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Nature-based solutions are increasingly suggested for mitigating coastal flood risks in the face of climate change. Managed realignment (MR), a coastal adaptation strategy that entails the landward realignment of coastal defences to restore coastal habitats (often salt marshes), plays a pivotal role in implementing nature-based solutions in the coastal zone. Across Europe, more than 130 sites have been implemented so far, often to harness their potential to mitigate coastal flood risks while restoring coastal habitats (ABPmer, 2021). However, local communities often oppose MR projects, not only because they are seen as returning hard-won land to the sea but also because their coastal protection function is less trusted than traditional hard engineering techniques. This scepticism has foundation. The proclaimed coastal protection function of MRs is based on a broad body of literature on the protective function of natural salt marshes. However, contrary to natural salt marshes, MRs are often semi-enclosed tidal basins with narrow breaches to the open sea/estuary. Recent studies indicate that MR-internal hydrodynamics may significantly reduce their coastal protection, depending on their engineering design. To successfully implement MR, a much-improved scientific knowledge base is needed, as well as a process for addressing community concerns and genuinely engaging stakeholders in decision-making beyond the usual obligatory consultancy approach. Here, we propose the co-production of scientific knowledge with local communities and stakeholders to optimize the success of coastal nature-based solutions and promote community acceptance.

This study explores the uncertainty introduced in global assessments of coastal flood exposure and risk when not accounting for water-level attenuation due to land-surface characteristics. We implement a range of plausible water-level attenuation values for characteristic land-cover classes in the flood module of the Dynamic and Integrated Vulnerability Assessment (DIVA) modelling framework and assess the sensitivity of flood exposure and flood risk indicators to differences in attenuation rates. Results show a reduction of up to 44 % in area exposure and even larger reductions in population exposure and expected flood damages when considering water-level attenuation. The reductions vary by country, reflecting the differences in the physical characteristics of the floodplain as well as in the spatial distribution of people and assets in coastal regions. We find that uncertainties related to not accounting for water attenuation in global assessments of flood risk are of similar magnitude to the uncertainties related to the amount of sea-level rise expected over the 21st century. Despite using simplified assumptions to account for the process of water-level attenuation, which depends on numerous factors and their complex interactions, our results strongly suggest that an improved understanding and representation of the temporal and spatial variation of water levels across floodplains is essential for future impact modelling.

The geosciences are a highly suitable field of application for optimizing model parameters and experimental designs especially because many data are collected. In this paper, the weighted least squares estimator for optimizing model parameters is presented together with its asymptotic properties. A popular approach to optimize experimental designs called local optimal experimental designs is described together with a lesser known approach which takes into account the potential nonlinearity of the model parameters. These two approaches have been combined with two methods to solve their underlying discrete optimization problem. All presented methods were implemented in an open-source MATLAB toolbox called the Optimal Experimental Design Toolbox whose structure and application is described. In numerical experiments, the model parameters and experimental design were optimized using this toolbox. Two existing models for sediment concentration in seawater and sediment accretion on salt marshes of different complexity served as an application example. The advantages and disadvantages of these approaches were compared based on these models. Thanks to optimized experimental designs, the parameters of these models could be determined very accurately with significantly fewer measurements compared to unoptimized experimental designs. The chosen optimization approach played a minor role for the accuracy; therefore, the approach with the least computational effort is recommended.

Several coastal ecosystems-most notably mangroves and tidal marshes-exhibit biogenic feedbacks that are facilitating adjustment to relative sea-level rise (RSLR), including the sequestration of carbon and the trapping of mineral sediment 1 . The stability of reef-top habitats under RSLR is similarly linked to reef-derived sediment accumulation and the vertical accretion of protective coral reefs 2 . The persistence of these ecosystems under high rates of RSLR is contested 3 . Here we show that the probability of vertical adjustment to RSLR inferred from palaeo-stratigraphic observations aligns with contemporary in situ survey measurements. A deficit between tidal marsh and mangrove adjustment and RSLR is likely at 4 mm yr -1 and highly likely at 7 mm yr -1 of RSLR. As rates of RSLR exceed 7 mm yr -1 , the probability that reef islands destabilize through increased shoreline erosion and wave over-topping increases. Increased global warming from 1.5 °C to 2.0 °C would double the area of mapped tidal marsh exposed to 4 mm yr -1 of RSLR by between 2080 and 2100. With 3 °C of warming, nearly all the world's mangrove forests and coral reef islands and almost 40% of mapped tidal marshes are estimated to be exposed to RSLR of at least 7 mm yr -1 . Meeting the Paris agreement targets would minimize disruption to coastal ecosystems., (© 2023. The Author(s).)

Coastal tidal wetlands produce and accumulate significant amounts of organic carbon (C) that help to mitigate climate change. However, previous data limitations have prevented a robust evaluation of the global rates and mechanisms driving C accumulation. Here, we go beyond recent soil C stock estimates to reveal global tidal wetland C accumulation and predict changes under relative sea level rise, temperature and precipitation. We use data from literature study sites and our new observations spanning wide latitudinal gradients and 20 countries. Globally, tidal wetlands accumulate 53.65 (95%CI: 48.52-59.01) Tg C yr -1 , which is ∼30% of the organic C buried on the ocean floor. Modeling based on current climatic drivers and under projected emissions scenarios revealed a net increase in the global C accumulation by 2100. This rapid increase is driven by sea level rise in tidal marshes, and higher temperature and precipitation in mangroves. Countries with large areas of coastal wetlands, like Indonesia and Mexico, are more susceptible to tidal wetland C losses under climate change, while regions such as Australia, Brazil, the USA and China will experience a significant C accumulation increase under all projected scenarios., (© The Author(s) 2020. Published by Oxford University Press on behalf of China Science Publishing & Media Ltd.)

The response of coastal wetlands to sea-level rise during the twenty-first century remains uncertain. Global-scale projections suggest that between 20 and 90 per cent (for low and high sea-level rise scenarios, respectively) of the present-day coastal wetland area will be lost, which will in turn result in the loss of biodiversity and highly valued ecosystem services 1-3 . These projections do not necessarily take into account all essential geomorphological 4-7 and socio-economic system feedbacks 8 . Here we present an integrated global modelling approach that considers both the ability of coastal wetlands to build up vertically by sediment accretion, and the accommodation space, namely, the vertical and lateral space available for fine sediments to accumulate and be colonized by wetland vegetation. We use this approach to assess global-scale changes in coastal wetland area in response to global sea-level rise and anthropogenic coastal occupation during the twenty-first century. On the basis of our simulations, we find that, globally, rather than losses, wetland gains of up to 60 per cent of the current area are possible, if more than 37 per cent (our upper estimate for current accommodation space) of coastal wetlands have sufficient accommodation space, and sediment supply remains at present levels. In contrast to previous studies 1-3 , we project that until 2100, the loss of global coastal wetland area will range between 0 and 30 per cent, assuming no further accommodation space in addition to current levels. Our simulations suggest that the resilience of global wetlands is primarily driven by the availability of accommodation space, which is strongly influenced by the building of anthropogenic infrastructure in the coastal zone and such infrastructure is expected to change over the twenty-first century. Rather than being an inevitable consequence of global sea-level rise, our findings indicate that large-scale loss of coastal wetlands might be avoidable, if sufficient additional accommodation space can be created through careful nature-based adaptation solutions to coastal management.

Purpose: The purpose of this study is to quantify the impact of the different outcomes and definitions of suicidality on the association between antiepileptic drugs (AEDs) and suicidality., Methods: Retrospective cohort studies of selected AEDs (carbamazepine, gabapentin, lamotrigine, phenytoin, pregabalin, topiramate and valproate) using data from UK Clinical Practice Research Datalink (CPRD) alone and linked to UK Hospital Episode Statistics (HES) and UK Office of National Statistics (ONS), and from Danish national registries (DNR). Follow-up started at initiation of one of the study AEDs, divided into exposure periods, a maximum 90-day post-exposure period, and the reference period starting the day after the 90-day post-exposure period ended. Primary outcomes were completed suicide (SUI)/suicide attempt (SA) for CPRD and SUI/deliberate self-harm (DSH) for DNR. We applied adjusted Cox regression analyses and sensitivity analyses with varying outcome definitions., Results: We analyzed 84,524 AED users from CPRD-HES-ONS (1188 SUI/SA; 96 SUI) and 258,180 users from DNR (7561 SUI/DSH; 781 SUI). The adjusted hazard ratios (HRs) on SUI/SA ranged between 1.3 (95% confidence interval (CI): 0.84-2.00) for lamotrigine and 2.7 (1.24-5.81) for phenytoin in CPRD-HES-ONS, and between 0.9 (0.78-1.00) for valproate and 1.8 (1.10-3.07) for phenytoin on SUI/DSH in DNR. HRs for the primary outcomes varied consistently across exposure periods and data sources. HRs for SUI were in general lower, more stable and similar for periods of exposure and the 90-day post-exposure period., Conclusion: Applying different outcomes and definitions of suicidality had an impact on the relative risks of suicidality associated with the investigated AEDs with results for SUI being most consistent and reliable., (Copyright © 2016 John Wiley & Sons, Ltd.)

Background: This study estimated the risk of infection-related hospitalizations and death in patients with and without multiple sclerosis (MS)., Methods: We identified adults with MS in the US Department of Veterans Affairs (VA) system between 1999 and 2010. Each veteran with MS was matched, on age and sex, with up to four veterans without MS. Multivariable Cox proportional hazards regression models were performed to assess the influence of MS on the development of serious and fatal infections., Results: The cohort included 7743 veterans with MS and 30,972 veterans without MS. Mean (SD) age was 53.8 (13.3) years, and 80.8% were male. The incidence per 1000 person-years of overall serious infections was 19.2 (95% confidence interval [CI], 17.6-20.8) for those with MS and 10.3 (95% CI, 9.8-10.9) for those without MS. Fatal infection incidence rates were 1.2 (95% CI, 0.8-1.7) for patients with MS and 0.5 (95% CI, 0.3-0.6) for patients without MS. Regression models showed that veterans with MS were at greater risk for overall serious (hazard ratio [HR] = 1.52, P < .01) and fatal (HR = 1.85, P = .03) infections and serious respiratory (HR = 1.31, P = .01), urinary tract (HR = 4.44, P < .01), and sepsis-related infections (HR = 2.56, P < .01)., Conclusions: This study provides evidence that VA patients with MS are more likely than those without MS to be hospitalized and die of infection.

Objective: The annual prevalence of antiepileptic drug (AED) prescribing reported in the literature differs considerably among European countries due to use of different type of data sources, time periods, population distribution, and methodologic differences. This study aimed to measure prevalence of AED prescribing across seven European routine health care databases in Spain, Denmark, The Netherlands, the United Kingdom, and Germany using a standardized methodology and to investigate sources of variation., Methods: Analyses on the annual prevalence of AEDs were stratified by sex, age, and AED. Overall prevalences were standardized to the European 2008 reference population., Results: Prevalence of any AED varied from 88 per 10,000 persons (The Netherlands) to 144 per 10,000 in Spain and Denmark in 2001. In all databases, prevalence increased linearly: from 6% in Denmark to 15% in Spain each year since 2001. This increase could be attributed entirely to an increase in "new," recently marketed AEDs while prevalence of AEDs that have been available since the mid-1990s, hardly changed. AED use increased with age for both female and male patients up to the ages of 80 to 89 years old and tended to be somewhat higher in female than in male patients between the ages of 40 and 70. No differences between databases in the number of AEDs used simultaneously by a patient were found., Significance: We showed that during the study period of 2001-2009, AED prescribing increased in five European Union (EU) countries and that this increase was due entirely to the newer AEDs marketed since the 1990s. Using a standardized methodology, we showed consistent trends across databases and countries over time. Differences in age and sex distribution explained only part of the variation between countries. Therefore, remaining variation in AED use must originate from other differences in national health care systems., (Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.)

Objective: To explore the risk of ischemic stroke, hemorrhagic stroke, or TIA in patients with Alzheimer disease (AD) or vascular dementia (VD)., Methods: We conducted a follow-up study with a nested case-control analysis using the UK-based General Practice Research Database. We included patients aged 65 years and older with an incident diagnosis of AD or VD between 1998 and 2008 and a comparison group of dementia-free patients. We estimated incidence rates of ischemic stroke, hemorrhagic stroke, or TIA in patients with AD, VD, or without dementia, and we calculated odds ratios with 95% confidence intervals (CIs) of developing such an outcome in patients with AD or VD, stratified by use of antipsychotic drugs., Results: We followed 6,443 cases with AD, 2,302 with VD, and 9,984 dementia-free patients over time and identified 281 cases with incident ischemic stroke, 139 with hemorrhagic stroke, and 379 with TIA. The incidence rates of ischemic stroke for patients with AD, VD, or no dementia were 4.7/1,000 person-years (PYs) (95% CI 3.8-5.9), 12.8/1,000 PYs (95% CI 9.8-16.8), and 5.1/1,000 PYs (95% CI 4.3-5.9), respectively. Compared with dementia-free patients, the odds ratio of developing a TIA for patients with AD treated with atypical antipsychotic drugs was 4.5 (95% CI 2.1-9.2)., Conclusions: Patients with VD, but not AD, have a markedly higher risk of developing an ischemic stroke than those without dementia. In patients with AD, but not VD, use of atypical antipsychotic drugs was associated with an increased risk of TIA.

Purpose: Patients with Alzheimer's disease (AD) have an increased risk of developing seizures or epilepsy. Little is known about the role of risk factors and about the risk of developing seizures/epilepsy in patients with vascular dementia (VD). The aim of this study was to assess incidence rates (IRs) of seizures/epilepsy in patients with AD, VD, or without dementia, and to identify potential risk factors of seizures or epilepsy., Methods: We conducted a follow-up study with a nested case-control analysis using the United Kingdom-based General Practice Research Database (GPRD). We identified patients aged ≥65 years with an incident diagnosis of AD or VD between 1998 and 2008 and a matched comparison group of dementia-free patients. Conditional logistic regression was used to estimate the odds ratio (OR) with a 95% confidence interval (CI) of developing seizures/epilepsy in patients with AD or VD, stratified by age at onset and duration of dementia as well as by use of antidementia drugs., Key Findings: Among 7,086 cases with AD, 4,438 with VD, and 11,524 matched dementia-free patients, we identified 180 cases with an incident diagnosis of seizures/epilepsy. The IRs of epilepsy/seizures for patients with AD or VD were 5.6/1,000 person-years (py) (95% CI 4.6-6.9) and 7.5/1,000 py (95% CI 5.7-9.7), respectively, and 0.8/1,000 py (95% CI 0.6-1.1) in the dementia-free group. In the nested case-control analysis, patients with longer standing (≥3 years) AD had a slightly higher risk of developing seizures or epilepsy than those with a shorter disease duration, whereas in patients with VD the contrary was observed., Significance: Seizures or epilepsy were substantially more common in patients with AD and VD than in dementia-free patients. The role of disease duration as a risk factor for seizures/epilepsy seems to differ between AD and VD., (Wiley Periodicals, Inc. © 2012 International League Against Epilepsy.)

As there is no consensus in the specialized literature, it is often difficult to recognize the ties existing between dementia, delirium and depression. Depression preceding dementia is well-documented. Depressive symptoms during the process of dementia are less well-known. So are the close relationships between dementia and delirium as well as between delirium and depression. The commonality of symptoms between the three often causes diagnostic dilemmas. Unfortunately, elderly patients can often present two, or even three, of the "3 D's" simultaneously. Untangling the 3 D's has been the subject of several articles. We propose a synthesis as well as our thoughts on the subject from a clinical psychogeriatric standpoint.

Endogenous evoked potentials of two types (CNV and P300 complexes) as well as their respective reaction times were recorded in 29 elderly, active subjects (15 men and 14 women) between 60 and 84 years of age. Our subjects also passed anxiety, depression and cognitive scales. The different results were then analyzed in relation with each other and in relation with age and sex. No age-related differences were found in the principal elements measured in the P300 complex, but several elements of the CNV complex were clearly shown to be age-sensitive. Sex-related differences were found in the N2 and P3a potentials. CNV morphology (Tecce type A) and cognitive scores were found to be related to Spielberger's anxiety-trait sub-scale. Several results also highlighted the heterogeneity of this age group. The need for complementary studies in this age group is then discussed with the hope that neurophysiology can become a useful tool in psychogeriatrics.