Climate change-related risks and adaptation potential in Central and South America during the 21st century

Climate-related risks in Central and South America have received increased attention and concern in science and policy, but an up-to-date comprehensive review and synthesis of risks and adaptation potential is currently missing. For this paper we evaluated over 200 peer-reviewed articles and grey literature documents published since 2012. We found that climate change in Central and South America during the 21st century may increase the risk to severe levels for the following topical risk clusters: (a) Food insecurity; (b) Floods and landslides; (c) Water scarcity; (d) Epidemics of vector-borne diseases; (e) Amazon Forest biome shift; (f). Coral bleaching; (g) Coastal risks of sea level rise, storm surges and erosion; (h) Systemic failure due to cascading impacts of hazards and epidemics. Our synthesis also identified feasible adaptation measures for each risk. The impacts of the risks will be heterogeneous throughout the region, with rural communities, Indigenous peoples, Afro-Latin Americans, women, disabled people, and migrants identified as being the most severely affected. We refer to a number of adaptation options for each risk. However, unabated climate change together with low adaptive capacity will strictly limit adaptation options. Immediate strengthening of policies for building adaptive capacity and increase of research on the risk-adaptation nexus in Central and South America are paramount. Our findings might contribute to guide the adjustment and emphasis of adaptation policies and climate risk management strategies from local to national level

A multi-technique approach to understanding delithiation damage in LiCoO thin films

We report on the delithiation of LiCoO2 thin films using oxalic acid (C2H2O4) with the goal of understanding the structural degradation of an insertion oxide associated with Li chemical extraction. Using a multi-technique approach that includes synchrotron radiation X-ray diffraction, scanning electron microscopy, micro Raman spectroscopy, photoelectron spectroscopy and conductive atomic force microscopy we reveal the balance between selective Li extraction and structural damage. We identify three different delithiation regimes, related to surface processes, bulk delithiation and damage generation. We find that only a fraction of the grains is affected by the delithiation process, which may create local inhomogeneities. However, the bulk delithiation regime is effective to delithiate the LCO film. All experimental evidence collected indicates that the delithiation process in this regime mimics the behavior of LCO upon electrochemical delithiation. We discard the formation of Co oxalate during the chemical extraction process. In conclusion, the chemical route to Li extraction provides additional opportunities to investigate delithiation while avoiding the complications associated with electrolyte breakdown and simplifying in-situ measurement

Central and South America

The chapter is divided into two main sections. The first section follows an integrative approach in which hazards, exposure, vulnerability, impacts and risks are discussed following the eight climatically homogeneous sub-regions described in WGI AR6 (Figure 12.1). The second section assesses the implemented and proposed adaptation practices by sector; in doing so, it connects to the WGII AR6 crosschapter themes. The storyline is then a description of the hazards, exposure, vulnerability and impacts providing as much detail as is available in the literature at the sub-regional level, followed by the identification of risks as a result of the interaction of those aspects. This integrated sub-regional approach ensures a balance in the text, particularly for countries that are usually underrepresented in the literature but that show a high level of vulnerability and impacts, such as those observed in CA. The sectoral assessment of adaptation that follows is useful for policymakers and implementers, usually focused and organised by sectors, government ministries or secretaries that can easily locate the relevant adaptation information for their particular sector. To ensure coherence in the chapter, a summary of the assessed adaptation options by key risks is presented, followed by a feasibility assessment for some relevant adaptation options. The chapter closes with case studies and a discussion of the knowledge gaps evidenced in the process of the assessment.EEA Santa CruzFil: Castellanos, Edwin J. Universidad del Valle de Guatemala; Guatemala.Fil: Lemos, Maria Fernanda. Pontifical Catholic University of Rio de Janeiro; Brasil.Fil: Astigarraga, Laura. Universidad de la República; Uruguay.Fil: Chacón, Noemí. Instituto Venezolano de Investigaciones Científicas; Venezuela.Fil: Cuvi, Nicolás. Facultad Latinoamericana de Ciencias Sociales (FLACSO); Ecuador.Fil: Huggel, Christian. University of Zurich; Switzerland.Fil: Miranda Sara, Liliana Raquel. Foro Ciudades para la Vida; Peru.Fil: Moncassim Vale, Mariana. Federal University of Rio de Janeiro; Brasil.Fil: Ometto, Jean Pierre. National Institute for Space Research; Brasil.Fil: Peri, Pablo Luis. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; Argentina.Fil: Peri, Pablo Luis. Universidad Nacional de la Patagonia Austral; Argentina.Fil: Peri, Pablo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Postigo, Julio C. Indiana University; Estados Unidos.Fil: Ramajo Gallardo, Laura. Adolfo Ibanez University; Chile.Fil: Roco, Lisandro. Catholic University of The North; Chile.Fil: Rusticucci, Matilde Monica. Universidad de Buenos Aires; Argentina

Central America urgently needs to reduce the growing adaptation gap to climate change

Central America is highly impacted by current extreme events associated with climate variability and the adverse effects of climate change, showing high vulnerability compounded by its historical context and socioeconomic structure. In light of the important findings published by the WGII of the IPCC AR6 in 2022 on the adverse effects of climate change on the Central American region, there is still a clear need to improve data availability and to increase the number of studies on projections of changes in the climate, risks, impacts, vulnerability, and adaptation from the region to inform decision-makers and practitioners. The region has seen an increase in the number of adaptation projects implemented; however, there is limited information about their success or failure, and there are few case studies and reviews of lessons learned, highlighting an important gap in the implementation of effective adaptation measures. This article presents a current review of the literature on climatology, hydrology, impacts and vulnerability, mitigation and adaptation responses, action plans, and potential losses and damages in the region. It also proposes actionable recommendations based on the main gaps found and presents a case study of the Central American Dry Corridor, one of the climate change and underdevelopment hotspots of the region. We finish with a discussion highlighting the importance of considering system transitions perspectives and the need to plan and implement more transformational adaptation approaches to reduce further losses and damages and to further address adaptation gaps in Central America

Defining Natural History: Assessment of the Ability of College Students to Aid in Characterizing Clinical Progression of Niemann-Pick Disease, Type C

Niemann-Pick Disease, type C (NPC) is a fatal, neurodegenerative, lysosomal storage disorder. It is a rare disease with broad phenotypic spectrum and variable age of onset. These issues make it difficult to develop a universally accepted clinical outcome measure to assess urgently needed therapies. To this end, clinical investigators have defined emerging, disease severity scales. The average time from initial symptom to diagnosis is approximately 4 years. Further, some patients may not travel to specialized clinical centers even after diagnosis. We were therefore interested in investigating whether appropriately trained, community-based assessment of patient records could assist in defining disease progression using clinical severity scores. In this study we evolved a secure, step wise process to show that pre-existing medical records may be correctly assessed by non-clinical practitioners trained to quantify disease progression. Sixty-four undergraduate students at the University of Notre Dame were expertly trained in clinical disease assessment and recognition of major and minor symptoms of NPC. Seven clinical records, randomly selected from a total of thirty seven used to establish a leading clinical severity scale, were correctly assessed to show expected characteristics of linear disease progression. Student assessment of two new records donated by NPC families to our study also revealed linear progression of disease, but both showed accelerated disease progression, relative to the current severity scale, especially at the later stages. Together, these data suggest that college students may be trained in assessment of patient records, and thus provide insight into the natural history of a disease

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Constraining bedrock erosion during extreme flood events

The importance of high-magnitude, short-lived flood events in controlling the evolution of bedrock landscapes is not well understood. During such events, erosion processes can shift from one regime to another upon the passing of thresholds, resulting in abrupt landscape changes that can have a long lasting legacy on landscape morphology. Geomorphological mapping and topographic analysis document the evidence for, and impact of, extreme flood events within the Jökulsárgljúfur canyon (North-East Iceland). Surface exposure dating using cosmogenic 3He of fluvially sculpted bedrock surfaces determines the timing of the floods that eroded the canyon and helps constrain the mechanisms of bedrock erosion during these events. Once a threshold flow depth has been exceeded, the dominant erosion mechanism becomes the toppling and transportation of basalt lava columns and erosion occurs through the upstream migration of knickpoints. Surface exposure ages allow identification of three periods of rapid canyon cutting during erosive flood events about 9, 5 and 2 ka ago, when multiple active knickpoints retreated large distances (> 2 km), each leading to catastrophic landscape change within the canyon. A single flood event ~9 ka ago formed, and then abandoned, Ásbyrgi canyon, eroding 0.14 km3 of rock. Flood events ~5 and ~2 ka ago eroded the upper 5 km of the Jökulsárgljúfur canyon through the upstream migration of vertical knickpoints such as Selfoss, Dettifoss and Hafragilsfoss. Despite sustained high discharge of sediment-rich glacial meltwater (ranging from 100 to 500 m3 s-1); there is no evidence for a transition to an abrasion-dominated erosion regime since the last erosive flood: the vertical knickpoints have not diffused over time and there is no evidence of incision into the canyon floor. The erosive signature of the extreme events is maintained in this landscape due to the nature of the bedrock, the discharge of the river, large knickpoints and associated plunge pools. The influence of these controls on the dynamics of knickpoint migration and morphology are explored using an experimental study. The retreat rate of knickpoints is independent of both mean discharge, and temporal variability in the hydrograph. The dominant control on knickpoint retreat is the knickpoint form which is set by the ratio of channel flow depth to knickpoint height. Where the knickpoint height is five times greater than the flow depth, the knickpoints developed undercutting plunge pools, accelerating the removal of material from the knickpoint base and the overall retreat rate. Smaller knickpoints relative to the flow depth were more likely to diffuse from a vertical step into a steepened reach or completely as the knickpoint retreated up the channel. These experiments challenge the established assumption in models of landscape evolution that a simple relationship exists between knickpoint retreat and discharge/drainage area. In order to fully understand how bedrock channels, and thus landscapes, respond and recover to transient forcing, further detailed study of the mechanics of erosion processes at knickpoints is required

Mapping density, diversity and species-richness of the Amazon tree flora

Using 2.046 botanically-inventoried tree plots across the largest tropical forest on Earth, we mapped tree species-diversity and tree species-richness at 0.1-degree resolution, and investigated drivers for diversity and richness. Using only location, stratified by forest type, as predictor, our spatial model, to the best of our knowledge, provides the most accurate map of tree diversity in Amazonia to date, explaining approximately 70% of the tree diversity and species-richness. Large soil-forest combinations determine a significant percentage of the variation in tree species-richness and tree alpha-diversity in Amazonian forest-plots. We suggest that the size and fragmentation of these systems drive their large-scale diversity patterns and hence local diversity. A model not using location but cumulative water deficit, tree density, and temperature seasonality explains 47% of the tree species-richness in the terra-firme forest in Amazonia. Over large areas across Amazonia, residuals of this relationship are small and poorly spatially structured, suggesting that much of the residual variation may be local. The Guyana Shield area has consistently negative residuals, showing that this area has lower tree species-richness than expected by our models. We provide extensive plot meta-data, including tree density, tree alpha-diversity and tree species-richness results and gridded maps at 0.1-degree resolution

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/ COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence

La Asociación Colombiana de Infectología (ACIN) y el Instituto de Evaluación de Nuevas Tecnologías de la Salud (IETS) conformó un grupo de trabajo para desarrollar recomendaciones informadas y basadas en evidencia, por consenso de expertos para la atención, diagnóstico y manejo de casos de Covid 19. Estas guías son dirigidas al personal de salud y buscar dar recomendaciones en los ámbitos de la atención en salud de los casos de Covid-19, en el contexto nacional de Colombia