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Evidence of the physical and economic impacts of climate change is a critical input to policy development and decision-making. In addition to the magnitude of potential impacts, detailed estimates of where, when, and to whom those damages may occur; the types of impacts that will be most damaging; uncertainties in these damages; and the ability of adaptation to reduce potential risks are all interconnected and important considerations. This study utilizes the reduced-complexity model, the Framework for Evaluating Damages and Impacts (FrEDI), to rapidly project economic and physical impacts of climate change across 10 000 future scenarios for multiple impact sectors, regions, and populations within the contiguous United States (US). Results from FrEDI show that net national damages increase overtime, with mean climate-driven damages estimated to reach USD 2.9 trillion (95 % confidence interval (CI): USD 510 billion to USD 12 trillion) annually by 2090. Detailed FrEDI results show that for the analyzed sectors the majority of annual long-term (e.g., 2090) damages are associated with climate change impacts to human health, including mortality attributable to climate-driven changes in temperature and air pollution (O3 and PM2.5) exposure. Regional results also show that annual long-term climate-driven damages vary geographically. The Southeast (all regions are as defined in Fig. 5) is projected to experience the largest annual damages per capita (mean: USD 9300 per person annually; 95 % CI: USD 1800–USD 37 000 per person annually), whereas the smallest damages per capita are expected in the Southwest (mean: USD 6300 per person annually; 95 % CI: USD 840–USD 27 000 per person annually). Climate change impacts may also broaden existing societal inequalities, with, for example, Black or African Americans being disproportionately affected by additional premature mortality from changes in air quality. Lastly, FrEDI projections are extended through 2300 to estimate the net present climate-driven damages within US borders from marginal changes in greenhouse gas emissions. Combined, this analysis provides the most detailed illustration to date of the distribution of climate change impacts within US borders.

Purpose Anastomotic leak (AL) is an uncommon but potentially devastating complication after rectal resection. We aim to provide an updated assessment of bowel function and quality of life after AL, as well as associated short- and long-term outcomes. Methods A retrospective audit of all rectal resections performed at a colorectal unit and associated private hospitals over the past 10 years was performed. Relevant demographic, operative, and histopathological data were collected. A prospective survey was performed regarding patients’ quality of life and fecal continence. These patients were matched with nonAL patients who completed the same survey. Results One hundred patients (out of 1,394 resections) were included. AL was contained in 66.0%, not contained in 10.0%, and only anastomotic stricture in 24.0%. Management was antibiotics only in 39.0%, percutaneous drainage in 9.0%, operative abdominal drainage in 19.0%, transrectal drainage in 6.0%, combination of percutaneous drainage and transrectal drainage in 2.0%, and combination abdominal/transrectal drainage in 1.0%. The 1-year stoma rate was 15.0%. Overall, mean Fecal Incontinence Severity Instrument scores were higher for AL patients than their matched counterparts (8.06±10.5 vs. 2.92±4.92, P=0.002). Patients with an AL had a mean EuroQol visual analogue scale (EQ-VAS) of 76.23±19.85; this was lower than the matched mean EQ-VAS for non-AL patients of 81.64±18.07, although not statistically significant (P=0.180). Conclusion The majority of AL patients in this study were managed with antibiotics only. AL was associated with higher fecal incontinence scores in the long-term; however, this did not equate to lower quality of life scores.

Workers in climate exposed industries such as agriculture, construction, and manufacturing face increased health risks of working on high temperature days and may make decisions to reduce work on high-heat days to mitigate this risk. Utilizing the American Time Use Survey (ATUS) for the period 2003 through 2018 and historical weather data, we model the relationship between daily temperature and time allocation, focusing on hours worked by high-risk laborers. The results indicate that labor allocation decisions are context specific and likely driven by supply-side factors. We do not find a significant relationship between temperature and hours worked during the Great Recession (2008-2014), perhaps due to high competition for employment, however during periods of economic growth (2003-2007, 2015-2018) we find a significant reduction in hours worked on high-heat days. During periods of economic growth, for every degree above 90 on a particular day, the average high-risk worker reduces their time devoted to work by about 2.6 minutes relative to a 90-degree day. This effect is expected to intensify in the future as temperatures rise. Applying the modeled relationships to climate projections through the end of century, we find that annual lost wages resulting from decreased time spent working on days over 90 degrees across the United States range from $36.7 to $80.0 billion in 2090 under intermediate and high emission futures, respectively.

Abstract Atmospheric methane directly affects surface temperatures and indirectly affects ozone, impacting human welfare, the economy, and environment. The social cost of methane (SC‐CH4) metric estimates the costs associated with an additional marginal metric ton of emissions. Current SC‐CH4 estimates do not consider the indirect impacts associated with ozone production from changes in methane. We use global model simulations and a new BenMAP webtool to estimate respiratory‐related deaths associated with increases in ozone from a pulse of methane emissions in 2020. By using an approach consistent with the current SC‐CH4 framework, we monetize and discount annual damages back to present day values. We estimate that the methane‐ozone mechanism is attributable to 760 (95% CI: 330–1200) respiratory‐related deaths per million metric tons of methane globally, for a global net present damage of $1800/mT (95% CI: $760–$2800/mT CH4; 2% Ramsey discount rate); this would double the current SC‐CH4 if included. These physical impacts are consistent with recent studies, but comparing direct costs is challenging. Economic damages are sensitive to uncertainties in the exposure and health risks associated with tropospheric ozone, assumptions about future projections of NOx emissions, socioeconomic conditions, and mortality rates, monetization parameters, and other factors. Our estimates are highly sensitive to uncertainties in ozone health risks. We also develop a reduced form model to test sensitivities to other parameters. The reduced form tool runs with a user‐supplied emissions pulse, as well as socioeconomic and precursor projections, enabling future integration of the methane‐ozone mechanism into the SC‐CH4 modeling framework.

Obstetric cholestasis is a pregnancy-specific liver disorder which most commonly develops in the second or third trimester. It typically presents with generalised pruritus, often worst on the hands and feet, and no rash. Diagnosis is made on the basis of clinical presentation and elevated bile acid levels. Whilst obstetric cholestasis usually has no significant maternal adverse outcomes, aside from decreased quality of life from pruritus, it can lead to significant foetal complications, including stillbirth. There are no treatments for obstetric cholestasis, which resolves only following delivery. Thus, depending on the severity of obstetric cholestasis, early induction of labour may be recommended. As symptoms may precede bile acid elevation, repeat testing after a week is usually recommended when initial levels are normal. This report describes a case where a 35-year-old pregnant woman presented with pruritus but a normal bile acid level of 3 μmol/L. On repeat testing the following day the level had risen to 62, diagnosing obstetric cholestasis, and resulting in an urgent induction of labour at 38 weeks and 2 days of gestation. The patient gave birth to a healthy girl. This highlights the importance of close monitoring and consideration of early repeated blood tests where clinical suspicion is high, and/or a diagnosis of obstetric cholestasis would have significant management implications, to prevent adverse foetal outcomes.

Background: The goal of cytoreductive surgery for peritoneal malignancy is to remove all macroscopic disease, which occasionally requires the excision of the umbilicus. While the absence of the umbilicus can be aesthetically undesirable for patients, umbilical reconstruction is rarely performed due to the perceived complexity and increased risk of wound infections (Sakata et al. in Colorectal Dis 23:1153–1157, 2021). This study aims to evaluate the outcomes, cosmetic results and patient satisfaction of umbilical reconstruction during cytoreductive surgery. Methods: Consecutive patients from a prospectively maintained database who underwent cytoreductive surgery with umbilical excision and reconstruction were evaluated. Our technique for umbilical reconstruction involved recreating the subcutaneous fat space and fashioning umbilical skin flaps that anchor to the anterior fascia. Outcomes assessed included post-operative infection rate, wound dehiscence, seroma formation, wound appearance and patient satisfaction. Results: Umbilical reconstruction was performed on 50 patients, with 12 (24%) experiencing wound-related complications. Of these, eight patients (16%) had superficial wound infections, while one patient (2%) developed a deep wound infection; three patients (6%) required local wound drainage, though none needed surgical revision. There were no reports of wound seromas, skin necrosis, wound widening nor umbilical stenosis. All patients reported satisfaction with the outcome of their reconstruction. Conclusions: Our novel technique for umbilical reconstruction during cytoreductive surgery did not negatively impact wound healing outcomes. Recreating the umbilicus improved cosmetic results and patient satisfaction, enhancing body image for those undergoing major abdominal surgery. This approach should be considered for patients undergoing major laparotomies that necessitates umbilical excision. [ABSTRACT FROM AUTHOR]

Brand equity in higher education has received significant scholarly attention in recent years. However, there are a number of contradictions between the empirically approved determinants and the dimensions of brand equity in higher education. This research empirically investigates an adopted brand equity conceptual model in both a developed market and an emerging higher education market to develop a comparative analysis based on cultural dimensions. The empirical study included a qualitative exploratory research and a subsequent quantitative research in USA (an example of a developed market) and Egypt (an example of emerging market). Further, the authors qualitatively explored, via in-depth qualitative interviews, the industry for more insightful results based on customer's perception in both markets. Findings indicated that the determinants of brand equity reported in the literature vary depending on the higher education industry maturity and cultural contexts.

Background: Colorectal cancer is the third most common cancer worldwide. Micropapillary carcinoma (MPC) is increasingly identified as a poor prognostic marker in various cancers, including breast, bladder and lung. It remains an under recognized subtype in colorectal cancer. The aim of this study is to evaluate the prevalence, implications and impact on survival of MPC in colorectal cancer in an Australian cohort. Methods: A retrospective review of all colorectal cancer resections in two tertiary centres in Sydney Australia was performed, between 2019 and 2024. MPC was identified on histolopathology as per standard guidelines of the resected specimens. Variables collected included age, sex, TNM, site, lymphovascular invasion (LVI), and lymph node involvement. Results: Of 597 colorectal cancer resections during the study period, 21 cases of MPC were identified (3.5%). Mean age was 60 years (SD 15 years). Twenty patients (95%) had T3–T4 tumours, 19 (90%) had positive lymph node involvement, 18 (86%) had confirmed or suspected LVI, and 4 (19%) had distant metastatic disease. Overall 1‐year survival was 90% and 3‐year survival was 76%. Conclusion: MPC is associated with high risk features in colorectal adenocarcinoma. Accurate histopathological diagnosis of these more aggressive cancers should guide prognostication, individualized adjuvant treatment and close surveillance. [ABSTRACT FROM AUTHOR]

Black carbon aerosol plays a unique and important role in Earth's climate system. Black carbon is a type of carbonaceous material with a unique combination of physical properties. This assessment provides an evaluation of black-carbon climate forcing that is comprehensive in its inclusion of all known and relevant processes and that is quantitative in providing best estimates and uncertainties of the main forcing terms: direct solar absorption; influence on liquid, mixed phase, and ice clouds; and deposition on snow and ice. These effects are calculated with climate models, but when possible, they are evaluated with both microphysical measurements and field observations. Predominant sources are combustion related, namely, fossil fuels for transportation, solid fuels for industrial and residential uses, and open burning of biomass. Total global emissions of black carbon using bottom-up inventory methods are 7500 Gg yr(-1) in the year 2000 with an uncertainty range of 2000 to 29000. However, global atmospheric absorption attributable to black carbon is too low in many models and should be increased by a factor of almost 3. After this scaling, the best estimate for the industrial-era (1750 to 2005) direct radiative forcing of atmospheric black carbon is +0.71 W m(-2) with 90% uncertainty bounds of (+0.08, +1.27) W m(-2). Total direct forcing by all black carbon sources, without subtracting the preindustrial background, is estimated as +0.88 (+0.17, +1.48) W m(-2). Direct radiative forcing alone does not capture important rapid adjustment mechanisms. A framework is described and used for quantifying climate forcings, including rapid adjustments. The best estimate of industrial-era climate forcing of black carbon through all forcing mechanisms, including clouds and cryosphere forcing, is +1.1 W m(-2) with 90% uncertainty bounds of +0.17 to +2.1 W m(-2). Thus, there is a very high probability that black carbon emissions, independent of co-emitted species, have a positive forcing and warm the climate. We estimate that black carbon, with a total climate forcing of +1.1 W m(-2), is the second most important human emission in terms of its climate forcing in the present-day atmosphere; only carbon dioxide is estimated to have a greater forcing. Sources that emit black carbon also emit other short-lived species that may either cool or warm climate. Climate forcings from co-emitted species are estimated and used in the framework described herein. When the principal effects of short-lived co-emissions, including cooling agents such as sulfur dioxide, are included in net forcing, energy-related sources (fossil fuel and biofuel) have an industrial-era climate forcing of +0.22 (-0.50 to +1.08) W m(-2) during the first year after emission. For a few of these sources, such as diesel engines and possibly residential biofuels, warming is strong enough that eliminating all short-lived emissions from these sources would reduce net climate forcing (i.e., produce cooling). When open burning emissions, which emit high levels of organic matter, are included in the total, the best estimate of net industrial-era climate forcing by all short-lived species from black-carbon-rich sources becomes slightly negative (-0.06 W m(-2) with 90% uncertainty bounds of -1.45 to +1.29 W m(-2)).The uncertainties in net climate forcing from black-carbon-rich sources are substantial, largely due to lack of knowledge about cloud interactions with both black carbon and co-emitted organic carbon. In prioritizing potential black-carbon mitigation actions, non-science factors, such as technical feasibility, costs, policy design, and implementation feasibility play important roles. The major sources of black carbon are presently in different stages with regard to the feasibility for near-term mitigation. This assessment, by evaluating the large number and complexity of the associated physical and radiative processes in black-carbon climate forcing, sets a baseline from which to improve future climate forcing estimates.

The article discusses the use of preoperative oral antibiotics in colorectal surgery, highlighting the divergent practices between Europe and North America. Various meta-analyses have shown that combining oral and IV antibiotics can reduce surgical site infections and anastomotic leaks. While there is no international consensus on the use of oral antibiotics, ongoing research, such as the CABE trial, aims to evaluate their effectiveness in improving patient outcomes. The article also emphasizes the importance of antimicrobial stewardship to avoid bacterial resistance. [Extracted from the article]

Workers in climate exposed industries such as agriculture, construction, and manufacturing face increased health risks of working on high temperature days and may make decisions to reduce work on high-heat days to mitigate this risk. Utilizing the American Time Use Survey (ATUS) for the period 2003 through 2018 and historical weather data, we model the relationship between daily temperature and time allocation, focusing on hours worked by high-risk laborers. The results indicate that labor allocation decisions are context specific and likely driven by supply-side factors. We do not find a significant relationship between temperature and hours worked during the Great Recession (2008-2014), perhaps due to high competition for employment, however during periods of economic growth (2003-2007, 2015-2018) we find a significant reduction in hours worked on high-heat days. During periods of economic growth, for every degree above 90 on a particular day, the average high-risk worker reduces their time devoted to work by about 2.6 minutes relative to a 90-degree day. This effect is expected to intensify in the future as temperatures rise. Applying the modeled relationships to climate projections through the end of century, we find that annual lost wages resulting from decreased time spent working on days over 90 degrees across the United States range from $36.7 to $80.0 billion in 2090 under intermediate and high emission futures, respectively.

Abstract The use of residential heating devices is a key source of black carbon and other short‐lived climate forcer emissions in Arctic and other high‐latitude regions, with important impacts to the Arctic climate and human health. The types of combustion technologies and fuels used vary by region, which impacts the emission profiles of these pollutants and thus the magnitude of Arctic climate responses. Using emission inventory data from 14 European countries, we derive wood‐fueled residential heating emissions of black carbon, organic carbon, and sulfate from six appliance types in 2016. Using previously derived equilibrium Arctic temperature responses, we estimate Arctic temperature influences from each appliance type. Using the 2016 appliance emission data as a baseline, we compute the emission mass and Arctic temperature mitigation potential from hypothetical stove conversion scenarios. A total of 43.2 gigagrams (Gg) of black carbon, 175.7 Gg of organic carbon, and 10.3 Gg of sulfate were emitted in 2016 from the six appliance types in the 14 countries. The combined emissions increased Arctic surface temperatures by +2.8 millikelvin. If each country converted its appliance fleet to the technologically advanced pellet stoves and boilers, the combined black carbon, organic carbon, and sulfate emissions from heating appliances could be reduced by 94% and the Arctic temperature response reduced by 85%. The specific source and originating region of emissions are important factors in resolving the magnitude of their impacts. Improved country‐level accounting of specific appliances and their emission characteristics can lead to a better understanding of potential mitigation options.

The 100-year global warming potential (GWP) is the primary metric used to compare the climate impacts of emissions of different greenhouse gases (GHGs). The GWP relies on radiative forcing rather than damages, assumes constant future concentrations, and integrates over a timescale of 100 years without discounting; these choices lead to a metric that is transparent and simple to calculate, but have also been criticized. In this paper, we take a quantitative approach to evaluating the choice of time horizon, accounting for many of these complicating factors. By calculating an equivalent GWP timescale based on discounted damages resulting from CH4 and CO2 pulses, we show that a 100-year timescale is consistent with a discount rate of 3.3 % (interquartile range of 2.7 % to 4.1 % in a sensitivity analysis). This range of discount rates is consistent with those often considered for climate impact analyses. With increasing discount rates, equivalent timescales decrease. We recognize the limitations of evaluating metrics by relying only on climate impact equivalencies without consideration of the economic and political implications of metric implementation.

Abstract The U.S. Global Climate Change Research Program has identified climate change as a growing public health threat. We investigated the potential effects of changes in ambient daily maximum temperature on hyperthermia and cardiovascular emergency department (ED) visits using records for patients age 64 and younger from a private insurance database for the May–September period for 2005–2012. We found a strong positive relationship between daily maximum temperatures and ED visits for hyperthermia but not for cardiovascular conditions. Using the fitted relationship from 136 metropolitan areas, we calculated the number and rate of hyperthermia ED visits for climates representative of year 1995 (baseline period), as well as years 2050 and 2090 (future periods), for two climate change scenarios based on outcomes from five global climate models. Without considering potential adaptation or population growth and movement, we calculate that climate change alone will result in an additional 21,000–28,000 hyperthermia ED visits for May to September, with associated treatment costs between $6 million and $52 million (2015 U.S. dollars) by 2050; this increases to approximately 28,000–65,000 additional hyperthermia ED visits with treatment costs between $9 million and $118 million (2015 U.S. dollars) by 2090. The range in projected additional hyperthermia visits reflects the difference between alternative climate scenarios, and the additional range in valuation reflects different assumptions about per‐case valuation.