ABSTRACT
P4 Table 1Characteristics of the subjectsCharacteristics Subjects with ILAs on LDCT (n = 39) Age, yr, mean (± SD) 68.8 (± 4.3) Gender, n (%) Female 15 (38.5) Male 24 (61.5) Smoking status, n (%) Current 7 (17.9) Ex 32 (82.1) Respiratory symptoms, n (%) None 19 (48.7) Cough 3 (7.7) Dyspnoea 9 (23.1) Cough & dyspnoea 6 (15.4) N/A 2 (5.1) Physical examination findings, n (%) None 5 (12.8) Crackles 17 (43.6) N/A 17 (43.6) Baseline lung function,%pred, median (range) FEV1,% pred 91 (58 – 130) FVC,% pred 94.8 (65 – 143) TLco,% pred 57.6 (28.4 – 98.8) Kco,% pred 79.5 (36.4 – 94) MDT Diagnosis ILAs, n (%) 8 (20.5) ILD, n (%) IPF 14 (35.9) Smoking-related ILD 6 (15.4) Hypersensitivity pneumonitis 4 (10.3) PPFE 3 (7.7) Sarcoidosis 1 (2.6) Post-COVID ILD 1 (2.6) Vasculitis 1 (2.6) Unclassifiable 1 (2.6) Treatment, n (%) Smoking cessation advice 6 (15.4) Antifibrotic 7 (17.9) Immunomodulatory treatment 2 (5.1) None 23 (59) ResultsILAs of >5% extent on LDCT were identified in 39/1853 (2.1%) subjects screened between August 2018 and April 2021 (table 1). Respiratory symptoms were present in 18/39 (46.1%) and crackles were auscultated in 17 of 22 subjects (77.3%) undergoing physical examination. Past exposure to potential environmental triggers was noted in 21/39 (53.8%). Diagnostic bronchoalveolar lavage was performed in 7/39 (17.9%) and one patient underwent transbronchial lung cryobiopsy. After MDT discussion, ILD was concluded in 31/39 (79.5%) cases, of which 14/31 (45.2%) were diagnosed with IPF. In the IPF subgroup, antifibrotics were initiated in 7/14 (50%) of cases. In those diagnosed with other ILDs, immunomodulatory treatment was initiated in 2/25 (8%) subjects.ConclusionA large proportion of individuals with newly identified ILAs have an abnormal clinical examination and respiratory symptoms, consistent with the widely held suspicion that ILD is underdiagnosed in the community. Lung cancer screening in this demographic provides a unique opportunity to address this unmet health metric. Earlier identification of ILD, specifically IPF, allows institution of antifibrotic therapies proven to modify the natural history of the disease by preserving lung function and extending life. The cost-effectiveness of this approach for ILD screening warrants detailed evaluation.
ABSTRACT
The 2015 Paris Agreement is falling short of its aspirations, as signatory countries are struggling to implement the policies required to meet the targets. The global scenario framework formed by the Shared Socioeconomic Pathways (SSPs) and the Representative Concentration Pathways (RCPs) places little emphasis on the dynamics of climate policy implementation. Social science approaches to understanding these dynamics are not well-integrated into climate scenario research. We apply an implementation research approach to analyse the transition to clean energy in the US and China, as well as two examples from Europe–Germany and Spain–which have shown markedly diverging implementation trajectories. We propose four implementation scenarios (ISs) for clean energy worldwide which relate to different configurations of actors in the policy system. These are: (1) Civil Society Takes Control (IS1)–where ideologically opposed governments are marginalised by citizens and forward-thinking investors;(2) Strong-arm Transition (IS2)–where a single party state drives the transition without the involvement of civil society;(3) Systemic Limits (IS3)–which highlights the need to focus on the whole energy system, not just renewables;and (4) Renewable Austerity (IS4)–where an economic downturn offers powerful anti-transition actors the opportunity to advocate removal of support for climate mitigation, as they did after the 2007–2008 financial crisis. This scenario could be repeated as countries seek to recover from the Covid-19 pandemic. Our study offers a framework for structured analysis of real-world constraints faced by implementing actors, which we argue is urgently needed to help national and international policy makers achieve climate goals. Key policy insights The world is struggling to implement the Paris Agreement, partly because the complex dynamics of climate policy implementation are poorly understood. Social science approaches to understanding these dynamics are not well-integrated into climate scenario research. Implementation research focussing on the actors and context provides a useful framework for analysis of implementation efforts from major global carbon emitters. The approach offers new and distinctive scenario narratives that go beyond Representative Concentration Pathways (RCPs) and Shared Socioeconomic Pathways (SSPs). These new scenarios can help policy makers evaluate likely outcomes of climate policy implementation based on information about actors and context. © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.