-month period of a prospective study. One patient died. Seventeen patients were treated with emergency surgery. Electrocardiograms showed pericarditis changes in all patients. Fifteen patients (56%) developed 18 cardiac complications. Five of these (33%) needed definitive therapy. Cardiac complications included (1) late onset hemopericarditis and cardiac tamponade; (2) myocardial infarction; (3) complete heart block; (4) intracardiac defects (including ventricular septal defect, aorto-right ventricular communication with aortic incompetence, and a combination of the two), and (5) anterior descending coronary artery aneurysm with coronary arteriovenous fistula and left ventricular aneurysm. There is a high incidence of serious cardiac complications in patients with penetrating chest trauma involving the heart, and close follow-up of these patients is important.

Multiple measurements of serum osmolality (Sosm) and urine osmolality (Uosm) were assessed in 295 surgical patients in the past two years. These were performed with a recently developed osmometer which gives results at the bedside in one or two minutes. In six illustrative cases the value of these determinations is emphasized in trauma with free water retention, hypovolemic shock, respiratory insufficiency, sepsis, hyperalimentation with hyperosmolality, and renal failure. These osmolality measurements in the critically ill and injured patient have demonstrated that when the measured plasma osmolality is compared to the calculated osmolality and a significant discrepancy is found, there is accumulation of abnormal metabolite. Increase in these solutes carries ominous prognostic significance. Further, Uosmmeasurement is essential to the diagnosis and management of acute renal failure.