Uninterrupted use of continuous positive airway pressure after endoscopic endonasal approach for pituitary tumors.

KEY POINTS: Resumption of continuous positive airway pressure (CPAP) in the immediate postoperative period after endoscopic endonasal approaches (EEA) for pituitary adenomas can be safe.

Earth beyond six of nine planetary boundaries.

This planetary boundaries framework update finds that six of the nine boundaries are transgressed, suggesting that Earth is now well outside of the safe operating space for humanity. Ocean acidification is close to being breached, while aerosol loading regionally exceeds the boundary. Stratospheric ozone levels have slightly recovered. The transgression level has increased for all boundaries earlier identified as overstepped. As primary production drives Earth system biosphere functions, human appropriation of net primary production is proposed as a control variable for functional biosphere integrity. This boundary is also transgressed. Earth system modeling of different levels of the transgression of the climate and land system change boundaries illustrates that these anthropogenic impacts on Earth system must be considered in a systemic context.

A Horizon Scan to Support Chemical Pollution-Related Policymaking for Sustainable and Climate-Resilient Economies.

While chemicals are vital to modern society through materials, agriculture, textiles, new technology, medicines, and consumer goods, their use is not without risks. Unfortunately, our resources seem inadequate to address the breadth of chemical challenges to the environment and human health. Therefore, it is important we use our intelligence and knowledge wisely to prepare for what lies ahead. The present study used a Delphi-style approach to horizon-scan future chemical threats that need to be considered in the setting of chemicals and environmental policy, which involved a multidisciplinary, multisectoral, and multinational panel of 25 scientists and practitioners (mainly from the United Kingdom, Europe, and other industrialized nations) in a three-stage process. Fifteen issues were shortlisted (from a nominated list of 48), considered by the panel to hold global relevance. The issues span from the need for new chemical manufacturing (including transitioning to non-fossil-fuel feedstocks); challenges from novel materials, food imports, landfills, and tire wear; and opportunities from artificial intelligence, greater data transparency, and the weight-of-evidence approach. The 15 issues can be divided into three classes: new perspectives on historic but insufficiently appreciated chemicals/issues, new or relatively new products and their associated industries, and thinking through approaches we can use to meet these challenges. Chemicals are one threat among many that influence the environment and human health, and interlinkages with wider issues such as climate change and how we mitigate these were clear in this exercise. The horizon scan highlights the value of thinking broadly and consulting widely, considering systems approaches to ensure that interventions appreciate synergies and avoid harmful trade-offs in other areas. We recommend further collaboration between researchers, industry, regulators, and policymakers to perform horizon scanning to inform policymaking, to develop our ability to meet these challenges, and especially to extend the approach to consider also concerns from countries with developing economies. Environ Toxicol Chem 2023;42:1212-1228. © 2023 Crown copyright and The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. This article is published with the permission of the Controller of HMSO and the King's Printer for Scotland.

Radiographic predictors of occult intracranial involvement in olfactory neuroblastoma patients.

BACKGROUND: Traditional management of olfactory neuroblastoma (ONB) includes margin-negative resection with removal of cribriform plate, dura, and olfactory bulb, regardless of intracranial disease. This approach may be overtreating certain patients. Our investigation examines risk factors associated with occult intracranial disease to optimize therapeutic outcomes. METHODS: This retrospective, multi-institutional cohort study examined clinical covariates associated with occult intracranial involvement. Patient demographics, staging, Hyam's grade, and pathologic involvement of dura, olfactory bulb/tract, and brain were collected. Diagnostic imaging was reviewed. Positive and negative predictive value (NPV) were estimated along with effect size estimates. Cox hazard regression examined associations with overall survival (OS) and disease-free survival (DFS). RESULTS: A total of 224 subjects with new diagnoses of ONB (2005-2021) were identified. Skull base bone involvement on computed tomography (CT) had the highest NPV for pathologic dura (88.0%), olfactory bulb (88%), and brain involvement (97.3%). Hyam's grade category was significantly associated with dural involvement (φC  = 0.26; 95% confidence interval [CI]: 0.16, 0.42). Subjects without radiologic skull base involvement (n = 66) had pathologic positivity of 12.1%. Within this subgroup, Hyam's grade was clinically significant for dural positivity (φ = 0.34; 95% CI: -0.12, 0.71) with 28.6% involvement in high grade tumors. Neither clinical nor pathologic positivity of intracranial structures were associated with significantly different OS or DFS. CONCLUSIONS: Both CT and magnetic resonance imaging (MRI) had reasonably good NPV for involvement of dura and olfactory bulb. Higher Hyam's grade was associated with dural involvement. Patients with low-grade tumors not involving the skull base may be suitable for avoiding skull base resection; however, further investigation is warranted.

Chemistry must respond to the crisis of transgression of planetary boundaries.

Recent assessments alarmingly indicate that many of the world's leading chemicals are transgressing one or more of the nine planetary boundaries, which define safe operating spaces within which humanity can continue to develop and thrive for generations to come. The unfolding crisis cannot be ignored and there is a once-in-a-century opportunity for chemistry - the science of transformation of matter - to make a critical difference to the future of people and planet. How can chemists contribute to meeting these challenges and restore stability and strengthen resilience to the planetary system that humanity needs for its survival? To respond to the wake-up call, three crucial steps are outlined: (1) urgently working to understand the nature of the looming threats, from a chemistry perspective; (2) harnessing the ingenuity and innovation that are central to the practice of chemistry to develop sustainable solutions; and (3) transforming chemistry itself, in education, research and industry, to re-position it as 'chemistry for sustainability' and lead the stewardship of the world's chemical resources. This will require conservation of material stocks in forms that remain available for use, through attention to circularity, as well as strengthening engagement in systems-based approaches to designing chemistry research and processes informed by convergent working with many other disciplines.

The lure of novel biological and chemical entities in food-system transformations.

Synthetic chemicals and biologically engineered materials are major forces in today's food systems, but they are also major drivers of the global environmental changes and health challenges that characterize the Anthropocene. To address these challenges, we will need to increase assessment activity, promote alternative production practices with less reliance on such technologies, and regulate social campaigns and experiments.

Exceeding 1.5°C global warming could trigger multiple climate tipping points.

Climate tipping points occur when change in a part of the climate system becomes self-perpetuating beyond a warming threshold, leading to substantial Earth system impacts. Synthesizing paleoclimate, observational, and model-based studies, we provide a revised shortlist of global "core" tipping elements and regional "impact" tipping elements and their temperature thresholds. Current global warming of ~1.1°C above preindustrial temperatures already lies within the lower end of some tipping point uncertainty ranges. Several tipping points may be triggered in the Paris Agreement range of 1.5 to <2°C global warming, with many more likely at the 2 to 3°C of warming expected on current policy trajectories. This strengthens the evidence base for urgent action to mitigate climate change and to develop improved tipping point risk assessment, early warning capability, and adaptation strategies.

Participant perspectives of an online co-design process to develop a prevention-focused mental health and well-being platform for primary producers.

OBJECTIVE: To explore participant experiences of an online co-design process to develop a web-based preventative mental health and well-being intervention targeting primary producers in rural Australia. SETTING: Rural Victoria, Australia. PARTICIPANTS: Participants from a primary producer background, including horticulture, fisheries, animal cultivation and farm consultancy, were eligible for the study if they had participated in both the co-design and beta testing processes for a primary producer platform. DESIGN: A qualitative study using semi-structured phone-based interviews was undertaken. A reflexive inductive approach to data analysis was employed to develop themes. RESULTS: Eleven participants were interviewed, with an average age of 51 years, of which 7 were female. Five main themes were developed. These included: (1) participant diversity, (2) impact of online delivery on co-design participation, (3) experiences of the co-design process, (4) maintaining a shared vision and goals and (5) acting on the co-design recommendations. Use of online methods was a clear enabler to engage participants who were geographically dispersed and offers an alternative to more conventional approaches to co-design using face-to-face methods. Some aspects of participant engagement may need a greater focus when conducted online compared with face-to-face. CONCLUSIONS: Using an online co-design method to develop a preventative mental health and well-being web-based platform for primary producers was novel. Findings address a gap in the literature around the experience of participants engaging in a co-design process and identify opportunities to improve participant engagement and experience with the online format.

A shared future: chemistry's engagement is essential for resilience of people and planet.

Strengthening resilience-elasticity or adaptive capacity-is essential in responding to the wide range of natural hazards and anthropogenic changes humanity faces. Chemistry's roles in resilience are explored for the first time, with its technical capacities set in the wider contexts of cross-disciplinary working and the intersecting worlds of science, society and policy. The roles are framed by chemistry's contributions to the sustainability of people and planet, examined via the human security framework's four material aspects of food, health, economic and environmental security. As the science of transformation of matter, chemistry is deeply involved in these material aspects and in their interfacing with human security's three societal and governance aspects of personal, community and political security. Ultimately, strengthening resilience requires making choices about the present use of resources as a hedge against future hazards and adverse events, with these choices being co-determined by technical capacities and social and political will. It is argued that, to intensify its contributions to resilience, chemistry needs to take action along at least three major lines: (i) taking an integrative approach to the field of 'chemistry and resilience'; (ii) rethinking how the chemical industry operates; and (iii) engaging more with society and policy-makers.

Failures to disagree are essential for environmental science to effectively influence policy development.

While environmental science, and ecology in particular, is working to provide better understanding to base sustainable decisions on, the way scientific understanding is developed can at times be detrimental to this cause. Locked-in debates are often unnecessarily polarised and can compromise any common goals of the opposing camps. The present paper is inspired by a resolved debate from an unrelated field of psychology where Nobel laureate David Kahneman and Garry Klein turned what seemed to be a locked-in debate into a constructive process for their fields. The present paper is also motivated by previous discourses regarding the role of thresholds in natural systems for management and governance, but its scope of analysis targets the scientific process within complex social-ecological systems in general. We identified four features of environmental science that appear to predispose for locked-in debates: (1) The strongly context-dependent behaviour of ecological systems. (2) The dominant role of single hypothesis testing. (3) The high prominence given to theory demonstration compared investigation. (4) The effect of urgent demands to inform and steer policy. This fertile ground is further cultivated by human psychological aspects as well as the structure of funding and publication systems.

Outside the Safe Operating Space of the Planetary Boundary for Novel Entities.

We submit that the safe operating space of the planetary boundary of novel entities is exceeded since annual production and releases are increasing at a pace that outstrips the global capacity for assessment and monitoring. The novel entities boundary in the planetary boundaries framework refers to entities that are novel in a geological sense and that could have large-scale impacts that threaten the integrity of Earth system processes. We review the scientific literature relevant to quantifying the boundary for novel entities and highlight plastic pollution as a particular aspect of high concern. An impact pathway from production of novel entities to impacts on Earth system processes is presented. We define and apply three criteria for assessment of the suitability of control variables for the boundary: feasibility, relevance, and comprehensiveness. We propose several complementary control variables to capture the complexity of this boundary, while acknowledging major data limitations. We conclude that humanity is currently operating outside the planetary boundary based on the weight-of-evidence for several of these control variables. The increasing rate of production and releases of larger volumes and higher numbers of novel entities with diverse risk potentials exceed societies' ability to conduct safety related assessments and monitoring. We recommend taking urgent action to reduce the harm associated with exceeding the boundary by reducing the production and releases of novel entities, noting that even so, the persistence of many novel entities and/or their associated effects will continue to pose a threat.

Understanding Variable Motor Responses to Direct Electrical Stimulation of the Human Motor Cortex During Brain Surgery.

Direct electrical stimulation of the brain is the gold standard technique used to define functional-anatomical relationships during neurosurgical procedures. Areas that respond to stimulation are considered "critical nodes" of circuits that must remain intact for the subject to maintain the ability to perform certain functions, like moving and speaking. Despite its routine use, the neurophysiology underlying downstream motor responses to electrical stimulation of the brain, such as muscle contraction or movement arrest, is poorly understood. Furthermore, varying and sometimes counterintuitive responses can be seen depending on how and where the stimulation is applied, even within the human primary motor cortex. Therefore, here we review relevant neuroanatomy of the human motor system, provide a brief historical perspective on electrical brain stimulation, explore mechanistic variations in stimulation applications, examine neurophysiological properties of different parts of the motor system, and suggest areas of future research that can promote a better understanding of the interaction between electrical stimulation of the brain and its function.

Keystone actors do not act alone: A business ecosystem perspective on sustainability in the global clothing industry.

Global industries are typically dominated by a few disproportionately large and influential transnational corporations, or keystone actors. While concentration of economic production is not a new phenomenon, in an increasingly interconnected and globalized world, the scale of the impacts of keystone actors on diverse social-ecological systems continues to grow. In this article, we investigate how keystone actors in the global clothing industry engage in collaboration with a variety of other organizations to address nine interrelated biophysical and socioeconomic sustainability challenges. We expand on previous theoretical and empirical research by focusing on the larger business ecosystem in which keystone actors are embedded, and use network analysis to assess the contributions of different actor types to the architecture of the ecosystem. This systemic approach to the study of keystone actors and sustainability challenges highlights an important source of influence largely not addressed in previous research: the presence of organizations that occupy strategic positions around keystone actors. Such knowledge can help identify governance strategies for advancing industry-wide transformation towards sustainability.

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.

Integrating the Water Planetary Boundary With Water Management From Local to Global Scales.

The planetary boundaries framework defines the "safe operating space for humanity" represented by nine global processes that can destabilize the Earth System if perturbed. The water planetary boundary attempts to provide a global limit to anthropogenic water cycle modifications, but it has been challenging to translate and apply it to the regional and local scales at which water problems and management typically occur. We develop a cross-scale approach by which the water planetary boundary could guide sustainable water management and governance at subglobal contexts defined by physical features (e.g., watershed or aquifer), political borders (e.g., city, nation, or group of nations), or commercial entities (e.g., corporation, trade group, or financial institution). The application of the water planetary boundary at these subglobal contexts occurs via two approaches: (i) calculating fair shares, in which local water cycle modifications are compared to that context's allocation of the global safe operating space, taking into account biophysical, socioeconomic, and ethical considerations; and (ii) defining a local safe operating space, in which interactions between water stores and Earth System components are used to define local boundaries required for sustaining the local water system in stable conditions, which we demonstrate with a case study of the Cienaga Grande de Santa Marta wetlands in Colombia. By harmonizing these two approaches, the water planetary boundary can ensure that water cycle modifications remain within both local and global boundaries and complement existing water management and governance approaches.

Trajectories of the Earth System in the Anthropocene.

We explore the risk that self-reinforcing feedbacks could push the Earth System toward a planetary threshold that, if crossed, could prevent stabilization of the climate at intermediate temperature rises and cause continued warming on a "Hothouse Earth" pathway even as human emissions are reduced. Crossing the threshold would lead to a much higher global average temperature than any interglacial in the past 1.2 million years and to sea levels significantly higher than at any time in the Holocene. We examine the evidence that such a threshold might exist and where it might be. If the threshold is crossed, the resulting trajectory would likely cause serious disruptions to ecosystems, society, and economies. Collective human action is required to steer the Earth System away from a potential threshold and stabilize it in a habitable interglacial-like state. Such action entails stewardship of the entire Earth System-biosphere, climate, and societies-and could include decarbonization of the global economy, enhancement of biosphere carbon sinks, behavioral changes, technological innovations, new governance arrangements, and transformed social values.

Towards defining an environmental investment universe within planetary boundaries.

Science is increasingly able to identify precautionary boundaries for critical Earth system processes, and the business world provides societies with important means for adaptive responses to global environmental risks. In turn, investors provide vital leverage on companies. Here, we report on our transdisciplinary science/business experience in applying the planetary boundaries framework (sensu Rockström et al., Ecol Soc 14, 2009) to define a boundary-compatible investment universe and analyse the environmental compatibility of companies. We translate the planetary boundaries into limits for resource use and emissions per unit of economic value creation, using indicators from the Carnegie Mellon University EIO­LCA database. The resulting precautionary 'economic intensities' can be compared with the current levels of companies' environmental impact. This necessarily involves simplifying assumptions, for which dialogue between biophysical science, corporate sustainability and investment perspectives is needed. The simplifications mean that our translation is transparent from both biophysical and financial viewpoints, and allow our approach to be responsive to future developments in scientific insights about planetary boundaries. Our approach enables both sub­industries and individual companies to be screened against the planetary boundaries. Our preliminary application of this screening to the entire background universe of all investable stock­listed companies gives a selectivity of two orders of magnitude for an investment universe of environmentally attractive stocks. We discuss implications for an expanded role of environmental change science in the development of thematic equity funds.