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Activity pacing (AP) is a concept that is central to many chronic pain theories and treatments, yet there remains confusion regarding its definition and effects.To review the current knowledge concerning AP and integrate this knowledge in a manner that allows for a clear definition and useful directions for future research.A narrative review of the major theoretical approaches to AP and of the empirical evidence regarding the effects of AP interventions, followed by an integrative discussion.The concept of AP is derived from 2 main traditions: operant and energy conservation. Although there are common elements across these traditions, significant conceptual and practical differences exist, which has led to confusion. Little empirical evidence exists concerning the efficacy of AP as a treatment for chronic pain.Future research on AP should be based on a clear theoretical foundation, consider the context in which the AP behavior occurs and the type of pacing problem ("underactivity" vs. "overactivity"), and should examine the impact of AP treatment on multiple clinical outcomes. We provide a provisional definition of AP and specific recommendations that we believe will move the field forward.

The development of net negative electric cities encompasses the three strategies of decarbonizing power supply, energy efficiency and electrification. There is potential to pursue these combined strategies rapidly to hold climate change to within 1.5 °C. Recent work has identified many cities in developing countries that are ideal for electrification today based on carbon intensity and high access to electricity. Net negative electric cities could be achieved by following a comprehensive policy framework for low carbon investment.

ABSTRACTAims  To describe three aspects of the epidemiology of alcohol‐attributable deaths in Europe, dose, demography and place, and to illustrate how such knowledge can better be used to inform alcohol policy formulation and implementation.Design  epidemiological and population health modeling.Setting  Europe.Participants  Based on country‐specific aggregate statistics.Measurements  Exposure: country‐specific adult per capita consumption triangulated with survey data; outcomes: mortality statistics.Findings  The absolute risk of dying from an alcohol‐attributable disease and injury (accounting for a protective effect for ischaemic diseases) increases with increasing daily alcohol consumption beyond 10g alcohol per day, the first data point. Over 2/3 of all alcohol‐attributable deaths occurring amongst the 20–64 year old population of the European Union (minus Cyprus and Malta) occur in the 45–64 year olds. About 25% of the difference in life expectancy between western and eastern Europe for men aged 20–64 years in 2002 can be attributed to alcohol, largely, but not exclusively, as a result of differences in heavy episodic drinking patterns.Conclusions  Any reduction in the dose of alcohol consumed, at least down to 10g/day, will reduce the annual and lifetime risk of an alcohol‐related death. There is a need for alcohol policy to focus on measures in reducing alcohol consumption, throughout middle age, with immediacy of impact. Policy should strive to reduce alcohol‐related health inequalities, with the specific recommendations for policy depending on the cost‐effectiveness of interventions related to the epidemiological profile of the country or region under consideration. Fortunately, there are evidence‐based policy options that reduce the amount of alcohol consumed and many alcohol‐related harms with immediate effect, that reduce the risk of an alcohol‐related death in middle age, and that would help to close the health gap between eastern and western Europe.

While it is well known that patients receiving opioids should refrain from alcohol consumption, little is known about the involvement of alcohol in opioid-related deaths.We conducted a population-based analysis of opioid-related deaths in Ontario with and without alcohol involvement between 1993 and 2013, and reported rates overall and stratified by manner of death. We compared the characteristics of individuals who died of an opioid overdose based on the presence or absence of alcohol involvement.The rate of opioid-related deaths increased 288% from 11.9 per million (95% confidence interval (CI) 9.8-13.9 per million) in 1993-46.2 per million (95% CI 42.6-49.8 per million) in 2013. The rate of opioid-related deaths without alcohol involvement increased 388% from 7.4 per million to 36.1 per million, while deaths involving alcohol increased by 125% from 4.5 per million to 10.1 per million. Therefore, although the annual number of opioid-related deaths involving alcohol rose, the proportion of opioid-related deaths involving alcohol declined from 37.8% in 1993-21.9% by 2013. Generally, opioid-related deaths involving alcohol were less likely to involve other central nervous system depressants, and more likely to occur among men and those with a history of alcohol use disorder.Although the relative contribution of alcohol in opioid-related deaths has declined, 1 in 5 fatal opioid overdoses still involved alcohol in 2013. Our findings highlight the ongoing need for targeted messaging around risks of opioids alone, and in combination with alcohol and other CNS depressants.

Bioavailability has been used as a key indicator in chemical risk assessment yet poorly quantified risk factor. Worldwide, the framework used to assess potentially contaminated sites is similar, and the decisions are based on threshold contaminant concentration. The uncertainty in the definition and measurement of bioavailability had limited its application to environment risk assessment and remediation. Last ten years have seen major developments in bioavailability research and acceptance. The use of bioavailability in the decision making process as one of the key variables has led to a gradual shift towards a more sophisticated risk-based approach. Now a days, many decision makers and regulatory organisations 'more readily accept' this concept. Bioavailability should be the underlying basis for risk assessment and setting remediation goals of those contaminated sites that pose risk to environmental and human health. This paper summarises the potential application of contaminant bioavailability and bioaccessibility to the assessment of sites affected by different contaminants, and the potential for this to be the underlying basis for sustainable risk assessment and remediation in Europe, North America and Australia over the coming decade.

Cities globally face significant risks from climate change, and are taking an increasingly active role in formulating and implementing climate change adaptation policy. However, there are few, if any, global assessments of adaptation taking place across cities. This study develops and applies a framework to track urban climate change adaptation policy using municipal adaptation reporting. From 401 local governments globally in urban areas with >1. m people, we find that only 61 cities (15%) report any adaptation initiatives, and 73 cities (18%) report on planning towards adaptation policy. We classified cities based on their adaptation reporting as extensive adaptors, moderate adaptors, early stage adaptors, and non-reporting. With few exceptions, extensive adaptors are large cities located in high-income countries in North America, Europe, and Oceania, and are adapting to a variety of expected impacts. Moderate adaptors usually address general disaster risk reduction rather than specific impacts, and are located in a mix of developed and developing countries. Early stage adaptors exhibit evidence of planning for adaptation, but do not report any initiatives. Our findings suggest that urban adaptation is in the early stages, but there are still substantive examples of governments taking leadership regardless of wealth levels and institutional barriers.

Dietary ion content is known to alter the acid-base balance in freshwater fish. The current study investigated the metabolic impact of acid-base disturbances produced by differences in dietary electrolyte balance (DEB) in the meagre (Argyrosomus regius), an euryhaline species. Changes in fish performance, gastric chyme characteristics, pH and ion concentrations in the bloodstream, digestive enzyme activities and metabolic rates were analyzed in meagre fed ad libitum two experimental diets (DEB 200 or DEB 700mEq/kg) differing in the Na2CO3 content for 69days. Fish fed the DEB 200 diet had 60-66% better growth performance than the DEB 700 group. Meagre consuming the DEB 200 diet were 90-96% more efficient than fish fed the DEB 700 diet at allocating energy from feed into somatic growth. The pH values in blood were significantly lower in the DEB 700 group 2h after feeding when compared to DEB 200, indicating that acid-base balance in meagre was affected by electrolyte balance in diet. Osmolality, and Na+ and K+ concentrations in plasma did not vary with the dietary treatment. Gastric chyme in the DEB 700 group had higher pH values, dry matter, protein and energy contents, but lower lipid content than in the DEB 200 group. Twenty-four hours after feeding, amylase activity was higher in the gastrointestinal tract of DEB 700 group when compared to the DEB 200 group. DEB 700 group had lower routine metabolic (RMR) and standard metabolic (SMR) rates, indicating a decrease in maintenance energy expenditure 48h after feeding the alkaline diet. The current study demonstrates that feeding meagre with an alkaline diet not only causes acid-base imbalance, but also negatively affects digestion and possibly nutrient assimilation, resulting in decreased growth performance.

Megacities in low- and middle-income countries face unique threats from climate change as vulnerable populations and infrastructure are concentrated in high-risk areas. This paper develops a theoretical framework to characterize adaptation readiness in Global South cities and applies the framework to Dhaka, Bangladesh, a city with acute exposure and projected impacts from flooding and extreme heat. To gather case evidence from Dhaka we draw upon interviews with national and municipal government officials and a review of planning documents and peer-reviewed literature. We find: (1) national-level plans propose a number of adaptation strategies, but urban concerns compete with priorities such as protection of coastal assets and agricultural production; (2) municipal plans focus on identifying vulnerability and impacts rather than adaptation strategies; (3) interviewees suggest that lack of coordination among local government (LG) organizations and lack of transparency act as barriers for municipal adaptation planning, with national plans driving policy where LGs have limited human and financial resources; and (4) we found limited evidence that national urban adaptation directives trickle down to municipal government. The framework developed offers a systematic and standardized means to assess and monitor the status of adaptation planning in Global South cities, and identify adaptation constraints and opportunities.