Large-scale Programs Research Articles

Using an acoustic complexity index to help monitor climate change effects on avian diversity

Passive recording technologies have become a valuable tool for ecologists to accumulate large data sets on vocalizing species assemblages and to study the response of biodiversity to regional and global environmental change. However, the process of interpreting these recordings and identifying species can be time-consuming. To automate this process, and to derive diversity metrics directly from the audio files, soundscape ecologists developed and published many bioacoustics indices, which are calculated using computer algorithms that mathematically summarize the acoustic energy in a recording. Of these indices, the acoustic complexity index (ACI) is perhaps the most widely proposed surrogate of bird species richness. Although several studies have shown the ACI to have positive correlations with species richness, it remains unknown how well the ACI will perform over large, habitat-diverse, regions. Our aim, here, was to examine whether site-level bird species richness (alpha diversity) correlated with the ACI across a large heterogenous mountain region. Further, we explored whether the elevational trends for alpha diversity and the ACI exhibited similar unimodal patterns with corresponding maximums and whether any shifts in the elevation of these maximums could be tracked over time in response to climate change. We deployed recording devices along two extensive transects on the Pacific Crest Trail in California, USA; these included a 689-km trail section in northern California and a 531-km section in southern California. Point counts for birds from the field were combined with the interpretation of the recordings to estimate alpha diversity using a Bayesian multispecies occupancy model. We found that alpha diversity exhibited a positive linear relationship with the ACI on both trail sections. However, these relationships were not strong (low R2 values). Similar mid-elevation maximums for alpha diversity and the ACI were observed along the northern trail section. Power analysis revealed that with repeated annual surveys using our protocols, we could detect an average shift in the elevation of either maximum species richness or ACI of approximately 100 m over 20 years (i.e., 5 m/yr), which could be improved in precision to 50 m (i.e., 2.5 m/yr) with a 5-fold increase in survey effort. Although there was considerable unexplained variation in our diversity- and ACI-elevation trends, which we suspect was due to microhabitat and microclimate effects, we concluded that the ACI was a useful, albeit coarse, surrogate of alpha diversity across large regions. The ACI warrants consideration by ecologists and land managers for application in large-scale monitoring programs.

Implementing a text-messaging intervention for unhealthy alcohol use in emergency departments: protocol for implementation strategy development and a pilot cluster randomized implementation trial

BackgroundUnhealthy alcohol use (UAU) is a leading cause of premature mortality among adults in the USA. Emergency departments (EDs) are key intervention settings for UAU but often have limited time and resources. One low-burden, scalable approach to address UAU is text-messaging interventions. Despite strong research support and promise for scalability, there is little research on how to implement such interventions in healthcare settings. The process of providers making them available to patients in an efficient way within already busy and overburdened ED workflows and patients adopting them remains a new area of research. The purpose of this three-phase study is to develop and test an implementation strategy for UAU text-messaging interventions in EDs.MethodOur first aim is to examine barriers and facilitators to staff offering and patients accepting a text-messaging intervention in the ED using an explanatory, sequential mixed methods approach. We will examine alcohol screening data in the electronic health records of 17 EDs within a large integrated health system in the Northeast and conduct surveys among chairpersons in each. This data will be used to purposively sample 4 EDs for semi-structured interviews among 20 clinical staff, 20 patients, and 4 chairpersons. Our second aim is to conduct a stakeholder-engaged intervention mapping process to develop a multi-component implementation strategy for EDs. Our third aim is to conduct a mixed method 2-arm cluster randomized pilot study in 4 EDs that serve ~11,000 UAU patients per year to assess the feasibility, acceptability, and preliminary effectiveness of the implementation strategy. The Integrated Promoting Action on Research Implementation in Health Services framework will guide study activities.DiscussionLow-burden technology, like text messaging, along with targeted implementation support and strategies driven by identified barriers and facilitators could sustain large-scale ED-based alcohol screening programs and provide much needed support to patients who screen positive while reducing burden on EDs. The proposed study would be the first to develop and test this targeted implementation strategy and will prepare for a larger, fully powered hybrid effectiveness-implementation trial. Findings may also be broadly applicable to implementation of patient-facing mobile health technologies.Trial registrationThis study was registered at ClinicalTrials.gov (NCT05350878) on 4/28/2022.

Hypertension Treatment in Nigeria (HTN) Program: rationale and design for a type 2 hybrid, effectiveness, and implementation interrupted time series trial

BackgroundHypertension is the most common cardiovascular disease in Nigeria and contributes to a large non-communicable disease burden. Our aim was to implement and evaluate a large-scale hypertension treatment and control program, adapted from the Kaiser Permanent Northern California and World Health Organization HEARTS models, within public primary healthcare centers in the Federal Capital Territory, Nigeria.MethodsA type 2 hybrid, interrupted time series design was used to generate novel information on large-scale implementation and effectiveness of a multi-level hypertension control program within 60 primary healthcare centers in the Federal Capital Territory, Nigeria. During the formative phase, baseline qualitative assessments were held with patients, health workers, and administrators to inform implementation package adaptation. The package includes a hypertension patient registry with empanelment, performance and quality reporting, simplified treatment guideline emphasizing fixed-dose combination therapy, reliable access to quality essential medicines and technology, team-based care, and health coaching and home blood pressure monitoring. Strategies to implement and adapt the package were identified based on barriers and facilitators mapped in the formative phase, previous implementation experience, mid-term qualitative evaluation, and ongoing stakeholder and site feedback. The control phase included 11 months of sequential registration of hypertensive patients at participating primary healthcare centers, followed by implementation of the remainder of the package components and evaluation over 37 subsequent, consecutive months of the intervention phase.The formative phase was completed between April 2019 and August 2019, followed by initiation of the control phase in January 2020. The control phase included 11 months (January 2020 to November 2020) of sequential registration and empanelment of hypertensive patients at participating primary healthcare centers. After completion of the control phase in November 2020, the intervention phase commenced in December 2020 and will be completed in December 2023.DiscussionThis trial will provide robust evidence for implementation and effectiveness of a multi-level implementation package more broadly throughout the Federal Capital Territory, which may inform hypertension systems of care throughout Nigeria and in other low- and middle-income countries. Implementation outcome results will be important to understand what system-, site-, personnel-, and patient-level factors are necessary for successful implementation of this intervention.Trial registrationClinicalTrials.gov NCT04158154. The trial was prospectively registered on November 8, 2019.

Enhanced women’s decision-making power after the Suchana intervention in north-eastern Bangladesh: a cluster randomised pre-post study

ObjectivesWomen’s decision-making power is a dimension of empowerment and is crucial for better physical and psychosocial outcomes of mothers. Suchana, a large-scale development programme in Bangladesh, actively provided social interventions...

Valid and Convenient Questionnaire Assessment of Chinese Body Constitution: Item Characteristics, Reliability, and Construct Validation.

BackgroundBody constitution is a fundamental concept in traditional Chinese medicine (TCM) for clinical diagnosis, treatment of illness, and community-based health promotion. Clinical assessment of patients’ body constitutions, however, has never been easy and consistent, even by well-trained clinicians and TCM practitioners. Therefore, questionnaires such as the popular Constitution in Chinese Medicine Questionnaire (CCMQ) can be an appealing and convenient assessment alternative. The present research borrowed advanced methodologies for questionnaire development in psychology and other social sciences to examine the performance of the CCMQ in terms of (i) the strength of relations of each item with its designated constitution, (ii) the reliabilities of each constitution, and (iii) the overall 9-constitution structure. This research provided empirical evidence to support the use of the CCMQ and proposed directions for refinement in future revisions of the CCMQ or similar measures.MethodsA total of 1571 volunteers from three villages in southern China participated in the CCMQ survey. The item characteristics, reliabilities, interconstitution correlations, and confirmatory factor analysis of the 9-body-constitution structure were examined.ResultsThe results generally supported the appropriateness of the clinical observations (the questionnaire items) and the CCMQ 9-constitution classification structure. Nevertheless, some relatively weaker items, item pairs with similar meanings, and highly overlapping constitutions were identified for future CCMQ revisions.ConclusionThe CCMQ measured the 9 constitutions efficiently and with reasonably good reliability and construct validity. Given the various challenges to assessing TCM body constitutions even by experienced clinicians, the CCMQ provides an appealing alternative to measure the Chinese body constitutions of healthy participants in large-scale research or community health promotion programs. The present study also demonstrated how advanced methodologies in social sciences can help validate and refine the CCMQ and similar complementary medicine measures.

Estimating hydrological consequences of vegetation greening

• LAI increased significantly up to 72.2% of the whole YRB area in 1981–2018. • Vegetation greening decreased SW and Q, but increased ET in selected catchments. • Sensitivities of the changes in Q and ET to the changes in LAI increased as LAI grows. • Sensitivity of ET and Q to LAI changes increased as the climate became drier. Large-scale afforestation program has alleviated environmental problems to some extent in China. However, the response of hydrological processes to vegetation greening at different catchments remains unclear. This study identified the impact of vegetation changes on runoff (Q), evapotranspiration (ET), and soil water storage (SW), as well as their relationships and sensitivities based on a coupled SWAT-PML model for 23 catchments from 2000 to 2018 in the Yellow River Basin (YRB). Results show that leaf area index (LAI) was significantly ( p < 0.05) increased in 72.2% of the YRB area. Vegetation greening decreased SW and Q, but increased ET in all catchments. The effects of vegetation greening on Q and ET were contrasting with axisymmetric fluctuation distribution. The changes in SW, ET, and Q were strongly correlated with the changes in LAI. Sensitivity of the changes in ET and Q to LAI changes increased when the climate becomes drier. Our study suggests that the vegetation greening followed by the afforestation policy implementation has caused gradually increasing impacts on Q and ET. However, such effects are spatially heterogeneous due to different degrees of increase in LAI and aridity conditions. Given the water crisis problem in the YRB, afforestation activity should be taken into consideration of the increasing water demand and the negative effects of vegetation greening on water resources in the future.

Paisan Ruamviboonsuk: saving sight in Thailand

Earlier this year, WHO announced the winners of its 2022 awards for outstanding contributions to public health. Paisan Ruamviboonsuk won the Sasakawa Health Prize for his work on diabetic retinopathy in Thailand, which led to the establishment of a cadre of nurses and technicians trained to diagnose the condition and a nationwide screening programme run by the Ministry of Public Health. Ruamviboonsuk, clinical professor at the College of Medicine, Rangsit University, Rajavithi Hospital (Bangkok, Thailand), received the award at a ceremony in Geneva, Switzerland, hosted by the World Health Assembly on May 27, 2022.Back in the mid-1990s, diabetic retinopathy accounted for almost a third of blindness in Thailand. At the time, around 4 million people in the country were living with diabetes (today there are closer to 7 million). For those in rural areas, arranging to see a specialist for their recommended annual eye examination was not always straightforward. Film-based cameras could be used to photograph the retina, but it would still take several days to make a diagnosis. Real-time diabetic retinopathy screening by deep learning in a multisite national screening programme: a prospective interventional cohort studyA deep-learning system can deliver real-time diabetic retinopathy detection capability similar to retina specialists in community-based screening settings. Socioenvironmental factors and workflows must be taken into consideration when implementing a deep-learning system within a large-scale screening programme in LMICs. Full-Text PDF Open Access

Climate change and cocoyam (Colocasia esculenta (L.) Schott) production: assessing impacts and potential adaptation strategies in Zimbabwe

Tropical root and tuber crops such as cocoyam (Colocasia esculenta (L.)) are important for food security and livelihoods and yet neglected in climate change impact studies and large-scale crop improvement programs. The aim of this study was to apply the maximum entropy modelling approach to assess production potential for the orphan crop cocoyam under current and projected climatic conditions by 2050 and 2070 in Zimbabwe. A robust model fit was achieved (AUC > 0.9) with variable importance showing that precipitation-related factors were most important in determining the suitability of cocoyam. About 4.3% of the country is suitable for cocoyam production in Zimbabwe under current climatic conditions with the most suitable areas in eastern districts of Chipinge, Chimanimani, Mutare, Mutasa, Nyanga and Makoni. By 2050, model means project a decrease of 6%, 9%, 10% and 15% under RCP2.6, RCP4.5, RCP6.0 and RCP8.5, respectively. More drastic decreases are projected by 2070 with almost a quarter (23%) of the current suitable areas having lost their suitability for cocoyam production. There is a general model agreement in the direction of impacts except for RCP2.6 where CCSM4 model projects increases in suitability for cocoyam in the country while other models project decreases. We find that regulating canopy microclimate variation increases potential for cocoyam production under climate change and can be implemented to ensure resilience of cocoyam production systems. Therefore, stabilizing or improving orphan crops systems will substantially contribute to local food security and reduction of malnutrition especially during the lean season.

Public policy in the context of digitalization of society. International experience in implementing programs and digitization strategies

It is analyzed that the process of digitalization is objective, depends on globalization processes. However, this process, as well as political and market relations in general, is characterized by certain features, defects and failures of the market that require government regulation and intervention. In most countries of the modern world, one of the priority strategic tasks and national priorities is the introduction of information and communication technologies (ICT) and the development of elements of the digital society. Digital technologies, as well as related social and human activities form the digital sphere of modern society, which in the current environment determines the economic and innovative potential of the state, education and human development, determines social progress, good governance and democratic procedures. The development of the principles of the digital society stimulates the improvement of ways and methods of interaction in the framework of socio-economic relations. The use of information technology allows to expand communication processes, changes the composition and status of their participants, the principles of spatial interaction through networking, increases the decentralization of management decisions in the public and private sectors. Based on the analysis of modern theoretical models, it is possible to outline the model of digital policy. Elements of the model are the digital field, which influences the use of certain ways of interaction of digital political entities with the digital infrastructure; digital infrastructure - a number of technologies / tools for network integration; user networks - communities of citizens who master and use digital technologies / tools to achieve common goals, self-government; digital policymakers integrating these networks for policy implementation Thus, a new reality has emerged in the world, which encourages governments of all countries to pursue a system of digital economy through digital transformation by improving relevant areas of national legislation, development and implementation of large-scale government strategies, projects and programs, including full digital technology. A comprehensive study of digital politics as a new phenomenon of the political process in the modern world, which arises under the influence of global digitalization. It has been found that the digitalization of politics is a valence, unstable, incomplete process, which can be explained by the very nature of global digitalization, which is constantly self-improving and self-renewing. This also affects the principles of digital policymakers, who are constantly improving their tools through the formation of larger communities. So the balance of power in the digital world depends on the immediate integration of these communities by one or another digital political entity. Digitalization of public policy is described as a constant modification of the digital infrastructure of the political process. Categories have been established for the study of digitalization of politics in order to identify its impact on modern discourse: "digital politics", "digital political actors". Factors influencing the process of digitalization of public policy in foreign countries are identified. A model of digital policy is proposed, which allows to determine the content and principles of transformation of state policy in the digital environment, in particular: 1) the procedure for creating a new type of political actor - digital political entity; 2) creating conditions for the creation of different types of networks for policy implementation within digital policy practices, 3) methods of using digital infrastructure for policy implementation, 4) principles of producing a new type of political content that changes the structure and formats of political texts.

European Lobster Larval Development and Fitness Under a Temperature Gradient and Ocean Acidification.

Climate change combined with anthropogenic stressors (e.g. overfishing, habitat destruction) may have particularly strong effects on threatened populations of coastal invertebrates. The collapse of the population of European lobster (Homarus gammarus) around Helgoland constitutes a good example and prompted a large-scale restocking program. The question arises if recruitment of remaining natural individuals and program-released specimens could be stunted by ongoing climate change. We examined the joint effect of ocean warming and acidification on survival, development, morphology, energy metabolism and enzymatic antioxidant activity of the larval stages of the European lobster. Larvae from four independent hatches were reared from stage I to III under a gradient of 10 seawater temperatures (13–24°C) combined with moderate (∼470 µatm) and elevated (∼1160 µatm) seawater pCO2 treatments. Those treatments correspond to the shared socio-economic pathways (SSP), SSP1-2.6 and SSP5-8.5 (i.e. the low and the very high greenhouse gas emissions respectively) projected for 2100 by the Intergovernmental Panel on Climate Change. Larvae under the elevated pCO2 treatment had not only lower survival rates, but also significantly smaller rostrum length. However, temperature was the main driver of energy demands with increased oxygen consumption rates and elemental C:N ratio towards warmer temperatures, with a reducing effect on development time. Using this large temperature gradient, we provide a more precise insight on the aerobic thermal window trade-offs of lobster larvae and whether exposure to the worst hypercapnia scenario may narrow it. This may have repercussions on the recruitment of the remaining natural and program-released specimens and thus, in the enhancement success of future lobster stocks.

Long-term health after Severe Acute Malnutrition in children and adults- the role of the Pancreas (SAMPA): Protocol.

Background: Prenatal growth retardation may increase the risk of later chronic non-communicable diseases (NCDs), including diabetes; however, long-term effects of wasting malnutrition in childhood or adulthood are less studied. Pancreatic exocrine and endocrine functions, both critical for nutrition and NCD aetiology, may not fully recover following malnutrition. However, the evidence and mechanistic information is piecemeal. We hypothesise that wasting malnutrition at any age has long-term detrimental effects on endocrine and exocrine pancreatic structure and function. Methods: The SAMPA international research programme will assess pancreatic structure and function in 3700 participants from ongoing observational nutrition cohorts, two adolescent and four adult, in Zambia, Tanzania, Philippines, and India. Pancreas size, structure, and calcification will be assessed by ultrasound and computed tomography (CT) scan; exocrine function by faecal elastase and serum lipase; and endocrine function by haemoglobin A1c (HbA1c) and blood glucose, insulin and C-peptide concentrations during an oral glucose tolerance test (OGTT). In-depth hormonal analyses of incretins, glucagon, proinsulin and trypsinogen during OGTT and intravenous glucose tolerance tests will be done in subsets of adult participants. Pancreatic size and function outcomes will be compared between people with and without prior wasting malnutrition. Analyses will investigate effect modification by sex, current age, time since malnutrition, current body mass index and dietary patterns. Mathematical modelling of OGTT data will be used to estimate the relative contribution to glucose dysregulation of decreased insulin production, changes in insulin clearance and increased insulin resistance. Proinsulin/insulin ratio will be analysed in archived samples from the Tanzanian cohort using a nested case-control design to investigate whether abnormal values precede diabetes. Conclusions: SAMPA, a large-scale multi-centre research programme using data from people with or without prior wasting malnutrition to assess several aspects of pancreatic phenotype, will provide coherent evidence for future policies and programmes for malnutrition and diabetes.

Can Restoration of the Commons Reduce Rural Vulnerability? A Quasi-Experimental Comparison of COVID-19 Livelihood-based Coping Strategies among Rural Households in Three Indian States

India has been hard hit by the COVID-19 pandemic. In the context of a larger quasi-experimental impact assessment, we assess the pandemic’s effects on household coping behavior in 80 villages spread across four districts and three states (n = 772). Half of these villages were targeted by a largescale common land restoration program spearheaded by an NGO, the Foundation for Ecological Security (FES). The other half are yet to be targeted but are statistically similar vis-à-vis FES’s village targeting criteria. Analyzing the results of a phone survey administered eight to ten months into the pandemic and its associated lockdowns, we find that the livelihood activities of households in both sets of villages were adversely impacted by COVID-19. Consequently, most households had to resort to various negative coping behaviors, e.g., distressed asset sales and reduced farm input expenditure. From the same mobile survey data, we construct a Livelihoods Coping Strategies Index (LCSI) and find that households in villages targeted by FES’s common land restoration initiative score 11.3% lower on this index on average, equating to a 4.5 percentage point difference. While modest, this statistically significant effect estimate (<em>p</em> &lt; 0.05) is consistent across the four districts and robust to alterative model and outcome specifications. We find no empirical support that our observed effect was due to improved access to common pool resources or government social programs. Instead, we speculate that this effect may be driven by institutional factors, rather than economic, a proposition we will test in future work.

COVID-19 vaccination for children aged 5–11 years

COVID-19 vaccination for children aged 5–11 years

Effect of home-based childcare on childhood mortality in rural Maharashtra, India: a cluster randomised controlled trial

BackgroundMelghat, an impoverished rural area in Maharashtra state, India; has scarce hospital services and low health-seeking behaviour. At baseline (2004) the under-five mortality rate (U5MR) (number of deaths in children...

Teacher Incentives and Student Performance: Evidence from Brazil

Abstract This paper provides evidence on a large-scale teacher incentive program in the state of São Paulo, Brazil, which awarded group bonuses to teachers and school staff conditional on improvements in student performance. By using a difference-in-differences and triple-differences framework with a series of alternative counterfactual groups, I show that the program had positive effects on student achievement up to seven years after implementation, although improvements vary across grades and subjects. Although it could be expected that free-riding effects increase with the number of teachers in schools, limiting the impact of the program, this does not seem to be the case.

Utilization of Peritoneal Dialysis in the United States: Progress in Tackling Obstacles to Expansion.

To facilitate the desired increase in home dialysis utilization in the United States, multiple factors need to be taken into consideration in order to achieve this complex task. Through policy-level facilitators such as the Advancing American Kidney Health Initiative and the expansion of telehealth utilization, adjustments to the existing payment models, providing health equity incentives, increasing number of provider education materials on home therapies, and allaying patient fears with the expansion of home dialysis education nationwide, we have taken several steps in the right direction. There is still a long way to go, and further improvements can be made while utilizing lessons learned from some of our international peers who have been successful in their implementation of large-scale home dialysis programs.

Movements of Hatchery-Reared Dusky Groupers Released in a Northeast Atlantic Coastal Marine Protected Area

No-take areas are key instruments to promote the effectiveness of Marine Protected Areas (MPAs), particularly concerning the protection of endangered species such as the dusky grouper (Epinephelus marginatus). However, despite the establishment of no-take areas and the prohibition of catching this species in a southwestern Portuguese MPA (SACVMP—‘Sudoeste Alentejano’ and ‘Costa Vicentina’ Marine Park) since 2011, there is still no evidence of population recovery. By using acoustic biotelemetry, this work aimed to evaluate the feasibility of restocking hatchery-reared adult dusky groupers in two no-take areas within the SACVMP. In 2019 and 2021, thirty groupers were tagged with acoustic transmitters and the site attachment and movements of the groupers were assessed in the releasing sites (no-take areas). None of the tagged fish settled down in either of the areas, leaving the no-take areas mainly at dusk and night. Some individuals displayed extended movements of more than a hundred kilometers along the Portuguese coast which was rarely reported for this species. At least in some coastal stretches, those movements were performed close to the shore, which may evidence the importance of coastal MPAs to protect and promote the connectivity of species more associated with rocky reef habitats. Following studies should focus on the conditions that promote site attachment and fidelity by hatchery-reared dusky groupers so that future large-scale restocking programs can be successful in MPAs with appropriate habitats.

Strengthening effectiveness evaluations to improve programs for women, children and adolescents

ABSTRACT A full understanding of the pathways from efficacious interventions to population impact requires rigorous effectiveness evaluations conducted under realistic scale-up conditions at country level. In this paper, we introduce a deductive framework that underpins effectiveness evaluations. This framework forms the theoretical and conceptual basis for the ‘Real Accountability: Data Analysis for Results’ (RADAR) project, intended to address gaps in guidance and tools for the evaluation of projects being implemented at scale to reduce mortality among women and children. These gaps include needs for a framework to guide decisions about evaluations and practical measurement tools, as well as increased capacity in evaluation practice among donors and program planners at global, national and project levels. RADAR aimed to improve the evidence base for program and policy decisions in reproductive, maternal, newborn and child health and nutrition (RMNCH&N). We focus on five linked methodological steps – presented as core evaluation questions – for designing and implementing effectiveness evaluation of large-scale programs that support both the needs of program managers to improve their programs and the needs of donors to meet their accountability responsibilities. RADAR has operationalized each step with a tool to facilitate its application. We also describe cross-cutting methodological issues and broader contextual factors that affect the planning and implementation of such evaluations. We conclude with proposals for how the global RMNCH&N community can support rigorous program evaluations and make better use of the resulting evidence.

The value of information about solar geoengineering and the two-sided cost of bias

ABSTRACT Solar geoengineering (SG) might be able to reduce climate risks if used to supplement emissions cuts and carbon removal. Yet, the wisdom of proceeding with research to reduce its uncertainties is disputed. Here, we use an integrated assessment model to estimate that the value of information that reduces uncertainty about SG efficacy. We find the value of reducing uncertainty by one-third by 2030 is around $4.5 trillion, most of which comes from reduced climate damages rather than reduced mitigation costs. Reducing uncertainty about SG efficacy is similar in value to reducing uncertainty about climate sensitivity. We analyse the cost of over-confidence about SG that causes too little emissions cuts and too much SG. Consistent with concerns about SG’s moral hazard problem, we find an over-confident bias is a serious and costly concern; but, we also find under-confidence that prematurely rules out SG can be roughly as costly. Biased judgments are costly in both directions. A coin has two sides. Our analysis quantitatively demonstrates the risk-risk trade-off around SG and reinforces the value of research that can reduce uncertainty. Key policy insights The value of reducing uncertainty about solar geoengineering is comparable to the value of reducing uncertainty about other key climate factors, such as equilibrium climate sensitivity. The benefits of research that reduces uncertainty about solar geoengineering may be more than a thousand times larger than the cost of a large-scale research programme. Under-confidence in solar geoengineering’s effectiveness can be as costly as over-confidence. The majority of the benefits of reduced uncertainty come from reducing climate damages rather than from slowing emissions reductions.

Abortion Legalization in Uruguay: Effects on Adolescent Fertility.

The Latin American and Caribbean adolescent fertility rates are among the highest in the world: about 1.7 million children are born to teen mothers every year, and most of them are declared unintended pregnancies. The region also has the highest rate of unintended pregnancy of any world region, and nearly half of such pregnancies end in abortion. However, fewer than 18 percent of the region's women live in countries where abortion is broadly legal. This paper estimates the causal effect of abortion legalization on adolescent fertility in Uruguay using official data on legal abortions provided after the 2012 reform. We employed a difference-in-differences strategy, classifying states by whether they are responsive or unresponsive to the reform. The results suggest that abortion reform had a negative impact on the adolescent birth rate by 2.5-2.8 births per thousand adolescents aged 15-19 (a 4 percent decrease from the preintervention average). Additionally, we exploited variation in reform implementation intensity through the estimation of fixed-effect linear regression models and found consistent results. Our findings are robust to controlling for a concurrent large-scale program of contraceptive implants. We conclude that legislation aimed at enhancing rights and reducing avoidable deaths and complications from unsafe abortions may also have spillover effects that help reduce adolescent fertility.