National Prioritization Research Articles

Newborn screening for severe combined immunodeficiency in Malaysia: current status, challenges and progress.

Early diagnosis of Severe Combined Immunodeficiency (SCID) increases survival outcomes and quality of life while significantly minimizing healthcare burden and costs. Despite growing evidence supporting the benefits and cost-effectiveness of SCID detection through newborn screening (NBS), it has yet to be implemented in Malaysia. This study aims to explore experts' opinions on the current status, challenges, and crucial strategies needed for the successful implementation of SCID NBS. A guided, structured interview was employed to explore opinions on the current status, barriers, and strategies for implementing SCID NBS in Malaysia. All 13 invited experts participated in this study, indicating complete participation from the entire Malaysian immunology fraternity (consisting of eight clinical immunologists and five immunopathologists). Several initiatives are ongoing to establish SCID NBS in Malaysia. Hindrances such as low immunologist-to-patient ratio, unequal placements of immunologists throughout Malaysia, society's low disease awareness, national health prioritization, lack of stakeholder engagement, and inadequacy of local study/data were highlighted. Pilot research on SCID NBS, advocacy workshops, and promotion materials are among the ongoing activities outlined in the blueprint, paving the way for this nationwide NBS program to be achievable in the near future. This article provides recommendations to policymakers in mandating SCID NBS. Strategies by key stakeholders are underway, particularly in advocacy programs and efforts to increase awareness among clinicians and the public.

Improving childhood cancer care in South Africa using the Paediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool

Aim Using the St. Jude Paediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool, the South African Association of Paediatric Haematology Oncology (SAAPHO) collaborated with St Jude Children’s Research Hospital to evaluate the delivery of health services and provide evidence-based assessments to inform and prioritise action plans to improve childhood cancer care. Methods PrOFILE was used to assess paediatric oncology care in thirteen public-sector hospitals comprehensively. Following that, representatives from each of the thirteen public-sector hospitals and from SAAPHO, the National Department of Health, the World Health Organization, St. Jude Global, and Childhood Cancer Foundation South Africa participated in a national stakeholder prioritisation workshop. Participants were assigned one of the PrOFILE components (Context, Workforce, Diagnostics, Multidisciplinary Team, Therapy, or Patients and Outcomes), forming six working groups to assess, map, and evaluate childhood cancer topics. Using a modified implementation mapping approach and through participation in structured co-designed activities, each group designed multi-level health interventions: prioritising initiatives identified by the SAAPHO, setting goals for each priority, co-designing project-specific logic models, reviewing potential barriers to implementation, and developing a post-workshop agenda. Results Individual hospital reports and a national aggregate report were compiled to discuss opportunities and priorities. The goal of the workshop was to utilise evidence-based assessments to achieve, a) objective assessment data to inform prioritisation exercises conducted by stakeholders, and b) priorities and action plans to inform childhood cancer control activities and demonstrate national organisation, human resources capabilities, and technical support to improve childhood cancer care. Through structured discussion and voting, six priority areas were identified and assigned to working groups: redrafting the organisation’s constitution, standardising multidisciplinary reporting, developing protocols and treatment guidelines, establishing fever-management guidelines, strengthening chemotherapy safety practices, and enhancing hospital-based cancer registries. Conclusions An implementation map enabled stakeholders to develop actionable plans, the success of which is demonstrated by the active implementation of the identified priorities by the focused working groups. This could serve as a model for countries with identified priorities but need more means to implement them. Based on mapping and outputs from the PrOFILE workshop, the NDoH will facilitate the creation of a childhood cancer committee to sustain progress on the key themes and priorities identified through the PrOFILE mapping process.

Navigating sustainability: key factors in prioritising Sustainable Development Goals

Prioritising sustainable development goals (SDGs) is one of the fundamental approaches to achieving global sustainability objectives, as it helps efficient resource allocation, addresses urgent needs, enhances policy coherence, and measures impact. Despite existing efforts, there remains an unclear understanding of the key factors needed for effective SDG prioritisation, presenting challenges for strategic planning and decision-making. This study provides an evidence-based analysis of these critical factors by examining relevant literature, conducting surveys, and employing Analytical Hierarchy Process (AHP)-based Multi-Criteria Decision Analysis (MCDA). The study identifies four primary factors for SDG prioritisation: SDG interrelations, performance, scope, and alignment. The findings confirm that national prioritisation have more priority compared to global, regional, and sub-national systems, and that prioritisation is more valuable at the indicator level rather than at the goal or target levels. Additionally, prioritisation should initially focus on off-track SDGs. Notably, academia ranks SDG prioritisation based on relationships and performance highly, while government officials emphasise alignment and relevance. Moreover, the results indicate that academia prefers target-level prioritisation, while government officials lean towards indicator level. However, both groups favour national scale over global and regional scales.

Why does a public health issue (not) get priority? Agenda setting for the national burns programme in India.

There is growing scholarly interest in what leads to global or national prioritization of specific health issues. By retrospectively analysing agenda setting for India's national burn programme, this study aimed to better understand how the agenda-setting process influenced its design, implementation and performance. We conducted document reviews and key informant interviews with stakeholders and used a combination of analytical frameworks on policy prioritization and issue framing for analysis. The READ (readying material, extracting data, analysing data and distilling findings) approach was used for document reviews, and qualitative thematic analysis was used for coding and analysis of documents and interviews. The findings suggest three critical features of burns care policy prioritization in India: challenges of issue characteristics, divergent portrayal of ideas and its framing as a social and/or health issue and over-centralization of agenda setting. First, lack of credible indicators on the magnitude of the problem and evidence on interventions limited issue framing, advocacy and agenda setting. Second, the policy response to burns has two dimensions in India: response to gender-based intentional injuries and the healthcare response. While intentional burns have received policy attention, the healthcare response was limited until the national programme was initiated in 2010 and scaled up in 2014. Third, over-centralization of agenda setting (dominated by a few homogenous actors, located in the national capital, with attention focused on the national ministry of health) contributed to limitations in programme design and implementation. We note following elements to consider when analysing issues of significant burden but limited priority: the need to analyse how actors influence issue framing, the particularities of issues, the inadequacy of any one dominant frame and the limited intersection of frames. Based on this analysis in India, we recommend a decentralized approach to agenda setting and for the design and implementation of national programmes from the outset.

Lessons from Peru to reduce under-5 mortality: understanding program implementation and context

BackgroundHealth policymakers aiming to reduce under-5 mortality (U5M) often lack data regarding how successful interventions in other countries were implemented. The Exemplars in U5M Study identified countries that achieved significant reductions in amenable U5M. This case study in Peru used implementation research to explore the contextual factors and strategies that contributed to the successful implementation of key evidence-based interventions (EBIs).MethodsThis research utilized a hybrid implementation research framework and a mixed-methods approach to understand the factors associated with EBI implementation and the successful reduction of U5M between 2000–2015. A desk review of existing literature on EBIs and U5M in Peru was completed, and in-depth interviews were performed with key Peruvian informants to understand the implementation strategies employed and the contextual factors that facilitated or were barriers to success. For the purposes of this analysis, three EBIs were selected and evaluated: antenatal care visits (ANC), facility-based deliveries, and infant vaccination.ResultsBetween 2000–2015, the percent of mothers attending at least four antenatal care visits rose from 69% to 96.9%, and the percent of facility-based deliveries increased from 56 to 91%. Three doses of the tetanus/diphtheria/pertussis vaccine, widely acknowledged as a key global health indicator, reached 90% by 2015. Key informants noted that economic growth, financial reforms, strong national commitment to reduce poverty in Peru, and national prioritization of maternal and child health, were important contextual factors that contributed to the successful reduction of U5M. They noted key strategies that helped achieve success during the implementation of EBIs, including utilization of data for decision-making, adaptation driven by cultural sensitivity to address gaps in coverage, and a focus on equity and anti-poverty initiatives with the participation of government, civil society, and political parties to assure continuity of policies.ConclusionSeveral EBIs contributed to the successful reduction of U5M in Peru between 2000–2015. Strategies such as the focus on equity throughout the study period contributed to an increase in coverage of EBIs like ANC visits, facility-based deliveries and infant vaccination which worked to reduce U5M. Understanding how Peru successfully implemented programs that reduced preventable infant and child deaths could be useful to replicating this substantial public health success in other low- and middle-income countries.

The Health Justice Policy Tracker: COVID-19 Policies To Advance Health Justice For Vulnerable Populations.

The rapid spread of COVID-19 throughout the world in early 2020 created unprecedented challenges for national governments. Policies developed during the early months of the pandemic, before the first mRNA vaccines were authorized for emergency use, provide a window into national governments' prioritization of populations that were particularly vulnerable. We developed the COVID-19 Health Justice Policy Tracker to capture and categorize these policies using a health justice lens. In this article we present the results of a preliminary analysis of the tracker data. The tracker focuses on policies for six population groups: children, the elderly, people with disabilities, migrant workers, incarcerated people, and people who were refugees or were seeking political asylum. It includes 610 policies, most targeting children and the elderly and providing financial support. National governments also prioritized measures such as policies to ensure access to mental health care and social services, digital and teleservices, continuity of children's education, and food security. The tracker provides a resource for researchers and policy makers seeking model language and tested policy approaches to advance health justice during future crises.

TB programme stakeholder views on lessons from the COVID-19 response in South Africa.

The global COVID-19 pandemic has reversed many of the hard-won gains made in TB programmes and the associated reduction in the number of TB deaths, case notifications and incidence over the last three decades. Modelling estimates show that the impact will be lasting. There are global calls to recover the shortfalls along the TB care cascade that have resulted from COVID-19, with the recognition that the COVID-19 response holds lessons to inform more robust and comprehensive TB programmes and services. To explore lessons from response measures to the COVID-19 pandemic in two high TB burden South African provinces. This was an exploratory qualitative study. We conducted interviews with TB programme stakeholders (managers and facility-level staff: n = 35) between February and June 2022. We identified eight facilitators of the COVID-19 response, including political will, rapid policy development, multi-sectoral collaboration, patient-centred models of care delivery, community engagement, mHealth and telehealth technologies, rigorous contact tracing and widespread mask wearing. Political will was singled out as a critical driver of the response. Leveraging COVID-19 inspired collaborations, technologies and avenues for health service delivery is an opportunity to maximise benefits for the TB programme. Reinvestment in national TB programmes and political prioritisation of TB are critical.

Development of the national bariatric prioritization tool in Aotearoa New Zealand.

Bariatric surgery is a proven effective method of reducing obesity and reversing or preventing obesity-related comorbidities. The aim of this study is to describe the development of a tool to assist with the prioritization of patients with obesity for bariatric surgery. The tool would meet the criteria for being evidence-based, fair, implementable and transparent. The development of the tool involved a validated step-by-step process based on the consensus of clinical judgement of the New Zealand Ministry of Health working party. The process involved elicitation of criteria, clinical ranking of vignettes and creation of weightings using the 1000Minds® tool. The concurrent validity was tested by comparing tool rankings of vignettes to clinical judgement rankings. Four major criteria (impact on life, likelihood of achieving maximum benefit with respect to control of diabetes, duration of benefit and surgical risk) are used to characterize the need and potential to benefit. The impact on life criterion has the largest weighting (up to 44.3%). There was good concurrent validity with a correlation coefficient r = 0.67. The tool as presented is evidence-based, transparent and internally valid. The next step is to assess the predictive validity of the tool using real patient data to evaluate the effectiveness of the tool and determine what modifications may be required.

A systems perspective on national prioritisation of sustainable development goals: Insights from Australia

Achieving the Sustainable Development Goals (SDGs) requires effective national initiatives and resource allocation. Yet, the simultaneous attainment of all goals is hindered by constraints such as limited budgets and resources, varied national priorities, and the intricate nature of the goals. As we approach 2030 and beyond, an urgent need for an effective, data-driven prioritisation system exists to optimise what can be accomplished. A considerable knowledge gap persists in identifying the priority areas that demand concentrated attention and how their improvement would propel overall sustainability goals. To bridge this gap, our study presents a prioritisation approach that identifies significant SDG indicators based on urgency and impact, utilising Benchmarking, Bivariate, and Network analysis. Furthermore, we introduce an innovative Impact Index (IMIN) to assess an indicator’s extensive effect on the SDG network. This system carries significant international relevance by establishing a robust framework to identify key, potent, and interconnected indicators. It supports decision-makers worldwide in comprehending their nation’s SDG performance and promotes efficient resource allocation. In the specific context of Australia, our analysis spotlights several impactful, yet underperforming SDG indicators. These include the protection of Freshwater, Terrestrial, and Mountain Key Biodiversity Areas (KBAs), the share of renewable energy and energy intensity level of primary energy, targeted research and development, gender equality in national parliaments, and carbon-efficient manufacturing, amongst others.

DEVELOPMENT OF A PREDICTION MODEL (NZSPINE) FOR SIGNIFICANT ADVERSE OUTCOME AFTER SPINE SURGERY

Numerous prediction tools are available for estimating postoperative risk following spine surgery. External validation studies have shown mixed results. We present the development, validation, and comparative evaluation of novel tool (NZSpine) for modelling risk of complications within 30 days of spine surgery.Data was gathered retrospectively from medical records of patients who underwent spine surgery at Waikato Hospital between January 2019 and December 2020 (n = 488). Variables were selected a priori based on previous evidence and clinical judgement. Postoperative adverse events were classified objectively using the Comprehensive Complication Index. Models were constructed for the occurrence of any complication and significant complications (based on CCI >26). Performance and clinical utility of the novel model was compared against SpineSage (https://depts.washington.edu/spinersk/), an extant online tool which we have shown in unpublished work to be valid in our local population.Overall complication rate was 34%. In the multivariate model, higher age, increased surgical invasiveness and the presence of preoperative anemia were most strongly predictive of any postoperative complication (OR = 1.03, 1.09, 2.1 respectively, p <0.001), whereas the occurrence of a major postoperative complication (CCI >26) was most strongly associated with the presence of respiratory disease (OR = 2.82, p <0.001).Internal validation using the bootstrapped models showed the model was robust, with an AUC of 0.73. Using sensitivity analysis, 80% of the model's predictions were correct. By comparison SpineSage had an AUC of 0.71, and in decision curve analysis the novel model showed greater expected benefit at all thresholds of risk.NZSpine is a novel risk assessment tool for patients undergoing acute and elective spine surgery and may help inform clinicians and patients of their prognosis. Use of an objective tool may help to provide uniformity between DHBs when completing the “clinician assessment of risk” section of the national prioritization tool.

Occurrence and Distribution of Common Diseases and Pests of U.S. Cannabis: A Survey

Hemp and marijuana, both Cannabis sativa L., are revitalized crops to U.S. agricultural and horticultural industries. Hemp (Δ⁹-Tetrahydrocannabinol content < 0.3%) was reintroduced in 2014 under a pilot research program and legalized in 2018. Hemp can now be grown in all 50 states. Marijuana (Δ⁹-THC content > 0.3%), although classified as a Schedule I narcotic by the U.S. Drug Enforcement Administration, is legal in 37 states for medical and/or recreational use. Although C. sativa is often promoted as a pest-free crop, multiple diseases and arthropod pests have been identified and confirmed in recent years. There are limited options for control of diseases and pests affecting hemp. A survey of diagnosticians, researchers, and industry leaders conducted from 2021 to 2022 sought to determine the distribution and occurrence of 76 common diseases and pests on C. sativa across the United States. A total of 148 responses were collected and grouped by U.S. region: Western, Great Plains, North Central, Northeastern, and Southern. Survey results suggest that whereas some pathogens and pests are widely distributed across the United States, others occur more frequently in specific regions. This finding may indicate variations in economic importance by region. Results from this survey provide a foundation for regional and national prioritization of research and regulatory activities.

The State of Public Space in Lusaka

Lusaka, a city of around three million people, faces massive urban growth challenges. Designed on the Garden City planning paradigm principles, the city currently lacks open public recreational spaces. The lack of public space is often linked to the high land value alongside the high demand for housing, the lack of national government prioritization of public space provision policies, and a general lack of financial resources available to Lusaka's local council.This article explores the state of formal public spaces in Lusaka, its urban history, development patterns, and the effects of these factors on everyday life and social interactions. It also outlines different private sector attempts to make up for the lack of public spaces through the provision of private green spaces (e.g., green private entertainment centres, private play parks, private back yards, and front yards) and the commercial units and malls that cover some public space functions. It asks questions on where kids play (e.g., private play parks, mall play parks, etc.) and highlights the design elements preventing streets from becoming lively public spaces (e.g., walls and roads).The article also examines Lusaka's plans for creating green and open spaces networks inside the city and their applicability. It studies public space provision plans in Lusaka's Development Plan 2030 and older public space provision attempts. It highlights the urgency and the importance of taking serious steps towards public space provision in the city now. The article used field research, mapping, desktop research, and interviews.

Setting national research priorities for difficult-to-treat depression in the UK between 2021-2026.

Difficult-to-treat depression (DTD) presents a substantial health care challenge, with around one-third of people diagnosed with a depressive episode in the UK finding that their symptoms persist following treatment. This study aimed to identify priority research questions (RQs) that could inform the development of new and improved treatments, interventions, and support for people with DTD. Using an adapted Child Health and Nutrition Research Initiative (CHNRI) method, this national prioritisation exercise engaged 60 leading researchers and health care professionals in the UK, as well as 25 wider stakeholders with relevant lived experience to produce a ranked list of priority RQs in DTD. The final list of 99 distinct RQs was independently scored by 42 individuals against a list of five criteria: answerability, effectiveness, impact on health, deliverability, and equity. Highly ranked RQs covered a range of novel and existing treatments. The three highest scoring RQs included evaluation of psychological and pharmacological therapies (eg, behavioural activation, and augmentation therapies), as well as social interventions to reduce loneliness or increase support for people with DTD. This exercise identified and prioritised 99 RQs that could inform future research and funding decisions over the next five years. The results of this research could improve treatment and support for people affected by DTD. It also serves as an example of ways in which the CHNRI method can be adapted in a collaborative manner to provide a more active role for patients, carers, and health care professionals.

Regulatory-driven risk assessment to improve drinking-water quality: A case study of private water supplies in England and Wales

Owing to the managerial and regulatory setup of Private Water Supplies (PWS) in England and Wales, the attention and resource required to achieve ‘wholesome’ drinking-water, a regulatory term reflecting quality standards, is often limited. The requirement to risk assess PWS was first included in the English and Welsh Regulations in 2009 and 2010 respectively. However, compliance rates with risk assessment requirements remain low with concerns raised regarding the lack of subsequent action. Using a mixed methods approach of interviews and surveys, this research seeks to: (i) identify available data sources for the completion of risk assessments by Local Authorities; (ii) understand factors which facilitate or hinder decisions made and action taken based on risk assessments; (iii) investigate the influence of the regulatory environment on (i) and (ii); and (iv) pose suggestions for more efficient data use to help improve the drinking-water quality of PWS in England and Wales. Findings highlight gaps in the legislation which impact the national level understanding of PWS drinking-water quality and subsequently impact national level prioritization and resource allocation. The assigned stakeholders responsible for risk assessment are reviewed and discussed. Recommendations include the development of an environmental health database to support institutional data sharing; a greater recognition of the differing resource type and enforcement strategies required to undertake risk assessment, in comparison to water quality sampling alone; introduction of Sanitary Inspection forms to PWS operators and financial support structures to facilitate remedial action. Methods which may support reduced sampling data, such as hydrogeological modeling, are discussed.

Cancer research across Africa: a comparative bibliometric analysis

IntroductionResearch is a critical pillar in national cancer control planning. However, there is a dearth of evidence for countries to implement affordable strategies. The WHO and various Commissions have recommended...

The global burden of neglected zoonotic diseases: current state of evidence

Abstract The majority of emerging infectious diseases are zoonoses, most of which are classified as “neglected”. By affecting both humans and animals, zoonoses pose a dual burden. The disability-adjusted life year (DALY) metric quantifies human health burden using mortality and morbidity. This review aims to describe and analyze the current state of evidence on the burden of neglected zoonotic diseases (NZDs) and start a discussion on the current understanding of the global burden of NZDs. We identified 26 priority NZDs through consulting the CDC One Health Zoonotic Disease Prioritization Exercise, the Joint External Evaluation reports, and the WHO roadmap for NTDs. A systematic review of global and national burden of disease (BoD) studies for these priority NZDs was conducted using pre-selected databases. Data on diseases, location and DALYs were extracted for each eligible study. A total of 1887 records were screened, resulting in 72 eligible studies (58 national or sub-national, 12 global, and 2 regional studies). The highest number of BoD studies was found for non-typhoidal salmonellosis (23), whereas no estimates were found for West Nile, Marburg and Lassa fever. Geographically, the highest number of studies were found in the Netherlands (11), China (5) and Iran (4). The number of BoD studies retrieved mismatched the perceived importance in national prioritization exercises. For example, anthrax was considered a priority NZD in 73 countries, but only one national estimate was retrieved. By summing the available global estimates, these diseases would cause at least 10 million DALYs in total. The burden of NZDs at the global level remains scattered, and trends were challenging to identify. There are several priority NZDs for which no burden estimates exist, and the number of BoD studies does not reflect national disease priorities. To have complete and consistent estimates of the global burden of NZDs, these diseases should be integrated into larger global BoD initiatives. Key messages • There is a mismatched between the estimated retrieved in the search and the perception of the importance of these disease. This amplify the need for a comprehensive program. • No complete list of zoonoses exist, and the definition used is vague. A stricter definition of zoonoses and what defines them will help provide a clear view of dealing with and controlling them.

Establishing priorities for diabetes action goals according to key opinion leaders and health professionals

BackgroundThe ever-increasing burden of diabetes and the limited resources highlight the need for prioritization of national action goals for diabetes management. The Israeli National Diabetes Council (INDC) initiated a prioritization process aiming to set a top list of diabetes related goals, as suggested by decision makers and health professionals.MethodsA 2-step prioritization process, including a small (n = 32) circle of key opinion leaders of the INDC and a larger (n = 195) nationwide circle of diabetes health professionals consisting of physicians, nurses, and dieticians working in diabetes care centers, hospitals and family practice clinics, was established. An online questionnaire presenting 45 different action areas in diabetes prevention and care was distributed to the INDC members who ranked the 3 top diabetes priorities based on their individual interpretation of importance and applicability. The 7 highest ranking priorities were later presented to hospital-based and community diabetes health professionals. These professionals selected the 3 top priorities, based on their perceived importance.ResultsCouncil members opted mostly for action areas regarding specific populations, such as clinics for adult type-1 diabetes patients, diabetic foot, and pediatric and adolescent patients, while the health professionals’ top priorities were mostly in the general field of prevention, namely high-risk prediabetes population, prevention of obesity, and promotion of healthy life-style. In addition, priorities differed between hospital and community health professionals as well as between different professional groups.ConclusionsA national prioritization process of action areas in diabetes prevention and care is attainable. The resulting item list is affected by professional considerations. These priorities may direct efforts in the implementation of interventions to improve national-level diabetes management.

Research priority setting for paediatric rheumatology in the UK.

The evidence base that underlies the management of children and young people with paediatric rheumatic diseases is deficient. In this field, there are many crucial unanswered questions. The UK Paediatric Rheumatology Clinical Studies Group, supported by UK National Institute for Health Research Clinical Research Network: children and Versus Arthritis, elicited ideas for research priorities from paediatric rheumatologists, trainees, allied health-care professionals, nurse specialists, patients, parents of patients, carers, and charities. These ideas were collected through online surveys and face-to-face meetings. A modified Delphi process was used, which included online research priority ranking surveys and a consensus workshop. A longlist of 55 disease-specific research priorities and 37 general research priorities were voted on in the first survey. A list of 11 top general research priorities was produced. The top ten disease-specific research priorities were discussed in depth at a Delphi workshop to determine their final ranking. This Health Policy paper will help to guide clinicians, academics, and funding bodies to prioritise research in paediatric rheumatic diseases, specifically in areas of unmet patient needs.

The global potential for increased storage of carbon on land

Constraining the climate crisis requires urgent action to reduce anthropogenic emissions while simultaneously removing carbon dioxide from the atmosphere. Improved information about the maximum magnitude and spatial distribution of opportunities for additional land-based removals of CO2 is needed to guide on-the-ground decision-making about where to implement climate change mitigation strategies. Here, we present a globally consistent spatial dataset (approximately 500-m resolution) of current, potential, and unrealized potential carbon storage in woody plant biomass and soil organic matter. We also provide a framework for prioritizing actions related to the restoration, management, and maintenance of woody carbon stocks and associated soils. By comparing current to potential carbon storage, while excluding areas critical to food production and human habitation, we find 287 petagrams (PgC) of unrealized potential storage opportunity, of which 78% (224 PgC) is in biomass and 22% (63 PgC) is in soil. Improved management of existing forests may offer nearly three-fourths (206 PgC) of the total unrealized potential, with the majority (71%) concentrated in tropical ecosystems. However, climate change is a source of considerable uncertainty. While additional research is needed to understand the impact of natural disturbances and biophysical feedbacks, we project that the potential for additional carbon storage in woody biomass will increase (+17%) by 2050 despite projected decreases (−12%) in the tropics. Our results establish an absolute reference point and conceptual framework for national and jurisdictional prioritization of locations and actions to increase land-based carbon storage.

USEEIO v2.0, The US Environmentally-Extended Input-Output Model v2.0

USEEIO v2.0 is an environmental-economic model of US goods and services that can be used for life cycle assessment, footprinting, national prioritization, and related applications. This paper describes the development of the model and accompanies the release of a full model dataset as well as various supporting datasets of national environmental totals by US industry. Novel methodological elements since USEEIO v1 models include waste sector disaggregation, final demand vectors for US consumption and production, a domestic form of the model that can be used to separate domestic and foreign impacts, and price adjustment matrices for converting outputs to purchaser price and in various US dollar years. Improvements in modeling national totals of industry and environmental flows are described. The model is validated through reproduction of national totals from input data sources and through analysis of changes from the most recent complete USEEIO model that can be explained based on data updates or method changes. The model datasets can all be reproduced with open source software packages.