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Significant social and healthcare inequalities exist in the provision and access to bereavement services. An aging population and the deaths related to the Covid-19 pandemic mean that more people are experiencing bereavement. This has accelerated the need to address this crucial area of psychological, social and healthcare support. We aimed to analyse the experiences of those bereaved in the last five years by drawing on data from the UK Commission on Bereavement (UKCB) to explore how age, gender, ethnicity, and sexual orientation were perceived to impact on inequalities relating to access, effectiveness, satisfaction, and delivery of services. We carried out a qualitative thematic secondary analysis of free text data of 1,119 survey responses of adult members of the public who had been bereaved in the last five years, and of 130 survey responses from organisations and professionals working with bereaved people. Free text responses from the public adult survey were categorised by group (age, gender, ethnicity, sexual orientation), and the organisational survey responses were categorised by responses relating to these groups. These were then analysed using qualitative methods. The adult survey and organisational survey were studied separately to identify patterns and themes before combining the themes together. We found that those over 50 years old often reported not wanting to cause a fuss, saw seeking help as a weakness and were reluctant to access digital support. Family pressures, lack of time, and perceptions of less support available for younger people were reported in respondents under 50 years. Participants from ethnic minority groups found the value of support was compromised where there were language barriers and a lack of cultural and religious understanding. LBGTQ+ respondents valued non-judgemental understanding and a feeling of belonging from support where this is lacking on a wider level. Men leaned towards a preference for more informal and practical support. Age, gender, ethnicity, or sexual orientation affected many respondents’ access to formal and informal bereavement support as well as the effectiveness, satisfaction, and delivery of services. This report contributes recommendations which add to those of the UKCB, which can help to reduce inequalities in effective bereavement support.

Idiopathic pulmonary fibrosis (IPF) consists of fibrotic alveolar remodeling and progressive loss of pulmonary function. Genetic and experimental evidence indicates that chronic alveolar injury and failure to properly repair the respiratory epithelium are intrinsic to IPF pathogenesis. Loss of alveolar type 2 (AT2) stem cells or mutations that either impair their self-renewal and/or impair their differentiation into AT1 cells can serve as a trigger of pulmonary fibrosis. Recent reports indicate increased YAP activity in respiratory epithelial cells in IPF lungs. Individual IPF epithelial cells with aberrant YAP activation in bronchiolized regions frequently co-express AT1, AT2, conducting airway selective markers and even mesenchymal or EMT markers, demonstrating ‘indeterminate’ states of differentiation and suggesting that aberrant YAP signaling might promote pulmonary fibrosis. Yet, Yap and Taz have recently also been shown to be important for AT1 cell maintenance and alveolar epithelial regeneration after Streptococcus pneumoniae-induced injury. To investigate how epithelial Yap/Taz might promote pulmonary fibrosis or drive alveolar epithelial regeneration, we inactivated the Hippo pathway in AT2 stem cells resulting in increased nuclear Yap/Taz, and found that this promotes their alveolar regenerative capacity and reduces pulmonary fibrosis following bleomycin injury by pushing them along the AT1 cell lineage. Vice versa, inactivation of both Yap1 and Wwtr1 (encoding Taz) or Wwtr1 alone in AT2 cell stem cells impaired alveolar epithelial regeneration and resulted in increased pulmonary fibrosis upon bleomycin injury. Interestingly, the inactivation of only Yap1 in AT2 stem cells promoted alveolar epithelial regeneration and reduced pulmonary fibrosis. Together, these data suggest that epithelial Yap promotes, and epithelial Taz reduces pulmonary fibrosis suggesting that targeting Yap but not Taz-mediated transcription might help promote AT1 cell regeneration and treat pulmonary fibrosis.

It is well known that supplemental oxygen used to treat preterm infants in respiratory distress is associated with permanently disrupting lung development and the host response to influenza A virus (IAV). However, many infants who go home with normally functioning lungs are also at risk for hyperreactivity after a respiratory viral infection. We recently reported a new, low-dose hyperoxia mouse model (40% for 8 days; 40×8) that causes a transient change in lung function that resolves, rendering 40×8 adult animals functionally indistinguishable from room air controls. Here we report that when infected with IAV, 40×8 mice display an early transient activation of TGFβ signaling and later airway hyperreactivity associated with peribronchial inflammation (profibrotic macrophages) and fibrosis compared with infected room air controls, suggesting neonatal oxygen induced hidden molecular changes that prime the lung for hyperreactive airways disease. Although searching for potential activators of TGFβ signaling, we discovered that thrombospondin-1 (TSP-1) is elevated in naïve 40×8 mice compared with controls and localized to lung megakaryocytes and platelets before and during IAV infection. Elevated TSP-1 was also identified in human autopsy samples of former preterm infants with bronchopulmonary dysplasia. These findings reveal how low doses of oxygen that do not durably change lung function may prime it for hyperreactive airways disease by changing expression of genes, such as TSP-1, thus helping to explain why former preterm infants who have normal lung function are susceptible to airway obstruction and increased morbidity after viral infection.

Idiopathic pulmonary fibrosis (IPF) consists of fibrotic alveolar remodeling and progressive loss of pulmonary function. Genetic and experimental evidence indicate that chronic alveolar injury and failure to properly repair the respiratory epithelium are intrinsic to IPF pathogenesis. Loss of alveolar type 2 (AT2) stem cells or mutations that either impair their self-renewal and/or impair their differentiation into AT1 cells can serve as a trigger of pulmonary fibrosis. Recent reports indicate increased YAP activity in respiratory epithelial cells in IPF lungs. Individual IPF epithelial cells with aberrant Yap activation in bronchiolized regions frequently co-express AT1, AT2, conducting airway selective markers and even mesenchymal or EMT markers, demonstrating “indeterminate” states of differentiation and suggesting that aberrant Yap signaling might promote pulmonary fibrosis. Yet, Yap and Taz have recently also been shown to be important for AT1 cell maintenance and alveolar epithelial regeneration afterStreptococcus pneumoniaeinduced injury. To investigate how epithelial Yap/Taz might promote pulmonary fibrosis or drive alveolar epithelial regeneration, we inactivated the Hippo pathway in AT2 stem cells resulting in increased nuclear Yap/Taz and found that this promotes their alveolar regenerative capacity and reduces pulmonary fibrosis following bleomycin injury by pushing them along the AT1 cell lineage. Vice versa, inactivation of bothYapandTazorTazalone in AT2 cells stem cells impaired alveolar epithelial regeneration and resulted in increased pulmonary fibrosis upon bleomycin injury. Interestingly, inactivation of onlyYapin AT2 stem cells promoted alveolar epithelial regeneration and reduced pulmonary fibrosis. Together, these data suggest that epithelial Yap promotes, and epithelial Taz reduces pulmonary fibrosis suggesting that targeting Yap but not Taz mediated transcription might help promote AT1 cell regeneration and treat pulmonary fibrosis.

ObjectivesThe COVID-19 pandemic has stimulated growing research on treatment options. We aim to provide an overview of the characteristics of studies evaluating COVID-19 treatment.DesignRapid scoping reviewData sourcesMedline, Embase and biorxiv/medrxiv from inception to 15 May 2021.SettingHospital and community care.ParticipantsCOVID-19 patients of all ages.InterventionsCOVID-19 treatment.ResultsThe literature search identified 616 relevant primary studies of which 188 were randomised controlled trials and 299 relevant evidence syntheses. The studies and evidence syntheses were conducted in 51 and 39 countries, respectively.Most studies enrolled patients admitted to acute care hospitals (84%), included on average 169 participants, with an average age of 60 years, study duration of 28 days, number of effect outcomes of four and number of harm outcomes of one. The most common primary outcome was death (32%).The included studies evaluated 214 treatment options. The most common treatments were tocilizumab (11%), hydroxychloroquine (9%) and convalescent plasma (7%). The most common therapeutic categories were non-steroidal immunosuppressants (18%), steroids (15%) and antivirals (14%). The most common therapeutic categories involving multiple drugs were antimalarials/antibiotics (16%), steroids/non-steroidal immunosuppressants (9%) and antimalarials/antivirals/antivirals (7%). The most common treatments evaluated in systematic reviews were hydroxychloroquine (11%), remdesivir (8%), tocilizumab (7%) and steroids (7%).The evaluated treatment was in favour 50% and 36% of the evaluations, according to the conclusion of the authors of primary studies and evidence syntheses, respectively.ConclusionsThis rapid scoping review characterised a growing body of comparative-effectiveness primary studies and evidence syntheses. The results suggest future studies should focus on children, elderly ≥65 years of age, patients with mild symptoms, outpatient treatment, multimechanism therapies, harms and active comparators. The results also suggest that future living evidence synthesis and network meta-analysis would provide additional information for decision-makers on managing COVID-19.

In injured airways of the adult lung, epithelial progenitors are called upon to repair by nearby mesenchymal cells via signals transmitted through the niche. Currently, it is unclear whether repair is coordinated by the mesenchymal cells that maintain the niche or by the airway epithelial cells that occupy it. Here, we show that the spatiotemporal expression of Fgf10 by the niche is primarily orchestrated by the niche's epithelial occupants-both those that reside prior to, and following, injury. During homeostasis, differentiated airway epithelial cells secrete Sonic hedgehog (Shh) to inhibit Fgf10 expression by Gli1

We project climate change induced changes in fluvial flood risks for six global warming levels between 1.5 and 4 °C by 2100, focusing on the major river basins of six countries. Daily time series of precipitation, temperature and monthly potential evapotranspiration were generated by combining monthly observations, daily reanalysis data and projected changes in the five CMIP5 GCMs also selected in the ISI-MIP fast track project. These series were then used to drive the HBV hydrological model and the CaMa-Flood hydrodynamic model to simulate river discharge and flood inundation. Our results indicate that return periods of 1 in 100-year floods in the late twentieth century (Q100-20C) are likely to decrease with warming. At 1.5 °C warming, 47%, 66%, 27%, 65%, 62% and 92% of the major basin areas in Brazil, China, Egypt, Ethiopia, Ghana and India respectively experience a decrease in the return period of Q100-20C, increasing to 54%, 81%, 28%, 82%, 86% and 96% with 4 °C warming. The decrease in return periods leads to increased number of people exposed to flood risks, particularly with 4 °C warming, where exposure in the major river basin areas in the six countries increases significantly, ranging from a doubling (China) to more than 50-fold (Egypt). Limiting warming to 1.5 °C would avoid much of these increased risks, resulting in increases ranging from 12 to 1266% for the 6 countries.

The Intergovernmental Panel on Climate Change (IPCC) reports provide policy-relevant insights about climate impacts, vulnerabilities and adaptation through a process of peer-reviewed literature assessments underpinned by expert judgement. An iconic output from these assessments is the burning embers diagram, first used in the Third Assessment Report to visualize reasons for concern, which aggregate climate-change-related impacts and risks to various systems and sectors. These burning embers use colour transitions to show changes in the assessed level of risk to humans and ecosystems as a function of global mean temperature. In this Review, we outline the history and evolution of the burning embers and associated reasons for concern framework, focusing on the methodological approaches and advances. While the assessment framework and figure design have been broadly retained over time, refinements in methodology have occurred, including the consideration of different risks, use of confidence statements, more formalized protocols and standardized metrics. Comparison across reports reveals that the risk level at a given temperature has generally increased with each assessment cycle, reflecting accumulating scientific evidence. For future assessments, an explicit, transparent and systematic process of expert elicitation is needed to enhance comparability, quality and credibility of burning embers.

Ataxia-telangiectasia (A-T), caused by mutations in the A-T mutated ( ATM) gene, is a neurodegenerative disorder affecting ∼1 in 40,000–100,000 children. Recurrent respiratory infections are a common and challenging comorbidity, often leading to the development of bronchiectasis in individuals with A-T. The role of ATM in development of immune memory in response to recurrent respiratory viral infections is not well understood. Here, we infect wild-type (WT) and Atm-null mice with influenza A virus (IAV; HKx31, H3N2) and interrogate the immune memory with secondary infections designed to challenge the B cell memory response with homologous infection (HKx31) and the T cell memory response with heterologous infection (PR8, H1N1). Although Atm-null mice survived primary and secondary infections, they lost more weight than WT mice during secondary infections. This enhanced morbidity to secondary infections was not attributed to failure to effectively clear virus during the primary IAV infection. Instead, Atm-null mice developed persistent peribronchial inflammation, characterized in part by clusters of B220+B cells. Additionally, levels of select serum antibodies to hemagglutinin-specific IAV were significantly lower in Atm-null than WT mice. These findings reveal that Atm is required to mount a proper memory response to a primary IAV infection, implying that vaccination of children with A-T by itself may not be sufficiently protective against respiratory viral infections.

In acute care settings hearing loss (HL) is associated with impaired patient-provider communication, increased length of stay, and increased mortality. COVID-19 has exacerbated this problem with the widespread use of masks and eye shields which muffle speech and prevent lip reading. Our 800-bed tertiary care medical center lacked a standardized approach to identify patients with HL and address communication barriers. Three first year medical students spearheaded the initiative as part of a health systems improvement curriculum with support from a faculty coach and a faculty researcher. From September 2020 to October 2021, the students met with stakeholders, leadership and champions and unit staff, identified the current state and completed a gap analysis through interviews, surveys, and direct observation. The pilot in May 2021 included two week-long PDSA cycles on one hospital unit to: 1) screen patients aged 65 and older using the validated 10-item HHIE-S questionnaire, 2) implement an education and awareness campaign with bedside signage, posters, and conferences and 3) provide a personal amplifier (purchased in bulk by the medical center) with verbal and written instructions. A total of 29 patients screened positive and were given personal amplifiers. Post-pilot interviews reported increased provider awareness and knowledge around best communication practices. Patients and staff reported limited amplifier use due to poor sound quality, small dials, poorly fitting ear buds and a short battery life. Based on these results the team recommended discontinuing the personal amplifiers and identifying other communication tools including higher quality personal amplifiers and speech to text applications.

The potential impact of climate change on agriculture has been one of the most discussed topics in the literature on climate change. Although the possible impacts of climate change on crop yields have been widely studied, there remains little quantitative understanding of the heterogeneous economic responses to climate-induced crop yield changes in different economies, particularly at higher levels of warming. This study assesses the economic impacts of eight scenarios of warming, from 1.5 to 4 °C, on rice and wheat yields in China, India, Brazil, Egypt, Ghana and Ethiopia. The role of both natural and social factors in crop production is considered by coupling a statistical crop model (ClimaCrop) and a global economic model (GTAP). Changes in economic outputs, consumer and producer prices and national economic welfare are presented. The study shows marginal benefits of crop yield changes on GDP and welfare in China up to 3.5 and 3.0 °C, respectively. This is due to projected increases in rice yields which lower domestic consumer rice prices. Although at higher warming levels these trends begin to reverse. The other countries are negatively impacted due to declining crop yields, with increasing consumer prices of domestic and imported rice and wheat. GDP and welfare declines, with more severe reductions associated with the higher warming levels, particularly in India and Ethiopia. The method is beneficial as the economic outputs reflect a more in-depth picture of the response of global markets and ultimately regional consequences of agricultural impacts that will be of importance to decision makers.

Summarization: Global sustainability is intertwined with freshwater security. Emerging changes in global freshwater availability have been recently detected as a combined result of human interventions, natural variability and climate change. Expected future socio-economic and climatic changes will further impact freshwater resources. The quantification of the impacts is challenging due to the complexity of interdependencies between physical and socio-economic systems. This study demonstrates a vulnerability based assessment of global freshwater availability through a conceptual framework, considering transient hydro-climatic impacts of crossing specific warming levels (1.5 °C, 2 °C and 4 °C) and related socio-economic developments under high-end climate change (RCP8.5). We use high resolution climate scenarios and a global land surface model to develop indicators of exposure for 25,000 watersheds. We also exploit spatially explicit datasets to describe a range of adaptation options through sensitivity and adaptive capacity indicators according to the Shared Socioeconomic Pathways (SSPs). The combined dynamics of climate and socio-economic changes suggest that although there is important potential for adaptation to reduce freshwater vulnerability, climate change risks cannot be totally and uniformly eliminated. In many regions, socio-economic developments will have greater impact on water availability compared to climate induced changes. The number of people under increased freshwater vulnerability varies substantially depending on the level of global warming and the degree of socio-economic developments, from almost 1 billion people at 4 °C and SSP5 to almost 3 billion people at 4 °C and SSP3. Generally, it is concluded that larger adaptation efforts are required to address the risks associated with higher levels of warming of 4 °C compared to the lower levels of 1.5 °C or 2 °C. The watershed scale and country level aggregated results of this study can provide a valuable resource for decision makers to plan for climate change adaptation and mitigation actions. Παρουσιάστηκε στο: Global and Planetary Change

The earth's climate has a profound influence on the earth's ecosystems and biodiversity. Climate change is already resulting in changes in terrestrial species distributions and phenology. It is also increasing the frequency and intensity of extreme weather events, and increases in floods, heatwaves, drought, and fire are also affecting ecosystems. If global warming is not limited to 1.5°C above preindustrial levels, future projections show large and accelerating risks to biodiversity. Effects include large scale geographic range loss of over 50% for large proportions of widespread and common species of plants, animals and insects, accelerating risks of extinction, and large-scale disruption of ecosystem functioning. Biodiversity underpins the functioning of ecosystems and its loss threatens services that ecosystems provide to humans such as flood prevention, soil conservation, water purification, crop pollination, food provision, tourism, amenity, and human wellbeing. Some types of land-based climate change mitigation methods could themselves compete with biodiversity conservation. To address these risks, climate change mitigation policies would need to be aligned with carbon sequestration in terrestrial ecosystems, by eliminating deforestation and restoring ecosystems of all types.

The Paris Climate Agreement aims to hold global-mean temperature well below 2 °C and to pursue efforts to limit it to 1.5 °C above preindustrial levels. While it is recognized that there are benefits for human health in limiting global warming to 1.5 °C, the magnitude with which those societal benefits will be accrued remains unquantified. Crucial to public health preparedness and response is the understanding and quantification of such impacts at different levels of warming. Using dengue in Latin America as a study case, a climate-driven dengue generalized additive mixed model was developed to predict global warming impacts using five different global circulation models, all scaled to represent multiple global-mean temperature assumptions. We show that policies to limit global warming to 2 °C could reduce dengue cases by about 2.8 (0.8-7.4) million cases per year by the end of the century compared with a no-policy scenario that warms by 3.7 °C. Limiting warming further to 1.5 °C produces an additional drop in cases of about 0.5 (0.2-1.1) million per year. Furthermore, we found that by limiting global warming we can limit the expansion of the disease toward areas where incidence is currently low. We anticipate our study to be a starting point for more comprehensive studies incorporating socioeconomic scenarios and how they may further impact dengue incidence. Our results demonstrate that although future climate change may amplify dengue transmission in the region, impacts may be avoided by constraining the level of warming.

Climate change is already affecting species and their distributions. Distributional range changes have occurred and are projected to intensify for many widespread plants and animals, creating associated risks to many ecosystems. Here, we estimate the climate change-related risks to the species in globally significant biodiversity conservation areas over a range of climate scenarios, assessing their value as climate refugia. In particular, we quantify the aggregated benefit of countries’ emission reduction pledges (Intended Nationally Determined Contributions and Nationally Determined Contributions under the Paris Agreement), and also of further constraining global warming to 2 °C above pre-industrial levels, against an unmitigated scenario of 4.5 °C warming. We also quantify the contribution that can be made by using smart spatial conservation planning to facilitate some levels of autonomous (i.e. natural) adaptation to climate change by dispersal. We find that without mitigation, on average 33% of each conservation area can act as climate refugium (or 18% if species are unable to disperse), whereas if warming is constrained to 2 °C, the average area of climate refuges doubles to 67% of each conservation area (or, without dispersal, more than doubles to 56% of each area). If the country pledges are fulfilled, an intermediate estimate of 47–52% (or 31–38%, without dispersal) is obtained. We conclude that the Nationally Determined Contributions alone have important but limited benefits for biodiversity conservation, with larger benefits accruing if warming is constrained to 2 °C. Greater benefits would result if warming was constrained to well below 2 °C as set out in the Paris Agreement.

It is increasingly recognized that climate change could affect the quality of water through complex natural and anthropogenic mechanisms. Previous studies on climate change and water quality have mostly focused on assessing its impact on pollutant loads from agricultural runoff. A sub-daily SWAT model was developed to simulate the discharge, transport, and transformation of nitrogen from all known anthropogenic sources including industries, municipal sewage treatment plants, concentrated and scattered feedlot operations, rural households, and crop production in the Upper Huai River Basin. This is a highly polluted basin with total nitrogen (TN) concentrations frequently exceeding Class V of the Chinese Surface Water Quality Standard (GB3838-2002). Climate change projections produced by 16 Global Circulation Models (GCMs) under the RCP 4.5 and RCP 8.5 scenarios in the mid (2040-2060) and late (2070-2090) century were used to drive the SWAT model to evaluate the impacts of climate change on both the TN loads and the effectiveness of three water pollution control measures (reducing fertilizer use, constructing vegetative filter strips, and improving septic tank performance) in the basin. SWAT simulation results have indicated that climate change is likely to cause an increase in both monthly average and extreme TN loads in February, May, and November. The projected impact of climate change on TN loads in August is more varied between GCMs. In addition, climate change is projected to have a negative impact on the effectiveness of septic tanks in reducing TN loads, while its impacts on the other two measures are more uncertain. Despite the uncertainty, reducing fertilizer use remains the most effective measure for reducing TN loads under different climate change scenarios. Meanwhile, improving septic tank performance is relatively more effective in reducing annual TN loads, while constructing vegetative filter strips is more effective in reducing annual maximum monthly TN loads.

Climate change is projected to have significant effects on the distribution of species globally, but research into the implications in parts of Africa has been limited. Using species distribution modelling, this study models climate change-related risks to the terrestrial biodiversity (birds, mammals, reptiles, amphibians and plants) of Kenya’s economically-important and ecologically diverse Tana River Basin. Large reductions in species richness are projected with just 2°C warming (relative to preindustrial levels) with birds and plants seeing the greatest impact. Potential climate refugia for biodiversity are identified within the basin, but often overlap with areas already converted to agriculture or set aside for agricultural expansion, and the majority are outside protected areas. Similarly, some protected areas contain no projected refugia at higher levels of global warming, showing they may be insufficient to protect the basin’s biodiversity as climate changes. However, risks to biodiversity are much smaller if the Paris Agreement’s goal of limiting global warming to ‘well below 2°C’ warming, rather than 2°C only, is met. The potential for refugia for plants and animals decreases strongly with warming. For example, 82% of the basin remaining climatically suitable for at least 75% of the plants currently present at 1.5°C warming, as compared with 23% at 2°C and 3% at 4.5°C. This research provides the first assessment of the combined effects of development plans and climate change on biodiversity of the Tana River Basin, including identifying potential areas for restoration, and contributes to a greater understanding of biodiversity protection and adaptation options in Kenya.

Although the number of studies discerning the impact of climate change on ecological systems continues to increase, there has been relatively little sharing of the lessons learnt when accumulating this evidence. At a recent workshop entitled ‘Using climate data in ecological research’ held at the UK Met Office, ecologists and climate scientists came together to discuss the robust analysis of climate data in ecology. The discussions identified three common pitfalls encountered by ecologists: 1) selection of inappropriate spatial resolutions for analysis; 2) improper use of publically available data or code; and 3) insufficient representation of the uncertainties behind the adopted approach. Here, we discuss how these pitfalls can be avoided, before suggesting ways that both ecology and climate science can move forward. Our main recommendation is that ecologists and climate scientists collaborate more closely, on grant proposals and scientific publications, and informally through online media and workshops. More sharing of data and code (e.g. via online repositories), lessons and guidance would help to reconcile differing approaches to the robust handling of data. We call on ecologists to think critically about which aspects of the climate are relevant to their study system, and to acknowledge and actively explore uncertainty in all types of climate data. And we call on climate scientists to make simple estimates of uncertainty available to the wider research community. Through steps such as these, we will improve our ability to robustly attribute observed ecological changes to climate or other factors, while providing the sort of influential, comprehensive analyses that efforts to mitigate and adapt to climate change so urgently require.

Background This report was produced for the Canadian Task Force on Preventive Health Care to provide guidelines on screening for abdominal aortic aneurysm (AAA) with ultrasound scan. Purpose The aim of this systematic review is to examine the evidence on benefits and harms of AAA screening. Search strategy This systematic review considered studies from the most recent United States Preventive Services Task Force review on AAA screening and passed through the screening process with citations identified in our search up to April 2015 (PROSPERO Registration #CRD42015019047). Results For benefits of one-time AAA screening in men compared with controls, pooled analyses from four randomized controlled trials with moderate quality evidence showed significant reductions in AAA-related mortality and AAA rupture rate up to 13 to 15 years of follow-up with 42% reduction (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.39-0.88; number needed to screen = 212) and 38% reduction (RR, 0.62; 95% CI, 0.45-0.86; number needed to screen = 200), respectively. The effect of on all-cause mortality was marginally significant for longer follow-up. The Chichester trial examined the benefits of one-time AAA screening in women and found no significant differences between screening and control arms for up to 10 years of follow-up (RR, 0.88; 95% CI, 0.72-1.07). For consequences of one-time AAA screening in men compared with controls, there was a significant increase in the total number of AAA-related procedures over a follow-up of 13 to 15 years (2.16 times more likely) compared with controls. For harms of one-time AAA screening, no significant differences were observed in 30-day postoperative mortality for elective and emergency operations with compared control groups. Evidence from the Multicenter Aneurysm Screening Study trial using 13-year follow-up data showed that one-time AAA screening with ultrasound scan was potentially associated with an overdiagnosis of 45% (95% CI, 42%-47%) among screen-detected men. Conclusions Population-based screening for AAA with ultrasound scan in asymptomatic men aged 65 years and older showed statistically significant reductions in AAA-related mortality and rupture and, hence, avoids unnecessary AAA-related deaths. The current evidence showed no benefit of one-time AAA screening in woman. Limited evidence is available on the benefits of repeat AAA screening and targeted screening approaches based on risk factors for AAA. Future research should explore the differential benefits of AAA screening based on risk factors that increase risk for developing AAA.

To evaluate the effectiveness of colorectal cancer (CRC) screening in asymptomatic adults. A search was conducted of the Medline, Embase, and the Cochrane Library databases. A targeted search of PubMed was conducted for on-topic randomized controlled trials (RCTs). Meta-analysis across 4 RCTs for guaiac fecal occult blood testing (gFOBT) and flexible sigmoidoscopy (FS) screening showed a reduction of 18% (risk ratio [RR], 0.82; 95% CI [CI], 0.73-0.92) and 26% (RR, 0.74; 95% CI, 0.67-0.83) in CRC mortality for the screening group compared to controls, respectively. The number needed to screen (NNS) were 377 (95% CI, 249-887) and 864 (95% CI, 672-1266) for gFOBT and FS screening, respectively. A reduction of 8% and 27% in incidence of late-stage CRC was also observed for gFOBT and FS screening, respectively, but both had no significant effect on all-cause mortality. A single RCT found that screening with immunochemical fecal occult blood test (iFOBT) had no significant impact on CRC mortality (RR, 0.88; 95% CI, 0.72-1.07). Screening with FS has potential harms such as perforation, major and minor bleeding, and death from the procedure or from follow-up colonoscopy. gFOBT and FS screening reduce CRC mortality and incidence of late-stage disease. The absolute effect and NNS were much more favorable for older adults (≥ 60 years), suggesting that a targeted screening approach may avoid exposing younger adults to the harms of CRC screening, from which they are unlikely to derive any significant benefit. Although there is insufficient RCT evidence on the impact of iFOBT on mortality outcomes. compared to gFOBT, this test showed higher sensitivity and comparable specificity, indicating the need to update and reevaluate the evidence in light of future high-quality research. The protocol for this systematic review have been published with PROSPERO 2014: CRD42014009777.

Human SCGB1A1 protein has been shown to be significantly reduced in BAL, sputum, and serum from humans with asthma as compared with healthy individuals. However, the mechanism of this reduction and its functional impact have not been entirely elucidated. By mining online datasets, we found that the mRNA of SCGB1A1 was significantly repressed in brushed human airway epithelial cells from individuals with asthma, and this repression appeared to be associated with reduced expression of FOXA2. Consistently, both Scgb1A1 and FoxA2 were downregulated in an ovalbumin-induced mouse model of asthma. Furthermore, compared with wild-type mice, Scgb1a1 knockout mice had increased airway hyperreactivity and inflammation when they were exposed to ovalbumin, confirming the antiinflammatory role of Scgb1a1 in protection against asthma phenotypes. To search for potential asthma-related stimuli of SCGB1A1 repression, we tested T-helper cell type 2 cytokines. Both IL-4 and IL-13 repressed epithelial expression of SCGB1A1 and FOXA2. Importantly, infection of epithelial cells with human rhinovirus similarly reduced expression of these two genes, which suggests that FOXA2 may be the common regulator of SCGB1A1. To establish the causal role of reduced FOXA2 in SCGB1A1 repression, we demonstrated that FOXA2 was required for SCGB1A1 expression at baseline. FOXA2 overexpression was sufficient to drive promoter activity and expression of SCGB1A1 and was also able to restore the repressed SCGB1A1 expression in IL-13–treated or rhinovirus-infected cells. Taken together, these findings suggest that low levels of epithelial SCGB1A1 in asthma are caused by reduced FOXA2 expression.

ObjectiveTo compare the efficacy, effectiveness, and safety of the herpes zoster live attenuated vaccine with the herpes zoster adjuvant recombinant subunit vaccine or placebo for adults aged 50 and older.DesignSystematic review with bayesian meta-analysis and network meta-analysis.Data sourcesMedline, Embase, and Cochrane Library (inception to January 2017), grey literature, and reference lists of included studies.Eligibility criteria for study selectionExperimental, quasi-experimental, and observational studies that compared the live attenuated vaccine with the adjuvant recombinant subunit vaccine, placebo, or no vaccine in adults aged 50 and older. Relevant outcomes were incidence of herpes zoster (primary outcome), herpes zoster ophthalmicus, post-herpetic neuralgia, quality of life, adverse events, and death.Results27 studies (22 randomised controlled trials) including 2 044 504 patients, along with 18 companion reports, were included after screening 2037 titles and abstracts, followed by 175 full text articles. Network meta-analysis of five randomised controlled trials found no statistically significant differences between the live attenuated vaccine and placebo for incidence of laboratory confirmed herpes zoster. The adjuvant recombinant subunit vaccine, however, was statistically superior to both the live attenuated vaccine (vaccine efficacy 85%, 95% credible interval 31% to 98%) and placebo (94%, 79% to 98%). Network meta-analysis of 11 randomised controlled trials showed the adjuvant recombinant subunit vaccine to be associated with statistically more adverse events at injection sites than the live attenuated vaccine (relative risk 1.79, 95% credible interval 1.05 to 2.34; risk difference 30%, 95% credible interval 2% to 51%) and placebo (5.63, 3.57 to 7.29 and 53%, 30% to 73%, respectively). Network meta-analysis of nine randomised controlled trials showed the adjuvant recombinant subunit vaccine to be associated with statistically more systemic adverse events than placebo (2.28, 1.45 to 3.65 and 20%, 6% to 40%, respectively).ConclusionsUsing the adjuvant recombinant subunit vaccine might prevent more cases of herpes zoster than using the live attenuated vaccine, but the adjuvant recombinant subunit vaccine also carries a greater risk of adverse events at injection sites.Protocol registrationProspero CRD42017056389.

Advances in computing power and infrastructure, increases in the number and size of ecological and environmental datasets, and the number and type of data collection methods, are revolutionizing the field of Ecology. To integrate these advances, virtual laboratories offer a unique tool to facilitate, expedite, and accelerate research into the impacts of climate change on biodiversity. We introduce the uniquely cloud-based Biodiversity and Climate Change Virtual Laboratory (BCCVL), which provides access to numerous species distribution modelling tools; a large and growing collection of biological, climate, and other environmental datasets; and a variety of experiment types to conduct research into the impact of climate change on biodiversity.Users can upload and share datasets, potentially increasing collaboration, cross-fertilisation of ideas, and innovation among the user community. Feedback confirms that the BCCVL's goals of lowering the technical requirements for species distribution modelling, and reducing time spent on such research, are being met. BCCVL facilitates and expedites modelling of climate change's impact on biodiversity.BCCVL integrates numerous species distribution modelling tools and myriad datasets.BCCVL negates the need for advanced programming and modelling expertise.BCCVL allows for increases in productivity and complexity of experimental design.BCCVL facilitates the sharing of data promoting transparency in the research process.

West African rainfed agriculture is highly vulnerable to climate variability and change. Global warming is projected to result in higher regional warming and have a strong impact on agriculture. This study specifically examines the impact of global warming levels (GWLs) of 1.5°, 2° and 3 °C relative to 1971–2000 on crop suitability over West Africa. We used 10 Coupled Model Intercomparison Project Phase5 Global Climate Models (CMIP5 GCMs) downscaled by Coordinated Regional Downscaling Experiment (CORDEX) Rossby Centre’s regional Atmospheric model version 4, RCA4, to drive Ecocrop, a crop suitability model, for pearl millet, cassava, groundnut, cowpea, maize and plantain. The results show Ecocrop simulated crop suitability spatial representation with higher suitability, observed to the south of latitude 14°N and lower suitability to its north for 1971–2000 for all crops except for plantain (12°N). The model also simulates the best three planting months within the growing season from September-August over the past climate. Projected changes in crop suitability under the three GWLs 1.5–3.0 °C suggest a spatial suitability expansion for legume and cereal crops, notably in the central southern Sahel zone; root and tuber and plantain in the central Guinea-Savanna zone. In contrast, projected decreases in the crop suitability index value are predicted to the south of 14°N for cereals, root and tuber crops; nevertheless, the areas remain suitable for the crops. A delay of between 1-3 months is projected over the region during the planting month under the three GWLs for legumes, pearl millet and plantain. A two month delay in planting is projected in the south, notably over the Guinea and central Savanna zone with earlier planting of about three months in the Savanna-Sahel zones. The effect of GWL2.0 and GWL3.0 warming in comparison to GWL1.5 °C are more dramatic on cereals and root and tuber crops, especially cassava. All the projected changes in simulated crop suitability in response to climatic variables are statistically significant at 99% confidence level. There is also an increasing trend in the projected crop suitability change across the three warming except for cowpea. This study has implications for improving the resilience of crop production to climate changes, and more broadly, to food security in West Africa.

A wide range of climate vulnerability and risk assessments have been implemented using different approaches at different scales, some with a broad multi-sectoral scope and others focused on single risks or sectors. This paper describes the novel approach to vulnerability and risk assessment which was designed and put into practice in the United Kingdom's Second Climate Change Risk Assessment (CCRA2) so as to build upon its earlier assessment (CCRA1). First, we summarize and critique the CCRA1 approach, and second describe the steps taken in the CCRA2 approach in detail, providing examples of how each was applied in practice. Novel elements of the approach include assessment of both present day and future vulnerability, a focus on the urgency of adaptation action, and a structure focused around systems of receptors rather than conventional sectors. Both stakeholders and reviewers generally regarded the approach as successful in providing advice on current risks and future opportunities to the UK from climate change, and the fulfilment of statutory duty. The need for a well-supported and open suite of impact indicators going forward is highlighted. This article is part of the theme issue ‘Advances in risk assessment for climate change adaptation policy'.

Tuberculosis has historically thrived in some of the most impoverished and marginalized populations; however, research into why lower socio-economic populations are at a higher risk of contracting diseases remains to be a topic lacking exploration. This is becoming a more prevalent issue as multi-drug resistant Tuberculosis (MDR-TB) and extensively-drug resistant Tuberculosis (XDR-TB) are on the rise in individuals living in poverty. The main research question that will be addressed in this paper is: How do socio-economic inequalities play a role in rising incidence rates of Tuberculosis in South Africa, and what are the future challenges in dealing with MDR-TB and XDR-TB? South Africa is a particularly important country of focus because of the racial inequity that has resulted in economic disparity, and a large percentage of the population living below the poverty line. Reviews of existing literature on Tuberculosis and correlations to poverty will be critically analyzed and applied, as well as the use of government documents, including Statistics South Africa, and the World Health Organization. A cross-cultural comparison of Canada and South Africa will be included to highlight the long-term effects of marginalization societal stratification. The health care policies dealing with treatment will also be discussed, with a specific focus on social epidemiology. This paper will argue that long-term racial inequalities in South Africa has result in economic disparity, through which Black Africans and people of Colour are more susceptible to contracting TB, MDR-TB, and insufficient health resources to support them.

One and a half degrees on biodiversity Insects are the most diverse group of animals on Earth and are ubiquitous in terrestrial food webs. We have little information about their fate in a changing climate; data are scant for insects compared with other groups of organisms. Warren et al. performed a global-scale analysis of the effects of climate change on insect distribution (see the Perspective by Midgley). For vertebrates and plants, the number of species losing more than half their geographic range by 2100 is halved when warming is limited to 1.5°C, compared with projected losses at 2°C. But for insects, the number is reduced by two-thirds. Science , this issue p. 791 ; see also p. 714

Background A scoping review to characterize the literature on the use of conversations in social media as a potential source of data for detecting adverse events (AEs) related to health products. Methods Our specific research questions were (1) What social media listening platforms exist to detect adverse events related to health products, and what are their capabilities and characteristics? (2) What is the validity and reliability of data from social media for detecting these adverse events? MEDLINE, EMBASE, Cochrane Library, and relevant websites were searched from inception to May 2016. Any type of document (e.g., manuscripts, reports) that described the use of social media data for detecting health product AEs was included. Two reviewers independently screened citations and full-texts, and one reviewer and one verifier performed data abstraction. Descriptive synthesis was conducted. Results After screening 3631 citations and 321 full-texts, 70 unique documents with 7 companion reports available from 2001 to 2016 were included. Forty-six documents (66%) described an automated or semi-automated information extraction system to detect health product AEs from social media conversations (in the developmental phase). Seven pre-existing information extraction systems to mine social media data were identified in eight documents. Nineteen documents compared AEs reported in social media data with validated data and found consistent AE discovery in all except two documents. None of the documents reported the validity and reliability of the overall system, but some reported on the performance of individual steps in processing the data. The validity and reliability results were found for the following steps in the data processing pipeline: data de-identification (n = 1), concept identification (n = 3), concept normalization (n = 2), and relation extraction (n = 8). The methods varied widely, and some approaches yielded better results than others. Conclusions Our results suggest that the use of social media conversations for pharmacovigilance is in its infancy. Although social media data has the potential to supplement data from regulatory agency databases; is able to capture less frequently reported AEs; and can identify AEs earlier than official alerts or regulatory changes, the utility and validity of the data source remains under-studied. Trial registration Open Science Framework (https://osf.io/kv9hu/). Electronic supplementary material The online version of this article (10.1186/s12911-018-0621-y) contains supplementary material, which is available to authorized users.

Research findings are often inaccessible to those who need them and knowledge sharing between researchers, practitioners and community groups can be impeded by organizational, role and priority differences. This paper presents a university-community project designed to make research knowledge available to diverse users, facilitate their input, and build connections between diverse communities impacted by child disability. A team of Canadian researchers, social workers and community partners held workshops to discuss findings of a study on parenting adopted children with special needs and share research knowledge on advocacy for children with disabilities. Parents, service providers, professionals and organizations from disability and adoption communities met together in small mixed role groups to discuss the issues raised and identify priorities. Workshop material was captured to produce practical audio-visual and print documents, which were made available at no cost to all those who could use them. Formative and summative workshop evaluation concluded that project goals were achieved primarily because of ongoing community involvement and a respectful, open climate which encouraged sharing of expertise across roles and disciplines. Reflections of team members and community partners add data on the usefulness and challenges of this type of collaborative project.

Aim The evidence for self-management programmes in older adults varies in methodological approaches, and disease criteria. Using predetermined methodological criteria, we evaluated the effect of diabetes-specific self-management programme interventions in older adults. Methods The EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials databases were searched from January 1980 to November 2013, as were reference lists from systematic reviews, meta-analyses and clinical practice guidelines. A total of 13 trials met the selection criteria, which included 4517 older adult participants; 2361 participants randomized to a diabetes self-management programme and 2156 to usual care. Results The pooled effect on HbA1c was a reduction of –2 mmol/mol (–0.2%; 95% CI –0.3 to –0.1); tailored interventions [–3 mmol/mol (–0.2%; 95% CI –0.4 to –0.1)] or programmes with a psychological emphasis [–3 mmol/mol (–0.2; 95% CI –0.4 to –0.1)] were most effective. A pooled treatment effect on total cholesterol was a 5.81 mg/dl reduction (95% CI –10.33 to –1.29) and non-significant reductions in systolic and diastolic blood pressure. Conclusions Diabetes self-management programmes for older adults demonstrate a small reduction in HbA1c, lipids and blood pressure. These findings may be of greater clinical relevance when offered in conjunction with other therapies.

Background: Childhood obesity is a public health concern. One-third of North American children and youth are overweight or obese. We reviewed the evidence of behavioural and pharmacological weight-management interventions on body mass index (BMI), BMI z-score and the prevalence of overweight and obesity in children and youth. Methods: We updated the search of a previous review. We searched 4 databases up to August 2013. We included randomized trials of primary care–relevant behavioural (diet, exercise, lifestyle) and pharmacological (orlistat) interventions for treating overweight and obesity in children and youth aged 2–18 years if 6-month post-baseline data were provided for BMI, BMI z-score or prevalence of overweight and obesity. In addition, we examined secondary health outcomes such as lipid and glucose levels, blood pressure, quality of life and physical fitness. We included any study reporting harms. We performed meta-analyses when possible, and we examined the features of interventions that showed benefits. Results: Thirty-one studies (29 behavioural, 2 pharmacological and behavioural) were included. Both intervention types showed a significant effect on BMI or BMI z-score in favour of treatment (behavioural: standardized mean difference [SMD] –0.54, 95% confidence interval [CI] –0.73 to –0.36; orlistat plus behavioural: SMD –0.43, 95% CI –0.60 to –0.25). Studies reported no significant difference between groups in the likelihood of reduced prevalence of overweight or overweight and obesity. Pooled estimates for blood pressure and quality of life showed significant benefits in favour of treatment (systolic blood pressure mean difference [MD] –3.42, 95% CI –6.65 to –0.29; diastolic blood pressure MD –3.39, 95% CI –5.17 to –1.60; quality of life MD 2.10, 95% CI 0.60 to 3.60). Gastrointestinal difficulties were more common in youth taking orlistat than in the control group (risk ratio 3.77, 95% CI 2.56 to 5.55). We saw much variability across efficacious interventions. Interpretation: Low- to moderate-quality evidence suggests behavioural treatments are associated with a medium effect in terms of reduced BMI or BMI z-score compared with a small effect shown by combined pharmacological–behavioural interventions. Future research should evaluate active weight maintenance interventions in adolescents with longer follow-up and examine the effectiveness of combined pharmacological and behavioural interventions. Registration: PROSPERO no. CRD42012002754

Over-exploitation and economic underperformance are widespread in the world's fisheries. Global climate change is further affecting the distribution of marine species, raising concern for the persistence of biodiversity and presenting additional challenges to fisheries management. However, few studies have attempted to extend bioclimatic projections to assess the socio-economic impacts of climate-induced range shifts. This study investigates the potential implications of changes in relative environmental suitability and fisheries catch potential on UK fisheries by linking species distribution modelling with cost-benefit analyses. We develop scenarios and apply a multimodel approach to explore the economic sensitivity of UK fisheries and key sources of uncertainty in the modelling procedure. We projected changes in maximum potential catch of key species and the resulting responses in terms of net present value (NPV) over a 45-year period under scenarios of change in fuel price, discount rate and government subsidies. Results suggest that total maximum potential catch will decrease within the UK EEZ by 2050, resulting in a median decrease in NPV of 10%. This value decreases further when trends of fuel price change are extrapolated into the future, becoming negative when capacity-enhancing subsidies are removed. Despite the variation in predictions from alternative models and data input, the direction of change in NPV is robust. This study highlights key factors influencing future profitability of UK fisheries and the importance of enhancing adaptive capacity in UK fisheries.

The study presents a methodology to characterise short- or long-term drought events, designed to aid understanding of how climate change may affect future risk. An indicator of drought magnitude, combining parameters of duration, spatial extent and intensity, is presented based on the Standardised Precipitation Index (SPI). The SPI is applied to observed (1955–2003) and projected (2003–2050) precipitation data from the Community Integrated Assessment System (CIAS). Potential consequences of climate change on drought regimes in Australia, Brazil, China, Ethiopia, India, Spain, Portugal and the USA are quantified. Uncertainty is assessed by emulating a range of global circulation models to project climate change. Further uncertainty is addressed through the use of a high-emission scenario and a low stabilisation scenario representing a stringent mitigation policy. Climate change was shown to have a larger effect on the duration and magnitude of long-term droughts, and Australia, Brazil, Spain, Portugal and the USA were highlighted as being particularly vulnerable to multi-year drought events, with the potential for drought magnitude to exceed historical experience. The study highlights the characteristics of drought which may be more sensitive under climate change. For example, on average, short-term droughts in the USA do not become more intense but are projected to increase in duration. Importantly, the stringent mitigation scenario had limited effect on drought regimes in the first half of the twenty-first century, showing that adaptation to drought risk will be vital in these regions.

Background The clinical specialty of obstetrics is under particular scrutiny with increasing litigation costs and unnecessary tests and procedures done in attempts to prevent litigation. We aimed to identify reports evaluating or comparing the effectiveness of medical liability reforms and quality improvement strategies in improving litigation-related outcomes in obstetrics. Methods We conducted a rapid scoping review with a 6-week timeline. MEDLINE, EMBASE, LexisNexis Academic, the Legal Scholarship Network, Justis, LegalTrac, QuickLaw, and HeinOnline were searched for publications in English from 2004 until June 2015. The selection criteria for screening were established a priori and pilot-tested. We included reports comparing or evaluating the impact of obstetrics-related medical liability reforms and quality improvement strategies on cost containment and litigation settlement across all countries. All levels of screening were done by two reviewers independently, and discrepancies were resolved by a third reviewer. In addition, two reviewers independently extracted relevant data using a pre-tested form, and discrepancies were resolved by a third reviewer. The results were summarized descriptively. Results The search resulted in 2729 citations, of which 14 reports met our eligibility criteria. Several initiatives for improving the medical malpractice litigation system were found, including no-fault approaches, patient safety policy initiatives, communication and resolution, caps on compensation and attorney fees, alternative payment system and liabilities, and limitations on litigation. Conclusions Only a few litigation policies in obstetrics were evaluated or compared. Included documents showed that initiatives to reduce medical malpractice litigation could be associated with a decrease in adverse and malpractice events. However, due to heterogeneous settings (e.g., economic structure, healthcare system) and variation in the outcomes reported, the advantages and disadvantages of initiatives may vary. Electronic supplementary material The online version of this article (10.1186/s13643-017-0569-5) contains supplementary material, which is available to authorized users.

Climate mitigation policies are rarely assessed in terms of the proportion of climate impacts they can avoid both regionally and globally. Research shows that policies with a 50% chance of remaining below a 2 °C rise in temperature may reduce the impacts of climate change by 20–65% by 2100, relative to pathways with a temperature rise of 4 °C.

This article considers social work engagement with the arts. We are interested in claims made in the social work literature about why art matters (or should matter) to social work, and about what art achieves for people and communities and ideas. We focus in particular on the images and metaphors at play in descriptions of arts-informed social work projects. Our intent is to offer a framework for understanding what social work communities think (and hope, and imagine) happens when we take up the arts in education, practice and research.

BACKGROUND Existing guidelines on screening children less than 5 years of age for developmental delay vary. In this systematic review, we synthesized the literature on the effectiveness and harms of screening for developmental delay in asymptomatic children aged 1-4 years. METHODS We searched MEDLINE, Embase and PsychINFO for relevant articles published to June 16, 2015. We identified studies that included children aged 1-4 years who were not at high risk of developmental delay, screened in a primary care setting. Randomized trials and controlled cohort studies were considered for benefits (cognitive, academic and functional outcomes); no restrictions on study design were imposed for the review of harms. RESULTS Two studies were included. One used the Ages and Stages Questionnaire II for screening and reported significantly more referrals to early intervention in the intervention groups than in the control group (relative risk [RR] 1.95, 95% confidence interval [CI] 1.49-2.54, in the intervention group with office support and RR 1.71, 95% CI 1.30-2.25, in the intervention group without office support). The time to referral was 70% shorter in the intervention group with office support (rate ratio 0.30, 95% CI 0.19-0.48) and 64% shorter in the intervention group without office support (rate ratio 0.36, 95% CI 0.23-0.59), compared with the control group. The other study used the VroegTijdige Onderkenning Ontwikkelingsstoornissen Language Screening instrument to screen children aged 15 months at enrolment for language delay. It reported no differences between groups in academic performance outcomes at age 8 years. INTERPRETATION The evidence on screening for developmental delay in asymptomatic children aged 1-4 years is inconclusive. Further research with longer-term outcomes is needed to inform decisions about screening and screening intervals.

Summary There is growing recognition as to the importance of extreme climatic events (ECEs) in determining changes in species populations. In fact, it is often the extent of climate variability that determines a population's ability to persist at a given site. This study examined the impact of ECEs on the resident UK butterfly species (n = 41) over a 37-year period. The study investigated the sensitivity of butterflies to four extremes (drought, extreme precipitation, extreme heat and extreme cold), identified at the site level, across each species' life stages. Variations in the vulnerability of butterflies at the site level were also compared based on three life-history traits (voltinism, habitat requirement and range). This is the first study to examine the effects of ECEs at the site level across all life stages of a butterfly, identifying sensitive life stages and unravelling the role life-history traits play in species sensitivity to ECEs. Butterfly population changes were found to be primarily driven by temperature extremes. Extreme heat was detrimental during overwintering periods and beneficial during adult periods and extreme cold had opposite impacts on both of these life stages. Previously undocumented detrimental effects were identified for extreme precipitation during the pupal life stage for univoltine species. Generalists were found to have significantly more negative associations with ECEs than specialists. With future projections of warmer, wetter winters and more severe weather events, UK butterflies could come under severe pressure given the findings of this study.

Species distribution models are important tools to explore the effects of future global change on biodiversity. Specifically, AquaMaps, Maxent and the Sea Around Us Project algorithm are three approaches that have been applied to predict distributions of marine fishes and invertebrates. They were designed to cope with issues of data quality and quantity common in species distribution modelling, and especially pertinent to the marine environment. However, the characteristics of model projections for marine species from these different approaches have rarely been compared. Such comparisons provide information about the robustness and uncertainty of the projections, and are thus important for spatial planning and developing management and conservation strategies. Here we apply the three commonly used species distribution modelling methods for commercial fish in the North Sea and North Atlantic, with the aim of drawing comparisons between the approaches. The effect of different assumptions within each approach on the predicted current relative habitat suitability was assessed. Predicted current distributions were tested following data partitioning and selection of pseudoabsences from within a specified distance of occurrence data. As indicated by the test statistics, each modelling method produced plausible predictions of relative habitat suitability for each species, with subsequent incorporation of expert knowledge generally improving predictions. However, because of the differences between modelling algorithms, methodologies and patterns of relative suitability, comparing models using test statistics and selecting a ‘best’ model are not recommended. We propose that a multi-model approach should be preferred and a suite of possible predictions considered if biases due to uncertainty in data and model formulation are to be minimised.

The UK’s eight proposed new nuclear power stations are all to be sited on the coast. With a total cradle-to-grave life cycle of at least 160 years, and heightened awareness of inundation risk following the failure of the Fukushima I nuclear plant in Japan this year, Britain’s nuclear developers have to show how they plan to cope with the possibility of rising sea levels, higher sea temperatures and more extreme weather events over the next two centuries. This paper describes the adaptation options for new nuclear and other major long-lived coastal developments. Despite uncertainty about climate scenarios for the 2200s, it explains how flexibility of design and safety margins can be incorporated from the outset and, when combined with routine environmental monitoring, how sites can be adaptively managed throughout their life cycles.

This article reviews some of the major lines of recent scientific progress relevant to the choice of global climate policy targets, focusing on changes in understanding since publication of the Intergovernmental Panel on Climate Change Fourth Assessment Report (IPCC AR4). Developments are highlighted in the following major climate system components: ice sheets; sea ice; the Atlantic Meridional Overturning Circulation; tropical forests; and accelerated carbon release from permafrost and ocean hydrates. The most significant developments in each component are identified by synthesizing input from multiple experts from each field. Overall, while large uncertainties remain in all fields, some substantial progress in understanding is revealed.

e18678Background: The use of neoadjuvant chemotherapy (NAC) has allowed pathologic complete response (pCR) to become a predictive measure for breast cancer recurrence-free survival and overall surv...