Arctic Research Centre

AIM: To examine the association between a healthy diet, assessed by the Healthy Diet Indicator (HDI), and cognitive decline in older adults. METHODS: Data from 21,837 participants aged ≥55 years from 3 cohorts (Survey in Europe on Nutrition and the Elderly, a Concerted Action [SENECA], Rotterdam Study [RS], Nurses' Health Study [NHS]) were analyzed. HDI scores were based on intakes of saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, fruits and vegetables, and fiber. The Telephone Interview for Cognitive Status in NHS and Mini-Mental State Examination in RS and SENECA were used to assess cognitive function from multiple repeated measures. Using multivariable-adjusted, mixed linear regression, mean differences in annual rates of cognitive decline by HDI quintiles were estimated. RESULTS: Multivariable-adjusted differences in rates in the highest versus the lowest HDI quintile were 0.01 (95% CI -0.01, 0.02) in NHS, 0.00 (95% CI -0.02, 0.01) in RS, and 0.00 (95% CI -0.05, 0.05) in SENECA with a pooled estimate of 0.00 (95% CI -0.01, 0.01), I2 = 0%. CONCLUSIONS: A higher HDI score was not related to reduced rates of cognitive decline in European and American older adults.

BACKGROUND: Although lifestyle factors have been studied in relation to individual non-communicable diseases (NCDs), their association with development of a subsequent NCD, defined as multimorbidity, has been scarcely investigated. The aim of this study was to investigate associations between five lifestyle factors and incident multimorbidity of cancer and cardiometabolic diseases. METHODS: In this prospective cohort study, 291,778 participants (64% women) from seven European countries, mostly aged 43 to 58 years and free of cancer, cardiovascular disease (CVD), and type 2 diabetes (T2D) at recruitment, were included. Incident multimorbidity of cancer and cardiometabolic diseases was defined as developing subsequently two diseases including first cancer at any site, CVD, and T2D in an individual. Multi-state modelling based on Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (95% CI) of developing cancer, CVD, or T2D, and subsequent transitions to multimorbidity, in relation to body mass index (BMI), smoking status, alcohol intake, physical activity, adherence to the Mediterranean diet, and their combination as a healthy lifestyle index (HLI) score. Cumulative incidence functions (CIFs) were estimated to compute 10-year absolute risks for transitions from healthy to cancer at any site, CVD (both fatal and non-fatal), or T2D, and to subsequent multimorbidity after each of the three NCDs. RESULTS: During a median follow-up of 11 years, 1910 men and 1334 women developed multimorbidity of cancer and cardiometabolic diseases. A higher HLI, reflecting healthy lifestyles, was strongly inversely associated with multimorbidity, with hazard ratios per 3-unit increment of 0.75 (95% CI, 0.71 to 0.81), 0.84 (0.79 to 0.90), and 0.82 (0.77 to 0.88) after cancer, CVD, and T2D, respectively. After T2D, the 10-year absolute risks of multimorbidity were 40% and 25% for men and women, respectively, with unhealthy lifestyle, and 30% and 18% for men and women with healthy lifestyles. CONCLUSION: Pre-diagnostic healthy lifestyle behaviours were strongly inversely associated with the risk of cancer and cardiometabolic diseases, and with the prognosis of these diseases by reducing risk of multimorbidity.

Computer-aided detection, localisation, and segmentation methods can help improve colonoscopy procedures. Even though many methods have been built to tackle automatic detection and segmentation of polyps, benchmarking of state-of-the-art methods still remains an open problem. This is due to the increasing number of researched computer vision methods that can be applied to polyp datasets. Benchmarking of novel methods can provide a direction to the development of automated polyp detection and segmentation tasks. Furthermore, it ensures that the produced results in the community are reproducible and provide a fair comparison of developed methods. In this paper, we benchmark several recent state-of-the-art methods using Kvasir-SEG, an open-access dataset of colonoscopy images for polyp detection, localisation, and segmentation evaluating both method accuracy and speed. Whilst, most methods in literature have competitive performance over accuracy, we show that the proposed ColonSegNet achieved a better trade-off between an average precision of 0.8000 and mean IoU of 0.8100, and the fastest speed of 180 frames per second for the detection and localisation task. Likewise, the proposed ColonSegNet achieved a competitive dice coefficient of 0.8206 and the best average speed of 182.38 frames per second for the segmentation task. Our comprehensive comparison with various state-of-the-art methods reveals the importance of benchmarking the deep learning methods for automated real-time polyp identification and delineations that can potentially transform current clinical practices and minimise miss-detection rates.

As the permafrost region warms, its large organic carbon pool will be increasingly vulnerable to decomposition, combustion, and hydrologic export. Models predict that some portion of this release will be offset by increased production of Arctic and boreal biomass; however, the lack of robust estimates of net carbon balance increases the risk of further overshooting international emissions targets. Precise empirical or model-based assessments of the critical factors driving carbon balance are unlikely in the near future, so to address this gap, we present estimates from 98 permafrost-region experts of the response of biomass, wildfire, and hydrologic carbon flux to climate change. Results suggest that contrary to model projections, total permafrost-region biomass could decrease due to water stress and disturbance, factors that are not adequately incorporated in current models. Assessments indicate that end-of-the-century organic carbon release from Arctic rivers and collapsing coastlines could increase by 75% while carbon loss via burning could increase four-fold. Experts identified water balance, shifts in vegetation community, and permafrost degradation as the key sources of uncertainty in predicting future system response. In combination with previous findings, results suggest the permafrost region will become a carbon source to the atmosphere by 2100 regardless of warming scenario but that 65%-85% of permafrost carbon release can still be avoided if human emissions are actively reduced.

Introduction: Two species of Aedes (Ae.) mosquitoes ( Ae. aegypti and Ae. albopictus ) are primary vectors for emerging arboviruses that are a significant threat to public health and economic burden worldwide. Distribution of these vectors and the associated arboviruses, such as dengue virus, chikungunya virus, yellow fever virus, and Zika virus, was for a long time restricted by geographical, ecological, and biological factors. Presently, arbovirus emergence and dispersion are more rapid and geographically widespread, largely due to expansion of the range for these two mosquitoes that have exploited the global transportation network, land perturbation, and failure to contain the mosquito population coupled with enhanced vector competence. Ae. aegypti and Ae. albopictus may also sustain transmission between humans without having to depend on their natural reservoir forest cycles due to arthropod adaptation to urbanization. Currently, there is no single strategy that is adequate to control these vectors, especially when managing arbovirus outbreaks. Objective: This review aimed at presenting the characteristics and abilities of Ae. aegypti and Ae. albopictus , which can drive a global public health risk, and suggests strategies for prevention and control. Methods: This review presents the geographic range, reproduction and ecology, vector competence, genetic evolution, and biological and chemical control of these two mosquito species and how they have changed and developed over time combined with factors that may drive pandemics and mitigation measures. Conclusion: We suggest that more efforts should be geared toward the development of a concerted multidisciplinary approach.

Significant climate risks are associated with a positive carbon-temperature feedback in northern latitude carbon-rich ecosystems, making an accurate analysis of human impacts on the net greenhouse gas balance of wetlands a priority. Here, we provide a coherent assessment of the climate footprint of a network of wetland sites based on simultaneous and quasi-continuous ecosystem observations of CO2 and CH4 fluxes. Experimental areas are located both in natural and in managed wetlands and cover a wide range of climatic regions, ecosystem types, and management practices. Based on direct observations we predict that sustained CH4 emissions in natural ecosystems are in the long term (i.e., several centuries) typically offset by CO2 uptake, although with large spatiotemporal variability. Using a space-for-time analogy across ecological and climatic gradients, we represent the chronosequence from natural to managed conditions to quantify the "cost" of CH4 emissions for the benefit of net carbon sequestration. With a sustained pulse-response radiative forcing model, we found a significant increase in atmospheric forcing due to land management, in particular for wetland converted to cropland. Our results quantify the role of human activities on the climate footprint of northern wetlands and call for development of active mitigation strategies for managed wetlands and new guidelines of the Intergovernmental Panel on Climate Change (IPCC) accounting for both sustained CH4 emissions and cumulative CO2 exchange.

Abstract Antarctic and Southern Ocean science is vital to understanding natural variability, the processes that govern global change and the role of humans in the Earth and climate system. The potential for new knowledge to be gained from future Antarctic science is substantial. Therefore, the international Antarctic community came together to ‘scan the horizon’ to identify the highest priority scientific questions that researchers should aspire to answer in the next two decades and beyond. Wide consultation was a fundamental principle for the development of a collective, international view of the most important future directions in Antarctic science. From the many possibilities, the horizon scan identified 80 key scientific questions through structured debate, discussion, revision and voting. Questions were clustered into seven topics: i) Antarctic atmosphere and global connections, ii) Southern Ocean and sea ice in a warming world, iii) ice sheet and sea level, iv) the dynamic Earth, v) life on the precipice, vi) near-Earth space and beyond, and vii) human presence in Antarctica. Answering the questions identified by the horizon scan will require innovative experimental designs, novel applications of technology, invention of next-generation field and laboratory approaches, and expanded observing systems and networks. Unbiased, non-contaminating procedures will be required to retrieve the requisite air, biota, sediment, rock, ice and water samples. Sustained year-round access to Antarctica and the Southern Ocean will be essential to increase winter-time measurements. Improved models are needed that represent Antarctica and the Southern Ocean in the Earth System, and provide predictions at spatial and temporal resolutions useful for decision making. A co-ordinated portfolio of cross-disciplinary science, based on new models of international collaboration, will be essential as no scientist, programme or nation can realize these aspirations alone.

Metabarcoding of lake sediments have been shown to reveal current and past biodiversity, but little is known about the degree to which taxa growing in the vegetation are represented in environmental DNA (eDNA) records. We analysed composition of lake and catchment vegetation and vascular plant eDNA at 11 lakes in northern Norway. Out of 489 records of taxa growing within 2 m from the lake shore, 17-49% (mean 31%) of the identifiable taxa recorded were detected with eDNA. Of the 217 eDNA records of 47 plant taxa in the 11 lakes, 73% and 12% matched taxa recorded in vegetation surveys within 2 m and up to about 50 m away from the lakeshore, respectively, whereas 16% were not recorded in the vegetation surveys of the same lake. The latter include taxa likely overlooked in the vegetation surveys or growing outside the survey area. The percentages detected were 61, 47, 25, and 15 for dominant, common, scattered, and rare taxa, respectively. Similar numbers for aquatic plants were 88, 88, 33 and 62%, respectively. Detection rate and taxonomic resolution varied among plant families and functional groups with good detection of e.g. Ericaceae, Roseaceae, deciduous trees, ferns, club mosses and aquatics. The representation of terrestrial taxa in eDNA depends on both their distance from the sampling site and their abundance and is sufficient for recording vegetation types. For aquatic vegetation, eDNA may be comparable with, or even superior to, in-lake vegetation surveys and may therefore be used as an tool for biomonitoring. For reconstruction of terrestrial vegetation, technical improvements and more intensive sampling is needed to detect a higher proportion of rare taxa although DNA of some taxa may never reach the lake sediments due to taphonomical constrains. Nevertheless, eDNA performs similar to conventional methods of pollen and macrofossil analyses and may therefore be an important tool for reconstruction of past vegetation.

BACKGROUND: Smoking is the most important individual risk factor for many cancer sites but its association with breast and prostate cancer is not entirely clear. Rate advancement periods (RAPs) may enhance communication of smoking related risk to the general population. Thus, we estimated RAPs for the association of smoking exposure (smoking status, time since smoking cessation, smoking intensity, and duration) with total and site-specific (lung, breast, colorectal, prostate, gastric, head and neck, and pancreatic) cancer incidence and mortality. METHODS: This is a meta-analysis of 19 population-based prospective cohort studies with individual participant data for 897,021 European and American adults. For each cohort we calculated hazard ratios (HRs) for the association of smoking exposure with cancer outcomes using Cox regression adjusted for a common set of the most important potential confounding variables. RAPs (in years) were calculated as the ratio of the logarithms of the HRs for a given smoking exposure variable and age. Meta-analyses were employed to summarize cohort-specific HRs and RAPs. RESULTS: Overall, 140,205 subjects had a first incident cancer, and 53,164 died from cancer, during an average follow-up of 12 years. Current smoking advanced the overall risk of developing and dying from cancer by eight and ten years, respectively, compared with never smokers. The greatest advancements in cancer risk and mortality were seen for lung cancer and the least for breast cancer. Smoking cessation was statistically significantly associated with delays in the risk of cancer development and mortality compared with continued smoking. CONCLUSIONS: This investigation shows that smoking, even among older adults, considerably advances, and cessation delays, the risk of developing and dying from cancer. These findings may be helpful in more effectively communicating the harmful effects of smoking and the beneficial effect of smoking cessation.

BACKGROUND: There is uncertainty about the relevance of animal foods to the pathogenesis of ischemic heart disease (IHD). We examined meat, fish, dairy products, and eggs and risk for IHD in the pan-European EPIC cohort (European Prospective Investigation Into Cancer and Nutrition). METHODS: In this prospective study of 409 885 men and women in 9 European countries, diet was assessed with validated questionnaires and calibrated with 24-hour recalls. Lipids and blood pressure were measured in a subsample. During a mean of 12.6 years of follow-up, 7198 participants had a myocardial infarction or died of IHD. The relationships of animal foods with risk were examined with Cox regression with adjustment for other animal foods and relevant covariates. RESULTS: The hazard ratio (HR) for IHD was 1.19 (95% CI, 1.06-1.33) for a 100-g/d increment in intake of red and processed meat, and this remained significant after exclusion of the first 4 years of follow-up (HR, 1.25 [95% CI, 1.09-1.42]). Risk was inversely associated with intakes of yogurt (HR, 0.93 [95% CI, 0.89-0.98] per 100-g/d increment), cheese (HR, 0.92 [95% CI, 0.86-0.98] per 30-g/d increment), and eggs (HR, 0.93 [95% CI, 0.88-0.99] per 20-g/d increment); the associations with yogurt and eggs were attenuated and nonsignificant after exclusion of the first 4 years of follow-up. Risk was not significantly associated with intakes of poultry, fish, or milk. In analyses modeling dietary substitutions, replacement of 100 kcal/d from red and processed meat with 100 kcal/d from fatty fish, yogurt, cheese, or eggs was associated with ≈20% lower risk of IHD. Consumption of red and processed meat was positively associated with serum non-high-density lipoprotein cholesterol concentration and systolic blood pressure, and consumption of cheese was inversely associated with serum non-high-density lipoprotein cholesterol. CONCLUSIONS: Risk for IHD was positively associated with consumption of red and processed meat and inversely associated with consumption of yogurt, cheese, and eggs, although the associations with yogurt and eggs may be influenced by reverse causation bias. It is not clear whether the associations with red and processed meat and cheese reflect causality, but they were consistent with the associations of these foods with plasma non-high-density lipoprotein cholesterol and for red and processed meat with systolic blood pressure, which could mediate such effects.

A major challenge in planning for adaptation to climate change is to assess future development not only in relation to climate but also in relation to social, economic and political changes that affect the capacity for adaptation or otherwise play a role in decision making. One approach is to use scenario methods. This article presents a methodology that combines top-down scenarios and bottom-up approaches to scenario building, with the aim of articulating local so-called extended socio-economic pathways. Specifically, we used the Shared Socioeconomic Pathways (SSPs) of the global scenario framework as developed by the climate research community to present boundary conditions about potential global change in workshop discussion with local and regional actors in the Barents region. We relate the results from these workshops to the different elements of the global SSPs and discuss potential and limitations of the method in relation to use in decision making processes.

OBJECTIVE: To summarize the evidence on the health benefits of tai chi. SOURCES OF INFORMATION: A literature review was conducted on the benefits of tai chi for 25 specific conditions, as well as for general health and fitness, to update a 2014 review of systematic reviews. Systematic reviews and recent clinical trials were assessed and organized into 5 different groups: evidence of benefit as excellent, good, fair, or preliminary, or evidence of no direct benefit. MAIN MESSAGE: During the past 45 years more than 500 trials and 120 systematic reviews have been published on the health benefits of tai chi. Systematic reviews of tai chi for specific conditions indicate excellent evidence of benefit for preventing falls, osteoarthritis, Parkinson disease, rehabilitation for chronic obstructive pulmonary disease, and improving cognitive capacity in older adults. There is good evidence of benefit for depression, cardiac and stroke rehabilitation, and dementia. There is fair evidence of benefit for improving quality of life for cancer patients, fibromyalgia, hypertension, and osteoporosis. Current evidence indicates no direct benefit for diabetes, rheumatoid arthritis, or chronic heart failure. Systematic reviews of general health and fitness benefits show excellent evidence of benefit for improving balance and aerobic capacity in those with poor fitness. There is good evidence for increased strength in the lower limbs. There is fair evidence for increased well-being and improved sleep. There were no studies that found tai chi worsened a condition. A recent systematic review on the safety of tai chi found adverse events were typically minor and primarily musculoskeletal; no intervention-related serious adverse events have been reported. CONCLUSION: There is abundant evidence on the health and fitness effects of tai chi. Based on this, physicians can now offer evidence-based recommendations to their patients, noting that tai chi is still an area of active research, and patients should continue to receive medical follow-up for any clinical conditions.

Abstract Global lake volume estimates are scarce, highly variable, and poorly documented. We developed a rigorous method for estimating global lake depth and volume based on the Hurst coefficient of Earth's surface, which provides a mechanistic connection between lake area and volume. Volume‐area scaling based on the Hurst coefficient is accurate and consistent when applied to lake data sets spanning diverse regions. We applied these relationships to a global lake area census to estimate global lake volume and depth. The volume of Earth's lakes is 199,000 km 3 (95% confidence interval 196,000–202,000 km 3 ). This volume is in the range of historical estimates (166,000–280,000 km 3 ), but the overall mean depth of 41.8 m (95% CI 41.2–42.4 m) is significantly lower than previous estimates (62–151 m). These results highlight and constrain the relative scarcity of lake waters in the hydrosphere and have implications for the role of lakes in global biogeochemical cycles.

Body temperature, blubber thickness and lung capacity (Vc) were recorded in newly killed minke whales, while respiratory frequency (f) was determined in free-swimming animals. Mean deep (thoracic) body temperature was 34.7 +/- 0.8 (SD) degrees C (n = 14). Weighted mean core/blubber interface temperature in animals caught in 2.5-5.5 degrees C water was 28.8 +/- 1.7 degrees C (n = 8). The minimum average rate of sensible heat loss (HLs) was 3.81 +/- 0.53 (SD) W kgw-0.75 (n = 8) in animals with body masses (w) in the range of 1840 to 5740 kg, HLs being inversely proportional to w (HLs = -2.98 10(-4) w +4.89 W kgw-0.75 (n = 8, r2 = 0.73, P less than 0.01)). The average rate of respiratory heat loss (HLr) was 0.26 +/- 0.04 (SD) W kgw-0.75, regardless of w, in the same 8 animals. Total rates of heat loss (HL = HLr+HLs) in 2.5-5.5 degrees C water ranged between 3.40 and 4.87 W kgw-0.75, with an average of 4.06 +/- 0.52 (SD) W kgw-0.75 (n = 8). Estimates of oxygen consumption based on records of f and Ve, and data on oxygen extraction from other cetaceans, yielded a range of metabolic rates which compared nicely with the calculated HL values.

Abstract This article challenges the tendency, both academic and popular, to assign empathy the status of a virtue. The widespread inclination to associate empathy with the morally and socially “good”—with compassion, understanding, cultural bonding, and non-violent sociality—ignores what we propose to call the “dark side of empathy”: that is, the multiple ways in which empathy is routinely deployed to manipulate, seduce, deceive, and dehumanize others by means of vicariousness. Two diverse ethnographic cases, of hunting in Siberia and political violence in Indonesia, provide the empirical background for a discussion of the complex relationship of empathy to mimesis, deception, violence, and sociality.

infections and the transmission patterns at the wildlife/livestock/human interface is of paramount importance before implementing any brucellosis control or eradication program in animals, even more so should interventions be justified within One Health. In addition to calling for transdisciplinary collaboration, One Health formally aims to conserve the environment and to promote the well-being of animals. In this opinion paper, the One Health approach of brucellosis is reviewed in the industrialized and the low and middle income countries, highlighting pitfalls and shortcomings of serological studies and discussing the role of urban and peri-urban farming for the re-emergence of brucellosis in the developing world. The role of wildlife as a potential reservoir is highlighted and different management strategies are discussed. Lastly, beyond its role in the control of brucellosis, the ethical dimension of culling wildlife to control disease emergence or spill-back of infections in livestock is discussed. Core transdisciplinary competencies such as values and ethics are critically important in guiding the development of One Health curricula and in continuing professional education, as they describe the knowledge, skills, and attitudes required to be effective. A conceptual framework needs to be developed from inception to knowledge translation. Importantly, transdisciplinary competencies should be developed as an adjunct to discipline-specific areas of expertise, not as a replacement. A profound understanding of the biology of infectious agents is and will always remain a pre-requisite for any sound One Health approach.

The Arctic is entering a new ecological state, with alarming consequences for humanity. Animal-borne sensors offer a window into these changes. Although substantial animal tracking data from the Arctic and subarctic exist, most are difficult to discover and access. Here, we present the new Arctic Animal Movement Archive (AAMA), a growing collection of more than 200 standardized terrestrial and marine animal tracking studies from 1991 to the present. The AAMA supports public data discovery, preserves fundamental baseline data for the future, and facilitates efficient, collaborative data analysis. With AAMA-based case studies, we document climatic influences on the migration phenology of eagles, geographic differences in the adaptive response of caribou reproductive phenology to climate change, and species-specific changes in terrestrial mammal movement rates in response to increasing temperature.

Yamal, translates as the ‘end of the land’ in the language of its native Nenets population. The setting of this anthropological monograph, Yamal is home to the world’s largest domestic reindeer herds. The region also accounts for almost 90 extraction of huge untapped deposits is now about to transform vast expanses of tundra pastures into an industrial landscape. This book gives a valuable insight into nomadic life in the context of post-Soviet transformation at the onset of gas extraction. Stammler meticulously analyses relations between reindeer nomads and their social, political and natural environments, as well as their engagement with the developing market economy. Their high level of social adaptability is combined with a sense of belonging to their animals and their land. This study makes an original and significant contribution to wider debates about nomadic pastoralism and to anthropological studies of trade, barter, property and territoriality. The book is also recommended to those with an interest in background information on the regions that fuel the global economy in the 21st century. kursiv”This is a tale of profound breadth and depth from a little known region with a fascinating history. The story is expertly presented in engaging language. This volume should serve scholars of different stripes and provenances, not just Arctic anthropologists. Stammler’s analysis is warmly sympathetic to his hosts yet retains the appropriate level of detachment throughout. Highly recommended.” – Bruce Forbes, research professor in global change, Arctic Centre, University of Lapland kursiv”A unique study which goes beyond ‘culture’ to give a detailed socio-economic explanation for the exceptional resilience and continuing nomadism of the Yamal Nenets. Essential reading for anyone interested in northern pastoralism, the anthropology of land and movement, or the diversity of local responses to the state.” – Piers Vitebsky, Scott Polar Research Institute, University of Cambridge, author of kursiv”Reindeer people: living with animals and spirits in Siberia” Florian Stammler was a founding member of the “Siberia Project Group” at the Max Planck Institute for Social Anthropology. After his PhD degree he worked as a research associate in the Scott Polar Institute at the University of Cambridge. In 2005 he joined the Arctic Centre at the University of Lapland as a senior researcher in anthropology and Russian studies.

BACKGROUND: Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion. AIM: To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care. DESIGN: A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients' responses to the EQ-5D quality of life instrument. SETTING/PARTICIPANTS: Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital. RESULTS: EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs. CONCLUSION: The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.

The timing of breeding is a life-history trait that can greatly affect fitness, because successful reproduction depends on the match between the food requirements for raising young and the seasonal peak in food availability. We analysed phenology (hatch dates) in relation to climate change for 2 seabird species breeding in the high-Arctic, little auks Alle alle and black-legged kittiwakes Rissa tridactyla, for the periods 1963-2008 and 1970-2008, respectively. We show that spring climate has changed during the study period, with a strong increase in both air temperature (TEMP) and sea surface temperature (SST) and a decrease in sea ice concentration. Little auks showed a trend for earlier breeding over the study period, while kittiwakes showed a non-significant trend for later breeding, demonstrating different phenological responses in these 2 species. Little auks and kittiwakes adjusted their timing of breeding to different environmental signals. Spring TEMP was the best predictor of little auk phenology, with a significant negative effect. Spring SST was the strongest predictor of kittiwake phenology, with a non-significant negative effect. Spring sea ice concentration and the North Atlantic Oscillation (NAO) winter index had a low relative variable importance. Furthermore, in kittiwakes, years with late breeding were associated with low clutch size and mean annual breeding success, indicating poor investment and food availability. This study identifies some spring environmental factors important for regulating the timing of breeding in the high-Arctic, most likely through effects on snow cover limiting access to nest sites and the development of the polar marine food web. It remains to be investigated whether environmental factors are reliable predictors of marine prey phenology, and whether the decision to start breeding is constrained by food availability.