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Earth is heading towards a climate that last existed more than three million years ago (Ma) during the ‘mid-Pliocene warm period’ 1 , when atmospheric carbon dioxide concentrations were about 400 parts per million, global sea level oscillated in response to orbital forcing 2 , 3 and peak global-mean sea level (GMSL) may have reached about 20 metres above the present-day value 4 , 5 . For sea-level rise of this magnitude, extensive retreat or collapse of the Greenland, West Antarctic and marine-based sectors of the East Antarctic ice sheets is required. Yet the relative amplitude of sea-level variations within glacial–interglacial cycles remains poorly constrained. To address this, we calibrate a theoretical relationship between modern sediment transport by waves and water depth, and then apply the technique to grain size in a continuous 800-metre-thick Pliocene sequence of shallow-marine sediments from Whanganui Basin, New Zealand. Water-depth variations obtained in this way, after corrections for tectonic subsidence, yield cyclic relative sea-level (RSL) variations. Here we show that sea level varied on average by 13 ± 5 metres over glacial–interglacial cycles during the middle-to-late Pliocene (about 3.3–2.5 Ma). The resulting record is independent of the global ice volume proxy 3 (as derived from the deep-ocean oxygen isotope record) and sea-level cycles are in phase with 20-thousand-year (kyr) periodic changes in insolation over Antarctica, paced by eccentricity-modulated orbital precession 6 between 3.3 and 2.7 Ma. Thereafter, sea-level fluctuations are paced by the 41-kyr period of cycles in Earth’s axial tilt as ice sheets stabilize on Antarctica and intensify in the Northern Hemisphere 3 , 6 . Strictly, we provide the amplitude of RSL change, rather than absolute GMSL change. However, simulations of RSL change based on glacio-isostatic adjustment show that our record approximates eustatic sea level, defined here as GMSL unregistered to the centre of the Earth. Nonetheless, under conservative assumptions, our estimates limit maximum Pliocene sea-level rise to less than 25 metres and provide new constraints on polar ice-volume variability under the climate conditions predicted for this century. Sea level varied by 13 ± 5 metres on average, but up to 25 metres, over glacial–interglacial cycles during the Pliocene epoch, due to partial collapses of Antarctic Ice Sheets.

The Pliocene and Early Pleistocene, between 5.3 and 0.8 million years ago, span a transition from a global climate state that was 2–3 °C warmer than present with limited ice sheets in the Northern Hemisphere to one that was characterized by continental-scale glaciations at both poles. Growth and decay of these ice sheets was paced by variations in the Earth’s orbit around the Sun. However, the nature of the influence of orbital forcing on the ice sheets is unclear, particularly in light of the absence of a strong 20,000-year precession signal in geologic records of global ice volume and sea level. Here we present a record of the rate of accumulation of iceberg-rafted debris offshore from the East Antarctic ice sheet, adjacent to the Wilkes Subglacial Basin, between 4.3 and 2.2 million years ago. We infer that maximum iceberg debris accumulation is associated with the enhanced calving of icebergs during ice-sheet margin retreat. In the warmer part of the record, between 4.3 and 3.5 million years ago, spectral analyses show a dominant periodicity of about 40,000 years. Subsequently, the powers of the 100,000-year and 20,000-year signals strengthen. We suggest that, as the Southern Ocean cooled between 3.5 and 2.5 million years ago, the development of a perennial sea-ice field limited the oceanic forcing of the ice sheet. After this threshold was crossed, substantial retreat of the East Antarctic ice sheet occurred only during austral summer insolation maxima, as controlled by the precession cycle. The volume of the East Antarctic ice sheet is influenced by changes in the Earth’s orbit. Ice-rafted debris accumulation between 4.3 and 2.2 million years ago suggests precession affected the extent of the marine margins of the ice sheet.

A range of future climate scenarios are projected for high atmospheric CO2 concentrations, given uncertainties over future human actions as well as potential environmental and climatic feedbacks. The geological record offers an opportunity to understand climate system response to a range of forcings and feedbacks which operate over multiple temporal and spatial scales. Here, we examine a single interglacial during the late Pliocene (KM5c, ca. 3.205±0.01 Ma) when atmospheric CO2 exceeded pre-industrial concentrations, but were similar to today and to the lowest emission scenarios for this century. As orbital forcing and continental configurations were almost identical to today, we are able to focus on equilibrium climate system response to modern and near-futureCO2. Using proxy data from 32 sites, we demonstrate that global mean sea-surface temperatures were warmer than pre-industrial values, by ∼2.3 ∘C for the combined proxy data (foraminifera Mg/Ca and alkenones), or by ∼3.2–3.4 ∘C (alkenones only). Compared to the pre-industrial period, reduced meridional gradients and enhanced warming in the North Atlantic are consistently reconstructed. There is broad agreement between data and models at the global scale, with regional differences reflecting ocean circulation and/or proxy signals. An uneven distribution of proxy data in time and space does, however, add uncertainty to our anomaly calculations. The reconstructed global mean sea-surface temperature anomaly for KM5c is warmer than all but three of the PlioMIP2 model outputs, and the reconstructed North Atlantic data tend to align with the warmest KM5c model values. Our results demonstrate that even under low-CO2 emission scenarios, surface ocean warming may be expected to exceed model projections and will be accentuated in the higher latitudes.

Based on Nationally Determined Contributions concurrent with Shared Socioeconomic Pathways (SSPs) 2-4.5, the IPCC predicts global warming of 2.1–3.5 ∘C (very likely range 10–90th percentile) by 2100 CE. However, global average temperature is a poor indicator of regional warming and global climate models (GCMs) require validation with instrumental or proxy data from geological archives to assess their ability to simulate regional ocean and atmospheric circulation, and thus, to evaluate their performance for regional climate projections. The south-west Pacific is a region that performs poorly when GCMs are evaluated against instrumental observations. The New Zealand Earth System Model (NZESM) was developed from the United Kingdom Earth System Model (UKESM) to better understand south-west Pacific response to global change, by including a nested ocean grid in the south-west Pacific with 80 % greater horizontal resolution than the global-scale host. Here, we reconstruct regional south-west Pacific sea-surface temperatures (SSTs) for the mid-Pliocene warm period (mPWP; 3.3–3.0 Ma), which has been widely considered a past analogue with an equilibrium surface temperature response of +3 ∘C to an atmospheric CO2 concentration of ∼350–400 ppm, in order to assess the warming distribution in the south-west Pacific. This study presents proxy SSTs from seven deep sea sediment cores distributed across the south-west Pacific. Our reconstructed SSTs are derived from molecular biomarkers preserved in the sediment – alkenones (i.e. U37K′ index) and isoprenoid glycerol dialkyl glycerol tetraethers (i.e. TEX86 index) – and are compared with SSTs reconstructed from the Last Interglacial (125 ka), Pliocene Model Intercomparison Project (PlioMIP) outputs and transient climate model projections (NZESM and UKESM) of low- to high-range SSPs for 2090–2099 CE. Mean interglacial equilibrium SSTs during the mPWP for the south-west Pacific sites were on average 4.2 ∘C (1.8–6.1 ∘C likely range) above pre-industrial temperatures and show good agreement with model outputs from NZESM and UKESM under mid-range SSP 2–4.6 conditions. These results highlight that not only is the mPWP an appropriate analogue when considering future temperature change in the centuries to come, but they also demonstrate that the south-west Pacific region will experience warming that exceeds that of the global mean if atmospheric CO2 remains above 350 ppm.

Early to Middle Miocene sea-level oscillations of approximately 40–60 m estimated from far-field records1,2,3 are interpreted to reflect the loss of virtually all East Antarctic ice during peak warmth2. This contrasts with ice-sheet model experiments suggesting most terrestrial ice in East Antarctica was retained even during the warmest intervals of the Middle Miocene4,5. Data and model outputs can be reconciled if a large West Antarctic Ice Sheet (WAIS) existed and expanded across most of the outer continental shelf during the Early Miocene, accounting for maximum ice-sheet volumes. Here we provide the earliest geological evidence proving large WAIS expansions occurred during the Early Miocene (~17.72–17.40 Ma). Geochemical and petrographic data show glacimarine sediments recovered at International Ocean Discovery Program (IODP) Site U1521 in the central Ross Sea derive from West Antarctica, requiring the presence of a WAIS covering most of the Ross Sea continental shelf. Seismic, lithological and palynological data reveal the intermittent proximity of grounded ice to Site U1521. The erosion rate calculated from this sediment package greatly exceeds the long-term mean, implying rapid erosion of West Antarctica. This interval therefore captures a key step in the genesis of a marine-based WAIS and a tipping point in Antarctic ice-sheet evolution

The West Antarctic Ice Sheet (WAIS) presently holds enough ice to raise global sea level by 4.3 m if completely melted. The unknown response of the WAIS to future warming remains a significant challenge for numerical models in quantifying predictions of future sea level rise. Sea level rise is one of the clearest planet-wide signals of human-induced climate change. The Sensitivity of the West Antarctic Ice Sheet to a Warming of 2 ∘C (SWAIS 2C) Project aims to understand past and current drivers and thresholds of WAIS dynamics to improve projections of the rate and size of ice sheet changes under a range of elevated greenhouse gas levels in the atmosphere as well as the associated average global temperature scenarios to and beyond the +2 ∘C target of the Paris Climate Agreement. Despite efforts through previous land and ship-based drilling on and along the Antarctic margin, unequivocal evidence of major WAIS retreat or collapse and its causes has remained elusive. To evaluate and plan for the interdisciplinary scientific opportunities and engineering challenges that an International Continental Drilling Program (ICDP) project along the Siple coast near the grounding zone of the WAIS could offer (Fig. 1), researchers, engineers, and logistics providers representing 10 countries held a virtual workshop in October 2020. This international partnership comprised of geologists, glaciologists, oceanographers, geophysicists, microbiologists, climate and ice sheet modelers, and engineers outlined specific research objectives and logistical challenges associated with the recovery of Neogene and Quaternary geological records from the West Antarctic interior adjacent to the Kamb Ice Stream and at Crary Ice Rise. New geophysical surveys at these locations have identified drilling targets in which new drilling technologies will allow for the recovery of up to 200 m of sediments beneath the ice sheet. Sub-ice-shelf records have so far proven difficult to obtain but are critical to better constrain marine ice sheet sensitivity to past and future increases in global mean surface temperature up to 2 ∘C above pre-industrial levels. Thus, the scientific and technological advances developed through this program will enable us to test whether WAIS collapsed during past intervals of warmth and determine its sensitivity to a +2 ∘C global warming threshold (UNFCCC, 2015).

Isavuconazole is a novel triazole with broad-spectrum antifungal activity. The SECURE trial assessed efficacy and safety of isavuconazole versus voriconazole in patients with invasive mould disease. This was a phase 3, double-blind, global multicentre, comparative-group study. Patients with suspected invasive mould disease were randomised in a 1:1 ratio using an interactive voice–web response system, stratified by geographical region, allogeneic haemopoietic stem cell transplantation, and active malignant disease at baseline, to receive isavuconazonium sulfate 372 mg (prodrug; equivalent to 200 mg isavuconazole; intravenously three times a day on days 1 and 2, then either intravenously or orally once daily) or voriconazole (6 mg/kg intravenously twice daily on day 1, 4 mg/kg intravenously twice daily on day 2, then intravenously 4 mg/kg twice daily or orally 200 mg twice daily from day 3 onwards). We tested non-inferiority of the primary efficacy endpoint of all-cause mortality from first dose of study drug to day 42 in patients who received at least one dose of the study drug (intention-to-treat [ITT] population) using a 10% non-inferiority margin. Safety was assessed in patients who received the first dose of study drug. This study is registered with ClinicalTrials.gov, number NCT00412893. 527 adult patients were randomly assigned (258 received study medication per group) between March 7, 2007, and March 28, 2013. All-cause mortality from first dose of study drug to day 42 for the ITT population was 19% with isavuconazole (48 patients) and 20% with voriconazole (52 patients), with an adjusted treatment difference of −1·0% (95% CI −7·8 to 5·7). Because the upper bound of the 95% CI (5·7%) did not exceed 10%, non-inferiority was shown. Most patients (247 [96%] receiving isavuconazole and 255 [98%] receiving voriconazole) had treatment-emergent adverse events (p=0·122); the most common were gastrointestinal disorders (174 [68%] vs 180 [69%]) and infections and infestations (152 [59%] vs 158 [61%]). Proportions of patients with treatment-emergent adverse events by system organ class were similar overall. However, isavuconazole-treated patients had a lower frequency of hepatobiliary disorders (23 [9%] vs 42 [16%]; p=0·016), eye disorders (39 [15%] vs 69 [27%]; p=0·002), and skin or subcutaneous tissue disorders (86 [33%] vs 110 [42%]; p=0·037). Drug-related adverse events were reported in 109 (42%) patients receiving isavuconazole and 155 (60%) receiving voriconazole (p<0·001). Isavuconazole was non-inferior to voriconazole for the primary treatment of suspected invasive mould disease. Isavuconazole was well tolerated compared with voriconazole, with fewer study-drug-related adverse events. Our results support the use of isavuconazole for the primary treatment of patients with invasive mould disease. Astellas Pharma Global Development, Basilea Pharmaceutica International.

Coral reefs around the world are undergoing severe decline in the past few decades. Mass coral mortalities have predominantly been reported to be caused by coral bleaching or disease outbreaks. Temporary hypoxic conditions caused by algal blooms can trigger mass coral mortalities though are reported rarely. In this study in Gulf of Mannar (GoM), southeast India, we report a significant coral mortality caused by a bloom of the ciguatoxic dinoflagellate Noctiluca scintillans during September–October 2019. Dissolved oxygen levels declined below 2 mg l −1 during the bloom causing temporary hypoxia and mortality (up to 71.23%) in the fast growing coral genera Acropora , Montipora and Pocillopora . Due to global climate change, more frequent and larger algal blooms are likely in the future. Hence, it is likely that shallow water coral reefs will be affected more frequently by episodic hypoxic conditions driven by algal blooms. More studies are, however, required to understand the mechanism of coral mortality due to algal blooms, impacts on community composition and the potential for subsequent recovery.

In a trial involving 1033 patients hospitalized with Covid-19, the addition of baricitinib to remdesivir was associated with shorter recovery time, particularly among patients receiving high-flow oxygen, and with a 30% higher odds of improvement at day 15 than remdesivir alone. Adverse events were less frequent with the combination therapy.