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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

In recent years there has been increasing attention to the transition toward a bioeconomy. From comparable transitions toward sustainability, we know that transitions require integral, inclusive approaches toward developing a long-term strategy, focusing not only on technological innovation, but also on involving the public. This is not easy. Public engagement encompasses diverse forms of public and civil society participation, and it is crucial to understand the specificities of these interactions and their effects on potential transition pathways. We present a conceptual-analytical paper where the focus lies on understanding sense-making practices in the construction of publics in the bioeconomy. Using a case-study approach, this article describes five partialities of the constructed public in the bioeconomy and analyzes the orchestration, productive dimensions and effects of these constructions. Our analysis offers a new perspective on, and appreciation of, the partiality of different forms of public participation, and varying degrees in which possibilities of system change in the bioeconomy transition are inclusive or exclusive toward differentially constructed publics. This offers an alternative, constructive way of exploring actor dynamics and politics in system change. We aim to contribute to a more nuanced and integral interpretation of public engagement in sustainability transitions, which is relevant to actors from academia, policy, industry and other spheres relevant to the bioeconomy transition.

Universal access to clean electricity (SDG7) in remote areas of the rural South remains a key challenge for economic growth, and has particular implications for equitable, inclusive and sustainable development. In Pakistan, techno-economic constraints in grid expansion for last-mile users, combined with the country’s high solar energy potential make off-grid solar energy generation a viable solution, provided its technological, social and economic implications are well-understood in terms of actual energy demands and designed for equitable distribution. This paper presents a socio-technical feasibility assessment for designing equitable and inclusive off-grid solar systems using the case-study of Helario village in Tharparkar, Pakistan, with a key focus on gender-specific benefits. A mixed-methods approach is used to conduct a baseline field assessment of existing energy sources, community needs, women’s access and energy use, affordability, future energy aspirations and social acceptability of renewable energy technologies. Results indicate gendered differences in mobility, education, everyday practices and income that have socio-economic implications, whereby women can benefit more from electrification, particularly when electricity is interlinked with access to clean water. Results are used to model, simulate and optimise a solar-battery mini-grid system for tiered and equitable energy access using CLOVER. Analysis shows that a system designed with a 10-year lifetime provides the lowest levelised cost of electricity and minimum emissions intensity, emphasising the need for long-term energy system planning. This paper serves as a demonstration for policymakers, project developers and rural communities for designing more equitable and inclusive energy systems with clear gendered implications for sustainable future access.

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

Abstract We analyze the effect of CEO education on environmental decision-making. Using a unique sample of Danish firms from 1996 to 2012, we find that CEO education significantly improves firms' energy efficiency. We seek to derive causality using health shocks: the hospitalization of highly educated CEOs induces a drop in energy efficiency, whereas the hospitalization of less educated CEOs does not have any significant effect. Exploring the mechanisms at play, we show that our results are largely driven by advanced education in business degrees. Moreover, we show that CEO education is associated with greater environmental awareness: highly educated CEOs exhibit greater concerns for climate change, as measured by a survey of social preferences, and drive more environmentally efficient cars. Taken together, our findings suggest that education shapes managerial styles giving rise to greater sustainability in corporate actions.

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.