Reptiles are an important, yet often understudied, taxon in nature conservation. They play a significant role in ecosystems1 and can serve as indicators of environmental health, often responding more rapidly to human pressures than other vertebrate groups.2 At least 21% of reptiles are currently assessed as threatened with extinction by the IUCN.3 However, due to the lack of comprehensive global assessments until recently, they have been omitted from spatial studies addressing conservation or spatial prioritization (e.g., Rosauer et al.,4,5,6,7,8 Fritz and Rahbek,4,5,6,7,8 Farooq et al.,4,5,6,7,8 Meyer et al., 4,5,6,7,8 and Farooq et al.4,5,6,7,8). One important knowledge gap in conservation is the lack of spatially explicit information on the main threats to biodiversity,9 which significantly hampers our ability to respond effectively to the current biodiversity crisis.10,11 In this study, we calculate the probability of a reptile species in a specific location being affected by one of seven biodiversity threats-agriculture, climate change, hunting, invasive species, logging, pollution, and urbanization. We conducted the analysis at a global scale, using a 50 km × 50 km grid, and evaluated the impact of these threats by studying their relationship with the risk of extinction. We find that climate change, logging, pollution, and invasive species are most linked to extinction risk. However, we also show that there is considerable geographical variation in these results. Our study highlights the importance of going beyond measuring the intensity of threats to measuring the impact of these separately for various biogeographical regions of the world, with different historical contingencies, as opposed to a single global analysis treating all regions the same.

Human dietary patterns are a major cause of environmental transformation, with agriculture occupying ~ 50% of global land space, while food production itself is responsible for ~ 30% of all greenhouse gas emissions and 70% of freshwater use. Furthermore, the global population is also growing, such that by 2050, it is estimated to exceed ~ 9 billion. While most of this expansion in population is expected to occur in developing countries, in high-income countries there are also predicted changes in demographics, with major increases in the number of older people. There is a growing consensus that older people have a greater requirement for protein. With a larger and older population, global needs for protein are set to increase. This paper summarises the conclusions from a Rank Prize funded colloquium evaluating novel strategies to meet this increasing global protein need.

Estuaries are important ecosystems providing irreplaceable services for humankind and, in turn, are extensively influenced by human activities and climate changes. Microbial processes, which are largely controlled by viruses, are always responsible for the ecological function and environmental problems in estuaries. However, we know little about the ecology and importance of viruses in estuarine systems. Here, we investigated viral ecological dynamics in estuarine systems on local (four largest estuaries in China in different seasons) and global scales. Viral production varied by almost 20-fold in Chinese estuaries with significant seasonality, being responsible for the removal of 1.41%-21.45% of the bacterioplankton standing stock each day, and contributed directly to the organic carbon pool by releasing an average of 3.57 µg of cellular carbon per liter per day. By compiling data from 21 estuaries across the world, we found for the first time that viral population size peaked at mid-latitude and viral production increased towards the equator in estuarine ecosystems. The results indicated the higher viral impact on microbial mortality and dissolved organic matter cycling in tropical estuaries. Our field investigation and global synthesized analysis provide compelling evidence of spatiotemporal variations in estuarine viral dynamics. The global view of viral impacts on estuarine microbial mortality offers important insight for incorporating viruses into ecological models and understanding the environmental implications of the tropicalization of temperate aquatic ecosystems under a scenario of climate warming.

Although plant-plant interactions (i.e. competition and facilitation) have long been recognised as key drivers of plant community composition and dynamics, their global patterns and relationships with climate have remained unclear. Here, we assembled a global database of 10,502 pairs of empirical data from the literature to address the patterns of and climatic effects on the net outcome of plant interactions in natural communities. We found that plant interactions varied among plant performance indicators, interaction types and biomes, yet competition occurred more frequently than facilitation in plant communities worldwide. Unexpectedly, plant interactions showed weak latitudinal pattern and were weakly related to climate. Our study provides a global comprehensive overview of plant interactions, highlighting competition as a fundamental mechanism structuring plant communities worldwide. We suggest that further investigations should focus more on local factors (e.g. microclimate, soil and disturbance) than on macroclimate to identify key environmental determinants of interactions in plant communities.

The colours of fleshy fruits play a critical role in plant dispersal by advertising ripe fruits to consumers. Fruit colours have long been classified into syndromes attributed to selection by animal dispersers, despite weak evidence for this hypothesis. Here, we test the relative importance of biotic (bird and mammal frugivory) and abiotic (wet season temperatures, growing season length and UV-B radiation) factors in determining fruit colour syndrome in 3163 species of fleshy-fruited plants. We find that both dispersers and environment are important, and they interact. In warm areas, contrastive, bird-associated fruit colours increase with relative bird frugivore prevalence, whereas in cold places these colours dominate even where mammalian dispersers are prevalent. We present near-global maps of predicted fruit colour syndrome based on our species-level model and our newly developed characterisations of relative importance of bird and mammal frugivores.

OBJECTIVE: Breast cancer in young women (< 40 years) is rare and carries a poor prognosis relative to breast cancer in older women. Most studies examining global breast cancer patterns do not describe the trends in young women specifically.
METHODS: Data from GLOBOCAN 2018 were used to compare breast cancer incidence and mortality rates among younger (ages 0-39) vs. older (ages 40+) women across 185 countries. The coefficient of variation (the ratio of the standard deviation to the mean) was used to quantify relative variability.
RESULTS: The risk of developing breast cancer to age 39 ranged from 0.13% in Guinea to 0.95% in South Korea (coefficient of variation: 46%), and the risk of death from breast cancer to age 39 ranged from 0.02% in China to 0.72% in Cameroon (coefficient of variation: 81%). In contrast, the risk of developing breast cancer to age 74 ranged from 1.5% in Mozambique to 12.2% in Belgium (coefficient of variation: 50%), and the risk of death from breast cancer to age 74 ranged from 0.65% in South Korea to 3.0% in Somalia (coefficient of variation: 36%).
CONCLUSIONS: Among young women, breast cancer mortality rates varied more worldwide than breast cancer incidence. In contrast, among older women/women of all ages, breast cancer incidence varied more than breast cancer mortality. Further research is required to examine the impact of stage at diagnosis, clinicopathologic features, and treatments received, on variations in the survival and mortality of breast cancer in young women around the world.

The picoplankton is an important component of aquatic food webs and plays a significant biogeochemical and ecological role in the environment. Little is known about this fraction of the plankton in temperate estuaries and especially in South America. In this article, we study the absolute and relative importance of the picoplankton along an annual cycle, and their relationship with physical and chemical variables in the Río de la Plata estuary. We also review the existing research in estuaries around the world concerning this community and present our results in a global context. The seasonal variation in the abundance of the different groups analyzed was very noticeable. Phycocyanin-rich picocyanobacteria (Pcy) were the main component (in abundance and in biovolume) of the picophytoplankton (PPP) almost during the whole year, with a maximum abundance of 7.3 × 105 cell mL-1 in summer, three orders of magnitude higher compared to autumn-winter. Picoeukaryotes, larger phytoplankton and heterotrophic bacteria showed the same seasonal trend, although with a lower range of variation than that of the Pcy. Considering all the phototrophic planktonic fractions, in terms of biomass, the PPP reached a maximum of 43% of the total biomass in spring. The dynamics of PPP found in this area are consistent with the observed in other temperate estuaries, where temperature is the main variable that influences its development, and with a high seasonal variation. Additionally, the absolute and relative importance of Pcy showed a consistently increasing trend towards lower latitude estuaries. The review also showed us that there is scarce information related to the picoplankton fraction in the Southern Hemisphere, its sanitary implications due to their potential of toxicity or their ecological role in coastal zones. The results presented here show the importance of this fraction, not only in Río de la Plata, but in many estuaries of the world, with a clear increase of relative abundance as we approach the equator.

To investigate global patterns of cardiovascular risk factor control in patients with type 2 diabetes mellitus (T2D).
DISCOVER is an international, observational cohort study of patients with T2D beginning second-line glucose-lowering therapy. Risk factor management was examined among eligible patients (ie, those with the risk factor) at study baseline. Inter-country variability was estimated using median odds ratios (MORs).
Among 14 343 patients with T2D from 34 countries, the mean age was 57.4 ± 12.0 years and the median (interquartile range) duration of T2D was 4.2 (2.0-8.0) years; 11.8% had documented atherosclerotic cardiovascular disease (ASCVD). Among eligible patients, blood pressure was controlled in 67.5% (9284/13756), statins were prescribed in 43.7% (5775/13208), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers were prescribed in 55.6% (5292/9512), aspirin was prescribed in 53.3% of those with established ASCVD (876/1645), and 84.4% (12 102/14343) were non-smoking. Only 21.5% of patients (3088/14343) had optimal risk factor management (defined as control of all eligible measures), with wide inter-country variability (10%-44%), even after adjusting for patient and site differences (MOR 1.47, 95% confidence interval 1.24-1.66).
Globally, comprehensive control of ASCVD risk factors is not being achieved in most patients, with wide variability among countries unaccounted for by patient and site differences. Better country-specific strategies are needed to implement comprehensive cardiovascular risk factor control consistently in patients with T2D to improve long-term outcomes.

There is growing evidence that cyanobacterial blooms are becoming more common in different parts of the world; within this context, predictive cyanobacteria models have an essential role in lake management. Several models have been successfully used in temperate systems to describe the main drivers of cyanobacterial blooms, but relatively less work has been conducted in the Tropics. We analyzed data from six Brazilian reservoirs and from five Canadian lakes using a combination of regression tree analyses and variation partitioning to evaluate the similarities and differences between regions. Our results, together with a synthesis of the literature from different latitudes, showed that trophic state (i.e. nutrients), climatic variables (e.g., temperature and/or precipitation) and hydrodynamic regimes (i.e. water residence time) are significant drivers of cyanobacteria biomass over several scales. Nutrients came out as the primary predictor in both regions, followed by climate, but when all systems were pooled together, water residence time came out as most important. The consistency in variables identified between regions suggests that these drivers are widely important and cyanobacteria responded quite similarly in different geographical settings and waterbody types (i.e. lakes or reservoirs). However, more work is needed to identify key thresholds across latitudinal gradients. Taken together, these results suggest that multi-region syntheses can help identify drivers that predict broad-scale patterns of cyanobacteria biomass.

Previous studies have reported significant variation in prostate cancer rates and trends mainly due to differences in detection practices, availability of treatment, and underlying genetic susceptibility.
To assess recent worldwide prostate cancer incidence, mortality rates, and trends using up-to-date incidence and mortality data.
We present estimated age-standardized prostate cancer incidence and mortality rates by country and world regions for 2018 based on the GLOBOCAN database. We also examined rates and temporal trends for incidence (44 countries) and mortality (76 countries) based on data series from population-based registries.
The highest estimated incidence rates were found in Australia/New Zealand, Northern America, Western and Northern Europe, and the Caribbean, and the lowest rates were found in South-Central Asia, Northern Africa, and South-Eastern and Eastern Asia. The highest estimated mortality rates were found in the Caribbean (Barbados, Trinidad and Tobago, and Cuba), sub-Saharan Africa (South Africa), parts of former Soviet Union (Lithuania, Estonia, and Latvia), whereas the lowest rates were found in Asia (Thailand and Turkmenistan). Prostate cancer incidence rates during the most recent 5 yr declined (five countries) or stabilized (35 countries), after increasing for many years; in contrast, rates continued to increase for four countries in Eastern Europe and Asia. During the most recent 5 data years, mortality rates among the 76 countries examined increased (three countries), remained stable (59 countries), or decreased (14 countries).
As evident from available data, prostate cancer incidence and mortality rates have been on the decline or have stabilized recently in many countries, with decreases more pronounced in high-income countries. These trends may reflect a decline in prostate-specific antigen testing (incidence) and improvements in treatment (mortality).
We examined recent trends in prostate cancer incidence and mortality rates in 44 and 76 countries, respectively, and found that rates in most countries stabilized or decreased.