Science of The Total Environment

Hexafluoropropylene oxide dimer acid (GenX), a replacement for legacy per- and polyfluoroalkyl substances (PFAS), is increasingly detected in the environment, yet its chronic toxicity remains poorly characterized. Current safety assessments rely largely on short-term, high-dose studies that may not capture the biological consequences of long-term, low-dose exposure. To address this gap, we employed 3D human liver (HepG2/C3A) spheroids cultured in a continuously rotating bioreactor system (ClinoStar) to systematically evaluate dose- and time-dependent mRNA changes in response to GenX under environmentally relevant conditions. Spheroids were exposed to GenX (0.08-50 M, spanning environmentally relevant to mechanistically informative concentrations) for acute (4 days) and chronic (4 weeks) durations, followed by genome-wide TempO-Seq transcriptomic profiling and benchmark dose (BMD) modeling. GenX elicited pronounced non-monotonic mRNA changes in acute exposure conditions, with the greatest number of differentially expressed genes (DEGs) observed at an intermediate concentration (0.4 M). In contrast, chronic exposure exhibited a generally concentration-dependent increase in DEGs, except for the 10 M condition, indicating a more consistent dose-response relationship than acute exposure. Notably, acute and chronic exposures elicited qualitatively distinct mRNA changes with low concordance across matched concentrations, demonstrating that exposure duration was a major determinant of mRNA changes. Acute low-dose GenX exposure preferentially modulated mRNA encoding components of cell cycle-related pathways, whereas acute higher dose exposures suppress mRNA levels of the constituents of lipid metabolic pathways and increase expression of mRNA encoding proteins involved in stress- and toxicity-associated signaling. Chronic exposure revealed a different pattern of changes in mRNA expression not observed under acute exposure conditions, including suppression of cellular components involved in lipid-related pathways at the lowest concentration tested. At higher concentrations, mRNA levels of components of multiple metabolic pathways were altered. Benchmark dose modeling identified a significantly lower transcriptomic point of departure (tPOD) for chronic exposure as compared to acute exposure, suggesting increased cellular sensitivity to prolonged GenX exposure and supporting the relevance of chronic models for human exposure assessment. Collectively, these findings demonstrate that GenX elicits time-dependent and non-monotonic changes in mRNA levels of human liver (HepG2/C3A) spheroids, with distinct responses depending on the exposure duration and dose. This study, therefore, highlights the importance of incorporating chronic, human-relevant in vitro models and transcriptomic endpoints into PFAS risk assessment and suggests that conventional short-term assays may underestimate the biological impact of sustained low-dose exposure. Key message (Impact of the study)This study provides systematic comparisons of short term (4 day) versus longer term (4 weeks), environmentally relevant GenX exposure in human liver spheroids, revealing non-monotonic, time-dependent changes in mRNA levels encoding cellular components of lipid metabolism-related pathways with potential implications for appropriate dose and time exposure parameters for use in New Approach Methods to be applied in risk assessment.

Hospital-based wastewater surveillance may complement community and clinical surveillance data in important ways, and may be useful in jurisdictions without community-based wastewater surveillance. From May 2024-April 2026, we analyzed weekly samples (n=190) from three hospitals in New York City using digital PCR to evaluate the sensitivity, specificity, and positive predictive value (PPV) of wastewater viral detection against facility SARS-CoV-2 and influenza A/B inpatient caseloads. Sensitivity was 38-42% for SARS-CoV-2 and 36-49% for influenza A/B, while specificity exceeded 72% for all pathogens. During respiratory seasons, sensitivity reached 81% for SARS-CoV-2 and 81% for influenza A; both had 100% sensitivity during peak case weeks. Notably, off-peak influenza detections occurred in hospital wastewater at all three hospitals in summer 2024 without corresponding hospital case detection, suggesting the presence of undiagnosed cases. These findings underscore the potential utility of hospital-based wastewater monitoring for tracking respiratory virus activity.

Per- and polyfluoroalkyl substances (PFAS) pose significant environmental risks, yet their impact on food crops like legumes remain insufficiently understood. This study investigated the developmental and physiological responses of hydroponically grown mung bean (Vigna radiata) to varying concentrations of perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS). High concentrations (1 mM) of PFOA severely impaired early plant development, significantly delaying seed germination, reducing leaf emergence, and suppressing root hair formation compared to PFOS and controls. Over a narrower concentration range (5-500 {micro}M), both compounds caused transient growth stunting at early timepoints (48 h), though plants exhibited partial recovery over time. High-dose exposure (500 {micro}M) significantly decreased seedling wet weights, leaf area, and leaf biomass without affecting dry weights, indicating disrupted water retention and homeostasis rather than reduced biomass accumulation. Spectrophotometric analysis revealed a dose- and compound-dependent effect on photosynthesis, with low-dose PFOA (5 {micro}M) significantly increasing leaf chlorophyll absorbance. Furthermore, quantification of callose deposition revealed that high-dose PFOA (500 {micro}M) and medium-dose PFOS (50 {micro}M) raised baseline immune stress responses, which were not further elevated by subsequent flagellin-22 (flg22) challenge, suggesting a contaminant-induced immune priming mechanism. These findings highlight distinct, chemical-specific toxicological impact of PFAS on legume growth, water dynamics, and defence priming, underscoring critical implications for agricultural productivity and food safety.

The COVID-19 pandemic remains a global concern, partly due to the rapid mutation rate of SARS-CoV-2 and the emergence of new variants. Wastewater surveillance has proven effective in estimating infection incidence and detecting variants earlier than clinical testing. Its importance has grown as testing rates decline due to milder disease progression. However, current methods typically rely on the prior classification of SARS-CoV-2 lineages or their signature mutations, which may delay detection. We present an alternative method that identifies changes in the viral genetic population over time without requiring prior lineage classification. This population-based approach was applied to sequencing data from wastewater samples, which are generally noisier than clinical samples. We analyzed publicly available sequencing samples from wastewater plants covering Swiss catchments in Altenrhein, St. Gall, Geneva, and Zurich. To address noise, only samples with read depths above 40 and genome coverage of at least 90% were included. Genetic diversity within pooled populations over two time periods was compared to assess changes in viral composition. We demonstrate that SARS-CoV-2 variants can be detected in wastewater sequencing data without prior lineage classification. Our method successfully detected shifts in genetic populations that corresponded to the emergence of known variants of concern (VOCs) in the analyzed regions. Notably, it also revealed the rising prevalence during the first surges of the Omicron variant. Despite the increased noise in wastewater compared to clinical samples, our approach remains effective. However, achieving reliable predictions depends on high sequencing depth, broad genome coverage, and frequent sampling.

Background: Microplastics have been detected in many freshwater ecosystems, including stagnant waters where mosquito larvae develop. Larvae are therefore exposed to microplastic pollution, which may affect their life history traits or microbiota along with immune gene expression. However, these effects have never been tested in mosquitoes, despite their major public health importance as vectors of numerous pathogens. Method: We exposed mosquito larvae, from hatching to adult emergence, to four concentrations of polyethylene microplastics (MPs): 0, 60, 200, and 600 MPs/mL. Fourth-instar larvae and newly emerged adult females were collected for each treatment. To investigate the effects of MPs on gene expression and bacterial microbiota, RNA sequencing and 16S metabarcoding approaches were performed on three biological replicates for each developmental stage. Results: Microplastic exposure induced a non-monotonic dose-dependent transcriptomic response. In larvae, only a limited number of genes were differentially expressed (five to eight per concentration), with immune-related genes downregulated at both low and high concentrations. In adult females, the intermediate concentration (200 MPs/mL) elicited the strongest response with 14 differentially expressed genes (DEGs). Regarding the microbiota, microplastic exposure reduced bacterial diversity in larvae, with the lowest diversity observed at the highest concentration. However, no significant changes were detected in the microbiota of adult females. Conclusion: Overall, this study shows that adult females are affected by larval exposure to MPs (i.e. differential expression in immune-related genes) and warrants further studies in this field. This includes: 1) investigating further the effects of MPs on mosquitoes' populations (e.g. through multi-generational studies), 2) gaining more environmentally relevant knowledge on MP effects (i.e. using MPs with a biofilm and/or adsorbed pollutants) and 3) focusing on the effects of MPs on mosquitoes' vectorial capacities.

Summary Background: Wastewater and environmental surveillance (WES) enables community-level monitoring of infectious diseases. Most progress has focused on sewer-based surveillance, yet nearly half of the global population relies on non-sewered sanitation. In non-sewered settings, urban drainage channels have been used for poliovirus environmental surveillance, but their potential for a multi-pathogen WES with spatially defined catchments, and comparability to sewer-based surveillance, remains under-explored. Methods: Ten drainage channel sampling points with delineated micro-catchments (0.95-3.83 km2 with 12,885-44,146 people) were selected within Kampala. A total of 255 drainage channel and 54 wastewater treatment plant (WWTP) influent samples were collected during two campaigns in March and September-October 2025. A multi-target panel was quantified by digital PCR, including enteric viruses (Norovirus GI and GII, Rotavirus), respiratory viruses (SARS-CoV-2, Influenza A and B viruses, Respiratory Syncytial Virus (RSV)), non-O1/O139 Vibrio cholerae (V. cholerae), and Pepper Mild Mottle Virus (PMMoV) as a fecal indicator. Findings: Enteric viruses, non-O1/O139 V. cholerae, and PMMoV were consistently detected across all drainage channels and WWTP influents. Concentrations were generally lower in drainage than WWTP influents, except for non-O1/O139 V. cholerae. When normalized by PMMoV, concentrations across most drainage channels were comparable to WWTP influents, although comparability varied by target and location. Both concentrations and PMMoV-normalized concentrations varied across sampling locations. Trends between campaigns varied by pathogen target and were not explained by any single micro-catchment characteristic. Influenza A virus was the most frequently detected respiratory virus (8-23% in drainage channels; 3-10% in WWTP influents), while SARS-CoV-2, Influenza B, and RSV were rarely detected. Interpretation: PMMoV-normalized concentrations across most micro-catchments were comparable to WWTP influents, with spatial heterogeneity implying neighborhood-level differences in disease prevalence. Catchment-delineated drainage surveillance has potential to offer spatially resolved public health information in non-sewered settings comparable to sewer-based wastewater monitoring. Funding: Eawag Discretionary Funding

Wastewater-based epidemiology (WBE) has emerged as a powerful population-level surveillance tool, but its coverage is structurally concentrated in in-network urban areas, potentially leaving rural populations underrepresented. Routine human movement between sewered (in-network) and unsewered (off-network) areas may, however, cause wastewater treatment plant (WWTP) measurements to reflect infectious disease dynamics beyond sewer boundaries. We evaluated this hypothesis using daily clinical COVID-19 testing data (January 2021-April 2022) across New York State excluding New York City (NYC). We disaggregated weekly cases and tests into in-network (WWTP catchment area) and off-network (outside WWTP catchment area) components applied to two geographic frameworks: administrative counties (N = 53 mixed-coverage) and mobility-defined communities identified through Walktrap community detection applied to census tract-level movement networks (N = 32 mixed-coverage). In/off-network COVID-19 trends were strongly correlated under both frameworks. County-level statewide aggregate correlations were high (incidence r = 0.994, positivity r = 0.996), as were individual county correlations (median r = 0.909 and 0.932, respectively). Mobility-defined community-level statewide correlations were similarly strong (r = 0.990 and 0.992), with comparable unit-level medians (r = 0.877 and 0.894). The mobility-defined community framework provided better population balance between in-network and off-network strata (87.5% vs. 69.8% in balanced range) and a higher floor on representativeness (minimum r = 0.440 vs. 0.177). Population size was the dominant predictor of in-network/off-network alignment at both scales; wastewater infrastructure density and off-network signal variability provided additional explanatory power at the mobility-defined community level. WWTPs broadly represent COVID-19 dynamics in surrounding off-network populations, supporting their use as sentinel surveillance sites. Representativeness weakens in smaller, more rural communities, and mobility-defined communities provide a complementary framework for identifying where this occurs.

Since the COVID-19 pandemic, wastewater-based surveillance (WBS) has emerged as a key approach to assess community-level health and the evolution of pathogens. To date, most established WBS systems focus on polymerase chain reaction (PCR) based detection and targeted sequencing of known pathogens because these approaches are well-accepted and include amplification of pathogen target sequences of interest thereby enabling lower limits of detection. Metagenomic next-generation sequencing (mNGS) is a promising approach to enable pathogen detection and surveillance beyond predefined pathogen lists, but its regular application to WBS has not been yet widely adopted because many key performance characteristics are not well-understood, including limit of detection (LOD) and false positive/negative rates. This paper describes a computational analysis to estimate the operational LOD of various sequencing approaches using a simplified model of a local wastewater (WW) system involving a military base. This paper also presents findings from two types of experiments: 1) laboratory-spiked, those for which Atlantibacter subterraneus (Asub) is introduced into real-world WW samples in a laboratory setting, and 2) system-spiked, those for which Asub is introduced at a source location of a real-world WW system. Findings indicate that mNGS detection performance varies with sequencing method and the data analysis process. In addition, findings indicate that site-specific method characterization should be used when implementing mNGS for WBS because sites can have different WW system configurations, background organisms and sequencing inhibitors.

Inorganic arsenic is a widespread environmental contaminant and known human carcinogen, yet the mechanisms by which nutritional status modulates arsenic toxicity remain poorly understood. Here, we investigated the main and interactive effects of environmentally relevant concentrations of arsenic, low food quantity, and low dietary phosphorus supply on genome-wide gene expression in aquatic grazer Daphnia pulex. Differential gene expression analysis identified a total of 1,213 differently expressed genes with interactions of arsenic x nutrient stressors accounting for approximately 70% of the transcriptomic response. Low phosphorus emerged as a dominant main effect stressor and it also had a profound impact on transcription as a co-stressor. The low phosphorus x arsenic interaction exhibited the greatest transcriptional impact (435 DE genes), revealing that phosphorus limitation rather than food quantity influences arsenic toxicity at the gene expression level. Gene ontology and Pathway Activation Analysis revealed that main effects elicited simple yet distinct functional responses, whereas arsenic x nutrient interactions induced complex pathway-level disruptions including cell signaling, detoxification metabolism, DNA repair mechanisms, and energy homeostasis. Further assessment of gene expression revealed that all arsenic x nutrient interactions are antagonistic supporting previous literature that found arsenic behaves antagonistically as a co-stressor. Our results provide mechanistic insight into how nutritional status modulates arsenic toxicity and highlights the importance of considering arsenic x nutrient co-stressor interactions.

{middle dot} Globally, forest ecosystems face widespread mortality events. However, the independent impacts of distinct stressors, such as heat stress vs edaphic drought, remain poorly understood and physiological early warning indicators for tree mortality are urgently required. {middle dot} We exposed well-watered saplings of Fagus sylvatica, Pseudotsuga menziesii and Picea abies to summer heat waves and subsequent natural winter-desiccation. Physiological parameters (e.g. gas exchange, water uptake velocity via 2H labelling, and volatile organic compound emissions) were monitored throughout the growing season and survival was assessed regularly until subsequent spring to capture immediate and delayed mortality as a consequence of legacy effects. {middle dot} Heat exposure without soil water deficit, followed by winter desiccation, triggered species-specific mortality rates (51.8% F. sylvatica, 48.2% P. abies, 16.9% P. menziesii), with P. abies exhibiting significantly faster mortality response than the other species. Reduced water uptake, lower stomatal conductance, impaired photosynthetic efficiency, and altered VOC emissions distinguished non-surviving from surviving saplings months before visible damage in all three species. {middle dot} Heat stress drives mortality independent of edaphic drought, with sub-lethal physiological indicators detectable up to 10 months before visual signs. These early warning indicators could enable damage detection before lethal thresholds are crossed, offering new strategies for mitigating climate change-driven forest decline.

Micronutrient deficiencies are prevalent in Madagascar, where diets rely heavily on starchy staples and access to animal-source foods is limited. Small dried fish (SDF) are widely available, yet their nutritional value and health risks remain poorly documented. We combined market surveys, taxonomic identification, and micronutrient and heavy metal analyses of nine SDF types collected along National Road 7. The samples encompassed 33 fish families, were dominated by small pelagic species (Clupeidae and Engraulidae), and were appreciated by consumers. A daily portion (5 g for infants; 10 g for young children and women of childbearing age) contributed substantially to Recommended Nutrient Intakes (RNIs). Across samples and groups, SDF were rich (>30% of RNI) in selenium and, for infants and young children, in calcium. All samples were a source of (>15% of RNI), or rich in, phosphorus, whereas iron contributions were more variable but often substantial. Several samples exceeded 100% of RNIs for selenium, calcium, iron, or manganese in infants and young children, and some were also sources of magnesium and, less frequently, zinc. Vitamin A was absent from sun-dried samples but detected in a smoked freshwater type. Heavy metal concentrations varied markedly, and portions of several types led to estimated exposures to inorganic arsenic or cadmium exceeding reference values, whereas freshwater species and some pelagic types showed a more favorable nutrition-risk balance. Overall, SDF are affordable, nutrient-dense foods with strong potential to alleviate micronutrient deficiencies in Madagascar, while highlighting the need for type-specific guidance to balance nutritional benefits and contamination risks.

Environmental exposure to endocrine disrupting chemicals, like bisphenol-A (BPA), can impart detrimental effects on developing feto-placental unit, during pregnancy. Placenta remains a central player maintaining this feto-placental homeostasis for sustenance of a healthy pregnancy. Thus, the bisphenol-A mediated endocrine disruption affects the healthy functioning of placenta by altering key processes, such as tissue remodelling, angiogenesis, and metabolism. However, the underlying mechanism of BPA-altered ECM remodelling remains elusive. Therefore, in this study we investigated the BPA mediated changes in placental tissue remodelling using a bisphenol-A exposed murine model during pregnancy. The results reveal that, the phenotypic changes in feto-placental interface correlates with perturbed placental proteome in response to BPA. Further investigation highlights a S100a10-Annexin A2 axis mediated upregulation of tissue plasminogen activator (tPA), which drives altered extracellular matrix (ECM) degradation in placental decidua. This culminates into functional dysregulation in feto-placental axis, leading to reduced size of fetus and placenta. Therefore, this study provides novel insights of a S100a10-Annexin A2 axis associated mechanism for alteration of ECM remodelling in placental decidua due to BPA exposure, which may lead to toxicity related adverse pregnancy outcome.

Forest soils are an important source of volatile organic compounds (VOCs), yet little is known about how different tree species influence soil VOC emissions and the role of rhizosphere processes in mediating VOC release form roots. We analysed soil VOC emissions from the soil surface and bulk soil as well as from roots with intact rhizosphere and washed roots of Picea abies and Fagus sylvatica. Tree saplings were grown on natural forest soil, and VOC emissions and gas exchange of soils and roots were measured under controlled conditions using online gas analysers integrated into an automated system. To assess the contribution of rhizosphere soil and microbial communities to root VOC emissions, roots were analysed (a) without washing, preserving the rhizosphere, (b) water-washed, and (c) ethanol-washed (70 vol%) to minimize microbial contributions. Species-specific VOC emission patterns were observed in both soils and roots. P. abies showed higher total emission rates and a more diverse, terpenoid-rich VOC profile dominated by -pinene, {beta}-pinene, {beta}-myrcene, and -phellandrene than F. sylvatica. Notably, these differences were evident not only at the soil surface but also in root and litter free bulk soil. Root washing further revealed that the rhizosphere is a hotspot of terpenoid production in P. abies, with significantly higher monoterpenoid emissions from unwashed roots than from water or ethanol-washed roots. This study demonstrates how tree species shape net soil VOC emissions, potentially leading to cascading effects on atmospheric VOC concentrations, and highlights the importance of the rhizosphere in regulating belowground VOC production.

Leptospirosis is a globally important environmentally transmitted disease, with approximately one million cases and 60,000 deaths reported annually. In low-income urban communities, inadequate sanitation, drainage and waste management may increase human exposure to contaminated environments. This study investigated the influence of environmental engineering risk factors on Leptospira exposure in four disadvantaged urban communities (favelas) in Salvador, Brazil. A high-precision georeferenced field survey was developed to identify, map and characterise sanitation, stormwater drainage and solid waste infrastructure. Cross-sectional spatial analyses of baseline data were used to assess associations between environmental risk factors and the residential locations of individuals with anti-Leptospira antibodies. Seropositive individuals tended to reside closer to environmental risk factors and at lower relative elevations. Density analyses indicated that seropositive individuals tended to reside closer to inadequate or partially adequate sewerage components than to sewage-contaminated streams or open sewage points. Inadequate streets showed also showed high density peaks, suggesting that exposure may occur through frequent contact with contaminated runoff and standing water. In contrast, open waste dumping sites and vacant lots showed weaker and more diffuse spatial patterns. The findings highlight the importance of infrastructure quality shaping leptospirosis risk within urban informal settlements. The proposed methodology provides a practical approach for high-resolution characterisation of environmental exposure pathways and may support targeted engineering interventions and epidemiological investigations of leptospirosis and other environmentally transmitted diseases.

Typical environmental exposures to the toxic class of chemicals known as polycyclic aromatic hydrocarbons (PAHs) involve complex mixtures; however, relatively few mechanistic toxicity studies have evaluated them as environmental mixtures, instead focusing on individual compounds or simple mixtures. In this study, we first derived Republic Sediment Extract (REPSE), a complex PAH mixture extracted from sediment at the Republic Creosoting site of the Elizabeth River in Norfolk, Virginia. After characterizing the PAH contents of REPSE, we evaluated its mechanisms of developmental neurotoxicity in three evolutionarily distinct taxa, leveraging the unique strengths of Atlantic killifish, zebrafish, and Caenorhabditis elegans as model species, with a focus on the Aryl hydrocarbon Receptor (AhR) pathway. Embryonic REPSE exposure caused induction of CYP1A in both fish species at sub-teratogenic concentrations, consistent with activation of the canonical AhR pathway. These sub-teratogenic exposures nevertheless induced neurotoxicity across both fish species, altering neurobehavioral phenotypes in fish, and induced dopaminergic neuronal damage in worms, again at non-teratogenic concentrations. To determine whether these effects were linked to canonical AhR response pathways, we examined killifish offspring from the pollution-adapted Republic Creosoting population, which exhibited characteristic recalcitrance to CYP1A induction, but remained susceptible to the neurobehavioral effects of REPSE. The induction of neuronal damage in worms provides orthogonal evidence for a non-AhR mechanism, because C. elegans AhR is not transcriptionally activated by PAHs as in vertebrates. Further probing of potential mechanisms underlying REPSE-induced neurotoxicity in worms revealed altered neuronal redox status (roGFP) and energy availability (ATP:ADP ratio). Collectively, our multispecies approach reveals conserved mechanisms of PAH mixture neurotoxicity, including effects that extend beyond canonical AhR signaling.

Background Childhood respiratory mortality in China has fallen by over 90% in three decades alongside sustained national warming, yet national long-run evidence on temperature and child respiratory mortality is lacking. Methods We linked Global Burden of Disease (GBD) 2021 mortality estimates for China - lower respiratory infections (LRI), ages 0-19, and asthma, ages 0-24, 1990-2021 - with C-LSAT 0.5 deg gridded temperature data (1990-2019), aggregated nationally and to five climate zones. Four annual indicators (mean temperature, diurnal temperature range, seasonal amplitude, interannual variability) entered regressions of log mortality rates with Newey-West standard errors. A bootstrapped (500 resamples) quadratic model probed the minimum mortality temperature (MMT), with PM2.5-adjusted analyses and future-exposure, permutation, and detrended falsification tests. Results LRI deaths fell by 96.3% (330,194 in 1990 to 12,098 in 2021; 95% uncertainty interval 9,669-14,891) and asthma deaths by 94.9% (3,287 to 167), while mean temperature rose 0.364 deg C per decade and diurnal temperature range narrowed 0.092 deg C per decade. Baseline coefficients were large (mean temperature -1.696, SE 0.174; diurnal temperature range +2.408, SE 0.336; seasonal amplitude -0.162, SE 0.082; interannual variability +2.924, SE 1.514, per 1 deg C in log rate), but the future-exposure test failed and detrending nullified every coefficient: the associations are trend-level, and short-cycle causal effects are not identifiable. Nor was the national MMT identifiable - observed temperature support spans only 6.66-8.13 deg C, and the nominal turning point of 35.84 deg C is an extrapolation artifact (quadratic term p = 0.963). Within the observed range, warming and declining mortality moved in the same direction. Conclusions The 96% decline in childhood respiratory mortality cannot be attributed to warming. China sits on the low-temperature side of the optimum, and the marginal direction of future warming requires stronger designs to establish. The falsification framework offers a discipline for climate-health inference in China.

Many urban health outcomes are shaped by environmental stressors that occur together rather than in isolation, yet methods for measuring such co-occurrence at the neighbourhood scale remain underdeveloped. We developed a multi-metric framework for joint co-exposure assessment and applied it to characterise the joint spatial distribution of summer surface heat and fine particulate matter (PM2.5) across 42,304 census tracts in 48 large US metropolitan areas during summers 2015 to 2020, covering approximately 174.6 million residents. The framework combines a composite co-exposure index, a joint exceedance indicator, a conditional exceedance ratio that compares observed joint occurrence to within-group statistical independence, and an upper tail dependence parameter estimated using both the non-parametric Caperaa-Fougeres-Genest estimator and a Gumbel copula, with bias-corrected and accelerated (BCa) confidence intervals obtained from a 5,000-replicate metropolitan-area block bootstrap. Among residents of predominantly Black tracts, 13.21% lived in neighbourhoods that simultaneously exceeded the within-metropolitan-area 80th percentile for both heat and PM2.5, compared with 3.33% of residents of predominantly White tracts; the corresponding heat-only and PM2.5-only ratios were 2.88 and 2.48. Residents of Home Owners Loan Corporation grade D tracts had 3.97 times the odds (95% confidence interval 2.79 to 5.66) of joint hotspot residence compared with grade A residents after adjustment for contemporary tract racial composition, poverty, renter-occupancy, and pre-1960 housing. The within-group conditional exceedance ratio at the 80th percentile was 2.29 in predominantly White tracts (95% BCa CI 1.81 to 2.78), 1.27 in predominantly Black tracts (0.71 to 1.56), and 1.13 in predominantly Hispanic tracts (0.70 to 1.41); the White interval excluded one while the Black and Hispanic intervals included one, which we interpret as power-limited given fewer contributing CBSAs. Magnitudes attenuated under near-surface air temperature surfaces but the direction and statistical significance of the primary findings were preserved. The framework is portable to other compound-exposure questions and supports cumulative-impact assessment.

Hydroclimate whiplash, defined as the rapid transition between unusually wet and dry conditions, is expected to intensify under climate change, yet its population health impacts remain largely unknown. Here we quantified the association between hydroclimate whiplash and mortality across the contiguous United States from 2003 to 2023 using monthly county-level mortality records, standardized precipitation evapotranspiration index data, and two-stage time-series models. We identified overall and direction-specific dry-to-wet and wet-to-dry whiplash events at seasonal and sub-annual timescales and across 5-, 10-, and 20-year recurrence intervals. More severe whiplash events were associated with higher all-cause mortality risk; 5-, 10-, and 20-year sub-annual overall whiplash events increased mortality risk over five months by 3.4%, 4.5%, and 5.7%, respectively. Elevated risks were observed across cause-specific mortality outcomes, with the strongest association for infectious diseases. We estimated that 103,471 deaths were attributable to overall whiplash during the study period. These findings identify hydroclimate whiplash as an emerging climate-related public health threat and suggest that adaptation strategies focused on single hazards may underestimate the health burden of rapid, sequential hydroclimatic extremes.

Background: Pro-inflammatory and high-environmental-impact diets both threaten population and planetary health, but whether the two objectives align or conflict across countries is unresolved. We tested whether a supply-based dietary inflammatory index (sDII) is coupled to greenhouse-gas (GHG), land and freshwater footprints, and whether a nutrition-feasible reallocation can lower both simultaneously. Methods: From FAO Food Balance Sheets we built sDII (12 inflammatory-weighted components; construct validity r=0.9999) and five per-capita footprints using three independent life-cycle inventories for 182 national food-supply series. For each country, constrained optimisation reallocated 13 food-group supplies under isoenergetic, protein-preserving and food-group-bound constraints, minimising sDII and GHG jointly (Pareto frontier). Health burden was estimated via pooled relative-risk meta-analysis and 2023 World Bank population data. Results: sDII was only weakly associated with GHG (Spearman rho=0.14), land (rho=0.13) and freshwater (rho=0.28) in 2023. The balanced-Pareto reallocation lowered both sDII and GHG in 182/182 series (100% synergy): population-weighted delta sDII=-0.235, GHG -37.5%, land -49.3%, water -17.2%, i.e. 4.28 Gt CO2e/yr avoided. The associated reduction in metabolic-syndrome burden was directionally consistent but modest (~1.1% of the prevalent pool, ~2.84 million cases). Results were robust to three life-cycle inventories and three feasibility-bound regimes. Conclusions: Anti-inflammatory and low-carbon goals are decoupled rather than conflicting, and an isoenergetic, protein-preserving reallocation reconciles them in every country. Environmental gains are large and robust; health gains are directionally consistent but modest--triangulation, not a causal claim.

Accurate accounting of aquatic methane emissions is critical for climate change mitigation, yet current global budgets overlook a key driver: the elevation-regulated atmospheric pressure. Here, we present the first large-scale investigation of methane ebullition across 164 shallow waters spanning elevations from sea level to 4886 meters. We demonstrate that ebullition rate increases with elevation-over four times higher at >3000 m a.s.l. than at sea level-due to two synergistic, pressure-dependent physical mechanisms: a degas effect (enhanced bubble formation) and a trigger effect (facilitated bubble ascent). Independent theoretical prediction of the combined effects shows near-perfect agreement with the empirical elevation trend, quantitatively confirming that these physical mechanisms are the primary drivers of enhanced ebullition at high elevations. Our findings reveal that mountain aquatic ecosystems represent unaccounted methane hotspots that have been systematically underestimated in global inventories.We therefore call for urgent integration of these ecosystems into IPCC assessments and targeted mountain mitigation and sustainable management strategies.