Public health: a forgotten piece of the adaptation law puzzle

This paper uses the problem of extreme heat to illustrate the inadequacy of laws for protecting public health under climate change. Climate change is already having serious effects on public health. The Intergovernmental Panel on Climate Change (IPCC) Sixth Assessment Report highlights significant adaptation gaps for human health protection, urging that public health adaptation must be ‘proactive, timely and effective’. The law can be a powerful tool for advancing adaptation to protect public health, but there has been very little scholarly analysis of its potential, or whether in some circumstances it may promote maladaptation. For example, legal regimes for land use planning typically respect existing uses of property and make retrofitting for climate-proofing hard to mandate. These regimes can take many years to amend so new infrastructure continues to comply with outdated approaches, such as relying on air conditioning for cooling and offering limited shading. Laws also promote a focus on crisis management during a heat event but fail to promote the preventive action necessary to foster resilience. We present a case study of how the law exacerbates public health risks from extreme heat and falls short of facilitating adaptation in the Greater Western Sydney region of Australia, an area with a population of 2.6 million. In 2019, this area experienced a record near-surface air temperature of 52°C (125.6°F) causing significant adverse physical and mental health impacts. The public health impacts of extreme temperatures in this region are well documented, as are the increasing strains on emergency and health services. This case study demonstrates that laws could help to control heat in the landscape and secure the safety of vulnerable populations, but to do so they must prioritize adaptation to the health impacts of climate change

Wilderness Law in the Anthropocene: Purism or Pragmatism

Wilderness is vanishing. Despite explicit legislative protection of wilderness values for over half a century, rapid environmental degradation worldwide in recent decades has severely diminished the extent and quality of terrestrial and marine wilderness to the point where we must reassess the fundamental premises and future of wilderness law. With increased human demands on the natural world, and with climate breakdown looming, the very notion of “wilderness” itself may one day be considered meaningless or irrelevant. We examine legal developments in the United States, Australia, and Europe to critically evaluate the state of wilderness law. In this Anthropocene era, when humans control so much of Earth’s resources, we examine whether the law should aim for a “purist” approach, in which wilderness areas are simply left untouched, or a “pragmatic”‘ approach, in which wilderness is actively managed to maintain its cherished values in the face of mounting adversity. A variety of intermediary positions are conceivable between these endpoints, and the best approach to wilderness management will likely depend on several considerations including who or what “wilderness” is meant to serve, the geographic and biological features of the landscape, environmental threats the area faces, the presence of Indigenous or other local communities, and the values that the guiding law means to serve. We offer recommendations to improve wilderness law to navigate the Anthropocene. We suggest proceeding with care and humility, staying as close to purism as possible, while acknowledging that sometimes we must take a pragmatic approach and intervene to preserve the wilderness qualities our laws are designed to protec

Pregnancy and Infant Outcomes among HIV-Infected Women Taking Long-Term ART with and without Tenofovir in the DART Trial

Diana Gibb and colleagues investigate the effect of in utero tenofovir exposure by analyzing the pregnancy and infant outcomes of HIV-infected women enrolled in the DART trial

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Transformation in the forest: the role for restoration in the transition away from native forestry in Australia

The native forestry industry is being reconsidered, or actively phased out, across most parts of Australia. This kind of transition has happened elsewhere in the world but, in Australia, there is no clarity from governments about what those forestry areas will become, from an ecological or legal perspective. In this research, we investigate the ecological, climatic, and governance con- texts for this transition away from native forestry, placing our results in the context of the Global Biodiversity Framework’s push to restore 30% of the Earth’s land, coasts and oceans. We demonstrate important gaps in government planning for the future of former native forestry coupes, arguing that “after forestry” many of these places will need active intervention to recover these ecosystems and address historic land degradation. This case study combines legal analysis with a review of the restoration literature to illustrate the importance of the governance framework within which restoration science is evolving. We demonstrate the complexity of governing restoration at large scales as the climate changes, as well as potential opportunities to reconcile fragmented governance arrangements, to ensure that this transition results in resilient forest ecosystems in cur- rently degraded areas

Wilderness law in the anthropocene:Pragmatism and purism

Wilderness is vanishing. Despite explicit legislative protection of wilderness values for over half a century, rapid environmental degradation worldwide in recent decades has severely diminished the extent and quality of terrestrial and marine wilderness to the point where we must reassess the fundamental premises and future of wilderness law. With increased human demands on the natural world, and with climate breakdown looming, the very notion of “wilderness” itself may one day be considered meaningless or irrelevant. We examine legal developments in the United States, Australia, and Europe to critically evaluate the state of wilderness law. In this Anthropocene era, when humans control so much of Earth’s resources, we examine whether the law should aim for a “purist” approach, in which wilderness areas are simply left untouched, or a “pragmatic”’ approach, in which wilderness is actively managed to maintain its cherished values in the face of mounting adversity. A variety of intermediary positions are conceivable between these endpoints, and the best approach to wilderness management will likely depend on several considerations including who or what “wilderness” is meant to serve, the geographic and biological features of the landscape, environmental threats the area faces, the presence of Indigenous or other local communities, and the values that the guiding law means to serve. We offer recommendations to improve wilderness law to navigate the Anthropocene. We suggest proceeding with care and humility, staying as close to purism as possible, while acknowledging that sometimes we must take a pragmatic approach and intervene to preserve the wilderness qualities our laws are designed to protect

Wilderness law in the anthropocene: Pragmatism and purism

Wilderness is vanishing. Despite explicit legislative protection of wilderness values for over half a century, rapid environmental degradation worldwide in recent decades has severely diminished the extent and quality of terrestrial and marine wilderness to the point where we must reassess the fundamental premises and future of wilderness law. With increased human demands on the natural world, and with climate breakdown looming, the very notion of “wilderness” itself may one day be considered meaningless or irrelevant. We examine legal developments in the United States, Australia, and Europe to critically evaluate the state of wilderness law. In this Anthropocene era, when humans control so much of Earth’s resources, we examine whether the law should aim for a “purist” approach, in which wilderness areas are simply left untouched, or a “pragmatic”’ approach, in which wilderness is actively managed to maintain its cherished values in the face of mounting adversity. A variety of intermediary positions are conceivable between these endpoints, and the best approach to wilderness management will likely depend on several considerations including who or what “wilderness” is meant to serve, the geographic and biological features of the landscape, environmental threats the area faces, the presence of Indigenous or other local communities, and the values that the guiding law means to serve. We offer recommendations to improve wilderness law to navigate the Anthropocene. We suggest proceeding with care and humility, staying as close to purism as possible, while acknowledging that sometimes we must take a pragmatic approach and intervene to preserve the wilderness qualities our laws are designed to protect