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Background: Sodium oxybate (SMO) has been shown to be effective in the maintenance of abstinence (MoA) in alcohol-dependent patients in a series of small randomized controlled trials (RCTs). These results needed to be confirmed by a large trial investigating the treatment effect and its sustainability after medication discontinuation. Aims: To confirm the SMO effect on (sustained) MoA in detoxified alcohol-dependent patients. Methods: Large double-blind, randomized, placebo-controlled trial in detoxified adult alcohol-dependent outpatients (80% men) from 11 sites in four European countries. Patients were randomized to 6 months SMO (3.3–3.9 g/day) or placebo followed by a 6-month medication-free period. Primary outcome was the cumulative abstinence duration (CAD) during the 6-month treatment period defined as the number of days with no alcohol use. Secondary outcomes included CAD during the 12-month study period. Results: Of the 314 alcohol-dependent patients randomized, 154 received SMO and 160 received placebo. Based on the pre-specified fixed-effect two-way analysis of variance including the treatment-by-site interaction, SMO showed efficacy in CAD during the 6-month treatment period: mean difference +43.1 days, 95% confidence interval (17.6–68.5; p = 0.001). Since significant heterogeneity of effect across sites and unequal sample sizes among sites ( n = 3–66) were identified, a site-level random meta-analysis was performed with results supporting the pre-specified analysis: mean difference +32.4 days, p = 0.014. The SMO effect was sustained during the medication-free follow-up period. SMO was well-tolerated. Conclusions: Results of this large RCT in alcohol-dependent patients demonstrated a significant and clinically relevant sustained effect of SMO on CAD. Trial registration: ClinicalTrials.gov Identifier: NCT04648423

The UN Sustainable Development Goals (SDGs) and the Paris Agreement have ushered in a new era of policymaking to deliver on the formulated goals. Energy policies are key to ensuring universal access to affordable, reliable, sustainable, and modern energy (SDG7). Yet they can also have considerable impact on other goals. To successfully achieve multiple goals concurrently, policies need to balance different objectives and manage their interactions. Refining previously contemplated design principles, we identify three key principles - complementary, transparency and adaptability - as highly pertinent for multiple-objective energy policies based on a synthesis of seventeen coordinated policy case studies. First, policies should entail complementary measures and design provisions that specifically target non-energy objectives (complementarity). Second, policy impacts should be tracked comprehensively in both energy and non-energy domains to uncover diminishing returns and facilitate policy learning (transparency). Third, policies should be capable of adapting to changing objectives over time (adaptability). These principles are rarely considered in current policies, implying the need to mainstream them into the next generation of policymaking by pointing to best practices and new tools.

Abstract To improve food security a conceptual integration beyond the scope of production in the agricultural sector due to examination of critical supply chain system compartments and levels of services (“integrated food production and supply systems”) is proposed. For creating systematic results, a platform integrating various perspectives of experts has been established following the principle of triple helix stakeholdership (business practice, public management/policy and also science). During a series of workshops, the main actors, success factors, challenges and communication strategies have been identified for shaping sustainable food supply chains under use of systems thinking and the application of Participatory Systems mapping (PSM). In this line, the paper presents how “system maps” based on the method of PSM are used to gain insights into sustainable logistics services facilitating sustainable consumption patterns, enabling participatory considerations and the productive exchange of knowledge.

Impacts in the form of innovation and commercialization are essential components of publicly funded research projects. PHUSICOS ("According to nature" in Greek), an EU Horizon 2020 program (H2020) Innovation Action project, aims to demonstrate the use of nature-based solutions (NBS) to mitigate hydrometeorological hazards in rural and mountainous areas. The work program is built around key innovation actions, and each Work Package (WP) leader is specifically responsible for nurturing innovation processes, maintaining market focus, and ensuring relevance for the intended recipients of the project results. Key success criteria for PHUSICOS include up-scaling and mainstream implementation of NBS to achieve broader market access. An innovation strategy and supporting tools for implementing this within PHUSICOS has been developed and key concepts forming the basis for this strategy are presented in this research note.

The development of a sustainable bio-based economy has drawn much attention in recent years, and research to find smart solutions to the many inherent challenges has intensified. In nature, perhaps the best example of an authentic sustainable system is oxygenic photosynthesis. The biochemistry of this intricate process is empowered by solar radiation influx and performed by hierarchically organized complexes composed by photoreceptors, inorganic catalysts, and enzymes which define specific niches for optimizing light-to-energy conversion. The success of this process relies on its capability to exploit the almost inexhaustible reservoirs of sunlight, water, and carbon dioxide to transform photonic energy into chemical energy such as stored in adenosine triphosphate. Oxygenic photosynthesis is responsible for most of the oxygen, fossil fuels, and biomass on our planet. So, even after a few billion years of evolution, this process unceasingly supports life on earth, and probably soon also in outer-space, and inspires the development of enabling technologies for a sustainable global economy and ecosystem. The following review covers some of the major milestones reached in photosynthesis research, each reflecting lasting routes of innovation in agriculture, environmental protection, and clean energy production.

Sustainable Development Goals and the Paris Agreement stand as milestone diplomatic achievements. However, immense discrepancies between political commitments and governmental action remain. Combined national climate commitments fall far short of the Paris Agreement's 1.5/2°C targets. Similar political ambition gaps persist across various areas of sustainable development. Many therefore argue that actions by nonstate actors, such as businesses and investors, cities and regions, and nongovernmental organizations (NGOs), are crucial. These voices have resonated across the United Nations (UN) system, leading to growing recognition, promotion, and mobilization of such actions in ever greater numbers. This article investigates optimistic arguments about nonstate engagement, namely: (a) “the more the better”; (b) “everybody wins”; (c) “everyone does their part”; and (d) “more brings more.” However, these optimistic arguments may not be matched in practice due to governance risks. The current emphasis on quantifiable impacts may lead to the under‐appreciation of variegated social, economic, and environmental impacts. Claims that everybody stands to benefit may easily be contradicted by outcomes that are not in line with priorities and needs in developing countries. Despite the seeming depoliticization of the role of nonstate actors in implementation, actions may still lead to politically contentious outcomes. Finally, nonstate climate and sustainability actions may not be self‐reinforcing but may heavily depend on supporting mechanisms. The article concludes with governance risk‐reduction strategies that can be combined to maximize nonstate potential in sustainable and climate‐resilient transformations.This article is categorized under: Policy and Governance > Multilevel and Transnational Climate Change Governance

Land use is central to addressing sustainability issues, including biodiversity conservation, climate change, food security, poverty alleviation, and sustainable energy. In this paper, we synthesize knowledge accumulated in land system science, the integrated study of terrestrial social-ecological systems, into 10 hard truths that have strong, general, empirical support. These facts help to explain the challenges of achieving sustainability in land use and thus also point toward solutions. The 10 facts are as follows: 1) Meanings and values of land are socially constructed and contested; 2) land systems exhibit complex behaviors with abrupt, hard-to-predict changes; 3) irreversible changes and path dependence are common features of land systems; 4) some land uses have a small footprint but very large impacts; 5) drivers and impacts of land-use change are globally interconnected and spill over to distant locations; 6) humanity lives on a used planet where all land provides benefits to societies; 7) land-use change usually entails trade-offs between different benefits—"win–wins" are thus rare; 8) land tenure and land-use claims are often unclear, overlapping, and contested; 9) the benefits and burdens from land are unequally distributed; and 10) land users have multiple, sometimes conflicting, ideas of what social and environmental justice entails. The facts have implications for governance, but do not provide fixed answers. Instead they constitute a set of core principles which can guide scientists, policy makers, and practitioners toward meeting sustainability challenges in land use.