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A chronic Kidney Disease of unknown etiology (CKDu) has emerged with disproportionately high prevalence across dry lowland agricultural communities globally. Here we present the results of a prospective cohort of 293 patients with CKDu in the endemic region of Wilgamuwa, Sri Lanka, in whom we measured baseline kidney function and undertook quarterly follow up over 2 years. Well water was the primary historic drinking water source in the region, although a majority (68%) of participants reported switching to reverse osmosis water during study follow ups. Participants who reported ever drinking from well water had estimated glomerular filtration rates −6.7 (SD: 2.8) ml/min/1.73 m 2 lower than participants who did not drink from well water historically ( p  = 0.0184) during the study period. Geospatial analysis identifies a cluster within the region where CKDu progression is significantly higher than the surrounding area. Samples of household wells ( n  = 262) indicated 68% had detectable agrochemical compounds with concentration above global water quality standards. It is expected that the detected contaminants compounds are indicators of poor water quality and that there is likely additional agrochemical exposure including commercial additives that may contribute to CKDu onset and/or progression. Thus, our study finds that well water exposure during a person’s lifetime in this region is associated with kidney function decline and identifies and quantifies putative nephrotoxic agrochemicals above safe drinking water concentrations in these wells.

This viewpoint paper addresses the ongoing challenges and opportunities within the data-for-health ecosystem, drawing insights from a multistakeholder workshop. Despite notable progress in the digitization of health care systems, data sharing and interoperability remain limited, so the full potential of health care data is not realized. There is a critical need for data ecosystems that can enable the timely, safe, efficient, and sustainable collection and sharing of health care data. However, efforts to meet this need face risks related to privacy, data protection, security, democratic governance, and exclusion. Key challenges include poor interoperability, inconsistent approaches to data governance, and concerns about the commodification of data. While emerging platforms such as social media play a growing role in gathering and sharing health information, their integration into formal data systems remains limited. A robust and secure data-for-health ecosystem requires stronger frameworks for data governance, interoperability, and citizen engagement to build public trust. This paper argues that reframing health care data as a common good, improving the transparency of data acquisition and processing, and promoting the use of application programming interfaces (APIs) for real-time data access are essential to overcoming these challenges. In addition, it highlights the need for international norms and standards guided by multisector leadership, given the multinational nature of data sharing. Ultimately, this paper emphasizes the need to balance risks and opportunities to create a socially acceptable, secure, and effective data-sharing ecosystem in health care.

Soil carbon (C) storage is a key ecosystem service. Soil C stocks play a vital role in soil fertility and climate regulation, but the factors that control these stocks at regional and national scales are unknown, particularly when their composition and stability are considered. As a result, their mapping relies on either unreliable proxy measures or laborious direct measurements. Using data from an extensive national survey of English grasslands, we show that surface soil (0–7 cm) C stocks in size fractions of varying stability can be predicted at both regional and national scales from plant traits and simple measures of soil and climatic conditions. Soil C stocks in the largest pool, of intermediate particle size (50–250 μm), were best explained by mean annual temperature (MAT), soil pH and soil moisture content. The second largest C pool, highly stable physically and biochemically protected particles (0·45–50 μm), was explained by soil pH and the community abundance‐weighted mean (CWM) leaf nitrogen (N) content, with the highest soil C stocks under N‐rich vegetation. The C stock in the small active fraction (250–4000 μm) was explained by a wide range of variables: MAT, mean annual precipitation, mean growing season length, soil pH and CWM specific leaf area; stocks were higher under vegetation with thick and/or dense leaves. Testing the models describing these fractions against data from an independent English region indicated moderately strong correlation between predicted and actual values and no systematic bias, with the exception of the active fraction, for which predictions were inaccurate. Synthesis and applications. Validation indicates that readily available climate, soils and plant survey data can be effective in making local‐ to landscape‐scale (1–100 000 km²) soil C stock predictions. Such predictions are a crucial component of effective management strategies to protect C stocks and enhance soil C sequestration.

Summary The ability of soil microbial communities to withstand and recover from disturbance or stress is important for the functional stability of forest ecosystems. However, the relationship between the community responses of soil microbes and variation in tree mixtures vs functional composition remains poorly understood. We investigated soil biochemical properties and soil microbial resistance and resilience to drought in three 4‐year‐old tree monocultures (Acer saccharum Marsh, Larix laricina (Duroi) K. Koch and Pinus strobus L.) and two tree species combinations (L. laricina/A. saccharum and L. laricina/P. strobus) planted in a high‐density tree field experiment located in southern Quebec, Canada. The experimentally imposed drought stress consisted of maintaining soil material for 30 days at 25% of water‐holding capacity (WHC). Microbial biomass was assessed immediately after the water stress (resistance) and 15 and 30 days following drought (resilience). Results showed that tree communities influenced soil chemistry, soil respirometry properties and microbial resistance and resilience. We measured significant non‐additive (i.e. both synergistic and antagonistic) effects of mixing tree species in some of the soil biochemical properties measured, mostly in the L. laricina/A. saccharum mixture. However, we did not find non‐additive effects of tree mixtures on microbial resistance and resilience. A structural equation modelling analysis revealed that resistance and resilience were mostly modulated by direct effects of community‐weighted means (CWM) of leaf litter lignin content and mineralizable N, and by indirect links from tree density and CWM of leaf litter N content via mineralizable N. This study suggests that tree species identity surpassed species mixtures as a key driver of soil microbial resistance and resilience. We showed a trade‐off between microbial resistance and resilience in soil food webs, which is consistent with ecological theory. Our results indicate that differences in functional traits between tree species may rapidly be reflected in divergent soil biochemical properties and that these differences can in turn drive soil microbial resistance and resilience to drought. Lay Summary

A multi-season convection-permitting regional climate simulation of the Maritime Continent (MC) using the Met Office Unified Model (MetUM) with 2.2 km grid spacing is presented and evaluated. The simulations pioneer the use of atmosphere–ocean coupling with the multi-column K profile parametrisation (KPP) mixed-layer ocean model in atmospheric convection-permitting climate simulations. Comparisons are made against a convection-parametrised simulation in which it is nested and which in turn derives boundary conditions from the ERA5 reanalysis. This paper describes the configuration, performance of the mean state and variability in the two simulations compared against observational datasets. The models have both minor sea surface temperature (SST) and wet precipitation biases. The diurnal cycle, representation of equatorial waves, and relationship between SST and precipitation are all improved in the convection-permitting model compared to the convection-parametrised model. The Madden–Julian oscillation (MJO) is present in both models with a faster-than-observed propagation speed. However, it is unclear whether fidelity of the MJO simulation is inherent to the model or whether it predominantly arises from the forcing at the boundaries.

Whilst research on indecent image of children (HOC) offenders is increasing, little is known about HOC content. This paper presents a content analysis on the sexual actions depicted in a sample of 729 HOC from 26 offenders. Victims were most often White females aged around 9.5 years, with most offenders in the 18-24 age range, male and White. Most images show erotic posing with no sexual activity, with 13.4% presenting sexual activity by an adult on a child and 12.8%presenting sexual activity by a child on an adult. Explicit portrayals of physical aggression, humiliation or overt physical suffering were conspicuously rare. Few images depicted attempts to display pseudo affection towards the victim. Interactions were found in several variables between victims' age and gender and offenders' age and gender. The need to more fully understand the nature and content ofHOC and their psychological signifrcance are discussed.

Recent description of the microbiology of sepsis on the wards or information on the real-life antibiotic choices used in sepsis is lacking. There is growing concern of the indiscriminate use of antibiotics and omission of microbiological investigations in the management of septic patients. We performed a secondary analysis of three annual 24-h point-prevalence studies on the general wards across all Welsh acute hospitals in years 2016–2018. Data were collected on patient demographics, as well as radiological, laboratory and microbiological data within 48-h of the study. We screened 19,453 patients over the three 24 h study periods and recruited 1252 patients who fulfilled the entry criteria. 775 (64.9%) patients were treated with intravenous antibiotics. Only in 33.65% (421/1252) of all recruited patients did healthcare providers obtain blood cultures; in 25.64% (321/1252) urine cultures; in 8.63% (108/1252) sputum cultures; in 6.79% (85/1252) wound cultures; in 15.25% (191/1252) other cultures. Out of the recruited patients, 59.1% (740/1252) fulfilled SEPSIS-3 criteria. Patients with SEPSIS-3 criteria were significantly more likely to receive antibiotics than the non-septic cohort (p < 0.0001). In a multivariable regression analysis increase in SOFA score, increased number of SIRS criteria and the use of the official sepsis screening tool were associated with antibiotic administration, however obtaining microbiology cultures was not. Our study shows that antibiotics prescription practice is not accompanied by microbiological investigations. A significant proportion of sepsis patients are still at risk of not receiving appropriate antibiotics treatment and microbiological investigations; this may be improved by a more thorough implementation of sepsis screening tools.

Neighbours in Bankdale Road, Washwood Heath, were today also in shock after three men were seized by armed police from their end of the quiet suburban street. Witnesses told of 50 or more police, some armed with sub machine guns, who ripped the front door at No 59 Bankdale Road from its hinges and stormed inside. Another neighbour, Benia Meen aged 32, who run Benia Hairdressers in nearby Alum Rock Road, said: 'I looked out the window and I saw police vans back down the road and armed police in the road pointing guns at the house and firing. The guys who live in the house have only been in there about three weeks.' Julia Batchelor, a 43-year- old mother of two who lives in nearby Winslow Avenue, said: 'There were flashes going everywhere, we came out to look but the police told us to get inside. SAFETY FEARS: Clockwise from top left, [Sunny Sahota], who lives near the Heybarnes Road homes of Mandy Higginson andJohn Bedder. Bottom left, Joe Tilt who saw the arrest in Bankdale Road; FRIGHTENED NEIGHBOURS: Liam and Linda Walsh, of Heybarnes Road, with daughter Kayleigh, front right, and friend Paisley Stuart, 10; COLLECTING EVIDENCE: Police forensic officers remove items from the house in Bankdale Road; FLASHES EVERYWHERE: Julie Batchelor and daughter Hannah, 7, and (below) Anthony Pease, who all saw the Bankdale Road raid