PURPOSE: To analyze outcomes of surgical and conservative treatment options for multidirectional instability (MDI). METHODS: A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. A comprehensive search of the PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar databases using various combinations of the keywords 'shoulder,' 'multidirectional instability,' 'dislocation,' 'inferior instability,' 'capsulorrhaphy,' 'capsular plication,' 'capsular shift,' 'glenoid,' 'humeral head,' 'surgery,' and 'glenohumeral,' over the years 1966 to 2014 was performed. RESULTS: Twenty-four articles describing patients with open capsular shift, arthroscopic treatment, and conservative or combined management in the setting of atraumatic MDI of the shoulder were included. A total of 861 shoulders in 790 patients was included. The median age was 24.3 years, ranging from 9 to 56 years. The dominant side was involved in 269 (58%) of 468 shoulders, whereas the nondominant side was involved in 199 (42%) shoulders. Patients were assessed at a median follow-up period of 4.2 years (ranging from 9 months to 16 years). Fifty-two of 253 (21%) patients undergoing physiotherapy required surgical intervention for MDI management, whereas the overall occurrence of redislocation was seen in 61 of 608 (10%) shoulders undergoing surgical procedures. The redislocation event occurred in 17 of 226 (7.5%) shoulders with open capsular shift management, in 21 of 268 (7.8%) shoulders with arthroscopic plication management, in 12 of 49 (24.5%) shoulders undergoing arthroscopic thermal shrinkage, and in 11 of 55 (22%) shoulders undergoing arthroscopic laser-assisted capsulorrhaphy. CONCLUSIONS: Arthroscopic capsular plication and open capsular shift are the best surgical procedures for treatment of MDI after failure of rehabilitative management. Arthroscopic capsular plication shows results comparable to open capsular shift. LEVEL OF EVIDENCE: Level IV, systematic review of Level I to IV studies

Disposal Operations

Governance of Oceans Through Regional Seas

The excessive release of nitrogen compounds into the environment is one of the biggest problems of our time. Nitrogen compounds, such as nitrogen oxides and ammonia, pollute the environment and endanger human health in numerous and complex ways.

OBJECTIVES: To evaluate (1) the state of the art in sustainability research and (2) the outcomes of professionals' adherence to guideline recommendations in medical practice. DESIGN: Systematic review. DATA SOURCES: Searches were conducted until August 2015 in MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and the Guidelines International Network (GIN) library. A snowball strategy, in which reference sections of other reviews and of included papers were searched, was used to identify additional papers. ELIGIBILITY CRITERIA: Studies needed to be focused on sustainability and on professionals' adherence to clinical practice guidelines in medical care. Studies had to include at least 2 measurements: 1 before (PRE) or immediately after implementation (EARLY POST) and 1 measurement longer than 1 year after active implementation (LATE POST). RESULTS: The search retrieved 4219 items, of which 14 studies met the inclusion criteria, involving 18 sustainability evaluations. The mean timeframe between the end of active implementation and the sustainability evaluation was 2.6 years (minimum 1.5-maximum 7.0). The studies were heterogeneous with respect to their methodology. Sustainability was considered to be successful if performance in terms of professionals' adherence was fully maintained in the late postimplementation phase. Long-term sustainability of professionals' adherence was reported in 7 out of 18 evaluations, adherence was not sustained in 6 evaluations, 4 evaluations showed mixed sustainability results and in 1 evaluation it was unclear whether the professional adherence was sustained. CONCLUSIONS: (2) Professionals' adherence to a clinical practice guideline in medical care decreased after more than 1 year after implementation in about half of the cases. (1) Owing to the limited number of studies, the absence of a uniform definition, the high risk of bias, and the mixed results of studies, no firm conclusion about the sustainability of professionals' adherence to guidelines in medical practice can be drawn

In 2014 the Research Bureau of the People’s Bank of China convened a Green Finance Task Force made up of 40 experts from ministries, financial regulators, academics, banks and other financial institutions, complemented by international experts brought together by the UNEP Inquiry to consider the steps that China could take to establish a green financial system.This detailed report on one of the fourteen recommendations complements the main report."

Intercity Passenger Transport (Case: HSR)Freight Transport (Case: Dedicated Corridors)Alternate Freight Infrastructure Choices (Case: Coal?by?Wire Option)Adapting to Changing Climate (Case: Konkan Railways)

Agenda for the First Meeting of the African Ocean Governance Strategy

Este documento visa apresentar aos decisores políticos das cidades um conjunto de oito mensagens-chave que a ONU Meio Ambiente reconhece como fundamentais para tornar as cidades mais eficientes no uso de recursos. O documento também traz exemplos concretos de políticas locais bem-sucedidas. Cada mensagem apresenta um estudo de caso de uma cidade para destacar os benefícios das medidas tomadas para aumentar a eficiência dos recursos.

Following the endorsement of the UNEP Indigenous Peoples’ Policy Guidance in 2012, UNEP has continuously improved its engagement with Indigenous Peoples’ representatives and experts and has ensured Indigenous Peoples’ participation, including from previous or current UNPFII Forum members in relevant workshops, meetings and conferences throughout the year 2014. Indigenous experts have substantially contributed to more integrated perspectives on topics such as the development of indicators on land rights and land tenure in the context of the Sustainable Development Goals (SDGs) and the Post‐2015 Development Agenda, changes in the Arctic (UNEP Live), environmental management and monitoring (UNEP Year Book 2014 , Chapter 6, Citizen Science) as well as the first Global Intergovernmental Multi‐stakeholder Consultation on ‐the Sixth Global Environmental Outlook (GEO 6), October 2014, which agreed that the GEO‐6 analysis should draw on diverse knowledge systems, including the use of accepted guidelines for using peer reviewed scientific literature, grey literature, data, and indigenous and local knowledge.

Casio

This desktop review was undertaken with the aim of identifying key stakeholders and partners at continental, sub-regional, basin, national and local levels, with a particular focus on a wide range of actors such as intergovernmental institutions, regional economic commissions, government agencies, development partners, non-states actors, and research institutions working in the pursuit for adaptation solutions in the Nile Basin.

Adequate, appropriate finance is crucial for sustainable development in the Asia-Pacific region. The United Nations Economic and Social Commission for Asia and the Pacific UN (ESCAP) estimates that the region needs to invest around US$2.5 trillion a year between 2013 and 2030 to achieve key sustainable development goals. The region’s developing financial and capital markets provide a unique opportunity for innovative financial and capital market policies, regulations and standards that can align private capital flows to the financing needs of sustainable development. Notably, the region’s savings, US$8.4 trillion in 2012, represents more than half of the world’s total savings, the channeling of which will make a significant difference to regional and international progress towards sustainable development.

Fortalecer las capacidades científicas y recopilación de datos para el monitoreo

Achieving sustainable development requires investment in an inclusive, green economy. Today, mismatches between what is financed and what needs financing contributes to continued environ¬mental deterioration of natural capital and insufficient investment in infrastruc¬ture and people to secure inclusive prosperity. Financial decision-making responds to price and policy signals in the real econo¬my, but is also impacted by how the financial system is organized, informed par¬ticularly by the actions of the financial system’s governing institutions, including government ministries, central banks and regulators, and rating agencies, stan¬dard setters and stock exchanges. The UNEP Inquiry has explored how changes in financial system design can bring the environment more effectively into financial decision-making. Its insights have been informed by an international Advisory Council and insights from practical country experience and extensive international engagement and research reflected in over fifty research papers. The Inquiry’s insights suggest an historic opportunity in shaping a financial sys¬tem that can more effectively finance the development of an inclusive, green economy. Such an opportunity can be achieved through leadership commit¬ted to developing the financial system to ensure it meets its broader purpose through complementary and coordinated action by financing institutions, those governing the system, and policymakers. The Inquiry’s Three Key Messages Are That: Financing for sustainable development can be delivered through action within the financial system, as well as in the real economy. Policy innovations from developing and developed countries demonstrate how the financial system can be better aligned with sustainable development. Systematic national action can now be taken to shape a sustainable financial system, complemented by international cooperation.

Much of the most creative reform to green the financial system is taking place in countries as diverse as Brazil, China, Indonesia, and South Africa. Leadership from the less developed countries is, for understandable reasons, rarer so the case of Bangladesh stands out. Taking full advantage of its broad mandate, the Bangladesh Bank has launched a series of pioneering initiatives to stimulate the rapid growth of green and inclusive finance, hoping thus to accelerate the transformation of the wider finance and capital markets in the same direction. The below panel, moderated by Mark Halle, Vice-President, Strategy and Executive Director of IISD-Europe, will discuss a series of questions, drawing on the case of Bangladesh and comparing it with experience from other developing countries.

UNEP Regional cooperation

This report provides the accessible scientific basis and validation for the statements and recommendations made in the Summary for Policy-makers: Arctic Pollution Issues 2015 reporti that was delivered to Arctic Council Ministers at their meeting in Iqaluit, Canada in April 2015. It is also the basis for a related AMAP State of the Arctic Environment report Arctic Pollution Issues 2015: Overviewii. It includes extensive background data and references to the scientific literature, and details the sources for graphics reproduced in the overview report. Whereas the Summary for Policy-makers report contains recommendations that focus mainly on policy-relevant actions concerned with addressing contaminant impacts on Arctic human populations, the conclusions and recommendations presented in this report also cover issues of a more scientific nature, such as proposals for filling gaps in knowledge, and recommendations relevant to future monitoring and research work.

BACKGROUND: Despite considerable evidence showing the importance of the nursing and midwifery workforce, there are no systematic reviews outlining how these cadres are best supported to provide universal access and reduce health care disparities at the primary health care (PHC) level. This review aims to identify nursing and midwifery policy, staffing, education and training interventions, collaborative efforts and strategies that have improved the quantity, quality and relevance of the nursing and midwifery workforce leading to health improvements for vulnerable populations. METHODS: We undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The quality of retrieved papers was appraised using standard tools. The characteristics of screened papers were described, and a deductive qualitative content analysis methodology was applied to analyse the interventions and findings of included studies using a conceptual framework. RESULTS: Thirty-six papers were included in the review, the majority (25) from high-income countries and nursing settings (32). Eleven papers defined leadership and governance approaches that had impacted upon the health outcomes of disadvantaged groups including policies at the national and state level that had led to an increased supply and coverage of nursing and midwifery staff and scope of practice. Twenty-seven papers outlined human resource management strategies to support the expansion of nurse's and midwives' roles that often involved task shifting and task sharing. These included approaches to managing staffing supply, distribution and skills mix; workloads; supervision; performance management; and remuneration, financial incentives and staffing costs. Education and training activities were described in 14 papers to assist nurses and midwives to perform new or expanded roles and prepare nurses for inclusive practice. This review identified collaboration between nurses and midwives and other health providers and organizations, across sectors, and with communities and individuals that resulted in improved health care and outcomes. CONCLUSIONS: The findings of this review confirm the importance of a conceptual framework for understanding and planning leadership and governance approaches, management strategies and collaboration and education and training efforts to scale up and support nurses and midwives in existing or expanded roles to improve access to PHC for vulnerable populations

BACKGROUND: Although community engagement (CE) is widely used in health promotion, components of CE models associated with improved health are poorly understood. This study aimed to examine the magnitude of the impact of CE on health and health inequalities among disadvantaged populations, which methodological approaches maximise the effectiveness of CE, and components of CE that are acceptable, feasible, and effective when used among disadvantaged populations. DESIGN: The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We carried out methodological assessments of the included studies using rating scales. The analysis focussed on model synthesis to identify the key CE components linked to positive study outcomes and comparative analysis between positive study outcomes, processes, and quality indicators of CE. RESULTS: Out of 24 studies that met our inclusion criteria, 21 (87.5%) had positively impacted health behaviours, public health planning, health service access, health literacy, and a range of health outcomes. More than half of the studies (58%) were of good quality, whereas 71% and 42% of studies showed good community involvement in research and achieved high levels of CE, respectively. Key CE components that affected health outcomes included real power-sharing, collaborative partnerships, bidirectional learning, incorporating the voice and agency of beneficiary communities in research protocol, and using bicultural health workers for intervention delivery. CONCLUSIONS: The findings suggest that CE models can lead to improved health and health behaviours among disadvantaged populations if designed properly and implemented through effective community consultation and participation. We also found several gaps in the current measurement of CE in health intervention studies, which suggests the importance of developing innovative approaches to measure CE impact on health outcomes in a more rigorous way