Accelerated shifts in terrestrial life zones under rapid climate change.

Rapid climate change is impacting biodiversity, ecosystem function, and human well-being. Though the magnitude and trajectory of climate change are becoming clearer, our understanding of how these changes reshape terrestrial life zones-distinct biogeographic units characterized by biotemperature, precipitation, and aridity representing broad-scale ecosystem types-is limited. To address this gap, we used high-resolution historical climatologies and climate projections to determine the global distribution of historical (1901-1920), contemporary (1979-2013), and future (2061-2080) life zones. Comparing the historical and contemporary distributions shows that changes from one life zone to another during the 20th century impacted 27 million km2 (18.3% of land), with consequences for social and ecological systems. Such changes took place in all biomes, most notably in Boreal Forests, Temperate Coniferous Forests, and Tropical Coniferous Forests. Comparing the contemporary and future life zone distributions shows the pace of life zone changes accelerating rapidly in the 21st century. By 2070, such changes would impact an additional 62 million km2 (42.6% of land) under "business-as-usual" (RCP8.5) emissions scenarios. Accelerated rates of change are observed in hundreds of ecoregions across all biomes except Tropical Coniferous Forests. While only 30 ecoregions (3.5%) had over half of their areas change to a different life zone during the 20th century, by 2070 this number is projected to climb to 111 ecoregions (13.1%) under RCP4.5 and 281 ecoregions (33.2%) under RCP8.5. We identified weak correlations between life zone change and threatened vertebrate richness, levels of vertebrate endemism, cropland extent, and human population densities within ecoregions, illustrating the ubiquitous risks of life zone changes to diverse social-ecological systems. The accelerated pace of life zone changes will increasingly challenge adaptive conservation and sustainable development strategies that incorrectly assume current ecological patterns and livelihood provisioning systems will persist.

Global rarity of intact coastal regions.

Management of the land-sea interface is essential for global conservation and sustainability objectives because coastal regions maintain natural processes that support biodiversity and the livelihood of billions of people. However, assessments of coastal regions have focused strictly on either the terrestrial or marine realm. Consequently, understanding of the overall state of Earth's coastal regions is poor. We integrated the terrestrial human footprint and marine cumulative human impact maps in a global assessment of the anthropogenic pressures affecting coastal regions. Of coastal regions globally, 15.5% had low anthropogenic pressure, mostly in Canada, Russia, and Greenland. Conversely, 47.9% of coastal regions were heavily affected by humanity, and in most countries (84.1%) >50% of their coastal regions were degraded. Nearly half (43.3%) of protected areas across coastal regions were exposed to high human pressures. To meet global sustainability objectives, all nations must undertake greater actions to preserve and restore the coastal regions within their borders.

costa, huella humana, impacto humano cumulativo, litoral, presión humana, restauración, tierras vírgenes Resumen El manejo de la interfaz entre la tierra y el mar es esencial para los objetivos mundiales de conservación y sustentabilidad ya que las regiones costeras mantienen los procesos naturales que sostienen a la biodiversidad y al sustento de miles de millones de personas. Sin embargo, los análisis de las regiones costeras se han enfocado estrictamente en el ámbito marino o en el terrestre, pero no en ambos. Por consiguiente, el conocimiento del estado general de las regiones costeras del planeta es muy pobre. Integramos la huella terrestre humana y mapas marinos del impacto humano cumulativo en un análisis global de las presiones antropogénicas que afectan las áreas costeras. De las áreas costeras de todo el mundo, el 15.5% tuvieron una presión antropogénica reducida, principalmente en Canadá, Rusia y Groenlandia. En cambio, el 47.9% de las regiones costeras estuvieron fuertemente afectas por la humanidad, y en la mayoría de los países (84.1%) >50% de sus regiones litorales se encuentran degradadas. Casi la mitad (43.3%) de las áreas protegidas en las regiones costeras tienen un grado de exposición a fuertes presiones humanas. Para cumplir los objetivos mundiales de sustentabilidad, todos los países deben emprender mejores acciones para preservar y restaurar las regiones litorales dentro de sus fronteras.

Multinational coordination required for conservation of over 90% of marine species.

Marine species are declining at an unprecedented rate, catalyzing many nations to adopt conservation and management targets within their jurisdictions. However, marine species and the biophysical processes that sustain them are naive to international borders. An understanding of the prevalence of cross-border species distributions is important for informing high-level conservation strategies, such as bilateral or regional agreements. Here, we examined 28,252 distribution maps to determine the number and locations of transboundary marine plants and animals. More than 90% of species have ranges spanning at least two jurisdictions, with 58% covering more than 10 jurisdictions. All jurisdictions have at least one transboundary species, with the highest concentrations of transboundary species in the USA, Australia, Indonesia, and the Areas Beyond National Jurisdiction. Distributions of mapped biodiversity indicate that overcoming the challenges of multinational governance is critical for a much wider suite of species than migratory megavertebrates and commercially exploited fish stocks-the groups that have received the vast majority of multinational management attention. To effectively protect marine biodiversity, international governance mechanisms (particularly those related to the Convention on Biological Diversity, the Convention on Migratory Species, and Regional Seas Organizations) must be expanded to promote multinational conservation planning, and complimented by a holistic governance framework for biodiversity beyond national jurisdiction.

Necrotizing Pneumonia, a Skeletal Muscle Lesion, and a Fungating Duodenal Mass: An Atypical Presentation of Rapidly Progressing Lung Adenocarcinoma.

Lung adenocarcinoma, the predominant subtype of non-small cell lung cancer, typically metastasizes to common sites such as the liver and adrenal glands. However, rare instances involve skeletal muscle metastasis. We present a case of a 45-year-old female with a medical history of hypertension, epilepsy, and fibromyalgia, who presented to the emergency department with hemoptysis and multifocal pain. Chest imaging revealed a cavitary lesion which appeared to be necrotizing pneumonia. Further investigations uncovered a fluid collection in the left thigh, which would be identified as poorly differentiated carcinoma. Subsequent testing identified the lung as the primary source of metastasis. Despite radiation treatment, the patient's condition deteriorated over the next 50 days, highlighting the aggressive nature of the disease.

Correction of omega-3 fatty acid deficiency and improvement in disease activity in patients with systemic lupus erythematosus treated with krill oil concentrate: a multicentre, randomised, double-blind, placebo-controlled trial.

OBJECTIVE: Omega-3 polyunsaturated fatty acids (PUFAs) play a critical role in regulating inflammation and lipid metabolism. This study sought to ascertain the frequency of omega-3 deficiency in patients with SLE and investigate whether supplementation with krill oil concentrate (KOC) could replenish omega-3 levels and decrease SLE disease activity. METHODS: A multicentre, randomised, double-blind, placebo-controlled trial was conducted in adult patients with active SLE. Eligible patients were randomised to receive 4 g/day KOC or placebo (vegetable oil mixture) for the first 24 weeks, and thereafter patients could opt to enter an open-label extension. The primary end point was improvement of the red blood cell Omega-3 Index from baseline to week 24. Changes in clinical features, including SLE Disease Activity Index 2000 (SLEDAI-2K) disease activity scores, were also monitored. RESULTS: Seventy-eight patients met eligibility criteria and were randomised to a treatment group (n=39 per group). The baseline Omega-3 Index in the total SLE cohort was a mean 4.43% (±SD 1.04%). After 4 weeks of KOC treatment, the Omega-3 Index rapidly increased to 7.17%±1.48% (n=38) and after 24 weeks to 8.05%±1.79% (n=25) (each p<0.001 vs baseline), whereas no significant change from baseline was noted in patients receiving placebo. Increases in the Omega-3 Index in KOC-treated patients persisted through week 48. After patients switched from placebo to KOC at 24 weeks, the mean Omega-3 Index showed a rapid and significant increase (from 4.63%±1.39% at week 24 (n=26) to 7.50%±1.75% at week 48 (n=12); p<0.001). Although there were no changes in disease activity in the study population overall, SLEDAI-2K scores decreased significantly in the KOC group during the 24-week randomised period among those who had high disease activity at baseline (SLEDAI-2K ≥9) (p=0.04, p=0.02 and p=0.01 vs placebo at 4, 8 and 16 weeks, respectively; n=9 per group). KOC was well-tolerated, with no significant safety concerns. CONCLUSION: KOC corrected omega-3 deficiency in patients with SLE. Supplementation with KOC was safe and decreased disease activity in those with more active disease. These findings warrant further evaluation of omega-3 fatty acid supplementation with KOC in the management of SLE. TRIAL REGISTRATION NUMBER: NCT03626311.

GLP-1 Agonists for Weight Loss: Pharmacology and Clinical Implications.

This review investigates the various pharmacologic treatments for overweight and obesity in adults, especially glucagon-like peptide 1 (GLP-1) agonists. In light of the globally expanding obesity pandemic and the limited selection of treatments, physicians must be equipped with knowledge regarding proven medications and their nuanced differences to best support patients on their path to a healthier lifestyle. In this review, we explore the current medical therapies for obesity, including all major categories, individual mechanisms of action, pharmacokinetics and pharmacodynamics, adverse effects, risks, and absolute contraindications. Additionally, we review the evidence of four recent clinical trials, two systematic reviews, and two meta-analyses describing the efficacy of GLP-1 agonists in decreasing weight, lowering HbA1c, and improving obesity comorbidities. We also discuss total cost and cost-effectiveness compared to other categories, long-term adherence, barriers to use, and reasons for discontinuation of this drug category. Our goal is that this review can serve as a framework to aid providers in building their knowledge and selecting the most advantageous weight loss medication for each patient.

The admixed brushtail possum genome reveals invasion history in New Zealand and novel imprinted genes.

Combining genome assembly with population and functional genomics can provide valuable insights to development and evolution, as well as tools for species management. Here, we present a chromosome-level genome assembly of the common brushtail possum (Trichosurus vulpecula), a model marsupial threatened in parts of their native range in Australia, but also a major introduced pest in New Zealand. Functional genomics reveals post-natal activation of chemosensory and metabolic genes, reflecting unique adaptations to altricial birth and delayed weaning, a hallmark of marsupial development. Nuclear and mitochondrial analyses trace New Zealand possums to distinct Australian subspecies, which have subsequently hybridised. This admixture allowed phasing of parental alleles genome-wide, ultimately revealing at least four genes with imprinted, parent-specific expression not yet detected in other species (MLH1, EPM2AIP1, UBP1 and GPX7). We find that reprogramming of possum germline imprints, and the wider epigenome, is similar to eutherian mammals except onset occurs after birth. Together, this work is useful for genetic-based control and conservation of possums, and contributes to understanding of the evolution of novel mammalian epigenetic traits.

Combination Olanzapine and Samidorphan for the Management of Schizophrenia and Bipolar 1 Disorder in Adults: A Narrative Review.

Schizophrenia is a debilitating psychotic disorder characterized by positive symptoms such as delusions, hallucinations, and disorganized thoughts, and negative symptoms like lack of effect or motivation. Bipolar 1 disorder (B1D) is a psychiatric illness characterized by recurrent manic episodes in alternation with depressive episodes and interspersed periods of euthymia, ultimately resulting in psychological distress and impairment of daily functioning. Effective treatments are needed for both schizophrenia and B1D to reach the treatment goals of reducing the debilitating symptomology, improving social functioning and quality of life, and increasing the chances of recovery and more favorable long-term outcomes. To date, olanzapine is one of the most efficacious atypical antipsychotics (AAPs) for the treatment of both schizophrenia and B1D and is associated with fewer extrapyramidal effects compared to other treatments. However, compared to other AAPs, olanzapine is associated with a greater chance of metabolic syndrome, limiting its clinical use and affecting treatment compliance. Samidorphan mitigates the weight gain side effects of olanzapine by antagonizing µ-, κ-, and δ-opioid receptors. The use of combination drugs to treat psychiatric conditions is an emerging field with the goal of increasing therapeutic efficacy and decreasing undesirable side effects. Clinical trials have demonstrated combination on olanzapine and samidorphan (OLZ/SAM) treatment resulted in significantly less weight gain than olanzapine monotherapy. Clinical trial patients reported improvements in symptoms of psychosis, reduced weight gain, and overall satisfaction with their treatment. OLZ/SAM has been as shown to be a safe and effective pharmaceutical option for the clinical management of schizophrenia and B1D.

Prevalence and Predictors of High-Grade Anal Dysplasia in People With HIV in One Southeastern Ryan White HIV/AIDS Program Clinic.

Background: Prevalence of anal cancer is increasing among people with HIV (PWH). Screening for anal cancer involves evaluating cytology and biopsy with high-resolution anoscopy (HRA) if indicated. In this study, we sought to identify the prevalence of abnormal anal cytology and biopsy-proven high-grade dysplasia, defined as anal intraepithelial neoplasia 2 and 3 (AIN2+). Methods: Demographic and clinical data were collected from participants age ≥30 years with ≥1 anal Pap smear performed during the study period (12/18/2017-05/29/2021). A subgroup analysis was performed on those with ≥1 HRA. Logistic regression estimated adjusted odds ratios (aORs) for variables of interest such as age, race, gender, presence of HPV strains, and sexual practices. Results: Of 317 participants, 48% (n = 152) had abnormal cytology (93% low-grade squamous intraepithelial lesion [SIL] or atypical cells of undetermined significance [ASCUS] and 7% high-grade SIL). Most with abnormal cytology proceeded to HRA (n = 136/152). Of those with HRA, 62% (n = 84/136) had AIN2+. History of anoreceptive intercourse (aOR 4.62; 95% CI 1.08-23.09; P = .047), HPV 16 (aOR 4.13; 95% CI 1.63-11.30; P = .004), and "other" high-risk HPV strains (aOR 5.66; 95% CI 2.31-14.78; P < .001) were significantly associated with AIN2+. Conclusions: Nearly half of those screened had abnormal cytology, highlighting the high prevalence of anal dysplasia in PWH. Though only 7% had high-grade SIL on cytology, 62% of those biopsied had AIN2+, suggesting that cytology underestimates the severity of dysplasia on biopsy. HPV 16 and "other" high-risk strains were associated with AIN2 + and could be considered for risk-stratifying patients in the screening algorithm.

A Missed Opportunity: Extragenital Screening for Gonorrhea and Chlamydia Sexually Transmitted Infections in People With HIV in a Southeastern Ryan White HIV/AIDS Program Clinic Setting.

Background: Guidelines recommend annual screening for gonorrhea/chlamydia in sexually active people with HIV at multiple sites (urogenital, oropharyngeal, rectal). In the first year of multisite screening at our Ryan White HIV/AIDS Program clinic, we studied (1) sexual history documentation rate, (2) sexually transmitted infection (STI) screening rate, (3) characteristics associated with STIs, and (4) the percentage of extragenital STIs that would have been missed without multisite screening. Methods: Participants were ≥14 years old with ≥1 in-person medical visit at our clinic in 2019. Descriptive analyses were performed, and adjusting for number of sites tested, a log-binomial model was used to estimate the association between characteristics and STI diagnosis in men. Results: In this cohort (n = 857), 21% had no sexual history recorded. Almost all STI diagnoses were among males (99.3%). Sixty-eight percent (253/375) received appropriate urogenital testing, 63% (85/134) received appropriate oropharyngeal testing, and 69% (72/105) received appropriate rectal testing. In male participants with ≥1 STI test (n = 347), Hispanic ethnicity and having a detectable HIV viral load were associated with an STI diagnosis. Of those diagnosed with an STI who had multisite testing, 96% (n = 25/26) were positive only at an extragenital site. Conclusions: Screening rates were similar across all anatomical sites, indicating no obvious bias against extragenital testing. In males, STIs were more frequently diagnosed in people who identify as Hispanic and those with detectable viral loads, which may indicate more condomless sex in these populations. Based on infections detected exclusively at extragenital sites, our clinic likely underdiagnosed STIs before implementation of multisite screening.

Patient-Reported Outcome Information Collected from Lupus Patients Using a Mobile Application: Compliance and Validation.

OBJECTIVE: Patient-reported outcomes (PROs) can provide critical information concerning the impact of a disease on an individual. Mobile technology to collect PRO data in an electronic format (ePRO) allows for frequent assessment in the person's regular environment. The goal of this study was to assess the compliance with a phone application (app) and validate ePRO information in individuals with systemic lupus erythematosus (SLE). METHODS: A smartphone app that collects ePRO data from various clinical instruments was developed. Information was collected by both an ePRO and a paper-administered instrument as part of a multicenter randomized interventional clinical trial of patients meeting American College of Rheumatology (ACR) criteria for the classification of SLE. To determine agreement between PRO information collected in the different formats, intraclass correlation coefficients (ICCs), paired Student's t tests, and Bland-Altman plots were evaluated. Compliance and Cronbach's alpha were also assessed as a measure of survey reliability. RESULTS: For the 62 subjects from diverse ancestral backgrounds, compliance with ePRO completion was high (more than 75%). Cronbach alpha values for PROs indicated moderate to high survey reliability. The vast majority (73.4%) of ICC values were indicative of good to excellent reliability between measurement methods. Bland-Altman plots verified method agreement, and 87% of pairwise t tests yielded an insignificant difference between information collected with the different administration methods. CONCLUSION: The excellent compliance and the high level of consistency between data collected by paper and that collected by electronic methods indicate that the app provides a reliable means of cataloging real-time changes in PROs in SLE patients.

Evaluating the cascade of care for anal cancer screening within a Ryan White HIV/AIDS Program clinic.

BACKGROUND: Care cascades can inform providers about differences in engagement and retention in care between patient populations thereby improving participation by targeting interventions more effectively. The objective of this study was to assess the uptake and retention of participants along the anal cancer screening algorithm within a single HIV clinic. METHODS: Retrospective procedural and demographic data were collected within a Ryan White HIV/AIDS Program clinic from 18 December 2017 to 29 May 2021. A care cascade was constructed among eligible participants who engaged and were retained in the anal cancer screening algorithm. Engagement was defined as having at least one anal Pap smear. Retention was defined as having a follow-up anal Pap smear, and/or high resolution anoscopy, as indicated. Risk ratios (RR) were calculated to reveal factors associated with initiation and retention in screening. RESULTS: Of 821 eligible participants, 312 (38%) engaged in screening and 205 (66%) were retained in care. Anoreceptive intercourse was positively associated with engagement (RR 2.81, 95% confidence interval [CI] 2.05-3.90, p<0.001), whereas male gender was negatively associated (RR 0.26, 95% CI 0.20-0.33, p<0.001). Abnormal cytology results on Pap smear were associated with retention (RR 1.39, 95% CI 1.03-1.86, p=0.03). CONCLUSIONS: Overall engagement in anal cancer screening is low within our clinic, particularly among men, but retention in the screening program is notably better, especially among those with abnormal cytology. Target populations have been identified to increase awareness, and qualitative studies are underway to understand perceptions and barriers to engagement in anal cancer screening.

Reconsidering priorities for forest conservation when considering the threats of mining and armed conflict.

Many threats to biodiversity can be predicted and are well mapped but others are uncertain in their extent, impact on biodiversity, and ability for conservation efforts to address, making them more difficult to account for in spatial conservation planning efforts, and as a result, they are often ignored. Here, we use a spatial prioritisation analysis to evaluate the consequences of considering only relatively well-mapped threats to biodiversity and compare this with planning scenarios that also account for more uncertain threats (in this case mining and armed conflict) under different management strategies. We evaluate three management strategies to address these more uncertain threats: 1. to ignore them; 2. avoid them; or 3. specifically target actions towards them, first individually and then simultaneously to assess the impact of their inclusion in spatial prioritisations. We apply our approach to the eastern Democratic Republic of the Congo (DRC) and identify priority areas for conserving biodiversity and carbon sequestration services. We found that a strategy that avoids addressing threats of mining and armed conflict more often misses important opportunities for biodiversity conservation, compared to a strategy that targets action towards areas under threat (assuming a biodiversity benefit is possible). We found that considering mining and armed conflict threats to biodiversity independently rather than simultaneously results in 13 800-14 800 km2 and 15 700-25 100 km2 of potential missed conservation opportunities when undertaking threat-avoiding and threat-targeting management strategies, respectively. Our analysis emphasises the importance of considering all threats that can be mapped in spatial conservation prioritisation.

Stress and Health Outcomes in Midwestern Latinx Youth: The Moderating Role of Ethnic Pride.

BACKGROUND: Stress has been linked to numerous health outcomes, including internalizing and externalizing behaviors, self-esteem, and physical health. Culture has also been linked to stress and health. This study examined the links between stress and health, and the potential moderating role of Latinx ethnic pride (LEP). METHODS: The sample consisted of 119 Latinx youth from the Midwestern U.S. Mothers and youth completed surveys. Variables included the Multicultural Events Scale for Adolescents (MESA), parent and home stressors/risks (PHSR), LEP, depressive symptoms, aggression, frustration, and self-esteem. Research assistants measured child heights and weights and calculated BMI percentiles. RESULTS: LEP was negatively related to MESA, depressive symptoms, aggression, and frustration, and positively related to self-esteem. MESA and PHSR were associated with depressive symptoms, aggression, frustration, and self-esteem, but not with BMI percentile. In adjusted regression analyses, LEP moderated the effects MESA had on frustration and self-esteem, marginally moderated the link between MESA and depressive symptoms, and was not related to aggression or BMI percentile. LEP did not moderate the relationship between PHSR with any health outcomes. CONCLUSIONS: Stressors were generally related to child mental health. LEP may play an important role in protecting against some of the effects of stressful events on mental health outcomes.

Humid tropical vertebrates are at lower risk of extinction and population decline in forests with higher structural integrity.

Reducing deforestation underpins global biodiversity conservation efforts. However, this focus on retaining forest cover overlooks the multitude of anthropogenic pressures that can degrade forest quality and imperil biodiversity. We use remotely sensed indices of tropical rainforest structural condition and associated human pressures to quantify the relative importance of forest cover, structural condition and integrity (the cumulative effect of condition and pressures) on vertebrate species extinction risk and population trends across the global humid tropics. We found that tropical rainforests of high integrity (structurally intact and under low pressures) were associated with lower likelihood of species being threatened and having declining populations, compared with forest cover alone (without consideration of condition and pressures). Further, species were more likely to be threatened or have declining populations if their geographic ranges contained high proportions of degraded forest than if their ranges contained lower proportions of forest cover but of high quality. Our work suggests that biodiversity conservation policies to preserve forest integrity are now urgently required alongside ongoing efforts to halt deforestation in the hyperdiverse humid tropics.

The minimum land area requiring conservation attention to safeguard biodiversity.

Ambitious conservation efforts are needed to stop the global biodiversity crisis. In this study, we estimate the minimum land area to secure important biodiversity areas, ecologically intact areas, and optimal locations for representation of species ranges and ecoregions. We discover that at least 64 million square kilometers (44% of terrestrial area) would require conservation attention (ranging from protected areas to land-use policies) to meet this goal. More than 1.8 billion people live on these lands, so responses that promote autonomy, self-determination, equity, and sustainable management for safeguarding biodiversity are essential. Spatially explicit land-use scenarios suggest that 1.3 million square kilometers of this land is at risk of being converted for intensive human land uses by 2030, which requires immediate attention. However, a sevenfold difference exists between the amount of habitat converted in optimistic and pessimistic land-use scenarios, highlighting an opportunity to avert this crisis. Appropriate targets in the Post-2020 Global Biodiversity Framework to encourage conservation of the identified land would contribute substantially to safeguarding biodiversity.

Effect of Bulky Anion around the Dication on the Electronic Structure and Normal Frequencies in 1,3-Bis(3-methylimidazolium-1-yl)propane Bis(trifluoromethanesulfonyl)imide Ionic Liquid.

A manifestation of hydrogen bonding between the dication and anions attributed to their relative position of the anions around the cation can influence both the conformational equilibrium and the physical properties of ionic liquids. With this view, we studied the electronic structure and normal frequencies using density functional theory calculations to analyze the hydrogen-bonding interactions in dicationic ionic liquids. The conformers are distinguished based on the hydrogen-bonding sites of the cation and anion. The weak hydrogen bonding between the dication and anions in dication ionic liquids can lead to greater conformational equilibrium compared to the monocation system. Consequences of these interactions for the vibrational spectrum are analyzed to provide an insight into the conformational equilibrium in dicationic ionic liquids at the molecular level.

Financial, Food, and Housing Insecurity Due to Coronavirus Disease 2019 Among At-Risk People With Human Immunodeficiency Virus in a Nonurban Ryan White HIV/AIDS Program Clinic.

Coronavirus disease 2019 negatively impacts social determinants of health that contribute to disparities for people with human immunodeficiency virus (HIV). Insecurity of food, housing, and employment increased significantly in April 2020 among patients with lower incomes at a Ryan White HIV/AIDS program clinic in the Southern United States.

Just ten percent of the global terrestrial protected area network is structurally connected via intact land.

Land free of direct anthropogenic disturbance is considered essential for achieving biodiversity conservation outcomes but is rapidly eroding. In response, many nations are increasing their protected area (PA) estates, but little consideration is given to the context of the surrounding landscape. This is despite the fact that structural connectivity between PAs is critical in a changing climate and mandated by international conservation targets. Using a high-resolution assessment of human pressure, we show that while ~40% of the terrestrial planet is intact, only 9.7% of Earth's terrestrial protected network can be considered structurally connected. On average, 11% of each country or territory's PA estate can be considered connected. As the global community commits to bolder action on abating biodiversity loss, placement of future PAs will be critical, as will an increased focus on landscape-scale habitat retention and restoration efforts to ensure those important areas set aside for conservation outcomes will remain (or become) connected.