Individual-level Change Research Articles

Comprehensive blood metabolomics profiling of Parkinson’s disease reveals coordinated alterations in xanthine metabolism

Parkinson’s disease (PD) is a highly heterogeneous disorder influenced by several environmental and genetic factors. Effective disease-modifying therapies and robust early-stage biomarkers are still lacking, and an improved understanding of the molecular changes in PD could help to reveal new diagnostic markers and pharmaceutical targets. Here, we report results from a cohort-wide blood plasma metabolic profiling of PD patients and controls in the Luxembourg Parkinson’s Study to detect disease-associated alterations at the level of systemic cellular process and network alterations. We identified statistically significant changes in both individual metabolite levels and global pathway activities in PD vs. controls and significant correlations with motor impairment scores. As a primary observation when investigating shared molecular sub-network alterations, we detect pronounced and coordinated increased metabolite abundances in xanthine metabolism in de novo patients, which are consistent with previous PD case/control transcriptomics data from an independent cohort in terms of known enzyme-metabolite network relationships. From the integrated metabolomics and transcriptomics network analysis, the enzyme hypoxanthine phosphoribosyltransferase 1 (HPRT1) is determined as a potential key regulator controlling the shared changes in xanthine metabolism and linking them to a mechanism that may contribute to pathological loss of cellular adenosine triphosphate (ATP) in PD. Overall, the investigations revealed significant PD-associated metabolome alterations, including pronounced changes in xanthine metabolism that are mechanistically congruent with alterations observed in independent transcriptomics data. The enzyme HPRT1 may merit further investigation as a main regulator of these network alterations and as a potential therapeutic target to address downstream molecular pathology in PD.

Serum tumor markers for response prediction and monitoring of advanced lung cancer: A review focusing on immunotherapy and targeted therapies.

The value of serum tumor markers (STMs) in the current therapeutic landscape of lung cancer is unclear. This scoping review gathered evidence of the predictive, prognostic, and monitoring value of STMs for patients with advanced lung cancer receiving immunotherapy (IT) or targeted therapy (TT). Literature searches were conducted (cut-off: May 2022) using PubMed and Cochrane CENTRAL databases. Medical professionals advised on the search strategies. Study heterogeneity limited the evidence and inferences from the 36 publications reviewed. While increased baseline levels of serum cytokeratin 19 fragment antigen (CYFRA21-1) and carcinoembryonic antigen (CEA) may predict IT response, results for TT were less clear. For monitoring IT-treated patients, STM panels (including CYFRA21-1, CEA, and neuron-specific enolase) may surpass the power of single analyses to predict non-response. CYFRA21-1 measurement could aid in monitoring TT-treated patients, but the value of CEA in this context requires further investigation. Overall, baseline and dynamic changes in individual or combined STM levels have potential utility to predict treatment outcome and for monitoring of patients with advanced lung cancer. In advanced lung cancer, STMs provide additional relevant clinical information by predicting treatment outcome, but further standardization and validation is warranted.

Catching Fire: How National Humiliation Spreads Hostile Foreign Policy Preferences on Chinese Social Media

Abstract Research shows that emotions alter preferences, which are central to many models of political choice. However, how can theories that explain individual-level preference change explain policy outcomes, which usually take place at higher levels of analysis? I outline three competing approaches to this question, ultimately building on the third approach, which argues that emotions can spread through emotional contagion within identity groups. This implies emotions can broadly shift preferences towards or away from conflict during crises. It also explains how identities, which are relatively constant over the medium term, can suddenly become fault lines in a conflict. I find supporting evidence using a large (more than 1.6 billion posts) nationally representative data set of Chinese social media posts. Users’ national humiliation posts lead their followers to become more likely to make posts about national humiliation, suggesting contagion, and about using military force and maintaining territorial disputes, suggesting preference change.

Corporate Scandals as Punctuating Events That Change Human Resource Roles

Corporate scandals disrupt the landscape for organizational leaders and employees, providing a burning platform that creates new momentum for change. Here, we explore the implications for the human resources (HR) function as organization-level responses to scandals cannot occur without individual-level changes in employee behaviors—the domain of HR. We apply event systems theorizing to uncover the nature of the scandals through notions of strength, space, and time to better understand the range of possible outcomes for HR function roles. Empirical data are presented from in-depth qualitative case studies carried out in five large multinational corporations in the pharmaceutical, chemical, and financial services industries. Subsequently, we uncover how organization-level scandals punctuate the equilibrium of organizational operations, facilitating a recalibration of the balance between the potentially competing institutional logics of moral legitimacy and business priorities. We furthermore challenge universal HR role typology theorizing regarding the direct influence of external stakeholders on the role that HR can adopt inside organizations. Overall, we demonstrate that organizational responses to corporate scandals require individual-level and collective employee behavior change, placing the HR function at the intersection of managing risk, compliance, and legal requirements.

Assessing effects of pandemic-related policies on individual public transit travel patterns: A Bayesian online changepoint detection based framework

During a pandemic or natural disaster, people may alter transit usage behavior due to perception of changes in the environment. To effectively respond to these crises, it is important for governments and public transit agencies to understand when these changes occurred and how they were affected by relevant policies and responsive strategies. In this study, we develop a methodological framework based on Bayesian online changepoint detection (BOCD) to identify the occurrence time, direction, and persistency of changes in individual-level transit usage. We demonstrate the effectiveness of this framework in informing government decision-making in the context of COVID-19. Using Jeju Island, South Korea as a case study, we apply the framework over a nearly two-year smart card dataset collected from the beginning of 2019 till nine months into the pandemic. By focusing on frequent transit users, we detect when these users significantly changed their transit usage frequency during the pandemic and identify several types of users who experienced different behavior change patterns. Besides demonstrating the great heterogeneity in individual-level behavior changes, we perform a regression analysis to further understand how these changes were affected by key government policies (e.g., Risk alert, Social distancing, Public transit policy, and Eased social distancing). Our results suggest that only certain sets of policies appear to have significant effects. In particular, introducing Risk alert would cause a 277% to 317% increase in the number of users who reduced transit usage frequency. Policies that eased social distancing, though, would cause a 134% to 155% increase in the number of users with travel frequency increase. The proposed BOCD framework enables a scalable solution to identifying and understanding changes of individual transit behavior. The methodology and findings are beneficial for developing targeted policies and interventions to facilitate daily travel and public transit operations during public health crises.

Independent and synergistic effects of microplastics and endocrine-disrupting chemicals on the reproductive social behavior of fathead minnows (Pimephales promelas).

Microplastics (MPs) have become an environmental concern in recent years, with most research focused on the physiological effects of exposure. Comparatively little consideration has been given to the potential behavioral impacts of exposure, which may also have fitness consequences for individuals. Moreover, MPs can serve as vectors for endocrine-disrupting chemicals and other locally co-occurring contaminants known to impair behavioral responses. This project aimed to determine whether MPs alone or in association with a common environmental EDC (17-alpha ethinyl estradiol; EE2) alter reproductive behavior and decision-making in fish. Male and female fathead minnows (Pimephales promelas) were exposed to MPs associated with either a low (10 ng/L; MPEE2 10) or high (50 ng/L, MPEE2 50) concentration of EE2, or MPs without EE2 (MPvirgin) for 30 days via a dietary feeding protocol. Behavioral trials were conducted on Day 31 to determine the effects of exposure on male-female social interactions. The expression of male sexually selected traits, including courtship, was unaffected by exposure. However, non-exposed females in all treatment groups trended toward discrimination against exposed males, which reached statistical significance for the MPEE2 50 group. Female fish exposed to MPs, alone or in association with EE2, were equally likely to approach and associate with non-exposed and exposed males. The results from this study suggest that MPs may alter social behavior in fishes and that the behavioral impacts of exposure may be more strongly pronounced in females than males. Such individual-level changes in fitness have the potential to impact population size, with downstream effects on the broader aquatic community.

“They Need to Go in There”: Criminalized Subjectivity among Formerly Incarcerated Black Men

Black people are overrepresented in the American criminal justice system, yet policy-based criminal justice research has historically ignored the perspectives of criminalized Black people. Using interviews with 27 formerly incarcerated Black men, the author helps address this issue by exploring how carceral experiences produce “criminalized subjectivities.” In particular, when explicitly asked about what they would say to powerful state officials about their contact with the criminal justice system, the Black men in this study described a range of practices and policies they viewed as unfair and contradictory. Interviewees discussed: unequal judicial processes, inhumane prison conditions, postimprisonment barriers to reintegration, and the rigged nature of racialized mass criminalization. The author argues that, taken together, their responses constitute a critical perspective urging structural (rather than individual-level) change, rooted in experiences with invisibilization and criminalization.

Psychological Outcomes of 12–15-Year-Olds with Gender Dysphoria Receiving Pubertal Suppression in the UK: Assessing Reliable and Clinically Significant Change

The evidence base for psychological benefits of GnRHA for adolescents with gender dysphoria (GD) was deemed “low quality” by the UK National Institute of Health and Care Excellence. Limitations identified include inattention to clinical importance of findings. This secondary analysis of UK clinical study data uses Reliable and Clinically Significant Change approaches to address this gap. The original uncontrolled study collected data within a specialist GD service. Participants were 44 12–15-year-olds with GD. Puberty was suppressed using “triptorelin”; participants were followed-up for 36 months. Secondary analysis used data from parent-report Child Behavior Checklists and Youth Self-Report forms. Reliable change results: 15–34% of participants reliably deteriorated depending on the subscale, time point and parent versus child report. Clinically significant change results: 27–58% were in the borderline (subclinical) or clinical range at baseline (depending on subscale and parent or child report). Rates of clinically significant change ranged from 0 to 35%, decreasing over time toward zero on both self-report and parent-report. The approach offers an established complementary method to analyze individual level change and to examine who might benefit or otherwise from treatment in a field where research designs have been challenged by lack of control groups and low sample sizes.

The Effectiveness of Violence Reduction Therapy in Detained Adult Male Populations: Insights from a Systematic Review and Treatment Evaluation Capturing Individual Level Changes

ABSTRACT A systematic review examined the effectiveness of violence reduction therapy in detained forensic populations, capturing 23 papers. This demonstrated several themes and a failure to consider individual change alongside group effects. Consequently, the review was followed by evaluation of an aggression therapy program (Life Minus Violence-Enhanced: LMV-E) among adult male forensic patients (n = 26), which considered group and individual treatment change. Collectively, the research demonstrated a positive effect on emotional regulation (anger), with the ability to control and experience this particularly evidenced following therapy. The paper highlights the importance of accounting for individual change and developing theory informed evaluations.

Development of a proteomic signature associated with severe disease for patients with COVID-19 using data from 5 multicenter, randomized, controlled, and prospective studies

Significant progress has been made in preventing severe COVID-19 disease through the development of vaccines. However, we still lack a validated baseline predictive biologic signature for the development of more severe disease in both outpatients and inpatients infected with SARS-CoV-2. The objective of this study was to develop and externally validate, via 5 international outpatient and inpatient trials and/or prospective cohort studies, a novel baseline proteomic signature, which predicts the development of moderate or severe (vs mild) disease in patients with COVID-19 from a proteomic analysis of 7000 + proteins. The secondary objective was exploratory, to identify (1) individual baseline protein levels and/or (2) protein level changes within the first 2 weeks of acute infection that are associated with the development of moderate/severe (vs mild) disease. For model development, samples collected from 2 randomized controlled trials were used. Plasma was isolated and the SomaLogic SomaScan platform was used to characterize protein levels for 7301 proteins of interest for all studies. We dichotomized 113 patients as having mild or moderate/severe COVID-19 disease. An elastic net approach was used to develop a predictive proteomic signature. For validation, we applied our signature to data from three independent prospective biomarker studies. We found 4110 proteins measured at baseline that significantly differed between patients with mild COVID-19 and those with moderate/severe COVID-19 after adjusting for multiple hypothesis testing. Baseline protein expression was associated with predicted disease severity with an error rate of 4.7% (AUC = 0.964). We also found that five proteins (Afamin, I-309, NKG2A, PRS57, LIPK) and patient age serve as a signature that separates patients with mild COVID-19 and patients with moderate/severe COVID-19 with an error rate of 1.77% (AUC = 0.9804). This panel was validated using data from 3 external studies with AUCs of 0.764 (Harvard University), 0.696 (University of Colorado), and 0.893 (Karolinska Institutet). In this study we developed and externally validated a baseline COVID-19 proteomic signature associated with disease severity for potential use in both outpatients and inpatients with COVID-19.

Liver and Plasma Fatty Acid Characterization in Cultured Brown Trout at Distinct Reproductive Stages.

Fatty acids are energy sources, and their profiles are used as biomarkers of metabolic status and physiological changes in fish. Within this context, the main aim of this study was to identify the fatty acids that best discriminate the reproductive status of male and female farmed brown trout. The fatty acid composition in liver and plasma samples from the adults of both sexes was monitored along four distinct reproductive stages, namely the spawning capable (December), regressing (March), regenerating (July), and developing (November) stages. Irrespective of the sex and stage, the most representative fatty acids were palmitic acid (16:0), stearic acid (18:0), oleic acid (18:1 n-9), arachidonic acid (20:4 n-6), eicosapentaenoic acid (EPA, 20:5 n-3), and docosahexaenoic acid (DHA, 22:6 n-3). There were no significant sex differences in fatty acid classes in the liver and plasma. Despite this, there were several changes in individual fatty acid levels between the sexes. In the liver, both males and females showed high monounsaturated fatty acid and low polyunsaturated fatty acid (PUFA) levels during the regressing and regenerating stages. At spawning capable and developing stages, a reverse profile was noted. The plasma profiles were mainly influenced by changes in saturated fatty acids and PUFAs in males and by PUFA in females. Based on the most representative fatty acids, four patterns were established for female plasma samples, one for each reproductive stage. This scenario suggests that female plasma samples are promising for the discrimination of gonadal reproductive status, and this potential can be further explored in aquaculture and environmental monitoring studies.

Species-richness, abundance, and body size of stream-breeding anurans across land-use types in Sabah, Malaysia (Borneo)

Approximately 70% of Earth’s surface is impacted by human land-use. While numerous studies have demonstrated that species richness is higher in primary (undisturbed) forest than in secondary forest or agriculture sites, some studies fail to detect differences in species richness across land-use type. Recent work suggests that individual-level changes such as body size or body condition can occur more rapidly than population- or community-level processes, such as abundance and species richness, respectively. Thus, body size and condition may be more sensitive measures of environmental changes. We examined body size, body condition, abundance, and species richness of anurans in primary forest, secondary forest, and agriculture in Sabah, Malaysian Borneo, to determine whether individual-, population-, and community-level measures show similar sensitivities to land-use type. We found that observed anuran species richness and estimated population size are lower in agriculture than in primary or secondary forest, as were body size (SVL), mass, and body condition of female Meristogenys orphnocnemis. Further, anuran body condition (all species pooled) was higher in primary forest than agriculture or secondary forest, and size (SVL), mass, and body condition of male M. orphnocnemis were higher in primary forest than in agriculture or secondary forest areas. Collectively, our data demonstrate that primary forests are the best habitat for anurans in Sabah, and that individual-level processes such as size, mass, and body condition, show larger differences across land-use type than population- (abundance) or community-level processes (species richness). These data highlight the importance of primary forest for preserving anuran biodiversity in Borneo.

Entrepreneurial intentions’ temporal stability – intraindividual and group-level analyses

PurposeEntrepreneurial intention (EI) has been studied prolifically, as a precursor to entrepreneurial action, and a desired outcome of entrepreneurship education. Yet, the paucity of extant studies that analyze its temporal stability has been noted. This paper aims to address this gap by studying the temporal stability of EI, investigating its persistence as an attitudinal state over time.Design/methodology/approachA series of intraindividual and group-level longitudinal analyses were undertaken, over an 11-year period, using a student sample from Portugal. The authors highlight the magnitude of EI change over time, where item-structure, relative and absolute stability and group and individual-level EI changes are all considered.FindingsResults indicate an initially strong to moderate EI item-structure stability and relative stability over the first five years, with moderate signs of deterioration. This deterioration becomes even more pronounced across the full 11-year period. Regarding EI absolute stability, while college students (as a group) did not display a general tendency to develop higher or lower EI during the first five years, a small deterioration was found over the 11-year period. At the individual level, EI instability was detected, and this increased with time. Finally, the exploratory results suggest that entrepreneurship education may buffer the deterioration of EI.Practical implicationsThe findings provide a more nuanced reasoning for dampened EI–entrepreneurial behavior associations and highlight key determinants of EI change, which can inform educational experts and policymakers.Originality/valueThe legitimacy of the EI field lays heavily on the existence of a stable EI construct and a strong relationship between intentions and behavior. The methodology provides a new and more complete picture of EI’s temporal stability.

Barriers and facilitators to engagement in care and medication adherence for women living with HIV in the Southern United States

ABSTRACT Women living in the South have the second highest rate of HIV and the lowest rate of viral suppression among women in all regions in the United States (U.S.). Viral suppression is achieved by successfully linking women to HIV care and supporting adherence to antiretroviral therapy (ART). We aimed to qualitatively explore perceived barriers and facilitators to HIV care engagement and ART adherence among women living with HIV in the South. Participants (N = 40) were recruited across a broad geographic area of the South, assisted by a location-specific Community/Clinician Advisory Board (CCAB). Qualitative research methods were used to generate in-depth descriptions of women's experiences in accessing HIV care and adhering to ART. Intrapersonal qualities expressed through resilience and self-efficacy were amongst the most prominent themes for both engagement in care and adherence to medications. Structural barriers such as transportation and distance to care continued to be a barrier to engagement, while medication delivery facilitated adherence. Conclusion: Our findings highlight the complexity and interrelated nature of factors impacting care and adherence. Multilevel interventions that incorporate structural factors in addition to individual-level behavioral change are needed to facilitate engagement in care and adherence to ART.

Community pharmacists’ readiness to take action to improve working conditions

ObjectiveThe objective of this study was to assess pharmacists’ readiness to take actions resulting in change at the individual level or systemic level. Design/Setting and Participants/Outcome measuresAn online survey was distributed via pharmacy-related social media pages and several state pharmacy association newsletters and e-mail listservs. Fifteen items assessed participants’ readiness to pursue change using a 5-point scale based on the transtheoretical model of behavior change (1 = Do not plan on doing, 2 = Plan to take in the next 6 months, 3 = Plan to take in the next month, 4 = Took in the past 6 months, 5 = Took more than 6 months ago). Categorical principal components analysis (CATPCA) was used as a data reduction technique to identify underlying components of the 15 items assessing readiness to improve working conditions. Component scores for each component were calculated and used as dependent variables in multivariable linear regression models to test associations between the components and sociodemographic and work-related predictors. ResultsCATPCA revealed a 12-item scale with 2 components accounting for 39.97% of the total variance. Pharmacists working in independent pharmacies had a significantly higher willingness than chain pharmacists to pursue actions with potential to result in systemic-level changes, such as contacting or joining an organization to attempt to improve their current working conditions (regression coefficient = 0.623, P < 0.001). Pharmacists working in independent pharmacies had a significantly lower willingness than chain pharmacists to pursue actions resulting in individual-level changes, such as changing their current job or quitting (regression coefficient = −0.485, P < 0.001). ConclusionPharmacists working in national chains may be less willing than independent pharmacists to pursue systemic-level changes owing to fear of discipline from employers. Future research should examine the effect of interventions intended to increase pharmacists’ motivation and readiness to pursue changes to improve working conditions.

Changes in prey body size differentially reduces predation risk across predator and prey abundances

Trophic interactions underpin the structure of ecological communities by describing the rates at which consumers exploit their resources. The rates at which predators consume their prey are influenced by prey traits, with many species inducing defensive modifications to prey traits following the threat of predation. Here we use different clonal lines of the protist Paramecium being consumed by Stenostomum predators to highlight how differences in prey traits impact rates of predation. Clonal lines differed in their body width traits, and in their ability to induce changes in body width. By using a factorial cross of predator and prey abundances for different clonal lines we demonstrate how evolutionary or induced alterations in prey traits can impact the relative threat of predation. Our experiments show how interference among predators impacts predation rate, and how increased body width increased predator handling times. Given that reductions in the strength of interspecific interactions are associated with increased levels of overall community stability, our results indicate how individual level changes may scale up to impact whole communities.

Association Between Fluctuations in Blood Lipid Levels Over Time With Incident Alzheimer Disease and Alzheimer Disease-Related Dementias.

Prevention strategies for Alzheimer disease and Alzheimer disease-related dementias (AD/ADRDs) are urgently needed. Lipid variability, or fluctuations in blood lipid levels at different points in time, has not been examined extensively and may contribute to the risk of AD/ADRD. Lipid panels are a part of routine screening in clinical practice and routinely available in electronic health records (EHR). Thus, in a large geographically defined population-based cohort, we investigated the variation of multiple lipid types and their association to the development of AD/ADRD. All residents living in Olmsted County, Minnesota on the index date January 1, 2006, aged 60 years or older without an AD/ADRD diagnosis were identified. Persons with ≥3 lipid measurements including total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), or high-density lipoprotein cholesterol (HDL-C) in the 5 years before index date were included. Lipid variation was defined as any change in individual's lipid levels over time regardless of direction and was measured using variability independent of the mean (VIM). Associations between lipid variation quintiles and incident AD/ADRD were assessed using Cox proportional hazards regression. Participants were followed through 2018 for incident AD/ADRD. The final analysis included 11,571 participants (mean age 71 years; 54% female). Median follow-up was 12.9 years with 2,473 incident AD/ADRD cases. After adjustment for confounding variables including sex, race, baseline lipid measurements, education, BMI, and lipid-lowering treatment, participants in the highest quintile of total cholesterol variability had a 19% increased risk of incident AD/ADRD, and those in highest quintile of triglycerides, variability had a 23% increased risk. In a large EHR derived cohort, those in the highest quintile of variability for total cholesterol and triglyceride levels had an increased risk of incident AD/ADRD. Further studies to identify the mechanisms behind this association are needed.

Taking equity-mindedness to the next level: the equity-minded organization

University and college leaders have an espoused interest in racial equity. In recent years, university and college leaders have invested in diversity, equity, and inclusion (DEI) training that focuses on developing individual attributes that reflect equity-mindedness. For example, DEI training efforts have often been focused on helping faculty develop critical race consciousness by raising their awareness of systemic racism in their routine teaching, mentoring, and hiring practices. However, in many cases, DEI training and equity change efforts primarily focus on individual-level change without critically identifying, disrupting, and transforming organizational processes and policies that perpetuate structural racism. In this paper, we synthesized research on race, organizations, and equity-mindedness to argue that racial equity change efforts should aspire to transform universities and colleges into equity-minded organizations. At the organizational level, equity-mindedness has the potential to structure organizational behavior, shape policy development, and frame practitioner and leader understandings of organizational equity issues in ways that are more aligned with their commitments to equity and justice. Through an analysis of higher education equity change efforts, we introduce a framework for equity-minded organizations. Theorizing equity-mindedness at the organizational level creates opportunities for university leaders, stakeholders, and researchers to move beyond the traditional prose of commitments to DEI to the design of programs, policies, and practices that can lead to more lasting structural changes.

#2758 AMBIENT HEAT EXPOSURE AND ESTIMATED GLOMERULAR FILTRATION RATE TRAJECTORY: A POST-HOC ANALYSIS OF THE DAPA-CKD TRIAL

Abstract Background and Aims Higher ambient temperatures have been associated with higher rates of admission for kidney stones and acute kidney injury. Occupational heat stress is also a risk factor for impaired kidney function in several rural resource-poor settings. It is unclear if higher ambient heat exposure is associated with a faster loss of kidney function in patients with established, all-cause, chronic kidney disease (CKD). We therefore undertook a post-hoc analysis of the DAPA-CKD trial linking participant data to publicly available climate measurements. Method The DAPA-CKD trial randomized 4304 patients with proteinuric CKD (estimated glomerular filtration rate, eGFR, 25-75 mL/min/1.73 m2; urine albumin-to-creatinine ratio, ACR, 23-566 mg/mmol) to dapaglifozin or placebo in addition to standard of care. We examined the association between daily study centre-level ambient heat exposure (defined as a mean heat index, HI, &amp;gt;30; European Centre for Medium-Range Weather Forecasts ERA5 reanalysis dataset) and individual-level change in eGFR using both a linear-mixed effects model and a case-time series approach to address potential unmeasured individual- and centre-level confounding. Results Climate and eGFR data were available on 3915 (91%) participants across 361 centres in 21 countries. Over a median of 28 months, participants (mean age: 62 years; mean eGFR: 43mL/min/1.73 m2) were followed-up at centres where there was a median of 1 day (interquartile range: 0 to 64 days) with an HI&amp;gt;30. Each 30-day period of HI&amp;gt;30 over the study period was associated with a change in eGFR of -0.7% (95% CI: -1.0% to -0.3%), equivalent to an additional eGFR loss of between 1.2 and 4.0mL/min/1.73 m2 per year in a patient with an eGFR of 45mL/min/1.73 m2 located in a very hot versus temperate environment. Similar estimates were obtained using the case time series approach. This association persisted after adjustment for potential haemoconcentration effects on the day of testing and further analyses provided no evidence that these findings varied with baseline eGFR, albuminuria or randomised treatment arm (Figure 1), or by high- versus middle-income country study centre location. Conclusion Higher ambient heat exposure is associated with a more rapid decline in kidney function among patients with CKD. Efforts to mitigate heat exposure should be prospectively tested as part of a comprehensive strategy to slow the progression of kidney disease.

Perceived national wealth increases support for structural climate policies

Climate change cannot be successfully mitigated solely through individual-level actions. Structural change is urgently needed. While wealthy countries have the greatest capacity to implement structural change, the question remains to what extent perceived country wealth is associated with support for structural climate policies over individual-level behaviour change policies. We found in Australian (Study 1) and UK (Study 2) samples (N = 967) that perceived national wealth positively predicts people's support for structural (vs. individual-level behaviour) change policies. In an experimental (Study 3, N = 401) and a quasi-experimental study (Study 4, N = 400; comparing South African and UK participants), we found that people in both wealthy and poor countries more strongly prefer wealthy (vs. poor) countries to implement structural (vs. individual-level behaviour) change policies. There was some evidence that these effects are mediated by perceiving wealthy countries to have a moral obligation to contribute to the solution of global issues. The findings suggest that there is considerable public support for wealthy countries to spearhead structural transformations to limit climate change. These insights can help environmental organisations and policymakers to gain public support for climate policies by emphasising their countries' moral obligation to implement change and by countering blame-deflecting narratives.