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The central role of forests in climate change mitigation, as recognized in the Paris agreement, makes it increasingly important to develop and test methods for monitoring and evaluating the carbon effectiveness of REDD+. Over the last decade, hundreds of subnational REDD+ initiatives have emerged, presenting an opportunity to pilot and compare different approaches to quantifying impacts on carbon emissions. This study (1) develops a Before-After-Control-Intervention (BACI) method to assess the effectiveness of these REDD+ initiatives; (2) compares the results at the meso (initiative) and micro (village) scales; and (3) compares BACI with the simpler Before-After (BA) results. Our study covers 23 subnational REDD+ initiatives in Brazil, Peru, Cameroon, Tanzania, Indonesia and Vietnam. As a proxy for deforestation, we use annual tree cover loss. We aggregate data into two periods (before and after the start of each initiative). Analysis using control areas ('control-intervention') suggests better REDD+ performance, although the effect is more pronounced at the micro than at the meso level. Yet, BACI requires more data than BA, and is subject to possible bias in the before period. Selection of proper control areas is vital, but at either scale is not straightforward. Low absolute deforestation numbers and peak years influence both our BA and BACI results. In principle, BACI is superior, with its potential to effectively control for confounding factors. We conclude that the more local the scale of performance assessment, the more relevant is the use of the BACI approach. For various reasons, we find overall minimal impact of REDD+ in reducing deforestation on the ground thus far. Incorporating results from micro and meso level monitoring into national reporting systems is important, since overall REDD+ impact depends on land use decisions on the ground.

Climate change is expected to impact crop yields globally, with some regions benefiting from favorable conditions and CO2 fertilization, while others face adverse effects from altered precipitation and higher temperatures. Changes in crop yields can destabilize the global food system and pose challenges to food security. Moreover, crop production is crucial, as biofuels are becoming increasingly important contributors to climate change mitigation measures aimed at limiting global warming. This study uses the Integrated Model to Assess the Global Environment integrated assessment model framework to analyze different indicators related to food security and climate change mitigation under varying climate change impacts on crop yields. Twelve spatially explicit crop productivity projections were taken from the full archive of the Global Gridded Crop Model Intercomparison of 120 climate-crop model combinations, forced by CMIP6-based climate scenarios. The selection includes two average-performing climate-crop model combinations, two pessimistic combinations that perform one standard deviation below the mean, and two optimistic model combinations that perform one standard deviation above the mean. To single out the effect of climate change on productivity changes, we drew samples from two representative concentration pathways (RCP2.6 and RCP8.5). These productivity projections were applied within an otherwise uniform scenario (SSP2) and analyzed for their effect on total calorie demand, crop prices, and number of people at risk of undernourishment to quantify food security. Risks to climate change mitigation targets were explored by modeling the total bioenergy supply, emissions, and global mean temperature. The results revealed significant differences in the risk of food security and mitigation potential between different regions and climate change scenarios. Across scenarios, the crop area extent can vary up to 2 million km2 due to changing crop yields. The projected change in global hunger ranges from 60 to 160 million undernourished people, indicating uncertainty between climate and crop model combinations. Low-income regions are especially impacted because of their high sensitivity to changes in food prices. Global climate change mitigation ambitions can also deviate by the latter part of the 21st century, as changes in yields will impact biofuel production as well as agriculture, forestry and other land use emissions. The quantitative insights generated by this study highlight the need for global policy efforts to make the agricultural system more adaptive to climate change to handle potential negative impacts.

The future of food and land systems is crucial for achieving multiple UN Sustainable Development Goals, given their essential role in providing adequate nutrition and their significant impact on Earth system processes. Despite widespread consensus on the need for transformation, discussed strategies vary widely, from technology-driven to sufficiency-focused approaches, emphasizing different agents of change and policy mixes. This study assesses the implications of a new generation of target-seeking scenarios incorporating such diverse sustainability perspectives. We apply two integrated assessment models to explore food and land futures under three whole-economy sustainable development pathways (SDPs): Economy-driven Innovation, Resilient Communities, and Managing the Global Commons. Our assessment shows that the SDPs align sufficient food supply with progress towards planetary integrity, halting biodiversity loss, mitigating adverse impacts from irrigation, and significantly reducing nitrogen pollution. While all SDPs comply with the Paris climate target, they diverge in the timing of climate mitigation efforts and focus on different greenhouse gases and emission sources. The Economy-driven Innovation pathway rapidly achieves net-negative CO2 emissions from the land system, whereas the pathways Resilient Communities and Managing the Global Commons significantly decrease agricultural non-CO2 emissions. Moreover, sustainability interventions attenuate trade-offs associated with narrowly focused mitigation scenarios and reduce reliance on carbon dioxide removal strategies like bioenergy with carbon capture and storage.

Currently, climate impacts are mostly absent in the analysis of process-based integrated assessment models (IAMs). This is becoming increasingly problematic given the fact that climate impacts are expected to influence both baseline developments as well as the capacity to mitigate and adapt in the future. This paper presents a set of scenarios made using the IAM IMAGE with climate change impacts on labor productivity and GDP, renewable energy supply, heating and cooling demand, food production, water availability, and biodiversity. The results show that these impacts can have significant effect on existing projections of the economic, energy and land system that are usually not included in IAM projections. In the current implementation, the aggregated economic impacts are often larger in size than sectoral feedbacks, such as those on energy supply and demand, GHG emissions, and food consumption. Importantly, we find that there are several hotspot areas, including Western Africa, Indonesia and the Middle East, where multiple risks accumulate more than in other regions.

The UN sustainable development goals (SDGs) and the Paris climate target require a holistic transformation towards human well-being within planetary boundaries. However, there are growing debates on how to best pursue these targets. Proposed transformation strategies include market- and technology-driven green-growth, shifting towards a sufficiency-oriented post-growth economy, and a transformation driven primarily by strong government action. Here we quantify three alternative sustainable development pathways (SDPs), Economy-driven Innovation, Resilient Communities, and Managing the Global Commons, that reflect these different societal strategies. We compare the quantifications from two integrated assessment models and two sectoral models of the buildings and materials sectors across a broad set of indicators for sustainable development and climate action. Our global multi-scenario and multi-model analysis shows that all three SDPs enable substantial progress towards the human development goals of the SDGs. They simultaneously limit global warming and prevent further environmental degradation, with the sufficiency-oriented Resilient Communities scenario showing the lowest peak warming and lowest reliance on carbon dioxide removal as well as the largest improvements in biodiversity intactness. The SDPs also alleviate the concerns about the biogeophysical and technological feasibility of narrowly-focused climate change mitigation scenarios. However, the shifts in energy and food consumption patterns assumed in the SDPs, ranging from moderate in Economy-driven Innovation to very ambitious in Resilient Communities, also lead to increased challenges regarding socio-cultural feasibility.

The central role of forests in climate change mitigation, as recognized in the Paris agreement, makes it increasingly important to develop and test methods for monitoring and evaluating the carbon efectiveness of REDD+. Over the last decade, hundreds of subnational REDD+ initiatives have emerged, presenting an opportunity to pilot and compare diferent approaches to quantifying impacts on carbon emissions. This study (1) develops a BACI method to assess the efectiveness of these REDD+ initiatives; (2) compares the results at the meso (initiative) and micro (village) scales; and (3) compares BACI with the simpler BA results. Our study covers 23 subnational REDD+ initiatives in Brazil, Peru, Cameroon, Tanzania, Indonesia and Vietnam. As a proxy for deforestation, we use annual tree cover loss. We aggregate data into two periods (before and after the start of each initiative). Analysis using control areas (“control-intervention”) suggests better REDD+ performance, although the efect is more pronounced at the micro than at the meso level. Yet, BACI requires more data than BA, and is subject to possible bias in the before period. Selection of proper control areas is vital, but at either scale is not straightforward. Low absolute deforestation numbers and peak years infuence both our BA and BACI results. In principle, BACI is superior, with its potential to efectively control for confounding factors. We conclude that the more local the scale of performance assessment, the more relevant is the use of the BACI approach. For various reasons, we end overall minimal impact of REDD+ in reducing deforestation on the ground thus far. Incorporating results from micro and meso level monitoring into national reporting systems is important, since overall REDD+ impact depends on land use decisions on the ground.

Vection, a feeling of self-motion while being physically stationary, and postural sway can be modulated by various visual factors. Moreover, vection and postural sway are often found to be closely related when modulated by such visual factors, suggesting a common neural mechanism. One well-known visual factor is the depth order of the stimulus. The density, i.e. number of objects per unit area, is proposed to interact with the depth order in the modulation of vection and postural sway, which has only been studied to a limited degree. We therefore exposed 17 participants to 18 different stimuli containing a stationary pattern and a pattern rotating around the naso-occipital axis. The density of both patterns was varied between 10 and 90%; the densities combined always added up to 100%. The rotating pattern occluded or was occluded by the stationary pattern, suggesting foreground or background motion, respectively. During pattern rotation participants reported vection by pressing a button, and postural sway was recorded using a force plate. Participants always reported more vection and swayed significantly more when rotation was perceived in the background and when the rotating pattern increased in density. As hypothesized, we found that the perceived depth order interacted with pattern density. A pattern rotating in the background with a density between 60 and 80% caused significantly more vection and postural sway than when it was perceived to rotate in the foreground. The findings suggest that the ratio between fore- and background pattern densities is an important factor in the interaction with the depth order, and it is not the density of rotating pattern per se. Moreover, the observation that vection and postural sway were modulated in a similar way points towards a common neural origin regulating both variables.

To describe the delivery of care for patients with rheumatic and musculoskeletal diseases (RMDs) from the perspective of rheumatologists in the Netherlands during the first months of the COVID-19 pandemic. A mixed methods design was used with quantitative and qualitative data from a cross-sectional survey sent to all members of the Dutch Rheumatology Society in May 2020. The survey contained questions on demographics, the current way of care delivery, and also on usage, acceptance, facilitators and barriers of telemedicine. Quantitative data were analyzed descriptively. The answers to the open questions were categorized into themes. Seventy-five respondents completed the survey. During the COVID-19 pandemic, continuity of care was guaranteed through telephone and video consultations by 99% and 9% of the respondents, respectively. More than 80% of the total number of outpatient visits were performed exclusively via telephone with in-person visits only on indication. One-quarter of the respondents used patient reported outcomes to guide telephone consultations. The top three facilitators for telemedicine were less travel time for patients, ease of use of the system and shorter waiting period for patients. The top three barriers were impossibility to perform physical examination, difficulty estimating how the patient is doing and difficulty in reaching patients. During the COVID-19 epidemic, care for patients with RMDs in the Netherlands continued uninterrupted by the aid of telemedicine. On average, respondents were content with current solutions, although some felt insecure mainly because of the inability to perform physical examination and missing nonverbal communication with their patients.

Advances in therapeutic approaches for melanoma urge the need for biomarkers that can identify patients at risk for recurrence and to guide treatment. The potential use of liquid biopsies in identifying biomarkers is increasingly being recognized. Here, we present a head‐to‐head comparison of several techniques to analyze circulating tumor cells (CTCs) and cell‐free DNA (cfDNA) in 20 patients with metastatic melanoma. In this study, we investigated whether diagnostic leukapheresis (DLA) combined with multimarker flow cytometry (FCM) increased the detection of CTCs in blood compared to the CellSearch platform. Additionally, we characterized cfDNA at the level of somatic mutations, extent of aneuploidy and genome‐wide DNA methylation. Both CTCs and cfDNA measures were compared to tumor markers and extracranial tumor burden on radiological imaging. Compared to the CellSearch method applied on peripheral blood, DLA combined with FCM increased the proportion of patients with detectable CTCs from 35% to 70% (P = 0.06). However, the median percentage of cells that could be recovered by the DLA procedure was 29%. Alternatively, cfDNA mutation and methylation analysis detected tumor load in the majority of patients (90% and 93% of samples successfully analyzed, respectively). The aneuploidy score was positive in 35% of all patients. From all tumor measurements in blood, lactate dehydrogenase (LDH) levels were significantly correlated to variant allele frequency (P = 0.004). Furthermore, the presence of CTCs in DLA was associated with tumor burden (P < 0.001), whereas the presence of CTCs in peripheral blood was associated with number of lesions on radiological imaging (P < 0.001). In conclusion, DLA tended to increase the proportion of patients with detectable CTCs but was also associated with low recovery. Both cfDNA and CTCs were correlated with clinical parameters such as LDH levels and extracranial tumor burden. This study provides a comprehensive analysis of liquid biopsies in patients with melanoma, an aggressive form of skin cancer. We profiled cfDNA using these various genetic and epigenetic approaches and we subsequently compared cfDNA to circulating tumor cells with the aim to increase the sensitivity of blood‐based tumor detection.

Vestibular patients occasionally report aggravation or triggering of their symptoms by visual stimuli, which is called visual vestibular mismatch (VVM). These patients therefore experience discomfort, disorientation, dizziness and postural unsteadiness. Firstly, we aimed to get a better insight in the underlying mechanism of VVM by examining perceptual and postural symptoms. Secondly, we wanted to investigate whether roll-motion is a necessary trait to evoke these symptoms or whether a complex but stationary visual pattern equally provokes them. Nine VVM patients and healthy matched control group were examined by exposing both groups to a stationary stimulus as well as an optokinetic stimulus rotating around the naso-occipital axis for a prolonged period of time. Subjective visual vertical (SVV) measurements, posturography and relevant questionnaires were assessed. No significant differences between both groups were found for SVV measurements. Patients always swayed more and reported more symptoms than healthy controls. Prolonged exposure to roll-motion caused in patients and controls an increase in postural sway and symptoms. However, only VVM patients reported significantly more symptoms after prolonged exposure to the optokinetic stimulus compared to scores after exposure to a stationary stimulus. VVM patients differ from healthy controls in postural and subjective symptoms and motion is a crucial factor in provoking these symptoms. A possible explanation could be a central visual-vestibular integration deficit, which has implications for diagnostics and clinical rehabilitation purposes. Future research should focus on the underlying central mechanism of VVM and the effectiveness of optokinetic stimulation in resolving it.