ChatGPT-4 Performance on USMLE Step 1 Style Questions and Its Implications for Medical Education: A Comparative Study Across Systems and Disciplines.

We assessed the performance of OpenAI's ChatGPT-4 on United States Medical Licensing Exam STEP 1 style questions across the systems and disciplines appearing on the examination. ChatGPT-4 answered 86% of the 1300 questions accurately, exceeding the estimated passing score of 60% with no significant differences in performance across clinical domains. Findings demonstrated an improvement over earlier models as well as consistent performance in topics ranging from complex biological processes to ethical considerations in patient care. Its proficiency provides support for the use of artificial intelligence (AI) as an interactive learning tool and furthermore raises questions about how the technology can be used to educate students in the preclinical component of their medical education. The authors provide an example and discuss how students can leverage AI to receive real-time analogies and explanations tailored to their desired level of education. An appropriate application of this technology potentially enables enhancement of learning outcomes for medical students in the preclinical component of their education.

Co-occurrence of biodiversity, carbon storage, coastal protection, and fish and invertebrate production to inform global mangrove conservation planning.

Mangrove forests support unique biodiversity and provide a suite of ecosystem services (ES) that benefit people. Decades of continual mangrove loss and degradation have necessitated global efforts to protect and restore this important ecosystem. Generating and evaluating asset maps of biodiversity and ES is an important precursor to identifying locations that can deliver conservation outcomes across varying scales, such as maximising the co-occurrence of specific ES. We bring together global datasets on mangrove-affiliated biodiversity, carbon stocks, fish and invertebrate production, and coastal protection to provide insight into potential trade-offs, synergies and opportunities from mangrove conservation. We map opportunities where high ES provision co-occurs with these areas that could be leveraged in conservation planning, and identify potential high-value opportunities for single ES that might otherwise be missed with a biodiversity focus. Hotspots of single ES, co-occurrence of multiple ES, and opportunities to simultaneously leverage biodiversity and ES occurred throughout the world. For example, efforts that focus on conserving or restoring mangroves to store carbon can be targed to deliver multiple ES benefits. Some nations, such as Vietnam, Oman, Ecuador and China, showed consistent (although not necessarily strong) correlations between ES pairs. A lack of clear or consistent spatial trends elsewhere suggests that some nations will likely benefit more from complementarity-based approaches that focus on multiple sites with high provision of different services. Individual sites within these nations, however, such as Laguna de Terminos in Mexico still provide valuable opportunities to leverage co-benefits. Ensuring that an ES focused approach is complemented by strategic spatial planning is a priority, and our analyses provide a precursor towards decisions about where and how to invest.

Implications of preferential access to land and clean energy for Sustainable Aviation Fuels.

Aviation is highly dependent on liquid fossil fuel, and the production of 'sustainable aviation fuels' (SAF) is being proposed as a solution to removing the fossil carbon component, especially for long-haul flights. An analysis of 12 aviation roadmaps for net zero 2050 reveals heavy reliance on biogenic SAF in the medium-term and synthetic e-kerosene in the longer term. Realising these roadmaps could require 9 % of global renewable electricity and 30 % of sustainably available biomass in 2050, with significant energy 'losses'. The continued use of hydrocarbon fuel in the roadmaps generates 1.35 GtCO2 in 2050, of which 30 % are still from fossil fuel. The net carbon savings from the 70 % depend on the direct and indirect life cycle emissions of producing SAF. Additional effects that are omitted in most roadmaps relate to decadal time lags in re-sequestering biocarbon in the case of forest biomass and the impact of non-CO2 emissions. Both require greater scrutiny in fully understanding the climate impact of SAF substitution. The scaling up of SAF to not only maintain but grow global aviation is problematic as it competes for land needed for nature-based carbon removal, clean energy that could more effectively decarbonise other sectors, and captured CO2 to be stored permanently. As such, SAF production undermines global goals of limiting warming to 1.5 °C; a conflict that is neither recognised in the roadmaps nor in the public debate.

Sickle-Cell Trait as a Risk Factor for an Unprovoked Venous Thromboembolism: A Case Report.

In this case report, we examine the increased risk of venous thromboembolism (VTE) in patients with sickle-cell trait (SCT), illustrated by a patient with SCT who developed pulmonary embolism (PE) despite low scores on conventional risk assessment tools. The case prompts both a discussion of risk assessment and management strategies in this population.

Enhanced Bio-P removal: Past, present, and future - A comprehensive review.

Excess amounts of phosphorus (P) and nitrogen (N) from anthropogenic activities such as population growth, municipal and industrial wastewater discharges, agriculture fertilization and storm water runoffs, have affected surface water chemistry, resulting in episodes of eutrophication. Enhanced biological phosphorus removal (EBPR) based treatment processes are an economical and environmentally friendly solution to address the present environmental impacts caused by excess P present in municipal discharges. EBPR practices have been researched and operated for more than five decades worldwide, with promising results in decreasing orthophosphate to acceptable levels. The advent of molecular tools targeting bacterial genomic deoxyribonucleic acid (DNA) has also helped us reveal the identity of potential polyphosphate-accumulating organisms (PAO) and denitrifying PAO (DPAO) responsible for the success of EBPR. Integration of process engineering and environmental microbiology has provided much-needed confidence to the wastewater community for the successful implementation of EBPR practices around the globe. Despite these successes, the process of EBPR continues to evolve in terms of its microbiology and application in light of other biological processes such as anaerobic ammonia oxidation and on-site carbon capture. This review provides an overview of the history of EBPR, discusses different operational parameters critical for the successful operation of EBPR systems, reviews current knowledge of EBPR microbiology, the influence of PAO/DPAO on the disintegration of microbial communities, stoichiometry, EBPR clades, current practices, and upcoming potential innovations.

Oceanographic anomalies coinciding with humpback whale super-group occurrences in the Southern Benguela.

Seasonal feeding behaviour of humpback whales (Megaptera novaeangliae) has been observed in the coastal waters of the Southern Benguela where the species has been observed forming super-groups during the austral spring in recent years since 2011. Super-groups are unprecedented densely-packed aggregations of between 20 and 200 individuals in low-latitude waters and their occurrences indicate possible changes in feeding behaviour of the species. We accessed published data on super-groups occurrence in the study area in 2011, 2014 and 2015, and investigated oceanographic drivers that support prey availability in this region. We found that enhanced primary production is a necessary but not sufficient condition for super-groups to occur. Positive chlorophyll anomalies occurring one month prior to the super-group occurrences were identified, but only a concurrent significantly reduced water volume export from the region throughout October were conducive to the aggregations in the specific years. Hydrodynamic model results attributed the anomalous decreased volume export to the strength and orientation of the Goodhope Jet and associated eddy activity. The combination of random enhanced primary production typical of the region and emerging anomalous conditions of reduced water export in October since 2011 resulted in favourable food availability leading to the unique humpback whale aggregations. The novelty of this grouping behaviour is indicative of the lack of such oceanographic conditions in the past. Given the recency of the events, it is difficult to attribute this reduction in ocean transport to climatic regime shifts, and the origin should be likely investigated in the distant water mass interaction with the greater Agulhas system rather than in local intensifications of the upwelling conditions. A positive trend in the humpback whale population abundance points to the need to monitor the exposure of the species to the changing climate conditions.

Water circulation and impact on water quality in the southwest of Efate Island, Vanuatu.

In Small Island Developing States (SIDS), water pollution is not monitored or assessed frequently enough to fully understand the processes, impacts of water quality issues and what solutions are available This study investigated flushing time in Erakor lagoon and Port Vila Bay, Vanuatu using a numerical model developed in Delft3D. Microbial contamination by Escherichia coli was detected in multiple locations in the lagoon system with counts exceeding thresholds related to human health concerns. Modelling demonstrated a poor flushing time overall with a further decrease as the influence of waves and wind increased, especially in Vila Bay. Sea level rise resulted in an increase in flushing time downstream of the lagoon near the open sea, while with a decrease upstream and in Vila Bay. Based on these results, we recommend long-term continuous monitoring and identification of higher risks areas to prioritise decisions around wastewater management.

Reaching over the gap: A review of trends in and status of red panda research over 193 years (1827-2020).

The red panda is a unique species taxonomically known for its peculiar biological and ecological characteristics, and extreme attractiveness. Despite being highly significant from conservation, scientific and economic perspectives, this species has experienced a declining population in the wild. Thus, to direct further research priorities and conservation actions and assess gaps in the current research trend of this species, a systematic literature review was conducted covering 175 journal articles published in English over 193 years (1827-2020). This review revealed that (1) the biological aspect was highly studied compared to other thematic areas of red panda (2) captive-based studies are relatively higher than the studies based in wild populations (3) China is leading the red panda studies amongst all red panda range (4) The universities were found contributing more to red panda studies than other institutions. Surprisingly, we found that the researchers from the non-range country were leading red panda study than those from range countries. Our review highlighted the need of prioritising studies in underrepresented locations and understudied thematic areas focusing on the assessment of climate change impact, bamboo distribution status, ecosystem services of red panda habitat, behavior and movement ecology, population estimation, and metapopulation dynamics. We urge landscape-level studies and long-term population monitoring. Besides, we also suggest the documentation and evaluation of the effectiveness of ongoing red panda-focused conservation programs. We also stress the need for strengthening the capacity of institutions and people from range countries.

Evaluating nature-based solutions for climate mitigation and conservation requires comprehensive carbon accounting.

Nature-based solutions (NbS) can address climate change, biodiversity loss, human well-being and their interactions in an integrated way. A major barrier to achieving this is the lack of comprehensiveness in current carbon accounting which has focused on flows rather than stocks of carbon and led to perverse outcomes. We propose a new comprehensive approach to carbon accounting based on the whole carbon cycle, covering both stocks and flows, and linking changes due to human activities with responses in the biosphere and atmosphere. We identify enhancements to accounting, namely; inclusion of all carbon reservoirs, changes in their condition and stability, disaggregated flows, and coverage of all land areas. This comprehensive approach recognises that both carbon stocks (as storage) and carbon flows (as sequestration) contribute to the ecosystem service of global climate regulation. In contrast, current ecosystem services measurement and accounting commonly use only carbon sequestration measured as net flows, while greenhouse gas inventories use flows from sources to sinks. This flow-based accounting has incentivised planting and maintaining young forests with high carbon uptake rates, resulting, perversely, in failing to reveal the greater mitigation benefit from protecting larger, more stable and resilient carbon stocks in natural forests. We demonstrate the benefits of carbon storage and sequestration for climate mitigation, in theory as ecosystem services within an ecosystem accounting framework, and in practice using field data that reveals differences in results between accounting for stocks or flows. Our proposed holistic and comprehensive carbon accounting makes transparent the benefits, trade-offs and shortcomings of NbS actions for climate mitigation and sustainability outcomes. Adopting this approach is imperative for revision of ecosystem accounting systems under the System of Environmental-Economic Accounting and contributing to evidence-based decision-making for international conventions on climate (UNFCCC), biodiversity (CBD) and sustainability (SDGs).

Evaluating coral reef ecosystem services outcomes from climate change adaptation strategies using integrative system dynamics.

Coral reef ecosystems provide a broad spectrum of essential ecological, economic and cultural services for Small Island Developing State (SIDS) communities. However, coral reef communities are increasingly threatened by the adverse impacts of human activities at both global and local scales. This study aims to develop an integrated dynamic assessment framework to evaluate coral reef conditions under different adaptation and climate change scenarios, and their consequential economic impacts in the small island community of Port Resolution on Tanna Island in Vanuatu. Our assessment framework follows a sequential multilayered modelling approach that uses System Dynamics (SD) coupled with Bayesian Network (BN) modelling to deal with the complexity and dynamicity of socioeconomic and environmental systems, and impacts from trans-discipline variables. The BN incorporated existing data and expert knowledge to project the future conditions of coral reefs under different scenario settings, and to parametrise and quantify the SD model where the existing data and information was insufficient. The SD was then used to simulate the dynamic relationship between coral reef condition and the economic benefits derived from its ecosystem services under different climate change (i.e. RCPs) and management scenarios through to 2070. Our findings show that sustainable community-based conservation management strategies are key to preserving the flow of coral reef ecosystem services under RCP 2.6 and 6.0. Importantly, we demonstrate that the implementation of an integrated portfolio of management strategies better protects ecosystem services provided by coral reefs and maximises the total economic benefits achieved over the long-term despite a temporary and short-term economic loss due to high initial capital investments and income reduction due to fishing and tourism restrictions.

Integrating statistical and mechanistic approaches with biotic and environmental variables improves model predictions of the impact of climate and land-use changes on future mosquito-vector abundance, diversity and distributions in Australia.

Changes to Australia's climate and land-use patterns could result in expanded spatial and temporal distributions of endemic mosquito vectors including Aedes and Culex species that transmit medically important arboviruses. Climate and land-use changes greatly influence the suitability of habitats for mosquitoes and their behaviors such as mating, feeding and oviposition. Changes in these behaviors in turn determine future species-specific mosquito diversity, distribution and abundance. In this review, we discuss climate and land-use change factors that influence shifts in mosquito distribution ranges. We also discuss the predictive and epidemiological merits of incorporating these factors into a novel integrated statistical (SSDM) and mechanistic species distribution modelling (MSDM) framework. One potentially significant merit of integrated modelling is an improvement in the future surveillance and control of medically relevant endemic mosquito vectors such as Aedes vigilax and Culex annulirostris, implicated in the transmission of many arboviruses such as Ross River virus and Barmah Forest virus, and exotic mosquito vectors such as Aedes aegypti and Aedes albopictus. We conducted a focused literature search to explore the merits of integrating SSDMs and MSDMs with biotic and environmental variables to better predict the future range of endemic mosquito vectors. We show that an integrated framework utilising both SSDMs and MSDMs can improve future mosquito-vector species distribution projections in Australia. We recommend consideration of climate and environmental change projections in the process of developing land-use plans as this directly impacts mosquito-vector distribution and larvae abundance. We also urge laboratory, field-based researchers and modellers to combine these modelling approaches. Having many different variations of integrated (SDM) modelling frameworks could help to enhance the management of endemic mosquitoes in Australia. Enhanced mosquito management measures could in turn lead to lower arbovirus spread and disease notification rates.

Australian songbird body size tracks climate variation: 82 species over 50 years.

The observed variation in the body size responses of endotherms to climate change may be explained by two hypotheses: the size increases with climate variability (the starvation resistance hypothesis) and the size shrinks as mean temperatures rise (the heat exchange hypothesis). Across 82 Australian passerine species over 50 years, shrinking was associated with annual mean temperature rise exceeding 0.012°C driven by rising winter temperatures for arid and temperate zone species. We propose the warming winters hypothesis to explain this response. However, where average summer temperatures exceeded 34°C, species experiencing annual rise over 0.0116°C tended towards increasing size. Results suggest a broad-scale physiological response to changing climate, with size trends probably reflecting the relative strength of selection pressures across a climatic regime. Critically, a given amount of temperature change will have varying effects on phenotype depending on the season in which it occurs, masking the generality of size patterns associated with temperature change. Rather than phenotypic plasticity, and assuming body size is heritable, results suggest selective loss or gain of particular phenotypes could generate evolutionary change but may be difficult to detect with current warming rates.

Spatial Bayesian Network for predicting sea level rise induced coastal erosion in a small Pacific Island.

An integrated approach combining Bayesian Network with GIS was developed for making a probabilistic prediction of sea level rise induced coastal erosion and assessing the implications of adaptation measures. The Bayesian Network integrates extensive qualitative and quantitative information into a single probabilistic model while GIS explicitly deals with spatial data for inputting, storing, analysing and mapping. The integration of the Bayesian Network with GIS using a cell-by-cell comparison technique (aka map algebra) provides a new tool to perform the probabilistic spatial analysis. The spatial Bayesian Network was utilised for predicting coastal erosion scenarios at the case study location of Tanna Island, Vanuatu in the South Pacific. Based on the Bayesian Network model, a rate of the island shoreline change was predicted probabilistically for each shoreline segment, which was transferred into GIS for visualisation purposes. The spatial distribution of shoreline change prediction results for various sea level rise scenarios was mapped. The outcomes of this work support risk-based adaptation planning and will be further developed to enable the incorporation of high resolution coastal process models, thereby supporting localised land use planning decisions.

On modelling the relationship between vegetation greenness and water balance and land use change.

Here we sought a biologically meaningful, climate variable that captures water-energy availability and is suitable for high resolution (250 m × 250 m) modelling of the fraction of photosynthetically active radiation intercepted by the sunlit canopy (F V ) derived from a 10-year (July 2000 - June 2010) time series of Moderate Resolution Imaging Spectroradiometer (MODIS) Normalized difference vegetation index (NDVI) satellite imagery for Australia. The long-term mean annual evaporation deficit, and mean annual water availability indices all yielded strong linear relationships with mean F V ([Formula: see text], %). We hypothesised whether some of the scatter about the relationships was related to land-use changes that have disrupted the vegetation-climate-soil equilibrium. Using continental-scale spatial data layers of protected area status and vegetation condition classes we repeated our analyses with restricted datasets. [Formula: see text] of intact native vegetation within protected areas was greater than all modified vegetation classes. There was a consistent decline in the slopes of the regression relationships with increasing intensity of woody vegetation clearing and livestock grazing. Where native vegetation has been transformed by land use there was a 25% reduction in predicted [Formula: see text].

Towards Improved Linkage of Disaster Risk Reduction and Climate Change Adaptation in Health: A Review.

Climate change and climate-sensitive disasters significantly impact health. Linking Disaster Risk Reduction (DRR) and Climate Change Adaptation (CCA) is essential for addressing these ever present, complex and increasing risks. Recent calls have been made to build these links in health. However, there is a need to clearly articulate why linking DRR and CCA is important in health. Furthermore, little is known about how DRR and CCA should be linked in health. By extensively examining relevant literature, this review presents the current state of knowledge of linking DRR and CCA in health. This includes the potential for maximising conceptual synergies such as building resilience, and reducing vulnerability and risk. Additionally, technical and operational synergies are identified to link DRR and CCA in health, including: policy, Early Warning Systems, vulnerability and risk assessment, health systems strengthening, infrastructure resilience, disaster preparedness and response, and health impact pathways. Public health actors have a central role in building these links due to their expertise, work functions, and experience in addressing complex health risks. The review concludes with recommendations for future research, including how to better link DRR and CCA in health; and the opportunities, challenges and enablers to build and sustain these links.

Commonalities between Disaster and Climate Change Risks for Health: A Theoretical Framework.

Disasters and climate change have significant implications for human health worldwide. Both climate change and the climate-sensitive hazards that result in disasters, are discussed in terms of direct and indirect impacts on health. A growing body of literature has argued for the need to link disaster risk reduction and climate change adaptation. However, there is limited articulation of the commonalities between these health impacts. Understanding the shared risk pathways is an important starting point for developing joint strategies for adapting to, and reducing, health risks. Therefore, this article discusses the common aspects of direct and indirect health risks of climate change and climate-sensitive disasters. Based on this discussion a theoretical framework is presented for understanding these commonalities. As such, this article hopes to extend the current health impact frameworks and provide a platform for further research exploring opportunities for linked adaptation and risk reduction strategies.

The phosphorus-rich signature of fire in the soil-plant system: a global meta-analysis.

The biogeochemical and stoichiometric signature of vegetation fire may influence post-fire ecosystem characteristics and the evolution of plant 'fire traits'. Phosphorus (P), a potentially limiting nutrient in many fire-prone environments, might be particularly important in this context; however, the effects of fire on P cycling often vary widely. We conducted a global-scale meta-analysis using data from 174 soil studies and 39 litter studies, and found that fire led to significantly higher concentrations of soil mineral P as well as significantly lower soil and litter carbon:P and nitrogen:P ratios. These results demonstrate that fire has a P-rich signature in the soil-plant system that varies with vegetation type. Further, they suggest that burning can ease P limitation and decouple the biogeochemical cycling of P, carbon and nitrogen. These effects resemble a transient reversion to an earlier stage of ecosystem development, and likely underpin at least some of fire's impacts on ecosystems and organisms.

Gaps and opportunities for the World Heritage Convention to contribute to global wilderness conservation.

Wilderness areas are ecologically intact landscapes predominantly free of human uses, especially industrial-scale activities that result in substantial biophysical disturbance. This definition does not exclude land and resource use by local communities who depend on such areas for subsistence and bio-cultural connections. Wilderness areas are important for biodiversity conservation and sustain key ecological processes and ecosystem services that underpin planetary life-support systems. Despite these widely recognized benefits and values of wilderness, they are insufficiently protected and are consequently being rapidly eroded. There are increasing calls for multilateral environmental agreements to make a greater and more systematic contribution to wilderness conservation before it is too late. We created a global map of remaining terrestrial wilderness following the established last-of-the-wild method, which identifies the 10% of areas with the lowest human pressure within each of Earth's 62 biogeographic realms and identifies the 10 largest contiguous areas and all contiguous areas >10,000 km2 . We used our map to assess wilderness coverage by the World Heritage Convention and to identify gaps in coverage. We then identified large nationally designated protected areas with good wilderness coverage within these gaps. One-quarter of natural and mixed (i.e., sites of both natural and cultural value) World Heritage Sites (WHS) contained wilderness (total of 545,307 km2 ), which is approximately 1.8% of the world's wilderness extent. Many WHS had excellent wilderness coverage, for example, the Okavango Delta in Botswana (11,914 km2 ) and the Central Suriname Nature Reserve (16,029 km2 ). However, 22 (35%) of the world's terrestrial biorealms had no wilderness representation within WHS. We identified 840 protected areas of >500 km2 that were predominantly wilderness (>50% of their area) and represented 18 of the 22 missing biorealms. These areas offer a starting point for assessing the potential for the designation of new WHSs that could help increase wilderness representation on the World Heritage list. We urge the World Heritage Convention to ensure that the ecological integrity and outstanding universal value of existing WHS with wilderness values are preserved.

An integrated risk and vulnerability assessment framework for climate change and malaria transmission in East Africa.

BACKGROUND: Malaria is one of the key research concerns in climate change-health relationships. Numerous risk assessments and modelling studies provide evidence that the transmission range of malaria will expand with rising temperatures, adversely impacting on vulnerable communities in the East African highlands. While there exist multiple lines of evidence for the influence of climate change on malaria transmission, there is insufficient understanding of the complex and interdependent factors that determine the risk and vulnerability of human populations at the community level. Moreover, existing studies have had limited focus on the nature of the impacts on vulnerable communities or how well they are prepared to cope. In order to address these gaps, a systems approach was used to present an integrated risk and vulnerability assessment framework for studies of community level risk and vulnerability to malaria due to climate change. RESULTS: Drawing upon published literature on existing frameworks, a systems approach was applied to characterize the factors influencing the interactions between climate change and malaria transmission. This involved structural analysis to determine influential, relay, dependent and autonomous variables in order to construct a detailed causal loop conceptual model that illustrates the relationships among key variables. An integrated assessment framework that considers indicators of both biophysical and social vulnerability was proposed based on the conceptual model. CONCLUSIONS: A major conclusion was that this integrated assessment framework can be implemented using Bayesian Belief Networks, and applied at a community level using both quantitative and qualitative methods with stakeholder engagement. The approach enables a robust assessment of community level risk and vulnerability to malaria, along with contextually relevant and targeted adaptation strategies for dealing with malaria transmission that incorporate both scientific and community perspectives.