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Sedimentation is a major issue at the Wala Dam, Jordan, and its impact on the serviceable lifetime of the reservoir is the primary driver for proposals to raise the height of the dam. The approach followed in this study involves the application of an optimized SWAT model of the Wala catchment to examine hypothetical and object-based catchment management scenarios, including land-use alteration, on a one-at-a-time basis to simulate discharge and sediment yield delivered to the dam over the period 1979 – 2013. Plantation scenarios study the response of the catchment to cultivation of barley and olive in selected areas. The simulated effect of altering plantation vary spatially with both location and scale. Changes in annual sediment and water delivery to the Wala reservoir are linked to a simple model of dam functional lifetime to establish a rational model framework for integrating hydrological and ecological decision-making in this highly-stressed setting. Considering the Wala Dam raising plan, it is concluded that the current capacity is hypothetically expected to fill up with sediment in 65.63 years based on the existing land-use conditions of the catchment. The ongoing 17 Mm3 expansion of the dam is predicted to lengthen life-span up to about 283 % of the current estimations based on the existing land-use. Longest life-span of the Wala Dam is expected to be achieved by cultivating the northern areas with olive in all cases considereing exisiting and expanded capacity within extreme and average climate conditons. Shortest life-span is relevant to cultivating barley over the whole catchment. Life-span estimated based on an extreme flood condition that occurred in year 1992 varies between 2.92 and 10.02 year. Although such conditions can be rare and highly unpredictable, they must be taken into consideration while designing dams. Land-use alteration plans do not necessarily improve life-span of the dam and therefore, careful studies must investigate end goals and feasibility of management plans. Catchment-scale water and sediment management within the Wala basin is part of a complex system of inter-relationships within the overall framework of the water-energy-food nexus. Retention of water in the landscape for ecological benefit, to the detriment of available resource to support water supplies, carries a significant cost in this context; on the other hand, the model results here suggest that land restoration (at least under the cropping scenarios tested) can be achieved with marginal impacts relative to the benefits of raising the Wala dam. This, however, has its own consequence; by further eroding the downstream export of water to the Dead Sea, schemes such as the Wala contribute to the progressive deterioration of that unique water body, with impacts of global ecological, cultural, economic and geopolitical scale. The variation observed between simulated land-use scenarios emphasises the potential use of catchment modelling to target land restoration measures to those areas where net ecological benefits, including water conservation and reduction of erosion, are maximised.

Objective To review the epidemiology of Coagulase-negative staphylococci (CoNS) in England over the recent 12-year period. Methods Laboratory confirmed CoNS reported from sterile sites in patients in England to the UK Health Security Agency (UKHSA) between 2010 and 2021 were extracted from the national laboratory database and analysed. Results Overall, 668,857 episodes of CoNS were reported. Unspeciated CoNS accounted for 56% (374,228) of episodes, followed by Staphylococcus epidermidis (26%; 174,050), S. hominis (6.5%; 43,501) and S. capitis (3.9%; 25,773). Unspeciated CoNS increased by 8.2% (95% CI, 7.1-9.3) annually between 2010 and 2016, then decreased annually by 6.4% (95% CI: -4.8 to -7.9) until 2021. Speciated CoNS increased by 47.6% (95% CI, 44.5-50.9) annually between 2010 and 2016 and increased annually by 8.9% (95% CI: 5.1 to 12.8) until 2021. Antimicrobial susceptibility profiles differed by species. Conclusions Reports of CoNS from normally sterile body sites in patients in England increased between 2010 and 2016 and remained stable between 2017 and 2021. There has been a striking improvement in species-level identification of CoNS in recent years. Monitoring trends in CoNS epidemiology is crucial for development of observational and clinical intervention studies on individual species.

This paper demonstrates the value of school logbooks, an unusual and hitherto underused archival source, to the field of the historical geographies of weather and climate. It examines logbooks for schools across the Outer Hebrides, or Western Isles, off the west coast of mainland Scotland, ranging from the late nineteenth century until the early twentieth century. The weather had numerous and varied impacts on everyday life on the islands and was frequently recorded in school logbooks. The paper shows that islanders were especially vulnerable to extreme weather events – typically strong winds, heavy rain, storms and snow – which affected children's school attendance, health and well-being. It is argued that vulnerability to extreme weather reflected the wider social vulnerability of the islands' crofting communities.

Climate reconstructions derived from proxy records for individual sites often fail to incorporate existing regional information, which may help to determine uncertainties and express variability within specific reconstructions or commonalities between datasets. Such an understanding is crucial when examining past human-environment interactions. Taking the eastern Mediterranean as our case study, we present here a new air temperature model for the last 10,000 years that utilises data from 33 previously published proxy-based independent reconstructions, using a novel fully Bayesian approach that applies multilevel regression models of individual temperature datasets grouped together into 300 year long consecutive sub-intervals. A Bayesian multilevel approach allows the model to share information between each regression model from the individual datasets and the 300 year grouped regression models. The results demonstrate commonalities between individual datasets derived from different sources, and embed the uncertainties within the model. Our results establish that the eastern Mediterranean region was consistently warmer than the 20th century, except for two short intervals at the end of the Early Holocene (between 8400 and 8250 yrs BP) and the start of the mid-Holocene (between 7800 and 7650 yrs BP). We also identify changes within temperature associated with both the 8.2 ka and 4.2 ka BP events, however our findings identify regional warming in the eastern Mediterranean, rather than cooling often associated with the 4.2 ka BP event. Our results are comparable with previous large scale hemispheric reconstructions, demonstrating that our model is a robust candidate for temperature reconstructions within a confined region, which can range from mesoscale up to macroscale.

To date few studies have reconstructed weather from personal diaries (also known as private diaries). In this paper, we consider different methods of indexing daily weather information, specifically precipitation, from eighteenth and nineteenth-century personal diaries. We examine whether there is a significant correlation between indexed weather information and local instrumental records for the period, thereby assessing the potential of discursive materials in reconstructing precipitation series. We demonstrate the potential for the use of diaries that record weather incidentally rather than as the primary purpose, and the value and utility of diaries covering short periods when used alongside nearby contemporary diaries. We show that using multiple overlapping personal diaries can help to produce a more objective record of the weather, overcoming some of the challenges of working with qualitative data. This paper demonstrates indices derived from such qualitative sources can create valuable records of precipitation. There is the potential to repeat the methodology described here using earlier material or material from further away from extant instrumental records, thereby addressing spatial and temporal gaps in current knowledge globally.

BACKGROUND Acute kidney injury (AKI) is an important adverse outcome after major surgery. Peri-operative goal-directed haemodynamic therapy (GDT) may improve outcomes by reducing complications such as AKI. OBJECTIVE To determine if GDT was associated with a reduced incidence of postoperative AKI according to specific renal biomarkers. DESIGN Prospective substudy of the OPTIMISE trial, a multicentre randomised controlled trial comparing peri-operative GDT to usual patient care. SETTING Four UK National Health Service hospitals. PATIENTS A total of 287 high-risk patients aged at least 50 years undergoing major gastrointestinal surgery. OUTCOME MEASURES The primary outcome measure was AKI defined as urinary neutrophil gelatinase-associated lipase (NGAL) at least 150 ng ml 24 and 72 h after surgery. Secondary outcomes were between-group differences in NGAL measurements and NGAL : creatinine ratios 24 and 72 h after surgery and AKI stage 2 or greater according to Kidney Disease Improving Global Outcomes (KDIGO) criteria within 30 days of surgery. RESULTS In total, 20 of 287 patients (7%) experienced postoperative AKI of KDIGO grade 2 or 3 within 30 days. The proportion of patients with urinary NGAL at least 150 ng ml 24 or 72 h after surgery was similar in the two groups [GDT 31/144 (21.5%) patients vs. usual patient care 28/143 (19.6%) patients; P = 0.88]. Absolute values of urinary NGAL were also similar at 24 h (GDT 53.5 vs. usual patient care 44.1 ng ml; P = 0.38) and 72 h (GDT 45.1 vs. usual patient care 41.1 ng ml; P = 0.50) as were urinary NGAL : creatinine ratios at 24 h (GDT 45 vs. usual patient care 43 ng mg; P = 0.63) and 72 h (GDT 66 vs. usual patient care 63 ng mg; P = 0.62). The incidence of KDIGO-defined AKI was also similar between the groups [GDT 9/144 (6%) patients vs. usual patient care 11/143 (8%) patients; P = 0.80]. CONCLUSION In this trial, GDT did not reduce the incidence of AKI amongst high-risk patients undergoing major gastrointestinal surgery. This may reflect improving standards in usual patient care. TRIAL REGISTRATION OPTIMISE Trial Registration ISRCTN04386758.

Anorexia–cachexia afflicts a high proportion of patients with cancer and other chronic diseases in their advanced stages. Anorexia–cachexia is a problem which may be most clearly appreciated by caregivers, whose effort to adopt a nourishing role is frustrated. An onerous burden of care inexorably falls upon them, affecting their own health, mobility, and savings. For many patients, anorexia–cachexia commonly results in hospitalization for prolonged periods, thus further creating costs for their families and the State where public health programmes exist. The primary events driving cachexia include anorexia and altered metabolism. Tumour—derived factors instigate, and immune- and central nervous systems amplify and propagate anorexia-cachexia. Systematic screening for anorexia-achexia is needed to support early initiation of treatment. Active management of symptoms, amelioration of food intake (nutritional support), suppression of inflammation-related metabolic change (anti-inflammatory drugs or nutrients) and physical activity are needed. Novel therapeutic targets for anorexia-cachexia are currently under investigation.

Nature Based Solutions (NBS), including Natural Flood Management (NFM) schemes are becoming an important component of many governmental and organisation responses to increases in flood and aridity risk. NFM structures may take multiple forms to slow, store, disconnect and filter distributed overland flow pathways within a catchment that coalesce to generate a flood-wave downstream and runoff rather than infiltrate groundwaters. To date few studies have conducted observations pre- and post-installation monitoring at river reach-scales, despite widespread and frequent installation, to investigate the efficacy of willowed engineered log jams (WELJs) interventions used in abating flood-flows, through backing-up flood-pulses with consequent reductions in downstream discharges. This paper examines the efficiency, before and after installation of five 1 m high WELJs incorporating 1,000 Bay willow (Salix pentandra) saplings supporting the dead horizontal timber, across a total of 130 linear metres spanning the floodplain of a decommissioned reservoir. One rain gauge, two fixed point time-lapse wildlife cameras and three water level stations were installed: upstream-of, within, and downstream-of all WELJs. The findings demonstrate a substantial reduction is achieved for most events, with an average of 27.3% reduction in peak discharge being achieved post-installation. The time to peak is little impacted, however there is demonstrable evidence of a longer and higher recessional limb to the events. These findings quantify for the first time the role that WELJs can play in a move towards re-naturalisation of water level regimes, with lower peak water flows achieved, and waters released from the river-reach more slowly. Furthermore, baseflow during dry periods is also elevated by 27.1%, offering greater resilience to dry periods and droughts. Consequently, over the river-reach scale (0–130 m), WELJs play an important role in alleviating flood and drought risk through suppressing flood peaks and increasing baseflow during low flows; steps towards improved hydro-morphological quality overall.

A greater appreciation of historical sources documenting the weather has been achieved during recent decades, recognising their value in understanding and interpreting long-term climate change, their application and utility for improving climate models and the opportunities they offer for a deeper consideration of societal responses to past climatic events. Using a variety of historical archives, the drought history of Beijing is extended back to 1368, and a new reconstructed instrumental monthly precipitation series presented from 1724-present (2019). This combined instrumental and documentary analysis permits an opportunity to explore past droughts and the inter-relationships between physical, social, and cultural drought impacts. The Standardised Precipitation Index (1724-2019) is augmented with a long-term historical drought classification (1368-2000) based on drought impacts (using a 5-class drought index). Long precipitation reconstruction enables both short- (monthly) and long-term (decadal) drought variability to be robustly assessed for Beijing since the Ming Dynasty, identifying a series of historically severe droughts of comparable severity to recent events, but with a range of varying social and cultural impacts.

Agricultural land use can increase runoff and erosion leading to detrimental downstream impacts. This paper examines the impact of agricultural land cover change on runoff and sediment generation at event scales using a model-based approach. SHETRAN, a physically based, spatially distributed model, was applied in two southwest England catchments to represent: (a) changes in the land cover (cropland extent and spatial arrangement), (b) changes in crop type, and (c) use of riparian buffer strips. A total of 84 simulated events within a 4-year period were used to quantify flow and sediment generation impacts. We found past changes in land cover resulted in significant differences in sediment yield (p < 0.05). Linear regression showed an increase in flow and sediment yield proportional to increases in arable crop area (p < 0.001). The spatial arrangement of cropped fields and riparian buffer strips produced no significant differences in event flow or sediment yield (p > 0.05). However, buffer strip scenarios compared with the base run showed sediment load reductions in specific events, up to 20% and 15% for woodland and grass riparian buffers, respectively. When comparing crop types with and without the use of post-harvest cover crops, we observed non-significant differences (both Qv and Sy). However, large reductions in modelled sediment yields occurred for some events (e.g., up to 60% for winter cereals, 50% for maize and 74% for spring cereals). For these scenarios, examination of rainfall event magnitude emphasized the importance of ground cover in mitigating soil erosion for maize and spring cereals, but not for winter cereals. Our findings indicate that significant changes in sediment delivery at the event scale are associated with cropland extent and crop types, depending on rainfall magnitude, but not on the spatial arrangement of cropped fields or the use of riparian buffer strips.

Natural Flood Management (NFM) is the name given to Nature Based Solutions (NBS) for Flood Management in the UK. It is a holistic flood management technique that employs natural hydrological processes, through the instillation of interventions, to slow the flow of water, creating a landscape scale flood management system. Despite widespread interest and supporting policy from governments and non-profit organisations NFM, as yet, has not been widely adopted as a mainstream flood management technique. A small number of academic studies examining perceived barriers to NFM adoption have identified a variety of individual factors as being responsible. It is commonly accepted that flood risk management broadly, and NFM specifically, are complex, challenges of interacting physical and human parameters and that academic, institutional and policy divisions are rarely sympathetic to embracing these complexities. A transdisciplinary problem framing study in conjunction with professionals experienced in the delivery of NFM projects in the UK aimed to capture these multifaceted parameters of flood management and strategic delivery at a landscape scale using Group Concept Mapping, a systems approach to identify conceptual convergence. This policy-delivery impasse was further explored by quantifying the relative importance of individual barriers and conceptual groupings from the perspective of two different practitioner groups (flood risk managers and conservation practitioners). The results demonstrate that the NFM delivery system can be grouped into seven interacting elements: policy and regulation, politics, public perception, cross-cutting issues, funding, technical knowledge and evidence, of which each have a varying number of barriers that limit NFM uptake. Opinions differs as to the importance of these individual barriers, however when considering the system broadly we identify that the institutional and social barriers are perceived as the most important, whilst technical knowledge and evidence are the areas of least concern. This paper aims to promote NBS flood management delivery in the UK and globally by generating, structuring and representing the multifaceted and multilevel NFM delivery system at a local level to evidence adaptive decision making at a regional, national and global level. Through problem structuring and an increased understanding and awareness of the structure and network of linking elements and perceived differences of practitioner groups that influence the system of delivery, steps can be taken towards solutions that are socially, scientifically and practically robust.

Syphilis rates have been increasing in men who have sex with men (MSM) in London. To describe risk behaviour and refine public health interventions, we conducted prospective enhanced surveillance of new syphilis cases in MSM attending selected London sexual health clinics (SHCs) between October 2016 and January 2017. Sexual health advisors (SHAs) completed 107 questionnaires. Eighteen per cent of respondents reported always using condoms, with lower use in HIV-positive (8%, 4/53) than HIV-negative men (33%, 14/52). Almost half of respondents reported condomless sero-discordant sex (46%, 33/72). The most frequent means of meeting new partners reported were venues (80%, 76/95), particularly bars or clubs (34%, 32/95), and apps or websites (79%, 75/95). Nearly a third of respondents reported engaging in group sex (32%, 30/95). Almost half reported drug use during sex (47%, 46/98), with HIV-positive men more likely to report use of the three main ‘chemsex’ drugs. The majority of respondents preferred health promotion information from SHAs (63%, 58/92) compared to other sources such as Google/Wikipedia and apps. Prevention activity should continue to focus on condomless sex, serosorting, multiple and overlapping partners, and chemsex. SHCs, particularly those serving HIV-positive men, are important sources for sexual health promotion advice.

Background Healthcare-associated Clostridium difficile infection (CDI) in pregnant/postpartum women is underreported, especially outside of North America. We report a cluster of cases in 2 neighboring secondary care hospitals in South-East England. The objective of this study was to identify the epidemiology and risk factors for infection. Methods An investigation into a cluster of cases of confirmed CDI in pregnant/postpartum women was performed over a 12-month period, from June 2016 to June 2017. Results Eleven cases, in 10 patients, were identified, including 1 patient who had a relapse. Eight of 10 patients developed symptoms after hospital discharge. All patients had received broad-spectrum antibiotics prior to CDI onset. Environmental vectors, such as labor room mattresses, that were found difficult to effectively decontaminate after heavy contamination with blood, feces, and other body fluids may have been possible reservoirs. An infection control care bundle was successful in preventing further cases. Conclusions Antibiotic use and exposure to the organism in a contaminated labor room environment are likely risk factors for healthcare-associated CDI in postpartum women. Active surveillance is necessary to prevent these infections, as these cases often present after hospital discharge.

Large-scale cell isolation is commonly performed in labs and core facilities for cell banking and drug discovery, and as a critical step in cell therapy manufacturing. Current methods can be a significant bottleneck in a lab’s workflow, often requiring a full day for sample processing and cell isolation. To address this need, we have developed two methods: manual column-free isolation using the Easy 250 EasySep™ magnet, and automated cell isolation in a closed system using RoboSep™-C. The Easy 250 magnet allows users to isolate cells from a full leukopak of up to 20 billion cells in under 30 minutes by simply pipetting out their target cells. Negative selection protocols have been optimized to achieve 95.3% T cell, 97.2% CD4+ T cell, 91.9% CD8+ T cell, 99.4% B cell, 96.5% NK cell, and 91.5% monocyte purities. Positive selection protocols obtain 95.4% CD3+ cell, 94.4% CD4+ T cell, 93.9% CD8+ T cell, and 96.2% CD14+ cell purities. RoboSep™-C automates this cell isolation procedure, along with the cell washing steps for sample preparation, in as little as 50 minutes. The instrument features a scale tower, pump and clamp modules to direct fluid through defined paths, and a magnet for separation of labelled cells. The system uses a sterile single-use tubing set that incorporates a cartridge for cell washing and concentration, and a magnet chamber for cell separation. Starting with fresh leukopaks, we obtained 95.9% T cell, 95.8% CD4+ T cell, and 89.6% CD8+ T cell purities following negative selection, and 92.0% CD4+ T cell and 89.5% CD8+ T cell purities following positive selection. These approaches offer efficient and user-friendly cell isolation that allow researchers to scale up their operations, and can be easily integrated upstream of existing workflows.

Nature Based Solutions (NBS) is a practice based approach developed in response to the global challenge of on-going environmental degradation and biodiversity loss. Interventions that restore or mimic hydrological processes to slow water within a catchment come under an umbrella term of NBS for flood management. Proponents of the practice link its use as beneficial in reducing flood risk but also climate change adaptation, urban hazard management, sustainable agriculture and eco-hydrology. Despite promising an integrated and sustainable future and receiving policy support, catchment scale adoption is limited. Understanding, designing and delivering NBS flood management is complex, crossing multiple disciplinary divides and practitioner communities, each with its own history, background, methods and uncertainties. Barriers and intervention points within the delivery system has received little investigation from the view of environmental professional practice. This research addressed this gap through participatory case studies of projects delivering NBS in England. We found low agreement amongst practitioners on how NBS for flood management is distinguished, resulting in differing perspectives on its identity and contested boundaries between it and other land and water interventions. Our transdisciplinary research project sought and generated a context for delivery that breaks down disciplinary boundaries and in doing so a new system and intervention point emerged. The problem that practitioners used NBS for flood management to address is a homogenised water cycle: reduced infiltration and increased surface runoff. Therefore NBS for flood management aims to reverse this by restoring catchment hydrodiversity in harnessing hydrological processes for integrated sustainable urban and catchment management. The implications for academic thinking and land and water management practice created by the novel conceptualisation of a catchment possessing an attribute of hydrodiversity is far reaching. In relation to supporting NBS for flood management mainstream adoption: the conceptualisation draws together different land use systems and a shared goal to deliver catchment hydrodiversity emerges enabling coordinated flood management at multiple spatial scales and across professional practice and disciplinary groups.

The occurrence of two severe droughts in north-east China since 2000 has raised attention in the risk presented by droughts. This paper presents a historic drought series for Shenyang in Liaoning Province, north-east China, from 1200 CE to the present with a reconstructed long precipitation series (1906–2015) augmented with historical documentary accounts. Analysis of the instrumental series using a standardized precipitation index (SPI) and extending it using historical records has produced a combined series spanning over 8 centuries. The combined long series was analysed for patterns in drought frequency, severity and typology. Three droughts comparable to those since 2000 occur in the instrumental series during the early 20th century (i.e. 1907, 1916–1918 and 1920–1921), and coeval archival sources reveal the human impacts of these severe droughts. The archival sources demonstrate how reduced vulnerability resulting from societal and cultural changes in the early 20th century helped prevent the loss of life experienced during comparable severe droughts at the end of the 19th century (1887 and 1891). Incorporating a longer temporal perspective to drought analysis shows that onset is often earlier than is documented explicitly within the archives, and so combined SPI series for a region could provide an early warning of drought development expressed as a water deficit in the previous year. Analysis of archival data provides a rich historical description of impacts and societal responses to severe drought. The archives provide a rich historical description of drought impacts and responses at the personal and community level whilst also detailing the different roles played by communities, state and international organizations in responding to events.

To date few studies have reconstructed weather from personal diaries. In this paper, we consider different methods of indexing daily weather information, specifically precipitation, from eighteenth and nineteenth century personal diaries. We examine whether there is a significant correlation between indexed weather information and local instrumental records for the period, thereby assessing the potential of discursive materials in reconstructing precipitation series. We demonstrate the potential for the use of diaries that record weather incidentally rather than as the primary purpose, and the value and utility of diaries which cover short periods when used alongside nearby contemporary diaries. We show that using multiple overlapping personal diaries can help to produce a more objective record of the weather, overcoming some of the challenges of working with qualitative data. This paper demonstrates indices derived from such qualitative sources can create valuable records of precipitation. There is the potential to repeat the methodology described here using earlier material, or material from further away from extant instrumental records, thereby addressing spatial and temporal gaps in current knowledge globally.

The English Lake District has experienced a number of recent devastating flood events (2005, 2009, 2015), without precedent in terms of magnitude during recent centuries. Climate projections for Northwest England have forecast intensification in frequency and magnitude of extreme precipitation, calling for a review of current catchment management practices. Flood hazard management requires precise estimates of extreme flood magnitude and frequency to better inform estimates of future risk, but are challenged by the short duration of river gauging data that often fails to capture the rarer, high magnitude events. Methodological developments increasingly permit the high-resolution analysis of palaeoflood frequency and magnitude from lake sediments; but development of a regional database is challenged by the variable distribution of lakes. Conversely reservoirs were built extensively across the British uplands from the mid-eighteenth century and are more ubiquitous in their distribution. Attempts to reconstruct flood chronologies from reservoir sediments are limited, despite this broad distribution and there is a growing need to capture reservoir catchment histories to guide management of upland water resources. Better histories for reservoir catchment is needed, because though dam failures are rare recent examples (e.g. Whaley Bridge, Derbyshire, August 2019) highlight a paucity of hydrological data associated with these often aging structures. Here, we investigate the sediment records from Thirlmere reservoir (Cumbria) and assess their value as indicators for flood history. A 200-year flood chronology has been interpreted from high-resolution particle size analyses and geochemical ratios diagnostic of variations in sediment grain size alongside historical documentary evidence, and a chronology has been developed through 210Pb dating. We address the following questions:1) Is it possible to create a high-resolution flood chronology of a centennial timescale from reservoir sediments to better inform reservoir catchment management practices?2) How similar are reservoir-based flood reconstructions to data from nearby lakes and historical records?3) Do catchment landuse practices, for example mining activity, affect sediment delivery to the reservoir basins perturbing flood reconstruction?

This study reports data from field sampling of catchment and reservoir bed sediments undertaken in October 2013 in the Wala catchment, Jordan, and findings of geochemical analysis of the sediments. The primary aim of this study is to investigate the relationship between sediments from different locations within the catchment and those deposited within the reservoir. This is set within the overall context of an attempt to rationalise the use of modelling in a data-poor environment. Can targeted, limited acquisition of geochemical information within a logistically challenging environment add value to existing datasets in respect of ground truth for model predictions of sediment provenance within the catchment? Channel bed sediments were collected from sub-catchment outlets throughout the Wala catchment and shallow cores (c. 500 mm) extracted from three locations around the Wala reservoir. XRF and particle size analysis were performed on all samples and the data analysed in respect of mineralogical and pollutant geochemical signatures. Contrary to evidence from temperate lake studies, there was no strong record of discrete event-driven deposition at the Wala, likely due to reworking of sediments during high-flow recharge events following complete draw-down of the reservoir in the highly intermittent hydrological setting. Pollutant geochemistry shows variations consistent with patterns of land-use in the catchment, with levels of Pb, Co, Cu and Cr associated with urbanised regions in the north and west of the region. Sampled concentrations, particularly those of the reservoir sediments, are typically below thresholds for environmental health concern. However, combined with the modelled bias in flow and sediment inputs from this region (driven by asymmetric rainfall distribution), this emphasises a potential concern for future management of water quality and protection of groundwater during aquifer recharge.

Background Accurate assessment of functional capacity, a predictor of postoperative morbidity and mortality, is essential to improving surgical planning and outcomes. We assessed if all 12 items of the Duke Activity Status Index (DASI) were equally important in reflecting exercise capacity. Methods In this secondary cross-sectional analysis of the international, multicentre Measurement of Exercise Tolerance before Surgery (METS) study, we assessed cardiopulmonary exercise testing and DASI data from 1455 participants. Multivariable regression analyses were used to revise the DASI model in predicting an anaerobic threshold (AT) >11 ml kg−1 min−1 and peak oxygen consumption (VO2 peak) >16 ml kg−1 min−1, cut-points that represent a reduced risk of postoperative complications. Results Five questions were identified to have dominance in predicting AT>11 ml kg−1 min−1 and VO2 peak>16 ml.kg−1min−1. These items were included in the M-DASI-5Q and retained utility in predicting AT>11 ml.kg−1.min−1 (area under the receiver-operating-characteristic [AUROC]-AT: M-DASI-5Q=0.67 vs original 12-question DASI=0.66) and VO2 peak (AUROC-VO2 peak: M-DASI-5Q 0.73 vs original 12-question DASI 0.71). Conversely, in a sensitivity analysis we removed one potentially sensitive question related to the ability to have sexual relations, and the ability of the remaining four questions (M-DASI-4Q) to predict an adequate functional threshold remained no worse than the original 12-question DASI model. Adding a dynamic component to the M-DASI-4Q by assessing the chronotropic response to exercise improved its ability to discriminate between those with VO2 peak>16 ml.kg−1.min−1 and VO2 peak Conclusions The M-DASI provides a simple screening tool for further preoperative evaluation, including with cardiopulmonary exercise testing, to guide perioperative management.

There are concerns that recent climate change is altering the frequency and magnitude of river floods in an unprecedented way. Historical studies have identified flood-rich periods in the past half millennium in various regions of Europe. However, because of the low temporal resolution of existing datasets and the relatively low number of series, it has remained unclear whether Europe is currently in a flood-rich period from a long-term perspective. Here we analyse how recent decades compare with the flood history of Europe, using a new database composed of more than 100 high-resolution (sub-annual) historical flood series based on documentary evidence covering all major regions of Europe. We show that the past three decades were among the most flood-rich periods in Europe in the past 500 years, and that this period differs from other flood-rich periods in terms of its extent, air temperatures and flood seasonality. We identified nine flood-rich periods and associated regions. Among the periods richest in floods are 1560–1580 (western and central Europe), 1760–1800 (most of Europe), 1840–1870 (western and southern Europe) and 1990–2016 (western and central Europe). In most parts of Europe, previous flood-rich periods occurred during cooler-than-usual phases, but the current flood-rich period has been much warmer. Flood seasonality is also more pronounced in the recent period. For example, during previous flood and interflood periods, 41 per cent and 42 per cent of central European floods occurred in summer, respectively, compared with 55 per cent of floods in the recent period. The exceptional nature of the present-day flood-rich period calls for process-based tools for flood-risk assessment that capture the physical mechanisms involved, and management strategies that can incorporate the recent changes in risk., This work was supported by the ERC Advanced Grant ‘FloodChange’ project (no. 291152), the Horizon 2020 ETN ‘System Risk’ project (no. 676027), the DFG project FOR 2416, the FWF projects I 3174 and W1219-N22, the Spanish Agency of Science and FEDER/UE projects CGL2016-75475/R, CGL2017-86839-C3-1-R, CGL2016-75996-R and CTM2017-83655-C2-2-R, the ICREA Academia programme, and project CZ.02.1.01/0.0/0.0/16_019/0000797, Ministry of Education, Youth and Sports of the Czech Republic.

Globally, few precipitation records extend to the 18th century. The England Wales Precipitation (EWP) series is a notable exception with continuous monthly records from 1766. EWP has found widespread use across diverse fields of research including trend detection, evaluation of climate model simulations, as a proxy for mid‐latitude atmospheric circulation, a predictor in long‐term European gridded precipitation data sets, the assessment of drought and extremes, tree‐ring reconstructions and as a benchmark for other regional series. A key finding from EWP has been the multi‐centennial trends towards wetter winters and drier summers. We statistically reconstruct seasonal EWP using independent, quality‐assured temperature, pressure and circulation indices. Using a sleet and snow series for the UK derived by Profs. Gordon Manley and Elizabeth Shaw to examine winter reconstructions, we show that precipitation totals for pre‐1870 winters are likely biased low due to gauge under‐catch of snowfall and a higher incidence of snowfall during this period. When these factors are accounted for in our reconstructions, the observed trend to wetter winters in EWP is no longer evident. For summer, we find that pre‐1820 precipitation totals are too high, likely due to decreasing network density and less certain data at key stations. A significant trend to drier summers is not robustly present in our reconstructions of the EWP series. While our findings are more certain for winter than summer, we highlight (a) that extreme caution should be exercised when using EWP to make inferences about multi‐centennial trends, and; (b) that assessments of 18th and 19th Century winter precipitation should be aware of potential snow biases in early records. Our findings underline the importance of continual re‐appraisal of established long‐term climate data sets as new evidence becomes available. It is also likely that the identified biases in winter EWP have distorted many other long‐term European precipitation series., The trend towards wetter winters and drier summers in EWP can be explained by changes in measurement practice and data biases. For winter (Figure below), the timing of divergence aligns with the introduction of the Snowdon Pattern Rain Gauge in the UK around 1863. Given the widespread use of EWP across environmental and climate research, we expect that our findings will challenge understanding of multi‐centennial trends in precipitation in the UK. These changes in measurement practice are also likely to affect other long‐term precipitation records in north‐west Europe.

BACKGROUND: Elevated high-sensitivity troponin (hsTnT) after noncardiac surgery is associated with higher mortality, but the temporal relationship between early elevated troponin and the later development of noncardiac morbidity remains unclear. METHODS: Prospective observational study of patients aged ≥45 yr undergoing major noncardiac surgery at four UK hospitals (two masked to hsTnT). The exposure of interest was early elevated troponin, as defined by hsTnT >99th centile (≥15 ng L(−1)) within 24 h after surgery. The primary outcome was morbidity 72 h after surgery, defined by the Postoperative Morbidity Survey (POMS). Secondary outcomes were time to become morbidity-free and Clavien–Dindo ≥grade 3 complications. RESULTS: Early elevated troponin (median 21 ng L(−1) [16–32]) occurred in 992 of 4335 (22.9%) patients undergoing elective noncardiac surgery (mean [standard deviation, sd] age, 65 [11] yr; 2385 [54.9%] male). Noncardiac morbidity was more frequent in 494/992 (49.8%) patients with early elevated troponin compared with 1127/3343 (33.7%) patients with hsTnT

Physically based models are useful frameworks for testing intervention strategies designed to reduce elevated sediment loads in agricultural catchments. Evaluating the success of these strategies depends on model accuracy, generally established by a calibration and evaluation process. In this contribution, the physically based SHETRAN model was assessed in two similar U.K. agricultural catchments. The model was calibrated on the Blackwater catchment (18 km²) and evaluated in the adjacent Kit Brook catchment (22 km²) using 4 years of 15 min discharge and suspended sediment flux data. Model sensitivity to changes in single and multiple combinations of parameters and sensitivity to changes in digital elevation model resolution were assessed. Model flow performance was reasonably accurate with a Nash–Sutcliffe efficiency coefficient of 0.78 in Blackwater and 0.60 in Kit Brook. In terms of event prediction, the mean of the absolute percentage of difference (μAbsdᵢff) between measured and simulated flow volume (Qv), peak discharge (Qp), sediment yield (Sy), and peak sediment flux (Sp) showed larger values in Kit Brook (48% [Qv], 66% [Qp], 298% [Sy], and 438% [Sp]) compared with the Blackwater catchment (30% [Qv], 41% [Qp], 106% [Sy], and 86% [Sp]). Results indicate that SHETRAN can produce reasonable flow prediction but performs less well in estimation of sediment flux, despite reasonably similar hydrosedimentary behaviour between catchments. The sensitivity index showed flow volume sensitive to saturated hydraulic conductivity and peak discharge to the Strickler coefficient; sediment yield was sensitive to the overland flow erodibility coefficient and peak sediment flux to raindrop/leaf soil erodibility coefficient. The multiparameter sensitivity analysis showed that different combinations of parameters produced similar model responses. Model sensitivity to grid resolution presented similar flow volumes for different digital elevation model resolutions, whereas event peak and duration (for both flow and sediment flux) were highly sensitive to changes in grid size.

Concern is growing that climate change may amplify global flood risk but short hydrological data series hamper hazard assessment. Lake sediment reconstructions are capturing a fuller picture of rare, high-magnitude events but the UK has produced few lake palaeoflood records. We report the longest lake-derived flood reconstruction for the UK to date, a 1500-year record from Brotherswater, northwest England. Its catchment is well-suited physiographically to palaeoflood research, but its homogeneous, dark brown sediment matrix precludes visual identification of flood layers. Instead, an outlier detection routine applied to high-resolution particle size measurements showed a >90% match, in stratigraphic sequence, to measured high river flows. Our late-Holocene palaeoflood reconstruction reveals nine multi-decadal periods of more frequent flooding (510–630 CE, 890–960, 990–1080, 1470–1560, 1590–1620, 1650–1710, 1740–1770, 1830–1890 and 1920–2012), and these show a significant association with negative winter North Atlantic Oscillation (wNAO) phasing and some synchrony with solar minima. These flood-rich episodes also overlap with local and regional land-use intensification, which we propose has amplified the flood signal by creating a more efficient catchment sediment conveyor and more rapid hillslope-channel hydrological connectivity. Disentangling anthropogenic and climatic drivers is a challenge but anthropogenic landscape transformation should evidently not be underestimated in palaeoflood reconstructions. Our paper also demonstrates that flood histories can be extracted from the numerous lakes worldwide containing organic-rich, visually homogeneous sediments. This transformative evidence base should lead to more reliable assessments of flood frequency and risks to ecosystems and infrastructure.

Contact tracing is a key part of tuberculosis prevention and care, aiming to hasten diagnosis and prevent transmission. The proportion of case-contact pairs for which recent transmission occurred and the typical timespans between the index case and their contact accessing care are not known; we aimed to calculate these. We analysed individual-level TB contact tracing data, collected in London from 20/01/2011-31/12/2015, linked to tuberculosis surveillance and MIRU-VNTR 24-locus strain-typing information. Of pairs of index cases and contacts diagnosed with active tuberculosis, 85/314 (27%) had strain typing data available for both. Of these pairs, 79% (67/85) shared indistinguishable isolates, implying probable recent transmission. Of pairs in which both contact and the index case had a social risk factor, 11/11 (100%) shared indistinguishable isolates, compared to 55/75 (75%) of pairs in which neither had a social risk factor (P = 0.06). The median time interval between the index case and their contact accessing care was 42 days (IQR: 16, 96). As over 20% of pairs did probably not involve recent transmission between index case and contact, the effectiveness of contact tracing is not necessarily limited to those circumstances where the index case has transmitted disease to their close contacts.

Historical data sources are used by a wide variety of disciplines, but rarely do they look outside their particular research fields at how others are using and applying historical data. The use and application of historical data has grown rapidly over the last couple of decades within the meteorological, geophysical and hydrological disciplines, but have done so relatively independently. By coevolving, each discipline has developed separate themes or areas, with varying degrees of uptake beyond their academic communities. We find that whilst the geophysical discipline has been relatively successful in engaging with international policymakers and stakeholders, this has not been reflected within the meteorological or hydrological disciplines to date. This disparity has occurred for a variety of reasons, including varying scales of disaster and social, political and cultural structures. In examining current developments within the disciplines, evidence suggests that this disparity is lessening, as each are using online databases and some citizen science, but that they continue to evolve independently with little unifying structure or purpose. This continued autonomy makes multi-hazard analysis challenging which, considering the potential that historical datasets present in the emerging field of multi-hazards analysis, is a considerable hindrance to this field of research. In looking forward, opportunities emerge for improved understanding of the risks presented to societies by natural hazards in the past, but also for examining how resilience, behaviour and adaptation alter during periods of repose.