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Anthropogenic climate change is causing a rapid redistribution of life on Earth, particularly in the ocean, with profound implications for humans. Yet warming-driven range shifts are known to be influenced by a variety of factors whose combined effects are still little understood. Here, we use scientist-verified out-of-range observations from a national citizen-science initiative to assess the combined effect of long-term warming, climate extremes (i.e., heatwaves and cold spells), ocean currents, and species traits on early stages of marine range extensions in two warming 'hotspot' regions of southern Australia. We find effects of warming to be contingent upon complex interactions with the strength of ocean currents and their mutual directional agreement, as well as species traits. Our study represents the most comprehensive account to date of factors driving early stages of marine species redistributions, providing important evidence for the assessment of the vulnerability of marine species distributions to climate change., (© 2022. The Author(s).)

The highly dynamic nature of the marine environment can have a substantial influence on the foraging behaviour and spatial distribution of marine predators, particularly in pelagic marine systems. However, knowledge of the susceptibility of benthic marine predators to environmental variability is limited. This study investigated the influence of local-scale environmental conditions and large-scale climate indices on the spatial distribution and habitat use in the benthic foraging Australian fur seal ( Arctocephalus pusillus doriferus ; AUFS). Female AUFS provisioning pups were instrumented with GPS or ARGOS platform terminal transmitter tags during the austral winters of 2001-2019 at Kanowna Island, south-eastern Australia. Individuals were most susceptible to changes in the Southern Oscillation Index that measures the strength of the El Niño Southern Oscillation, with larger foraging ranges, greater distances travelled and more dispersed movement associated with 1-yr lagged La Niña-like conditions. Additionally, the total distance travelled was negatively correlated with the current year sea surface temperature and 1-yr lagged Indian Ocean Dipole, and positively correlated with 1-yr lagged chlorophyll- a concentration. These results suggest that environmental variation may influence the spatial distribution and availability of prey, even within benthic marine systems., (© 2021 The Authors.)

Understanding the factors which influence foraging behaviour and success in marine mammals is crucial to predicting how their populations may respond to environmental change. The Australian fur seal (Arctocephalus pusillus doriferus, AUFS) is a predominantly benthic forager on the shallow continental shelf of Bass Strait, and represents the greatest biomass of marine predators in south-eastern Australia. The south-east Australian region is experiencing rapid oceanic warming, predicted to lead to substantial alterations in prey diversity, distribution and abundance. In the present study, foraging effort and indices of foraging success and efficiency were investigated in 138 adult female AUFS (970 foraging trips) during the winters of 1998-2019. Large scale climate conditions had a strong influence on foraging effort, foraging success and efficiency. Foraging effort and foraging success were also strongly influenced by winter chlorophyll-a concentrations and sea-surface height anomalies in Bass Strait. The results suggest increasing foraging effort and decreasing foraging success and efficiency under anticipated environmental conditions, which may have population-level impacts.

As interest in global health education continues to increase, residency programs seeking to accommodate learners' expectations for global health learning opportunities often face challenges providing high-quality global health training. To address these challenges, some residency programs collaborate across medical specialties to create interdisciplinary global health residency tracks or collaborative interdisciplinary global health tracks (CIGHTs). In this Perspective, the authors highlight the unique aspects of interdisciplinary tracks that may benefit residency programs by describing 3 established U.S.-based programs as models: those at Indiana University, Mount Sinai Hospital, and the University of Virginia. Through collaboration and economies of scale, CIGHTs are able to address some of the primary challenges inherent to traditional global health tracks: lack of institutional faculty support and resources, the need to develop a global health curriculum, a paucity of safe and mentored international rotations, and inconsistent resident interest. Additionally, most published global health learning objectives and competencies (e.g., ethics of global health work, predeparture training) are not discipline specific and can therefore be addressed across departments-which, in turn, adds to the feasibility of CIGHTs. Beyond simply sharing the administrative burden, however, the interdisciplinary learning central to CIGHTs provides opportunities for trainees to gain new perspectives in approaching global health not typically afforded in traditional global health track models. Residency program leaders looking to implement or modify their global health education offerings, particularly those with limited institutional support, might consider developing a CIGHT as an approach that leverages economies of scale and provides new opportunities for collaboration.

Changes over the scale of decades in oceanic environments present a range of challenges for management and utilisation of ocean resources. Here we investigate sources of global temporal variation in Sea Surface Temperature (SST) and Ocean Colour (Chl-a) and their co-variation, over a 14 year period using statistical methodologies that partition sources of variation into inter-annual and annual components and explicitly account for daily auto-correlation. The variation in SST shows bands of increasing variability with increasing latitude, while the analysis of annual variability in Chl-a shows mostly mid-latitude high variability bands. Covariation patterns of SST and Chl-a suggests several different mechanisms impacting Chl-a change and variance. Our high spatial resolution analysis indicates these are likely to be operating at relatively small spatial scales. There are large regions showing warming and rising of Chl-a, contrasting with regions that show warming and decreasing Chl-a. The covariation pattern in annual variation in SST and Chl-a reveals broad latitudinal bands. On smaller scales there are significant regional anomalies where upwellings are known to occur. Over decadal time scales both trend and variation in SST, Chl-a and their covariance is highly spatially heterogeneous, indicating that monitoring and resource management must be regionally appropriate.

Large scale migrations are a key component of the life history of many marine species. We quantified the annual migration cycle of juvenile southern bluefin tuna (Thunnus maccoyii; SBT) and spatiotemporal variability in this cycle, based on a multi-decadal electronic tagging dataset. Behaviour-switching models allowed for the identification of cohesive areas of residency and classified the temporal sequence of movements within a migration cycle from austral summer foraging grounds in the Great Australian Bight (GAB) to winter foraging grounds in the Indian Ocean and Tasman Sea and back to the GAB. Although specific regions within the Indian Ocean were frequented, individuals did not always return to the same area in consecutive years. Outward migrations from the GAB were typically longer than return migrations back to the GAB. The timing of individual arrivals to the GAB, which may be driven by seasonality in prey availability, was more cohesive than the timing of departures from the GAB, which may be subject to the physiological condition of SBT. A valuable fishery for SBT operates in the GAB, as do a number of scientific research programs designed to monitor SBT for management purposes; thus, understanding SBT migration to and from the area is of high importance to a number of stakeholders.

Background and Objectives: The prevalence of chronic kidney disease (CKD) has increased over the past two decades. The sensitivity of serum creatinine (sCr) to identify CKD is low. As a result, many healthcare centers report estimated GFR (eGFR) with routine blood work. The aim of this study was to determine the cost-effectiveness of automatic eGFR reporting compared with reporting sCr alone., Design, Setting, Participants, & Measurements: A Markov model was designed to evaluate the cost-effectiveness of reporting eGFR compared with reporting sCr alone in a hypothetical cohort of 60-yr-old individuals undergoing annual blood chemistry testing over 18 yr. Paths and path probabilities were identical between the two arms, except for the sensitivity and specificity of eGFR and sCr to detect CKD., Results: eGFR reporting was dominant with a cost/effectiveness ratio of $16,751/quality-adjusted life year (QALY) versus $16,779/QALY for sCr reporting. Monte Carlo microsimulations in a hypothetical cohort of 10,000 patients demonstrated that over 18 yr, an average of 13 fewer deaths, 29 fewer ESRD events, and 11,348 more false positive CKD (FP-CKD) cases occurred with eGFR reporting. A sensitivity analysis revealed that decreasing the FP-CKD quality of life by > 2% rendered sCr reporting more cost-effective than eGFR reporting. If FP-CKD reduced quality of life by 5%, the incremental cost-effectiveness ratio for sCr reporting versus eGFR reporting would be $4367/QALY., Conclusion: A decision analysis suggests that reporting eGFR may be beneficial, but this limited benefit was reversed with virtually any reduction in quality of life caused by incorrect diagnosis of CKD.