Changes In Resource Use Research Articles

Impact of heart failure diagnosis on recorded healthcare resource use by older people in Wales; is primary care shouldering a hidden burden?

Abstract Background Heart failure (HF) is associated with high healthcare resource use and mortality. Most of the evidence focuses on hospital admission data. The impact on primary care interactions and outpatient attendance is less well described, but this information is important in understanding resource utilisation, patient pathways, and in planning services. Purpose To examine how a diagnosis of HF impacts healthcare resource use and outcomes for older people in Wales. Methods We conducted a retrospective, population-level, observational study using linked anonymised electronic health record (EHR) data in Wales (2015-22). 737,230 individuals were aged 65y+ in the study period in primary and secondary care data. Of these, 65,010 had a code for HF in their primary or secondary care records. To evaluate changes in resource use, we excluded 13,990 individuals with fewer than 12 months health data pre- and post-diagnosis. We summarised general practice (GP) interactions, emergency department (ED) attendance, outpatient (OP) attendance, inpatient (IP) episodes and days, time between HF diagnosis and death, and place of death. Results The final cohort comprised 51,020 individuals 65y and over with a diagnosis of HF between 2015-2022. Incidence and prevalence of HF increased across the study period (1.4-1.5% and 8.5-9.1% respectively). Figure 1 shows the percentage change in healthcare resource use for the cohort when HF was diagnosed (12 months pre-and post-diagnosis comparison). Table 1 shows the average number of healthcare utilisation events per person. After a diagnosis of HF, there are fewer ED attendances (-28.2%) and IP admissions (-9.3%) but more OP appointments (31%) and GP interactions (20.3%). When admissions occur, hospital stays tend to be longer (55.4%). Median time (IQR) from HF diagnosis to death from any cause was 247(34-840) days, and with HF listed as a cause 186(25-780) days. In this cohort, the place of death was recorded as NHS establishment (20,379, 67.8%), community (5,450, 18.1%), non-NHS establishment (3,789,12.6%) and unknown (450, 1.5%). Conclusions In Wales, a diagnosis of HF in those 65y+ increases primary care interactions and OP attendances. The change in volume of primary care interactions is considerable (increase from 1,047,920 to 1,315,080). Longer hospital stays may suggest difficulty in managing patients or discharging back to community settings. Majority of those with HF die in NHS establishments. It is unclear whether this reflects deficits in end-of-life care. These results are important in planning effective health service delivery and in establishing baseline data from which to monitor quality improvements.

Diet Impact Assessment model: an interactive tool for analysing the health, environmental and affordability implications of diets

Abstract Global diets, environmental factors, and health require a holistic approach in public health discourse that takes into account the well-being of both humans and planetary health. Modeling tools have demonstrated being useful to estimate priorities and differences between countries and gain insight into future paths that depend on predetermined priorities. Modeling efforts that include environmental goals indicate the possibility of reducing environmental impacts while both improving food quality and overall health outcomes, especially in high-income settings. The aforementioned forecasts highlight the effectiveness of giving priority to dietary recommendations that lead to better, balanced patterns as the most effective approach to reducing mortality risks and environmental implications. The presentation will introduce the Diet Impact Assessment (DIA) model - a new interactive modelling tool for analysing the health, environmental and affordability implications of diets and dietary change. The tool enables countries to analyse user-specific scenarios of dietary change, and to estimate the health, environmental and cost burden of each scenario in terms of diet costs, avoidable deaths, changes in resource use and compatibility with global environmental targets, including those associated with food-related greenhouse gas emissions, land use, water use and fertilizer application. The tool was commissioned by the WHO Regional Office for Europe and is based on analytical frameworks developed by Marco Springmann and colleagues.

Quantifying wildland fire resources deployed during the compound threat of COVID-19

Fire agencies across the United States must make complex resource allocation decisions to manage wildfires using a national network of shared firefighting resources. Firefighters play a critical role in suppressing fires and protecting vulnerable communities. However, they are exposed to health and safety risks associated with fire, smoke inhalation, and infectious disease transmission. The COVID-19 pandemic further complicated these risks, prompting fire agencies to propose resource management adaptations to minimize COVID-19 exposure and transmission. It is unclear if and how the pandemic may have operationally influenced wildland firefighting personnel resource use given compounding wildfire and COVID-19 risks. Therefore, we developed generalized linear mixed models that were fit using multiple integrated datasets to detect changes in personnel resource use for years prior to and during the COVID-19 pandemic, while controlling for historical fire and landscape conditions, societal risks, and management objectives. Analyses of observed and predicted firefighting resource use revealed reductions in the mean personnel resources used per wildfire per day during the pandemic for models developed across the western U.S. and for various western U.S. fire regions. Notably, the Northern California and the Great Basin Coordination Centers showed statistically significant reductions in ground personnel use during the COVID-19 pandemic. Learning from wildland fire management strategies and resource use trends that occurred during the COVID-19 pandemic, fire agencies can better anticipate resource constraints that may arise during the compounding threats of severe wildland fire activity and infectious disease outbreaks to proactively prepare and adapt suppression management strategies.

Meaningful benefit of disease-modifying treatment: Evaluating changes in health-related resource use.

Are reductions in the rate of decline from the new disease-modifying treatments (DMTs) in early Alzheimer's disease (AD) meaningful? We examined whether such reductions may be reflected in changes in health-related resource use. Patients with Clinical Dementia Rating (CDR) = 0.5 or 1 with a clinical diagnosis of mild cognitive impairment or AD, reflecting clinical trial populations. Health-related resource use was reported using the Resource Use Inventory (RUI) including direct medical care, non-medical care, unpaid informal care, and time use. Faster decline in CDR-Sum of Boxes (CDR-SB) from baseline was independently associated with higher likelihood and hours of informal care received, and lower likelihood of employment/volunteer work, but not with direct medical care. Reductions in the rate of decline in CDR-SB seen from DMTs significantly affect patients' work capacity and need for informal care, indicators of economic impact meaningful to patients, families, and health systems. These measures are not readily captured in administrative data sets. Following a cohort of participants with MCI or mild dementia due to AD that mimics participants targeted for AD trials, this study showed slower decline in CDR-SB have significant effects on patients' work capacity and need for informal care, but not on their direct medical care utilization such as hospitalizations, ED use, and doctors' visits.Capturing potential benefits in health-related resource use may require direct measures of informal care and work/volunteer effort which are meaningful outcomes to patients, families and health systems.Caution is needed in our effort to assess benefits of recently developed disease modifying treatment in AD using electronic health records and administrative data from which utilization of direct medical care are routinely collected as these data sources may not capture the most apparent changes in resource utilization during early disease stages.

Does an allied health transdisciplinary stroke assessment save time, improve quality of care, and save costs? Results of a pre-/post- clinical study

Purpose: Demand for stroke services is increasing. To save time and costs, stroke care could be reorganised using a transdisciplinary assessment model embracing overlapping allied health professional skills. The study compares transdisciplinary assessment to discipline-specific allied health assessment on an acute stroke unit, by evaluating assessment time, quality of care, and cost implications. Method: The pre-/post- clinical study used non-randomised groups and 3-month follow-up after hospital admission. Patients with confirmed/suspected stroke received usual discipline-specific allied health assessment (pre-implementation phase) or the novel transdisciplinary assessment (post-implementation phase). Staff/student assessment times (primary outcome) and medical record data (secondary outcomes) were collected. Time differences were estimated using multivariable linear regression controlling for confounding factors. Cost minimisation and sensitivity analyses estimated change in hospital resource use. Findings: When the transdisciplinary assessment was used ( N = 116), compared to usual assessment ( N = 63), the average time saving was 37.6 min (95% CI −47.5, −27.7; p < 0.001) for staff and 62.2 min (95% CI −74.1, −50.3; p < 0.001) for students. The median number of allied health occasions of service reduced from 8 (interquartile range 4–23) to 5 (interquartile range 3–10; p = 0.011). There were no statistically significant or clinically important changes in patient safety, outcomes or stroke guideline adherence. Improved efficiency was associated with an estimated cost saving of $379.45 per patient (probabilistic 95% CI −487.15, −271.48). Discussion and conclusion: Transdisciplinary stroke assessment has potential for reorganising allied health services to save assessment time and reduce healthcare costs. The transdisciplinary stroke assessment could be considered for implementation in other stroke services.

Archaeological evidence of resource utilisation of walrus, Odobenus rosmarus, over the past two millennia: A systematic review protocol.

The walrus, Odobenus rosmarus, is an iconic pinniped and predominant molluscivore that is well adapted to Arctic and subarctic environments. Its circumpolar distribution, large body size and ivory tusks facilitated its vital role as food, raw material (for tools and art), income, and cultural influence on many Arctic Indigenous communities for millennia. Intensification of hunting (often due to the arrival of Europeans, especially between the 16 th and 19 th centuries) to obtain ivory, hide, blubber and meat, resulted in diminished, sometimes extirpated, walrus populations. Zooarchaeological, artefactual and documentary evidence of walrus material has been collated at local and regional scales and is frequently focused on a specific culture or period of time. Systematic collation of this evidence across the Northern Hemisphere will provide insight into the chronology and circumpolar distribution of walrus hunting and provide a tool to document societal change in walrus resource use. Here, we lay out a systematic review protocol to collate records of archaeological walrus artefacts, tusks and bones that have been documented primarily within published literature to archive when and where (as feasible) walrus extractions occurred between 1 CE and 2000 CE. These data will be openly available for the scientific community. The resulting dataset will be the first to provide spatiotemporal information (including the recognition of knowledge gaps) regarding past walrus populations and extirpations on a circumpolar scale. Our protocol is published to ensure reproducibility and comparability in the future, and to encourage the adoption of systematic review methodology (including pre-published protocols) in archaeology.

Changes in Edible-wild Plant Resource Use in Mountainous Communities after WWII:

Changes in Edible-wild Plant Resource Use in Mountainous Communities after WWII:

Potential Residence and Coexistence Strategy of Tursiops truncatus in a Coastal Lagoon in the Southern Gulf of Mexico: Ecological Inferences Using Stable Isotopes

The Terminos Lagoon Flora and Fauna Protection Area is the largest coastal lagoon in the southern Gulf of Mexico and has the largest population of bottlenose dolphins, Tursiops truncatus, reported in the region. Photo identification studies have reported permanent and seasonal residence of dolphins; however, how dolphins coexist ecologically is unknown. In the present study, from 17 dead specimens stranded on the coast of Isla del Carmen (barrier island) between 2014 and 2016, stable isotopes in the liver, heart, and muscle, which represent different time scales, were analyzed to determine residence through δ13C values and niche width and trophic coexistence through δ15N values. Differences between sexes (δ13C liver: p = 0.009; heart: p = 0.01) and age classes (δ15N muscle: p = 0.02) were found, which indicated trophic sexual segregation and changes in resource use during growth, respectively. The lack of significant differences in δ13C values indicated isotopic equilibrium between the tissues, indicating the possible permanent residence of 12 dolphins in Terminos Lagoon as a coastal ecotype (− 16‰) and a second group (five dolphins) as an oceanic ecotype (− 18‰). In conclusion, most dolphins stranded in the Terminos Lagoon are potential permanent residents of this habitat, with evidence of resource partitioning as a coexistence strategy.

EPH254 Changes in Asthma-Related Healthcare Resource Use in Asthma Patients in the United States During the COVID-19 Pandemic

EPH254 Changes in Asthma-Related Healthcare Resource Use in Asthma Patients in the United States During the COVID-19 Pandemic

Cost consequence analysis of transcutaneous tibial nerve stimulation (TTNS) for urinary incontinence in care home residents alongside a randomised controlled trial

BackgroundUrinary incontinence (UI) is prevalent in more than half of residents of nursing and residential care homes and can have a detrimental impact on dignity and quality of life. Care homes predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous tibial nerve stimulation (TTNS) is a non-invasive, safe, low-cost intervention with demonstrated effectiveness for reducing UI in adults. We examined the costs and consequences of delivering TTNS to care home residents in comparison to sham (inactive) electrical stimulation.MethodsA cost consequence analysis approach was used to assemble and present the resource use and outcome data for the ELECTRIC trial which randomised 406 residents with UI from 37 care homes in the United Kingdom to receive 12 sessions of 30 min of either TTNS or sham (inactive) TTNS. TTNS was administered by care home staff over 6 weeks. Health state utility was measured using DEMQOL-U and DEMQOL-PROXY-U at baseline, 6 weeks and 18 weeks follow-up. Staff completed a resource use questionnaire at baseline, 6 weeks and 18 weeks follow-up, which also assessed use of absorbent pads.ResultsHRQoL did not change significantly in either randomised group. Delivery of TTNS was estimated to cost £81.20 per participant, plus training and support costs of £121.03 per staff member. 85% of participants needed toilet assistance as routine, on average requiring one or two staff members to be involved 4 or 5 times in each 24 h. Daily use of mobility aids and other assistive devices to use the toilet were reported. The value of staff time to assist residents to use the toilet (assuming an average of 5 min per resident per visit) was estimated as £19.17 (SD 13.22) for TTNS and £17.30 (SD 13.33) for sham (per resident in a 24-hour period).ConclusionsUse of TTNS to treat UI in care home residents did not lead to changes in resource use, particularly any reduction in the use of absorbent pads and no cost benefits for TTNS were shown. Managing continence in care homes is labour intensive, requiring both high levels of staff time and use of equipment aids.Trial registrationISRCTN98415244, registered 25/04/2018. NCT03248362 (Clinical trial.gov number), registered 14/08//2017.

Clinical Practice Patterns and Risk Factors for Severe Conditions in Pediatric Hospitalizations With Respiratory Syncytial Virus in Japan: A Nationwide Analyses (2018-2022).

Respiratory syncytial virus (RSV) represents a global health challenge, especially among younger children. While the disease burden in Japan has been preliminarily quantified, there remains a lack of comprehensive understanding regarding treatment patterns and the influence of known risk factors at a national scale. We conducted a retrospective cohort study consisting of 50,482 children under 5 years hospitalized with RSV infections during 2018-2022 using the Medical Data Vision database. We investigated trends in patient characteristics, health resource use, treatment patterns, and laboratory data. Additionally, multivariable modified Poisson regression models were used to investigate the risk factors associated with severe conditions. We observed an increasing trend in the inpatient healthcare costs and decreasing trends in the use of antibiotics, bronchodilators, systemic corticosteroids and other symptomatic medications from 2018 to 2022. Risk factors associated with severe RSV infections were children less than 1 year (risk ratio, 2.90; 95% CI: 2.53-3.32) and the number of complex chronic diseases (risk ratio for 1 disease, 2.68; 95% CI: 2.34-3.06: risk ratio for 2 or more diseases, 6.91; 95% CI: 5.81-8.21). Annual inpatient healthcare costs for RSV infections were estimated at 11-14 billion Japanese Yen for younger children. Our study observed the changes in practice patterns and health resource use for children hospitalized with RSV infections and identified risk factors associated with severe conditions. These findings provide insights for policymakers and clinicians aiming to devise strategies for further improving clinical practices, including newly developed vaccines and single-dose long-acting monoclonal antibodies.

Clinical Practice Patterns, Health Resource Use and Risk Factors for Severe Conditions Among Children Hospitalized With COVID-19 in Japan.

The trends in clinical practice patterns and health resource use, as well as risk factors for severe conditions among children hospitalized with coronavirus disease-2019 (COVID-19), remain unclear. We conducted a retrospective observational study consisting of 9876 children hospitalized with COVID-19 during 2020-2022 using the Medical Data Vision database in Japan. We investigated trends in patient characteristics, health resource use, treatment patterns and laboratory data. Additionally, log-binomial regression models were used to investigate the risk factors associated with severe COVID-19 among pediatric inpatients with COVID-19. We observed decreasing trends in the lengths of hospital stays, healthcare costs, computed tomography use, and antibiotic use, and increasing trends in treatment with intravenous hydration and use of antipyretics, antiepileptics, antiemetics and antivirals from the first wave to the seventh wave of COVID-19 pandemic. During the 3-year period, the risk of severe COVID-19 was almost stable at 3%. Risk factors associated with severe COVID-19 were children aged 0 years [risk ratio (RR): 1.69; 95% confidence interval (CI): 1.02-2.78], the number of complex chronic diseases (RR for 1 disease: 4.49; 95% CI: 2.76-7.32; RR for 2 or more diseases: 10.2; 95% CI: 5.19-20.3) and asthma (RR: 1.84; 95% CI: 1.06-3.20). Our study observed the changes in practice patterns and health resource use for children hospitalized with COVID-19 and identified risk factors associated with severe COVID-19. These findings indicate the importance of vigilant monitoring and tailored treatment strategies in children with these risk factors.

Actual Quality Changes in Natural Resource and Gas Grid Use in Prospective Hydrogen Technology Roll-Out in the World and Russia

About 95% of current hydrogen production uses technologies involving primary fossil resources. A minor part is synthesized by low-carbon and close-to-zero-carbon-footprint methods using RESs. The significant expansion of low-carbon hydrogen energy is considered to be a part of the “green transition” policies taking over in technologically leading countries. Projects of hydrogen synthesis from natural gas with carbon capture for subsequent export to European and Asian regions poor in natural resources are considered promising by fossil-rich countries. Quality changes in natural resource use and gas grids will include (1) previously developed scientific groundwork and production facilities for hydrogen energy to stimulate the use of existing natural gas grids for hydrogen energy transport projects; (2) existing infrastructure for gas filling stations in China and Russia to allow the expansion of hydrogen-fuel-cell vehicles (HFCVs) using typical “mini-plant” projects of hydrogen synthesis using methane conversion technology; (3) feasibility testing for different hydrogen synthesis plants at medium and large scales using fossil resources (primarily natural gas), water and atomic energy. The results of this study will help focus on the primary tasks for quality changes in natural resource and gas grid use. Investments made and planned in hydrogen energy are assessed.

1417P Change in healthcare resource use and associated costs of patients with metastatic lung cancer between 2013 and 2019: An observational study from the French national claims database

1417P Change in healthcare resource use and associated costs of patients with metastatic lung cancer between 2013 and 2019: An observational study from the French national claims database

The Role of Wildfires in the Interplay of Forest Carbon Stocks and Wood Harvest in the Contiguous United States During the 20th Century.

Wildfires and land use play a central role in the long-term carbon (C) dynamics of forested ecosystems of the United States. Understanding their linkages with changes in biomass, resource use, and consumption in the context of climate change mitigation is crucial. We reconstruct a long-term C balance of forests in the contiguous U.S. using historical reports, satellite data, and other sources at multiple scales (national scale 1926-2017, regional level 1941-2017) to disentangle the drivers of biomass C stock change. The balance includes removals of forest biomass by fire, by extraction of woody biomass, by forest grazing, and by biomass stock change, their sum representing the net ecosystem productivity (NEP). Nationally, the total forest NEP increased for most of the 20th century, while fire, harvest and grazing reduced total forest stocks on average by 14%, 51%, and 6%, respectively, resulting in a net increase in C stock density of nearly 40%. Recovery from past land-use, plus reductions in wildfires and forest grazing coincide with consistent forest regrowth in the eastern U.S. but associated C stock increases were offset by increased wood harvest. C stock changes across the western U.S. fluctuated, with fire, harvest, and other disturbances (e.g., insects, droughts) reducing stocks on average by 14%, 81%, and 7%, respectively, resulting in a net growth in C stock density of 14%. Although wildfire activities increased in recent decades, harvest was the key driver in the forest C balance in all regions for most of the observed timeframe.

Farm consolidation and turnover dynamics linked to increased crop diversity and higher agricultural input use

ContextCrop-type composition and configuration at field and landscape scales are known to impact ecological functions in agricultural landscapes. However, links between regional farmland structures (e.g., variable farm size, ownership, configuration, etc.), which are important determinants of farm-level management decisions, and subsequent changes in agroecosystem impacts, remain understudied.Objective:To investigate these dynamics, we examined relationships between changing farm structures, as indicated by farm consolidation and persistence, and concurrent changes in crop diversity and agricultural resource use between 2002 and 2018 in Kern County, California.Methods:We integrated parcel-level datasets documenting farm size, operatorship, crop cover, pesticide usage and evapotranspiration rates for 2002 and 2018. We then applied seemingly unrelated regression analyses to quantify potential relationships between these key variables.Results and conclusions:In our study area we observed low (28%) persistence of farm operators from 2002 to 2018 and farm consolidation, as evidenced by a 43% increase in farm midpoint size in the studied time period. We further found significant associations between farm structures and agro-environmental outcomes. A doubling in farm size was associated with an 8% increase in crop diversity, but also with an 18% increase in pesticide-use and a 7% increase in water use at the farm level, raising concerns about the impact of large farms on landscape-scale resource use. Both crop diversity and water use were higher in persistent farms (8% and 11%, respectively) than in replaced or emergent farms. Our findings illustrate how regional shifts in farm size and operatorship may link to changes in crop diversity and resource use. SignificanceGiven continued concerns about the impacts that landscape simplification, pesticide use, and water shortages may have on agroecosystems both in our study region and beyond, our study highlights regional farm structure dynamics as a key element to investigate further and to consider in policies aiming to increase the sustainability of future agricultural landscapes.

Impacts of routine varicella vaccination program and COVID-19 pandemic on varicella and herpes zoster incidence and health resource use among children in Japan

PurposeTo determine the epidemiological trends in pediatric varicella and herpes zoster incidence and changes in healthcare resource use from 2005 to 2022 using a nationally representative database in Japan. Materials and methodsWe conducted a retrospective observational study consisting of 3.5 million children with 177 million person-months during 2005–2022 using Japan Medical Data Center (JMDC) claims database in Japan. We investigated trends in incidence rates of varicella and herpes zoster and changes in healthcare resource use (e.g., antiviral use, office visits, and healthcare costs) over 18 years. Interrupted time-series analyses were used to investigate the impact of the routine varicella vaccination program in 2014 and infection prevention measures against COVID-19 on incidence rates of varicella and herpes zoster and related healthcare utilization. ResultsAfter the introduction of the routine immunization program in 2014, we observed level changes in incidence rates (45.6 % reduction [95 %CI, 32.9–56.0] of varicella cases, antiviral use (40.9 % reduction [95 %CI, 25.1–53.3]), and relevant healthcare costs (48.7 % reduction [95 %CI, 38.2–57.3]). Furthermore, infection prevention measures against COVID-19 were associated with additional level changes in varicella rates (57.2 % reduction [95 %CI, 44.5–67.1]), antiviral use (65.7 % reduction [59.7–70.8]), and healthcare costs (49.1 % [95 %CI, 32.7–61.6]). In contrast, the changes in incidence and healthcare costs for herpes zoster were relatively small, which showed 9.4 % elevated level change with a decreasing trend and 8.7 % reduced level change with a decreasing trend after the vaccine program and the COVID-19 pandemic. The cumulative incidence of herpes zoster in children born after 2014 was lower than that before 2014. ConclusionsVaricella incidence and healthcare resource use were largely affected by the routine immunization program and infection prevention measures against COVID-19, while these impacts on herpes zoster were relatively small. Our study indicates that immunization and infection prevention measures largely changed pediatric infectious disease practices.

Trends in Influenza and Related Health Resource Use During 2005-2021 Among Children in Japan.

To determine the epidemiological trends in pediatric influenza and changes in healthcare resource use from 2005 to 2021 using nationally representative outpatient database in Japan. We conducted a retrospective cohort study consisting of 3.5 million children with 177 million person-months during 2005-2021 using Japan Medical Data Center claims database in Japan. We investigated trends in incidence rates of influenza and changes in healthcare resource use (eg, use of antivirals) over 17 years. Generalized estimation equations were used to investigate the impact of the 2009 influenza pandemic and the coronaviral disease 2019 (COVID-19) pandemic on incidence rates of influenza and related healthcare utilization. Annual incidence rates of influenza were estimated at 55 cases per 1000 person-years with a 93% relative increase [95% confidence interval (CI): 80%-107%] during the 2009 influenza pandemic and a 99.4% relative reduction (95% CI: 99.3%-99.4%) during the COVID-19 pandemic. Similar patterns were observed for health resource use, total healthcare costs, admission rates and antiviral agent use. Approximately 80% of children with influenza received prescriptions for antivirals. The most prescribed antivirals were oseltamivir, but we observed a temporal increase in zanamivir use during 2007-2009, an increasing trend in laminamivir use during 2010-2017, a temporal increase in baloxavir use in 2018. Symptomatic medications with serious side effects (codeine, salicylate, sedative antihistamine) showed decreasing trends over the study period. Influenza incidence and healthcare resource use were largely affected by the 2009 influenza pandemic and the COVID-19 pandemic. Our study indicates improvement of quality in healthcare delivered to children.

Linking climate policy across economic sectors: A case for green growth in Nepal

AbstractWhile the energy sector is the largest global contributor to greenhouse gas (GHG) emissions, the agriculture, forestry, and other land use (AFOLU) sector account for up to 80% of GHG emissions in the least developed countries (LDCs). Despite this, the nationally determined contributions (NDCs) of LDCs, including Nepal, focus primarily on climate mitigation in the energy sector. This paper introduces green growth—a way to foster economic growth while ensuring access to resources and environmental services—as an approach to improving climate policy coherence across sectors. Using Nepal as a case country, this study models the anticipated changes in resource use and GHG emissions between 2015 and 2030, that would result from implementing climate mitigation actions in Nepal's NDC. The model uses four different scenarios. They link NDC and policies across economic sectors and offer policy insights regarding (1) energy losses that could cost up to 10% of gross domestic product (GDP) by 2030, (2) protection of forest resources by reducing the use of biomass fuels from 465 million gigajoules (GJ) in 2015 to 195 million GJ in 2030, and (3) a significant reduction in GHG emissions by 2030 relative to the business‐as‐usual (BAU) case by greater use of electricity from hydropower rather than biomass. These policy insights are significant for Nepal and other LDCs as they seek an energy transition towards using more renewable energy and electricity.

Climatic, geographic and anthropogenic factors shape the structure of bat–fruit networks in the Neotropical region

AbstractNatural and anthropogenic environmental gradients are associated with changes in species richness, abundance and resource use. There is increasing interest in understanding how the structure of interaction networks varies along environmental gradients, but most studies have focused on bird–plant networks, while studies on mutualistic networks formed by other vertebrate groups are scarce. Here, we compiled a database of 48 bat–fruit networks distributed in the Neotropical region and evaluated the influence of annual precipitation, annual mean temperature, latitude, altitude and human impacts on nestedness, modularity, specialization, interaction diversity and species richness. Furthermore, we characterized the distribution of the roles of bat species in networks of interactions inserted in different biomes of the Neotropical region. We found that annual mean temperature increased nestedness, but decreased modularity and diversity of interactions. In addition, the diversity of interactions was greater in areas with higher annual precipitation, with less human impact and in lower latitude regions. Plant richness increased in regions with higher annual precipitation, while latitude negatively affected both plant and bat richness. Regarding the role played by bat species, we observed that most species occupy peripheral positions and only 4% of the species acted as connectors. Consistent with previous studies that evaluated other mutualistic systems, we demonstrated that the structure of bat–fruit networks is influenced by climatic, geographic and anthropogenic factors. These findings enhance our understanding of how ecological communities are structured along an environmental gradient and allow us to understand how these systems can be affected by changes in climate and land use.