A general pattern of trade-offs between ecosystem resistance and resilience to tropical cyclones.

Tropical cyclones drive coastal ecosystem dynamics, and their frequency, intensity, and spatial distribution are predicted to shift with climate change. Patterns of resistance and resilience were synthesized for 4138 ecosystem time series from n = 26 storms occurring between 1985 and 2018 in the Northern Hemisphere to predict how coastal ecosystems will respond to future disturbance regimes. Data were grouped by ecosystems (fresh water, salt water, terrestrial, and wetland) and response categories (biogeochemistry, hydrography, mobile biota, sedentary fauna, and vascular plants). We observed a repeated pattern of trade-offs between resistance and resilience across analyses. These patterns are likely the outcomes of evolutionary adaptation, they conform to disturbance theories, and they indicate that consistent rules may govern ecosystem susceptibility to tropical cyclones.

What factors influence healthcare professionals to refer children and families to paediatric psychology?

OBJECTIVES: This study aimed to investigate factors influencing referral of children with physical illness to paediatric psychology. Due to high rates of mental health problems within this population, studies have shown that referral to paediatric psychology should be increased. However, few studies have examined factors shaping healthcare professionals' referral behaviour. METHODS: This study used the theory of planned behaviour to develop a questionnaire which explores factors influencing the referral of children and families to paediatric psychology. Psychometric properties of the questionnaire were examined. RESULTS: The questionnaire was found to have good reliability and validity. The main constructs of the theory of planned behaviour were useful in predicting intention to refer to paediatric psychology. Specific beliefs about referral were shown to influence intention to refer. CONCLUSION: Findings suggest that individual attitudes and beliefs can impact healthcare professionals' referral behaviour, indicating that multidisciplinary interventions and inter-professional education relating to the psychological aspects of illness are required.

A systematic review of randomised controlled trials using psychological interventions for children and adolescents with medically unexplained symptoms: A focus on mental health outcomes.

BACKGROUND: Medically unexplained symptoms affect between 4% and 20% of children and adolescents; 30-60% of these children also experience mental health difficulties. Trials and reviews have focussed on physical gains in this population, often overlooking mental health outcomes. OBJECTIVES: To use a systematic review methodology guided by the PRISMA checklist to (1) investigate the effectiveness of psychological interventions for mental health difficulties in children and adolescents with medically unexplained symptoms and (2) identify aspects of interventions associated with their success. METHODS: Randomised controlled studies investigating the impact of psychological interventions on mental health in children and adolescents with medically unexplained symptoms were included. Systematic searches of PsycINFO, MEDLINE and CINAHL were undertaken from inception to January 2018. Studies were appraised using the quality appraisal checklist. A qualitative synthesis of studies was completed. RESULTS: In all, 18 studies were identified. Interventions targeting parental responses to illness and family communication appeared to have the best outcomes. CONCLUSIONS: Psychological interventions may be effective in improving mental health outcomes within this population; however, evidence for the efficacy of these interventions is limited due to a high risk of bias within the majority of reviewed studies. Future research using rigorous methodology and non-cognitive behavioural therapy interventions is recommended.

Deep soils modify environmental consequences of increased nitrogen fertilizer use in intensifying Amazon agriculture.

Agricultural intensification offers potential to grow more food while reducing the conversion of native ecosystems to croplands. However, intensification also risks environmental degradation through emissions of the greenhouse gas nitrous oxide (N2O) and nitrate leaching to ground and surface waters. Intensively-managed croplands and nitrogen (N) fertilizer use are expanding rapidly in tropical regions. We quantified fertilizer responses of maize yield, N2O emissions, and N leaching in an Amazon soybean-maize double-cropping system on deep, highly-weathered soils in Mato Grosso, Brazil. Application of N fertilizer above 80 kg N ha-1 yr-1 increased maize yield and N2O emissions only slightly. Unlike experiences in temperate regions, leached nitrate accumulated in deep soils with increased fertilizer and conversion to cropping at N fertilization rates >80 kg N ha-1, which exceeded maize demand. This raises new questions about the capacity of tropical agricultural soils to store nitrogen, which may determine when and how much nitrogen impacts surface waters.

Drought drives rapid shifts in tropical rainforest soil biogeochemistry and greenhouse gas emissions.

Climate change models predict more frequent and severe droughts in the humid tropics. How drought will impact tropical forest carbon and greenhouse gas dynamics is poorly understood. Here we report the effects of the severe 2015 Caribbean drought on soil moisture, oxygen, phosphorus (P), and greenhouse gas emissions in a humid tropical forest in Puerto Rico. Drought significantly decreases inorganic P concentrations, an element commonly limiting to net primary productivity in tropical forests, and significantly increases organic P. High-frequency greenhouse gas measurements show varied impacts across topography. Soil carbon dioxide emissions increase by 60% on slopes and 163% in valleys. Methane (CH4) consumption increases significantly during drought, but high CH4 fluxes post-drought offset this sink after 7 weeks. The rapid response and slow recovery to drought suggest tropical forest biogeochemistry is more sensitive to climate change than previously believed, with potentially large direct and indirect consequences for regional and global carbon cycles.

Teaching Medical Students to Communicate With Empathy and Clarity Using Improvisation.

PROBLEM: Medical educators widely accept that health care providers need strong communication skills. The authors sought to develop a course incorporating improvisation to teach health professions students communication skills and build empathy. APPROACH: Teaching health care professionals to communicate more effectively with patients, the public, and each other is a goal of the Alan Alda Center for Communicating Science at Stony Brook University. The authors designed an interprofessional elective for medical, nursing, and dental students that differed in several respects from traditional communication training. The Communicating Science elective, which was offered by the Alda Center from 2012 to 2016, used verbal and nonverbal exercises, role-playing, and storytelling, including improvisation exercises, to teach students to communicate with empathy and clarity. OUTCOMES: In course evaluations completed by 76 students in 2012 and 2013, 100% said they would recommend the course to fellow students, saw the relevance of the course content to their careers, and desired more of the course content in their school's curriculum. As a result of this positive feedback, from 2014 to 2016, 10 hours of instruction pairing empathy and communication training was embedded in the preclinical curriculum at the Stony Brook University School of Medicine. NEXT STEPS: This course could be an effective model, and one that other institutions could employ, for improving communication skills and empathy in the next generation of health care professionals. Next steps include advocating for communication skills training to be embedded throughout the curriculum of a four-year medical school program.

Getting Road Expansion on the Right Track: A Framework for Smart Infrastructure Planning in the Mekong.

The current unprecedented expansion of infrastructure promises to enhance human wellbeing but risks causing substantial harm to natural ecosystems and the benefits they provide for people. A framework for systematically and proactively identifying the likely benefits and costs of such developments is badly needed. Here, we develop and test at the subregional scale a recently proposed global scheme for comparing the potential gains from new roads for food production with their likely impact on biodiversity and ecosystem services. Working in the Greater Mekong-an exceptionally biodiverse subregion undergoing rapid development-we combined maps of isolation from urban centres, yield gaps, and the current area under 17 crops to estimate where and how far road development could in principle help to increase food production without the need for cropland expansion. We overlaid this information with maps summarising the importance of remaining habitats to terrestrial vertebrates and (as examples of major ecosystem services) to global and local climate regulation. This intersection revealed several largely converted yet relatively low-yielding areas (such as central, eastern, and northeastern Thailand and the Ayeyarwady Delta), where narrowing yield gaps by improving transport links has the potential to substantially increase food production at relatively limited environmental cost. Concentrating new roads and road improvements here while taking strong measures to prevent their spread into areas which are still extensively forested (such as northern Laos, western Yunnan, and southwestern Cambodia) could thus enhance rural livelihoods and regional food production while helping safeguard vital ecosystem services and globally significant biological diversity.

Spatially explicit estimates of N2 O emissions from croplands suggest climate mitigation opportunities from improved fertilizer management.

With increasing nitrogen (N) application to croplands required to support growing food demand, mitigating N2 O emissions from agricultural soils is a global challenge. National greenhouse gas emissions accounting typically estimates N2 O emissions at the country scale by aggregating all crops, under the assumption that N2 O emissions are linearly related to N application. However, field studies and meta-analyses indicate a nonlinear relationship, in which N2 O emissions are relatively greater at higher N application rates. Here, we apply a super-linear emissions response model to crop-specific, spatially explicit synthetic N fertilizer and manure N inputs to provide subnational accounting of global N2 O emissions from croplands. We estimate 0.66 Tg of N2 O-N direct global emissions circa 2000, with 50% of emissions concentrated in 13% of harvested area. Compared to estimates from the IPCC Tier 1 linear model, our updated N2 O emissions range from 20% to 40% lower throughout sub-Saharan Africa and Eastern Europe, to >120% greater in some Western European countries. At low N application rates, the weak nonlinear response of N2 O emissions suggests that relatively large increases in N fertilizer application would generate relatively small increases in N2 O emissions. As aggregated fertilizer data generate underestimation bias in nonlinear models, high-resolution N application data are critical to support accurate N2 O emissions estimates.

A global strategy for road building.

The number and extent of roads will expand dramatically this century. Globally, at least 25 million kilometres of new roads are anticipated by 2050; a 60% increase in the total length of roads over that in 2010. Nine-tenths of all road construction is expected to occur in developing nations, including many regions that sustain exceptional biodiversity and vital ecosystem services. Roads penetrating into wilderness or frontier areas are a major proximate driver of habitat loss and fragmentation, wildfires, overhunting and other environmental degradation, often with irreversible impacts on ecosystems. Unfortunately, much road proliferation is chaotic or poorly planned, and the rate of expansion is so great that it often overwhelms the capacity of environmental planners and managers. Here we present a global scheme for prioritizing road building. This large-scale zoning plan seeks to limit the environmental costs of road expansion while maximizing its benefits for human development, by helping to increase agricultural production, which is an urgent priority given that global food demand could double by mid-century. Our analysis identifies areas with high environmental values where future road building should be avoided if possible, areas where strategic road improvements could promote agricultural development with relatively modest environmental costs, and 'conflict areas' where road building could have sizeable benefits for agriculture but with serious environmental damage. Our plan provides a template for proactively zoning and prioritizing roads during the most explosive era of road expansion in human history.

Solutions for a cultivated planet.

Increasing population and consumption are placing unprecedented demands on agriculture and natural resources. Today, approximately a billion people are chronically malnourished while our agricultural systems are concurrently degrading land, water, biodiversity and climate on a global scale. To meet the world's future food security and sustainability needs, food production must grow substantially while, at the same time, agriculture's environmental footprint must shrink dramatically. Here we analyse solutions to this dilemma, showing that tremendous progress could be made by halting agricultural expansion, closing 'yield gaps' on underperforming lands, increasing cropping efficiency, shifting diets and reducing waste. Together, these strategies could double food production while greatly reducing the environmental impacts of agriculture.

What history reveals about Forge River pollution on Long Island, New York's south shore.

Fifty years ago, the Forge River and Moriches Bay, of Long Island's south shore lagoonal system, achieved notoriety when their polluted conditions were alluded to in a report of the US President's Science Advisory Committee (1965). The Woods Hole Oceanographic Institution investigated the bay throughout the 1950s, identifying duck farming as the cause of "objectionable", "highly contaminated" conditions of these waters. Much has changed: duck farming declined; the river was dredged to remove polluted sediments, improve navigation; and barrier island inlets stabilized. Yet, the river remains seasonally eutrophic. Why? This paper reviews what occurred in the Forge River watershed. While governments aggressively curtailed the impacts of duck pollution, they failed to manage development and sewage pollution. The Forge experience indicates that watershed management is a continuing governmental responsibility as development accelerates. Otherwise, we will always be looking for that instantaneous remediation that is usually not affordable and is socially contentious.