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Background: Nutritional status in pediatric patients undergoing heart transplantation (HT) is frequently a focus of clinical management and requires high resource utilization. Pre‐operative nutrition status has been shown to affect post‐operative mortality but no studies have been performed to assess how nutritional status may change and the risk of developing nutritional comorbidities long‐term in the post‐transplant period. Methods: A single‐center retrospective chart review of patients ≥2 years of age who underwent heart transplantation between 1/1/2005 and 4/30/2020 was performed. Patient data were collected at listing, time of transplant, 1‐year, and 3‐year follow‐up post‐transplant. Nutrition status was classified based on body mass index (BMI) percentile in the primary analysis. Alternative nutritional indices, namely the nutrition risk index (NRI), prognostic nutrition index (PNI), and BMI z‐score, were utilized in secondary analyses. Results: Of the 63 patients included, the proportion of patients with overweight/obese status increased from 21% at listing to 41% at 3‐year follow‐up. No underweight patients at listing became overweight/obese at follow‐up. Of patients who were overweight/obese at listing, 88% maintained that status at 3‐year follow‐up. Overweight/obese status at listing, 1‐year, and 3‐year post‐transplantation were significantly associated with developing metabolic syndrome. In comparison to the alternative nutritional indices, BMI percentile best predicted post‐transplant metabolic syndrome. Conclusions: The results suggest that pediatric patients who undergo heart transplantation are at risk of developing overweight/obesity and related nutritional sequelae (ie, metabolic syndrome). Improved surveillance and interventions targeted toward overweight/obese HT patients should be investigated to reduce the burden of associated comorbidities. [ABSTRACT FROM AUTHOR]

The Brazil/U.S. Aspen Global Forum on Climate Change Policies and Programs has facilitated a dialogue between key Brazil and U.S. public and private sector leaders on the subject of the Clean Development Mechanism (CDM). With support from the U.S. government, a cooperative effort between Lawrence Berkeley National Laboratory and the University of Sao Paulo conducted an assessment of a number of projects put forth by Brazilian sponsors. Initially, we gathered information and conducted a screening assessment for ten projects in the energy sector and six projects in the forestry sector. Some of the projects appeared to offer greater potential to be attractive for CDM, or had better information available. We then conducted a more detailed assessment of 12 of these projects, and two other projects that were submitted after the initial screening. An important goal was to assess the potential impact of Certified Emission Reductions (CERs) on the financial performance of projects. With the exception of the two forestry-based fuel displacement projects, the impact of CERs on the internal rate of return (IRR) is fairly small. This is true for both the projects that displace grid electricity and those that displace local (diesel-based) electricity production. The relative effect of CERs is greater for projects whose IRR without CERs is low. CERs have a substantial effect on the IRR of the two short-rotation forestry energy substitution projects. One reason is that the biofuel displaces coke and oil, both of which are carbon-intensive. Another factor is that the product of these projects (charcoal and woodfuel, respectively) is relatively low value, so the revenue from carbon credits has a strong relative impact. CERs also have a substantial effect on the NPV of the carbon sequestration projects. Financial and other barriers pose a challenge for implementation of most of the projects. In most cases, the sponsor lacks sufficient capital, and loans are available only at high interest rate and with substantial guarantee. A few of the projects might go ahead without the benefit of CERs, but most probably would not. Whether the projected revenue from CERs would be sufficient to induce sponsors to proceed with the projects is an important issue that requires further investigation. All of the projects contribute to economic development in Brazil. The forestry projects in particular would create a significant number of rural jobs, and contribute income to rural communities. Some of the carbon sequestration projects would provide environmental benefits with respect to protection of biodiversity and soil.

This paper describes a standardized method for establishing a multi-project baseline for a power system. The method provides an approximation of the generating sources that are expected to operate on the margin in the future for a given electricity system. It is most suitable for small-scale electricity generation and electricity efficiency improvement projects. It allows estimation of one or more carbon emissions factors that represent the emissions avoided by projects, striking a balance between simplicity of use and the desire for accuracy in granting carbon credits.