Latitudinal variation in global range-size of aquatic macrophyte species shows evidence for a Rapoport effect

1. To test hypotheses concerning the applicability of the Rapoport effect (RE: “species that occur at higher latitudes tend to have greater geographical range-size than species which have ranges limited to latitudes closer to the equator”) to aquatic macrophytes at global scale, we analysed the world latitudinal distribution and range-size of 1,083 vascular aquatic macrophyte species, from 91 genera in 11 families. We targeted macrophyte families strongly associated with inland aquatic habitats (i.e. with a zero, or only very low, proportion of constituent species which occur also in non-aquatic habitats), and which are distributed across a substantial latitudinal gradient, a necessary condition to test our hypotheses.
2. The macrophyte species present in these families include plants from all the normally accepted life form-defined functional groups of macrophytes, namely submerged, free-floating, floating-leaf rooted and emergent species, and represent the three major vascular taxonomic groups occurring as aquatic macrophytes (ferns/fern allies, monocots, and dicots). For the analysis, we used both latitude-only and areal measures of macrophyte species geographic range-size, within a 10 × 10° (latitude × longitude) grid of 238 grid cells, covering the six world ecozones (Palaearctic, Orient, Australasia, Nearctic, Neotropics, Afrotropics) that primarily contain inland freshwater and brackish macrophyte habitats.
3. The results provide new insight into the relationships between global range-size of macrophytes, latitude, and other potential spatio-environmental and anthropogenic drivers acting upon these plants at world scale. In particular, the outcomes indicated that: (1) the range-size versus latitude distribution of macrophytes shows evidence of a strong RE influence, with significantly greater species range-size at higher latitudes; and (2) the β-diversity pattern of species distribution along this latitudinal gradient is poorly explained by nestedness organisation, and species turnover is a more likely explanation of the observed changes in species distribution with latitude.
4. Spatio-environmental and anthropogenic variables other than latitude may also influence the observed global geographical pattern of macrophyte range-size, although their importance as predictors varies between individual families. Extent of agricultural land use, altitude, and historic (post-Quaternary) climate change velocity were all significant predictor variables for some families. However, interestingly, neither the area of land nor the area of waterbody present per grid cell were major influences on macrophyte range-size distribution.
5. Our finding of evidence for an RE, acting at global scale in aquatic macrophytes, contributes to increasing the generality of conclusions so far reached about the large-scale factors that drive patterns of species range-size at global scale. The study also provides a baseline for future macroecological work on aquatic plants, and potentially other freshwater organisms, particularly in the context of predicting how the world ranges of freshwater biota will respond to ongoing global environmental change.

     

COVID-19, media coverage of bats and related Web searches: a turning point for bat conservation?

1. SARS-CoV-2, the virus that caused the COVID-19 pandemic, is genomically similar to a SARS-like beta-coronavirus found in Asian rhinolophid bats. This evolutionary relationship impressed the global media, which then emphasised bats as key actors in the spillover that resulted in the pandemic. In this study, we highlight changes in the traditional and new media coverage of bats and in Internet search volumes that occurred since the beginning of the COVID-19 pandemic in 2020.
2. We analysed Google and Wikipedia searches for bats and coronaviruses in 21 countries and eight languages, as well as television broadcasts in the USA, some of which have global coverage, between January 2016 and December 2020. In January 2020, the amount of television news about bats boomed, and news associated with the term ‘bat’ shifted to COVID-19-related topics. A nearly identical pattern was observed in Google searches during 2020 at the global scale. The daily time series of television coverage and Internet search volumes on bats and coronavirus in the USA covaried in the first quarter of 2020, in line with the existence of a media bubble. Time-series analysis revealed that both the Google Trends index and visits to Wikipedia pages about bats boomed in early 2020, despite the fact that this time of year is usually characterised by low search volumes.
3. Media coverage emphasised, correctly or not, the role of bats in the COVID-19 pandemic and amplified public interest in bats worldwide. The public image of these mammals, in many cases threatened and important ecosystem service providers, was seriously compromised. We therefore recommend that policymakers and journalists prioritise scientifically accurate communication campaigns about bats, which would help counteract the surge in bat persecution, and leverage interest towards positive human–bat interactions.

     

Achieving global mortality reduction targets and universal health coverage: The impact of COVID-19

Wenhui Mao and coauthors discuss possible implications of the COVID-19 pandemic for health aspirations in low- and middle-income countries.

Summary points

• The Coronavirus Disease 2019 (COVID-19) pandemic threatens progress toward a “grand convergence” in global health—universal reduction in deaths from infections and maternal and child health conditions to low levels—and toward achieving universal health coverage (UHC).
• Our analysis suggests that COVID-19 will exacerbate the difficulty of achieving grand convergence targets for tuberculosis (TB), maternal mortality, and, probably, for under-5 mortality. HIV targets are likely to be met.
• By 2035, our analysis suggests that the public sectors of low-income countries (LICs) would only be able to finance about a third of the costs of a package of 120 essential non-COVID-19 health interventions through domestic sources, unless the country increases significantly the priority assigned to the health sector; lower middle-income countries (LMICs) would likewise only be able to finance a little less than half.
• The likelihood of getting back on track for reaching grand convergence and UHC will depend on (i) how quickly COVID-19 vaccines can be deployed in LICs and LMICs; (ii) how much additional public sector health financing can be mobilized from external and domestic sources; and (iii) whether countries can rapidly strengthen and focus their health delivery systems.

     

Emerging zoonotic diseases originating in mammals: a systematic review of effects of anthropogenic land-use change

1. Zoonotic pathogens and parasites that are transmitted from vertebrates to humans are a major public health risk with high associated global economic costs. The spread of these pathogens and risk of transmission accelerate with recent anthropogenic land-use changes (LUC) such as deforestation, urbanisation, and agricultural intensification, factors that are expected to increase in the future due to human population expansion and increasing demand for resources.
2. We systematically review the literature on anthropogenic LUC and zoonotic diseases, highlighting the most prominent mammalian reservoirs and pathogens, and identifying avenues for future research.
3. The majority of studies were global reviews that did not focus on specific taxa. South America and Asia were the most-studied regions, while the most-studied LUC was urbanisation. Livestock were studied more within the context of agricultural intensification, carnivores with urbanisation and helminths, bats with deforestation and viruses, and primates with habitat fragmentation and protozoa.
4. Research into specific animal reservoirs has improved our understanding of how the spread of zoonotic diseases is affected by LUC. The behaviour of hosts can be altered when their habitats are changed, impacting the pathogens they carry and the probability of disease spreading to humans. Understanding this has enabled the identification of factors that alter the risk of emergence (such as virulence, pathogen diversity, and ease of transmission). Yet, many pathogens and impacts of LUC other than urbanisation have been understudied.
5. Predicting how zoonotic diseases emerge and spread in response to anthropogenic LUC requires more empirical and data synthesis studies that link host ecology and responses with pathogen ecology and disease spread. The link between anthropogenic impacts on the natural environment and the recent COVID-19 pandemic highlights the urgent need to understand how anthropogenic LUC affects the risk of spillover to humans and spread of zoonotic diseases originating in mammals.

     

Future climate change will severely reduce habitat suitability of the Critically Endangered Chinese giant salamander

1. Being the largest extant amphibian in the world, the IUCN Critically Endangered Chinese giant salamander Andrias davidianus is a charismatic species with great international public interest. While threats such as commercial overexploitation and habitat degradation have been extensively documented to affect natural populations of A. davidianus, still no information is available about the species sensitivity to climate change.
2. Here, we develop an ensemble of species distribution models (SDMs) for A. davidianus and projected its habitat suitability under present-day and future climate change scenarios. We based our SDMs on bioclimatic and topographic predictors, and recent (2012–2018) field-collected occurrence data across the whole distribution range of the species.
3. The ensemble SDMs exhibited good predictive capacity and suggested that slope, maximum temperature of warmest month, precipitation of driest month, and isothermality are the most influential predictors in determining distribution patterns in this species. The projections of our models point to a pronounced impact of climate changes over A. davidianus, with more than two-thirds of its suitable range expected to be lost in all scenarios of future climates tested.
4. In concert with the numerous other threats that are affecting this species, climate change poses a serious hindrance to the long-term survival of A. davidianus. We emphasise the urgent need of undertaking strict measures to manage this species and safeguard the few remaining available suitable habitats. We suggest that adaptive management strategies including designation of new reserves should be considered to mitigate the impacts of climate change on A. davidianus.

     

Global human security in the post–COVID-19 era: The rising role of East Asia

Kenji Shibuya and coauthors discuss the potential contribution of East Asian countries to global health in the light of COVID-19.

Summary points

• East Asia, comprising the 10 ASEAN countries, China, Japan, and the countries of the Korean peninsula, has achieved comparatively good outcomes during the ongoing Coronavirus Disease 2019 (COVID-19) pandemic.
• This can be explained by sociological imprinting of and learning from past outbreaks, as well as competent governance.
• Concomitantly, East Asian nations have also been expanding capacity in global health development and diplomatic outreach, although there is as yet no coherent regional bloc vision, shared strategy, or a common set of operating principles, thus limiting synergistic impact.
• We believe that concrete next steps to bolster cooperation and extend influence could include the establishment of an East Asian Center for Disease Control, joint work in health and human security by the Asian Development Bank (ADB) and Asian Infrastructure and Investment Bank, and a region-wide research funding programme.
• Much, however, depends on evolving geopolitics writ large, notably the instability and reorientation of global alliances, which have the potential to adversely affect relations between neighbouring East Asian member states.
• Health diplomacy for global human security has the potential to become a stabilising influence and can be a topic around which all actors can more comfortably rally.

While the constituent countries of East Asia share common elements of history and culture, there is great diversity and rapid transition in social systems, economic development, demography, and epidemiological profiles (S1 Table). These factors fundamentally lead to the full range of major global health challenges, including those concerning epidemics and pandemics of novel and reemerging pathogens.Here, in the light of Coronavirus Disease 2019 (COVID-19), we discuss East Asia’s experience in this and past major outbreaks, its capacity and willingness to share best practice and support global health development, and the regional bloc’s potential in reshaping the global architecture for human security.Geographically and ethnoculturally, East Asia has conventionally referred to the region comprising China, Japan, Republic of Korea (South Korea), Democratic People’s Republic of Korea (North Korea), and Mongolia. More recently, the term has been broadened to encompass Southeast Asia (viz the 10 member states of ASEAN, the Association of South East Asian Nations), largely due to expanded regional economic cooperation and latterly for geopolitical reasons.     

Evaluation of total purchasing pilots in England and Scotland and implications for primary care groups in England: personal interviews and analysis of routine data

Objectives: To evaluate the reported achievements of the 52 first wave total purchasing pilot schemes in 1996-7 and the factors associated with these; and to consider the implications of these findings for the development of the proposed primary care groups. Design: Face to face interviews with lead general practitioners, project managers, and health authority representatives responsible for each pilot; and analysis of hospital episode statistics. Setting: England and Scotland for evaluation of pilots; England only for consideration of implications for primary care groups. Main outcome measures: The ability of total purchasers to achieve their own objectives and their ability specifically to achieve objectives in the service areas beyond fundholding included in total purchasing. Results: The level of achievement between pilots varied widely. Achievement was more likely to be reported in primary than in secondary care. Reported achievements in reducing length of stay and emergency admissions were corroborated by analysis of hospital episode statistics. Single practice and small multipractice pilots were more likely than large multipractice projects to report achieving their objectives. Achievements were also associated with higher direct management costs per head and the ability to undertake independent contracting. Large multipractice pilots required considerable organisational development before progress could be made. Conclusion: The ability to create effective commissioning organisations the size of the proposed primary care groups should not be underestimated. To be effective commissioners, these care groups will need to invest heavily in their organisational development and in the short term are likely to need an additional development budget rather than the reduction in spending on NHS management that is planned by the government.

Key messages

• The level of reported achievement between the total purchasing pilots in 1996-7 varied widely; achievement was more likely to occur in primary than in secondary care
• Single practice and small multipractice pilots were more likely than large multipractice pilots to report achieving their objectives in 1996/97; achievements were also associated with higher direct management costs per head
• Large multipractice pilots needed more time for organisational development before progress could be made
• Difficulties in creating effective commissioning organisations the size of the proposed primary care groups should not be underestimated
• Primary care groups will need to invest heavily in organisational development and are likely to need an additional development budget in the short term

     

COVID-19 and indirect health implications in Africa: Impact,mitigation measures,and lessons learned for improved disease control

Seth Inzaule and co-authors discuss implications of the COVID-19 pandemic for health in African countries.

Summary points

• Coronavirus Disease 2019 (COVID-19) and the mitigation measures taken to limit its spread have significantly disrupted other essential health services in Africa. This disruption has threatened the control of major high-burden diseases such as HIV, tuberculosis (TB), and malaria as well as the prevention of maternal and child mortality.
• While the 2020 WHO global reports for HIV, TB, and malaria show progress in control of these diseases in African countries, there are still significant gaps in meeting the global targets. Similarly, modeling studies predict that most African countries are unlikely to meet the Sustainable Development Goals (SDGs) 2030 targets for reductions in maternal and child mortality under the current rate of progress.
• Prediction models and emerging empirical data indicate that the implemented mitigation measures against COVID-19 such as travel restrictions and lockdowns as well as the repurposing of health resources and suspension of prevention programs such as immunizations will lead to an increase in new infections and deaths, significantly reversing the gains achieved in the control of these health challenges.
• A more comprehensive COVID-19 response that minimizes indirect deaths is therefore warranted in Africa. These include implementing WHO recommendations that limit contact with the clinic where possible, such as multimonths drug dispensing, self-testing, virtual platforms for case management, community- and home-based prevention, and care services such as home distribution of test kits, vaccines, treatment, and mosquito nets.
• This is in addition to ensuring effective implementation of COVID-19 infection prevention and control measures in healthcare facilities including providing healthcare workers with personal protective equipment and prioritizing them for COVID-19 immunization.
• There is also a need to incorporate aggressive recovery plans to reverse the lost gains in disease control efforts and put African countries back on course toward achieving the global targets. This includes leveraging on the wider COVID-19 response enablements such as the increased political will and global solidarity funding efforts to support a more comprehensive response that accounts for the indirect public health effects of the pandemic.

     

Global patterns in seed germination after ingestion by mammals

1. Mammals play an important role in seed germination through the ingestion of fruits and seeds. Since seed germination is a basic step in seedling recruitment, understanding how mammals affect germination improves our understanding of the effect of loss of mammal populations on the dynamics of plant communities.
2. We used meta-analytical methods to describe global patterns in the effect of seed ingestion by mammals on seed germination success and rate. We collected data from 154 studies that included 115 mammal species and 448 plant species.
3. Our results showed a positive cumulative effect of mammals on seed germination. However, this effect differed between mammalian orders; thus, some groups such as elephants, primates, and new world marsupials emerged as important enhancers of seed germination. Also, the effect varied depending on the plant family and the bioregion. Increased seed germination after ingestion was positively related to fast germination.
4. This meta-analysis, the first to synthesise and compare most of the information presently available on how mammals affect seed germination after ingestion, shows a global positive effect of mammals as enhancers of seed germination. However, behind that positive effect lies a diversity of neutral, negative, and positive effects of different magnitudes, which may have multifactorial explanations. We hope that the patterns presented here open up new questions and help guide future research efforts.

     

Community‐based native seed production for restoration in Brazil – the role of science and policy

• Large‐scale restoration programmes in the tropics require large volumes of high quality, genetically diverse and locally adapted seeds from a large number of species. However, scarcity of native seeds is a critical restriction to achieve restoration targets.
• In this paper, we analyse three successful community‐based networks that supply native seeds and seedlings for Brazilian Amazon and Cerrado restoration projects. In addition, we propose directions to promote local participation, legal, technical and commercialisation issues for up‐scaling the market of native seeds for restoration with high quality and social justice.
• We argue that effective community‐based restoration arrangements should follow some principles: (i) seed production must be based on real market demand; (ii) non‐governmental and governmental organisations have a key role in supporting local organisation, legal requirements and selling processes; (iii) local ecological knowledge and labour should be valued, enabling local communities to promote large‐scale seed production; (iv) applied research can help develop appropriate techniques and solve technical issues.
• The case studies from Brazil and principles presented here can be useful for the up‐scaling restoration ecology efforts in many other parts of the world and especially in tropical countries where improving rural community income is a strategy for biodiversity conservation and restoration.

     

How do we make indoor environments and healthcare settings healthier?

It is now well accepted that our modern lifestyle has certain implications for our health (Schaub et al., 2006 ), mainly as a result of our willingness to remove ourselves from the biological diversity of our natural environments (Roduit et al., 2016 ), while still being drawn inextricably to interact with it (Kellert and Wilson, 1995 ). Much of our interaction with the biological world is shaped by our interaction with the microbiological world. The bacteria, fungi, viruses, archaea and protists that comprise the microbiome of this planet, are also key to the development and normal functioning of our bodies. Our immune system is built to shepherd our microbial exposure, ensuring that microbial organisms that we need are kept close (but not too close), and that less‐desirable organisms are expelled or killed before they can do too much damage. By moving from a life interacting with nature on a regular basis, to a life in which we isolate ourselves physically from natural microbial exposure, we may have instigated one of the great plagues of the 21st century; chronic immune disorders.     

A call for diversity,equity, and inclusion: Highlights from the Consortium of Universities for Global Health 2021 conference

Beryne Odeny reports from the CUGH 2021 virtual conference.

The first virtual Consortium of Universities for Global Health (CUGH) 2021 conference was held in March, 2021 [1]. Two weeks of satellite symposia culminated in this highly prestigious conference, which drew an eclectic group of renowned speakers, global health leaders, program implementers, researchers, and students from across the globe. There were more than 5000 delegates from diverse disciplines including public health, politics, education, medicine, planetary health, and finance. Top of the agenda was addressing critical gaps in global health and development against the backdrop of the COVID-19 pandemic.CUGH is an organization of over 170 academic institutions and organizations throughout the world, engaged in addressing global health challenges [1]. The 2021 conference was meticulously and creatively planned as was evidenced by the dynamic virtual platform, which hosted several global leader interviews, general sessions, 40 concurrent sessions, 7 plenary sessions, over 700 poster programs, and the Pulitzer Center Film festivals–yes, movies were on the menu [2]. Best of all, the platform held up, with minimal technical difficulties. The conference agenda had curated sessions carefully customized to varying attendee interests and expertise. Participants could seamlessly and discreetly shuttle between sessions.The inaugural interviews, with Dr. Anthony Fauci of the United States and Dr. Hugo Lopez-Gatell of Mexico, set the tone with emphasis on a much-needed global response to the ongoing pandemic. “2020 was a watershed moment in Global Health,” said Dr. Fauci. The COVID-19 pandemic indiscriminately unveiled the fragility of health systems in high income countries (HIC) and low- and middle-income countries (LMICs) alike. He unpacked the origins, evolution, and contention around current public health mandates such as mask wearing. He discussed vaccines–exploring vaccine manufacturing in LMICs, open patents, implications of emerging COVID-19 variants, and advice on curbing the prevailing vaccine infodemic (i.e., pandemic of misinformation) [2–4]. Dr. Lopez-Gatell described the pandemic as a “massive social event” fueled by deficits in health systems, politics, and governance, and by the growing tide of non-communicable diseases (NCDs) [5]. In a brief video recording, Dr. Tedros Adhanom Ghebreyesus, WHO’s Director-General, implored global partners to sign the COVID-19 Declaration on vaccine equity which he termed “the defining challenge of 2021” [6].The post-pandemic forecast for global health was dire. COVID-19 has disrupted decades of progress toward attainment of Universal Health Care (UHC) and it will be doubly difficult to restore, by 2035, health indicators to their levels prior to the pandemic [7–9]. A modelling study by Dr. Wenhui Mao of Duke University showed that, even in the most optimistic scenario, it may not be possible to achieve UHC in the next decade without breakthrough technologies and exceptional political commitment. Among four critical indicators of TB mortality rate, HIV mortality rate, under 5 mortality ratio, and maternal mortality ratio, Dr. Mao found that only the HIV indicator had potential for recovery by 2035.The metaphorical elephant in the room, and now its opposite, “the elephant not in the room”, respectively encapsulate two themes: neocolonialism and equity, especially for marginalized groups. Neocolonialism–a progeny of colonialism–resulting from sustained global North-South power imbalances, manifests in low prioritization of the most pressing challenges and diseases in LMICs. Equity was a poignant theme across the CUGH sessions and satellite symposia. Sessions were dedicated to exploring the hegemonic structures and institutional systems that underpin adverse health system performance and outcomes. A sampling of wide-ranging topics on global challenges exacerbated by neocolonialism and inequities comprised: a) elevating the visibility and power of researchers in LMICs, including fragile and conflict affected settings, through equitable access to funding, research autonomy and leadership, access to scholarly publishing, and senior authorship of research articles [10]; b) training next-generation global health professionals and building capacity for resource-challenged settings to address NCDs, including cancer care [5]; c) the Latin American and Caribbean health crises drawn by social gradients and inequities; d) navigating conflicting interests between public health and the corporate food industry; e) the dearth and role of women leaders in global health and in the COVID-19 response; f) the disproportionate incidence of HIV in adolescent girls and young women in sub-Saharan Africa (SSA) [11]; g) the disparate burden of neonatal mortality in LMICs and marginalized communities within HIC; and h) leveraging the power of film to evoke emotion and induce a consolidated response to global challenges. In addition, various facets of the human ecosystem were unpacked including climate change, biodiversity preservation, political climate, and the global kleptocracy, with attention to their implications for the health of the most marginalized populations.Despite the highlighted issues, there is, potentially, a panacea for these inequities and challenges. One speaker, Dr. Lisa Adams of Dartmouth College, proposed a paradigm shift that summarized a wide range of deliberations–“moving global health out of the realm of charity into global citizenship, security, human rights, equal partnership, and interdisciplinary collaboration between LMICs and HICs.” Moving forward, more deliberate effort should be given to some elements. First, rethinking governance and funding at a global level while promoting the autonomy of LMICs and conflict-affected settings to drive their health agenda–independent from HIC interests. Bringing the elephant into the room by making equal space for LMICs to set the agenda at global tables of discussion around funding, research, and development will be pivotal to dismantling neocolonialism. Furthermore, funders and partners should work with in-country systems in LMICs as opposed to bypassing them. This is essential to building resilient health systems unified at national levels to allow for cross-discipline collaborations and swift responses to health threats. Rwanda is a laudable example, having swiftly remodeled its existing health systems including routine electronic information systems for nationwide COVID-19 surveillance, testing, contact tracing, and vaccination. Second, investing time to build trusting relationships between researchers or implementers and policy makers by upholding a participatory approach to research and implementation of evidence-based practices. This is essential globally, to support development of global public goods such as vaccines, free from market dynamics and aimed at universal and equitable access. Third, introduce policies that engage economies to produce with less fragmentation of nature and reduced pollution. These include protected area management, financing of nature-positive projects, and conservationist work for natural capital preservation. Global and public health practitioners need to educate and empower citizens to choose healthy and ecologically sustainable consumption practices. Fourth, promoting development of novel technologies for preventing HIV infection, such as broadly neutralizing antibodies, could overturn the unequal burden of HIV in adolescents and young women in SSA. Finally, HIC have a lot they can learn from LMICs. COVID-19 evidently demonstrated that a country’s Global Health Security Index ranking is not necessarily commensurate to its degree of success in handling pandemics, among other public health threats [8,12,13].Throughout the conference, it was apparent that equity and collectivity in global health are necessary–not optional. Dr. Elvin Geng of Washington University, St. Louis remarked that the path to equity should be measurable with routinely incorporated metrics that track interventions to redress inequity and foster accountability. To achieve this, the tools of implementation science can be employed at both regional and global levels [14]. Overall, the remarkable interlacing of diverse disciplinary sessions at CUGH 2021 not only brought to light pressing world problems but equipped participants with a wellspring of potential remedies and collaborative opportunities. The panelists and speakers effectively portrayed the layered and multidimensional nature of global challenges underscoring the need for similarly multifaceted solutions. CUGH 2021 sparked thought-provoking discourse around global health strategies and re-invigorated the collective passion of global health experts, novices, and everyone in between, to build forward better.     

Accounting for space and uncertainty in real‐time location system‐derived contact networks

1. Point data obtained from real‐time location systems (RTLSs) can be processed into animal contact networks, describing instances of interaction between tracked individuals. Proximity‐based definitions of interanimal “contact,” however, may be inadequate for describing epidemiologically and sociologically relevant interactions involving body parts or other physical spaces relatively far from tracking devices. This weakness can be overcome by using polygons, rather than points, to represent tracked individuals and defining “contact” as polygon intersections.
2. We present novel procedures for deriving polygons from RTLS point data while maintaining distances and orientations associated with individuals' relocation events. We demonstrate the versatility of this methodology for network modeling using two contact network creation examples, wherein we use this procedure to create (a) interanimal physical contact networks and (b) a visual contact network. Additionally, in creating our networks, we establish another procedure to adjust definitions of “contact” to account for RTLS positional accuracy, ensuring all true contacts are likely captured and represented in our networks.
3. Using the methods described herein and the associated R package we have developed, called contact, researchers can derive polygons from RTLS points. Furthermore, we show that these polygons are highly versatile for contact network creation and can be used to answer a wide variety of epidemiological, ethological, and sociological research questions.
4. By introducing these methodologies and providing the means to easily apply them through the contact R package, we hope to vastly improve network‐model realism and researchers' ability to draw inferences from RTLS data.

     

Dynamic river processes drive variability in particulate organic matter over fine spatiotemporal scales

1. We sampled freshwater suspended particulate organic matter (POM) to determine its carbon and nitrogen stable isotope composition and collected co-located water chemistry data in California's Sacramento—San Joaquin Delta from sites on the Mokelumne and Cosumnes rivers. A 10-km² area was sampled across 12 sites and divided among three habitat types (i.e. riverine, slackwater/slough, and off-channel), 34 times between November 2016 and July 2017. Here, we describe the variability in water quality and POM variables, and assess factors associated with that variability using dimensional reduction and linear modelling within the context of our habitat types.
2. The stable isotope composition of freshwater POM and water chemistry variables differed significantly across small areas (<10 km) and short time frames (weekly). Hydrological connectivity amongst sites was found to be an important factor in the isotopic and elemental composition of POM.
3. During periods of low hydrological connectivity, in situ dynamics were strongly associated with differentiation of POM in different habitats. Discharge (16–433 m³/s) and water temperature (8–30°C) were the variables most associated with variations in the composition of POM. Slackwater sites showed the greatest variability in POM composition, which may be symptomatic of longer water residence times, increased cycling rates of nutrients and organic matter, or a combination of the two.
4. Variability in POM stable isotope composition demonstrates that caution should be exercised when interpreting analyses that assume a static POM stable isotope composition based on two-end member mixing. Unconstrained variability in space or time could confound interpretations of models and data. Moving forward, conceptual and numerical models for river ecosystems that emphasise temporally heterogeneous lateral exchange amongst habitat patches should be prioritised when considering restoration efforts and monitoring outcomes.

     

Functional structure and diversity of invertebrate communities in a glacierised catchment of the tropical Andes

1. In many mountainous areas, glaciers feed streams characterised by harsh environmental conditions, such as low water temperature, high turbidity, low channel stability, and high temporal variability in flow. Additionally, in many glacierised catchments, the mixture of streams arising from different water sources (glacier melt, groundwater, rainfall) generates high levels of environmental heterogeneity, which enhance species turnover rates and increase regional diversity.
2. Studies from mainly temperate regions have revealed some consistent patterns: a predominance of traits adaptive to harsh environmental conditions and reduced functional diversity with increased glaciality, both strongly related to environmental filtering. Here, we investigated variation in functional structure and diversity between macroinvertebrate communities from 15 stream sites, with different water sources (five glacier-fed, five groundwater-fed, and five mixed source) and level of glacier influence, in a glacierised catchment in the Ecuadorian Andes.
3. Our results revealed functional differences between communities inhabiting the different stream types. As found in temperate regions, high levels of glaciality were associated with an increase of small-sized taxa that do not swim but are temporarily attached to or burrow in the substrate, have a flying-adult stage, and feed by collecting–gathering. Similarly, we found a general decrease in functional diversity at sites with higher glacier influence. A null modelling approach suggested that in some of our glacier-fed sites, environmental filtering may be the main driver of community assembly, whereas other mechanisms, mainly regional (such as dispersal), but also local (such as intraspecific competition), may gain importance as glacier influence decreases.
4. Assemblage composition in streams in tropical glacierised catchments may be driven by both local and regional processes that generate a gradient of decreasing functional diversity with stronger glacier influence. However, lack of knowledge of relevant traits for taxa in tropical glacierised streams currently poses a substantial obstacle to predicting changes likely to arise from global warming and glacier melt in this region.

     

Toxic benthic freshwater cyanobacterial proliferations: Challenges and solutions for enhancing knowledge and improving monitoring and mitigation

1. This review summarises knowledge on the ecology, toxin production, and impacts of toxic freshwater benthic cyanobacterial proliferations. It documents monitoring, management, and sampling strategies, and explores mitigation options.
2. Toxic proliferations of freshwater benthic cyanobacteria (taxa that grow attached to substrates) occur in streams, rivers, lakes, and thermal and meltwater ponds, and have been reported in 19 countries. Anatoxin- and microcystin-containing mats are most commonly reported (eight and 10 countries, respectively).
3. Studies exploring factors that promote toxic benthic cyanobacterial proliferations are limited to a few species and habitats. There is a hierarchy of importance in environmental and biological factors that regulate proliferations with variables such as flow (rivers), fine sediment deposition, nutrients, associated microbes, and grazing identified as key drivers. Regulating factors differ among colonisation, expansion, and dispersal phases.
4. New -omics-based approaches are providing novel insights into the physiological attributes of benthic cyanobacteria and the role of associated microorganisms in facilitating their proliferation.
5. Proliferations are commonly comprised of both toxic and non-toxic strains, and the relative proportion of these is the key factor contributing to the overall toxin content of each mat.
6. While these events are becoming more commonly reported globally, we currently lack standardised approaches to detect, monitor, and manage this emerging health issue. To solve these critical gaps, global collaborations are needed to facilitate the rapid transfer of knowledge and promote the development of standardised techniques that can be applied to diverse habitats and species, and ultimately lead to improved management.

     

Postpartum mental illness during the COVID-19 pandemic: a population-based,repeated cross-sectional study

BACKGROUND:It is unclear whether the clinical burden of postpartum mental illness has increased during the COVID-19 pandemic. We sought to compare physician visit rates for postpartum mental illness in Ontario, Canada, during the pandemic with rates expected based on prepandemic patterns.METHODS:In this population-based, repeated cross-sectional study using linked health administrative databases in Ontario, Canada, we used negative binomial regression to model expected visit rates per 1000 postpartum people for March–November 2020 based on prepandemic data (January 2016–February 2020). We compared observed visit rates to expected visit rates for each month of the pandemic period, generating absolute rate differences, incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). The primary outcome was a visit to a primary care physician or a psychiatrist for any mental disorder. We stratified analyses by maternal sociodemographic characteristics.RESULTS:In March 2020, the visit rate was 43.5/1000, with a rate difference of 3.11/1000 (95% CI 1.25–4.89) and an IRR of 1.08 (95% CI 1.03–1.13) compared with the expected rate. In April, the rate difference (10.9/1000, 95% CI 9.14–12.6) and IRR (1.30, 95% CI 1.24–1.36) were higher; this level was generally sustained through November 2020. From April–November, we observed elevated visit rates across provider types and for diagnoses of anxiety, depressive and alcohol or substance use disorders. Observed increases from expected visit rates were greater for people 0–90 days postpartum compared with 91–365 days postpartum; increases were small among people living in low-income neighbourhoods. Public health units in the northern areas of the province did not see sustained elevations in visit rates after July; southern health units had elevated rates through to November.INTERPRETATION:Increased visits for mental health conditions among postpartum people during the first 9 months of the COVID-19 pandemic suggest an increased need for effective and accessible mental health care for this population as the pandemic progresses.

Postpartum mental illness affects as many as 1 in 5 mothers,¹ and can result in maternal suffering and diminished functioning.² Related impaired mother–infant interactions are linked to poor social, cognitive and behavioural outcomes in children across their lifespan.³ When mental illness becomes chronic and recurrent, its effects can extend to the entire family and across generations.⁴ With emergence of the novel coronavirus (SARS-CoV-2), the World Health Organization declared a global COVID-19 pandemic on Mar. 11, 2020. Globally, efforts to contain the virus have led to widespread travel restrictions, physical distancing and work limitations, causing broad social and financial disruption that has been associated with substantial mental health effects.^5,6During the COVID-19 pandemic, people have been reporting concerns about postpartum infection,⁷ and difficulty accessing the extended postpartum social support networks and key community programs that protect against mental illness, such as home visits from public health nurses, breastfeeding clinics and support groups, owing to public health measures.⁸ In Canadian surveys, about 50% of pregnant people reported psychological distress in spring 2020,⁹ and alcohol use increased among women, particularly among those with young children.¹⁰ Whether this represents an increased clinical burden of mental illness or need for care is unknown.Using routinely collected health care data from Ontario, Canada, (population of about 14.6 million), we aimed to examine whether rates of maternal visits to physicians for postpartum mental illness from March to November 2020 differed from expected visit rates based on pre-COVID-19 patterns, and to identify variation by provider type, clinical diagnosis, postpartum timing, parity, income, ethnicity and region of residence.     

The local and global mental health effects of the Covid-19 pandemic

This paper investigates the mental health effects of the local and global level Covid-19 pandemic among the UK population. To identify the effect, we use a high-quality dataset and an original strategy where we match the previous day’s confirmed pandemic cases to a four-month panel of individual mental health information observed during the interview next day. The approach suggested in this paper aims to identify the average mental health effect on the overall population for the first and second waves of the pandemic. Using a linear fixed-effects model specification, we report robust findings that the average mental health in the UK is substantially reduced by the local and global pandemic. The total reduction in the average mental health of the UK population during our sampling period (April - June, 2020) is about 1.5% for the local and 2.4% for the global cases, which sum up to a 3.9% reduction. Extrapolating the total reduction in average mental health during the first wave of the pandemic (February - September, 2020) sums up to 2.8% while the effect is as large as 9.6% for the first and second waves together, which covers roughly a year since the start. An extensive robustness check suggests that the findings are stable with respect to alternative pandemic datasets, measures, estimators, functional forms, and time functions. The characteristics of the most vulnerable individuals (e.g., elderly, chronic illness, and job security concerns) and their household conditions (e.g., living alone and no private space) are explored. The paper discusses on the implications of the results.     

Equity-Oriented Monitoring in the Context of Universal Health Coverage

Monitoring inequalities in health is fundamental to the equitable and progressive realization of universal health coverage (UHC). A successful approach to global inequality monitoring must be intuitive enough for widespread adoption, yet maintain technical credibility. This article discusses methodological considerations for equity-oriented monitoring of UHC, and proposes recommendations for monitoring and target setting. Inequality is multidimensional, such that the extent of inequality may vary considerably across different dimensions such as economic status, education, sex, and urban/rural residence. Hence, global monitoring should include complementary dimensions of inequality (such as economic status and urban/rural residence) as well as sex. For a given dimension of inequality, subgroups for monitoring must be formulated taking into consideration applicability of the criteria across countries and subgroup heterogeneity. For economic-related inequality, we recommend forming subgroups as quintiles, and for urban/rural inequality we recommend a binary categorization. Inequality spans populations, thus appropriate approaches to monitoring should be based on comparisons between two subgroups (gap approach) or across multiple subgroups (whole spectrum approach). When measuring inequality absolute and relative measures should be reported together, along with disaggregated data; inequality should be reported alongside the national average. We recommend targets based on proportional reductions in absolute inequality across populations. Building capacity for health inequality monitoring is timely, relevant, and important. The development of high-quality health information systems, including data collection, analysis, interpretation, and reporting practices that are linked to review and evaluation cycles across health systems, will enable effective global and national health inequality monitoring. These actions will support equity-oriented progressive realization of UHC.

This paper is part of the PLOS Universal Health Coverage Collection.

Summary Points

• The equitable realization of universal health coverage requires an equity-oriented approach to monitoring; equity advocates should be unified in proposing a technically sound platform for monitoring that is easy to understand and communicate.
• Global monitoring should include complementary dimensions of inequality (such as economic status and urban/rural residence, in addition to sex), adopt a gap or whole spectrum approach, and conceptualize economic-related measures using quintiles.
• Both absolute and relative measures of inequality as well as disaggregated data should be reported, and national averages should be presented alongside inequality monitoring.
• Targets for global monitoring of health inequalities should be based on proportional reduction of absolute inequality.
• Countries can develop capacity for health inequality monitoring by strengthening health information systems for data collection, analysis, reporting, and dissemination.