The Impact of the Novel Coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic on Case Fatality Rates and Cost of Surgical Care in Brazil.

Background The coronavirus disease 2019 (COVID-19) pandemic provoked disruptions in healthcare delivery. Following the recommendations of major surgical societies and surgical departments globally, most surgeries were widely canceled or postponed, causing significant disruptions to healthcare delivery worldwide, including in Brazil. Brazil's public healthcare system - Sistema Único de Saúde (SUS) was particularly affected, with a substantial decline in elective procedures, especially during the pandemic's early stages. The impact of the pandemic on surgical services in Brazil has not been adequately studied since most studies only cover the early phases of the pandemic. Thus, this study aims to analyze the case fatality rates and costs, associated with the different surgical procedure subgroups performed during the pre-pandemic, pandemic, recovery, and post-pandemic periods in all five regions of Brazil. Methods A retrospective cross-sectional design was used to examine surgical cases from 2019 to 2022. Data was divided into four time periods, named as the pre-pandemic (March-December 2019), pandemic (March-December 2020), recovery (March-December 2021), and post-pandemic (March-December 2022), and was analyzed for the cost of surgical procedures in the aforementioned four periods. In addition, the case fatality rates and rate ratios in the four periods stratified according to region were calculated. Results The cost of surgical procedures decreased during the pandemic and recovery period compared with pre-pandemic for all procedures except thoracic surgery where it was higher in the recovery period than pre-pandemic. No statistically significant change in cost was observed in surgeries of the central and peripheral nervous system, circulatory system, obstetric, and oncology. Case fatality rates increased among all five regions of Brazil in pandemic and recovery periods compared to pre-pandemic and post-pandemic periods. Case fatality rates increased during the pandemic and/or recovery as compared to pre-pandemic in all procedures except visual apparatus and obstetric surgeries were not affected by the pandemic in terms of case fatality rates. Conclusion The COVID-19 pandemic had a significant impact on surgical care costs and case fatality rates for surgery in Brazil. There was a decreasing trend in the costs of procedures during the pandemic, followed by a gradual recovery to baseline values, except for thoracic surgery. Case fatality rates rose initially and then declined, ultimately reaching baseline levels. The pandemic posed significant challenges to the healthcare system, affecting medical services, including surgical care.

Outcome Analysis of Total Hip Arthroplasty in the Setting of Post-traumatic Arthritis of the Hip: A Case Report.

This case report outlines the successful management of post-traumatic arthritis (PTA) in the left hip of a 60-year-old male with a history of a subtrochanteric femur fracture treated with Jewett Nail Plate osteosynthesis four decades ago. Despite seeking relief from various healthcare facilities and attempting alternative therapies, the patient experienced persistent pain and limited mobility. The decision was made to perform elective implant removal followed by total hip arthroplasty (THA). The surgical intervention involved a modified posterior approach, addressing specific challenges such as acetabular superior wall deficit and femoral sclerosis. A comprehensive management approach, considering the patient's complex medical history, including prolonged tobacco use and alcohol consumption, contributed to the successful outcome. Postoperative care included a multimodal drug cocktail for pain management and a well-coordinated physiotherapy program. Postoperative imaging confirmed the procedure's success, and the patient exhibited significant improvement in pain relief and functional outcomes. This case underscores the importance of a tailored and comprehensive approach in managing PTA, showcasing the effectiveness of elective implant removal followed by THA in addressing PTA of the hip.

Temporal Trends of Age-Adjusted Mortality Rates for Rheumatic Heart Disease in Brazil From 2000 to 2021.

Background Rheumatic heart disease (RHD) is a chronic cardiovascular condition stemming from an infectious origin, posing a substantial health burden, particularly in economically disadvantaged regions. It starts with acute rheumatic fever (ARF), a complication following group A Streptococcus infection, leading to heart valve damage and, over time, structural heart abnormalities. RHD contributes to premature deaths, especially in low-middle-income countries. Although the incidence and prevalence have generally reduced globally due to antibiotics and improved healthcare, it remains a significant public health concern in Brazil, echoing its prevalence in many developing nations around the world. RHD stands as a poignant testament to the intersection of socio-economic disparities and healthcare challenges within Brazil's diverse population. In Brazil, despite advancements in healthcare, RHD continues to impact communities, highlighting the urgent need for enhanced prevention strategies, access to quality healthcare services, and heightened awareness to combat this preventable, yet persistent, cardiac condition. Understanding the epidemiological landscape and socio-cultural factors influencing RHD in Brazil is crucial for developing targeted interventions aimed at mitigating its burden on individuals, families, and the healthcare system at large. Thus, our study focuses on analyzing age-related mortality rates linked to ARF and chronic RHD (ARHD) in Brazil from 2000 to 2021, particularly examining gender disparities. Materials and methods This retrospective cohort study employed a descriptive time-series approach, utilizing comprehensive nationwide data from Brazil spanning from 2000 to 2021 to assess trends in diverse age groups, among both sexes, enabling a detailed analysis of temporal patterns. Mortality data, extracted and categorized meticulously, were subjected to Joinpoint statistical analyses enabling comparative assessments, with average annual percent change (AAPC) and annual percent change (APC) serving as key metrics to quantify and interpret trends over the analyzed period. Results The acute RHD (ARHD)-related mortality declined over the analyzed years supported by AAPC, with higher mortality reduction in females. The age-adjusted mortality rate for "males and females" decreased from 78 to 67 deaths/100,000 from 2000 to 2021. Female mortality dropped from 85 to 69/100,000, and male mortality decreased from 73 to 63/100,000 over the same period. For ARHD, male age groups (20-29, 60-69, 70-79, 80+) showed declining mortality, while the 30-59 age group exhibited an upward. Females AAMR for chronic RHD (CRHD) decreased across all age groups, with significant reductions in the 80 years and above age group from 2000-2002 (APC: -11.94*) and steadily from 2002 onwards (APC: -1.33). Conclusions Our study revealed an overall decline in mortality rates for both acute and CRHD across both sexes. Females consistently exhibited higher mortality rates and a more pronounced reduction compared to males in both acute and CRHD. In ARHD, males experience the highest mortality in the 50-59 age group, while females have a peak in the 40-49 age group. The 60-69 age group had the highest mortality in CRHD for both sexes. Conversely, the 20-29 age group displayed the lowest mortality in CRHD, and the 80-89 age group had the lowest mortality in ARHD.

Recent Developments and Challenges in Projecting the Impact of Crop Productivity Growth on Biodiversity Considering Market-Mediated Effects.

The effect of an increase in crop productivity (output per unit of inputs) on biodiversity is hitherto poorly understood. This is because increased productivity of a crop in particular regions leads to increased profit that can encourage expansion of its cultivated area causing land use change and ultimately biodiversity loss, a phenomenon also known as "Jevons paradox" or the "rebound effect". Modeling such consequences in an interconnected and globalized world considering such rebound effects is challenging. Here, we discuss the use of computable general equilibrium (CGE) and other economic models in combination with ecological models to project consequences of crop productivity improvements for biodiversity globally. While these economic models have the advantage of taking into account market-mediated responses, resource constraints, endogenous price responses, and dynamic bilateral patterns of trade, there remain a number of important research and data gaps in these models which must be addressed to improve their performance in assessment of the link between local crop productivity changes and global biodiversity. To this end, we call for breaking the silos and building interdisciplinary networks across the globe to facilitate data sharing and knowledge exchange in order to improve global-to-local-to-global analysis of land, biodiversity, and ecosystem sustainability.

Unveiling the Dual Threat: Myocarditis in the Spectrum of Dengue Fever.

This meta-analysis aims to systematically review and analyze available studies on the association between myocarditis and dengue viral fever. A comprehensive literature search was carried out using several databases. Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size using random effect models. Besides, random effects models were used to calculate the overall pooled prevalence. Data from 26 articles (6622 dengue patients) showed that pooled estimate of myocarditis in dengue fever was 12.4% (95% CI, 8.41-17.08). Higher prevalence was seen in reports from Asia (15.2%) compared to that from Latin America (3.6%). Besides, the pooled prevalence of severity and mortality was 34% (95% CI, 20.49-49.04) and 26.44% (95% CI, 18.07-35.78) respectively. Significantly higher prevalence rates of severe disease in the pediatric population (52.4%) and studies with a higher percentage of females (52.1%) were also observed. However, higher mortality rates were seen in the adult population (34.8%) compared with the pediatric age group. Further, myocarditis in dengue patients was associated with increased risk of severity (RR = 2.44, 95% CI 1.007-5.93, P = 0.048) and mortality (RR = 19.41, 95% CI 7.19-52.38, P < 0.001) compared with dengue patients without myocarditis. No significant publication bias was evident in the meta-analysis. The findings highlight the clinical significance of early identification and management of myocarditis in patients with dengue fever.

Developing One Health surveillance systems.

The health of humans, domestic and wild animals, plants, and the environment are inter-dependent. Global anthropogenic change is a key driver of disease emergence and spread and leads to biodiversity loss and ecosystem function degradation, which are themselves drivers of disease emergence. Pathogen spill-over events and subsequent disease outbreaks, including pandemics, in humans, animals and plants may arise when factors driving disease emergence and spread converge. One Health is an integrated approach that aims to sustainably balance and optimize human, animal and ecosystem health. Conventional disease surveillance has been siloed by sectors, with separate systems addressing the health of humans, domestic animals, cultivated plants, wildlife and the environment. One Health surveillance should include integrated surveillance for known and unknown pathogens, but combined with this more traditional disease-based surveillance, it also must include surveillance of drivers of disease emergence to improve prevention and mitigation of spill-over events. Here, we outline such an approach, including the characteristics and components required to overcome barriers and to optimize an integrated One Health surveillance system.

Indicators to monitor the status of the tree of life.

Following the failure to fully achieve any of the 20 Aichi biodiversity targets, the future of biodiversity rests in the balance. The Convention on Biological Diversity's Kunming-Montreal Global Biodiversity Framework (GBF) presents the opportunity to preserve nature's contributions to people (NCPs) for current and future generations by conserving biodiversity and averting extinctions. There is a need to safeguard the tree of life-the unique and shared evolutionary history of life on Earth-to maintain the benefits it bestows into the future. Two indicators have been adopted within the GBF to monitor progress toward safeguarding the tree of life: the phylogenetic diversity (PD) indicator and the evolutionarily distinct and globally endangered (EDGE) index. We applied both to the world's mammals, birds, and cycads to show their utility at the global and national scale. The PD indicator can be used to monitor the overall conservation status of large parts of the evolutionary tree of life, a measure of biodiversity's capacity to maintain NCPs for future generations. The EDGE index is used to monitor the performance of efforts to conserve the most distinctive species. The risk to PD of birds, cycads, and mammals increased, and mammals exhibited the greatest relative increase in threatened PD over time. These trends appeared robust to the choice of extinction risk weighting. EDGE species had predominantly worsening extinction risk. A greater proportion of EDGE mammals (12%) had increased extinction risk compared with threatened mammals in general (7%). By strengthening commitments to safeguarding the tree of life, biodiversity loss can be reduced and thus nature's capacity to provide benefits to humanity now and in the future can be preserved.

Indicadores para monitorear el estado del árbol de la vida Resumen El futuro de la biodiversidad peligra tras no haberse logrado ninguno de los 20 Objetivos de Aichi. El Marco Global de Biodiversidad (GBF) de Kunming-Montreal del Convenio sobre la Diversidad Biológica (CDB) representa la oportunidad de preservar las contribuciones de la naturaleza a las personas (PNC) para las generaciones actuales y futuras mediante la conservación de la biodiversidad y la prevención de las extinciones. Es necesario salvaguardar el árbol de la vida -la historia evolutiva única y compartida de la vida en la Tierra- para mantener en el futuro los beneficios que aporta. En el GBF se han adoptado dos indicadores para supervisar los avances hacia el cuidado del árbol de la vida: el indicador de diversidad filogenética y el índice de especies evolutivamente distintas y globalmente amenazadas (EDGE). Aplicamos ambos a los mamíferos, las aves y las cícadas del mundo para demostrar su utilidad a escala mundial y nacional. El indicador de diversidad filogenética puede utilizarse para supervisar el estado de conservación general de grandes partes del árbol evolutivo de la vida, una medida de la capacidad de la biodiversidad para mantener los PNC para las generaciones futuras. El índice EDGE se utiliza para supervisar el rendimiento de los esfuerzos por conservar las especies más distintivas. El riesgo para la diversidad filogenética de aves, cícadas y mamíferos aumentó, y los mamíferos mostraron el mayor aumento relativo de la diversidad filogenética amenazada a lo largo del tiempo. Estas tendencias parecieron sólidas a la hora de elegir la valoración del riesgo de extinción. Las especies EDGE tuvieron un riesgo de extinción predominante cada vez peor. Una mayor proporción de mamíferos EDGE (12%) presentó un riesgo de extinción creciente en comparación con los mamíferos amenazados en general (7%). Si se refuerza el compromiso de salvaguardar el árbol de la vida, se puede reducir la pérdida de biodiversidad y preservar así la capacidad de la naturaleza para proporcionar beneficios a la humanidad ahora y en el futuro.

Sustainable Food Systems: The Way Forward in the Indian Context.

Current Indian food system is not sustainable as it fails to fulfil its primary function of delivering adequate nutrition to its population while causing high environmental impacts along with widespread poverty among farmers. Here, we discuss how recent research has enabled quantification of a country's current food system sustainability through multiple indicators across nutrition, environmental, and economic dimensions. This data can be used by policy makers, farmers, businesses, consumers, and other stakeholders to make scientific evidence-based informed decisions regarding which diets and food items to promote or discourage in near future to make progress towards sustainability. While several government initiatives are underway to transform Indian agri-food sector, the need of the hour is multi-sectoral collaboration across ministries along with dietary behavior changes by consumers, and innovations in agri-tech and food formulations by businesses to make farm production more efficient and products more nutrient dense.

Template for Evaluating Cradle-to-Site Environmental Life Cycle Impacts of Buildings in India.

A massive amount of building construction is expected in economically developing nations such as India over the next few years. The first step in ensuring that the new construction takes place in a sustainable manner is the knowledge about the building's impact on multiple environmental domains. Life cycle assessment (LCA) is a promising tool for this, but its application in the Indian construction sector is hampered by a lack of access to detailed inventory data on amounts of all building materials used and the per unit environmental footprints of individual materials (characterization factors). Here, we overcome these limitations by proposing a novel approach that connects the building bill of quantity data with publicly available analysis of rate documents to obtain the detailed material inventory. The approach then combines the material inventory data with the newly available India-specific environmental footprint database of construction materials to calculate the impacts of a building during its different life cycle stages (cradle to site). We demonstrate the new approach through a case study of a residential building within a hospital in North-East India and quantify its environmental footprint on six domains of the environment: energy use, global warming, ozone depletion, acidification, eutrophication, and photochemical oxidant formation potential. Results show that out of 78 materials used, bricks, aluminum sections, steel bars, and cement are the major contributors to the building's total environmental impact. The material manufacturing stage is the hotspot in the building's life cycle. Our approach can act as a template for conducting "cradle-to-site" LCA of buildings for which BOQ data becomes available in India and other countries in the future.

Thermal degradation model of used surgical masks based on machine learning methodology.

Background: The COVID-19 pandemic has leveraged facial masks to be one of the most effective measures to prevent the spread of the virus, which thereby has exponentially increased the usage of facial masks that lead to medical waste mismanagements which pose a serious threat to life. Thermal degradation or pyrolysis is an effective treatment method for the used facial mask wastes and this study aims to investigate the thermal degradation of the same. Methods: Predicted the TGA experimental curves of the mask components using a Machine Learning model known as Artificial Neural Network (ANN). Significant findings: Three different parts of the mask namely- ribbon, body, and corner were separated and used for the analysis. The thermal degradation behavior is studied using Thermogravimetric Analysis (TGA) and this is crucial for determining the reactivity of the individual mask components as they are subjected to a range of temperatures. Using the curves obtained from TGA, kinetic parameters such as Activation energy (E) and Pre-exponential factor (A) were estimated using the Coats-Redfern model-fitting method. Using the determined kinetic parameters, thermodynamic quantities such as a change in Enthalpy (ΔH), Entropy (ΔS), and Gibbs-Free energy (ΔG) were also calculated. Since TGA is a costly and time-consuming process, this study attempted to predict the TGA experimental curves of the mask components using a Machine Learning model known as Artificial Neural Network (ANN). The dataset obtained at a heating rate of 10°C/min was used to train the 3 different neural networks corresponding to the mask components and it showed an excellent agreement with experimental data (R2 > 0.99). Through this study, a complex chemical process such as thermal degradation was modelled using Machine Learning based on available experimental parameters without delving into the intricacies and complexities of the process.

Global importance of Indigenous Peoples, their lands, and knowledge systems for saving the world's primates from extinction.

Primates, represented by 521 species, are distributed across 91 countries primarily in the Neotropic, Afrotropic, and Indo-Malayan realms. Primates inhabit a wide range of habitats and play critical roles in sustaining healthy ecosystems that benefit human and nonhuman communities. Approximately 68% of primate species are threatened with extinction because of global pressures to convert their habitats for agricultural production and the extraction of natural resources. Here, we review the scientific literature and conduct a spatial analysis to assess the significance of Indigenous Peoples' lands in safeguarding primate biodiversity. We found that Indigenous Peoples' lands account for 30% of the primate range, and 71% of primate species inhabit these lands. As their range on these lands increases, primate species are less likely to be classified as threatened or have declining populations. Safeguarding Indigenous Peoples' lands, languages, and cultures represents our greatest chance to prevent the extinction of the world's primates.

Nutrient Adequacy of Global Food Production.

A major challenge for countries around the world is to provide a nutritionally adequate diet to their population with limited available resources. A comprehensive analysis that reflects the adequacy of domestic food production for meeting national nutritional needs in different countries is lacking. Here we combined national crop, livestock, aquaculture, and fishery production statistics for 191 countries obtained from UN FAO with food composition databases from USDA and accounted for food loss and waste occurring at various stages to calculate the amounts of calories and 24 essential nutrients destined for human consumption. We then compared the domestic production quantities of all nutrients with their population-level requirements estimated from age- and sex-specific intake recommendations of WHO to assess the nutrient adequacy of the national food production. Our results show inadequate production of seven out of 24 nutrients (choline, calcium, polyunsaturated fatty acids, vitamin A, vitamin E, folate, and iron) in most countries, despite the overall adequacy of the total global production. High-income countries produce adequate amounts of dietary nutrients in general, while the foods produced in low-income countries mainly comprising roots and cereal products often lack in important micronutrients such as choline, calcium, and vitamin B12. South Asian food production barely fulfills half of the required vitamin A. Our study identifies target nutrients for each country whose domestic production should be encouraged for improving nutritional adequacy through interventions such as increasing the production of foods or fortified foods that are rich in these inadequate nutrients while not undermining the local environment. This assessment can serve as an evidence base for nutrition-sensitive policies facilitating the achievement of the Sustainable Development Goals of zero hunger and good health and well-being.

A metric for spatially explicit contributions to science-based species targets.

The Convention on Biological Diversity's post-2020 Global Biodiversity Framework will probably include a goal to stabilize and restore the status of species. Its delivery would be facilitated by making the actions required to halt and reverse species loss spatially explicit. Here, we develop a species threat abatement and restoration (STAR) metric that is scalable across species, threats and geographies. STAR quantifies the contributions that abating threats and restoring habitats in specific places offer towards reducing extinction risk. While every nation can contribute towards halting biodiversity loss, Indonesia, Colombia, Mexico, Madagascar and Brazil combined have stewardship over 31% of total STAR values for terrestrial amphibians, birds and mammals. Among actions, sustainable crop production and forestry dominate, contributing 41% of total STAR values for these taxonomic groups. Key Biodiversity Areas cover 9% of the terrestrial surface but capture 47% of STAR values. STAR could support governmental and non-state actors in quantifying their contributions to meeting science-based species targets within the framework.

A secondary assessment of sediment trapping effectiveness by vegetated buffers.

Vegetated buffers and filter strips are a widely used Best Management Practice (BMP) for enhancing streamside ecosystem quality and water quality improvement through nonpoint source pollutant removal. Most existing studies are either site-specific, rely on limited data points, or evaluate buffer width and slope as the only design variables for predicting sediment reduction, not considering other parameters such as soil texture, vegetation types, and runoff loads that can significantly influence the buffer efficiency. In this paper, we carry out a meta-analysis of published studies and fit regression models to explore the sediment removal capacity of riparian buffers. We compiled 905 data points from over 90 studies (including data from an online BMP database) documenting sediment trapping by vegetated buffers and recorded data regarding buffer characteristics such as buffer width, slope, area, vegetation type, sediment loading, water flow rates, and sediment removal efficiency. We found that an exponential regression model describing the relationship between sediment removal efficiency by the buffer and water inflow/outflow volume ratio explained 44% of the variance. Adding the square root of roughness increased the R 2 to 0.50. The model performance was compared with other sediment reduction regression models reported in the literature. The results point towards the importance of considering flow parameters in vegetative buffer design. The improved empirical relationships derived here can be used at local scales to understand sediment trapping potential by vegetated buffers for water quality mitigation purposes and can be built into extant hydrologic models for improved watershed-scale assessments.

Current and future trends in socio-economic, demographic and governance factors affecting global primate conservation.

Currently, ~65% of extant primate species (ca 512 species) distributed in 91 countries in the Neotropics, mainland Africa, Madagascar, South Asia and Southeast Asia are threatened with extinction and 75% have declining populations as a result of deforestation and habitat loss resulting from increasing global market demands, and land conversion for industrial agriculture, cattle production and natural resource extraction. Other pressures that negatively impact primates are unsustainable bushmeat hunting, the illegal trade of primates as pets and as body parts, expanding road networks in previously isolated areas, zoonotic disease transmission and climate change. Here we examine current and future trends in several socio-economic factors directly or indirectly affecting primates to further our understanding of the interdependent relationship between human well-being, sustainable development, and primate population persistence. We found that between 2001 and 2018 ca 191 Mha of tropical forest (30% canopy cover) were lost as a result of human activities in the five primate range regions. Forty-six percent of this loss was in the Neotropics (Mexico, Central and South America), 30% in Southeast Asia, 21% in mainland Africa, 2% in Madagascar and 1% in South Asia. Countries with the greatest losses (ca 57% of total tree cover loss) were Brazil, Indonesia, DRC, China, and Malaysia. Together these countries harbor almost 50% of all extant primate species. In 2018, the world human population was estimated at ca 8bn people, ca 60% of which were found in primate range countries. Projections to 2050 and to 2100 indicate continued rapid growth of the human populations in these five primate range regions, with Africa surpassing all the other regions and totaling ca 4bn people by the year 2100. Socioeconomic indicators show that, compared to developed nations, most primate range countries are characterized by high levels of poverty and income inequality, low human development, low food security, high levels of corruption and weak governance. Models of Shared Socioeconomic Pathway scenarios (SSPs) projected to 2050 and 2100 showed that whereas practices of increasing inequality (SSP4) or unconstrained growth in economic output and energy use (SSP5) are projected to have dire consequences for human well-being and primate survivorship, practices of sustainability-focused growth and equality (SSP1) are expected to have a positive effect on maintaining biodiversity, protecting environments, and improving the human condition. These results stress that improving the well-being, health, and security of the current and future human populations in primate range countries are of paramount importance if we are to move forward with effective policies to protect the world's primate species and promote biodiversity conservation.

Bending the curve of terrestrial biodiversity needs an integrated strategy.

Increased efforts are required to prevent further losses to terrestrial biodiversity and the ecosystem services that it  provides1,2. Ambitious targets have been proposed, such as reversing the declining trends in biodiversity3; however, just feeding the growing human population will make this a challenge4. Here we use an ensemble of land-use and biodiversity models to assess whether-and how-humanity can reverse the declines in terrestrial biodiversity caused by habitat conversion, which is a major threat to biodiversity5. We show that immediate efforts, consistent with the broader sustainability agenda but of unprecedented ambition and coordination, could enable the provision of food for the growing human population while reversing the global terrestrial biodiversity trends caused by habitat conversion. If we decide to increase the extent of land under conservation management, restore degraded land and generalize landscape-level conservation planning, biodiversity trends from habitat conversion could become positive by the mid-twenty-first century on average across models (confidence interval, 2042-2061), but this was not the case for all models. Food prices could increase and, on average across models, almost half (confidence interval, 34-50%) of the future biodiversity losses could not be avoided. However, additionally tackling the drivers of land-use change could avoid conflict with affordable food provision and reduces the environmental effects of the food-provision system. Through further sustainable intensification and trade, reduced food waste and more plant-based human diets, more than two thirds of future biodiversity losses are avoided and the biodiversity trends from habitat conversion are reversed by 2050 for almost all of the models. Although limiting further loss will remain challenging in several biodiversity-rich regions, and other threats-such as climate change-must be addressed to truly reverse the declines in biodiversity, our results show that ambitious conservation efforts and food system transformation are central to an effective post-2020 biodiversity strategy.