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Accurate assessment of anthropogenic carbon dioxide (CO2) emissions and their redistribution among the atmosphere, ocean, and terrestrial biosphere is important to better understand the global carbon cycle, support the development of climate policies, and project future climate change. Here we describe data sets and a methodology to quantify all major components of the global carbon budget, including their uncertainties, based on the combination of a range of data, algorithms, statistics, and model estimates and their interpretation by a broad scientific community. We discuss changes compared to previous estimates as well as consistency within and among components, alongside methodology and data limitations. CO2 emissions from fossil fuels and industry (EFF) are based on energy statistics and cement production data, while emissions from land-use change (ELUC), mainly deforestation, are based on combined evidence from land-cover-change data, fire activity associated with deforestation, and models. The global atmospheric CO2 concentration is measured directly and its rate of growth (GATM) is computed from the annual changes in concentration. The mean ocean CO2 sink (SOCEAN) is based on observations from the 1990s, while the annual anomalies and trends are estimated with ocean models. The variability in SOCEAN is evaluated with data products based on surveys of ocean CO2 measurements. The global residual terrestrial CO2 sink (SLAND) is estimated by the difference of the other terms of the global carbon budget and compared to results of independent dynamic global vegetation models forced by observed climate, CO2, and land-cover change (some including nitrogen-carbon interactions). We compare the mean land and ocean fluxes and their variability to estimates from three atmospheric inverse methods for three broad latitude bands. All uncertainties are reported as ±1σ, reflecting the current capacity to characterise the annual estimates of each component of the global carbon budget. For the last decade available (2005-2014), EFF was 9.0 ± 0.5 GtC yrg'1, ELUC was 0.9 ± 0.5 GtC yrg'1, GATM was 4.4 ± 0.1 GtC yrg'1, SOCEAN was 2.6 ± 0.5 GtC yrg'1, and SLAND was 3.0 ± 0.8 GtC yrg'1. For the year 2014 alone, EFF grew to 9.8 ± 0.5 GtC yrg'1, 0.6 % above 2013, continuing the growth trend in these emissions, albeit at a slower rate compared to the average growth of 2.2 % yrg'1 that took place during 2005-2014. Also, for 2014, ELUC was 1.1 ± 0.5 GtC yrg'1, GATM was 3.9 ± 0.2 GtC yrg'1, SOCEAN was 2.9 ± 0.5 GtC yrg'1, and SLAND was 4.1 ± 0.9 GtC yrg'1. GATM was lower in 2014 compared to the past decade (2005-2014), reflecting a larger SLAND for that year. The global atmospheric CO2 concentration reached 397.15 ± 0.10 ppm averaged over 2014. For 2015, preliminary data indicate that the growth in EFF will be near or slightly below zero, with a projection of g'0.6 [range of g'1.6 to +0.5] %, based on national emissions projections for China and the USA, and projections of gross domestic product corrected for recent changes in the carbon intensity of the global economy for the rest of the world. From this projection of EFF and assumed constant ELUC for 2015, cumulative emissions of CO2 will reach about 555 ± 55 GtC (2035 ± 205 GtCO2) for 1870-2015, about 75 % from EFF and 25 % from ELUC. This living data update documents changes in the methods and data sets used in this new carbon budget compared with previous publications of this data set (Le Quéré et al., 2015, 2014, 2013). All observations presented here can be downloaded from the Carbon Dioxide Information Analysis Center (doi:10.3334/CDIAC/GCP-2015).

Efforts to control climate change require the stabilization of atmospheric CO 2 concentrations. This can only be achieved through a drastic reduction of global CO 2 emissions. Yet fossil fuel emissions increased by 29% between 2000 and 2008, in conjunction with increased contributions from emerging economies, from the production and international trade of goods and services, and from the use of coal as a fuel source. In contrast, emissions from land-use changes were nearly constant. Between 1959 and 2008, 43% of each year's CO 2 emissions remained in the atmosphere on average; the rest was absorbed by carbon sinks on land and in the oceans. In the past 50 years, the fraction of CO 2 emissions that remains in the atmosphere each year has likely increased, from about 40% to 45%, and models suggest that this trend was caused by a decrease in the uptake of CO 2 by the carbon sinks in response to climate change and variability. Changes in the CO 2 sinks are highly uncertain, but they could have a significant influence on future atmospheric CO 2 levels. It is therefore crucial to reduce the uncertainties. © 2009 Macmillan Publishers Limited. All rights reserved.

Background: In trachoma control programmes, azithromycin is distributed to treat the strains of chlamydia that cause ocular disease. We aimed to compare the effect of annual versus twice-yearly distribution of azithromycin on infection with these strains.Methods: We did a cluster-randomised trial in 24 subdistricts in northern Ethiopia, which we randomly assigned to receive annual or twice-yearly treatment for all residents of all ages. Random assignment was done with the RANDOM and SORT functions of Microsoft Excel. All individuals were offered their assigned treatment of a single, directly observed, oral dose of azithromycin. A 6 week course of topical 1% tetracycline ointment, applied twice daily to both eyes but not directly observed, was offered as an alternative to azithromycin in patients younger than 12 months, and in patients with self-reported pregnancy, with allergy, or who refused azithromycin. Our primary, prespecified outcome was the prevalence of ocular chlamydial infection in a random sample of children aged 0-9 years at baseline and every 6 months for a total of 42 months within sentinel villages. Our analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00322972.Findings: Antibiotic coverage of children aged 1-9 years was greater than 80% (range 80·9 to 93·0) at all study visits. In the groups treated annually, the prevalence of infection in children aged 0-9 years was reduced from a mean 41·9% (95% CI 31·5 to 52·2) at baseline to 1·9% (0·3 to 3·5) at 42 months. In the groups treated twice yearly, the prevalence of infection was reduced from a mean 38·3% (29·0 to 47·6) at baseline to 3·2 % (0·0 to 6·5) at 42 months. The prevalence of ocular chlamydial infection in children aged 0-9 years in groups treated annually was not different from that of the groups treated twice yearly at 18, 30, and 42 months (pooled regression p>0·99, 95 % CI -0·06 to 0·06). The mean elimination time in the twice-yearly treatment group was 7·5 months earlier (2·3 to 17·3) than that of the annual group (p=0·10, Cox proportional hazards model).Interpretation: After 42 months of treatment, the prevalence of ocular infection with chlamydia was similar in the groups treated annually and twice yearly. However, elimination of infection might have been more rapid in the groups of villages that received treatment twice yearly.Funding: National Institutes of Health (NEI U10 EY016214). [ABSTRACT FROM AUTHOR]

Greenhouse gas (GHG) emission inventories represent the link between national and international political actions on climate change, and climate and environmental sciences. Inventory agencies need to include, in national GHG inventories, emission and removal estimates based on scientific data following specific reporting guidance under the United Nation Framework Convention on Climate Change (UNFCCC) and the Paris Agreement, using the methodologies defined in the Intergovernmental Panel on Climate Change (IPCC) Guidelines. Often however, research communities and inventory agencies have approached the problem of climate change from different angles and by using terminologies, metrics, rules and approaches that do not always match. This is particularly true dealing with "Land Use, Land-Use Change and Forestry" (LULUCF), the most challenging among the inventory sectors to deal with, mainly because of high level of complexity of its carbon dynamics and the difficulties in disaggregating the fluxes between those caused by natural and anthropogenic processes. In this paper, we facilitate the understanding by research communities of the current (UNFCCC) and future (under the Paris Agreement) reporting requirements, and we identify the main issues and topics that should be considered when targeting improvement of the GHG inventory. In relation to these topics, we describe where and how the research community can contribute to producing useful inputs, data, methods and solutions for inventory agencies and policy makers, on the basis of available literature. However, a greater effort by both communities is desirable for closer cooperation and collaboration, for data sharing and the understanding of respective and common aims., Competing Interests: The authors report no declarations of interest., (© 2021 The Authors.)

Tropical secondary forests sequester carbon up to 20 times faster than old-growth forests. This rate does not capture spatial regrowth patterns due to environmental and disturbance drivers. Here we quantify the influence of such drivers on the rate and spatial patterns of regrowth in the Brazilian Amazon using satellite data. Carbon sequestration rates of young secondary forests (<20 years) in the west are ~60% higher (3.0 ± 1.0 Mg C ha -1  yr -1 ) compared to those in the east (1.3 ± 0.3 Mg C ha -1  yr -1 ). Disturbances reduce regrowth rates by 8-55%. The 2017 secondary forest carbon stock, of 294 Tg C, could be 8% higher by avoiding fires and repeated deforestation. Maintaining the 2017 secondary forest area has the potential to accumulate ~19.0 Tg C yr -1 until 2030, contributing ~5.5% to Brazil's 2030 net emissions reduction target. Implementing legal mechanisms to protect and expand secondary forests whilst supporting old-growth conservation is, therefore, key to realising their potential as a nature-based climate solution.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

The restoration and reforestation of 12 million hectares of forests by 2030 are amongst the leading mitigation strategies for reducing carbon emissions within the Brazilian Nationally Determined Contribution targets assumed under the Paris Agreement. Understanding the dynamics of forest cover, which steeply decreased between 1985 and 2018 throughout Brazil, is essential for estimating the global carbon balance and quantifying the provision of ecosystem services. To know the long-term increment, extent, and age of secondary forests is crucial; however, these variables are yet poorly quantified. Here we developed a 30-m spatial resolution dataset of the annual increment, extent, and age of secondary forests for Brazil over the 1986-2018 period. Land-use and land-cover maps from MapBiomas Project (Collection 4.1) were used as input data for our algorithm, implemented in the Google Earth Engine platform. This dataset provides critical spatially explicit information for supporting carbon emissions reduction, biodiversity, and restoration policies, enabling environmental science applications, territorial planning, and subsidizing environmental law enforcement.

Observed bimodal tree cover distributions at particular environmental conditions and theoretical models indicate that some areas in the tropics can be in either of the alternative stable vegetation states forest or savanna. However, when including spatial interaction in nonspatial differential equation models of a bistable quantity, only the state with the lowest potential energy remains stable. Our recent reaction-diffusion model of Amazonian tree cover confirmed this and was able to reproduce the observed spatial distribution of forest versus savanna satisfactorily when forced by heterogeneous environmental and anthropogenic variables, even though bistability was underestimated. These conclusions were solely based on simulation results for one set of parameters. Here, we perform an analytical and numerical analysis of the model. We derive the Maxwell point (MP) of the homogeneous reaction-diffusion equation without savanna trees as a function of rainfall and human impact and show that the front between forest and nonforest settles at this point as long as savanna tree cover near the front remains sufficiently low. For parameters resulting in higher savanna tree cover near the front, we also find irregular forest-savanna cycles and woodland-savanna bistability, which can both explain the remaining observed bimodality., Competing Interests: The authors have declared that no competing interests exist.

A bimodal distribution of tropical tree cover at intermediate precipitation levels has been presented as evidence of fire-induced bistability. Here we subdivide satellite vegetation data into those from human-unaffected areas and those from regions close to human-cultivated zones. Bimodality is found to be almost absent in the unaffected regions, whereas it is significantly enhanced close to cultivated zones. Assuming higher logging rates closer to cultivated zones and spatial diffusion of fire, our spatiotemporal mathematical model reproduces these patterns. Given a gradient of climatic and edaphic factors, rather than bistability there is a predictable spatial boundary, a Maxwell point, that separates regions where forest and savanna states are naturally selected. While bimodality can hence be explained by anthropogenic edge effects and natural spatial heterogeneity, a narrow range of bimodality remaining in the human-unaffected data indicates that there is still bistability, although on smaller scales than claimed previously.

Soils are subject to varying degrees of direct or indirect human disturbance, constituting a major global change driver. Factoring out natural from direct and indirect human influence is not always straightforward, but some human activities have clear impacts. These include land-use change, land management and land degradation (erosion, compaction, sealing and salinization). The intensity of land use also exerts a great impact on soils, and soils are also subject to indirect impacts arising from human activity, such as acid deposition (sulphur and nitrogen) and heavy metal pollution. In this critical review, we report the state-of-the-art understanding of these global change pressures on soils, identify knowledge gaps and research challenges and highlight actions and policies to minimize adverse environmental impacts arising from these global change drivers. Soils are central to considerations of what constitutes sustainable intensification. Therefore, ensuring that vulnerable and high environmental value soils are considered when protecting important habitats and ecosystems, will help to reduce the pressure on land from global change drivers. To ensure that soils are protected as part of wider environmental efforts, a global soil resilience programme should be considered, to monitor, recover or sustain soil fertility and function, and to enhance the ecosystem services provided by soils. Soils cannot, and should not, be considered in isolation of the ecosystems that they underpin and vice versa. The role of soils in supporting ecosystems and natural capital needs greater recognition. The lasting legacy of the International Year of Soils in 2015 should be to put soils at the centre of policy supporting environmental protection and sustainable development., (© 2015 John Wiley & Sons Ltd.)

The high uncertainty in land-based CO2 fluxes estimates is thought to be mainly due to uncertainty in not only quantifying historical changes among forests, croplands, and grassland, but also due to different processes included in calculation methods. Inclusion of a nitrogen (N) cycle in models is fairly recent and strongly affects carbon (C) fluxes. In this study, for the first time, we use a model with C and N dynamics with three distinct historical reconstructions of land-use and land-use change (LULUC) to quantify LULUC emissions and uncertainty that includes the integrated effects of not only climate and CO2 but also N. The modeled global average emissions including N dynamics for the 1980s, 1990s, and 2000-2005 were 1.8 ± 0.2, 1.7 ± 0.2, and 1.4 ± 0.2 GtC yr(-1) , respectively, (mean and range across LULUC data sets). The emissions from tropics were 0.8 ± 0.2, 0.8 ± 0.2, and 0.7 ± 0.3 GtC yr(-1) , and the non tropics were 1.1 ± 0.5, 0.9 ± 0.2, and 0.7 ± 0.1 GtC yr(-1) . Compared to previous studies that did not include N dynamics, modeled net LULUC emissions were higher, particularly in the non tropics. In the model, N limitation reduces regrowth rates of vegetation in temperate areas resulting in higher net emissions. Our results indicate that exclusion of N dynamics leads to an underestimation of LULUC emissions by around 70% in the non tropics, 10% in the tropics, and 40% globally in the 1990s. The differences due to inclusion/exclusion of the N cycle of 0.1 GtC yr(-1) in the tropics, 0.6 GtC yr(-1) in the non tropics, and 0.7 GtC yr(-1) globally (mean across land-cover data sets) in the 1990s were greater than differences due to the land-cover data in the non tropics and globally (0.2 GtC yr(-1) ). While land-cover information is improving with satellite and inventory data, this study indicates the importance of accounting for different processes, in particular the N cycle., (© 2013 John Wiley & Sons Ltd.)

Feeding 9-10 billion people by 2050 and preventing dangerous climate change are two of the greatest challenges facing humanity. Both challenges must be met while reducing the impact of land management on ecosystem services that deliver vital goods and services, and support human health and well-being. Few studies to date have considered the interactions between these challenges. In this study we briefly outline the challenges, review the supply- and demand-side climate mitigation potential available in the Agriculture, Forestry and Other Land Use AFOLU sector and options for delivering food security. We briefly outline some of the synergies and trade-offs afforded by mitigation practices, before presenting an assessment of the mitigation potential possible in the AFOLU sector under possible future scenarios in which demand-side measures codeliver to aid food security. We conclude that while supply-side mitigation measures, such as changes in land management, might either enhance or negatively impact food security, demand-side mitigation measures, such as reduced waste or demand for livestock products, should benefit both food security and greenhouse gas (GHG) mitigation. Demand-side measures offer a greater potential (1.5-15.6 Gt CO2 -eq. yr(-1) ) in meeting both challenges than do supply-side measures (1.5-4.3 Gt CO2 -eq. yr(-1) at carbon prices between 20 and 100 US$ tCO2 -eq. yr(-1) ), but given the enormity of challenges, all options need to be considered. Supply-side measures should be implemented immediately, focussing on those that allow the production of more agricultural product per unit of input. For demand-side measures, given the difficulties in their implementation and lag in their effectiveness, policy should be introduced quickly, and should aim to codeliver to other policy agenda, such as improving environmental quality or improving dietary health. These problems facing humanity in the 21st Century are extremely challenging, and policy that addresses multiple objectives is required now more than ever., (© 2013 John Wiley & Sons Ltd.)

Background: An important component of the World Health Organization's comprehensive trachoma elimination strategy is the provision of repeated annual mass azithromycin distributions, which are directed at reducing the burden of ocular chlamydia. Knowledge of characteristics associated with infection after mass antibiotic treatments could allow trachoma programs to focus resources to those most likely to be infected with ocular chlamydia., Methodology/principal Findings: We monitored 12 communities in rural Ethiopia that had received 3 annual mass azithromycin treatments as part of a cluster-randomized trial for trachoma. One year after the third treatment, a random sample of children from each village received conjunctival examination for follicular trachomatous inflammation (TF) and intense trachomatous inflammation (TI), conjunctival swabbing for chlamydial RNA and DNA, and a household survey. The primary outcome for this study was RNA evidence of ocular chlamydia, which we detected in 41 of 573 swabbed children (7.2%, 95%CI 2.7-17.8). In multivariate mixed effects logistic regression models, ocular chlamydial RNA was significantly associated with ocular discharge (OR 2.82, 95%CI 1.07-7.42), missing the most recent mass azithromycin treatment (OR 2.49, 95%CI 1.02-6.05), having a sibling with ocular chlamydia (OR 4.44, 95%CI 1.60-12.29), and above-median community population (OR 7.81, 95%CI 1.56-39.09). Ocular chlamydial infection was also independently associated with TF (OR 3.42, 95%CI 1.56-7.49) and TI (OR 5.39, 95%CI 2.43-11.98)., Conclusions/significance: In areas with highly prevalent trachoma treated with multiple rounds of mass azithromycin, trachoma programs could consider continuing mass azithromycin treatments in households that have missed prior mass antibiotic treatments, in households with clinically active trachoma, and in larger communities.

Trachoma control strategies, including latrine construction and antibiotic distribution, are directed at reducing ocular chlamydia, but may have additional benefits. In a cluster-randomized clinical trial, 24 subkebeles (administrative geographic units) in Ethiopia were offered a single mass azithromycin treatment, and half were randomized to receive an intensive latrine promotion. At a follow-up census 26 months after the baseline treatment, 320 persons had died. The mortality rate of children 1-5 years of age was 3.87 (95% confidence interval [CI] = 2.19-6.82) per 1,000 person-years in the latrine promotion arm, and 2.72 (95% CI = 1.37-5.42) per 1,000 person-years in the control arm. In a multi-level mixed effects logistic regression model controlling for age, there was no difference in mortality in persons randomized into the latrine or control arms (odds ratio = 1.18, 95% CI = 0.89-1.58). Latrine promotion provided no additional effect on mortality in the context of an azithromycin distribution program (clinicaltrials.gov, #NCT00322972).

During a cluster-randomized clinical trial for trachoma in Ethiopia, two rounds of adverse event surveillance were performed in a random sample of communities after community-wide mass azithromycin treatment. The prevalence of any reported adverse event ranged from 4.9% to 7.0% in children 1-9 years of age and from 17.0% to 18.7% in persons ≥ 10 years of age. Adverse events appeared to cluster by household and perhaps by village. Mass azithromycin distributions were well tolerated in this setting.

The World Health Organization (WHO) recommends environmental improvements such as latrine construction in the integrated trachoma control strategy, SAFE. We report a cluster-randomized trial assessing the effect of intensive latrine promotion on emergence of infection with ocular Chlamydia trachomatis after mass treatment with antibiotics.Twenty-four communities in Goncha Seso Enesie woreda, Amhara Regional State, Ethiopia, were enumerated, and a random selection of 60 children aged 0- 9 years in each was monitored for clinical signs of trachoma and ocular chlamydial infection at baseline, 12 and 24 months. All community members were offered treatment with a single dose of oral azithromycin or topical tetracycline. After treatment, 12 subkebeles were randomized to receive intensive latrine promotion. Mean cluster ocular infection in the latrine and the non-latrine arms were reduced from 45.5% (95% CI 34.1-56.8%) and 43.0% (95% CI 31.1-54.8%) respectively at baseline to 14.6% (95% CI 7.4-21.8%) and 14.8% (95% CI 8.9-20.8%) respectively at 24 months (P=0.93). Clinical signs fell from 72.0% (95% CI 58.2-85.5%) and 61.3% (95% CI 44.0-78.5%) at baseline to 45.8% (36.0-55.6%) and 48.5% (34.0-62.9%) respectively at 24 months (P=0.69). At 24 months, estimated household latrine coverage and use were 80.8% and 61.7% respectively where there had been intensive latrine promotion and 30.0% and 25.0% respectively in the single treatment only arm. We were unable to detect a difference in the prevalence of ocular chlamydial infection in children due to latrine construction.

Targets for bioenergy have been set worldwide to mitigate climate change. Although feedstock sources are often ambiguous, pledges in European nations, the United States and Brazil amount to more than 100 Mtoe of biorenewable fuel production by 2020. As a consequence, the biofuel sector is developing rapidly, and it is increasingly important to distinguish bioenergy options that can address energy security and greenhouse gas mitigation from those that cannot. This paper evaluates how bioenergy production affects land-use change (LUC), and to what extent land-use modelling can inform sound decision-making. We identified local and global internalities and externalities of biofuel development scenarios, reviewed relevant data sources and modelling approaches, identified sources of controversy about indirect LUC (iLUC) and then suggested a framework for comprehensive assessments of bioenergy. Ultimately, plant biomass must be managed to produce energy in a way that is consistent with the management of food, feed, fibre, timber and environmental services. Bioenergy production provides opportunities for improved energy security, climate mitigation and rural development, but the environmental and social consequences depend on feedstock choices and geographical location. The most desirable solutions for bioenergy production will include policies that incentivize regionally integrated management of diverse resources with low inputs, high yields, co-products, multiple benefits and minimal risks of iLUC. Many integrated assessment models include energy resources, trade, technological development and regional environmental conditions, but do not account for biodiversity and lack detailed data on the location of degraded and underproductive lands that would be ideal for bioenergy production. Specific practices that would maximize the benefits of bioenergy production regionally need to be identified before a global analysis of bioenergy-related LUC can be accomplished.

Background: Mass azithromycin distributions are used to clear ocular strains of chlamydia that cause trachoma, but treatments may also affect respiratory infections, diarrhea, and malaria. Here, we monitor a large cohort in which almost 90% of individuals received azithromycin. We assess whether receiving treatment is associated with reduced all-cause and infectious childhood mortality., Methods: As part of a clinical trial for trachoma, a census was conducted in 24 communities in rural Ethiopia. All individuals ≥1 year of age were eligible for single-dose oral azithromycin, although antibiotic coverage was not universal. A follow-up census was performed 26 months after treatment to estimate all-cause mortality among children 1-5 years of age, and verbal autopsies were performed to identify infectious mortality., Results: The cohort included 35,052 individuals ≥1 year of age and 5507 children 1-5 years of age, of whom 4914 received a dose of azithromycin. All-cause mortality was significantly lower among those 1-5-year-old children who received azithromycin (odds ratio [OR]=0.35 [95% confidence interval {CI}, 0.17-0.74]), as was infectious mortality (OR=0.20 [95% CI, 0.07-0.58]). When individuals were compared only with members of the same household, azithromycin treatment was still associated with reduced all-cause mortality in children 1-5 years of age (OR=0.40 [95% CI, 0.16-0.96]), although this relationship was not statistically significant for infectious mortality (OR=0.35 [95% CI, 0.10-1.28])., Conclusions: This study demonstrated an association between mass oral azithromycin treatment and reduced all-cause and infectious childhood mortality. This relationship could not be attributed to bias at the level of the household. Mass azithromycin distributions may have benefits unrelated to trachoma., (© The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.)

Climate change is predicted to become a major threat to biodiversity in the 21st century, but accurate predictions and effective solutions have proved difficult to formulate. Alarming predictions have come from a rather narrow methodological base, but a new, integrated science of climate-change biodiversity assessment is emerging, based on multiple sources and approaches. Drawing on evidence from paleoecological observations, recent phenological and microevolutionary responses, experiments, and computational models, we review the insights that different approaches bring to anticipating and managing the biodiversity consequences of climate change, including the extent of species' natural resilience. We introduce a framework that uses information from different sources to identify vulnerability and to support the design of conservation responses. Although much of the information reviewed is on species, our framework and conclusions are also applicable to ecosystems, habitats, ecological communities, and genetic diversity, whether terrestrial, marine, or fresh water.

It is unclear how the prevalence of clinically active trachoma correlates with the prevalence of ocular chlamydial infection at the community level. In 24 villages from a cluster-randomized clinical trial of mass azithromycin distributions in Ethiopia, the correlation between the prevalence of clinical activity (on examination) and chlamydial infection (by polymerase chain reaction) was moderately strong before mass antibiotic treatments (Pearson's correlation coefficient r = 0.75, 95% confidence interval [CI] = 0.52-0.87), but decreased at each time point during four biannual treatments (at 24 months, r = 0.15, 95% CI = -0.14-0.41). One year after the final treatment, the correlation coefficient had increased, but not to the pre-treatment level (r = 0.55, 95% CI = 0.30-0.73). In a region with hyperendemic trachoma, conjunctival examination was a useful indicator of the prevalence of chlamydial infection before treatments, less useful during mass treatments, but regained utility by one year after treatments had stopped.

Background: As part of the SAFE strategy, mass antibiotic treatments are useful in controlling the ocular strains of chlamydia that cause trachoma. The World Health Organization recommends treating at least 80% of individuals per community. However, the role of antibiotic coverage for trachoma control has been poorly characterized., Methodology/principal Findings: In a collection of cluster-randomized clinical trials, mass oral azithromycin was administered to 40 villages in Ethiopia. The village prevalence of ocular chlamydia was determined before treatment, and at two and six months post-treatment. The mean prevalence of ocular chlamydia was 48.9% (95% CI 42.8 to 55.0%) before mass treatments, decreased to 5.4% (95% CI 3.9 to 7.0%) at two months after treatments (p<0.0001), and returned to 7.9% (95% CI 5.4 to 10.4%) by six months after treatment (p = 0.03). Antibiotic coverage ranged from 73.9% to 100%, with a mean of 90.6%. In multivariate regression models, chlamydial prevalence two months after treatment was associated with baseline infection (p<0.0001) and antibiotic coverage (p = 0.007). However, by six months after treatment, chlamydial prevalence was associated only with baseline infection (p<0.0001), but not coverage (p = 0.31)., Conclusions/significance: In post-hoc analyses of a large clinical trial, the amount of endemic chlamydial infection was a strong predictor of chlamydial infection after mass antibiotic treatments. Antibiotic coverage was an important short-term predictor of chlamydial infection, but no longer predicted infection by six months after mass antibiotic treatments. A wider range of antibiotic coverage than found in this study might allow an assessment of a more subtle association.

Background: Trachoma-control programmes distribute oral azithromycin to treat the ocular strains of chlamydia that cause the disease and to control infection. Theoretically, elimination of infection is feasible if untreated individuals receive an indirect protective effect from living in repeatedly treated communities, which is similar to herd protection in vaccine programmes. We assessed indirect protection against trachoma with mass azithromycin distributions., Methods: In a cluster randomised trial, 24 subkebeles (government-defined units) in Amhara, Ethiopia, were randomised, with use of a simple random sample, to distribution four times per year of single-dose oral azithromycin to children aged 1-10 years (12 subkebeles, 4764 children), or to delayed treatment until after the study (control; 12 subkebeles, 6014 children). We compared the prevalence of ocular chlamydial infection in untreated individuals 11 years and older between baseline and 12 months in the treated subkebeles, and at 12 months between the treated and control subkebeles. Health-care and laboratory personnel were blinded to study group. Analysis was intention to treat. The study is registered with clinicaltrials.gov, number NCT00322972., Findings: At 12 months, 637 children aged 1-10 years and 561 adults and children aged 11 years and older were analysed in the children-treated group, and 618 and 550, respectively, in the control group. The mean prevalence of infection in children decreased from 48.4% (95% CI 42.9-53.9) to 3.6% (0.8-6.4) after four mass treatments. At 12 months, the mean prevalence of infection in the untreated age group (>/=11 years) was 47% (95% CI 33-57) less than baseline (p=0.002), and 35% (95% CI 1-57) less than that in untreated communities (p=0.04)., Interpretation: Frequent treatment of children, who are a core group for transmission of trachoma, could eventually eliminate infection from the entire community. Herd protection is offered by repeated mass antibiotic treatments, providing a strategy for elimination of a bacterial disease when an effective vaccine is unavailable., Funding: National Institutes of Health.

Purpose: Trachoma remains the leading infectious cause of blindness worldwide. The World Health Organization (WHO) recommends mass antibiotic distributions in its strategy to eliminate blinding trachoma. To determine the most effective antibiotic treatment strategy, it is essential to have a diagnostic test that can correctly measure the true status of ocular Chlamydia trachomatis infection in individuals, particularly after treatment. A newer ribosomal ribonucleic acid (rRNA)-based amplification test was compared with the current DNA-based polymerase chain reaction (PCR) for the detection of C. trachomatis., Methods: An rRNA-based assay and PCR were performed on swab specimens taken from the right upper tarsal conjunctiva of 240 children aged 1 to 5 years living among 16 endemic villages in the Gurage Zone, Ethiopia., Results: The rRNA-based test detected ocular C. trachomatis infection in 142 (59%) subjects compared with 67 (28%) detected by PCR (McNemar's test, P < 0.0001). The rRNA-based test gave positive results for all subjects who were positive by PCR and detected infection in 75 (31%) additional subjects., Conclusions: The rRNA-based test appears to have significantly greater sensitivity than PCR for the detection of ocular C. trachomatis infection in children in trachoma-endemic villages. The increased sensitivity of the rRNA-based test may be due to its ability to detect low levels of C. trachomatis infection in individuals, which can occur especially after antibiotic treatment. Data from past studies in which PCR was used to assess the prevalence of infectious trachoma after community-wide antibiotic treatments could have underestimated the true prevalence of infection.

The World Health Organization has distributed millions of doses of azithromycin to control the ocular chlamydial infection that causes trachoma. Theoretically, a loftier goal of elimination is feasible. Here, we demonstrate that, although local elimination of infection in the most severely affected communities is difficult, it is possible with biannual antibiotic distributions.

Background/aim: The World Health Organisation (WHO) hopes to achieve global elimination of trachoma, still the leading cause of preventable blindness worldwide, in part through mass antibiotic treatment. DNA-based nucleic acid amplification tests (NAATs) are currently used to evaluate the success of treatment programmes by measuring the prevalence of C trachomatis infection. Some believe that newer ribosomal RNA (rRNA)-based tests may be much more sensitive since bacterial rRNA is present in amounts up to 10 000 times that of genomic DNA. Others believe that rRNA-based tests are instead less sensitive but more specific, due to the presence of dead or subviable organisms that the test may not detect. This study compares an rRNA-based test to a DNA-based test for the detection of ocular C trachomatis infection in children living in trachoma-endemic villages., Methods: An rRNA-based amplification test and DNA-based polymerase chain reaction (PCR) were performed on swab specimens taken from the right upper tarsal conjunctiva of 56 children aged 0-10 years living in two villages in Amhara, Ethiopia., Results: The rRNA-based test detected ocular C trachomatis infection in 35 (63%) subjects compared with 22 (39%) detected by PCR (McNemar's test, p = 0.0002). The rRNA-based test gave positive results for all subjects that were positive by PCR, and also detected infection in 13 (23%) additional subjects., Conclusion: The rRNA-based test appears to have significantly greater sensitivity than PCR for the detection of ocular chlamydial infection in children in trachoma-endemic villages. Using the rRNA-based test, we may be able to detect infection that was previously missed with PCR. Past studies using DNA-based tests to assess prevalence of infectious trachoma following antibiotic treatment may have underestimated the true prevalence of infection.

Global change will alter the supply of ecosystem services that are vital for human well-being. To investigate ecosystem service supply during the 21st century, we used a range of ecosystem models and scenarios of climate and land-use change to conduct a Europe-wide assessment. Large changes in climate and land use typically resulted in large changes in ecosystem service supply. Some of these trends may be positive (for example, increases in forest area and productivity) or offer opportunities (for example, "surplus land" for agricultural extensification and bioenergy production). However, many changes increase vulnerability as a result of a decreasing supply of ecosystem services (for example, declining soil fertility, declining water availability, increasing risk of forest fires), especially in the Mediterranean and mountain regions.

The sensitivity of soil carbon to warming is a major uncertainty in projections of carbon dioxide concentration and climate. Experimental studies overwhelmingly indicate increased soil organic carbon (SOC) decomposition at higher temperatures, resulting in increased carbon dioxide emissions from soils. However, recent findings have been cited as evidence against increased soil carbon emissions in a warmer world. In soil warming experiments, the initially increased carbon dioxide efflux returns to pre-warming rates within one to three years, and apparent carbon pool turnover times are insensitive to temperature. It has already been suggested that the apparent lack of temperature dependence could be an artefact due to neglecting the extreme heterogeneity of soil carbon, but no explicit model has yet been presented that can reconcile all the above findings. Here we present a simple three-pool model that partitions SOC into components with different intrinsic turnover rates. Using this model, we show that the results of all the soil-warming experiments are compatible with long-term temperature sensitivity of SOC turnover: they can be explained by rapid depletion of labile SOC combined with the negligible response of non-labile SOC on experimental timescales. Furthermore, we present evidence that non-labile SOC is more sensitive to temperature than labile SOC, implying that the long-term positive feedback of soil decomposition in a warming world may be even stronger than predicted by global models.

Knowledge of carbon exchange between the atmosphere, land and the oceans is important, given that the terrestrial and marine environments are currently absorbing about half of the carbon dioxide that is emitted by fossil-fuel combustion. This carbon uptake is therefore limiting the extent of atmospheric and climatic change, but its long-term nature remains uncertain. Here we provide an overview of the current state of knowledge of global and regional patterns of carbon exchange by terrestrial ecosystems. Atmospheric carbon dioxide and oxygen data confirm that the terrestrial biosphere was largely neutral with respect to net carbon exchange during the 1980s, but became a net carbon sink in the 1990s. This recent sink can be largely attributed to northern extratropical areas, and is roughly split between North America and Eurasia. Tropical land areas, however, were approximately in balance with respect to carbon exchange, implying a carbon sink that offset emissions due to tropical deforestation. The evolution of the terrestrial carbon sink is largely the result of changes in land use over time, such as regrowth on abandoned agricultural land and fire prevention, in addition to responses to environmental changes, such as longer growing seasons, and fertilization by carbon dioxide and nitrogen. Nevertheless, there remain considerable uncertainties as to the magnitude of the sink in different regions and the contribution of different processes.