Priority Points Research Articles

Comparative Analysis of Electric and Conventional Vehicles Performance in the Evacuation Process of Mount Semeru Eruption Victims Based on Geographic Information Systems

The Lumajang Regency is highly vulnerable to various natural disasters, particularly the potential eruption of Mount Semeru. In disaster response efforts, the local government needs to prepare effective and efficient evacuation routes, taking into account the magnitude of the eruption impact in the Semeru disaster-prone area. This research focuses on evacuating vulnerable residents using electric and conventional vehicles. This study is categorized as a vehicle routing problem with energy constraint (VRPEC) because the electric vehicles utilized in this research do not require recharging during their operational process, ensuring rapid evacuation as it is essential. By utilizing Geographic Information Systems (GIS)-based optimization, the best route to evacuate all victims within 12 h is determined. This study involves developing scenarios considering the number of vehicles and their travel distances. There are also evacuation guidelines, including the implementation of priority points and evacuation zone usage. The research results indicate that scenarios EV 5, 8, and 10 are the most optimal for using electric vehicles. Meanwhile, the optimal scenario for conventional vehicles is scenario 5. This analysis shows that implementing electric vehicle scenarios is superior to conventional vehicle scenarios in terms of the total time required to evacuate all victims.

Algorithm of Development for Stabilization of Socio-Ecological Situation in Karakalpakstan

The relevance of developing a scientific framework for stabilizing the socio-ecological situation of the Republic of Karakalpakstan is determined by the need to address the environmental, social and economic challenges faced by the region. It is designed to improve the population’s quality of life, sustainable development and balanced interaction with the environment. The purpose of the research was to establish the relationship between social and environmental factors, to establish a mathematical model based on them, which will enable predicting future development and establishing a set of recommendations to improve the situation in the Republic of Karakalpakstan. The methods of theoretical analysis and mathematical modelling were used. The research outlines modern ideas about modelling the dynamics of socio-ecological processes in the example of the Republic of Karakalpakstan. It is established that the Republic has several problems, the solution of which should be started shortly. Considerable attention is paid to the setting of tasks and using for this purpose methods of system analysis of socio-ecological factors. In this work, the analysis of factors affecting the social and environmental environment of the Republic of Karakalpakstan using regression analysis is considered. The parameters of the developed mathematical model and their adequacy are determined. The developed mathematical model will allow identification of the social and ecological situation of the republic. At the end of the work, ten priority points for the next 5-10 years to improve the socio-ecological situation were presented. The practical value of the results is implemented in promoting the identification of new powerful reserves for further improvement of the management of social processes. This approach allows for increasing the national economic efficiency of the region and ensuring a balance between economic, social and environmental aspects of development, which is an essential step towards a sustainable future.

Calibration of Priority Points for Sensitization Status of Kidney Transplant Candidates in the United States.

A primary change to the national organ allocation system in 2014 for deceased donor kidney offers was to weight candidate priority based on sensitization (i.e. calculated panel reactive antibody percentage [CPRA%]) using a sliding scale. Increased priority for sensitized patients could improve equity in access to transplantation for disadvantaged candidates. We sought to evaluate the effect of these weights using a contemporary cohort of adult US kidney transplant candidates. We used the national Scientific Registry of Transplant Recipients to evaluate factors associated with sensitization using multivariable logistic models and rates of deceased donor transplantation using cumulative incidence models accounting for competing risks and multivariable Cox models. We examined 270,912 adult candidates placed on the waiting list between Jan,2016-September,2023. Six-year cumulative incidence of deceased donor transplantation for candidates with cPRA%=[80-85) and [90-95) was 48% and 53% respectively, as compared to 37% for candidates with cPRA%=[0-20). In multivariable models, candidates with high cPRA% had the highest adjusted hazards for deceased donor transplantation. There was significant effect modification such that the association of high cPRA% with adjusted rates of deceased donor transplantation varied by region of the country, gender, race/ethnicity, prior dialysis time and blood type. Results indicate that the weighting algorithm for highly sensitized candidates may overinflate the need for prioritization and lead to higher rates of transplantation. Findings suggest re-calibration of priority weights for allocation is needed to facilitate overall equity in access to transplantation for prospective kidney transplant candidates. However, priority points should also account for subgroups of candidates who are disadvantaged for access to donor offers.

Formation of priority points of industrial growth under sanctions pressure as a direction of techno-economy development

Aim. To determine the priority points of industry growth in the Russian Federation (RF) as an instrument of techno-economy development in the conditions of unstable external environment and sanctions pressure.Objectives. To substantiate the necessity of developing own technologies in industry in the turbulent macroeconomic environment; to identify the leading industries of the Russian Federation on the basis of comparative analysis; to analyze the possibility of network effect in the development of industry growth points; to determine the relationship between external sanctions pressure on priority industries and the specifics of the development of these industries-growth points.Methods. Theoretical and methodological generalizations were made using general methods of economic analysis: historical and logical, monographic and abstraction methods. In the practical component of the research economic and mathematical modeling, correlation and regression analysis technologies, matrix approach were used.Results. The development of such a direction as technoeconomics during the period of sanctions pressure allows industries to adapt to new conditions. In the process of analysis the main points of growth for the industrial sector of the Russian Federation were identified: production of medicines and materials used for medical purposes; production of computers, electronic and optical products, machinery and equipment. The high value of links within each industry and, accordingly, the possibility of the network effect was determined. Models reflecting the relationship between the functioning of industry growth points and the factors of industry development during the period of sanctions pressure were built.Conclusions. Today it is necessary to invest in the innovative potential of individual sub-sectors of industry (growth points) and develop industries that support the functioning of techno-economy and contribute to the formation of the network effect. Industries of this type have an additional positive impact on the development of the economy and contribute to the acceleration of adaptation processes, increase the productivity of industries in the turbulence of the external environment and sanctions pressure.

Increasing Access to Kidney Transplantation for Black and Asian Patients Through Modification of the Current A2 to B Allocation Policy.

The rate of A2 to B incompatible (ABO-i) kidney transplant continues to be low despite measures in the new Kidney Allocation System (KAS) to facilitate such transplants. This paper shows how the number of ABO-i transplants could increase if KAS policies were utilized to their fullest extent through a boost in ABO-i priority points. Predicting transplant outcomes using the Kidney Pancreas Simulated Allocation Model (KPSAM), preloaded with national data of 2010. We used this simulation to compare KAS to a new intervention in which priority equal to cPRA=100 has been given to blood type B candidate who are willing to accept an A blood type organ. The number of African American recipients increased by 375 (from 35% of recipient population to 38.7%), the number of blood type B African Americans increased by 65 (from 8% of recipient population to 9%), and the number of blood type B African Americans receiving blood type A kidneys increased by 49 (from 2% of recipient population to 2.5%). The same change occurred for Asians, particularly blood type B Asians (from 0.54% of the recipient population to 0.7%). Average wait time notably decreased by 27 days for blood type B African Americans. In the proposed scenario, 263 blood type B African Americans received blood type A organ (2.5% of recipient population) while only 181 (1.1%) of such transplants were performed in 2021. These results signify a considerable opportunity loss of ABO-i transplants for African American patients. If this policy was universally adopted, we would expect to see an overall increase of A2 to B transplantation, but in reality, not all centers perform ABOi transplantation. Thus, adopting this policy would incentivize other centers to perform more subtyping of A-type kidneys, and it would increase access to organs for blood type B Asian and African Americans in centers where ABOi transplantation already takes place.

Equity and Efficiency in Dynamic Matching: Extreme Waitlist Policies

Waitlists are commonly used to allocate scarce resources, such as public housing or organs. Waitlist policies attempt to prioritize agents who wait longer by assigning them priority points (à la first come, first served). We show that such point systems can lead to severe inequality across the agents’ assignment probabilities unless they use randomization. In particular, deterministic point systems lead to a more unequal allocation than any other rule that prioritizes earlier arrivals, an axiom that ensures that agents who wait longer are treated (weakly) better. Among the policies abiding by this axiom, we show that service in random order (SIRO) leads to the most equal allocation. From a utilitarian perspective, we show that the planner faces no trade-off between equity and efficiency when the flow utility from waiting is nonnegative or negative and increasing over time. In these cases, SIRO is also the most efficient policy. However, when the flow cost of waiting increases over time, then the planner may face an efficiency–equity trade-off: SIRO remains the most equitable policy but may not be the most efficient one. This paper was accepted by Omar Besbes, revenue management and market analytics.

ON TRACKS THE POLISSIA EXPEDITION OF 1932: THE NEWEST EXPLORATION OF MINERIES OF 17th—19th century ON THE MALYN REGION

In 2019 the authors conducted an archaeological survey near the city Malyn in the Zhytomyr region. The main task of the work was to find the locations of iron workshops known from historical sources of the 17th—19th centuries as «rudnia». Archival materials of the Poliska expedition of 1932, led by Oleksandr Ogloblin, were used to draw up the survey route. Photographs, location diagrams and descriptions of individual workshops of those studies made it possible to select priority points for a new visit to the sites of ancient industrial complexes.
 A total of 6 locations were surveyed. In their place, it was possible to record a concentration of swamp ore and iron slag, nearby — samples of ceramics, glass and other findings related to the functioning of miners’ villages. Near the humlet Antoniv, on an area of more than 1000 m2, a 3—5 m high slag accumulation was discovered, which was the place of storage of iron production waste from the local «rudnia» on the Voznia River.
 During the exploration several well-known and newly discovered archaeological sites were surveyed, including settlements from the times of Kievan Rus of the 10th—13th centuries near the villages of Nedashky, Ukrainka, Pyrizhky. Many samples of ceramic dishes of the 17th—19th centuries found in Malyn and Pyrizhky. Some of these ceramics have signs of local production. Fragments of tiles were found in some places, in Malyn — samples of ceramic tiles of the 18th (?) century. Near the village Korolivka, a previously unknown site of glass production — guta — was opened. Fragments of crucibles, vitreous mass, slag, ceramics of the 18th—19th centuries were found here. In several places fragments of molded ware, splinters of flint were found, which can be attributed to the Bronze Age (III—II millennia BC) and other eras.
 Near the humlet Antonov the remains of the Roman Catholic church of the end of the 18th (?) century were examined. The building was built by the Polish noblemen Penkowski, who owned a large estate on the Irsha River. Specimens of figured (patterned) brick were taken from this architectural monument. It is important to fix two stone tombstones made of red quartzite in the village Vorsivka near the church. They contain partially legible inscriptions, one of which is dated 1640. These finds testify to the existence in the first half of the 17th century industry of the manufacture of stone tombstones, the place of production of which is located 100 km to the north, in the area of the city of Ovruch, depending on the type of stone.

Residence-based priorities and school choice

Many countries use centralized school choice procedures to assign pupils to schools. To address excess demand for a particular school, ties are broken according to priority points granted based on various criteria, such as proximity to the school. Using a unique reform undertaken in Madrid (Spain), we estimate the impact of abolishing residence-based priorities on families’ school choices, the stated motivation for choosing a school, and the final school allocation. Utilizing several administrative datasets on school applications, we find that the reform increases families’ out-of-district school assignments and assignments to schools further away from their home address. Parents of immigrant children did not change their application behavior in the first years of the reform but caught up with natives three years after its implementation. Children generally accessed slightly better-performing schools, particularly those from lower-educated backgrounds.

Can vertical environmental regulation become a sharp weapon in China's green development process? The moderating role of pollution dividend.

Optimizing the vertical environmental regulation (VER) effect of the central government and reducing the negative execution motivation of local governments have become the priority points to accelerate the green development of China. Based on the spatial Durbin model, this paper not only examines the influence of VER on green development efficiency (GDE), but also discusses the moderating effect of politically and economically motivated pollution dividend (PPD and EPD) on the relationship between them. The research results are as follows: (1) VER has a U-shaped effect on local GDE, the green governance effect of which began to appear when VER was higher than 1.561. VER has an inverted N-shaped effect on adjacent GDE. When the VER intensity lies in (0.138, 3.012), it has a positive spatial spillover effect. (2) PPD weakens the local green governance effect of VER, while EPD positively moderates it. Both of them have no significant moderating effect on it in neighboring areas. (3) Cross-regional cooperative governance moderates the short-term weakness and pollution transfer of VER, and generally facilitates the positive moderating effect of PPD and EPD. In China's two major economic belts, VER, PPD and EPD also have different performances. This study proves the important influence of local inter-governmental competition and promotion tournament on the central environmental regulation for the first time, which is of great significance for optimizing the top-level design of the central government and implementing the governance responsibility of local governments.

State of economic play: European Union and economic diplomacy

The paper presents the state of economic play in the post financial and economic crisis of 2009 and the economic consequences which the pandemic will leave on largest global economies. We present the state of play for these key actors in regard to developments in the fields of sustainability and digitalisation, which in our belief will be the key priority points in the years to come. We present the views from policy and business sector point of view. The notion of Economic Diplomacy, as a soft power, is introduced into this analysis from the point of view of the relevant strength of different economies in regard to the power of their most propulsive (digitalised) companies. Comparisons between the EU, USA and China are presented and policy proposals are suggested.

Neurological Adverse Events Associated With Esketamine: A Disproportionality Analysis for Signal Detection Leveraging the FDA Adverse Event Reporting System.

Esketamine was approved for the treatment of treatment-resistant depression in 2019. After the approval of esketamine, numerous concerns have been raised regarding its long-term safety and tolerability. A previous systematic pharmacovigilance study on esketamine-related adverse events (AEs) was published in 2020; however, it has not been updated 2 years later. The primary aim of this study was to detect and characterize neurological safety signals of esketamine to partially update the knowledge in this field using the FDA pharmacovigilance database. Reporting odds ratio (ROR) was calculated for esketamine-related neurological AEs from 2019 to 2021 with a signal considered when the lower limit of the 95% confidence interval (CI) of ROR (ROR025) exceeded one. Severe and non-severe cases were compared using an independent samples t-test or chi-squared (χ2) test, and a rating scale was used to prioritize the signals. The database contained 720 cases of esketamine-associated neurological AEs, with 21 signals detected, ranging from a ROR025 of 1.05 (disturbance in attention) to 204.00 (sedation). 16 latest neurological AEs emerged in the second year of marketing approval of esketamine, with eight signals detected. The associations between esketamine and nervous system disorders persisted when stratifying by sex, age, and reporter type, whereas the spectrum of neurological AEs differed in stratification regimens. Esketamine dosage, antidepressant polypharmacy, or co-prescription with benzodiazepines affected AEs severity (t = 2.41, p = 0.017; χ2 = 6.75, p = 0.009; and χ2 = 4.10, p = 0.043; respectively), while age and sex did not (p = 0.053 and p = 0.397, respectively). Three signals were categorized as moderate clinical priority [i.e., sedation, dizziness, and dysgeusia (priority points 7, 5, and 5, respectively)], showing the same early failure type profiles. Notably, seven detected disproportionality signals were not previously detected in clinical trials. Although the majority of results were in line with those obtained in the previous study, there were discrepancies in the spectrum of neurological AEs and the effects of several risk factors on AEs severity among the two studies that should be recognized and managed early in clinical treatments.

Public Transport Perspectives for 2030 In Brazil: A Path Towards Sustainable Mobility

Objective: The objective of the study was to analyze projections that impact sustainable urban mobility for the year 2030 in small and medium-sized cities that use the bus as the main modal. Theoretical framework: The research brings perspectives to make urban mobility in small and medium-sized Brazilian cities more sustainable. Method: The Survey method was used; data collection through a questionnaire applied to public transport specialists in Brazil. In the data analysis, the calculation of the degree of agreement of the answers was used for 13 projections, in three aspects: probability of occurrence, business impact and the desire to occur. The averages of each category were also taken, plotted on a graph with X axis (probability of occurrence) and Y axis (impact on the transport sector). Results and conclusion: The results point to an increase in the use of semi-public transport, tariff changes and greater integration between the bus and more sustainable modes such as walking and cycling. For sustainable mobility, a greater interest in sustainability, investment in infrastructure, dedicated corridors and lanes, integration between modes, use of renewable energy and implementation of subsidy can be the key to environmental solutions. Research implications: The research contributed theoretically to the literature review and managerial and political questionnaire indicating the priority points for public and private investments. Originality/value: The research points out investment points to make urban mobility more sustainable and at the same time profitable for transport companies

Exploration and Stratification of Factors Contributing to the Improvement of Physicians’ and Nurses’ Satisfaction with Pharmacists’ Ward Pharmacy Services

This study was conducted based on a questionnaire survey addressed to physicians and nurses, who were in direct contact with pharmacists on their wards, in order to explore and stratify the factors contributing to the improvement of physicians’ and nurses’ satisfaction with the pharmacists’ ward pharmacy services. The participants were physicians and nurses working in wards of Tokyo Teishin Hospital who had given their consent to participate. The questionnaire asked the pharmacists to respond to seven questions regarding their ward pharmaceutical services and their overall evaluation. The customer satisfaction (CS) analysis showed that, for physicians, the priority improvement areas were participation in discussion rounds and conferences and participation in team medicine; for nurses, in addition to these points, confirmation of prescription content and monitoring of drug effects and side effects were priority points. Factor analysis showed that three factors were extracted for physicians and two factors for nurses, and they were categorized into several clusters. The CS analysis showed that both physicians and nurses desired more active involvement of pharmacists in discussion rounds and team care, and different factors were extracted for physicians and nurses, suggesting that the evaluation of ward pharmacy services differed between occupations.

Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation

The results of liver transplantation are excellent, with survival rates of over 90 and 80% at 1 and 5 years, respectively. The success of liver transplantation has led to an increase in the indications for liver transplantation. Generally, priorities are given to cirrhotic patients with a high Model for End-Stage Liver Disease (MELD) score on the principle of the sickest first and to patients with hepatocellular carcinoma (HCC) on the principle of priority points according to the size and number of nodules of HCC. These criteria can lead to a ‘competition’ on the waiting list between the above patients and those who are cirrhotic and have an intermediate MELD score or with life-threatening liver diseases not well described by the MELD score. For this latter group of patients, ‘MELD exception’ points can be arbitrarily given.

Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation

The results of liver transplantation are excellent, with survival rates of over 90 and 80% at 1 and 5 years, respectively. The success of liver transplantation has led to an increase in the indications for liver transplantation. Generally, priorities are given to cirrhotic patients with a high Model for End-Stage Liver Disease (MELD) score on the principle of the sickest first and to patients with hepatocellular carcinoma (HCC) on the principle of priority points according to the size and number of nodules of HCC. These criteria can lead to a ‘competition’ on the waiting list between the above patients and those who are cirrhotic and have an intermediate MELD score or with life-threatening liver diseases not well described by the MELD score. For this latter group of patients, ‘MELD exception’ points can be arbitrarily given.

Influence of Population Density on CO2 Emissions Eliminating the Influence of Climate

More than 50% of the world’s population lives in cities. Its buildings consume more than a third of the energy and generate 40% of the emissions. This makes cities in general and their buildings in particular priority points of attention for policymakers and utilities. This paper uses population density as a variable to know its influence on energy consumption and emissions produced in buildings. Furthermore, to show its effect more clearly, the influence of the climate was eliminated. The usual energy consumption in buildings is thermal and electrical. The study was carried out at the city level, both per inhabitant and per household. The area actually occupied by the city was considered. The proposed method was applied to the case of Spanish cities with more than 50,000 inhabitants. The results show that the higher the population density, the higher the energy consumption per inhabitant and household in buildings. The consumption of thermal energy is elastic, while that of electrical energy is inelastic, varying more than 100% between extreme groups. Regarding CO2 emissions, the higher the population density, the higher the emissions. Emissions of electrical origin barely vary by 2% and are greater than those of thermal origin. In addition, the proportion of emissions of electrical origin, with respect to the total, decreases with increasing population density from 74% to 55%. This research aims to help policymakers and utilities to take the appropriate measures that favor the use of renewable energies and reduce CO2 emissions.

Seasonal Tourism in Pangururan District, Samosir Regency, Indonesia

Abstract. Indonesia has a variety of tribes and cultures that cannot be separated from the natural beauty which is a tourist destination for the beauty of Lake Toba in North Sumatra. Pangururan District, Samosir Regency is one of the priority points of tourists because Pangururan District is the capital of Samosir Regency so that the impact of the influence of tourist destinations becomes a strategic area for national and international tourism. A person's fatigue in carrying out daily activities makes travelling one of the solutions to calm the mind after facing someone's busy life. Tourism has categories according to conditions, one of which is tourism. Tourism is defined as a form of sustainable tourist visits, in terms of attracting local and non-local tourists with the condition of a tourist destination provided with the natural beauty of Pangururan District, Samosir Regency. Tourism that occurs with tourist visits based on the holiday season and weekdays on tourist visits has increased during holidays with a high number compared to normal days. Tourism management still provides the best service so that tourists don't just drink. In this case, tourism shows the condition of tourists who visit during the holiday season so that they get a response so that the improvement of tourism management is better, this is evidenced by showing the results of field observations. With regard to tourism, it shows that the results are processed based on the opinion of the community as both visitors and local people

The Effect of Priority Given to Donor Card Holders on the Allocation of Livers for Transplant-Evidence From 7 Years of the Israeli Priority Program.

The Israeli Transplant Law grants priority in organ allocation to patients signing a donor card. Liver transplant candidates get additional 2 points on their Model for End Stage Liver Disease score for signing a donor card, 0.1 points for a relative holding a card, and 5 points if a relative donated an organ. We studied the effect of the priority program on waiting list mortality and allocation changes due to priority. Using Israeli Transplant data of 531 adult liver transplant candidates with chronic liver disease listed between 2012 and 2018 we compared waitlist mortality and transplant rate of candidates with and without priority. Then we analyzed liver allocations resulting from additional priority points and followed outcome of patients who were skipped in line. Of the 519 candidates, 294 did not sign a donor card, 82 signed, 140 had a relative sign, and for 3, a relative donated an organ. The rates of waitlist mortality in these 4 groups were 22.4%, 0%, 21.4%, and 0%, respectively, and the transplant rates were 50%, 59.8%, 49.3%, and 100%, respectively. Of the 30 patients who were skipped because of priority, 24 subsequently underwent transplant, 2 are on the waiting list, and 4 died within 0.75, 1.75, 7, and 17 mo. The 2 points added to the Model for End Stage Liver Disease score were associated with lower waitlist mortality and higher transplant rate for candidates signing a donor card without significantly affecting access to transplant during allocation. Further research and consideration of optimal policy when granting priority for candidates signing a donor card should continue.

SOSTAUGA project: reduction of water consumption and evaluation of potential uses for endogenous resources

PurposeThe University of A Coruña (UDC) elaborated the SOSTAUGA project, aiming to reach a higher sustainable level of its water management. SOSTAUGA defined four priority points of action: the restoration of the natural courses on the campus; the adoption of an ecological sanitation model; the sustainable management of urban runoff; and the reduction of water consumption in university facilities and activities. This paper aims to present the methodology, the actions and the results related to the reduction of water consumption and the potential for the use of endogenous resources.Design/methodology/approachThe agents involved were the senior management of the centres, the committees of the Green Campus, the scholarship students and the Office for the Environment. Several actions have been experienced: audit of water consumption in sanitary services; flow reduction in washbasin taps by means of valve adjustment (and repair of the valves when necessary); replacement of tap aerators with other more eco-efficient ones; replacement of faucets; introduction of dual-flush (DF) in cisterns; and information to users (eco-label).FindingsWater audit reached 68% of the total number of washbasins and tanks in the UDC. Efficient aerator installation covered 16% of taps and valve adjustment covered the further 33.5% and provided flow reduction of 42%. Another 20% of valve units required repair. The current situation in toilets combines tankless flush valves and cisterns with single flush mechanisms. The introduction of DF mechanisms was assessed and proposed. The cost of these actions was very low, as evidenced by the investment return period while showing a high potential for user awareness.Originality/valueBoth from the environmental (water saving) and from the economic and social points of view, this study shows that similar projects aimed at the efficient and rational use of water are applicable to the universities and other public and private schools, with potentially positive results on sustainability and people awareness.

Levers and leverage points for pathways to sustainability

Abstract Humanity is on a deeply unsustainable trajectory. We are exceeding planetary boundaries and unlikely to meet many international sustainable development goals and global environmental targets. Until recently, there was no broadly accepted framework of interventions that could ignite the transformations needed to achieve these desired targets and goals. As a component of the IPBES Global Assessment, we conducted an iterative expert deliberation process with an extensive review of scenarios and pathways to sustainability, including the broader literature on indirect drivers, social change and sustainability transformation. We asked, what are the most important elements of pathways to sustainability? Applying a social–ecological systems lens, we identified eight priority points for intervention (leverage points) and five overarching strategic actions and priority interventions (levers), which appear to be key to societal transformation. The eight leverage points are: (1) Visions of a good life, (2) Total consumption and waste, (3) Latent values of responsibility, (4) Inequalities, (5) Justice and inclusion in conservation, (6) Externalities from trade and other telecouplings, (7) Responsible technology, innovation and investment, and (8) Education and knowledge generation and sharing. The five intertwined levers can be applied across the eight leverage points and more broadly. These include: (A) Incentives and capacity building, (B) Coordination across sectors and jurisdictions, (C) Pre‐emptive action, (D) Adaptive decision‐making and (E) Environmental law and implementation. The levers and leverage points are all non‐substitutable, and each enables others, likely leading to synergistic benefits. Transformative change towards sustainable pathways requires more than a simple scaling‐up of sustainability initiatives—it entails addressing these levers and leverage points to change the fabric of legal, political, economic and other social systems. These levers and leverage points build upon those approved within the Global Assessment's Summary for Policymakers, with the aim of enabling leaders in government, business, civil society and academia to spark transformative changes towards a more just and sustainable world. A free Plain Language Summary can be found within the Supporting Information of this article.