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Purpose: Contemporary trauma resuscitation prioritizes control of bleeding and uses major haemorrhage protocols (MHPs) to prevent and treat coagulopathy. We aimed to determine whether augmenting MHPs with Viscoelastic Haemostatic Assays (VHA) would improve outcomes compared to Conventional Coagulation Tests (CCTs). Methods: This was a multi-centre, randomized controlled trial comparing outcomes in trauma patients who received empiric MHPs, augmented by either VHA or CCT-guided interventions. Primary outcome was the proportion of subjects who, at 24 h after injury, were alive and free of massive transfusion (10 or more red cell transfusions). Secondary outcomes included 28-day mortality. Pre-specified subgroups included patients with severe traumatic brain injury (TBI). Results: Of 396 patients in the intention to treat analysis, 201 were allocated to VHA and 195 to CCT-guided therapy. At 24 h, there was no difference in the proportion of patients who were alive and free of massive transfusion (VHA: 67%, CCT: 64%, OR 1.15, 95% CI 0.76–1.73). 28-day mortality was not different overall (VHA: 25%, CCT: 28%, OR 0.84, 95% CI 0.54–1.31), nor were there differences in other secondary outcomes or serious adverse events. In pre-specified subgroups, there were no differences in primary outcomes. In the pre-specified subgroup of 74 patients with TBI, 64% were alive and free of massive transfusion at 24 h compared to 46% in the CCT arm (OR 2.12, 95% CI 0.84–5.34). Conclusion: There was no difference in overall outcomes between VHA- and CCT-augmented-major haemorrhage protocols.

Planning for sustainable groundwater abstraction requires realistic and reliable assessments of groundwater drawdown in aquifers as well as impacted groundwater-dependent terrestrial and aquatic ecosystems. Present-day impact assessments allocate water for the environment and ecosystems in the form of environmental groundwater requirements (EGWRs). However, securing sustainable groundwater abstraction also requires stable groundwater quality for consumers and receptors (e.g. streams and groundwater-dependent ecosystems). We suggest dividing EGWR into two parts, namely EGWRflow, related to impacts on surface water, and EGWRwq, related to impacts on groundwater quality. We then propose a method for modelling maximum safe groundwater abstraction rates based on a relationship between water quality and piezometric heads. The method provides estimations of sustainable abstraction rates that secure stable water quality and maintain water security. Using hydrological modelling, we estimated spatially differentiated EGWRwq, for Zealand, Denmark, based on three different conditioned drawdowns of 3, 6 and 9 m. We found that depending on the boundaries and the different conditioned drawdowns EGWRwq poses a 2.5–83% share of the groundwater recharge. We found that a redistribution of water abstraction would make 27 million m3 available compared with actual abstraction, dependent on scale, while keeping within a conditioned drawdown of 3 m. Our results demonstrate how conditioned drawdown can be implemented with the objectives of evaluating actual abstraction and securing stable water quality, hence comprising a step towards more reliable and relevant groundwater impact assessments.

It is vital to understand long-term trends in water quality parameters when assessing the sustainability of groundwater abstraction. Withdrawal-to-availability analysis is still used widely in groundwater management considering quantities and utilization rates based on in- and outflows. In this study, we took a step further than the water balance approach and carried out a detailed investigation of trends in long-term time series of groundwater quality, in order to analyze the sustainability of groundwater abstraction. We assessed trends, links, and patterns in abstraction, potentiometric surface, and water quality parameters for 28 well fields around Copenhagen, Denmark. Groundwater monitoring data from 1900 until 2014 were investigated for each well field. During this period, the well fields experienced a 2-14 m decrease in the nearby potentiometric surface compared to the first-or pre-pumping-potentiometric surface recordings. Sulfate concentrations increased in 25 out of 27 well fields after the maximum abstraction period, compared to the earliest water quality measurements. The results indicate that in the 1980s, when water consumption (abstraction) and drawdown were at their highest, water abstraction caused a steady increase in sulfate and calcium, which we consider unsustainable. In contradiction, the abstraction in 24 well fields show almost steady sulfate levels in the aquifer after decreased water consumption since 1995. Only four well fields showed more than a 20 mg/L increase in sulfate concentration, which indicates that the recent abstraction does not interfere with sulfate levels in the aquifer. Our method and results show how long-term water quality trends can support the management of aquifer exploitation and evaluate sustainability on the well field scale.

Globally accelerating trends in societal development and human environmental impacts since the mid-twentieth century1,2,3,4,5,6,7 are known as the Great Acceleration and have been discussed as a key indicator of the onset of the Anthropocene epoch6. While reports on ecological responses (for example, changes in species range or local extinctions) to the Great Acceleration are multiplying8, 9, it is unknown whether such biotic responses are undergoing a similar acceleration over time. This knowledge gap stems from the limited availability of time series data on biodiversity changes across large temporal and geographical extents. Here we use a dataset of repeated plant surveys from 302 mountain summits across Europe, spanning 145 years of observation, to assess the temporal trajectory of mountain biodiversity changes as a globally coherent imprint of the Anthropocene. We find a continent-wide acceleration in the rate of increase in plant species richness, with five times as much species enrichment between 2007 and 2016 as fifty years ago, between 1957 and 1966. This acceleration is strikingly synchronized with accelerated global warming and is not linked to alternative global change drivers. The accelerating increases in species richness on mountain summits across this broad spatial extent demonstrate that acceleration in climate-induced biotic change is occurring even in remote places on Earth, with potentially far-ranging consequences not only for biodiversity, but also for ecosystem functioning and services.

Understanding groundwater abstraction effects is vital for holistic impact assessments in areas depending on groundwater resources. The objective of our study was to modify the state-of-the-art AWaRe (available water remaining), freshwater impact assessment specifically for use in LCAs in areas dependent on groundwater resources. The new method, called “AGWaRe” (available groundwater remaining), reflects groundwater availability, based on a fraction of available groundwater remaining locally relative to a reference. Furthermore, our method increases spatial resolution beyond 1770 km2 grid cells and adjusts demarcations in order to improve the representation of the heterogeneity of groundwater catchments. The applicability of AGWaRe was demonstrated on three groundwater systems producing 5 million m3 water for the city of Copenhagen, namely Advanced Treatment of Groundwater, Simple Treatment of Groundwater and Infiltration of Reclaimed water. Results were normalised to compare with other effects of supplying water to an average Danish person. The normalised impacts for drinking water for one person ranged between 0.1 and 39 PE (person equivalent) for the three systems, which indicates that effects on groundwater resources differ substantially between systems. A comparative LCA of these groundwater systems shows that other impact categories range between 0 and 1 PE/person. Advanced Treatment of Groundwater generally has the lowest effect, for example <50% of the other groundwater systems in Global Warming Potential. The AGWaRe results indicate that freshwater impacts from Simple Treatment of Groundwater are up to 100 times greater than for Infiltration of Reclaimed water. Furthermore, AGWaRe exposes differences between the groundwater systems that AWaRe cannot evaluate, because one AWaRe cell covers two of the systems in question. These improvements are crucial for groundwater managers looking to include sustainability considerations in their analysis and decision

Modelling tools are necessary for quantitative assessment of groundwater-dependent systems such as interacting groundwater aquifers and lakes. Numerical groundwater models supplemented by stream and lake submodels are the best available tools for testing the conceptual relation of surface water to groundwater, for identifying gaps in the amount and quality of data, and for better understanding the sustainability of a groundwater-lake system in the presence of stresses. Models are of particular interest when applied to an infrequently studied geological context that is subject to specific vulnerabilities and patterns of interaction. Volcanic lakes are one setting where flow models serve to extend current conceptual and practical understanding. In this study, a groundwater/surface-water flow model is presented for the flow-through Bracciano deep caldera lake located near Rome, Italy. The steady-state model quantifies and tests the existing conceptual understanding of the system by taking account of all sources and sinks, and by calibration of key parameters to head and flow data. A transient version of the model demonstrates the response of the system to dry and wet years and to anthropogenic stresses. Although precipitation is the dominant source of water overall for the lake, a major finding of this study is that the groundwater inflow to the lake can buffer fluctuations in lake-water level and reduce lake-level declines, especially during shorter periods of dry conditions.

Understanding dynamics of interactions between community groups and government agencies is crucial to improve community resilience for flood risk reduction through effective community engagement strategies. Overall, a variety of approaches are available, however they are limited in their application. Based on research of a case study in Kampung Melayu Village in Jakarta, further complexity in engaging community emerges in planning policy which requires the relocation of households living in floodplains. This complexity arises in decision-making processes due to barriers to communication. This obstacle highlights the need for a simplified approach for an effective flood risk management which will be further explored in this paper. Qualitative analyses will be undertaken following semi-structured interviews conducted with key actors within government agencies, non-governmental organisations (NGOs), and representatives of communities. The analyses involve investigation of barriers and constraints on community engagement in flood risk management, particularly relevant to collaboration mechanism, perception of risk, and technical literacy to flood risk. These analyses result in potential redirection of community consultation strategies to lead to a more effective collaboration among stakeholders in the decision-making processes. As a result, greater effectiveness in plan implementation of flood risk management potentially improves disaster resilience in the future.

Bracciano volcanic caldera lake (Italy) is part of the Sabatini Hydrogeological Unit. Studies indicate that the lake is in direct contact with the main aquifer. The area is exposed to continuous stresses from several public and private pumping wells tapping the groundwater aquifer. Over the last thirty years the withdrawals from the aquifer have increased. Another stress on the system is climate change leading to changes in precipitation and temperature conditions, which in turn affect aquifer recharge and the lake water budget. The effects of global warming are increasingly evident (IPCC 2014), and are expected to lead to an increase in the use of groundwater. A numerical groundwater flow model on the Bracciano lake and its hydrogeological basin was constructed using the finite-difference code MODFLOW2000. The model was implemented for steady state, at first and it was calibrated. After that, it was implemented for transient (monthly time steps over six years) conditions. A spatial interpolation of weather station information including rain and temperature (data over last 50 years), were considered as input values for the modelling of groundwater and lake water balance. The Bracciano model was applied to simulate possible climate change and water-use scenarios to better understand the behavior of an example volcanic lake under multiple stresses. The Bracciano model simulation results helps understanding the climate change effects on groundwater and lake water balance. It could also be a useful tool for analysing climate change adaptation strategies for water supply and groundwater and lake dependent ecosystems.