Eleanor J Sterling
email: sterling@amnh.org

Puaala Pascua

Amanda Sigouin

Nadav Gazit

Lisa Mandle

Erin Betley

John Aini

Simon Albert

Sophie Caillon

Jennifer E Caselle

Puaʻala Pascua

Samantha H Cheng

Joachim Claudet

Rachel Dacks

Emily S Darling

Chris Filardi

Stacy D Jupiter

Alexander Mawyer

Manuel Mejia

Kanoeʻulalani Morishige

Winifereti Nainoca

John Parks

Jamie Tanguay

Tamara Ticktin

Ron Vave

Veronica Wase

Supin Wongbusarakum

Joe Mccarter

Affiliations

Creating a space for place and multi-dimensional well-being: lessons learned

Introduction

The 2030 Agenda for Sustainable Development and Sustainable Development Goals (SDGs), adopted by the United Nations in 2015, lays out a shared vision for a more prosperous, equitable, and environmentally sustainable world where no one will be left behind. The SDGs are the result of a complex and extensive negotiation process [START_REF] Kamau | Transforming Multilateral Diplomacy: The Inside Story of the Sustainable Development Goals[END_REF] and encompass 17 broad and conceptually interlinked global goals, each with underlying targets and nested indicators (Fig. 1).

While the SDGs are presented as an indivisible whole, in practice there is little guidance or detail regarding potential or realized trade-offs and synergies between and across the goals [START_REF] Nilsson | Policy: map the interactions between Sustainable Development Goals[END_REF].

Achieving the interrelated SDGs will require systems approaches, explicitly considering the structure (elements and interactions), purpose, and emergent behavior of complex adaptive systems [START_REF] Preiser | Social-ecological systems as complex adaptive systems: organizing principles for advancing research methods and approaches[END_REF]. This can facilitate a better understanding of how (i) various SDG goals, targets, and indicators interconnect [START_REF] Nilsson | Policy: map the interactions between Sustainable Development Goals[END_REF][START_REF] Costanza | Modelling and measuring sustainable wellbeing in connection with the UN Sustainable Development Goals[END_REF]; (ii) SDGs are underpinned by biodiversity and ecosystem services or nature's contributions to people [START_REF] Díaz | Summary for policymakers of the global assessment report on biodiversity and ecosystem services of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services[END_REF]; and (iii) SDGs impact human well-being at the local scale.

An analysis by the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) finds that efforts to maximize SDGs relating to energy, economic growth, industry and infrastructure, sustainable consumption and production, poverty, food security, and cities could produce trade-offs for nature that in turn negatively affect human well-being and the achievement of interlinked goals [START_REF] Díaz | Summary for policymakers of the global assessment report on biodiversity and ecosystem services of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services[END_REF]. Global frameworks do ultimately impact local communities through the direction of financial resources and through on-the-ground implementation of development strategies. Ignoring complex interactions within and across social-ecological systems risks increased potential for misdiagnosis and implementation of interventions with unintended and potentially negative outcomes for communities at local scales [START_REF] Ramalingam | Aid on the edge of chaos: rethinking international cooperation in a complex world[END_REF].

National-level reporting agencies (such as National Statistics Offices) are in a unique position to be able to address interrelationships across goals while also setting national priorities, programs, targets, and associated indicators based on their country's geographic, political, technological, and other development-related contexts [START_REF] Nilsson | Policy: map the interactions between Sustainable Development Goals[END_REF]. With this in mind, national-level reporting agencies should be able to identify metrics (including goals and targets) that are relevant to people of that nations' varied viewpoints, aspirations, and cultural settings. One critical viewpoint to consider, especially given Member States' commitment to leave no one behind in the 2030 Agenda, is that of Indigenous Peoples and local communities (IPLCs), who manage or have tenure rights over more than a quarter of the world's land surface and whose participation and inclusion in environmental governance enhance environmental conservation, restoration, and sustainable use for broader society [START_REF] Díaz | Summary for policymakers of the global assessment report on biodiversity and ecosystem services of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services[END_REF]. Indigenous and local expert observations and knowledge are based upon and highlight the interconnections between parts of a system [START_REF] Berkes | Sacred Ecology[END_REF], and could help to connect across hierarchically structured global metrics (Fig. 1).

In addition, measurement of multidimensional well-being can be an integrated way for countries to assess culturally-relevant progress towards disparate sustainable development goals [START_REF] Costanza | Modelling and measuring sustainable wellbeing in connection with the UN Sustainable Development Goals[END_REF]8). A multidimensional well-being lens focuses by definition at a systems level, on both humans and non-humans, and builds on context-specific perceptions of health and well-being.

Using a well-being lens can also provide insights into the power dynamics among social groups, community decision-making, and the drivers of change (9), and allows social values and priorities to inform policies and management (10). Recognizing this point, several groups and organizations across multiple locations have attempted to operationalize a multidimensional wellbeing focus for monitoring societal progress that is aligned to specific local contexts with sensitivity across a broad range of human dimensions. For instance, in Aotearoa New Zealand, the Government has structured national budgeting around well-being, and will assess progress using indicators of intergenerational well-being (11). Other examples include "buen vivir" and associated Indigenous concepts in Central America [START_REF] Guardiola | Buen Vivir (living well) in Ecuador: community and environmental satisfaction without household material prosperity?[END_REF], "ubuntu" value systems in eastern Africa [START_REF] Gasper | Understanding the diversity of conceptions of well-being and quality of life[END_REF], Bhutan's Gross National Happiness Index [START_REF] Meier | The paradox of happiness: health and human rights in the kingdom of Bhutan[END_REF], Melanesian Well-being Indicators [START_REF] Tanguay | Making Culture Count: The Politics of Cultural Measurement[END_REF], the United Kingdom National Wellbeing Measures [START_REF]Measuring National Well-being: Quality of Life in the UK[END_REF], and the California Current Integrated Ecosystem Assessment [START_REF] Breslow | Evaluating indicators of human well-being for ecosystem-based management[END_REF].

In order to explore how the SDGs can best support local human well-being and environmental health, we systematically compare the SDG indicators with a list of regionallyderived well-being factors for the Pacific Islands [START_REF] Dacks | Developing biocultural indicators for resource management[END_REF] (hereafter "Factors"), which were developed by biological and social scientists and community members and organizers who all collaborate with communities from across the Pacific Islands on resource management or cultural vitality.

The Pacific Islands region is distinguished by its high biological and cultural diversity, and by historical and contemporary resilience to environmental and social variability [START_REF] Kueffer | What is the importance of islands to environmental conservation?[END_REF][START_REF] Mcmillen | Small islands, valuable insights: systems of customary resource use and resilience to climate change in the Pacific[END_REF]. The Factors are grouped into eight dimensions (hereafter "Dimensions") (Tables 1,S1). Collectively the list encompasses critical components of well-being and social-ecological resilience across the Pacific and is intended as a dynamic/living product, which can be adapted relative to needs and priorities of the groups that use it.

Here we seek to answer three main questions: (iii) based on the above, what are the trade-offs or challenges in national reporting and implementing of SDGs? Our analysis of overlaps and differences between local and global scales and approaches can assist decision makers to navigate the synergies and trade-offs between the SDGs, and result in better-informed efforts at different scales (Fig. 1). In closing, we provide a set of lessons learned for SDG indicator development and reporting at the national scale.

Results

Gap Analysis

We coded linkages between SDG indicators and Well-being Factors and identified 447 linkages that were made by at least two individual coders. The greatest number of linkages to the SDGs were from Factors within two Well-being Dimensions: Human Health (n=140) and Access to Infrastructure, Civic Services, and Financial Resources (Infrastructure/Finance) (n=126) (Figs. 2,S1). Within Human Health, the Factors with the greatest number of linkages were related to physical health (n=47) and individual and/or collective security and safety (n=26). For Access to Infrastructure, Civic Services, and Financial Resources, the Factors with the highest number of linkages were related to access to and use of health infrastructure and services (n=25) and equitable access to and use of financial resources and services in vulnerable populations (n=18) (for further detail see table S2). To understand how effectively each Well-being Dimension was represented by the SDGs, we calculated the percentage of Factors in each Dimension that were linked to at least one indicator (Fig. 3). Of the 89 Factors scored (table S1), 62 (70%) have linkages with at least one Through the coding activity and subsequent small working group discussions, we identified concepts present in the SDG indicators that had strong bearing on well-being but were not clearly articulated in the regionally-derived Factors. These topics were woven into an updated iteration of the Well-being Factors (table S1, new additions in bold) through the creation of four new Factors (e.g., Access to and use of education-related infrastructure and services), strengthening of existing Factors (e.g., expanding the Factor on individual or collective security to focus on social and economic risks in addition to environmental risk), and in revisions to the framing and language used. Gender and other forms of social equity are part of several Wellbeing Factors, but do not have distinct Dimensions or Factors.

Applicability, Trade-off, and Indicator Measurement Challenges Analyses

In addition to identifying overlaps and gaps between SDG indicators and Factors, we also drew on our experience working with communities across the Pacific, using a systems approach to assess if SDG indicators would be applicable to measure the Factors at the local scale, and if there are any potential trade-offs or measurement challenges. We deemed 160 SDG indicators, or 99% of the 162 indicators analyzed (see Methods, table S3), to have trade-off and applicability issues in some way at the local level, encapsulated in 913 coder assessment comments in total from across the 14 coders. We summarized the comments into seven categories that describe the nature of trade-offs and measurement challenges (Table 2).

Perceived practical challenges to indicator measurement encompassed issues such as 'Disaggregation', 'Feasibility', 'Links to Target', and 'Scale". For instance, in terms of 'Disaggregation', SDG 14.5.1: "protected area in relation to marine areas" may be more applicable with greater specificity in detail on governance type or spatial measures (e.g., include the proportion of protected area covered by customary marine tenure, which is not traditionally counted under "protected areas" but is increasingly being considered via categories such as Other Effective Area-Based Conservation Measures promulgated by the International Union for Conservation of Nature). Further, the spatial extent itself is arbitrary if it does not account for ecological characteristics, such as habitat type (sand flat, seagrass, mangrove, reef, etc.) and the life histories of species that may inhabit the protected area. Several SDG indicators pose potential 'Feasibility' issues, which can arise from lack of technical capacity and/or insufficient methodologies to meaningfully and accurately collect data. For example, different localities may have limited technical ability and resources to comprehensively track financial flows, and flows of goods and services (e.g., indicators 16.4.1, 16.4.2) resulting in large data gaps.

In 'Links to Target' challenges, an existing indicator might measure one link to a target and overlook other important aspects of the target. For instance, SDG 15.7.1 on the proportion of traded wildlife that was poached or illicitly trafficked does not adequately cover all aspects of the target it is nested under, which aims to enhance global support to combat poaching, including through increased capacity of local communities to pursue sustainable livelihood opportunities.

Regarding 'Scale' challenges, as one example SDG 2.5.1 measures the number of genetic resources for food and agriculture saved in medium or long term conservation facilities. These facilities tend to be ex situ and are often difficult for communities to access when needed. This could impede food security at the local scale if local conservation facilities such as community seed banks do not receive attention.

The greatest number of the 'Focus/Bias' category coder assessments were characterized by cultural biases towards a particular knowledge system to the exclusion of other ways of knowing. In the 'Social Harm Trade-off' category, these biases translated into the potential for unfavorable and unintended consequences of, for instance, overlooking social-cultural values and norms surrounding concepts such as poverty, food security, or livelihoods. For example, coders identified a bias towards formal employment, which could promote the uptake of lowwage employment at the expense of traditional subsistence livelihoods. In addition, indicator 8.3.1 measures the proportion of informal employment in non-agriculture sectors with the intent to identify informal labor markets that take advantage of marginalized individuals where legal and social protection is limited. However, intent does not always equal impact --the idea that work within the informal economy is inherently problematic could lead to degradation of subsistence labor, including fishing, which is increasingly recognized as substantial and valuable, and should be included in labor statistics [START_REF]International Labour Organization, Decent Work and the Sustainable Development Goals: A Guidebook on SDG Labour Market Indicators[END_REF]. In the 'Environmental Harm Trade-off' category, coder assessments related to indicators that could encourage environmental degradation. For instance, coder assessments classified as 'Environmental Harm Trade-off' identified that indicator 9.2.1 (concerning manufacturing value as a proportion of GDP) could also promote nonenvironmentally friendly manufacturing practices and encourage unsustainable use of natural resources over their conservation. Across all categories of challenges, many coder assessment comments identified tradeoffs and measurement challenges with indicators that emphasize monetary transactions for goods and services. This prompted us to undertake an additional analysis to assess the extent to which indicators rely on "monetary economy-based" metrics to denote success. Out of 162 indicators, 25 (15%) included components focusing on or directly relating to the monetary economy. In our analysis, coder assessments fell into one or both of two groupings: failure to convey the full breadth of well-being and diversity of local perspectives, and failure to encompass the nature and quality of economic growth. In the first grouping, coder assessments pointed out that indicators related to monetary compensation (e.g., indicator 8.5.1 regarding hourly earnings of employees) overlook other aspects of an individual's livelihood that may be key in subsistence communities. Monetary economy-based indicators can risk over-representing single perspectives on, and contribution to, sustainability (challenges of both 'Focus/Bias' as well as 'Scale'). For example, emphasis on industries (e.g., indicator 9.b.1 regarding the proportion of medium and high-tech industry value added in total value added) may overlook other important community or Indigenous activities that make strong contributions to social cohesion and community wellbeing.

In the second grouping, failure to encompass the nature and quality of economic growth, coders found that a focus on measuring changes in monetary economy-based indicators fails to convey other important factors. For instance, coder assessments regarding indicator 8.4.2 (related to domestic material consumption), pointed out that this indicator encourages material consumption growth which could lead to greater use of natural resources. It does not measure other factors such as the sustainability of such growth, including its environmental impact and potential for social harm. Coders also raised the point that focusing on expenditures for activities intended to promote sustainable development overlooks the potential negative impacts of these activities --more funds being spent does not necessarily imply success or beneficial impacts. For example, coder assessments regarding indicator 17.17.1 (concerning the amount of dollars committed to public-private and civil society partnerships) does not lend any insight into whether these partnerships were equitable or effective. These indicators are relatively easily measured, but may not be meaningful on their own. Overall, coder assessments underscored that very few indicators, or sets of indicators under a target, adequately addressed the potential for trade-offs or other feedbacks between goals, pointing to an important next step for SDG reporting efforts. The assessments also noted that some indicators could better reflect trade-offs and be better adapted to local use with minor modifications such as greater disaggregation, whereas others might be best addressed through reporting on metrics more relevant to local and national contexts. Coders called out already existing language useful to address these problems, such as is found in indicator 1.2.2: Proportion of men, women and children of all ages living in poverty in all its dimensions according to national definitions (emphasis added).

Discussion

Meeting the interconnected SDGs at a global level, while also supporting local and regional sustainable development, entails a careful framing of what success looks like [START_REF] Díaz | Summary for policymakers of the global assessment report on biodiversity and ecosystem services of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services[END_REF]. Our research shows that, in the context of the Pacific, there are overlaps but also significant gaps between local and regional conceptions of well-being and the globally-derived SDGs. Furthermore, internationally generated indicators may result in trade-offs and measurement challenges in local or regional contexts. While the SDGs themselves result from extensive negotiations and represent fixed global commitments, the implementation of the global sustainability agenda hinges on each country's sustainable development policies, plans, and programs. Our analysis highlights opportunities for national reporting organizations to describe and achieve progress toward these goals and targets in culturally and locally attuned ways.

Assessing the Overlaps and Gaps

Cross-referencing the Pacific Island Well-being Factors with SDG indicators yielded important insights regarding overlaps and gaps between regional and global scales. Our analysis shows that some Well-being Dimensions are very well-represented in global metrics. In fact, all individual Factors within three Dimensions, Sustainability Management, Infrastructure/Finance, and Human Health, were linked to at least one SDG indicator.

However, other Dimensions of locally important well-being, including People & Place and

Indigenous & Local Knowledge, are under-represented or are only obliquely referenced in the SDG indicators. These are problematic omissions. The People & Place Dimension encompasses important reciprocal relationships humans maintain with one another and with the environment [START_REF] Díaz | Summary for policymakers of the global assessment report on biodiversity and ecosystem services of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services[END_REF][START_REF] Kimmerer | Human Dimensions of Ecological Restoration: Integrating Science[END_REF][START_REF] Mcgregor | Na kua'aina: living Hawaiian culture[END_REF]. These relationships, which are often paired with corresponding social and cultural norms, codes of conduct, and responsibilities, manifest in different ways based on the socialcultural setting. The relationships contribute to individual/community well-being and environmental sustainability [START_REF] Dacks | Developing biocultural indicators for resource management[END_REF][START_REF] Chan | Opinion: why protect nature? Rethinking values and the environment[END_REF][START_REF] Masterson | The contribution of sense of place to social-ecological systems research: a review and research agenda[END_REF]. For instance, varivagana is an important cultural concept in Simbo, Solomon Islands, centered on generosity and reciprocal obligations across social networks [START_REF] Lauer | Globalization, Pacific Islands, and the paradox of resilience[END_REF]; in Hawai'i laulima emphasizes collective action supported by strong social networks [START_REF] Mcgregor | Na kua'aina: living Hawaiian culture[END_REF]. Connections and networks within communities can facilitate knowledge transfer and learning as well as exchange of resources, particularly in times of need, and their composition can have an outsized impact on support, self-organization, and resilience in the face of challenges [START_REF] Ramalingam | Aid on the edge of chaos: rethinking international cooperation in a complex world[END_REF]. A growing number of international efforts aim to articulate and evaluate these types of connections, such as the Organization for Economic Co-operation and Development's Better Life Initiative metrics on support networks [START_REF]Organisation for Economic Co-operation and Development (OECD)[END_REF]. These could serve as models for national agencies in reporting on these critical connections. Furthermore, in many places around the world, connections between people cannot be discussed in the absence of connections to place. In developing the Pacific Well-being Factors [START_REF] Dacks | Developing biocultural indicators for resource management[END_REF], community visioning workshop participants emphasized that relationships between people and their related connections to a place are fundamental to healthy communities. For instance, the Fijian term vanua (lit. land) encompasses the interconnectedness of all living things (including people) and their surrounding environment as well as the associated knowledge, practices, and skills that maintain those interactions [START_REF] Nainoca | [END_REF], a concept mirrored throughout the Pacific (e.g., whenua in Māori, fanua in Samoan) [START_REF] Huffer | Asia Pacific Perspectives on Environmental Ethics[END_REF]. The value systems associated with "alternative" economies, such as those that draw heavily on subsistence and other place-based practices, often inform cultural norms oriented around long-term sustainable interactions between humans and their environment [START_REF] Kimmerer | Human Dimensions of Ecological Restoration: Integrating Science[END_REF]. There is also an emerging literature on the concept of "solastalgia" -the sense of loss when people's connection to place is disrupted because of changes to that place that can lead to grief, anguish, and ill-health [START_REF] Connor | Environmental change and human health in upper hunter communities of New South Wales, Australia[END_REF]. Synthesis of these important values into global goals and policies and the full and effective participation of Indigenous Peoples and local communities (IPLCs) in environmental governance is crucial to sustaining well-being in place-based communities and broader society [START_REF] Díaz | Summary for policymakers of the global assessment report on biodiversity and ecosystem services of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services[END_REF].

The Indigenous and Local Knowledge Dimension concerns the processes by which

Indigenous Peoples and local communities develop, refine, and transmit knowledge. Traditional occupations based on Indigenous and local knowledge (ILK), such as subsistence fishing and farming, relate directly to food security and sovereignty and are also crucial for social cohesion, the perpetuation of place-based practices, and the maintenance of knowledge, values, and cultural protocols associated with those practices [START_REF] Pascua | Beyond services: a process and framework to incorporate cultural, genealogical, place-based, and indigenous relationships in ecosystem service assessments[END_REF]. However, ILK is impacted by a number of factors, including government policy: for example, numerous governments treat wildlife harvest practices on Indigenous territories (e.g. subsistence hunting and fishing) as unsustainable and characterize these practices as illegal poaching [START_REF] Lyver | Building biocultural approaches into Aotearoa -New Zealand's conservation future[END_REF]. An absence of ILK consideration in resource management planning can result in cascading negative impacts on communities involved in environmental management [START_REF] Berkes | Sacred Ecology[END_REF][START_REF] Dacks | Developing biocultural indicators for resource management[END_REF][START_REF] Lyver | Building biocultural approaches into Aotearoa -New Zealand's conservation future[END_REF].

Our comparison between the SDGs and Pacific Well-being Factors also uncovered gaps in the latter, specifically related to labor rights, education-related infrastructure, corruption, and harassment (table S1, new additions in bold). While gender and other forms of social equity are considered to be cross-cutting issues and feature in several Well-being Factors, gender equity does not have separate Dimensions or Factors because of its broadly applicable relevance [START_REF] Gupta | Sustainable development goals and inclusive development[END_REF].

In practice this made it difficult to undertake the gap analysis with specific SDG gender-equity indicators, and underscores the challenges for national level reporting agencies in grappling with cross-cutting concepts that can be unintentionally omitted.

Gauging Applicability, Trade-offs and Measurement Challenges of Globally Developed Indicators at the Local Level

Our analyses revealed not just gaps in connections between the regional Well-being Factors and SDG indicators; we also found that 99% of assessed indicators presented potential trade-offs or measurement challenges that could be problematic in some way for local-level use in Pacific Islands. The implementation process established for the SDGs anticipates this outcome, which is why countries have the freedom to develop tailored reporting tools built on indicators that are most relevant to their situations [START_REF] Nilsson | Policy: map the interactions between Sustainable Development Goals[END_REF]. We identified measurement challenges that range from relatively minor issues (e.g., concerns about interpretation) to more fundamental issues, including troubling trade-offs. With the former, small changes to some indicators (e.g., providing greater disaggregation information on governance type) might result in increased relevance at the local level. However, significant trade-offs arise when there are differing values at the global versus local scales.

Many indicators are based on social norms that may not be applicable in all cultural contexts, and good intentions can actually lead to trade-offs within a system, resulting in social harm. For example, existing SDG education indicators ignore informal learning opportunities, such as when children learn from helping their parents with work, where they can gain local knowledge to enhance productivity, adaptation, and resilience over the long term [e.g., [START_REF] Mccarter | In situ maintenance of traditional ecological knowledge on Malekula Island, Vanuatu[END_REF]]. We found that prioritizing formal employment in order to improve social and legal protections for workers creates a trade-off for subsistence-oriented traditional occupations. This can perpetuate the systematic disenfranchisement and further marginalization of Indigenous Peoples and local communities and the ILK systems that underpin aspects of resilience, particularly in rural areas.

National reporting agencies should follow the guidance of the International Labour Organization and recognize traditional occupations, such as subsistence farming and fishing, within the scope of "productive employment" and "decent work." Furthermore, we found that some indicators could drive activities that harm rights and access for IPLCs. For instance, several SDG indicators imply that central and national governments should safeguard natural or cultural heritage, when in many regions such maintenance is more likely to be supported at the local level [e.g., Melanesia [START_REF] Mccarter | In situ maintenance of traditional ecological knowledge on Malekula Island, Vanuatu[END_REF]]. Indicators prioritizing strict protected areas may promote the rights of central government at the expense of IPLCs. This can lead to disenfranchisement, community displacement, and potentially the replacement of effective local stewardship with ineffective/absentee management [START_REF] Fairhead | Green Grabbing: a new appropriation of nature?[END_REF].

Similarly, some indicators (e.g., ownership or secure rights of land as outlined in SDG 1.4.2, relying on legally recognized documentation to land) are based on privatization and individual land rights, ideas that may clash with culturally-mediated relationships to and interactions with place [START_REF] Carothers | Fisheries privatization, social transitions, and well-being in Kodiak, Alaska[END_REF]. Legally recognized documentation is not standard for land tenure systems in all communities and there may be other ways to articulate that communities "perceive their rights to land as secure". Resource privatization (for example, with the introduction of individual fishing quotas in Kodiak Alaska as described in [START_REF] Carothers | Fisheries privatization, social transitions, and well-being in Kodiak, Alaska[END_REF]), can have divisive, negative impacts on the cultural norms, values, and lifestyles that contribute to maintaining reciprocal relationships and well-being across people and place. We, the authors, have observed that in Indigenous communities the term "rights" is often paired with the term "responsibilities" [START_REF] Kimmerer | Human Dimensions of Ecological Restoration: Integrating Science[END_REF][START_REF] Vaughan | o Hā 'ena: creating state law based on customary indigenous norms of coastal management[END_REF].

Placing emphasis on property or access rights without reference to responsibility could break down existing stewardship structures, for instance collective or communal resource management systems [START_REF] Berkes | Sacred Ecology[END_REF]. Adaptive understandings of access and ownership will be increasingly important as communities around the world begin to experience the impacts of global climate change (for instance those losing their ancestral lands to sea-level rise).

Our analysis also indicated that the SDG indicators tended to center the monetary economy as a development pathway, which may fail to align with local norms and values and reflects a lack of a systems approach in considering the many interacting factors at play. We found that an overemphasis on the monetary economy can cause social or cultural harm by devaluing other important forms of reciprocity-oriented social norms [START_REF] Gneezy | A fine is a price[END_REF]. Economic assumptions such as individual maximization are often at odds with Indigenous and local perspectives on collective well-being and with long-standing community practices in which the non-monetary benefits of reciprocal human and environmental interactions may outweigh financial incentives or returns [START_REF] Winthrop | The strange case of cultural services: limits of the ecosystem services paradigm[END_REF]. One such imperiled value encompasses the knowledge and practice of growing and sharing food within and across communities, which ultimately impacts food security and sovereignty [START_REF] Vaughan | o Hā 'ena: creating state law based on customary indigenous norms of coastal management[END_REF]. Economic models that commodify natural resources and prioritize optimization and utility can lead to unsustainable resource use, which, in turn, may result in both environmental and social harm [START_REF] Gupta | Sustainable development goals and inclusive development[END_REF][START_REF] Costanza | Time to leave GDP behind[END_REF]. This may lead to policies, regulations, and management actions that prioritize individualistic pursuits of benefits (i.e., income generation) at the expense of social norms, community cohesion, and community trust which in turn can drive political and social instability [START_REF] Vaughan | o Hā 'ena: creating state law based on customary indigenous norms of coastal management[END_REF]. In addition, prioritizing ecosystem services that are the most easily assessed using monetary valuation techniques can diminish the importance of other values of nature, for instance relational, intrinsic, cultural heritage, and subsistence values [START_REF] Pascua | Beyond services: a process and framework to incorporate cultural, genealogical, place-based, and indigenous relationships in ecosystem service assessments[END_REF]. A systematic review of the literature on well-being outcomes of marine protected areas found disproportionate focus on economic indicators of well-being, and limited representation of indicators from other social and cultural domains, raising the prospect that the most quantifiable indicators have come to dominate the scholarship on well-being outcomes [START_REF] Ban | Wellbeing outcomes of marine protected areas[END_REF]. We note that this unevenness may stem from societal bias towards economic outcomes and the consequent abundance of relatively easily gathered data on economic indicators.

Stressing financial attributes, for instance with SDG indicators focusing disproportionately on quantifying economic status or income level with an emphasis on GDP-driven indicators [START_REF] Giannetti | A review of limitations of GDP and alternative indices to monitor human wellbeing and to manage eco-system functionality[END_REF][START_REF] Poole | Where is goal 18? The need for biocultural heritage in the sustainable development goals[END_REF], causes an imbalance in how countries are perceived [START_REF] Tanguay | Making Culture Count: The Politics of Cultural Measurement[END_REF] and can change the way people are perceived within their own community. Indicators that run counter to social norms potentially limit the ability to collect accurate data, and may also have long term impacts on communities such as "deficit thinking" in response to vulnerability frameworks [START_REF] Sterling | Biocultural approaches to well-being and sustainability indicators across scales[END_REF].

Monetary prioritization can facilitate negative trade-offs with other aspects of well-being and it is important to focus on the nature and quality of growth, rather than volume of growth alone [START_REF] Costanza | Modelling and measuring sustainable wellbeing in connection with the UN Sustainable Development Goals[END_REF]. Undesirable types of growth include voiceless growth, which suppresses democracy and includes growth that comes as a result of political repression and/or authoritarian regimes that silence dissenting voices; and rootless growth, which is detrimental to cultural identity, and includes instances when growth amplifies the power of the cultural majority which it uses to impose cultural uniformity (e.g., by negatively impacting cultural minority groups through actions such as choosing a national language). A disproportionate focus on economic growth also fails to take into account that above a certain income level more growth does not necessarily lead to greater well-being [START_REF] Costanza | Modelling and measuring sustainable wellbeing in connection with the UN Sustainable Development Goals[END_REF].

Key lessons learned

Building on the remarkable work already undertaken in the context of SDGs, we offer five lessons learned, which will be relevant to national reporting agencies charged with developing locally and nationally-relevant reporting and implementing tools. We provide overarching lessons to address the most critical challenges identified in our work.

Enhance systems-based approaches to designing and evaluating policy and management.

A growing literature is acknowledging and investigating the interrelationships among the SDGs, and within other policies that impact well-being sectors [START_REF] Díaz | Summary for policymakers of the global assessment report on biodiversity and ecosystem services of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services[END_REF][START_REF] Jenkins | My island home: place-based integration of conservation and public health in[END_REF]. This systems approach allows for identification, mapping, and leveraging synergies between and across multidimensional measures of sustainability and wellbeing. Seeking to understand the cross-sectoral synergies for policy and action can produce co-benefits across goals and targets, and improve indicators and datasets for national-level reporting. At the same time, intent does not equal impact. People developing or choosing to use an indicator should carefully consider the broader context and anticipate the dynamic interactions within complex adaptive systems that might lead to negative consequences for human well-being and environmental health.

Foster identification and use of meaningful indicators on the connections between both people and place, and on Indigenous and local knowledge.

Understanding the ways people connect with place and with one another is essential for sustainable outcomes. Small changes to some indicators (e.g., providing greater disaggregation information on governance type such as community-conserved areas as well as government-led protected areas) might result in increased relevance at the local level, whereas larger efforts need to be made where there are significant disconnects in values.

For instance, indicators that measure collective well-being and not just individual wellbeing would be important to consider.

Recognize potential biases towards easy-to-measure metrics. To paraphrase Elliot

Eisner, not everything that is easily measurable is important and not everything that is important is easily measured. For instance, focusing sustainability efforts on data-rich areas to the exclusion of other biologically and culturally important areas may unintentionally contribute to the continued marginalization of IPLCs and their ability to determine their own development priorities. Furthermore, reporting agencies should consider options beyond existing standardized quantitative metrics that may miss important place-based nuances [START_REF] Hicks | Engage key social concepts for sustainability[END_REF] and opt for a combination of qualitative and quantitative metrics. This may include a focus on not just endpoints, like population sizes of species, but also on the processes that contribute to effective population management such as local knowledge and social relationships [START_REF] Dacks | Developing biocultural indicators for resource management[END_REF].

Conclusion

Despite differences in framing or intention, efforts at global, national, sub-national, and local scales have significant potential to draw inspiration from one another and compare indicators to enable adaptive learning and evaluation. Transformative sustainable development requires interlinked policy objectives across sectors such that synergies can emerge during planning and implementation [START_REF] Ramalingam | Aid on the edge of chaos: rethinking international cooperation in a complex world[END_REF][START_REF] Schleicher | Will the Sustainable Development Goals address the links between poverty and the natural environment?[END_REF]. Identifying synergies and differences between indicators used at local and global scales and related approaches can result in stronger conceptualization and implementation at each scale (Fig. 1). Cross-scale comparison is not without its challenges; however, as we have shown, coordinated efforts can identify common ground leading to complementary metrics tailored to each scale. The critical role of international frameworks like the SDGs in national-level priority settings underscores the importance of indicators that acknowledge and address diverse community-based perspectives and cultural contexts. In the face of increasing calls for coordination across sectors to link goals and interventions, national level agencies can take a systems approach that addresses potential synergies and trade-offs across the SDGs. Our analysis points to areas of focus for further work, for instance on metrics connecting people and place.

Lessons learned from our analyses can inform national-level reporting on existing indicators, monitoring and reporting criteria developed by international funders and conservation and development implementers, and new agreements under negotiation (e.g., post-2020 biodiversity agenda discussions). While our work focuses on the Pacific Islands, the participatory process, the expert elicitation approach, and analytical method we used, as well as the key lessons learned, are transferable to other geographic areas with existing well-being frameworks.

We recommend complementary regionally-focused analyses to further clarify and weave local values, cultural practices, and Indigenous priorities into monitoring and evaluation programs across scales.

Materials and Methods

SDG indicators

We compiled the 232 SDG indicators as of March 2017. Our analyses examined the local applicability of these key indicators; consequently, we screened the indicator list before our analyses to eliminate those that were only intended to be measured across nations (e.g., SDG S3).

Pacific Island Well-being Factors

These analyses use a list of Well-being Factors (table S1), developed by biological and social scientists and community members and organizers who all collaborate with communities from across Pacific Islands on resource management or cultural vitality, to assess the local applicability of international indicators (Fig. 4). Taken together, these Factors represent our current understanding of the critical dimensions of well-being and biological and cultural resilience in different communities across the Pacific. Our comparative analyses used the 89 well-being Factors and eight overarching Dimensions, including detailed descriptions and placebased examples of each Factor drawn from an iterative process involving community visioning workshops and small working group triangulation [START_REF] Dacks | Developing biocultural indicators for resource management[END_REF].

In 2016, our small team of researchers organized and executed a series of visioning workshops in Fiji, Solomon Islands, Republic of the Marshall Islands, French Polynesia, and Hawai'i, engaging Indigenous Peoples and local community members and conservation professionals who work closely with them. Workshop participants brought a diverse array of experience with resilience and well-being through policy, management, and/or implementation via place-based practices. During a series of interactive and deliberative discussions, participants were asked to describe what "a good life" looks like in each of their communities.

Building on the workshop results, a small working group of researchers and conservation professionals convened to further triangulate and contextualize results drawn from across the region. The working group process led to further framework iterations. Ultimately, the results of the community visioning workshops combined with the small group work resulted in a framework of Factors organized into eight thematic Dimensions [START_REF] Dacks | Developing biocultural indicators for resource management[END_REF]. For further detail on the development of the Well-being Factors see [START_REF] Dacks | Developing biocultural indicators for resource management[END_REF]. The Well-being Factors will continue to evolve relative to the needs and priorities of communities in the Pacific. Additional Factors were identified as part of this research, and additional Dimensions could be identified in future iterations of the list.

Coding: Cross-referencing SDG Indicators and Well-being Factors

Comparisons of SDG Indicators and Well-Being Factors was undertaken using a multi-stage expert elicitation approach with a multi-disciplinary team of coders. Twenty-two coders undertook a pilot coding of all indicators and Well-being Factors using custom tailored excel spreadsheets during a workshop in 2017. We then developed a custom, web-based coding interface and proceeded in three major stages of coding. First, a subset of eight coders practiced with the interface to determine ease of use. Second, a group of 15 coders (see below for coding team description) conducted a gap analysis between the SDG indicators and the Factors. In this stage, every indicator was coded by at least four individuals. Coders were asked to independently assess each indicator in their assigned subset against each of the 89 Factors. Coders determined which indicators had a strong link with the Factors, meaning the indicator could be an effective and accurate measure for that Factor. Coders had the ability to choose multiple Factors for an indicator; similarly, a Factor could be linked with multiple indicators. Coders noted if there were no corresponding Factors for an indicator. Third, coders used a systems approach to assess if the indicator was relevant and well-aligned with community decision making needs in the Pacific Islands. If indicators were considered potentially problematic in relation to components or relationships with a system, coders identified the reason(s) using a basic typology of common indicator issues (Tables 2,3); coders were able to select multiple issues or none at all. They provided detailed comments to justify the ways in which indicators may not be aligned with Well-being Factors. This draft typology of trade-off and measurement challenges, based on initial coding trials, was developed in working groups between 2015 and 2017 and aligns with the within SDG interaction scores proposed by [START_REF] Nilsson | Policy: map the interactions between Sustainable Development Goals[END_REF] ranging from indivisible to consistent to cancelling. were assigned indicators that align to their expertise wherever possible and were encouraged to opt out of coding a particular indicator if they felt it to be outside their expertise.

Analyses

To assess our question on links between SDG indicators and well-being indicators, we only included links that were noted by two or more of the four coders, leaving a total of 447 verified links. As previously mentioned, a unique characteristic of the coding team was that all have key experience in one or more Pacific Islands and collectively they represent highly diverse academic disciplines and professional backgrounds. These diverse perspectives were valuable in providing an interdisciplinary and holistic context for our analyses. It also means that it would be unrealistic to expect consensus across replicates. We extracted basic descriptive statistics from the resulting database. After determining that the indicator linkages were unevenly distributed across Dimensions, we took a more granular look to understand which specific Factors were and were not well-represented by the SDG indicators (table S2; fig. S3). Table S2 provides a full list of specific Factors with a high number of linkages to the SDG indicators, and those with no linkages.

To assess our questions on applicability and trade-offs and measurement challenges between SDG indicators and Pacific Island Well-being Factors, we used methods in qualitative data analysis including pairwise comparisons and inductive content analysis. We also ensured that every coding exercise was done independently by at least two people with the results discussed amongst at least four people and undertook member checks (where manuscript authors reviewed results and analyses at multiple stages) to validate the qualitative data and analysis [START_REF] Merriam | Qualitative Research: A Guide to Design and Implementation[END_REF]. We extracted all coder assessments and conducted a qualitative three-stage analysis. In the first stage, three coders used inductive logic [START_REF] Charmaz | The Blackwell Encyclopedia of Sociology[END_REF] to review the assessments, test against the draft typology, and identify patterns within categories. In the second stage a team of four coders reviewed every assessment against the categories, noting where category descriptions were not sufficient and recommending greater detail. This resulted in rich descriptions of the trade-offs and measurement challenges between the international metrics and the Well-being Factors. In the third stage, four coders conducted a detailed scan of the comments to extract examples to illustrate the categories, including comments that noted the emphasis on monetary economybased aspects (i.e., monetary transactions for goods and services) of the indicators. A team of 6 coders further coded all 162 indicators to identify indicators with monetary economy-based components or criteria and undertake an additional analysis to assess the extent to which indicators rely on "monetary economy-based" metrics to denote success. S3) to undertake three analyses: a gap analysis, an applicability analysis, and a trade-off and measurement challenges analysis. These resulted in lessons learned for SDG national reporting and implementation agencies.

References and Notes

Figures and Tables

Table 1. The eight Pacific Islands Well-being Dimensions, including the number of

underlying Factors in each Dimension, an associated icon, and a brief description of each. A complete list of Factors can be found in table S1 and in [START_REF] Dacks | Developing biocultural indicators for resource management[END_REF].

Pacific Islands Wellbeing Dimensions (abbreviations in parentheses) and No. of Factors

Description

Sustainability Management 19 Factors

Sustainability management includes all processes and governance structures involved in extractive and non-extractive resource use, sustainability, and enforcement of rules, norms, and actions collectively involved in management of natural/cultural resources. Management coordinates, balances, and equitably accounts for multiple resource users and uses of a place. This is based on the best available knowledge, which may stem from multiple sources. Sustainability management encourages adaptability, accountability, prosperity, empowerment, and equitable access to resources and benefit sharing. Access to Infrastructure, Civic Services, and Financial Resources (Infrastructure/ Finance)

Factors

Equitable access to, and use of, infrastructure, civic services, and financial resources is critical to support activities that communities deem important for well-being. This could include development of livelihood opportunities, microcredit schemes, and other community services. Where communities perceive a need, this may include proximity to roads, public transportation, water supplies, waste management, communication systems (phone networks, internet), access to civic infrastructure (clinics, schools, and government offices) and their corresponding civic services, and access to markets for trade and sustainable tourism.

Factors

The ability to physically, appropriately, and equitably access a place for non-extractive or extractive sustainable use of natural and cultural resources. Access is sufficient to fulfill values and needs for subsistence, health, cultural, spiritual, aesthetic, emotional, or economic purposes. Recognition can be formalized by policy, law, or through customary practices.

Education 8 Factors

Access to knowledge, networks, and qualifications from both formal and informal educational systems includes appropriate and contextualized sources of knowledge, well trained and supported educators, and clean, safe, and inclusive facilities. This Dimension also includes scientific and technical information that may be useful to communities, including for sustainable resource management, waste management, health, and wellness. Local forms of knowledge described in other categories also play a significant role in this category. Environmental State (Environment)

Focus/Bias

The indicator may focus on one value system at the expense of locally-important criteria, or exhibit bias towards one system, strategy, priority, or agenda to the exclusion of others.

  (i) what are the overlaps and gaps between the SDG indicators and the Pacific Islands Well-being Dimensions?; (ii) to what extent are the SDG indicators applicable for measuring well-being at the local level in the Pacific?, and

  Only a handful of SDG indicators were associated with Wellbeing Dimensions Connectedness to People and Place (People & Place) (n=3) and Indigenous and Local Knowledge, Skills, Practice, Values, and Worldviews (Indigenous and Local Knowledge) (n=2). The greatest number of linkages were found with those SDG indicators within SDG 3 -Good Health and Well-being (n=101) (fig. S2).

Fig. 3 .

 3 Fig. 3. Only 20% of the Well-being Factors in the Dimension People & Place and 25% of the Indigenous and Local Knowledge Factors were linked with an SDG indicator.

2 .

 2 Draw on locally-relevant definitions of well-being to develop monitoring and evaluation indicators. Nations should spend more effort and attention on understanding what well-being means to their citizens in order to collectively move towards sustainability. Reporting bodies should be attentive to local and national priorities and values and recognize the importance of co-created knowledge and action. This helps avoid unintended harmful consequences in complex adaptive systems of development interventions based on globally defined standards or approaches. In locations with high cultural diversity and/or low social cohesion, identifying commonalities and focusing on indicators around those is a good place to start.

5 .

 5 Carefully consider how data are collected. Global goals shape national-level priorities and actions, creating cascading impacts realized at the local level through international aid and implementation of programs intended to achieve progress towards these metrics. Consequently, data collection should be conducted with empathy, follow placebased cultural protocols, align with standards of Free, Prior, and Informed Consent (see, for example, guidelines developed by the International Society of Ethnobiology), and be mindful of power dynamics within and across scales. Ultimately the successful implementation of indicators can depend on how and in what context data are collected rather than the specifics of the indicator itself.

1. 5 . 3

 53 Number of countries that adopt and implement national disaster risk reduction strategies in line with the Sendai Framework for Disaster Risk Reduction 2015-2030). Of note, due to removal of redundant and national level indicators, we did not include any indicators under SDG 13: Climate Action. The resulting list had 162 SDG indicators (table

  Coders: A total of 15 individuals participated in coding a comparison between SDGs indicators and the Well-being Factors. The coding team belongs to a variety of academic disciplines and professional backgrounds, including natural sciences (both terrestrial and marine), social sciences, and community-based natural resource management. They collectively possess considerable professional and lived experience spanning diverse areas of the Pacific. Coders

Fig. 1 .

 1 Fig. 1. Approaches to development of goals and indicators: learning across scales. (A) Global goals and indicators are frequently derived using a consensus process and result in highly hierarchical systems where categorized overarching outcomes can be reached through achieving sub-goals and targets (represented by blue boxes). (B) Indigenous and local perspectives that drive action can result from expert observations and lived and experienced knowledge that emphasize the interconnections between parts of a system (represented by red graphics). (C) Iterative consideration of similarities and differences between these scales and approaches can result in stronger efforts at both the local and global scales (represented by hybrid colors and shapes).

Fig. 2 .

 2 Fig. 2. Gap analysis of the number of linkages (selected by two or more coders) between Well-being Dimensions and the SDGs, encompassing each linkage made between an underlying Well-being Factor and an SDG indicator. The corresponding circle size and line width are proportional to the number of linkages; larger circles and thicker lines represent Dimensions or SDGs with a greater number of linkages.

Fig. 3 .

 3 Fig. 3. Analysis of Well-being Dimensions and links between the underlying Factors and at least one SDG indicator. Bar length represents the total number of Pacific Island Well-being Factors in each Dimension; percentages represent proportion of Factors within each Dimension that have at least one SDG linkage (blue) or no SDG linkages (red).

Fig. 4 .

 4 Fig. 4. Iterative process used to develop dimensions and nested factors, and subsequent analyses. As noted in (18), during Phase 1 workshops across multiple locations, a team identified and conceptually grouped characteristics of "the good life", including people and biodiversity. Through an iterative process the team synthesized the results and brought versions of the synthesis to Phase 2 workshops to generate additional characteristics and to review

Human Health 8 Factors

 8 Physical, emotional, spiritual, and mental health are critical components of the well-being of individuals, families, and communities and may be reflected in adaptability or resourcefulness in response to change. Knowledge of what supports healthy people exists across multiple dimensions of wellness. Access to Natural and Cultural Resources (Natural/Cultural Resources)

9 Factors 15 Factors 8 Factors

 9158 Includes the ecological, biological, physical, chemical, and human components of the environment and their interrelationships, functionalities, and resilience to change.Connectedness toPeople and Place (People & Place) Connectedness to place has strong bearing on cultural identity, rootedness and belonging, sense of responsibility and stewardship, social engagement, and natural resource management. Connectedness to place encompasses historical, physical, emotional, and spiritual bonds between people and their local environment. It is often informed and driven by knowledge of events and history, and experiences of survival and thriving in place. Connection to people includes relationships based on material (e.g., food, resources, land) or immaterial (e.g., trust, labor, knowledge, time, kinship, social alliances) circulation among individuals and within and across households and communities. Indigenous and Local Knowledge, Skills, Practice, Values, and Worldviews (Indigenous and Local Knowledge) Indigenous and local knowledge, skills, practices, values, and worldviews are dynamic, adaptive, and transmitted across and between generations. They are embedded within a worldview and ethos, and often include spiritual connections to place, including to specific species, landscapes, and ancestors. Table 2. Trade-off or measurement challenge categories and descriptions, including the number of indicators classified under each category; this reflects responses for the 160 indicators (out of 162 analyzed) considered to have trade-off or measurement challenges. Note: A single indicator can be listed under multiple categories.

Fig. S1 .

 S1 Fig. S1. Number of SDG indicators linked with Well-being Factors, by Dimension (includes only linkages made by two or more coders).

Fig. S2 .

 S2 Fig. S2. Number of SDG indicators linked with Well-being Factors, by Goal (includes only linkages made by two or more coders).

Fig. S3 .

 S3 Fig. S3. Well-being Factor overlap with SDG indicators, by Dimension and underlying Factor. The Well-being Factors are represented by the letter/number designations laid out in

  This could include, for instance, lack of recognition of different management, governance, education, or health systems and strategies.

	Globally relevant indicators may not be feasible to Claudet, Rachel Dacks, Emily Darling, Chris Filardi, Stacy D. Jupiter, Alexander Mawyer, Manuel
	measure at the local scale, due to lack of supporting Mejia, Kanoeʻulalani Morishige, Winifereti Nainoca, John Parks, Jamie Tanguay, Tamara Ticktin,
	Feasibility	personnel, technical skills, and/or opportunities for Ron Vave, Veronica Wase, Supin Wongbusarakum, Joe McCarter
			capacity development. There may also be challenges
			with data collection/analysis methods, such as social Correspondence to: sterling@amnh.org
			norms that preclude accurate responses to queries.	90
	The indicator may not be sufficient to address progress This PDF file includes:
			towards the target and may not adequately account for
	Links to Target figs. S1-S3 tables S1-S3	additional components. The indicator may also have poor or weak links to the intended target. The indicator is set at a scale or unit of measurement that	79
			may be meaningful at the national or global scale, but is
	Scale Supplementary Figures	not so at the local level, making it challenging to accurately or appropriately ascertain local progress.	67
			The indicator itself may be appropriate at the local level,
			but the suggested element measured does not
	Disaggregation	adequately convey locally-important characteristics.	67
			The indicator may be inappropriate to local contexts and
	Social Harm Trade-	measuring this indicator has the potential to cause social
	off		or cultural harm.	83
			The indicator may not adequately account for negative
			environmental externalities and making decisions based
	Environmental	mainly on this indicator has the potential to cause
	Harm Trade-off	environmental harm.	24

table S1 .

 S1 Reciprocity and exchange within and between communities D.8 Reciprocity between people and place D.9 Cooperation and social cohesion D.10 Intergenerational connections including practices of respect D.11 Connection to ancestors D.12 Religious or spiritual practices and connections to entities (living and non-living) D.13 Makeup and extent of migration, diaspora, and other forms of mobility D.14 Effects of environmental, social, and cultural change on identity D.15 Community-level engagement in activism and advocacy Dimension E: Indigenous and Local Knowledge, Skills, Practice, Values, and Worldviews Dimension description: Indigenous and Local Knowledge, skills, practices, values and worldviews are dynamic, adaptive, and transmitted across and between generations. They are embedded within a worldview and ethos, and often include spiritual connections to place, including to specific species, landscapes, and ancestors.

	D.7 E.1 Use of local biodiversity in cultural practices
	E.2 Knowledge and practice of cultural expressions
	E.3 Use and vitality of local language(s)
	E.4 Knowledge and practice of culturally significant social interaction norms
	E.5 Inter-or intra-generational transmission of knowledge, skills, practice, values, and belief
	E.6 Innovation in knowledge and practice based on tradition
	E.7
	Supplementary Tables

Presence of locally and culturally informed processes for knowledge management

  E.8 Indigenous and / or local knowledge, protected by legislation, where appropriate (i.e. intellectual property rights) E.9 Knowledge of socio-ecological connections, interdependence, and feedbacks Dimension F: Education Dimension description: Access to knowledge, networks, and qualifications from both formal and informal educational systems includes appropriate and contextualized sources of knowledge, well trained and supported educators, and clean, safe, and inclusive facilities. This Dimension also includes scientific and technical information that may be useful to communities, such as for sustainable resource management, waste management, health and wellness, among others. Local forms of knowledge described in other categories also play a significant role in this category. F.1 Quality of formal education F.2 Access to and use of formal education pathways F.3 Role of local knowledge in formal education F.4 Role of local language in formal education F.5 Local beliefs or values towards formal and informal education F.6 Diverse (formal and informal) learning opportunities F.7 Access to and use of vocational training F.8 Access to and use of technical and scientific information Dimension G: Human Health Dimension description: Physical, emotional, spiritual, and mental health are critical components of the well-being of individuals, families, and communities and may be reflected in adaptability or resourcefulness in response to change. Knowledge of what supports healthy people exists across multiple Dimensions of wellness. Familial or community-based support for individual or collective health Dimension H: Access to Infrastructure, Civic Services, and Financial ResourcesDimension description: Equitable access to, and use of, infrastructure, civic services, and financial resources is critical to support activities that communities deem important for well-being. This could include development of livelihood opportunities, conservation programs, and other community services. Where communities perceive a need, this may include proximity to roads, public transportation, water supplies, waste management, communication systems (phone networks, internet), access to civic infrastructure (clinics, schools, and government offices) and their corresponding civic services, and access to markets for trade and sustainable tourism. .18 Access to sustained funding or resources for sustainability management

	G.1 Physical health
	G.2 Spiritual health
	G.3 Emotional health
	G.4 Mental health
	G.5 Individual and/or collective self-sufficiency and resourcefulness
	G.6 Individual and/or collective security and safety
	G.7 Diverse sources of health and wellness knowledge
	G.8 H.1 Presence of adaptable, flexible, and or resilient infrastructure or services
	H.2 Access to and use of physical infrastructure and services
	H.3 Access to and use of affordable housing
	H.4 Access to and use of health infrastructure and services
	H.5 Access to and use of transportation infrastructure and services
	H.6 Access to and use of education-related infrastructure and services
	H.7 Access to and use of communication tools and infrastructure
	H.8 Equitable access to and use of financial resources and services in vulnerable populations
	H.9 Access to and use of markets

H.10 Access to and use of green infrastructure H.11 Access to and use of sustainable energy sources H.12 Access to and use of biosecurity infrastructure and services H.13 Access to and use of diverse sources of income generation H.14 Access to safe, secure, and locally-desirable occupations H.15 Equitable access to financial resources and infrastructure, recognized locally or nationally H.

[START_REF]Measuring National Well-being: Quality of Life in the UK[END_REF]

Local ability to control, manage, or influence external funding sources H.17 Financial or other resources derived from community members living overseas, in diaspora, or those who have migrated H

Table S2 . List of the two Well-being Factors with the highest number of linkages to SDG indicators for each Dimension (if more than two factors are listed it is the result of factors having the same number of linkages), as well as Well-being Factors that were not linked with any SDG indicators

 S2 . (See fig.S3for summary). Proportion of total adult population with secure tenure rights to land, with legally recognized documentation and who perceive their rights to land as secure, by sex and by type of tenure 1.5.1 Number of deaths, missing persons and directly affected persons attributed to disasters per 100,000 population 1.5.4 Proportion of local governments that adopt and implement local disaster risk reduction strategies in line with national disaster risk reduction strategies 2.1.1 Prevalence of undernourishment 2.1.2 Prevalence of moderate or severe food insecurity in the population, based on the Food Insecurity Experience Scale (FIES) 2.2.1 Prevalence of stunting (height for age <-2 standard deviation from the median of the World Health Organization (WHO) Child Growth Standards) among children under 5 years of age 2.2.2 Prevalence of malnutrition (weight for height >+2 or <-2 standard deviation from the median of the WHO Child Growth Standards) among children under 5 years of age, by type (wasting and overweight) 2.3.1 Volume of production per labour unit by classes of farming/pastoral/forestry enterprise size 2.3.2 Average income of small-scale food producers, by sex and indigenous status 2.4.1 Proportion of agricultural area under productive and sustainable agriculture 2.5.1 Number of plant and animal genetic resources for food and agriculture secured in either medium or long-term conservation facilities 2.5.2 Proportion of local breeds classified as being at risk, not-at-risk or at unknown level of risk of extinction 3.1.1 Coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services) for substance use disorders 3.5.2 Harmful use of alcohol, defined according to the national context as alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol 3.6.1 Death rate due to road traffic injuries 3.7.1 Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods 3.7.2 Adolescent birth rate (aged 10-14 years; aged 15-19 years) per 1,000 women in that age group 3.8.1 Coverage of essential health services (defined as the average coverage of essential services based on tracer interventions that include reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases and service capacity and access, among the general and the most disadvantaged population)

	1.4.2
	Pacific Well-being Dimension	Factors with the Highest Number	Factors with No Linkages to SDG
			of Linkages to SDG indicators	indicators
	Environmental State		A.2 State/status of biologically and	A.1 Ability of ecological systems to
			culturally important populations,	reorganize or recover after
			species, and varieties	disturbance
			A.7 Proportion of functionally intact	A.6 Level of habitat diversity for
			ecosystem(s) across land-and	land-and seascapes
			seascapes
				A.8 Status of ecosystem connectivity
	Access to Natural and Cultural	B.1 Access to and agency over a	B.2 Appropriate access to cultural
	Resources		sufficient quality and quantity of	resources, supported and
			natural and cultural resources	recognized by local and/or national
				rules
			B.3 Customary rights and tenure,
			supported by national or regional-	B.7 Knowledge of culturally
			level laws	significant places, sites, landscapes,
				and species
	Sustainability Management	C.1 Presence of a local	n/a
			sustainability ethos
			C.13 Resource planning and
	management towards sustainable Maternal mortality ratio land and seascapes Connectedness to People and Place D.3 Knowledge and practice of 3.1.2 Proportion of births attended by skilled health personnel D.1 Knowledge of traditional place
	3.2.1	social and cultural norms related to Under-five mortality rate	names or landscape terms
	3.2.2 3.3.1 3.3.2	place-based practices D.5 Knowledge and practice of Neonatal mortality rate Number of new HIV infections per 1,000 uninfected population, by sex, age D.2 Local perceptions of ecological and environmental risks and key populations individual and collective rights and obligations towards people and D.4 Connections within and between Tuberculosis incidence per 100,000 population
	3.3.3	place Malaria incidence per 1,000 population	communities and social groups
	3.3.4 3.3.5	D.15 Community-level engagement in activism and advocacy Hepatitis B incidence per 100,000 population Number of people requiring interventions against neglected tropical D.6 Knowledge and practice of genealogical connections related to rights, access, and management of diseases
	3.4.1	land and seascapes Mortality rate attributed to cardiovascular disease, cancer, diabetes or
		chronic respiratory disease
	3.4.2 3.5.1	Suicide mortality rate	D.7 Reciprocity and exchange within and between communities
				D.8 Reciprocity between people and
				place
				D.9 Cooperation and social
				cohesion
				D.10 Intergenerational connections
				including practices of respect
				D.11 Connection to ancestors
				D.12 Religious or spiritual practices
				and connections to entities (living
				and non-living)

Acknowledgments

The material is based upon work conducted by the Assessing Biocultural Indicators Working Group supported in part by SNAPP: Science for Nature and People Partnership, a collaboration of The Nature Conservancy, the Wildlife Conservation Society and the National Center for Ecological Analysis and Synthesis (NCEAS) at the University of California, Santa Barbara. Additional support came from the National Science Foundation (NSF) under Grants No. EF-1427091, 1427453, and 1444184. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation. SC received support from the InSHS-CNRS program "Soutien à la Mobilité Internationale-2018". We thank Ana Porzecanski for comments on drafts of the manuscript and members of the SNAPP working group for input.

Supplementary Materials

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Add captions for additional file types that cannot be embedded into the Word file. These [START_REF] Kueffer | What is the importance of islands to environmental conservation?[END_REF] Adaptability or capacity to respond to shorter-term impacts (e.g. natural disasters) or longer-term impacts (e.g. climate change) Dimension D: Connectedness to People and Place Dimension description: Connectedness to place has strong bearing on cultural identity, rootedness and belonging, sense of responsibility and stewardship, social engagement, and natural resource management. Connectedness to place encompasses historical, physical, emotional, and/or spiritual bonds between people and their local environment. It is often informed and driven by knowledge of events and history, and experiences of survival and thriving in place. Connection to people includes relationships based on material (e.g., food, resources, land) or immaterial (e.g., trust, labor, knowledge, time, kinship, social alliances) circulation among individuals and within and across households and communities. A highly-connected system is one in which there is trust, cohesion, respect, and a high degree of connectedness to place.


Manon Bolzinger
email: manon.bolzinger@outlook.fr

Erik Estivalèzes

Adeline Gallini

Eva Polirsztok

Kariman Abelin-Genevois

Christiane Baunin

Jérôme Sales De Gauzy

Pascal Swider

MRI evaluation of the hydration status of non-pathological lumbar intervertebral discs in a pediatric population

Keywords:

Introduction:

The intervertebral disc (IVD) is made up of the annulus fibrosus (AF) and the nucleus pulposus (NP) -an inert hydrated complex. The ability of the IVD to deform is correlated to that of the NP and depends on its hydration. As the IVD ages, its hydration decreases along with its ability to deform. In adolescent idiopathic scoliosis, one of the etiological hypotheses pertains to the IVD, thus making its condition relevant for the diagnosis and monitoring of this pathology. Hypothesis: IVD hydration depends on sex, age and spine level in an asymptomatic pediatric population. The corollary is data on a control group of healthy subjects. Material and methods: A cohort of 98 subjects with normal spine MRI was enrolled; their mean age was 13.3 years. The disc volume and hydration of each IVD was evaluated on T2-weighted MRI sequences, using previously validated image processing software. This evaluation focused on the lumbar spine, from the thoracolumbar junction to the lumbosacral junction. It was assumed that IVD hydration was related to the ratio of NP and AF volumes. A mixed multivariate linear analysis was used to explore the impact of age, sex and spinal level on disc hydration. Results: Disc hydration was higher overall in boys than in girls, but this difference was not significant. Hydration increased with age by +0.005 for each additional year (p = 0.0213). Disc hydration appears to be higher at the thoracolumbar junction than the lumbar spine, although this difference was not significant. Conclusion: Through this MRI study, we established a database of non-pathological lumbar disc hydration as a function of age, sex and spinal segment along with 95% confidence intervals. Level of evidence: IV.

Introduction

Homeostasis of the vertebral segment is associated with diffusion between the intervertebral disc (IVD) and the adjacent vertebral body through the cartilaginous endplate [START_REF] Urban | Nutrition of the intervertebral disc[END_REF]. In adults, the IVD is an avascular structure in which liquids pass from the nucleus pulposus (NP) (hydrated complex) toward a peripheral laminal structure, the annulus fibrosus (AF). The disc's vascularization changes gradually during growth to dwindle at the end of the trunk's growth in pre-adulthood.

IVD hydration depends on its proteoglycan content. Under physiological conditions, fluid and proteins are exchanged by a mechanotransduction process, involving hydrostatic and cyclic osmotic pressure associated to the circadian rhythm [START_REF] Setton | Mechanobiology of the intervertebral disc and relevance to disc degeneration[END_REF][START_REF] Henriksson | Identification of cell proliferation zones, progenitor cells and a potential stem cell niche in the intervertebral disc region: a study in four species[END_REF]. The composition and organization of the IVD extracellular matrix determines its biomechanical properties. These vary with age, physiological status and spinal level. Water loss is one of the first signs of IVD pathology [START_REF] Benneker | Correlation of radiographic and MRI parameters to morphological and biochemical assessment of intervertebral disc degeneration[END_REF]. Our study focused on a pediatric population that will serve as a control group for the study of adolescent idiopathic scoliosis (AIS). Among the multiple etiological factors for AIS, one of the hypotheses is based on the IVD. MRI is used for the diagnosis and follow-up of this disease [START_REF] Violas | A method to investigate intervertebral disc morphology from MRI in early idiopathic scoliosis: a preliminary evaluation in a group of 14 patients[END_REF][START_REF] Abelin-Genevois | Spino-pelvic alignment influences disc hydration properties after AIS surgery: a prospective MRI-based study[END_REF][START_REF] Waldenberg | MRI histogram analysis enables objective and continuous classification of intervertebral disc degeneration[END_REF]. After posterior spinal fusion, the reaction of the instrumented discs subjected to additional stresses is related to the instrumentation level and the number of levels fused [START_REF] Green | Long-term magnetic resonance imaging follow-up demonstrates minimal transitional level lumbar disc degeneration after posterior spine fusion for adolescent idiopathic scoliosis[END_REF][START_REF] Pesenti | Evolution of adolescent idiopathic scoliosis: results of a multicenter study at 20 years' follow-up[END_REF]. A landmark study [START_REF] Antoniou | The human lumbar intervertebral disc: evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration[END_REF] suggested that three clusters exist based on the composition of the IVD's extracellular matrix and its hydration: less than 5 years, between 25 and 40 years, between 40 and 80 years. A follow-up study [START_REF] Krueger | Changes in T2 relaxation times associated with maturation of the human intervertebral disk[END_REF] showed that lumbar IVD maturation is related to increased hydration.

We hypothesized that between 7 and 20 years, the hydration of non-pathological IVDs depends on sex, age and spinal level. The primary aim of this study was to determine the relationship between lumbar IVD hydration and sex, age, and spinal level in a pediatric population free of spinal conditions. The secondary aim was to generate mathematical curves to predict lumbar IVD hydration as a function of sex, age and spinal level in a pediatric population.

Materials and methods

Patient population

This retrospective study included 98 consecutive subjects (50% girls) between 7 and 20 years of age who underwent a spinal MRI at the Toulouse University Hospital that was considered normal. These subjects had undergone an MRI for the diagnosis of a urological or neurological disease, or lumbar pain over a 2-year period (04/2015-04/2017). To be included, no spinal disease or spinal postural disease could be detected after the MRI images were read by a pediatric imaging specialist.

The mean age of the included subjects was 13.3 years (SD = 2.92). Our evaluation focused on the lumbar spine, from the thoracolumbar junction to the lumbosacral junction. The MRI acquisition consisted of T2-weighted sequences in the sagittal plane with 15 to 20 consecutive slices per patient. The MRI unit was a PHILIPS Achieva X-Series 3.0T.

Disc volume

Automatic IVD detection and segmentation on MRI images is not yet optimized despite recent progress [START_REF] Zheng | Evaluation and comparison of 3D intervertebral disc localization and segmentation methods for 3D T2 MR data: a grand challenge[END_REF][START_REF] Gervais | MRI signal distribution within the intervertebral disc as a biomarker of adolescent idiopathic scoliosis and spondylolisthesis[END_REF]. Thus, our procedure made use of previously validated Biomechlab ® image processing software [START_REF] Violas | A method to investigate intervertebral disc morphology from MRI in early idiopathic scoliosis: a preliminary evaluation in a group of 14 patients[END_REF][START_REF] Abelin-Genevois | Spino-pelvic alignment influences disc hydration properties after AIS surgery: a prospective MRI-based study[END_REF][START_REF] Violas | Quantification of intervertebral disc volume properties below spine fusion, using Magnetic resonance imaging, in adolescent idiopathic scoliosis surgery[END_REF], which was developed in the MATLAB environment (MathWorks ® ). After automated decoding of the DICOM images, the disc volume was extrapolated using semi-automated detection of the AF and NP outlines. The protocol was repeated by a spine surgeon on each sagittal slice. Each disc was visible on an average of 10 sequential slices. The IVD segmentation and 3D reconstruction based on MRI data is shown in Fig. 1. The discs from T12-L1 to L5-S1 were evaluated. Anatomically, the NP was identified as a highly hydrated tissue resembling a viscous fluid, appearing as a hyperintense signal on T2-weighted images. The 2D segmentation of MRI slices and the 3D reconstruction were used to define the disc hydration as the ratio of NP volume to AF volume. The water content is concentrated in the NP; its volume gets smaller when the IVD is dehydrated, while the IVD's overall volume does not change. This relationship between IVD hydration and the NP/IVD volume is anatomically reliable.

Statistical analysis

For the statistical analysis, a mixed multivariable linear model was used to take into consideration the interindividual variation in patients. We sought to set up a hydration model by spinal level (T 12 -L 1 to L 5 -S 1 ), sex (boy or girl) and age. The age of the cohort corresponds to the ages at which AIS evolves [START_REF] Duval-Beaupere | Pour une théorie unique de l'évaluation des scolioses[END_REF][START_REF] Duval-Beaupère | Growth in scoliotics[END_REF]. Significant findings were defined as those with p < 0.05.

A generic statistical model of IVD hydration distribution was proposed by age, sex and spinal level. Twelve models were generated with 95% confidence intervals (CI).

Results

Table 1 summarizes the raw values of the disc volume based on the segmentation of the MRI images by spinal level and for the entire cohort (n = 98). The mean IVD volume was 8973 mm 3 and the mean NP volume was 2823 mm 3 . The mean hydration ratio was 0.335. The findings are summarized in Fig. 2.

Table 2 summarizes the statistical analysis of hydration by age, sex and spinal level based on the mixed multivariate linear model.

The T12-L1 disc was used as the reference when investigating the effect of spinal level. Hydration in the lower levels was always less than in the T12-L1 disc, but not significantly (0.1 ≤ p ≤ 0.8). Also, hydration decreases along with spinal column, but not significantly (p = 0.4915).

As for sex, the boys were used as a reference. Disc hydration was lower in girls by an average of -0.0158 although this was not significant (p = 0.21).

A generic statistical model of the population was generated based on linear regression with 95% CI. The variations in hydration by age, sex and spinal level are shown in Fig. 3. These models showed that hydration increased in boys independent of the spinal level and was slightly higher than in girls. In girls, age had no impact on T12-L1 and L5-S1 hydration while it had minimal impact on discs L1-L2 to L4-L5. Our models allowed us to generate IVD hydration prediction intervals. As expected, these had a wide range because of the additional uncertainty related to predicting individual values.

Discussion

Our main hypothesis -that IVD hydration was related to sex, age and spinal level -was partially confirmed. The influence of sex was not statistically significant although disc hydration level was generally lower in girls. The two subgroups were comparable in terms of age: mean age in girls was 13.4 years (range, 7.0-18.6), mean age in boys was 13.3 years (range, 7.0-19.2). This sex-related trend could be an argument in favor of the IVD being involved in the development of IAS, which is more common in girls. This hypothesis must be explored further, especially on IVD in the thoracic region, since our study was done solely on the lumbar spine whereas AIS has a right thoracic curvature.

The impact of spinal level was also investigated. While the thoracolumbar discs had higher hydration, this finding was not statistically significant. Hydration increases with age and appears to level off in the oldest patients of this cohort. An increase of +0.005 in the NP/AF ratio for each additional year was found in the overall cohort.

Histology studies have shown the IVD is a very specific structure, whose role is closely related to the adjacent cartilage. The chondrocyte-like cells in the NP produce type II collagen, while the chondrocyte-like cells in the cartilage and AF product both type I and II collagen [START_REF] Roberts | Histology and Pathology of the human intervertebral disc[END_REF]. Unlike in adults, during the first decade of life, blood vessels are visible in the AF and adjacent cartilage. The number of blood vessels decreases over time [START_REF] Roberts | Histology and Pathology of the human intervertebral disc[END_REF]. The water content depends on the presence of proteoglycans and collagen fibers forming the retentive framework [START_REF] Antoniou | The human lumbar intervertebral disc: evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration[END_REF][START_REF] Mwale | Quantitative MRI as a diagnostic tool of intervertebral disc matrix composition and integrity[END_REF]. The proteoglycans and water on one hand, and the collagen fibers on the other, have opposing distributions in the IVD. The amount of the former increases while the amount of collagen decreases from the periphery towards the NP. In the literature, there is a distinction between maturation and degeneration, separating processes before 10 years and after 20 years [START_REF] Rajasekaran | ISSLS prize winner: a study of diffusion in human lumbar discs: a serial magnetic resonance imaging study documenting the influence of the endplate on diffusion in normal and degenerate discs[END_REF]. The lumbar IVD hydration increases with maturation during the first two decades [START_REF] Krueger | Changes in T2 relaxation times associated with maturation of the human intervertebral disk[END_REF] then decreases after 25 years of age. IVD hydration peaks around 2 to 5 years of age, then decreases after 25 years [START_REF] Antoniou | The human lumbar intervertebral disc: evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration[END_REF], although there is no data on the in-between ages. In this symptomatic pediatric population, the hydration increased between 7 and 20 years of age. These results should be applicable to children 5 to 11 years; however, no MRI of normal spines were available for analysis in children of this age.

Homeostasis of a spinal level is due to mass transport between the disc and vertebral body through the vertebral end plates. The disc's vascularization decreases gradually from childhood though pre-adulthood, at which point it is non-existent. The disc has very good clinical and mechanical properties when these exchanges are well established. The NP is highly hydrated relative to the AF. Consequently, the ratio between the NP volume and the IVD volume can be used as an index of disc hydration and may represent the health of the spinal segment. In a clinical context, hydration can be measured on MRI slices. When following patients with scoliosis, adding disc hydration to the MRI assessment allows us to explore the poromechanical behavior of the segments and can guide the clinical decision making (location and extension of the instrumentation). Restoring the hydration levels postoperatively may be used to predict future clinical complications.

While this study is original, it has certain limitations. Most subjects had undergone the MRI in the context of urological or neurological conditions; however, 14% of subjects had an MRI for a low-back pain. Spine pathology was ruled out by the radiologist reading the images. Since this was a retrospective study, the time of day at which the MRI scans were completed was not controlled. The acquisitions were generally done in the morning to get around the influence of daily activities. This non-controlled parameter may be considered as a randomization element that contributes favorably to the reliability of our findings. Not every subject had a full set of data available; for example, morphological data such as kyphosis, lordosis and pelvic incidence were not always available [START_REF] Rajasekaran | ISSLS prize winner: a study of diffusion in human lumbar discs: a serial magnetic resonance imaging study documenting the influence of the endplate on diffusion in normal and degenerate discs[END_REF][START_REF] Janssen | Sagittal spinal profile and spinopelvic balance in parents of scoliotic children[END_REF]. The skeletal maturity and level of puberty were not known. Despite these limitations, the size of this cohort (98 subjects) is acceptable, given the challenges associated with creating a pediatric database.

Conclusion

This description of IVD hydration in a pediatric population free of spinal pathology during peak growth years is novel. We believe this cohort can be used as a control group for clinical studies. The generic model created based on sex, age and spinal level is at the heart of this study. It could be a reference database for studying how the IVD impacts the changes in spinal curvature and stability in adolescents with AIS.

Disclosure of interest

The authors declare that they have no competing interest.

Fig. 1 .

 1 Fig. 1. Semi-automated segmentation and automated volume reconstruction (Biomechlab ® ) of IVD from MRI slices (L5-S1 to L1-L2).

Fig. 2 .

 2 Fig. 2. Distribution of IVD hydration along the lumbar spine (T12-L1 to L5-S1) and by sex.

Fig. 3 .

 3 Fig. 3. Distribution of IVD hydration for the pediatric cohort (n = 98) by sex, age and spinal segment. The solid line is the best linear fit. The blue area is the 95% confidence interval and the dotted lines are the limits of the 95% prediction interval.

Table 1

 1 Distribution of quantitative variables in the pediatric cohort (n = 98). The volume and hydration ratio are classified by spinal segment with p25 = 25th percentile, p50 = 50th percentile, p75 = 75th percentile and SD = standard deviation.

	Parameter	Mean	SD	Min	p25	p50	p75	Max
	IVD volume (mm 3 )
	T12 L1	7611.3	3175.7	2127.4	5327.4	7183.6	9310.0	17863.1
	L1 L2	9593.0	3934.2	2325.5	6874.8	8836.1	12023.9	21111.2
	L2 L3	10012.5	3624.9	2821.3	7770.0	9480.4	11766.2	19257.0
	L3 L4	10039.8	3261.9	3365.4	8304.6	9324.5	11394.7	20510.0
	L4 L5	9169.9	3031.4	3184.0	6997.4	8680.8	10822.1	19394.5
	L5 S1	7407.2	2526.0	1541.6	5725.1	6979.9	8907.7	13586.8
	NP volume (mm 3 )
	T12 L1	2496.3	1585.7	338.2	1234.9	1890.7	3633.5	7715.4
	L1 L2	3091.5	1787.7	499.0	1685.5	2808.5	3916.2	7756.3
	L2 L3	3196.0	1625.6	563.0	2092.4	2699.0	3996.4	8135.0
	L3 L4	3110.0	1516.1	839.2	2047.4	2777.8	3955.5	7291.2
	L4 L5	2830.7	1195.6	837.5	1891.0	2570.1	3586.7	5727.2
	L5 S1	2216.8	905.0	348.0	1596.6	2072.7	2795.8	4824.7
	Hydration
	T12 L1	0.31	0.10	0.13	0.23	0.30	0.37	0.81
	L1 L2	0.31	0.07	0.14	0.26	0.31	0.35	0.50
	L2 L3	0.31	0.06	0.16	0.26	0.30	0.35	0.51
	L3 L4	0.30	0.07	0.15	0.25	0.30	0.35	0.50
	L4 L5	0.31	0.07	0.16	0.26	0.30	0.35	0.48
	L5 S1	0.30	0.07	0.15	0.26	0.29	0.34	0.68

Table 2

 2 Description

	Parameter	Mean	SD	t test	p	Min	Max
	Segment
	L1 L2	-0.00315	0.0068	-0.52	0.60	-0.01514	0.008842
	Segment
	L2 L3	-0.00143	0.0059	-0.23	0.81	-0.01342	0.01056
	Segment
	L3 L4	-0.00928	0.0065	-1.52	0.13	-0.02127	0.002711
	Segment
	L4 L5	-0.00298	0.0061	-0.49	0.62	-0.01497	0.009010
	Segment
	L5 S1	-0.00957	0.0071	-1.57	0.12	-0.02156	0.002422
	Gender
	Female	-0.01580	0.0126	-1.25	0.21	-0.04055	0.008953
	Age
		0.005007	0.0021	2.31	0.021	0.000747	0.009266

of the mixed multivariate linear model for the pediatric cohort. Disc hydration was determined relative to spinal level, age, and sex. Hydration in the T12-L1 disc was used as a reference.

Acknowledgements

We are grateful to the SOFCOT (France) for the scholarship awarded to Manon Bolzinger and to the Fondation Cotrel (Institut de France) for its on-going support of our research on idiopathic scoliosis. We are also grateful to Jérôme Briot PhD, who developed the Biomechlab ® software, for his help.

Funding

Master scholarship from the SOFCOT.

Author contributions

Contributed to the research work (M. Bolzinger, E. Estivalèzes, J. Sales de Gauzy, P. Swider), data acquisition (C. Baunin), data analysis or interpretation (M. Bolzinger, E. Estivalèzes, E. Polirsztok, K. Abelin-Genevois, A. Gallini, P. Swider).

Writing of article or substantial revision (M. Bolzinger, E. Estivalèzes, A Gallini, J. Sales de Gauzy, P. Swider).

Validation of submitted version (M. Bolzinger, J. Sales de Gauzy, P. Swider).