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The last 30 years have been a period of intense and continuous international negotiations to deal with climate change. During the same 30 years, 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 the 21st Conference of the Parties (COP21) to the United Nations Framework Convention on Climate Change (UNFCCC), 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 net zero emissions by the middle of the century. But currently these pledges, if fulfilled, will only limit global average temperature to 2.4˚C to 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 – though details of who finances 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.

In the five years since the Paris Agreement, achieving net zero emissions has become a defining frame for climate action. We review over 4000 countries, companies, and subnational governments, which together make up the preponderance of global emissions. We find 769 of these entities have net zero targets, but only 152 meet minimum criteria for robustness, including timing, status, coverage, use of offsets, and governance. Though net zero is now widespread as a concept, its operationalization is still in its infancy. Making net zero targets robust should now be a priority for policymakers in order to deliver Paris-consistent action, as well as securing more ambitious targets. Key policy insightsNet zero targets now cover two-thirds of the global economy, but robust net zero targets only cover around five percent.Strengthening targets and their implementation is particularly needed in the following areas: target status (including setting targets into law); coveraneuge of activities; limits to and transparency regarding the use of offsets; and publication of plans and of progress reports.Policymakers should aim to strengthen net zero targets by setting standards for robust net zero targets; building the capacity of entities, particularly those in the global South, to meet the technical and resource challenges required to effectively operationalize net zero emission targets. Net zero targets now cover two-thirds of the global economy, but robust net zero targets only cover around five percent. Strengthening targets and their implementation is particularly needed in the following areas: target status (including setting targets into law); coveraneuge of activities; limits to and transparency regarding the use of offsets; and publication of plans and of progress reports. Policymakers should aim to strengthen net zero targets by setting standards for robust net zero targets; building the capacity of entities, particularly those in the global South, to meet the technical and resource challenges required to effectively operationalize net zero emission targets.

Climate justice needs to be at the heart of the COP27 negotiations in Sharm El Sheikh. Climate justice is not just a financial transaction to protect the environment. It needs to be seen as the protection of the most vulnerable in society after centuries of resource exploitation. African countries disproportionately face impacts of climate change on their environments, their economies, their resources, and their infrastructure. This leads to greater vulnerability and increased exposure to the negative effects of a changing climate. In this article, we highlight the importance of climate justice and its role within the UN negotiations, and ultimately in concrete action. We discuss current climate impacts across key sectors in the African region, with a focus on health, infrastructure, food and water scarcity, energy, and finance. All sectors are affected by climate change. They are interconnected and under threat. This triggers a ripple effect, where threats in one sector have a knock-on effect on other sectors. We find that the current set of intergovernmental institutions have failed to adequately address climate justice. We also contend that a siloed approach to climate action has proven to be ineffective. As we head towards the next set of negotiations (COP27), this paper argues that the economic and social conditions in Africa can be addressed through financial and collaborative support for adaptation and localised solutions, but that this will only be achieved if climate justice is prioritised by the decision makers. This needs to include a global-scale transition in how climate finance is assessed and accessed. Climate justice underpins real effective and sustainable solutions for climate action in Africa.

The last 30 years have been a period of intense and continuous international negotiation to deal with climate change. During the same 30 years, humanity has doubled the amount of anthropogenic carbon dioxide in the atmosphere. There has, however, been progress and some notable successes. In 2015 at COP21, 196 countries signed 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. This was followed up at COP26 in Glasgow with many countries pledging to go net zero emissions by the middle of the century. But currently these pledges, if fulfilled, will only limit global average temperature to 2.4˚C to 2.8˚C. This article reviews the history of international climate change negotiations and examines what the key objectives are for future COP meetings.

Respiratory syncytial virus (RSV) remains a leading cause of medically-attended acute respiratory infection in infants and children. With multiple preventative interventions under development, accurate estimates of health care resource utilization are essential for policy decision making.We developed a literature-based decision-tree model that estimated annual medically-attended RSV (MA-RSV) lower respiratory tract infection (LRTI) and non-LRTI episodes in the US for all infants and for high-risk toddlers. The model accounted for the gestational age and birth-month of infants, and the seasonal variation in RSV incidence. The impact of no prophylaxis, palivizumab, maternal vaccine, and long-acting monoclonal antibody (mAb) interventions was estimated.We estimated 1.23 million (range: 0.96 million-1.40 million) annual MA-RSV LRTI/non-LRTI episodes comprised of 1.19 million (range: 0.93 million-1.36 million) emergency department (ED) and outpatient visits, and 39,040 (range: 32,726-45,851) hospitalizations. Outpatient and ED visits were comprised of 586,034 (range: 430,595-718,868) LRTIs and 608,733 (range: 495,705-644,658) non-LRTIs. The long-acting mAb intervention resulted in the greatest number of averted outpatient and ED episodes (310,997 [53%] LRTIs; 284,305 [47%] non-LRTIs) and hospitalizations (21,845 [56%]). Full-term infants constitute the highest proportion of episodes across all interventions.MA-RSV disease is substantial in infants and high-risk toddlers. Long-acting mAbs are most effective at reducing the number of MA-RSV LRTI/non-LRTI episodes, and the only intervention that prevents disease in older infants (≥6 months old).

This study aimed to improve local management of paediatric otitis media using the 2022 American-Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) Clinical Practice Guideline for Tympanostomy Tubes in Children.A SQUIRE 2.0 compliant quality improvement study was carried out within the outpatient department of our otolaryngology tertiary referral centre. Local outpatient management of paediatric otitis media was compared to the AAO-HNS guidelines, specifically focussing on the decision to offer tympanostomy tubes. Following initial audit of practice, an educational session was performed within the otolaryngology department and local practice was subsequently re-evaluated.Overall, 88 children were included (46 pre-intervention and 42 post-intervention) with a mean age of 7.6 years (range 1-12 years). Sixty-four (72.7%) children presented with suspected otitis media with effusion. The remainder presented with recurrent or persistent acute otitis media (24/88, 27.3%). Twenty-six children were offered tympanostomy tubes (29.5%). Initial evaluation of practice identified that the decision to offer tympanostomy tubes was guideline appropriate in 76.1% of children (35/46). This significantly improved following an educational session (40/42, 95.2%, p = 0.02). The reasons for non-guideline compliance included: otitis media with effusion3 months, no evidence of middle ear fluid and patients meeting criteria for tympanostomy tube insertion not being offered.A focussed educational intervention may improve local adherence to guidelines in the management of paediatric otitis media. Continued re-evaluation of local practice is essential in order to ensure children are managed in accordance with the guidelines.

Laryngeal malignancy encompasses about 1% of all cancers. Chondrosarcoma in the head and neck region represents about 0.1% of head and neck malignancies. Typical presenting symptoms relate to the anatomical location of these tumours and include dysphonia, inspiratory stridor, dysphagia, odynophagia or a neck mass. Benign and malignant cartilaginous cancers of the larynx have been described, and preoperative diagnosis can be difficult. Our report highlights the surgical management of a male patient in his 50s with chondrosarcoma of the thyroid cartilage.

Multiple analytical and preclinical studies were performed to compare the biochemical characteristics, pharmacokinetics (PK), safety and neoantigenicity of a new 5% liquid formulation of Alpha-1 Proteinase Inhibitor (Liquid A1PI, Prolastin®-C Liquid) with the lyophilized version (Lyophilized A1PI, Prolastin®-C). Liquid A1PI and Lyophilized A1PI had similar average mass (~52 kDa), and both forms exhibited glycoform patterns consistent with the known banding pattern of A1PI (dominated by the M6 and M4 bands, including deconvoluted masses). Both Liquid A1PI and Lyophilized A1PI yielded average percent purity values ranging from 96% to 99% and had active content ranging from 53 mg/mL to 59 mg/mL. The PK profile of Liquid A1PI was similar to Lyophilized A1PI. Safety assessments in rabbits showed good tolerability and no test article-related changes in mortality, clinical signs, clinical pathology, body weight, food consumption, or urinalysis parameters. Following immunodepletion of antibodies that recognize Lyophilized A1PI, there were no significant differences in the anti-drug titers among animals immunized with Lyophilized A1PI and Liquid A1PI (p > 0.05), indicating that no antibodies to neoantigens were generated. Liquid A1PI and Lyophilized A1PI have similar profiles with respect to biochemical characteristics, PK, safety and neoantigenicity.

Introduction Corona-virus Disease 2019 (COVID-19) has had a huge impact on the delivery of healthcare worldwide, particularly elective surgery. There is a lack of data regarding risk of postoperative COVID-19 infection in children undergoing elective surgery, and regarding the utility of pre-operative COVID-19 testing, and preoperative “cocooning” or restriction of movements. The purpose of this present study was to examine the safety of elective paediatric Otolaryngology surgery during the COVID-19 pandemic with respect to incidence of postoperative symptomatic COVID-19 infection or major respiratory complications. Materials and methods Prospective cohort study of paediatric patients undergoing elective Otolaryngology surgery between September and December 2020. Primary outcome measure was incidence of symptomatic COVID-19 or major respiratory complications within the 14 days after surgery. Parents of prospectively enrolled patients were contacted 14 days after surgery and enquiry made regarding development of postoperative symptoms, COVID-19 testing, or diagnosis of COVID-19. Results 302 patients were recruited. 125 (41.4%) underwent preoperative COVID-19 RTPCR testing. 66 (21.8%) restricted movements prior to surgery. The peak 14-day COVID-19 incidence during the study was 302.9 cases per 100,000 population. No COVID-19 infections or major respiratory complications were reported in the 14 day follow up period. Conclusion The results of our study support the safety of elective paediatric Otolaryngology surgery during the pandemic, in the setting of community incidence not exceeding that observed during the study period., Graphical abstract Image 1

Laryngocoele is a rare entity, defined as an abnormal cystic dilatation of saccule of the laryngeal ventricle. Three types of laryngocele have been described, based on their relation to the thyrohyoid membrane: internal, external or mixed type. Symptoms are variable, including neck swelling, shortness of breath, dysphonia and fever, if the laryngocoele becomes infected. Patients may also present in extremis with airway obstruction. We present the case of a healthy 34-year-old gentleman with acute airway obstruction due to a mixed infected laryngocoele. Flexible nasoendoscopy showed a large cystic swelling arising from the laryngeal ventricle. Computed tomography of neck confirmed a right paraglottic collection extending into the ventricle and glottis, causing significant airway compromise. The patient was managed with microlaryngoscopy and cystic decompression. At outpatient follow up, he was completely asymptomatic and is currently under surveillance. Endoscopic decompression is a safe and effective initial management for mixed laryngocoele.