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ObjectivesTo chart the global literature on gender equity in academic health research.DesignScoping review.ParticipantsQuantitative studies were eligible if they examined gender equity within academic institutions including health researchers.Primary and secondary outcome measuresOutcomes related to equity across gender and other social identities in academia: (1) faculty workforce: representation of all genders in university/faculty departments, academic rank or position and salary; (2) service: teaching obligations and administrative/non-teaching activities; (3) recruitment and hiring data: number of applicants by gender, interviews and new hires for various rank; (4) promotion: opportunities for promotion and time to progress through academic ranks; (5) academic leadership: type of leadership positions, opportunities for leadership promotion or training, opportunities to supervise/mentor and support for leadership bids; (6) scholarly output or productivity: number/type of publications and presentations, position of authorship, number/value of grants or awards and intellectual property ownership; (7) contextual factors of universities; (8) infrastructure; (9) knowledge and technology translation activities; (10) availability of maternity/paternity/parental/family leave; (11) collaboration activities/opportunities for collaboration; (12) qualitative considerations: perceptions around promotion, finances and support.ResultsLiterature search yielded 94 798 citations; 4753 full-text articles were screened, and 562 studies were included. Most studies originated from North America (462/562, 82.2%). Few studies (27/562, 4.8%) reported race and fewer reported sex/gender (which were used interchangeably in most studies) other than male/female (11/562, 2.0%). Only one study provided data on religion. No other PROGRESS-PLUS variables were reported. A total of 2996 outcomes were reported, with most studies examining academic output (371/562, 66.0%).ConclusionsReviewed literature suggest a lack in analytic approaches that consider genders beyond the binary categories of man and woman, additional social identities (race, religion, social capital and disability) and an intersectionality lens examining the interconnection of multiple social identities in understanding discrimination and disadvantage. All of these are necessary to tailor strategies that promote gender equity.Trial registration numberOpen Science Framework:https://osf.io/8wk7e/.

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.

The original article has been corrected: Legends in Fig. 7 in the article and legends in Figs. 9 and 10 of Supplementary Material 1 as well as contents in columns H and J of Supplementary Material 2 have been amended to the valid results.

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

Children and young adults with mutant forms of ataxia telangiectasia mutated (ATM), a kinase involved in DNA damage signaling and mitochondrial homeostasis, suffer from recurrent respiratory infections, immune deficiencies, and obstructive airways disease associated with disorganized airway epithelium. We previously showed in mice how Atm was required to mount a protective immune memory response to influenza A virus [IAV; Hong Kong/X31 (HKx31), H3N2]. Here, Atm wildtype (WT) and knockout (Atm-null) mice were used to investigate how Atm is required to regenerate the injured airway epithelium following IAV infection. When compared with WT mice, naive Atm-null mice had increased airway resistance and reduced lung compliance that worsened during infection before returning to naïve levels by 56 days postinfection (dpi). Although Atm-null lungs appeared pathologically normal before infection by histology, they developed an abnormal proximal airway epithelium after infection that contained E-cadherin+, Sox2+, and Cyp2f2+ cells lacking secretoglobin family 1 A member 1 (Scgb1a1) protein expression. Patchy and low expression of Scgb1a1 were eventually observed by 56 dpi. Genetic lineage tracing in HKx31-infected mice revealed club cells require Atm to rapidly and efficiently restore Scgb1a1 expression in proximal airways. Since Scgb1a1 is an immunomodulatory protein that protects the lung against a multitude of respiratory challenges, failure to efficiently restore its expression may contribute to the respiratory diseases seen in individuals with ataxia telangiectasia.

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.

Sea-levels will rise, even with stringent climate change mitigation. Mitigation will slow the rate of rise. There is limited knowledge on how the costs of coastal protection vary with alternative global warming levels of 1.5°C to 4.0°C. Analysing six sea-level rise scenarios (0.74m to 1.09m, 50th percentile) across these warming levels, and five Shared Socioeconomic Pathways, this paper quantifies the economic costs of flooding and protection due to sea-level rise using the Dynamic Interactive Vulnerability Assessment (DIVA) modelling framework. Results are presented for World Bank income groups and five selected countries from the present to 2100. Annual sea flood damage costs without additional adaptation are more influenced by socio-economic development than sea-level rise, indicating there are opportunities to control risk with development choices. In contrast, annual sea dike investment costs are more dependent on the magnitude of sea-level rise. In terms of total costs with adaptation, upper middle, low middle and low income groups are projected to have higher relative costs as a proportion of GDP compared with high income groups. If low income countries protected now, flood costs could be reduced after 2050 and beyond. However, without further adaptation, their coasts will experience growing risks and costs leaving them increasingly reliant on emergency response measures. adaptation. Without mitigation or adaptation, greater inequalities in damage costs between income groups could result. At country level, annual sea flood damage costs without additional adaptation are projected to rapidly increase with approximately 0.2m of sea-level rise, leaving limited time to plan and adapt. SB, PG, KJ, RJ and RW were funded by the Department for Business, Energy and Industrial Strategy (BEIS) under contract UK SBS CR18083. ASA, SB, SJ, DL, RN, RT and AV were funded by the European Union’s Seventh Programme for Research, Technological Development and Demonstration under grant agreement No. 603396 (RISES-AM project).

Floods are among the most frequent and costliest natural hazards. Fluvial flood losses are expected to increase in the future, driven by population and economic growth in flood-prone areas, and exacerbated in many regions by effects of climate change on the hydrological cycle. Yet, studies assessing direct and indirect economic impacts of fluvial flooding in combination with climate change and socio-economic projections at a country level are rare. This study presents an integrated flood risk analysis framework to calculate total (direct and indirect) economic damages, with and without socio-economic development, under a range of warming levels from < 1.5 to 4 °C in Brazil, China, India, Egypt, Ethiopia, and Ghana. Direct damages are estimated by linking spatially explicit daily flood hazard data from the Catchment-based Macro-scale Floodplain (CaMa-Flood) model with country- and sector-specific depth-damage functions. These values input into an economic Input-Output model for the estimation of indirect losses. The study highlights that total fluvial flood losses are largest in China and India when expressed in absolute terms. When expressed as a share of national GDP, Egypt faces the largest total losses under both the climate change and climate change plus socio-economic development experiments. The magnitude of indirect losses also increased significantly when socio-economic development was modelled. The study highlights the importance of including socio-economic development when estimating direct and indirect flood losses, as well as the role of recovery dynamics, essential to provide a more comprehensive picture of potential losses that will be important for decision makers.

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

In recent years, UK summer heatwaves have resulted in thousands of excess deaths, with both extreme temperatures and high humidity increasing health risks. Here, the UK Climate Projections 2018 (UKCP18) are compared to observational (HadUK-Grid) and reanalysis data (ERA5) to quantify model performance at capturing mean, extremes (95th to 99.5th percentiles) and variability in the climate state and heat stress metrics (simplified wet bulb global temperature, sWBGT; Humidex; apparent temperature). Simulations carried out for UKCP18 generally perform as well as or better than CMIP5 models in reproducing observed spatial patterns of UK climate relating to extreme heat, with RMSE values on average ∼30% less than for the CMIP5 models. Increasing spatial resolution in UKCP18 simulations is shown to yield a minor improvement in model performance (RMSE values on average ∼5% less) compared to observations, however there is considerable variability between ensemble members within resolution classes. For both UKCP18 and CMIP5 models, model error in capturing characteristics of extreme heat generally reduces when using heat stress metrics with a larger vapour pressure component, such as sWBGT. Finally, the 95th percentile of observed UK summer temperature is shown to have ∼60% greater interannual variability than the summer mean over the recent past (1981–2000). This effect is underestimated in UKCP18 models (∼33%) compared to HadUK-grid and ERA5. Compared to projected future changes in the global mean temperature, UK summer mean and 95th percentile temperatures are shown in increase at a faster rate than the global mean.

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.