Glacier mass loss is recognized as a major contributor to current sea level rise. However, large uncertainties remain in projections of glacier mass loss on global and regional scales. We present an ...ensemble of 288 glacier mass and area change projections for the 21st century based on 11 glacier models using up to 10 general circulation models and four Representative Concentration Pathways (RCPs) as boundary conditions. We partition the total uncertainty into the individual contributions caused by glacier models, general circulation models, RCPs, and natural variability. We find that emission scenario uncertainty is growing throughout the 21st century and is the largest source of uncertainty by 2100. The relative importance of glacier model uncertainty decreases over time, but it is the greatest source of uncertainty until the middle of this century. The projection uncertainty associated with natural variability is small on the global scale but can be large on regional scales. The projected global mass loss by 2100 relative to 2015 (79 ± 56 mm sea level equivalent for RCP2.6, 159 ± 86 mm sea level equivalent for RCP8.5) is lower than, but well within, the uncertainty range of previous projections.
Plain Language Summary
Melting glaciers (outside the large ice sheets in Greenland and Antarctica) contribute strongly to rising sea level and are expected to continue to do so throughout this century. However, the amount of future sea level rise from glaciers is not well known. One of the causes for uncertainty is the lack of knowledge of future greenhouse gas emissions. This uncertainty is growing steadily during the 21st century and constitutes the most important uncertainty by 2100. Another cause of uncertainty are the glacier models themselves, since they rely on approximations and simplifications of complex glacier processes. This uncertainty is very important until the middle of the 21st century, but less important in the second half of the 21st century. Overall, glaciers will lose around 18 % of their ice mass in a low‐emission scenario, or around 36 % in a high‐emission scenario, contributing roughly 79 or 159 mm to sea level rise by 2100.
Key Points
Glacier melt will contribute between 79 ± 56 (RCP2.6) and 159 ± 86 mm (RCP8.5) to sea level rise during 2015–2100
Until the mid‐21st century, disagreement between glacier models dominates the uncertainty
At the end of the 21st century, differing emission pathway choices made by human societies dominate the uncertainty
This study examines how growth in the population of former prisoners affects rates of communicable diseases such as tuberculosis, syphilis, chlamydia, and HIV.
We estimate state-level fixed effects ...count models showing how the former prisoner population affected communicable disease in U.S. states from 1987 to 2010, a period of dramatic growth in incarceration.
We find contingent effects, based on how specific diseases are recognized, tested, and treated in prisons. The rate of former prisoners increases diseases that are poorly addressed in the prison health care system (e.g., chlamydia), but decreases diseases that are routinely tested and treated (e.g., tuberculosis). For HIV, the relationship has shifted in response to specific treatment mandates and protocols. Data on prison healthcare spending tracks these contingencies.
Improving the health of prisoners can improve the health of the communities to which they return. We consider these results in light of the relative quality of detection and treatment available to underserved populations within and outside prisons.
•We examine the effects of incarceration on population health.•These effects depend on how specific diseases are recognized, tested, and treated.•High incarceration can increase incidence of diseases that prisons fail to address (e.g., chlamydia).•High incarceration can decrease incidence of diseases that prisons routinely test and Treat (e.g., TB).•Data on prison healthcare spending tracks the contingent effects of incarceration on community health.
We assess the effect of enhanced basal sliding on the flow and mass budget of the Greenland ice sheet, using a newly developed parameterization of the relation between meltwater runoff and ice flow. ...A wide range of observations suggest that water generated by melt at the surface of the ice sheet reaches its bed by both fracture and drainage through moulins. Once at the bed, this water is likely to affect lubrication, although current observations are insufficient to determine whether changes in subglacial hydraulics will limit the potential for the speedup of flow. An uncertainty analysis based on our best-fit parameterization admits both possibilities: continuously increasing or bounded lubrication. We apply the parameterization to four higher-order ice-sheet models in a series of experiments forced by changes in both lubrication and surface mass budget and determine the additional mass loss brought about by lubrication in comparison with experiments forced only by changes in surface mass balance. We use forcing from a regional climate model, itself forced by output from the European Centre Hamburg Model (ECHAM5) global climate model run under scenario A1B. Although changes in lubrication generate widespread effects on the flow and form of the ice sheet, they do not affect substantial net mass loss; increase in the ice sheet’s contribution to sea-level rise from basal lubrication is projected by all models to be no more than 5% of the contribution from surface mass budget forcing alone.
Successful adaptation to climate change at regional scales can often depend on understanding the nature of geomorphological responses to climate change at those scales. Here we use evidence from ...landscapes which are known to be environmentally sensitive to show that geomorphological change in response to shifts in climate can be highly nonlinear. Our study sites are two mountain massifs on the western coast of Ireland. Both sites have similar geological and Pleistocene glacial histories and are similar topographically, geomorphologically and in their climate histories. We show that despite these similarities their response to late Holocene, climate change has differed. Both massifs have responded to short-term climate changes over the last 4500 years that are considered to have been uniform across the region, but these climate changes have resulted in highly differentiated and nonlinear landscape responses. We argue this reflects nonlinearity in the forcing–response processes at such scales and suggests that current approaches to modelling the response of such systems to future climate change using numerical climate models may not accurately capture the landscape response. We end by discussing some of the implications for obtaining decision-relevant predictions of landscape responses to climatic forcing and for climate change adaptation and planning, using regional climate models.
Abstract Context Clinicians often feel challenged by the need to deliver difficult prognostic information to patients with a life-limiting illness while, at the same time, support their hopes. Few ...studies have examined nurses' perspectives on their roles in meeting these patient and family needs. Objectives Our objectives were to 1) describe nurses' perspectives on meeting patients' needs for hope and illness information and 2) offer insights for interventions designed to improve communication about end-of-life care for patients and their families. Methods Using experienced interviewers, we conducted one-on-one, semistructured interviews with 22 nurses caring for patients with advanced chronic obstructive pulmonary disease or cancer. Interviews were analyzed using a limited application of grounded theory. Results Three themes emerged: 1) Nurses support patients' hopes by understanding individual aspects of these hopes, focusing on patient's quality of life, and building trust with patients; 2) Nurses provide prognostic information by assessing what the patient knows and following their lead. Nurses report doing these two activities independently; and 3) Nurses identify activities associated with the provision of prognostic information that required collaboration with physicians. Important barriers that complicate effective discussion of prognosis with patients and families were identified. Conclusions Nurses describe behaviors that are useful when meeting patients' and families' needs for hope and which they are comfortable implementing in practice, without collaboration with other clinicians. By contrast, most behaviors related to meeting patients' and families' needs regarding prognostic information are completed collaboratively with physicians. These findings provide insight for the development of interdisciplinary interventions targeting communication around end-of-life care.
Assessing the extent to which glacial lake outburst floods (GLOFs) are increasing in frequency in modern times and whether their incidence is driven by anthropogenic climate change requires ...historical context. However, progress on this issue is hampered by incomplete GLOF inventories, especially in remote mountain regions. Here, we exploit high-resolution, multi-temporal satellite and aerial imagery, and documentary data to identify GLOF events across the glacierized Cordilleras of Peru and Bolivia, using a set of diagnostic geomorphic features. A total of 160 GLOFs from 151 individual sites are characterised and analysed, tripling the number of previously reported events. We provide statistics on location, magnitude, timing and characteristics of these events with implications for regional GLOF hazard identification and assessment. Furthermore, we describe several cases in detail and document a wide range of process chains associated with Andean GLOFs.
•Our inventory consists of 160 glacial lake outburst floods (GLOFs).•About two thirds of these have not been identified previously in the literature.•We analyze spatial and temporal patterns of GLOF occurrence.•We characterize pre-conditions, triggers and mechanisms of GLOFs.
AIMS: Non-native shrubs are important invaders of the Eastern Deciduous Forest, dramatically altering forest structure and functioning. Study of invasion mechanisms in this system has emphasized ...aboveground processes, and plant-soil feedbacks are relatively unexplored as a mechanism of shrub dominance. We tested whether plant-soil feedback in this habitat is affected by competition and whether arbuscular mycorrhizal fungi (AMF) are involved in plant-soil feedback. METHODS: We used a standard two-phase plant-soil feedback experiment run concurrently for each of three invasive shrub species, measuring feedback effects on AMF colonization, aboveground biomass, and the responses of native plant species in greenhouse mesocosms. RESULTS: Lonicera maackii and Ligustrum vulgare reduced AMF colonization of native roots, both with legacy effects (prior growth in soil) and direct effects (current growth in soil). Elaeagnus umbellata grown with natives left a legacy of increased AMF colonization of native communities. CONCLUSIONS: Our results suggest that woody invasive species can alter the AMF associations of native plants even after the invasive is no longer present. Such consequences merit study with other native species and where environmental factors, such as light availability, might be expected to compound the effects of changes in AMF.
Palliative care in the intensive care unit (ICU) is an important focus for quality improvement.
To evaluate the effectiveness of a multi-faceted quality improvement intervention to improve palliative ...care in the ICU.
We performed a single-hospital, before-after study of a quality-improvement intervention to improve palliative care in the ICU. The intervention consisted of clinician education, local champions, academic detailing, feedback to clinicians, and system support. Consecutive patients who died in the ICU were identified pre- (n = 253) and postintervention (n = 337). Families completed Family Satisfaction in the Intensive Care Unit (FS-ICU) and Quality of Dying and Death (QODD) surveys. Nurses completed the QODD. The QODD and FS-ICU were scored from 0 to 100. We used Mann-Whitney tests to assess family results and hierarchical linear modeling for nurse results.
There were 590 patients who died in the ICU or within 24 hours of transfer; 496 had an identified family member. The response rate for family members was 55% (275 of 496) and for nurses, 89% (523/590). The primary outcome, the family QODD, showed a trend toward improvement (pre, 62.3; post, 67.1), but was not statistically significant (P = 0.09). Family satisfaction increased but not significantly. The nurse QODD showed significant improvement (pre, 63.1; post, 67.1; P < 0.01) and there was a significant reduction in ICU days before death (pre, 7.2; post, 5.8; P < 0.01).
We found no significant improvement in family-assessed quality of dying or in family satisfaction with care, we found but significant improvement in nurse-assessed quality of dying and reduction in ICU length of stay with an intervention to integrate palliative care in the ICU. Improving family ratings may require interventions that have more direct contact with family members.
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