Syed T. Hussain

The close linkages between climate change adaptation and development have led to calls for addressing the two issues in an integrated way. ‘Mainstreaming' climate information, policies and measures into ongoing development planning and decision-making has been proposed as one solution, making a more sustainable, effective and efficient use of resources than designing and managing climate policies separately from ongoing activities. But what does mainstreaming look like in practice? This paper reviews the process of mainstreaming in Bangladesh, one of the countries that has made significant progress on adaptation planning and mainstreaming. The paper begins by making the case for mainstreaming, by exploring linkages and trade-offs between adaptation and development and reviewing the literature on mainstreaming. Second, it considers how to implement mainstreaming in practice, reviewing an existing four-step framework. Examining this framework against the plethora of mainstreaming experiences in Bangladesh, the paper considers how the framework can be used as a tool to review progress on mainstreaming in Bangladesh. The paper concludes that while the framework is useful for considering some of the preconditions necessary for mainstreaming, experiences in Bangladesh reflect a much more complex patchwork of processes and stakeholders that need to be taken into consideration in further research.

The close linkages between climate change adaptation and development have led to calls for addressing the two issues in an integrated way. ‘Mainstreaming’ climate information, policies and measures into ongoing development planning and decision‐making has been proposed as one solution, seen as making more sustainable, effective and efficient use of resources than designing and managing climate policies separately from ongoing development activities. But what does mainstreaming look like in practice? This article explores the process of mainstreaming, drawing on the country case study of Bangladesh, one of the countries that have made significant progress on adaptation planning and mainstreaming. The article begins by making the case for mainstreaming, by exploring the linkages and trade‐offs between adaptation and development and describing the various approaches to mainstreaming from the literature. Second, it considers how to implement mainstreaming in practice, reviewing an existing four‐step framework. Examining this framework against the plethora of mainstreaming experiences in Bangladesh, the article considers how the framework can be used as a tool for assessing the progress of mainstreaming progress in Bangladesh. The article concludes that while the framework is useful for considering some of the preconditions necessary for getting mainstreaming underway, experiences of mainstreaming in Bangladesh reflect a much more complex patchwork of processes and stakeholders that need to be taken into consideration in further research on this topic. WIREs Clim Change 2014, 5:37–51. doi: 10.1002/wcc.226 This article is categorized under: Climate and Development > Knowledge and Action in Development

Objective: This study aimed to evaluate the impact of cardiopulmonary bypass for thoraco-abdominal normothermic regional perfusion on the metabolic milieu of donation after cardiac death organ donors before transplantation. Methods: Local donation after cardiac death donor offers are assessed for suitability and willingness to participate. Withdrawal of life-sustaining therapy is performed in the operating room. After declaration of circulatory death and a 5-minute observation period, the cardiac team performs a median sternotomy, ligation of the aortic arch vessels, and initiation of thoraco-abdominal normothermic regional perfusion via central cardiopulmonary bypass at 37 °C. Three sodium chloride zero balance ultrafiltration bags containing 50 mEq sodium bicarbonate and 0.5 g calcium carbonate are infused. Arterial blood gas measurements are obtained every 15 minutes after every zero balance ultrafiltration bag is infused, and blood is transfused as needed to maintain hemoglobin greater than 8 mg/dL. Cardiopulmonary bypass is weaned with concurrent hemodynamic and transesophageal echocardiogram evaluation of the donor heart. The remainder of the procurement, including the abdominal organs, proceeds in a similar controlled fashion as is performed for a standard donation after brain death donor. Results: .001) . On average, donation after cardiac death donors received transfusions of 2.3 ± 1.5 units of packed red blood cells. Of the 18 donors who underwent normothermic regional perfusion, all hearts were deemed suitable for recovery and successfully transplanted, a yield of 100%. Other organs successfully recovered and transplanted include kidneys (80.6% yield), livers (66.7% yield), and bilateral lungs (27.8% yield). Conclusions: The use of cardiopulmonary bypass for thoraco-abdominal normothermic regional perfusion is a burgeoning option for improving the quality of organs from donation after cardiac death donors. Meticulous intraoperative management of donation after cardiac death donors with a specific focus on improving their metabolic milieu may lead to improved graft function in transplant recipients.