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The UK has experienced recurring periods of hydrological droughts in the past, including the drought declared in summer 2022. Seasonal hindcasts, consisting of a large sample of plausible weather sequences, can be used to create drought storylines and add value to existing approaches to water resources planning. In this study, the drivers of winter rainfall in the Anglian region in England are investigated using the ECMWF SEAS5 hindcast dataset, which includes 2850 plausible winters across 25 ensemble members and 3 lead times. Four winter clusters are defined using the hindcast winters based on possible combinations of various atmospheric circulation indices (such as the North Atlantic Oscillation, NAO; East Atlantic, EA, pattern; and El Niño–Southern Oscillation). Using the 2022 drought as a case study, we demonstrate how storylines representing alternative ways the event could have unfolded can be used to explore plausible worst-case scenarios over winter 2022/23 and beyond. The winter clusters span a range of temperature and rainfall response in the study region and represent circulation storylines that could have happened over winter 2022/23. River flow and groundwater level simulations with the large sample of plausible hindcast winters show that drier-than-average winters characterised by predominantly NAO - /EA - and NAO + /EA - circulation patterns could have resulted in the continuation of the drought with a high likelihood of below-normal to low river flows across all selected catchments and boreholes by spring and summer 2023. Catchments in Norfolk were particularly vulnerable to a dry summer in 2023 as river flows were not estimated to recover to normal levels even with wet winters characterised predominantly by NAO - /EA + and NAO + /EA + circulation patterns, due to insufficient rainfall to overcome previous dry conditions and the slow response nature of groundwater-dominated catchments. Through this analysis, we aim to demonstrate the added value of this approach to create drought storylines during an ongoing event. Storylines constructed in this way supplement traditional weather forecasts and hydrological outlooks, in order to explore a wider range of plausible outcomes. [ABSTRACT FROM AUTHOR]

Spatially extensive multi-year hydrological droughts cause significant environmental stress. The UK is expected to remain vulnerable to future multi-year droughts under climate change. Existing approaches to quantify hydrological impacts of climate change often rely solely on global climate model (GCM) projections following different emission scenarios. This may miss out low-probability events with significant impacts. As a means of exploring such events, physical climate storyline approaches aim to quantify physically coherent articulations of how observed events could hypothetically have unfolded in alternative ways. This study uses the 2010–2012 drought, the most recent period of severe hydrological drought in the UK, as a basis and analyses storylines based on changes to (1) precondition severity, (2) temporal drought sequence, and (3) climate change. Evidence from multiple storylines shows that the maximum intensity, mean deficit, and duration of the 2010–2012 drought were highly influenced by its meteorological preconditions prior to drought inception, particularly for northern catchments at shorter timescales. The influence of progressively drier preconditions reflects both the spatial variation in drought preconditions and the role of physical catchment characteristics, particularly hydrogeology in the propagation of multi-year droughts. There are two plausible storylines of an additional dry year with dry winter conditions repeated either before the observed drought or replacing the observed dramatic drought termination confirm the vulnerability of UK catchments to a "third dry winter" storyline. Applying the UKCP18 climate projections, we find that drought conditions worsen with global warming with a mitigation of drought conditions by wetter winters in northern catchments at high warming levels. Comparison of the storylines with a benchmark drought (1975–1976) and a protracted multi-year drought (1989–1993) shows that, for each storyline (including the climate change storylines), drought conditions could have matched and exceeded those experienced during the past droughts at catchments across the UK, particularly for southern catchments. The construction of storylines based on observed events can complement existing methods to stress test UK catchments against plausible unrealised droughts. [ABSTRACT FROM AUTHOR]

Introduction: Enhanced recovery after surgery (ERAS) is well established in many specialties but has not been widely adopted in renal transplantation. The aim of this survey was to understand current national practices and sentiment concerning ERAS for renal transplant recipients in the UK., Methodology: A national web-based survey was sent to consultant surgeons at all 23 UK adult renal transplant units. Completed questionnaires were collected between May and July 2020. Data were analysed according to individual responses and grouped according to the existence of formal ERAS pathways within units., Results: All transplant units were represented in this survey. Three units had a formal ERAS pathway for all recipients. Of the remaining units, 65.9% considered implementing an ERAS pathway in the near future. The most commonly perceived barrier to ERAS implementation was 'embedded culture within transplant units' (54.8% of respondents). A fifth of respondents insert surgical drains selectively and 11.7% routinely discontinue patient-controlled analgesia on postoperative day 1. Most respondents routinely remove urinary catheters on day 5 (70%) and ureteric stents 4-6 weeks post-transplantation (81.7%). Median length of stay for deceased donor kidney transplant recipients was lower in units with ERAS programmes (5-7 days versus 8-10 days, respectively). The main cited barriers for discharge were 'suboptimal fluid balance' and 'requirement of treatment for rejection'., Conclusions: Despite slow uptake of ERAS in kidney transplantation, appetite appears to be increasing, particularly in the post-COVID-19 era. The current practice and opinions of transplant specialists highlighted in this survey may help to establish nationally agreed ERAS guidelines in this field.

Background: Biliary leaks and anastomotic strictures are common early anastomotic biliary complications (EABCs) following liver transplantation. However, there are no large multicentre studies investigating their clinical impact or risk factors. This study aimed to define the incidence, risk factors and impact of EABC., Methods: The NHS registry on adult liver transplantation between 2006 and 2017 was reviewed retrospectively. Adjusted regression models were used to assess predictors of EABC, and their impact on outcomes., Results: Analyses included 8304 liver transplant recipients. Patients with EABC (9·6 per cent) had prolonged hospitalization (23 versus 15 days; P < 0·001) and increased chance for readmission within the first year (56 versus 32 per cent; P < 0·001). Patients with EABC had decreased estimated 5-year graft survival of 75·1 versus 84·5 per cent in those without EABC, and decreased 5-year patient survival of 76·9 versus 83·3 per cent; both P < 0.001. Adjusted Cox regression revealed that EABCs have a significant and independent impact on graft survival (leak hazard ratio (HR) 1·344, P = 0·015; stricture HR 1·513, P = 0·002; leak plus stricture HR 1·526, P = 0·036) and patient survival (leak HR 1·215, P = 0·136, stricture HR 1·526, P = 0·001; leak plus stricture HR 1·509; P = 0·043). On adjusted logistic regression, risk factors for EABC included donation after circulatory death grafts, graft aberrant arterial anatomy, biliary anastomosis type, vascular anastomosis time and recipient model of end-stage liver disease., Conclusion: EABCs prolong hospital stay, increase readmission rates and are independent risk factors for graft loss and increased mortality. This study has identified factors that increase the likelihood of EABC occurrence; research into interventions to prevent EABCs in these at-risk groups is vital to improve liver transplantation outcomes., (© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.)