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Despite a keen awareness of climate change, northern Indigenous Peoples have had limited participation in climate-change science due to limited access, power imbalances, and differences in worldview. A western science emphasis on facts and an indigenous emphasis on relationships to spiritual and biophysical components indicate important but distinct contributions that each knowledge system can make. Indigenous communities are experiencing widespread thawing of permafrost and coastal erosion exacerbated by loss of protective sea ice. These climate-induced changes threaten village infrastructure, water supplies, health, and safety. Climate-induced habitat changes associated with loss of sea ice and with landscape drying and extensive wildfires interact with northern development to bring both economic opportunities and environmental impacts. A multi-pronged approach to broadening indigenous participation in climate-change research should: 1) engage communities in designing climate-change solutions; 2) create an environment of mutual respect for multiple ways of knowing; 3) directly assist communities in achieving their adaptation goals; 4) promote partnerships that foster effective climate solutions from both western and indigenous perspectives; and 5) foster regional and international networking to share climate solutions.

Issue Title: Climatic Change Letters | Edited by Michael Oppenheimer | pages 281-290

Dr. Nancy Maynard was invited by the Alaska Forum on the Environment to participate in a Panel Discussion to discuss (1) background about what the US NCA and International IPCC assessments are, (2) the impact the assessments have on policy-making, (3) the process for participation in both assessments, (4) how we can increase participation by Indigenous Peoples such as Native Americans and Alaska Natives, (5) How we can increase historical and current impacts input from Native communities through stories, oral history, \"grey\" literature, etc. The session will be chaired by Dr. Bull Bennett, a cochair of the US NCA's chapter on \"Native and Tribal Lands and Resources\" and Dr. Maynard is the other co-chair of that chapter and they will discuss the latest activities under the NCA process relevant to Native Americans and Alaska Natives. Dr. Maynard is also a Lead Author of the \"Polar Regions\" chapter of the IPCC WG2 (5th Assessment) and she will describes some of the latest approaches by the IPCC to entrain more Indigenous peoples into the IPCC process.

Despite a keen awareness of climate change, northern Indigenous Peoples have had limited participation in climate-change science due to limited access, power imbalances, and differences in worldview. A western science emphasis on facts and an indigenous emphasis on relationships to spiritual and biophysical components indicate important but distinct contributions that each knowledge system can make. Indigenous communities are experiencing widespread thawing of permafrost and coastal erosion exacerbated by loss of protective sea ice. These climate-induced changes threaten village infrastructure, water supplies, health, and safety. Climate-induced habitat changes associated with loss of sea ice and with landscape drying and extensive wildfires interact with northern development to bring both economic opportunities and environmental impacts. A multi-pronged approach to broadening indigenous participation in climate-change research should: 1) engage communities in designing climate-change solutions; 2) create an environment of mutual respect for multiple ways of knowing; 3) directly assist communities in achieving their adaptation goals; 4) promote partnerships that foster effective climate solutions from both western and indigenous perspectives; and 5) foster regional and international networking to share climate solutions.

The number of diatom valves and fragments per gram of surface sediment in the Atlantic Ocean accurately reflects diatom abundance in the overlying waters, without any evidence of significant lateral drift during settling to the sea bottom. The distribution pattern of the number of resting spores per gram is similar to that for the whole and fragmented diatom valves. Fresh water diatoms and opal phytoliths are abundant in the sediments off the west coast of Africa where they have been deposited by the Trade Winds. Despite the relatively small number of core tops analyzed, the abundance and distribution patterns of diatoms in the sediments exhibit striking similarities to the patterns of primary productivity, phosphates, and annual production of silica in suspension in surface waters. Areas with high phosphate values and primary productivity and, therefore, areas of upwelling can be inferred from the quantitative distribution of diatoms in the sediments. Q-mode factor analysis, based on the abundance of forty-two species in thirty-seven core tops, produced six diatom species assemblages whose distributions provide additional information on the positions of certain water masses and major currents. Since the data on the quantitative distribution of diatom valves as well as on the diatom assemblages in the sediments of the Atlantic Ocean today allow prediction of certain water mass characteristics and circulation patterns of the overlying waters, they therefore, permit the reconstruction of paleoceanographic circulation patterns in ancient Atlantic Oceans, using the diatom distribution in sediments from dated horizons.

Maynard reviews \"Biodiversity and Human Health\" edited by Francesca Grifo and Joshua Rosenthal.

Traditional value assessment frameworks are challenged in comprehensively assessing the societal value new therapies bring to individuals with rare, progressive, genetic, fatal, neuromuscular diseases such as Duchenne muscular dystrophy (DMD). The objective of this study was to identify how value assessment frameworks may need to be adapted to measure the value to society of DMD therapies. Three stakeholder groups (6 patient advocates, 4 clinicians, 3 health economists; N = 13) participated in semi-structured interviews around the International Society for Pharmacoeconomics and Outcomes Research's Value Flower, which includes elements to consider within value assessments of healthcare technologies. All stakeholders agreed that traditional value assessment frameworks based on the quality-adjusted life year (QALY) are narrow and will undervalue new DMD therapies. All stakeholders expressed some level of concern that using the QALY as a key metric of value discriminates against patients with severe progressive diseases and disabilities. Some stakeholders saw value in using the QALY for cross-disease comparisons in resource-constrained environments if the methodology was appropriate. All stakeholders recommended considering additional elements of value in decision-making around new DMD therapies. These elements reflect: economic and humanistic costs incurred by patients, caregivers, and families with Duchenne, such as indirect out-of-pocket costs, lost productivity, and family spillovers; meaningful attributes for individuals with disabilities and high unmet need, such as severity of disease, value of hope, and real option value; and factors that contribute to improvements in population health, such as insurance value, equity, and scientific spillovers. These findings highlight the need to expand traditional value assessment frameworks and take a holistic approach that incorporates the perspectives of individuals with Duchenne, caregivers, clinicians, and health economists when assessing the societal value of new DMD therapies. Broadening value assessment will prevent restricted or delayed access to therapies for individuals with Duchenne.

Abstract Rationale Primary treatment of obstructive sleep apnea can be accompanied by a persistence of excessive sleepiness despite adherence. Furthermore, effectiveness of sleep apnea treatment is limited by poor adherence. Currently available pharmacologic options for the treatment of sleepiness in this population are limited. Objectives To evaluate the efficacy and safety of solriamfetol (JZP-110), a selective dopamine and norepinephrine reuptake inhibitor with robust wake-promoting effects, for the treatment of excessive sleepiness in participants with obstructive sleep apnea with current or prior sleep apnea treatment. Methods This was a double-blind, randomized, placebo-controlled, parallel-group, 12-week trial comparing solriamfetol, 37.5, 75, 150, and 300 mg, with placebo. Measurements and Main Results Of 476 randomized participants, 459 were included in the prespecified efficacy analyses. Coprimary endpoints (Maintenance of Wakefulness Test sleep latency and Epworth Sleepiness Scale score) were met at all solriamfetol doses (P < 0.05), with dose-dependent effects observed at Week 1 maintained over the study duration. All doses except 37.5 mg resulted in higher percentages of participants reporting improvement on Patient Global Impression of Change (key secondary endpoint; P < 0.05). Adverse events were reported in 47.9% of placebo- and 67.9% of solriamfetol-treated participants; five participants experienced serious adverse events (two [1.7%] placebo, three [0.8%] solriamfetol); none were deemed related to study drug. The most common adverse events with solriamfetol were headache (10.1%), nausea (7.9%), decreased appetite (7.6%), anxiety (7.0%), and nasopharyngitis (5.1%). Conclusions Solriamfetol significantly increased wakefulness and reduced sleepiness in participants with obstructive sleep apnea and excessive sleepiness; most adverse events were mild or moderate in severity. Clinical trial registered with www.clinicaltrials.gov (NCT02348606) and www.eudract.ema.europa.eu (EudraCT 2014-005514-31).

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a multisystem illness characterized by substantial reduction in function accompanied by profound unexplained fatigue not significantly relieved by rest, post-exertional malaise, and other symptoms. Reduced natural killer (NK) cell count and cytotoxicity has been investigated as a biomarker for ME/CFS, but few clinical laboratories offer the test and multi-site verification studies have not been conducted. We determined NK cell counts and cytotoxicity in 174 (65%) ME/CFS, 86 (32%) healthy control (HC) and 10 (3.7%) participants with other fatigue associated conditions (ill control [IC]) from the Multi-Site Clinical Assessment of ME/CFS (MCAM) study using an assay validated for samples shipped overnight instead of testing on day of venipuncture. We found a large variation in percent cytotoxicity [mean and (IQR) for ME/CFS and HC respectively, 34.1% (IQR 22.4-44.3%) and 33.6% (IQR 22.9-43.7%)] and no statistically significant differences between patients with ME/CFS and HC (p-value = 0.79). Analysis stratified on illness domain measured with standardized questionnaires did not identify an association of NK cytotoxicity with domain scores. Among all participants, NK cytotoxicity was not associated with survey results of physical and mental well-being, or health factors such as history of infection, obesity, smoking, and co-morbid conditions. These results indicate this assay is not ready for clinical implementation and studies are needed to further explore immune parameters that may be involved in the pathophysiology of ME/CFS.