To identify and synthesize return-to-sport (RTS) criteria reported after the Bristow-Latarjet procedure for anterior glenohumeral instability in athletes, and to evaluate the associated time to RTS, RTS rate, and instability recurrence, with the aim of informing an evidence-based combination of RTS criteria that may optimize earlier RTS while minimizing recurrence. This protocol follows the guidelines of the Preferred Reporting Items for Systematic review and Meta-Analysis-Protocols (PRISMA-P) statement and it has been registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024563618). We will include randomized and non-randomized comparative studies, cohort and case-control studies, and case series reporting explicit RTS criteria after Bristow-Latarjet in athletes, with a minimum follow-up of 12 months. Searches will be conducted in the PubMed, Web of Science, Embase, SciELO, CENTRAL and SPORTDiscus databases, as well as Google Scholar for grey literature, without restrictions on date, geography, or language. Two reviewers will independently screen and extract data using the Covidence (Veritas Health Innovation Ltd) software. The primary outcomes are time to RTS, RTS rate, and recurrence (using the time point closest to 12 months, when multiple assessments are available). The risk of bias will be assessed using the Risk of Bias 2 (RoB 2; the Cochrane Collaboration) for randomized clinical trials (RCTs), the Newcastle-Ottawa Scale (NOS) for non-randomized comparative studies, and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Series, and the certainty of the evidence will be rated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. When appropriate, random-effects meta-analysis and exploratory meta-regression will be performed; subgroup and sensitivity analyses are planned. The systematic review will provide a criterion-centered synthesis of RTS definitions and clearance strategies after Bristow-Latarjet, linking each criterion to clinically-relevant outcomes (time to RTS, RTS rate, and recurrence). The findings are expected to support more consistent, evidence-informed RTS decision-making and guide future prospective validation of optimized RTS criteria combinations. Identificar e sintetizar os critérios de retorno ao esporte relatados após o procedimento de Bristow-Latarjet para instabilidade glenoumeral anterior em atletas, e avaliar o tempo associado e a taxa de retorno ao esporte e a recorrência de instabilidade, com o objetivo de informar uma combinação baseada em evidências de critérios de retorno ao esporte que possa otimizar o retorno antecipado, para minimizar a recorrência. Este protocolo segue as diretrizes da declaração Preferred Reporting Items for Systematic review and Meta-Analysis-Protocols (PRISMA-P) e está registrado no International Prospective Register of Systematic Reviews (PROSPERO; CRD42024563618). Incluiremos estudos comparativos randomizados e não randomizados, estudos de coorte e de caso-controle, e séries de casos que relatem critérios explícitos de retorno ao esporte após Bristow-Latarjet em atletas, com seguimento mínimo de 12 meses. As buscas serão realizadas nas bases de dados PubMed, Web of Science, Embase, SciELO, CENTRAL e SPORTDiscus, além do Google Acadêmico para a literatura cinzenta, sem restrições de data, geografia ou idioma. Dois revisores farão a triagem e a extração de dados de forma independente, usando o programa Covidence (Veritas Health Innovation Ltd). Os resultados primários são o tempo até o retorno ao esporte, a taxa de retorno ao esporte e a recorrência (usando o ponto de tempo mais próximo de 12 meses, quando várias avaliações estão disponíveis). O risco de viés será avaliado utilizando a ferramenta Risk of Bias 2 (RoB 2; the Cochrane Collaboration) para ensaios clínicos randomizados (ECRs), a Newcastle-Ottawa Scale (NOS) para estudos comparativos não randomizados, e a Lista de Verificação de Avaliação Crítica para Séries de Casos do Joanna Briggs Institute (JBI) para séries de casos, e a certeza da evidência será classificada por meio da abordagem Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Quando apropriado, metanálise de efeitos aleatórios e metarregressão exploratória serão realizadas; análises de subgrupo e de sensibilidade estão planejadas. Esta revisão sistemática fornecerá uma síntese centrada nos critérios das definições de retorno ao esporte e das estratégias de liberação após Bristow-Latarjet relacionando cada critério a desfechos clinicamente relevantes (tempo até o retorno ao esporte taxa de retorno ao esporte e recorrência). Espera-se que os resultados apoiem a tomada de decisão de retorno ao esporte de forma mais consistente e baseada em evidências e orientem a futura validação prospectiva de combinações otimizadas de critérios de retorno ao esporte.
To identify and synthesize return-to-sport (RTS) criteria reported after the Bristow-Latarjet procedure for anterior glenohumeral instability in athletes, and to evaluate the associated time to RTS, RTS rate, and instability recurrence, with the aim of informing an evidence-based combination of RTS criteria that may optimize earlier RTS while minimizing recurrence. This protocol follows the guidelines of the Preferred Reporting Items for Systematic review and Meta-Analysis-Protocols (PRISMA-P) statement and it has been registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024563618). We will include randomized and nonrandomized comparative studies, cohort and case-control studies, and case series reporting explicit RTS criteria after Bristow-Latarjet in athletes, with a minimum follow-up of 12 months. Searches will be conducted in the PubMed, Web of Science, Embase, SciELO, CENTRAL and SPORTDiscus databases, as well as Google Scholar for grey literature, without restrictions on date, geography, or language. Two reviewers will independently screen and extract data using the Covidence (Veritas Health Innovation Ltd) software. The primary outcomes are time to RTS, RTS rate, and recurrence (using the time point closest to 12 months, when multiple assessments are available). The risk of bias will be assessed using the Risk of Bias 2 (RoB 2; the Cochrane Collaboration) for randomized clinical trials (RCTs), the Newcastle-Ottawa Scale (NOS) for nonrandomized comparative studies, and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Series, and the certainty of the evidence will be rated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. When appropriate, random-effects meta-analysis and exploratory meta-regression will be performed; subgroup and sensitivity analyses are planned. The systematic review will provide a criterion-centered synthesis of RTS definitions and clearance strategies after Bristow-Latarjet, linking each criterion to clinically-relevant outcomes (time to RTS, RTS rate, and recurrence). The findings are expected to support more consistent, evidence-informed RTS decision-making and guide future prospective validation of optimized RTS criteria combinations. Identificar e sintetizar os critérios de retorno ao esporte relatados após o procedimento de Bristow-Latarjet para instabilidade glenoumeral anterior em atletas, e avaliar o tempo associado e a taxa de retorno ao esporte e a recorrência de instabilidade, com o objetivo de informar uma combinação baseada em evidências de critérios de retorno ao esporte que possa otimizar o retorno antecipado, para minimizar a recorrência. Este protocolo segue as diretrizes da declaração Preferred Reporting Items for Systematic review and Meta-Analysis-Protocols (PRISMA-P) e está registrado no International Prospective Register of Systematic Reviews (PROSPERO; CRD42024563618). Incluiremos estudos comparativos randomizados e não randomizados, estudos de coorte e de caso-controle, e séries de casos que relatem critérios explícitos de retorno ao esporte após Bristow-Latarjet em atletas, com seguimento mínimo de 12 meses. As buscas serão realizadas nas bases de dados PubMed, Web of Science, Embase, SciELO, CENTRAL e SPORTDiscus, além do Google Acadêmico para a literatura cinzenta, sem restrições de data, geografia ou idioma. Dois revisores farão a triagem e a extração de dados de forma independente, usando o programa Covidence (Veritas Health Innovation Ltd). Os resultados primários são o tempo até o retorno ao esporte, a taxa de retorno ao esporte e a recorrência (usando o ponto de tempo mais próximo de 12 meses, quando várias avaliações estão disponíveis). O risco de viés será avaliado utilizando a ferramenta Risk of Bias 2 (RoB 2; the Cochrane Collaboration) para ensaios clínicos randomizados (ECRs), a Newcastle-Ottawa Scale (NOS) para estudos comparativos não randomizados, e a Lista de Verificação de Avaliação Crítica para Séries de Casos do Joanna Briggs Institute (JBI) para séries de casos, e a certeza da evidência será classificada por meio da abordagem Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Quando apropriado, metanálise de efeitos aleatórios e metarregressão exploratória serão realizadas; análises de subgrupo e de sensibilidade estão planejadas. Esta revisão sistemática fornecerá uma síntese centrada nos critérios das definições de retorno ao esporte e das estratégias de liberação após Bristow-Latarjet, relacionando cada critério a desfechos clinicamente relevantes (tempo até o retorno ao esporte, taxa de retorno ao esporte e recorrência). Espera-se que os resultados apoiem a tomada de decisão de retorno ao esporte de forma mais consistente e baseada em evidências, e orientem a futura validação prospectiva de combinações otimizadas de critérios de retorno ao esporte.
Tuberculosis (TB) is the leading global cause of death from a single infectious agent. Recent reductions in global health funding have threatened TB control, making comprehensive assessment of TB, HIV-related TB, and drug-resistant TB burdens before these disruptions essential for shaping effective responses. The WHO End TB Strategy sets targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence between 2015 and 2035. Using results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, this study aims to assess the burden of TB and multidrug-resistant TB (MDR-TB) across 204 countries and territories, and to evaluate progress towards the WHO End TB incidence and mortality targets. We quantified TB mortality using the Cause of Death Ensemble modelling platform with global vital registration, surveillance, verbal autopsy, and minimally invasive tissue sampling data. For TB morbidity estimation, we simultaneously modelled incidence, prevalence, and mortality by age and sex using DisMod-MR 2.1. A population attributable fraction (PAF) approach was applied to stratify morbidity and mortality estimates by HIV and drug-resistance status. We also calculated disability-adjusted life-years (DALYs) as the sum of years of life lost and years lived with disability. For the risk factor analysis, a comparative risk assessment framework was used and PAFs were derived for alcohol use, smoking, and high fasting plasma glucose to determine the proportion of TB burden associated with these risk factors. In 2023, there were an estimated 9·11 million (95% uncertainty interval 8·04-10·3) incident cases of all-form TB, 1·22 million (0·98-1·49) deaths, and 54·6 million (43·8-65·5) DALYs globally. HIV-related TB comprised 781 000 (690 000-879 000) incident cases and 210 000 (142 000-279 000) deaths, contributing 11·0 million (7·56-14·3) DALYs. MDR-TB accounted for 466 000 (198 000-1 080 000) incident cases, 102 000 (31 700-238 000) deaths, and 3·96 million (1·31-9·01) DALYs. From 2015 to 2023, global all-form TB incidence rates declined by 19·2% (17·8-20·5) and deaths declined by 22·6% (4·7-35·7); declines were larger for drug-susceptible TB than for MDR-TB. Sub-Saharan Africa and south Asia had the highest mortality burdens in 2023; reductions in all-form TB incidence and mortality were uneven between 2000 and 2023, with limited progress in both measures in Latin America and the Caribbean. Removing smoking, alcohol use, and high fasting plasma glucose would reduce global TB deaths to 768 000 (592 000-970 000) and DALYs to 34·9 million (27·8-43·8) in 2023; MDR-TB deaths would decrease to 77 200 (23 400-183 000) and DALYs to 3·12 million (1·03-7·29). Global progress towards WHO End TB targets is disparate and fragile. Although many regions achieved meaningful gains, others have stagnated in recent years. The complexity of TB prevention is amplified by divergent MDR-TB trends, the persistent burden of HIV, and growing exposure to modifiable risk factors. Recent volatility in global health financing threatens to further destabilise this vulnerable epidemiological landscape; concerted action is urgently needed to temper disruptions and preserve progress. Gates Foundation.
During 2014-2020, the Florida Department of Health in Sarasota County (DOH-Sarasota) developed a program to prepare for weather-related disaster impacts on the county's Access and Functional Needs (AFN) population, with a special focus on emergency communication and evacuation. This case report presents a retrospective evaluation of the planning process used to engage diverse stakeholders, build inter-agency collaborations, and integrate disaster and health policies to enhance community resilience. DOH-Sarasota fashioned their multi-tiered approach on agency-facing and community-engaged activities by implementing FEMA's Whole Community approach to better understanding AFN communities, to engage and empower both AFN residents and the organizations that serve them, and to strengthen AFN community assets in the context of hurricane preparedness. DOH-Sarasota's planning process aimed to build critical new partnerships, incorporate the perspectives of AFN groups in the planning process, and establish critical resource networks. Vulnerability is not uniform and understanding this diversity of needs is necessary to better target resources and expand opportunities for more representation in decision-making. By finding opportunities to gather and share knowledge in sustained and reflexive ways, the case study is a translatable example of how public health and emergency management agencies can expand their capacities and policies to integrate, collaborate, educate and innovate towards increased community resilience for AFN populations.
Chronic pain is a highly prevalent and disabling condition, yet its true population burden remains poorly characterised. This is partly due to the lack of validated case-finding methods within routinely collected electronic health records that adequately reflect people's lived experiences. Existing algorithms for identifying chronic pain are limited by poor validation, insufficient involvement of people with chronic pain, and low diagnostic accuracy. The C-PICTURE study aims to develop, refine, and validate an algorithm capable of accurately identifying individuals living with chronic pain within primary care electronic health records. This mixed-methods study comprises four phases, preceded by a pilot algorithm. Six diverse GP practices are purposively selected across Scotland to reflect variation in geography, population demographics, and socioeconomic context. Phase A involves review of 1,200 electronic medical records across the six practices to create a reference dataset for algorithm comparison. Phase B includes a patient-reported outcomes survey sent to approximately 6,200 adults, collecting data on chronic pain presence, severity, impact, and management strategies. Phase C consists of semi-structured interviews and focus groups with people with chronic pain and healthcare providers to explore discrepancies between coding-based and self-reported chronic pain, understand coding practices, and examine how people use healthcare services to manage needs. Phase D pilots the algorithm across the six practices using the Primary Care Intelligence Service, comparing algorithm performance with medical record review and patient-reported outcomes data. Sensitivity, specificity, predictive values, and Area Under the Receiver Operating Characteristic Curve are estimated, with cross-validation to assess internal validity. Data linkage across phases enables refinement and validation of the final algorithm. The C-PICTURE study will address evidence gaps by producing the first validated population-based method for identifying chronic pain using Scottish primary care data. Integrating clinical records, patient-reported data, and qualitative insights ensures the algorithm reflects both biomedical and lived experiences of chronic pain. Findings will have implications for policy, practice, and research, including highlighting limitations in current coding practices, supporting surveillance, and informing national planning for pain management services. The validated algorithm could also be adapted for use across the UK and internationally, supporting epidemiological monitoring and enabling future chronic pain research. This study is registered with the UK's Clinical Study Registry (ISRCTN reference number: 37628569; Registered on 27 February 2024; DOI: https://doi.org/10.1186/ISRCTN37628569).
The effect of land cover changes on annual peak discharge is evaluated using a novel method combining principal component analysis (PCA) and random forest regression (RF). This approach calculates original feature contributions by multiplying absolute PCA loadings with RF-derived component importances, enabling direct attribution of discharge variations to specific land cover types in each subbasin, which represents an integration unexplored in prior PCA-RF applications. The PCA-RF method is applied in the basin upstream of Golestan Dam, Iran. It uses multitemporal Landsat imagery for NDVI-based land cover classification, annual instantaneous peak discharge data from hydrometric stations, and elevation data for subbasin delineation over a limited period (post-2003, due to data constraints). Despite limitations like scarce hydrometric data and a short collection period, the method analyzes relationships between land cover classes and floods in subbasins. Remote sensing provides spatial vegetation patterns, organized via GIS; PCA reduces dimensionality and identifies key factors; RF models nonlinear relationships with high accuracy (R2 0.78-0.90, per SHAP insights). Quantitatively, urban/barren lands dominated in Tangerah (26.3%) and Hajji Qushan (30.9%) and thin vegetation in Galikash (26.9%) and Tamar Gorgan (26.8%), with dense vegetation lowest in Hajji Qushan (2%). Findings confirm land cover changes significantly impact flood peaks, varying spatially: Urban/barren lands accelerate runoff, and vegetation mitigates it. The PCA-RF method captures these dynamics despite constraints and offers policymakers insights for flood risk reduction, vegetation restoration, urban runoff control, sustainable management, and adaptive planning. Furthermore, this work provides insights into the interactions between land cover changes and flood risks that assist policymakers and land managers in developing effective strategies for flood risk reduction, water resource management, and sustainable use practices.
Boreal forests, sensitive indicators of global climate change, have age structures and spatial patterns strongly shaped by wildfire and logging that directly affect carbon budgets and biodiversity. In this study, we integrated multisource datasets to develop a quantitative framework for mapping forest age across the boreal biome. We first used change detection methods to identify stand-replacing disturbances from 1985 to 2020 and then used the time elapsed since disturbance to 2020 as the initial estimate of forest age. We combined forest inventory age records, canopy height, forest landscape integrity, and climatic variables in a random forest model to predict forest age (R2 = 0.62, RMSE = 35.46 years). Our findings revealed that boreal forests are generally in a mature state (mean: 112 years; median: 115 years), and their age structure displays a bimodal distribution primarily shaped by fire and logging regimes. Regions with frequent disturbances-such as western Canada and Siberia-are characterized by concentrations of young forests, leading to an increasing proportion of early-successional stands and a highly heterogeneous landscape mosaic. Some old-growth patches persist mainly in high-latitude areas near water bodies, which hold particular ecological value for maintaining long-term forest stability. We also found that the spatial distribution of forest age is jointly regulated by climatic factors (e.g., low vapor pressure deficit, low solar radiation, and high precipitation) and landscape integrity, which together influence fire regimes and the conditions necessary for long-term forest persistence. Our results highlighted the need to emphasize landscape-scale age structure diversity in conservation planning. Environmental characteristics can guide the delineation of priority areas, especially regions with high landscape integrity and low disturbance, to help address current protection gaps. This work improves the understanding of boreal forest age patterns and supports global carbon accounting, systematic conservation planning, and climate change adaptation. Mapeo panboreal de la edad de los bosques y sus implicaciones para la conservación Resumen Los bosques boreales, indicadores sensibles del cambio climático global, presentan estructuras de edad y patrones espaciales fuertemente determinados por los incendios forestales y la tala, lo cual afecta directamente los balances de carbono y la biodiversidad. En este estudio, integramos conjuntos de datos de múltiples fuentes para desarrollar un marco cuantitativo que permita cartografiar la edad de los bosques en todo el bioma boreal. Primero utilizamos métodos de detección de cambios para identificar las perturbaciones que provocaron la sustitución de rodales entre 1985 y 2020 y, luego, utilizamos el tiempo transcurrido desde la perturbación hasta 2020 como estimación inicial de la edad de los bosques. Combinamos registros de edad de inventarios forestales, altura del dosel, integridad del paisaje forestal y variables climáticas en un modelo de bosque aleatorio para predecir la edad de los bosques (R2 = 0.62; RMSE = 35.46 años). Nuestros hallazgos revelaron que los bosques boreales se encuentran, en general, en un estado maduro (promedio: 112 años; mediana: 115 años), y que su estructura de edad presenta una distribución bimodal determinada principalmente por los regímenes de incendios y tala. Las regiones con perturbaciones frecuentes —como el oeste de Canadá y Siberia— se caracterizan por concentraciones de bosques jóvenes, lo que da lugar a una proporción cada vez mayor de rodales en etapas tempranas de sucesión y a un mosaico paisajístico altamente heterogéneo. Algunos remanentes de bosques antiguos persisten principalmente en zonas de altas latitudes cercanas a cuerpos de agua, los cuales tienen un valor ecológico particular para mantener la estabilidad forestal a largo plazo. También descubrimos que la distribución espacial de la edad de los bosques está regulada conjuntamente por factores climáticos (por ejemplo, bajo déficit de presión de vapor, baja radiación solar y altas precipitaciones) y la integridad del paisaje, los cuales, en conjunto, influyen en los regímenes de incendios y en las condiciones necesarias para la persistencia de los bosques a largo plazo. Nuestros resultados pusieron de relieve la necesidad de dar mayor importancia a la diversidad de la estructura de edades a escala del paisaje en la planificación de la conservación. Las características ambientales pueden servir de guía para delimitar las áreas prioritarias, especialmente aquellas regiones con alta integridad paisajística y bajo nivel de perturbación, a fin de ayudar a subsanar las brechas actuales en materia de protección. Este trabajo mejora la comprensión de los patrones de edad de los bosques boreales y contribuye a la contabilidad global del carbono, a la planificación sistemática de la conservación y a la adaptación al cambio climático. 北方森林是全球气候变化的敏感指示器, 其年龄结构和空间格局受到野火和采伐的强烈塑造, 并直接影响碳收支和生物多样性。本研究整合多源数据集, 构建了一个用于绘制整个北方森林生物群系森林年龄的定量框架。我们首先采用变化检测方法识别1985年至2020年间发生的林分替代性干扰, 然后以截至2020年距干扰发生的时间作为森林年龄的初始估计值。随后, 我们结合森林清查年龄记录、冠层高度、森林景观完整性以及气候变量, 利用随机森林模型预测森林年龄(R2 = 0.62, RMSE = 35.46年)。 研究结果表明, 北方森林总体处于成熟状态(平均年龄:112年;中位数:115年), 其年龄结构呈现双峰分布, 主要受火干扰和采伐制度的共同塑造。频繁受干扰的地区, 如加拿大西部和西伯利亚, 年轻林集中分布, 导致早期演替林分比例上升, 并形成高度异质的景观镶嵌格局。一些老龄林斑块主要保留在靠近水体的高纬度地区, 对维持森林长期稳定性具有重要生态价值。我们还发现, 森林年龄的空间分布受到气候因子和景观完整性的共同调控;其中, 较低的水汽压亏缺、较低的太阳辐射和较高的降水等气候条件, 与景观完整性共同影响火干扰制度以及森林长期持续存在所需的环境条件。 本研究结果强调, 在保护规划中有必要重视景观尺度上的年龄结构多样性。环境特征可为优先保护区的划定提供依据, 特别是景观完整性较高且干扰强度较低的区域, 从而有助于弥补当前保护空缺。本研究深化了对北方森林年龄格局的认识, 并可为全球碳核算、系统性保护规划以及气候变化适应提供支撑。.
Water, energy, and food (WEF) insecurities are widespread in South Africa and are associated with adverse health outcomes. However, research has typically examined these insecurities separately, resulting in limited understanding of their interconnected associations with health and the pathways through which they may influence health outcomes. To develop a conceptual framework describing the associations between WEF insecurities and health outcomes in South Africa by synthesizing existing evidence on the pathways through which WEF insecurities may influence health. This scoping review used an iterative process combining literature synthesis and expert consultation. A scoping review of peer-reviewed studies was conducted to identify evidence of WEF-health associations and inform a preliminary framework. This was subsequently refined through expert consultation, including 13 semistructured interviews with academic and practitioner experts (October-November 2024) and 2 in-person workshops (March 2025). Literature searches were performed between September 2024 and April 2025 using Web of Science, PubMed, and Scopus. Reference lists of retrieved articles were screened to identify additional studies. Study selection followed predefined inclusion criteria based on the population-concept-context framework: human populations in South Africa (population), associations between WEF insecurities and health outcomes (concept), and publication between 2005 and 2025 (context). Methods and results are reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews guidelines. A total of 137 articles were included in the review, and 26 experts were consulted. Evidence indicated that WEF insecurities were associated with a range of adverse health outcomes, including communicable diseases, noncommunicable diseases, and injuries. Key pathways included inadequate water, sanitation, and hygiene; poor nutrition; and reliance on traditional energy sources. Additional identified intermediating factors included increased exposure to vector-borne diseases associated with surface water, overcrowded living conditions, and intimate partner violence. While most studies examined WEF-related exposures in isolation, limiting understanding of their combined and interacting effects, this synthesis revealed interconnected pathways that may link WEF insecurity and health. The findings of this scoping review of 137 articles plus expert consultation suggest that WEF insecurities are interconnected with determinants of health in South Africa, operating through multiple pathways. The conceptual framework clarifies how intersecting WEF insecurities may jointly influence health outcomes and highlights the need for integrated research and policy approaches addressing the WEF-health nexus. Applying such integrated perspectives may support more effective strategies to reduce health risks in settings facing overlapping resource insecurities.
Islands are at the forefront of global environmental change. Biological invasions, land-use change, and climate change are driving population declines and causing irreversible losses in island ecosystems. Although global threat exposure maps have been developed in recent years, they are mostly designed for coarse-grained, continental-extent analyses, often overlooking islands. Here, we assessed the cumulative exposure to biological invasion, land-use change, and climate change by 2050, for more than 16,000 islands worldwide using multiple threat markers. Climate change emerged as a ubiquitous threat, being the dominant threat for 65% of all islands, followed by land-use change (22%) and biological invasions (13%). Islands with the highest cumulative exposure were more likely to be isolated, without historical connection with the mainland. Small and low-elevation islands at low latitudes exhibited greater exposure to climate change, whereas larger, high-elevation islands tended to be more exposed to land-use change. Certain countries and subdivisions, such as Seychelles, Bangladesh, China, French Polynesia, and Micronesia, harbored statistically disproportionate numbers of highly exposed islands, highlighting geographic hotspots of cumulative exposure where conservation efforts might be particularly urgent. Our study indicates that by 2050, most islands will be simultaneously exposed to a triple threat arising from the combined impacts of land-use change, climate change, and biological invasions. This study provides robust quantification of island cumulative exposure to three key drivers of biodiversity loss, making a crucial step toward assessing global biodiversity vulnerability.
Sediment-groundwater interfaces regulate the mobilisation, transport, and attenuation of metal contaminants within highly heterogeneous and multi-scale subsurface systems. However, efforts to operationalise digital twins in this domain remain fragmented across modelling paradigms, disciplines, and scales of observation and prediction. This study provides a performance-centred, quantitatively harmonised meta-analysis of sediment-groundwater digital twin (SG-DT) implementations, explicitly addressing scale dependence, spatial heterogeneity, and process-level controls. A PRISMA 2020-compliant systematic review and meta-analysis of 175 studies (1997-2026; 27 countries) was conducted. SG-DT applications were stratified across a continuum from pore and laboratory scales to site, reach, and basin domains. Scaling effects were analysed via stratified synthesis and meta-regression, while heterogeneity was operationalised through facies-based zonation, parameter variability, and multi-source observational constraints. Predictive performance was quantified using a redesigned, baseline-consistent effect size (E), enabling harmonisation across heterogeneous metrics and validation protocols. Uncertainty was estimated using random-effects models (REML) with Hartung-Knapp adjustments, and heterogeneity was assessed via τ2 and I2 with scale-aware interpretation. Results indicate a robust positive pooled performance gain for surrogate-enabled SG-DTs relative to non-updating baselines under scale-consistent validation, while highlighting limitations related to data dependence and extrapolation. In a subset of comparable studies, SG-DTs achieved a pooled out-of-sample R2 of 0.67 (95% CI: 0.62-0.72). Meta-regression identifies continuous data assimilation and explicit uncertainty quantification as key drivers of performance, whereas residual heterogeneity reflects unresolved scale mismatches and inconsistent representation of subsurface complexity. SG-DTs are defined as systems coupling a process-informed hydro(geo)chemical core capturing reaction kinetics and flow-transport-geochemical coupling, streaming observations, and an updating operator within a closed-loop framework. As secondary outputs, we provide a scale-aware reference architecture embedded in a continuous verification-validation-uncertainty quantification loop and the SED-GW-DT-REPORT v1.0 standard for reproducible, FAIR-aligned reporting. These findings establish an auditable, scale-consistent evidence base for advancing reliable digital twin development in sediment-groundwater systems.
In many low- and middle-income countries, uneven service coverage across urban-rural gradients and tenure regimes produces highly heterogeneous household waste disposal behaviors, with important implications for public health, air quality, and environmental integrity. Using Eswatini's 2017 National Population and Housing Census-the first national census in the country to include household waste disposal variables and the first opportunity for a georeferenced, countrywide, household-level assessment-we analyzed 2326 enumeration areas (EAs) and 6 disposal modalities: regular collection, irregular collection, public pit dumping, backyard pits, open burning, and undesignated dumping. We applied spatially explicit multivariate clustering to identify distinct disposal profiles and then evaluated geographic patterning using spatial autocorrelation and hotspot mapping. Five clusters were distinguished, revealing a pronounced urban-rural divide and strong tenure effects. Urban and company-town settings exhibited the highest reliance on regular collection (mean ≈52%) yet retained substantial open burning (≈43%), indicating persistent behavioral and/or service-quality gaps even where collection exists. Rural EAs, particularly on customary Eswatini Nation Land (both rural development areas (RDA) and non-RDA), were characterized by dominant backyard pit use (≈81%) alongside elevated public pit dumping (≈61%) and undesignated dumping (≈24%). Spatial statistics further showed concentrated rural hotspots of informal disposal practices, with notable clustering in parts of Lubombo and Shiselweni. These results support targeted, cluster-specific practical and policy interventions that combine rural service expansion, demand-side behavior change to reduce open burning, and governance arrangements that explicitly engage traditional authorities in planning, siting, and compliance.
Generative artificial intelligence (GenAI) is rapidly entering higher education, but measures of adoption, frequency, intention, or general attitude do not explain whether students use GenAI in ways that support academic work. This study focused on learning-centred use of GenAI in academic work (LCU), defined as a task-focused, verification-oriented, and non-substitutive pattern of GenAI integration, and tested time-ordered paths from LCU to later academic functioning through self-regulated learning (SRL) and academic self-efficacy (ASE). We analysed a de-identified three-wave panel dataset from university students in China. The valid baseline panel included 1,200 students; 984 students were retained at T2, where SRL and ASE were measured in separated modules (T2a and T2b); and 788 complete cases were retained at T3, where academic procrastination and learning engagement were assessed. Baseline-adjusted composite-score path models controlled for prior SRL, ASE, procrastination, engagement, demographic characteristics, and GenAI-use covariates. Inverse probability weighting and auxiliary behavioural and rater indicators were used as sensitivity and convergence checks. T1 LCU positively predicted T2a SRL (β = 0.345, p < 0.001) and T2b ASE (β = 0.118, p = 0.002), and T2a SRL positively predicted T2b ASE (β = 0.244, p < 0.001). SRL and ASE subsequently predicted lower T3 academic procrastination and higher T3 learning engagement after baseline outcomes were controlled. Indirect effects from LCU to both T3 outcomes were supported through SRL, ASE, and the SRL-to-ASE sequence; no residual direct LCU-to-outcome paths remained statistically significant after these mechanisms were included. Inverse probability weighting (IPW) and auxiliary-indicator checks showed a similar substantive pattern. These findings show that the academic value of GenAI use is realised when students integrate it into learning-centred regulatory practice. Compared with frequency-based accounts, the present model identifies LCU as the behavioural condition that connects GenAI use with later academic functioning through strengthened SRL and ASE. The study advances a psychologically grounded account of GenAI in higher education and highlights the need to guide students toward task-focused, verification-oriented, and non-substitutive use that supports planning, monitoring, persistence, and engagement.
Halting biodiversity loss on semi-natural grassland has become a key priority of agri-environmental policies in Estonia. However, to what extent current schemes are sufficient to achieve biodiversity targets and the role of landscape factors is still insufficiently understood in this context. This study explored trade-offs between profitability and biodiversity conservation across heterogeneous Estonian agricultural landscapes to support the development of economically effective grassland conservation schemes. To this end, we selected twelve 'landscape windows' in a grassland-rich region that represent a gradient of several biodiversity-related landscape factors (semi-natural grassland share, yield potential and landscape complexity). Profitability was assessed using total gross margins derived from a bio-economic model, while biodiversity was evaluated through habitat values for different bird species, based on model outputs. We found that landscapes with higher complexity, which currently maintain higher biodiversity levels, had a corresponding lower farm profitability. In particular, landscape windows dominated by semi-natural grasslands with low grass yields showed the lowest profitability, largely due to limited capacity for feeding beef cattle. In contrast, arable land-dominated landscapes (i.e. those with higher yield potential) demonstrated considerable potential for enhancing biodiversity outcomes while minimising profitability losses. Therefore, conservation policy faces two main challenges: 1. preserving landscapes with high biodiversity value against further decline in profitability, 2. highlighting the need to explore and design biodiversity measures in arable-dominated landscapes that could improve biodiversity outcomes while limiting impacts on farm profitability. This study illustrates that landscape factors deserve greater attention in conservation planning.
Enhancing the coordination among the green development index (GDI), eco-environmental security (EES), and social well-being (SWB) in the Yangtze River Economic Belt (YREB) is essential for promoting high-quality regional development. Using panel data from 2008 to 2022, this study develops an integrated dynamic assessment framework for the GDI-EES-SWB (GES) system by combining entropy-CRITIC-based coupling coordination degree (CCD) evaluation, obstacle-factor diagnosis, and CNN-GRU-Attention-based scenario prediction. The results show that: (1) the regional mean CCD increased from 0.598 to 0.660 and further to 0.717, maintaining an "east high-west low" spatial gradient while regional disparities gradually converged, indicating an overall improvement in coordinated development; (2) constraints were mainly concentrated in GDI and EES, with the core obstacles including the number of patents granted, the proportion of ecological water use, and environmental regulation intensity. Specifically, the upper reaches were constrained by insufficient innovation output, the middle reaches faced dual constraints of innovation deficits and governance burdens, whereas the lower reaches mainly faced ecological security bottlenecks. (3) Scenario-based projections suggest a continued CCD rise through 2030, with considerable growth potential in Anhui and Hubei, particularly under the "innovation-driven and green-regulation synergy" scenario. Accordingly, this study proposes strengthening green innovation, optimizing resource allocation, and deepening environmental governance. These measures can help foster regional coordination and provide policy support for the YREB to achieve high-quality development and "dual-carbon" goals.
Land use/cover change (LUCC) alters vegetation structure and carbon sequestration capacity, thereby reshaping regional carbon cycling. However, the mechanisms driving the spatial heterogeneity of carbon storage (CS) in rapidly urbanizing coastal regions remain insufficiently understood. In this study, the relationship between land use and CS was quantified using land-use data from 2000, 2010, and 2020 for the Chaoshan region. Future land-use patterns were simulated under three development scenarios using the PLUS model, CS dynamics were evaluated with the InVEST model, and the dominant drivers of CS spatial heterogeneity were identified using the Geographical Detector. The results indicate that between 2000 and 2020, artificial surfaces expanded significantly (889.23 km²), while cultivated land decreased substantially (782.98 km²), and wetlands nearly disappeared. Spatially, CS exhibited a pattern of low storage in the southeast and southwest and high storage in the central and north, a distribution primarily influenced by NDVI, DEM, and Slope. Notably, a strong interaction between DEM and NDVI (q = 0.62) highlights a critical terrain-vegetation synergy in shaping CS patterns. By 2030, CS is projected to decline under all three development scenarios, with the lowest reduction under the low-carbon development (LCD) scenario, emphasizing its significant advantage in mitigating carbon loss. This study proposes spatially targeted strategies integrating forest enhancement in high-carbon mountainous regions, compact urbanization with cropland protection in southeastern areas, and coastal-riparian wetland restoration, underpinned by carbon compensation mechanisms to balance development with ecological conservation.
Primary Health Care (PHC) is responsible for organizing the care networks of the Unified Health System (SUS), and with advances in digital health and investments from the Ministry of Health, tools have been developed to support PHC management. This article presents the "PHC Teams and Facilities Map" a publicly accessible tool developed by the Monitoring and Evaluations Coordination of the Secretariat of Primary Health Care of the Ministry of Health. The platform allows visualization of the territorial distribution of Basic Health Units and teams through five thematic maps: demography, teams, coverage, rurality, and dengue. Public data from the Health Information System for Primary Care; the National Registry of Health Establishments; the Brazilian Institute of Geography and Statistics; as well as geological risk information from the Geological Survey of Brazil, and information on areas from the National Foundation for Indigenous Peoples and the National Institute for Colonization and Agrarian Reform were used. The initiative seeks to promote greater transparency and support in decision-making, and could become a valuable strategy in the primary health care planning process. A Atenção Primária à Saúde (APS) é responsável pela organização das redes de atenção do Sistema Único de Saúde, e com os avanços da saúde digital e investimentos do Ministério da Saúde, ferramentas vêm sendo desenvolvidas para apoiar a gestão da APS. Este artigo apresenta o “Mapa das Unidades Básicas de Saúde da APS”, ferramenta de acesso público, elaborada por uma Coordenação Geral da Secretaria de Atenção Primária à Saúde do Ministério da Saúde. A plataforma permite a visualização da distribuição territorial das Unidades Básicas de Saúde e das equipes por meio de cinco mapas temáticos: demografia, equipes, cobertura, ruralidade e dengue. Foram utilizados dados públicos do Sistema de Informação em Saúde para Atenção Básica; do Cadastro Nacional de Estabelecimentos de Saúde; do Instituto Brasileiro de Geografia e Estatística; além de informações de riscos geológicos do Serviço Geológico do Brasil, e sobre áreas da Fundação Nacional dos Povos Indígenas e do Instituto Nacional de Colonização e Reforma Agrária. A iniciativa busca promover maior transparência e apoio na tomada de decisões, e pode se tornar uma estratégia valiosa no processo de planejamento em saúde da APS. La Atención Primaria de Salud (APS) es responsable de organizar las redes de atención del Sistema Único de Salud (SUS). Gracias a los avances en salud digital y a las inversiones del Ministerio de Salud, se han desarrollado herramientas para apoyar su gestión. Este artículo presenta el “Mapa de Unidades Básicas de Salud de la APS”, una herramienta de acceso público desarrollada por la Coordinación General de la Secretaría de Atención Primaria de Salud del Ministerio de Salud. La plataforma permite visualizar la distribución territorial de las Unidades Básicas de Salud y los equipos mediante cinco mapas temáticos: demografía, equipos, cobertura, ruralidad y dengue. Se utilizaron datos públicos del Sistema de Información en Salud para la Atención Primaria; el Registro Nacional de Establecimientos de Salud; el Instituto Brasileño de Geografía y Estadística; así como información sobre riesgos geológicos del Servicio Geológico de Brasil e información sobre áreas de la Fundación Nacional para los Pueblos Indígenas y el Instituto Nacional de Colonización y Reforma Agraria. La iniciativa busca promover una mayor transparencia y apoyo en la toma de decisiones, y podría convertirse en una estrategia valiosa en el proceso de planificación de la atención primaria de salud. Palabras clave: Atención Primaria de Salud, Unidad Básica de Salud, Salud Digital, Cartografía Geográfica.
Litter-inhabiting fungi drive organic matter mineralization, regulate nutrient cycling, and support ecosystem stability. Understanding their dynamics in unique geological habitats is essential for predicting ecological recovery on volcanic landforms. Using high-throughput ITS sequencing and physicochemical analyses, we investigated litter-inhabiting fungal communities across four stand types on the Jingpo Lake lava plateau-shrub forest (SF), deciduous broad-leaved forest (DB), coniferous and broad-leaved mixed forest (CB), and coniferous forest (CF)-at the early (t1) and late (t2) stages of decomposition. The results showed significant differences in litter physical and chemical properties among forest stand types (p < 0.05). Regarding community composition, Ascomycota and Basidiomycota dominated throughout, and the core genera were primarily unclassified_o__Helotiales, Mortierella, and unclassified_k__Fungi. Alpha diversity analysis showed that DB had the highest Shannon and Pielou-e indices at stage t1, while CB exhibited higher OTUs and Chao1 indices at stage t2. Beta diversity showed that SF communities were significantly separated between the two stages. Co-occurrence networks showed the highest connectivity in CF with pronounced modularity. Notably, LEfSe analysis revealed that DB had the fewest biomarkers, suggesting matrix heterogeneity suppresses single-taxon dominance. Functionally, saprotrophs dominated initially but transitioned toward complex soil saprotroph and endophyte assemblages over time. Redundancy analysis (RDA) identified litter moisture content (LMC) and carbon (C) content as primary drivers, orchestrating a systematic shift in community assembly from "moisture-driven colonization" at t1 to "carbon quality screening" at t2. These findings provide a microecological basis for understanding plant-litter-microorganism coupling mechanisms and guiding ecological restoration in lava plateau ecosystems.
Fine particulate matter (PM2.5; aerodynamic diameter ≤2.5 µm) is a leading contributor to the global burden of disease and is associated with substantial morbidity and mortality. However, its health effects are often evaluated within single-exposure frameworks, limiting causal inference and reducing the translational relevance of evidence for policy development. In this study, we reconceptualise PM2.5 within the exposome framework by integrating external exposures, internal biological responses, and structural determinants of health across the life course. PM2.5 comprises a complex and dynamic mixture of pollutants from ambient and household sources, including biomass combustion, traffic emissions, and industrial activities. After inhalation, PM2.5 particles can penetrate the respiratory tract, and finer fractions may enter the systemic circulation, where they induce oxidative stress, inflammation, epigenetic dysregulation, and endocrine disruption. These mechanisms contribute to a broad spectrum of adverse health outcomes, including cardiovascular, respiratory, metabolic, and neurodegenerative diseases as well as cancers. The multi-level and temporally accumulated nature of these effects highlights the limitations of reductionist exposure assessment and underscores the need for integrative, systems-based approaches. Integrating cumulative impact assessment with exposome-wide approaches that leverage satellite, clinical, land-use, urban planning, and socioeconomic data can improve the characterisation of context-specific cumulative health effects. Positioning PM2.5 as a sentinel indicator of cumulative environmental risk provides a unifying framework for exposome-informed science and supports the development of more precise, equitable, and policy-relevant interventions.
Wildfires in the Northern Mediterranean are increasing in frequency and intensity, driven by climate change, land abandonment, and fuel accumulation. Traditional fire suppression approaches are insufficient to address the complex social-ecological drivers of wildfire risk. This paper advocates adopting landscape approaches as an integrated and adaptive framework for mitigation. We assess ten wildfire mitigation initiatives in four countries, using five dimensions: multifunctionality, synergies and trade-offs, cross-sectoral integration, participation, and adaptive management. High-performing initiatives showed integrative planning, multi-actor governance, and adaptive learning. Key enablers of landscape coherence include strong leadership, institutional support, and participatory governance. However, gaps emerged in monitoring trade-offs and aligning strategies across sectors and spatial scales. Advancing landscape approaches in wildfire policy requires greater investment in collaboration, shared learning, and long-term governance capacities. Our findings offer insights to scale multifunctional, adaptive, and socially legitimate wildfire mitigation strategies in Mediterranean landscapes and beyond.
Accurate representation of plant photosynthesis in terrestrial biosphere models (TBMs) is critical for reliable carbon-cycle simulations. Most TBMs employ the Farquhar-von Caemmerer-Berry (FvCB) model, which uses an empirical representation of electron transport that limits the simulation of gross primary productivity (GPP) and solar-induced chlorophyll fluorescence (SIF) under variable conditions. Here, we present BEPS-CB6F, an improved model that incorporates the mechanistic cytochrome b6f (Cyt b6f) scheme (CB6F) of Johnson and Berry into the Biosphere-atmosphere Exchange Process Simulator (BEPS). This implementation replaces empirical formulations with a process-based energy-allocation framework and links GPP and SIF through shared physiological parameters, including the maximum Cyt b6f activity (Vqmax) and the fraction of total leaf absorbance allocated to photosystem II (PSII) (β₂). BEPS-CB6F also integrates key photoprotective processes, including cyclic electron flow around photosystem I (CEF), non-photochemical quenching of photosystem II (NPQ), and photosynthetic control of Cyt b6f, within a two-leaf canopy scheme that differentiates sunlit and shaded responses. The results show that across flux-tower sites, BEPS-CB6F substantially improves SIF simulations, with RMSE and rRMSE reductions at more than 90% of sites, and yields moderate but consistent improvements in GPP, including higher R2 and reduced RMSE at over 80% of sites. The model alleviates GPP overestimation under low light, particularly in shaded leaves, and markedly reduces SIF overestimation under high irradiance in sunlit leaves. BEPS-CB6F further enhances performance during heat and high-VPD conditions. By explicitly representing temperature-responsive CEF and NPQ, it captures the strong midday suppression of GPP and SIF, including reductions in GPP and SIF during heatwaves. Sensitivity analyses indicate that Vqmax and β2 strongly influence GPP simulations, while β2 is the primary driver of SIF simulations. These results highlight the importance of mechanistic electron-transport representation and demonstrate the potential of CB6F to improve terrestrial biosphere model predictions of carbon uptake and fluorescence.