The impacts of sport emissions on climate: Measurement, mitigation, and making a difference.

As a global industry, sport makes potentially significant contributions to climate change through both carbon emissions and influence over sustainability practices. Yet, evidence regarding impacts is uneven and spread across many disciplines. This paper investigates the impacts of sport emissions on climate and identifies knowledge gaps. We undertook a systematic and iterative meta-analysis of relevant literature (1992-2022) on organized and individual sports. Using a defined search protocol, 116 sources were identified that map to four sport-related themes: (1) carbon emissions and their measurement; (2) emissions control and decarbonization; (3) carbon sinks and offsets; and (4) behavior change. We find that mega sport events, elite sport, soccer, skiing, and golf have received most attention, whereas grass-roots and women's sport, activity in Africa and South America, cricket, tennis, and volleyball are understudied. Other knowledge gaps include carbon accounting tools and indicators for smaller sports clubs and active participants; cobenefits and tradeoffs between mitigation-adaptation efforts in sport, such as around logistics, venues, sports equipment, and facilities; geopolitical influence; and scope for climate change litigation against hosts and/or sponsors of carbon-intensive events. Among these, researchers should target cobenefits given their scope to deliver wins for both climate mitigation and risk management of sport.

Assessment of Healthcare Resource Utilization by Anticoagulant Heparinoid Dosage Level in Patients Hospitalized with COVID-19.

The aim was to describe inpatients with COVID-19 empirically prescribed heparinoid anticoagulants and compare resource utilization between prophylactic/low-dose and therapeutic/high-dose groups. Methods: This retrospective observational study used real-world data from 880 US hospitals in the PINC AI™ Healthcare Database during 4/1/2020-11/30/2020. Descriptive analysis was used to characterize patients. Multivariable regression was used to evaluate intensive care unit (ICU) admissions, length of stay (LOS), mortality, and costs by anticoagulation dose group, adjusting for cohort characteristics. Among 122,508 inpatients, 29,225 (23.9%) received therapeutic/high-dose, and 93,283 (76.1%) received prophylactic/low-dose anticoagulation. The high-dose group had more comorbidities and worse laboratory values compared with low-dose. Respectively, ICU admission rates were 36.7% and 19.1% and LOS median (Q1, Q3) was 8 (5, 15) and 5 (3, 9) days. In separate adjusted models, high-dose anticoagulation was associated with a 45% increase in odds of ICU admission, 26% increase in odds of in-hospital mortality, 21% longer average LOS, and 28% greater average total cost compared with low-dose (each P < 0.001). Prophylactic/low-dose anticoagulation treatment was associated with decreased healthcare resource utilization (HRU) in hospitalized patients with COVID-19.

Dynamical-statistical seasonal forecasts of winter and summer precipitation for the Island of Ireland.

Seasonal precipitation forecasting is highly challenging for the northwest fringes of Europe due to complex dynamical drivers. Hybrid dynamical-statistical approaches offer potential to improve forecast skill. Here, hindcasts of mean sea level pressure (MSLP) from two dynamical systems (GloSea5 and SEAS5) are used to derive two distinct sets of indices for forecasting winter (DJF) and summer (JJA) precipitation over lead-times of 1-4 months. These indices provide predictors of seasonal precipitation via a multiple linear regression model (MLR) and an artificial neural network (ANN) applied to four Irish rainfall regions and the Island of Ireland. Forecast skill for each model, lead time, and region was evaluated using the correlation coefficient (r) and mean absolute error (MAE), benchmarked against (a) climatology, (b) bias corrected precipitation hindcasts from both GloSea5 and SEAS5, and (c) a zero-order forecast based on rainfall persistence. The MLR and ANN models produced skilful precipitation forecasts with leads of up to 4 months. In all tests, our hybrid method based on MSLP indices outperformed the three benchmarks (i.e., climatology, bias corrected, and persistence). With correlation coefficients ranging between 0.38 and 0.81 in winter, and between 0.24 and 0.78 in summer, the ANN model outperformed MLR in both seasons in most regions and lead-times. Forecast skill for summer was comparable to that in winter and for some regions/lead times even superior. Our results also show that climatology and persistence performed better than direct use of bias corrected dynamical outputs in most regions and lead-times in terms of MAE. We conclude that the hybrid dynamical-statistical approach developed here-by leveraging useful information about MSLP from dynamical systems-enables more skilful seasonal precipitation forecasts for Ireland, and possibly other locations in western Europe, in both winter and summer.

Reconstructed monthly river flows for Irish catchments 1766-2016.

A 250-year (1766-2016) archive of reconstructed river flows is presented for 51 catchments across Ireland. By leveraging meteorological data rescue efforts with gridded precipitation and temperature reconstructions, we develop monthly river flow reconstructions using the GR2M hydrological model and an Artificial Neural Network. Uncertainties in reconstructed flows associated with hydrological model structure and parameters are quantified. Reconstructions are evaluated by comparison with those derived from quality assured long-term precipitation series for the period 1850-2000. Assessment of the reconstruction performance across all 51 catchments using metrics of MAE (9.3 mm/month; 13.3%), RMSE (12.6 mm/month; 18.0%) and mean bias (-1.16 mm/month; -1.7%), indicates good skill. Notable years with highest/lowest annual mean flows across all catchments were 1877/1855. Winter 2015/16 had the highest seasonal mean flows and summer 1826 the lowest, whereas autumn 1933 had notable low flows across most catchments. The reconstructed database will enable assessment of catchment specific responses to varying climatic conditions and extremes on annual, seasonal and monthly timescales.

A case study using 2019 pre-monsoon snow and stream chemistry in the Khumbu region, Nepal.

This case study provides a framework for future monitoring and evidence for human source pollution in the Khumbu region, Nepal. We analyzed the chemical composition (major ions, major/trace elements, black carbon, and stable water isotopes) of pre-monsoon stream water (4300-5250 m) and snow (5200-6665 m) samples collected from Mt. Everest, Mt. Lobuche, and the Imja Valley during the 2019 pre-monsoon season, in addition to a shallow ice core recovered from the Khumbu Glacier (5300 m). In agreement with previous work, pre-monsoon aerosol deposition is dominated by dust originating from western sources and less frequently by transport from southerly air mass sources as demonstrated by evidence of one of the strongest recorded pre-monsoon events emanating from the Bay of Bengal, Cyclone Fani. Elevated concentrations of human-sourced metals (e.g., Pb, Bi, As) are found in surface snow and stream chemistry collected in the Khumbu region. As the most comprehensive case study of environmental chemistry in the Khumbu region, this research offers sufficient evidence for increased monitoring in this watershed and surrounding areas.

Into Thick(er) Air? Oxygen Availability at Humans' Physiological Frontier on Mount Everest.

Global audiences are captivated by climbers pushing themselves to the limits in the hypoxic environment of Mount Everest. However, air pressure sets oxygen abundance, meaning it varies with the weather and climate warming. This presents safety issues for mountaineers but also an opportunity for public engagement around climate change. Here we blend new observations from Everest with ERA5 reanalysis (1979-2019) and climate model results to address both perspectives. We find that plausible warming could generate subtle but physiologically relevant changes in summit oxygen availability, including an almost 5% increase in annual minimum VO2 max for 2°C warming since pre-industrial. In the current climate we find evidence of swings in pressure sufficient to change Everest's apparent elevation by almost 750 m. Winter pressures can also plunge lower than previously reported, highlighting the importance of air pressure forecasts for the safety of those trying to push the physiological frontier on Mt. Everest.

The emergence of heat and humidity too severe for human tolerance.

Humans' ability to efficiently shed heat has enabled us to range over every continent, but a wet-bulb temperature (TW) of 35°C marks our upper physiological limit, and much lower values have serious health and productivity impacts. Climate models project the first 35°C TW occurrences by the mid-21st century. However, a comprehensive evaluation of weather station data shows that some coastal subtropical locations have already reported a TW of 35°C and that extreme humid heat overall has more than doubled in frequency since 1979. Recent exceedances of 35°C in global maximum sea surface temperature provide further support for the validity of these dangerously high TW values. We find the most extreme humid heat is highly localized in both space and time and is correspondingly substantially underestimated in reanalysis products. Our findings thus underscore the serious challenge posed by humid heat that is more intense than previously reported and increasingly severe.

Multi-century trends to wetter winters and drier summers in the England and Wales precipitation series explained by observational and sampling bias in early records.

Globally, few precipitation records extend to the 18th century. The England Wales Precipitation (EWP) series is a notable exception with continuous monthly records from 1766. EWP has found widespread use across diverse fields of research including trend detection, evaluation of climate model simulations, as a proxy for mid-latitude atmospheric circulation, a predictor in long-term European gridded precipitation data sets, the assessment of drought and extremes, tree-ring reconstructions and as a benchmark for other regional series. A key finding from EWP has been the multi-centennial trends towards wetter winters and drier summers. We statistically reconstruct seasonal EWP using independent, quality-assured temperature, pressure and circulation indices. Using a sleet and snow series for the UK derived by Profs. Gordon Manley and Elizabeth Shaw to examine winter reconstructions, we show that precipitation totals for pre-1870 winters are likely biased low due to gauge under-catch of snowfall and a higher incidence of snowfall during this period. When these factors are accounted for in our reconstructions, the observed trend to wetter winters in EWP is no longer evident. For summer, we find that pre-1820 precipitation totals are too high, likely due to decreasing network density and less certain data at key stations. A significant trend to drier summers is not robustly present in our reconstructions of the EWP series. While our findings are more certain for winter than summer, we highlight (a) that extreme caution should be exercised when using EWP to make inferences about multi-centennial trends, and; (b) that assessments of 18th and 19th Century winter precipitation should be aware of potential snow biases in early records. Our findings underline the importance of continual re-appraisal of established long-term climate data sets as new evidence becomes available. It is also likely that the identified biases in winter EWP have distorted many other long-term European precipitation series.

The forgotten drought of 1765-1768: Reconstructing and re-evaluating historical droughts in the British and Irish Isles.

Historical precipitation records are fundamental for the management of water resources, yet rainfall observations typically span 100-150 years at most, with considerable uncertainties surrounding earlier records. Here, we analyse some of the longest available precipitation records globally, for England and Wales, Scotland and Ireland. To assess the credibility of these records and extend them further back in time, we statistically reconstruct (using independent predictors) monthly precipitation series representing these regions for the period 1748-2000. By applying the Standardized Precipitation Index at 12-month accumulations (SPI-12) to the observed and our reconstructed series we re-evaluate historical meteorological droughts. We find strong agreement between observed and reconstructed drought chronologies in post-1870 records, but divergence in earlier series due to biases in early precipitation observations. Hence, the 1800s decade was less drought prone in our reconstructions relative to observations. Overall, the drought of 1834-1836 was the most intense SPI-12 event in our reconstruction for England and Wales. Newspaper accounts and documentary sources confirm the extent of impacts across England in particular. We also identify a major, "forgotten" drought in 1765-1768 that affected the British-Irish Isles. This was the most intense event in our reconstructions for Ireland and Scotland, and ranks first for accumulated deficits across all three regional series. Moreover, the 1765-1768 event was also the most extreme multi-year drought across all regional series when considering 36-month accumulations (SPI-36). Newspaper and other sources confirm the occurrence and major socio-economic impact of this drought, such as major rivers like the Shannon being fordable by foot. Our results provide new insights into historical droughts across the British Irish Isles. Given the importance of historical droughts for stress-testing the resilience of water resources, drought plans and supply systems, the forgotten drought of 1765-1768 offers perhaps the most extreme benchmark scenario in more than 250-years.

Using a Scenario-Neutral Framework to Avoid Potential Maladaptation to Future Flood Risk.

This study develops a coherent framework to detect those catchment types associated with a high risk of maladaptation to future flood risk. Using the "scenario-neutral" approach to impact assessment the sensitivity of Irish catchments to fluvial flooding is examined in the context of national climate change allowances. A predefined sensitivity domain is used to quantify flood responses to +2 °C mean annual temperature with incremental changes in the seasonality and mean of the annual precipitation cycle. The magnitude of the 20-year flood is simulated at each increment using two rainfall-runoff models (GR4J, NAM), then concatenated as response surfaces for 35 sample catchments. A typology of catchment sensitivity is developed using clustering and discriminant analysis of physical attributes. The same attributes are used to classify 215 ungauged/data-sparse catchments. To address possible redundancies, the exposure of different catchment types to projected climate is established using an objectively selected subset of the Coupled Model Intercomparison Project Phase 5 ensemble. Hydrological model uncertainty is shown to significantly influence sensitivity and have a greater effect than ensemble bias. A national flood risk allowance of 20%, considering all 215 catchments is shown to afford protection against ~48% to 98% of the uncertainty in the Coupled Model Intercomparison Project Phase 5 subset (Representative Concentration Pathway 8.5; 2070-2099), irrespective of hydrological model and catchment type. However, results indicate that assuming a standard national or regional allowance could lead to local over/under adaptation. Herein, catchments with relatively less storage are sensitive to seasonal amplification in the annual cycle of precipitation and warrant special attention.

Mining Social Media to Identify Heat Waves.

Heat waves are one of the deadliest of natural hazards and their frequency and intensity will likely increase as the climate continues to warm. A challenge in studying these phenomena is the lack of a universally accepted quantitative definition that captures both temperature anomalies and associated mortality. We test the hypothesis that social media mining can be used to identify heat wave mortality. Applying the approach to India, we find that the number of heat-related tweets correlates with heat-related mortality much better than traditional climate-based indicators, especially at larger scales, which identify many heat wave days that do not lead to excess mortality. We conclude that social media based heat wave identification can complement climatic data and can be used to: (1) study heat wave impacts at large scales or in developing countries, where mortality data are difficult to obtain and uncertain, and (2) to track dangerous heat wave events in real time.

Gender Dysphoria in looked-after and adopted young people in a gender identity development service.

This research investigated the prevalence of looked-after and adopted young people within a case file review of 185 young people referred to a UK gender identity development service over a 2-year period (1 April 2009 to 1 April 2011). Data were extracted from referral letters, clinical notes and clinician letters. Looked-after young people were found to represent 4.9% of referrals in this cohort, which is significantly higher than within the English general population (0.58%). Adopted young people represented 3.8% of referrals. In addition, the findings showed that looked-after young people were less likely to receive a diagnosis of gender dysphoria compared with young people living within their birth family. There were no statistically significant differences in the gender ratio or age of first gender dysphoric experience between groups. Looked-after and adopted young people were also not found to be experiencing greater impairment in overall functioning compared to other young people referred to the gender identity development service. In conclusion, there are a substantial proportion of referrals pertaining to looked-after or adopted young people, and it appears the referral route and process through the service may be distinct, particularly for looked-after young people. This may be understood by considering the possible complexities in the presentation of these groups, alongside the established higher levels of complexity generally for those experiencing feelings of gender dysphoria.

Neurodevelopmental outcome in survivors of hypoxic ischemic encephalopathy without cerebral palsy.

To access outcome following hypoxic ischemic encephalopathy (HIE), survivors without cerebral palsy were invited for formal developmental assessment. Children aged ≥ 42 months were assessed using the NEPSY-2, Movement Assessment Battery for Children 2 (Movement ABC-2), Behavior Rating Inventory of Executive Function, and the Child Behavior Checklist. Children aged < 42 months were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (BSITD-3). One hundred forty-six children attended for assessments [Grade 1 (112), Grade 2 (33), and Grade 3 (1)]. BSITD-3 did not identify significant rates of impairment on cognitive, motor, or language subtests. A significant proportion of children scored < 3rd percentile on the adaptive behavior scale. In older age groups, difficulties were seen in 16/24 NEPSY-2 subtests and on timed assessments using Movement ABC-2. Difficulties arose especially in the "control" aspects of cognition and behavior. Behavioral difficulties were common with internalizing problems predominating. There was a graded effect with grade 2 cases differing significantly from grade 1 cases. CONCLUSION: Following HIE, children may experience attention, memory, and behavior difficulties which are not always evident at a young age. The adaptive behavior questionnaire may be a useful tool to select children requiring developmental surveillance beyond 2 years of age. What is known: • Diversity of outcome across grades of HIE is reported and few studies have looked at the milder consequences of HIE at school age. What is new: • Following HIE children may experience attention, memory, and behavior difficulties which are not always evident at a young age. • The adaptive behavior questionnaire may be a useful tool to select children requiring developmental surveillance beyond 2 years of age.

Communicating the deadly consequences of global warming for human heat stress.

In December of 2015, the international community pledged to limit global warming to below 2 °C above preindustrial (PI) to prevent dangerous climate change. However, to what extent, and for whom, is danger avoided if this ambitious target is realized? We address these questions by scrutinizing heat stress, because the frequency of extremely hot weather is expected to continue to rise in the approach to the 2 °C limit. We use analogs and the extreme South Asian heat of 2015 as a focusing event to help interpret the increasing frequency of deadly heat under specified amounts of global warming. Using a large ensemble of climate models, our results confirm that global mean air temperature is nonlinearly related to heat stress, meaning that the same future warming as realized to date could trigger larger increases in societal impacts than historically experienced. This nonlinearity is higher for heat stress metrics that integrate the effect of rising humidity. We show that, even in a climate held to 2 °C above PI, Karachi (Pakistan) and Kolkata (India) could expect conditions equivalent to their deadly 2015 heatwaves every year. With only 1.5 °C of global warming, twice as many megacities (such as Lagos, Nigeria, and Shanghai, China) could become heat stressed, exposing more than 350 million more people to deadly heat by 2050 under a midrange population growth scenario. The results underscore that, even if the Paris targets are realized, there could still be a significant adaptation imperative for vulnerable urban populations.

Brain magnetic resonance imaging and outcome after hypoxic ischaemic encephalopathy.

OBJECTIVE: To correlate pattern of injury on neonatal brain magnetic resonance imaging (MRI) with outcome in infants ≥36 + 0 weeks gestation with hypoxic ischaemic encephalopathy. METHODS: Prospective cohort study. Images were blindly reviewed. Children were assessed using a variety of standardised assessments. RESULTS: MRI brain was performed on 88 infants. Follow up was available in 73(83%) infants. Eight of 25(32%) children with normal imaging had below normal assessment scores. Eight infants (12%) had isolated punctate white matter lesions and five of these had abnormal assessment scores. Death and cerebral palsy were seen only in children with imaging scores ≥3 on basal ganglia/thalami (BGT) score or ≥4 on watershed score. No developmental concerns were raised in 3/7(43%) infants with isolated watershed injury. Ten of 13(77%) infants with isolated BGT injury died or developed cerebral palsy. All 23 children with posterior limb of the internal capsule (PLIC) injury displayed developmental difficulties. CONCLUSIONS: Almost one-third of infants with a normal MRI brain may be at risk of developmental problems. Punctate foci of white matter injury are common and not always benign. PLIC involvement is usually associated with neurological sequelae including isolated cognitive deficits. Worst outcomes are associated with basal ganglia injury.

A case-control study of hypoxic-ischemic encephalopathy in newborn infants at >36 weeks gestation.

OBJECTIVE: The purpose of this study was to determine risk factors that are associated with hypoxic ischemic encephalopathy (HIE). STUDY DESIGN: This was a case-control study that included newborn infants with HIE who were admitted to the hospital between January 2001 and December 2008. Two control newborn infants were chosen for each case. Logistic regression and classification and regression tree (CART) analysis that compared control infants and cases with grade 1 HIE and control infants and cases with grades 2 and 3 HIE was performed. RESULTS: Two hundred thirty-seven cases (newborn infants with grade 1 encephalopathy, 155; newborn infants with grade 2 encephalopathy, 61; newborn infants with grade 3 encephalopathy, 21) and 489 control infants were included. Variables that were associated independently with HIE included higher grade meconium, growth restriction, large head circumference, oligohydramnios, male sex, fetal bradycardia, maternal pyrexia and increased uterine contractility. CART analysis ranked high-grade meconium, oligohydramnios, and the presence of obstetric complications as the most discriminating variables and defined distinct risk groups with HIE rates that ranged from 0-86%. CONCLUSION: CART analysis provides information to help identify the time at which intervention in labor may be of benefit.

The placenta in infants >36 weeks gestation with neonatal encephalopathy: a case control study.

OBJECTIVE: To determine placental characteristics associated with neonatal encephalopathy (NE) and correlate these with short- and long-term neurodevelopmental outcome. DESIGN: Case/control study. SETTING: Neonatal Intensive Care Unit, Rotunda Hospital, Dublin, Ireland. PATIENTS: Newborns ≥36 weeks gestation, with NE (cases). Healthy term newborns (controls). INTERVENTIONS: Placental pathology was obtained from the official placental report. Brain MRI was blindly reviewed. Children were assessed using a variety of standardised assessments. Data were analysed using multinomial logistic regression analysis. MAIN OUTCOME MEASURES: RRR for grade of encephalopathy. OR for neurodevelopmental outcome. RESULTS: Placental reports were available on 141 cases (76 grade 1; 46 grade 2; 19 grade 3) and 309 control infants. Meconium phagocytosis, haemorrhage, raised placental to birth weight ratio and/or markers of infection/inflammation were independently associated with NE and showed a synergistic effect, when combined, for short- and long-term impairments. CONCLUSIONS: Evaluation of the mechanisms leading to the placental characteristics identified may help to characterise the causal pathway of NE.

Sudden unexplained death in childhood (1-4 years) in Ireland: an epidemiological profile and comparison with SIDS.

OBJECTIVE: To examine the incidence of sudden unexplained death in children 1-4 years old (SUDC) in Ireland and to compare the epidemiological profile of SUDC with that of SIDS. DESIGN: All cases of sudden unexplained death in children <5 years in Ireland between 1994 and 2008 were reviewed. Epidemiological information obtained from parental questionnaires and post-mortem reports was examined, and data on cases ≥52 weeks compared with cases <52 weeks. RESULTS: SUDC accounted for 5% (n=44) of deaths in children aged 1-4 years during 1994-2008. During this period, the SIDS rate dropped from 0.71 to 0.34 per 1000 live births, while the SUDC rate increased from 0.08 to 0.18 deaths per 10 000 population aged 1-4 years. The median age of SUDC cases was 71.5 weeks, and the male/female ratio was 1.3:1. All died during a sleep period, 71% between 10pm and 8am, and more than two-thirds were found prone. Fewest cases occurred during July-September (11%), and a greater proportion occurred at weekends (55%). 52% (17/33) had symptoms (any) in the 48 h before death, and 35% (11/31) visited their general practitioner because of illness in the week preceding death. SUDC differed from SIDS in prevalence of maternal smoking (38% vs 72%, p<0.001), bed-sharing (17% vs 49%, p<0.001), and whether found prone (72% vs 23%, p<0.001). CONCLUSION: While SUDC shares some characteristics with SIDS, there are also some important differences. Further data collection will help determine whether SIDS and SUDC represent the same pathophysiological entity. Standardisation of protocols for investigating sudden deaths is urgently required for accurate diagnosis of cases.