Risk-based lung cancer screening performance in a universal healthcare setting.

Globally, lung cancer is the leading cause of cancer death. Previous trials demonstrated that low-dose computed tomography lung cancer screening of high-risk individuals can reduce lung cancer mortality by 20% or more. Lung cancer screening has been approved by major guidelines in the United States, and over 4,000 sites offer screening. Adoption of lung screening outside the United States has, until recently, been slow. Between June 2017 and May 2019, the Ontario Lung Cancer Screening Pilot successfully recruited 7,768 individuals at high risk identified by using the PLCOm2012noRace lung cancer risk prediction model. In total, 4,451 participants were successfully screened, retained and provided with high-quality follow-up, including appropriate treatment. In the Ontario Lung Cancer Screening Pilot, the lung cancer detection rate and the proportion of early-stage cancers were 2.4% and 79.2%, respectively; serious harms were infrequent; and sensitivity to detect lung cancers was 95.3% or more. With abnormal scans defined as ones leading to diagnostic investigation, specificity was 95.5% (positive predictive value, 35.1%), and adherence to annual recall and early surveillance scans and clinical investigations were high (>85%). The Ontario Lung Cancer Screening Pilot provides insights into how a risk-based organized lung screening program can be implemented in a large, diverse, populous geographic area within a universal healthcare system.

Connecting the multiple dimensions of global soil fungal diversity.

How the multiple facets of soil fungal diversity vary worldwide remains virtually unknown, hindering the management of this essential species-rich group. By sequencing high-resolution DNA markers in over 4000 topsoil samples from natural and human-altered ecosystems across all continents, we illustrate the distributions and drivers of different levels of taxonomic and phylogenetic diversity of fungi and their ecological groups. We show the impact of precipitation and temperature interactions on local fungal species richness (alpha diversity) across different climates. Our findings reveal how temperature drives fungal compositional turnover (beta diversity) and phylogenetic diversity, linking them with regional species richness (gamma diversity). We integrate fungi into the principles of global biodiversity distribution and present detailed maps for biodiversity conservation and modeling of global ecological processes.

The SAFE (Social Accountability as the Framework for Engagement) for Health Institutions project: Rapid evidence narratives.

PROBLEM ADDRESSED: Family physicians stand to benefit from assistance with the implementation of social accountability strategies. OBJECTIVE OF PROGRAM: To develop rapid evidence narratives for key social accountability topics that summarize and mobilize evidence for practical use in social accountability strategies linking front-line, "bottom-up" actions with complementary "top-down" standards from the SAFE (Social Accountability as the Framework for Engagement) for Health Institutions evaluation tool. PROGRAM DESCRIPTION: The SAFE for Health Institutions project aims to accelerate transformation toward greater social accountability in family medicine practices and in other settings where family physicians work. A social accountability evaluation tool was developed to help with this transformation and includes a framework of 253 comprehensive top-down standards. Key social accountability topics linked to these standards were identified for rapid reviews of the literature, conducted between June and November 2021, with evidence reported as narratives. These rapid evidence narratives provide practical, evidence-based context including suggestions on how to address each topic across the micro, meso, and macro levels of care, connecting bottom-up actions with corresponding considerations for top-down policies, processes, and structures. Summaries of the rapid evidence narratives are being developed as a series of articles for Canadian Family Physician, focusing on what family physicians can do in clinical practices, with interdisciplinary teams, and in other work settings to accelerate change toward adopting or advancing socially accountable strategies. CONCLUSION: Rapid evidence narratives that summarize and mobilize evidence on key social accountability topics further the understanding of social accountability in family medicine and in other settings where family physicians work. Mapping actions across the micro, meso, and macro levels of care is a practical way to link front-line, bottom-up actions with a top-down social accountability strategy.

Exploring the development of a framework of social accountability standards for healthcare service delivery: a qualitative multipart, multimethods process.

OBJECTIVES: Social accountability is an equity-oriented health policy strategy that requires institutions to focus on local population needs. This strategy is well established in health professional education, but there is limited understanding of its application in healthcare service delivery. Building on what is known in the education setting, this study aimed to explore the development of a framework of comprehensive, evidence-based social accountability standards for healthcare service delivery institutions. DESIGN: This qualitative, multipart, multimethods study consisted of a modified Delphi process guided by an evidence-based social accountability tool for health professional education and complementary methods including developmental evaluation and a review of select literature to capture emerging evidence and contextual relevance. SETTING: The study took place in Northern Ontario, Canada at a medical school and a tertiary, regional academic health sciences centre that are both grounded in social accountability. PARTICIPANTS: Eight expert participants from diverse, multidisciplinary backgrounds, including a patient advocate, were purposefully recruited from both institutions, enrolled and seven completed the study. MAIN OUTCOME: The resulting framework of social accountability standards is organised into 4 major sections that capture broad and critical concepts; 17 key component reflective questions that address key themes; 39 aspirations that describe objective standards and 197 indicators linked to specific expectations. RESULTS: Three modified Delphi rounds were completed producing a framework of consensus derived standards. Developmental evaluation helped identify facilitators, barriers and provided real-time feedback to the study's processes and content. The literature reviewed identified 10 new concepts and 43 amendments. CONCLUSION: This study highlights the development of a comprehensive, evidence-based framework of social accountability standards for healthcare service delivery institutions. Future studies will aim to evaluate the application of these standards to guide equity-oriented social accountability health policy strategies in healthcare service delivery.

Spread of Makoyoh'sokoi (Wolf Trail): a community led, physical activity-based, holistic wellness program for Indigenous women in Canada.

Globally, Indigenous populations have been impacted by colonization. Populations who have endured colonization are at higher risk of developing chronic diseases. Canada's Truth and Reconciliation Commission emphasizes reducing barriers to participation in physical activity and recommends the creation of culturally relevant and supportive policies and programing. Physical activity is a cornerstone in health promotion and public health to combat chronic diseases; however, in Canada, Indigenous developed physical activity programing is sparse, and those targeting women are non-existent in some regions. Makoyoh'sokoi (The Wolf Trail Program) is an 18-week long, holistic wellness program that was created by and for Indigenous women. Makoyoh'sokoi was developed by communities following extensive consultation and cultural oversight. Makoyoh'sokoi's core program consists of 12 weeks of weekly physical activity programing and health education, followed by another 6 weeks of weekly health education. Notably, communities have control over the program to modify based on individual needs and challenges. Programs commence and conclude with a ceremony with Elders giving a blessing and opening each other to connection. The goals of Makoyoh'sokoi are to empower women, improve health outcomes, and to implement a sustainable program by training a network of community members in their respective communities to facilitate delivery.

The Rural Road Map For Action: an examination of undergraduate medical education in Canada.

Background: There is currently a maldistribution of physicians across Canada, with rural areas facing a greater physician shortage. The taskforce between the College of Family Physicians and the Society of Rural Physicians created a report, "The Rural Road Map for Action" (RRMA) to improve rural Canadians' health by training and retaining an increased number of rural family physicians. Using the RRMA as a framework, this paper aims to examine the extent to which medical schools in Canada are following the RRMA. Methods: Researchers used cross-sectional survey and collected data from 12 of 17 medical school undergraduate Deans from across Canada using both closed and open ended survey questions. Results were analyzed using quantitative (frequencies) and qualitative methods (content analysis). Results: Medical schools use different policies and procedures to recruit rural and Indigenous students. Although longitudinal integrated clerkships offer many benefits, few students have access to them. Leadership representation on decision-making education committees differed across medical schools pointing to a variation in the value of rural physicians' perspectives. Conclusion: This study illustrated that medical schools are making efforts that align with the RRMA. It is critical they continue to make strategic decisions embedded in educational policy and leadership to reinforce the importance of and influence of rural medical education to support workforce planning.

Contexte: À l'heure actuelle, la répartition des médecins sur le territoire canadien est inégale, les régions rurales étant confrontées à une plus forte pénurie de médecins. Le groupe de travail constitué par le Collège des médecins de famille du Canada (CMFC) et la Société de la médecine rurale du Canada (SMRC) a produit un rapport intitulé « Plan d'action pour la médecine rurale ¼ (PAMR) qui vise à améliorer la santé des Canadiens vivant en milieu rural par la formation et la rétention d'un nombre accru de médecins de famille en milieu rural. Cet article évalue dans quelle mesure les facultés de médecine du Canada suivent les recommandations du PAMR. Méthodes: Les chercheurs ont eu recours à une enquête transversale, comportant des questions fermées et ouvertes, pour recueillir des données auprès de 12 des 17 doyens aux études de premier cycle des facultés de médecine canadiennes. Les résultats ont été analysés à l'aide de méthodes quantitatives (calcul des fréquences) et qualitatives (analyse de contenu). Résultats: Les facultés de médecine appliquent des politiques et des procédures différentes pour recruter des étudiants d'origine rurale ou autochtone. Les externats longitudinaux intégrés offrent de nombreux avantages, mais peu d'étudiants y ont accès. La diversité au sein des comités pédagogiques décisionnels est si variable que l'on peut en déduire que le point de vue des médecins exerçant en milieu rural n'est pas toujours valorisé. Conclusion: Cette étude montre que les facultés de médecine déploient des initiatives qui sont conformes au PAMR. Il est essentiel que leurs décisions stratégiques demeurent ancrées dans un leadership et une politique éducative visant à renforcer et à mettre en valeur l'exposition des étudiants à la médecine rurale pour soutenir la planification des effectifs.

Integrating Smoking Cessation Into Low-Dose Computed Tomography Lung Cancer Screening: Results of the Ontario, Canada Pilot.

INTRODUCTION: Low-dose computed tomography screening in high-risk individuals reduces lung cancer mortality. To inform the implementation of a provincial lung cancer screening program, Ontario Health undertook a Pilot study, which integrated smoking cessation (SC). METHODS: The impact of integrating SC into the Pilot was assessed by the following: rate of acceptance of a SC referral; proportion of individuals who were currently smoking cigarettes and attended a SC session; the quit rate at 1 year; change in the number of quit attempts; change in Heaviness of Smoking Index; and relapse rate in those who previously smoked. RESULTS: A total of 7768 individuals were recruited predominantly through primary care physician referral. Of these, 4463 were currently smoking and were risk assessed and referred to SC services, irrespective of screening eligibility: 3114 (69.8%) accepted referral to an in-hospital SC program, 431 (9.7%) to telephone quit lines, and 50 (1.1%) to other programs. In addition, 4.4% reported no intention to quit and 8.5% were not interested in participating in a SC program. Of the 3063 screen-eligible individuals who were smoking at baseline low-dose computed tomography scan, 2736 (89.3%) attended in-hospital SC counseling. The quit rate at 1 year was 15.5% (95% confidence interval: 13.4%-17.7%; range: 10.5%-20.0%). Improvements were also observed in Heaviness of Smoking Index (p < 0.0001), number of cigarettes smoked per day (p < 0.0001), time to first cigarette (p < 0.0001), and number of quit attempts (p < 0.001). Of those who reported having quit within the previous 6 months, 6.3% had resumed smoking at 1 year. Furthermore, 92.7% of the respondents reported satisfaction with the hospital-based SC program. CONCLUSIONS: On the basis of these observations, the Ontario Lung Screening Program continues to recruit through primary care providers, to assess risk for eligibility using trained navigators, and to use an opt-out approach to referral for cessation services. In addition, initial in-hospital SC support and intensive follow-on cessation interventions will be provided to the extent possible.

Operation Remote Immunity: exploring the impact of a service-learning elective in remote Indigenous communities.

BACKGROUND: The novel coronavirus, COVID-19, emerged in December 2019. Shortly after, vaccines against the virus were distributed in Canada for public use, but the remoteness of many northern Indigenous communities in Ontario posed a challenge for vaccine distribution and dissemination. The Ministry of Health partnered with the Northern Ontario School of Medicine University (NOSMU) and the air ambulance service, Ornge, to assist in delivering the vaccination doses to 31 fly-in communities in the Nishnawbe Aski Nation and Moosonee, all within Ontario. These deployments were considered "service-learning electives" for Undergraduate and Postgraduate medical learners from NOSMU who joined the operation in two-week deployments. NOSMU is renowned for its social accountability mandate and gives its medical learners opportunities to participate in service-learning to enhance their medical skills and cultural sensitivity. The purpose of this study is to examine the relationship between social accountability and medical learners' experiences during a service-learning elective in northern Indigenous communities in Ontario during the COVID-19 pandemic. METHODS: Data were collected through a planned post-placement activity completed by eighteen Undergraduate and Postgraduate medical learners, who participated in the vaccine deployment. The activity consisted of a 500-word reflective response passage. Thematic analysis was used to identify, analyze, and report the themes within the collected data. RESULTS: Two themes were identified by the authors, which formed a concise overview of the collected data: (1) confronting the realities of working in Indigenous communities; and (2) service-learning as a path to social accountability. CONCLUSIONS: These vaccine deployments were an opportunity for medical learners to engage in service-learning and engage with Indigenous communities in Northern Ontario. Service-learning is an exceptional method which provides an opportunity to expand knowledge on the social determinants of health, social justice, and social accountability. The medical learners in this study reiterated the idea that learning medicine through a service-learning model leads to a greater depth of knowledge on Indigenous health and culture, and enhances medical knowledge compared to classroom learning.

Power/knowledge: A sociomaterial perspective on a new accreditation process during COVID-19.

INTRODUCTION: The COVID-19 pandemic had significant impacts on many aspects of health care and education, including the accreditation of medical education programmes. As a community of international educators, it is important that we study changes that resulted from the pandemic to help us understand educational processes more broadly. As COVID-19 unfolded in Canada, a revised format of undergraduate medical accreditation was implemented, including a shift to virtual site visits, a two-stage visit schedule, a focused approach to reviewing standards and the addition of a field secretary to the visit team. Our case study research aimed to evaluate the sociomaterial implications of these changes in format on the process of accreditation at two schools. METHODS: We interviewed key informants to understand the impacts, strengths and limitations of changes made to the accreditation format. We used an abductive approach to analyse transcripts and applied a sociomaterial lens in looking for interconnections between the material and social changes that were experienced within the accreditation system. RESULTS: Stakeholders within the accreditation system did not anticipate that changes to the accreditation format would have significant impacts on how accreditation functioned or on its overall outcomes. However, key informants described how the revised format of accreditation reconstructed how power was distributed and how knowledge was produced. The revised format contributed to changes in who held power within each of the programmes, within each of the visiting teams and between site members and visiting team members. As power shifted across stakeholders in response to material changes to the accreditation format, key informants described changes in how knowledge was produced. CONCLUSIONS: Our findings suggest that the most powerful knowledge about any given programme might best be obtained through individualised tools, technologies and voices that are most meaningful to the unique context of each programme. Deliberate attention to how knowledge and power are influenced by the interactions between material and social processes within accreditation may help educators and leaders see the effects of change.

Earthworms (Clitellata, Megadrili) of the world: an updated checklist of valid species and families, with notes on their distribution.

In the current paper we present an updated checklist of all the megadrile earthworms (Crassiclitellata: Annelida) in the world, and notes on the distribution of families worldwide. Biogeographic responses to geological phenomena including plate tectonics, as well as to past and present climate and habitat distributions, are the main factors determining the present distribution of earthworm families. A total of ca. 5,738 species/subspecies (5,406 species and 332 unique subspecies; i.e., not counting the nomino-typical subspecies) belonging to 23 families (including one non-crassiclitellate family: Moniligastridae) are currently recognized worldwide, of which three families (Tritogeniidae and Kazimierzidae from Southern Africa and Arecoidae, a new family from Brazil described herein), 35 genera and close to 1200 new taxa (including subspecies) were described in the 21st century. Nonetheless, the large number of still undescribed species will likely increase this value to well over 8,000 species. Ten families are monospecific and/or monogeneric and have a mostly restricted distribution. On the other hand, more than 87 widespread cosmopolitan species have been catalogued, some of them with important invasive potential, belonging mainly to families Lumbricidae, Acanthodrilidae, Benhamiidae, Megascolecidae, Rhinodrilidae and Ocnerodrilidae. Taxonomic housekeeping was performed for the preoccupied Rhinodrilidae genus Tairona Righi - herein substituted by Taironina nom. nov., and Guarani camaqua Rodríguez & Lima was reinstated and removed from synonymy with Criodrilus lacuum Hoffmeister, 1845, resulting in a wider definition of the Almidae family. Furthermore, Amynthas maximalis nom. nov. is proposed herein as a substitution name for the preoccupied name Amynthas maximus Qiu & Dong, 2019, and Arecoidae is proposed herein as a new monotypic family for the aquamegadrile species Areco reco Righi, Ayres & Bittencourt, 1978.

Examining the status of rural post-graduate family medicine education.

Introduction: Rural populations in Canada are generally in worse health when compared to their urban counterparts. In 2014, the College of Family Physicians of Canada and the Society of Rural Physicians of Canada formed a joint Task force to advocate for improved health in rural communities. As a task force, they developed the Rural Road Map for Action. This paper uses the Rural Road Map for Action as a framework to examine the current state of family medicine's Post-Graduate Medical Education (PGME) in Canada. Methods: Surveys were sent to the programme directors of all English- and French-speaking post-graduate family medicine programmes. Both quantitative and qualitative methods were used to analyse survey responses. Results: Thirteen of 17 respondents completed the questionnaire. Despite on-going efforts, our results suggest that few programmes have equity and diversity admission's policies for rural and Indigenous students; a gap exists between the number of residents who are educated in rural areas and those who end up practising in rural areas; residents lack skills in Indigenous health; and more funded professional development opportunities are needed for rural physicians. Conclusion: Rural healthcare concerns are typically under-represented in PGME. The Rural Road Map for Action brings focus to the specific healthcare needs of rural areas, highlighting a recruitment and retention strategy that aligns education, practice, policy and research activities. Medical schools and national physician organisations need to continue to advocate for the health of rural communities through increasing the rural physician workforce and providing appropriate training for rural practice.

Résumé Introduction: Les populations rurales du Canada sont généralement en moins bonne santé que leurs homologues urbaines. En 2014, le Collège des médecins de famille du Canada et la Société de la médecine rurale du Canada ont formé un groupe de travail conjoint pour défendre l'amélioration de la santé dans les collectivités rurales. En tant que groupe de travail, ils ont élaboré le Plan d'action pour la médecine rurale. Le présent document utilise ce Plan comme cadre pour examiner l'état actuel de la formation médicale postuniversitaire (FMP) de la médecine familiale au Canada. Méthodes: Les enquêtes ont été envoyées aux directeurs de programme de tous les programmes de médecine familiale postuniversitaire anglophones et francophones. Des méthodes quantitatives et qualitatives ont été utilisées pour analyser les réponses. Résultats: Treize des 17 répondants ont rempli le questionnaire. Malgré les efforts en cours, nos résultats suggèrent que peu de programmes ont des politiques d'admission en matière d'équité et de diversité pour les étudiants ruraux et autochtones; un écart existe entre le nombre de résidents qui sont formés dans les zones rurales et ceux qui finissent par exercer dans ces zones; les résidents manquent de compétences en matière de santé autochtone et; que davantage d'opportunités de développement professionnel financées sont nécessaires pour les médecins ruraux. Conclusion: Les préoccupations relatives aux soins de santé en milieu rural sont généralement sous-représentées dans la FMP. Le Plan d'action pour la médecine rurale met l'accent sur les besoins spécifiques des zones rurales en matière de soins de santé, en soulignant une stratégie de recrutement et de rétention qui aligne les activités d'éducation, de pratique, de politique et de recherche. Les facultés de médecine et les organisations nationales de médecins doivent continuer à défendre la santé des collectivités rurales en augmentant le nombre de médecins ruraux et en offrant une formation appropriée à la pratique rurale. Mots-clés: éducation médicale rurale, plan d'action pour la médecine rurale, santé rurale.

Teaching compassion for social accountability: A parallaxic investigation.

BACKGROUND: In an arts integrated interdisciplinary study set to investigate ways to improve social accountability (SA) in medical education, our research team has established a renewed understanding of compassion in the current SA movement. AIM: This paper explores the co-evolution of compassion and SA. METHODS: The study used an arts integrated approach to investigate people's perceptions of SA in four medical schools across Australia, Canada, and the USA. Each school engaged approximately 25 participants who partook in workshops and in-depth interviews. RESULTS: We began with a study of SA and the topic of compassion emerged out of our qualitative data and biweekly meetings within the research team. Content analysis of the data and pedagogical discussion brought us to realize the importance of compassion in the practice of SA. CONCLUSIONS: The cultivation of compassion needs to play a significant role in a socially accountable medical educational system. Medical schools as educational institutions may operate themselves with compassion as a driving force in engaging partnership with students and communities. Social accountability without compassion is not SA; compassion humanizes institutional policy by engaging sympathy and care.

Comparing and using prominent social accountability frameworks in medical education: moving from theory to implementation in Northern Ontario, Canada.

Background: Social accountability in medical education is conceptualized as a responsibility to respond to the needs of local populations and demonstrate impact of these activities. The objective of this study was to rigorously examine and compare social accountability theories, models, and frameworks to identify a theory-informed structure to understand and evaluate the impacts of medical education in Northern Ontario. Methods: Using a narrative review methodology, prominent social accountability theories, models, and frameworks were identified. The research team extracted important constructs and relationships from the selected frameworks. The Theory Comparison and Selection Tool was used to compare the frameworks for fit and relevance. Results: Eleven theories, models, and frameworks were identified for in-depth analysis and comparison. Two realist frameworks that considered community relationships in medical education and social accountability in health services received the highest scores. Frameworks focused on learning health systems, evaluating institutional social accountability, and implementing evidence-based practices also scored highly. Conclusion: We used a systematic theory selection process to describe and compare social accountability constructs and frameworks to inform the development of a social accountability impact framework for the Northern Ontario School of Medicine. The research team examined important constructs, relationships, and outcomes, to select a framework that fits the aims of a specific project. Additional engagement will help determine how to combine, adapt, and implement framework components to use in a Northern Ontario framework.

Contexte: La responsabilité sociale dans l'éducation médicale est conceptualisée comme étant la responsabilité de répondre aux besoins des populations locales et de démontrer l'impact de ces activités. L'objectif de cette étude était d'examiner rigoureusement et de comparer les théories, les modèles et les cadres de la responsabilité sociale afin d'élaborer un dispositif ayant des fondements théoriques qui servirait à cerner et à évaluer les retombées de l'éducation médicale dans le Nord de l'Ontario. Méthodes: Suivant une méthodologie de revue narrative, les théories, modèles et cadres principaux de la responsabilité sociale ont été recensés. L'équipe de recherche a extrait les concepts et les relations importants des cadres sélectionnés. Les cadres ont ensuite été comparés sur le plan de l'adéquation et de la pertinence à l'aide d'un outil de comparaison et de sélection des théories (le Theory Comparison and Selection Tool). Résultats: Onze théories, modèles et cadres ont été retenus pour une analyse et une comparaison approfondies. Deux cadres réalistes prenant en considération les relations communautaires dans l'éducation médicale et la responsabilité sociale dans les services de soins de santé ont reçu les scores les plus élevés. Les cadres axés sur l'apprentissage des systèmes de santé e, sur l'évaluation de la responsabilité sociale des institutions et sur la mise en œuvre de pratiques fondées sur les données probantes ont également obtenu des scores élevés. Conclusion: Nous avons utilisé un processus systématique de sélection des théories pour décrire et comparer les construits et les cadres de responsabilité sociale afin d'éclairer le développement d'un cadre de référence sur les retombées de la responsabilité sociale pour l'École de médecine du Nord de l'Ontario. L'équipe de recherche a examiné les construits importants, les liens entre ces derniers et les retombées afin de choisir un cadre pouvant répondre aux objectifs d'un projet spécifique. Des travaux ultérieurs permettront de déterminer de quelle manière il sera possible de combiner, d'adapter et de mettre en œuvre les composantes de ce cadre qui sera utilisé dans le Nord de l'Ontario.

Integrating natural gradients, experiments, and statistical modeling in a distributed network experiment: An example from the WaRM Network.

A growing body of work examines the direct and indirect effects of climate change on ecosystems, typically by using manipulative experiments at a single site or performing meta-analyses across many independent experiments. However, results from single-site studies tend to have limited generality. Although meta-analytic approaches can help overcome this by exploring trends across sites, the inherent limitations in combining disparate datasets from independent approaches remain a major challenge. In this paper, we present a globally distributed experimental network that can be used to disentangle the direct and indirect effects of climate change. We discuss how natural gradients, experimental approaches, and statistical techniques can be combined to best inform predictions about responses to climate change, and we present a globally distributed experiment that utilizes natural environmental gradients to better understand long-term community and ecosystem responses to environmental change. The warming and (species) removal in mountains (WaRM) network employs experimental warming and plant species removals at high- and low-elevation sites in a factorial design to examine the combined and relative effects of climatic warming and the loss of dominant species on community structure and ecosystem function, both above- and belowground. The experimental design of the network allows for increasingly common statistical approaches to further elucidate the direct and indirect effects of warming. We argue that combining ecological observations and experiments along gradients is a powerful approach to make stronger predictions of how ecosystems will function in a warming world as species are lost, or gained, in local communities.

The economic impact of rural healthcare on rural economies: A rapid review.

Introduction: One critical component of any rural community is its healthcare system. Rural healthcare systems are essential as rural communities have worse health outcomes when compared to urban areas. Rural healthcare systems might also have a positive impact on rural economies. In some rural areas, these health services are threatened with a reduction or closure. This rapid review was carried out to examine the impact of rural healthcare systems' declines on rural economies. Methods: We conducted a rapid review of peer-reviewed and grey literature sources on studies that examined the economic impact of rural healthcare on rural economies in Canada, Australia, Scandinavia and the United States of America (USA). We used a data extraction template adapted from the Centre for Reviews and Dissemination. Results: We found 17 research papers between two databases and nine websites. Articles examined various health professions (dentist, physician assistant and pharmacist), the inclusion of family physicians, a physician with an increased scope of practice (obstetrics and surgery), the impact of a rural primary care hospital, telemedicine, a distributed medical education programme and the health care sector. Conclusion: Rural healthcare seems to have a positive impact on jobs and labour-based wages in rural communities. There is a considerable need for research outside the USA.

Résumé Introduction: Un élément essentiel de toute communauté rurale est son système de soins de santé. Les systèmes de soins de santé ruraux sont essentiels car les communautés rurales présentent des résultats sanitaires moins bons que les zones urbaines. Ces systèmes pourraient également avoir un impact positif sur les économies rurales. Dans certaines zones rurales, ces services de santé sont menacés de réduction ou de fermeture. Cette revue rapide a été réalisée pour examiner l'impact du déclin des systèmes de soins de santé ruraux sur les économies rurales. Méthodes: Nous avons procédé à un examen rapide de documentation évaluée par les pairs et de documentation parallèle sur les études qui ont examiné l'impact économique des soins de santé ruraux sur les économies rurales au Canada, en Australie, en Scandinavie et aux États-Unis. Nous avons utilisé un modèle d'extraction de données adapté du Centre for Reviews and Dissemination. Résultats: Nous avons trouvé 17 articles de recherche entre deux bases de données et neuf sites Web. Les articles portaient sur diverses professions de santé (dentiste, assistant(e) médical(e), pharmacien(ne)), l'inclusion des médecins de famille, un médecin ayant un champ d'exercice élargi (obstétrique et chirurgie), l'impact d'un hôpital rural de soins primaires, la télémédecine, un programme d'enseignement médical distribué et le secteur des soins de santé. Conclusion: Les soins de santé en milieu rural semblent avoir un impact positif sur les emplois et les salaires basés sur le travail dans les communautés rurales. Il existe un besoin considérable de recherche en dehors des États-Unis. Mots-clés: rural, soins de santé, économie, revue.

Global patterns in endemicity and vulnerability of soil fungi.

Fungi are highly diverse organisms, which provide multiple ecosystem services. However, compared with charismatic animals and plants, the distribution patterns and conservation needs of fungi have been little explored. Here, we examined endemicity patterns, global change vulnerability and conservation priority areas for functional groups of soil fungi based on six global surveys using a high-resolution, long-read metabarcoding approach. We found that the endemicity of all fungi and most functional groups peaks in tropical habitats, including Amazonia, Yucatan, West-Central Africa, Sri Lanka, and New Caledonia, with a negligible island effect compared with plants and animals. We also found that fungi are predominantly vulnerable to drought, heat and land-cover change, particularly in dry tropical regions with high human population density. Fungal conservation areas of highest priority include herbaceous wetlands, tropical forests, and woodlands. We stress that more attention should be focused on the conservation of fungi, especially root symbiotic arbuscular mycorrhizal and ectomycorrhizal fungi in tropical regions as well as unicellular early-diverging groups and macrofungi in general. Given the low overlap between the endemicity of fungi and macroorganisms, but high conservation needs in both groups, detailed analyses on distribution and conservation requirements are warranted for other microorganisms and soil organisms.