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Flood-prone people and decision-makers are often unwilling to discuss and prepare for exceptional events, as such events are hard to perceive and out of experience for most people. Once an exceptional flood occurs, affected people and decision-makers are able to learn from this event. However, this learning is often focussed narrowly on the specific disaster experienced, thus missing an opportunity to explore and prepare for even more severe, or different, events. We propose spatial counterfactual floods as a means to motivate society to discuss exceptional events and suitable risk management strategies. We generate a set of extreme floods across Germany by shifting observed rainfall events in space and then propagating these shifted fields through a flood model. We argue that the storm tracks that caused past floods could have developed several tens of km away from the actual tracks. The set of spatial counterfactual floods generated contains events which are more than twice as severe as the most disastrous flood since 1950 in Germany. Moreover, regions that have been spared from havoc in the past should not feel safe, as they could have been badly hit as well. We propose spatial counterfactuals as a suitable approach to overcome society's unwillingness to think about and prepare for exceptional floods expected to occur more frequently in a warmer world.

Pedo-transfer functions (PTFs) relate soil/landscape static properties to a wide range of model inputs (e.g., soil hydraulic parameters) that are essential to soil hydrological modeling. Combining PTFs and hydrological models is a powerful strategy allowing the use of soil/landscape static properties for the generalization of large-scale modeling. However, since the spatial scales of soil hydraulic parameters required for model inputs and soil/landscape static properties are often not identical, cross-scale transfer is required, which can be a significant source of errors. Here, we investigate uncertainties in cross-scale transfer and develop an approach that avoids them. The proposed method uses the convolutional neural network (CNN) as a cross-scale transfer approach to directly map soil/landscape static properties to soil hydraulic parameters across different spatial scales. The proposed CNN approach is applied under two different estimation strategies to invert the hydraulic parameters of a soil-water balance model and subsequently the quality of the parameters is assessed. Both synthetical and real-world results around the conterminous United States indicate that in general the employed end-to-end strategy is superior to the two-step strategy. The CNN-based integrated model successfully reduces potential errors in cross-scale transfer and can be applied to other areas lacking information on hydraulic parameters or observations. The proposed method can be extended to improve parameter estimation in earth system models and enhance our understanding of key hydrological processes.

Optimization of spatially consistent parameter fields is believed to increase the robustness of parameter estimation and its transferability to ungauged basins. The current paper extends previous multi-objective and transferability studies by exploring the value of both multi-basin and spatial pattern calibration of distributed hydrologic models as compared to single-basin and single-objective model calibrations, with respect to tradeoffs, performance and transferability. The mesoscale Hydrological Model (mHM) is used across six large central European basins. Model simulations are evaluated against streamflow observations at the basin outlets and remotely sensed evapotranspiration patterns. Several model validation experiments are performed through combinations of single- (temporal evaluation through discharge) and multi-objective (temporal and spatial evaluation through discharge and spatial evapotranspiration patterns) calibrations with holdout experiments saving alternating basins for model evaluation. The study shows that there are very minimal tradeoffs between spatial and temporal performance objectives and that a joint calibration of multiple basins using multiple objective functions provides the most robust estimations of parameter fields that perform better when transferred to ungauged basins. The study indicates that particularly the multi-basin calibration approach is key for robust parametrizations, and that the addition of an objective function tailored for matching spatial patterns of ET fields alters the spatial parameter fields while significantly improving the spatial pattern performance without any tradeoffs with discharge performance. In light of model equifinality, the minimal tradeoff between spatial and temporal performance shows that adding spatial pattern evaluation to the traditional temporal evaluation of hydrological models can assist in identifying optimal parameter sets.

Central Europe, including Germany, has faced exceptional multi-year terrestrial water storage (TWS) deficits since 2018, negatively impacting various sectors such as forestry, energy production, and drinking water supply. Currently, the understanding of the recovery dynamics behind such extreme events is limited, which hampers accurate water management decisions. We used a simulation of the mesoscale hydrological model (mHM) over the last 257 years (1766–2022) to provide the first long-term perspective on the dynamics of the TWS deficit recovery in Germany. The results show that severe TWS deficits surpassing a peak deficit of -42 mm (-15 km³) exhibit large variability in recovery times (3–31 months). The 2018–2021 TWS deficit period was unprecedented in terms of recovery time (31 months), mean intensity and the associated negative 30-year TWS trend. In recent decades, we identified increased evapotranspiration (E) fluxes that have impacted TWS dynamics in Germany. Increased E flux anomalies contributed to prolonged TWS recovery, given that the TWS deficit did not quickly recover through above-average precipitation (P). An extreme TWS deficit similar to that in 2018 was recovered by above-average P within three months in the winter of 1947–1948. Our research contributes to an improved understanding of the dynamics and drivers of TWS deficit recovery.

Flood-prone people and decision-makers are often unwilling to discuss and prepare for exceptional events, as such events are hard to perceive and out of experience for most people. Once an exceptional flood occurs, affected people and decision-makers are able to learn from this event. However, this learning is often focussed narrowly on the specific disaster experienced, thus missing an opportunity to explore and prepare for even more severe, or different, events. We propose spatial counterfactual floods as a means to motivate society to discuss exceptional events and suitable risk management strategies. We generate a set of extreme floods across Germany by shifting observed rainfall events in space and then propagating these shifted fields through a flood model. We argue that the storm tracks that caused past floods could have developed several tens of km away from the actual tracks. The set of spatial counterfactual floods generated contains events which are more than twice as severe as the most disastrous flood since 1950 in Germany. Moreover, regions that have been spared from havoc in the past should not feel safe, as they could have been badly hit as well. We propose spatial counterfactuals as a suitable approach to overcome society's unwillingness to think about and prepare for exceptional floods expected to occur more frequently in a warmer world.

The need to develop and provide integrated observation systems to better understand and manage global and regional environmental change is one of the major challenges facing Earth system science today. In 2008, the German Helmholtz Association took up this challenge and launched the German research infrastructure TERrestrial ENvironmental Observatories (TERENO). The aim of TERENO is the establishment and maintenance of a network of observatories as a basis for an interdisciplinary and long-term research programme to investigate the effects of global environmental change on terrestrial ecosystems and their socio-economic consequences. State-of-the-art methods from the field of environmental monitoring, geophysics, remote sensing, and modelling are used to record and analyze states and fluxes in different environmental disciplines from groundwater through the vadose zone, surface water, and biosphere, up to the lower atmosphere. Over the past 15 years we have collectively gained experience in operating a long-term observing network, thereby overcoming unexpected operational and institutional challenges, exceeding expectations, and facilitating new research. Today, the TERENO network is a key pillar for environmental modelling and forecasting in Germany, an information hub for practitioners and policy stakeholders in agriculture, forestry, and water management at regional to national levels, a nucleus for international collaboration, academic training and scientific outreach, an important anchor for large-scale experiments, and a trigger for methodological innovation and technological progress. This article describes TERENO’s key services and functions, presents the main lessons learned from this 15-year effort, and emphasises the need to continue long-term integrated environmental monitoring programmes in the future.

Accurate simulation of reservoirs has been a challenge for global hydrological models due to highly discontinuous water management and uncertainties in reservoir shape representation. In addition, at a global scale, it is crucial to consider those reservoirs that disrupt the downstream flow regime. We augment the mesoscale Hydrological Model with a newly developed lake module (LM) that incorporates an existing reservoir regulation scheme with non-consumptive demand predictions from random forest. We also evaluate the sensitivity of reservoir shape on streamflow and evaporation for three shape approximations of varying complexities. We tested the LM across 31 non-consumptive reservoirs covering an extensive range of hydroclimatic characteristics and demonstrate the applicability by using freely available global reservoir information. Streamflow simulations with reservoirs and model calibration show a median Kling-Gupta Efficiency improvement of +0.94 (calibration) and +0.77 (validation) when compared against model simulations without reservoirs and default parameter set. We find reservoir evaporation highly sensitive to reservoir shape with half-pyramid approximation consistently resulting in best fit at reservoirs with surveyed bathymetry. In contrast, the linear approximation (rectangular prism) produced a median bias of +114% relative to half-pyramid, for estimating evaporation, across all the reservoirs. Streamflow simulations were insensitive to the reservoir shape. Our analysis shows that 30% of the non-consumptive hydropower reservoirs of the GRanD data set are non-disruptive and can be excluded without loss to model realism. Further work is necessary for testing the regulation approach in reservoirs with consumptive water usage.

Despite considerable advances in flood forecasting during recent decades, state-of-the-art, operational flood early warning systems (FEWS) need to be equipped with near-real-time inundation and impact forecasts and their associated uncertainties. High-resolution, impact-based flood forecasts provide insightful information for better-informed decisions and tailored emergency actions. Valuable information can now be provided to local authorities for risk-based decision-making by utilising high-resolution lead-time maps and potential impacts to buildings and infrastructures. Here, we demonstrate a comprehensive floodplain inundation hindcast of the 2021 European Summer Flood illustrating these possibilities for better disaster preparedness, offering a 17-hour lead time for informed and advisable actions.

Contemporary initiatives such as the Digital Twins and paradigms like the Hyper-resolution Modeling are pushing the boundaries of high-performance computing, bringing resolutions of large-scale hydrological models (HM) down to sub-kilometer, in attempts of making "Locally Relevant Hydrological Models Everywhere" a reality. As global water models converge towards this hyper-resolution, we notice the insufficient attention given to model scalability i.e., consistent simulations across different resolutions using the same set of model parameters. Besides, the way distributed HMs have been resolving the stream network with grids requires high resolution model runs to offset the errors, especially at locations with smaller catchment area, hence the calling of the hyper-resolution modeling. We equip the mesoscale hydrological model (mHM, https://mhm-ufz.org) with a novel stream network upscaling scheme called subgrid catchment conservation or SCC. We hypothesize the conservation of the subgrid catchment area to have threefold effect in distributed HMs: 1) improvement in the consistency of model performance across modeling resolutions, 2) streamflow simulations become both plausible everywhere and locally relevant, and 3) the long-standing conundrum of streamflow estimation at multiple gauging stations within a grid cell will be solved. The experimental setup is a single modeling domain encompassing 187 GRDC streamflow stations in the Rhine river basin. The wide range of catchment sizes at the gauges (1 km2 to more than 150,000 km2), notable presence of proximate clusters of gauges, and good data availability (average availability of 30 years) makes Rhine an apt case for the hypotheses testing. We compare streamflow simulated by the SCC with the D8 stream network upscaling scheme, both with default parameter set. SCC shows remarkable streamflow scalability with nine out of 10 stations exceeding the mean flow benchmark across 1 km to 100 km model resolutions. In comparison

Climate change is altering the water cycle from the global to the local scale. The increase in temperatures and changing precipitation patterns intensify not only mean values, but also the frequency and severity of extreme weather events, leading to alterations in water availability and distribution. This study assesses the impact of climate change on flood patterns (maximum annual river discharge) in Germany. Climate models ranging from different spatial scales will be compared for the five largest German catchments outlets (including headwaters). The climate model ensembles from the EURO-CORDEX initiative, and the ICON climate model from the Destination Earth Initiative / NextGEMS project will be used along with the mHM (mhm-ufz.org) model. The river discharge values produced from the mHM model will be used to calculate the Q90 (90th percentile of daily discharge) and the Qmax (maximum annual discharge) parameters. Initial results from the EURO-CORDEX initiative predict a 5-15% reduction in Q90 and Qmax in the summer half year, and a 5-30% increase in Q90 and Qmax in the winter half year, in the alpine regions in Germany. In the Elbe and Oder catchments (north-eastern part of Germany) there in a greater increase in Q90 and Qmax in the summer half year than the winter half year. This increase becomes more prominent with increasing warming. However, there is a large spread in the ensemble predictions, with uncertainty reducing with increasing warming. These parameters and results will be compared with the results from the ICON climate model to understand the contribution of spatial and/or temporal resoltion towards flood prediction.

Este estudio, en el cual el solicitante es autor senior (útimo autor), estuvo encaminado a determinar si un protocolo de evaluación de enfermedad coronaria adaptado al riesgo basal en pacientes receptores de trasplante hepático, era capaz de atenuar el riesgo de enfermedad coronaria y en la supervivencia de pacientes trasplantados. El resultado fundamental de este estudio prospectivo fue que este protocolo (que comprende una evaluacion escalonada de la anatomía coronaria con intervenciones terapéuticas adaptadas) iguala la probabilidad de eventos cardiovasculares postrasplante con respecto a los pacientes de bajo riesgo. La aplicabilidad de este estudio es grande puesto que permite de forma protocolizada y adaptada a cada paciente la valoracion precisa del riesgo coronario, evitando exploraciones agresivas., The prevalence and management of coronary artery disease (CAD) in liver transplantation (LT) candidates are not well characterized. The aims of this study were to evaluate the impact on clinical outcomes of a specifically designed protocol for the management of asymptomatic CAD in LT candidates and to investigate noninvasive risk profiles for obstructive and nonobstructive CAD for 202 LT candidates. Those with high baseline cardiovascular risk (CVR; defined by the presence of classic CVR factors and/or decreased ejection fraction) received coronary angiography and significant arterial stenosis and were treated with percutaneous stents. Patients were followed up after LT until death or coronary event (CE). There were 78 patients who received coronary evaluation (62 direct angiography, 14 computed tomography coronary angiography, and 2 both). Of them, 39 (50%) patients had CAD of any severity, and 6 (7.7%) had significant lesions (5 were amenable to be treated with stents, whereas 1 patient had diffuse lesions which contraindicated the LT). Insulin-dependent diabetes was the only factor related to CAD of any severity (odds ratio, 3.44; 95% confidence interval [CI], 1.00-11.97). A total of 69 patients (46 with coronary evaluation) received LT. The incidence of CEs and overall survival after LT were similar between patients with and without coronary evaluation. Furthermore, no differences occurred between these groups in a multivariate competing risk model (subhazard ratio, 0.84; 95% CI, 0.27-2.61; P = 0.76). In conclusion, the application of an angiographic screening protocol of CAD in a selected high-risk Mediterranean population is safe and effective. The short- and medium-term incidence rates of CEs and death after LT in this population are similar to that observed in low-risk patients., Depto. de Medicina, Fac. de Medicina, TRUE, pub

Se trata de un artículo que describe, por primera vez en humanos, la seguridad y el impacto fisiopatológico de un nuevo dispositivo de soporte hepático artificial, diseñado específicamente para antagonizar los mecanismos fisiopatológicos de la cirrosis descompensada. El estudio , financiado mediante un proyecto europeo, indica que el dispositivo es seguro, aplicable, tiene influencia en los numerosos aspectos mecanísticos explorados y, finalmente, apuntando a datos de posible eficacia clínica. Globalmente, se puede considerar que el estudio es una evidente prueba de concepto positiva. Desde el punto de vista de la trascendencia social y sanitaria, si los estudios en fase III determinan la eficacia sobre variables clínicas, representaría una herramienta de gran valor para el tratamiento de pacientes con cirrosis y con fracaso hepático agudo sobre crónico. La revista Journal of Hepatology está en el primer decil de la especialidad con un FI de XXX. El investigador solicitante del sexenio es primer firmante del artículo habiendo participado en el diseño y ejecución del proyecto así como en la elaboración de los resultados y del manuscrito en todas sus fases. Representa además la continuacion en una línea de investigación con numerosas publicaciones previas (Banares R et al. Hepatology 2013; Saliba F, Bañares R et al. Intensive Care Medicine 2022), Background & Aims: Acute-on-chronic liver failure (ACLF) is characterized by severe systemic inflammation, multi-organ failure and high mortality rates. Its treatment is an urgent unmet need. DIALIVE is a novel liver dialysis device that aims to exchange dysfunctional albumin and remove damage- and pathogen-associated molecular patterns. This first-in-man randomizedcontrolled trial was performed with the primary aim of assessing the safety of DIALIVE in patients with ACLF, with secondary aims of evaluating its clinical effects, device performance and effect on pathophysiologically relevant biomarkers. Methods: Thirty-two patients with alcohol-related ACLF were included. Patients were treated with DIALIVE for up to 5 days and end points were assessed at Day 10. Safety was assessed in all patients (n = 32). The secondary aims were assessed in a prespecified subgroup that had at least three treatment sessions with DIALIVE (n = 30). Results: There were no significant differences in 28-day mortality or occurrence of serious adverse events between the groups. Significant reduction in the severity of endotoxemia and improvement in albumin function was observed in the DIALIVE group, which translated into a significant reduction in the CLIF-C (Chronic Liver Failure consortium) organ failure (p = 0.018) and CLIF-C ACLF scores (p = 0.042) at Day 10. Time to resolution of ACLF was significantly faster in DIALIVE group (p = 0.036). Biomarkers of systemic inflammation such as IL-8 (p = 0.006), cell death [cytokeratin-18: M30 (p = 0.005) and M65 (p = 0.029)], endothelial function [asymmetric dimethylarginine (p = 0.002)] and, ligands for Toll-like receptor 4 (p = 0.030) and inflammasome (p = 0.002) improved significantly in the DIALIVE group. Conclusions: These data indicate that DIALIVE appears to be safe and impacts positively on prognostic scores and pathophysiologically relevant biomarkers in patients with ACLF. Larger, adequately powered studies are warranted to further confi, Unión Europea, Depto. de Medicina, Fac. de Medicina, TRUE, pub

En este estudio, en el cual el solicitante es autor senior (último autor) se analizó, sobre la base de una gran cohorte internacional colaborativa, si los pacientes con enfermedad hepatica crónica agudizada (ACLF por su acrónimo inglés de Acute on Chronic liver failure) presentaban peor pronóstico de la hemorragia aguda por varices esofágicas y si era factible, en términos de seguridad y eficacia la realizacion de una derivacion portosistémica percutánea intrahepática (TIPS). En el estudio, se demuestra que el pronóstico de la hemorragia en estos pacientes es marcadamente peor que en los pacientes sin ACLF y que, a pesar de una mayor mortalidad que en los pacientes sin ACLF, la realización del TIPS mejora la supervivencia de la hemorragia aguda por varices en pacientes con ACLF. El estudio sustenta claramente la posibilidad y el beneficio terapéutico del TIPS en estos enfermos, respondiento a una pregunta de gran trascendencia en el tratamiento de estos complejos pacientes. Desde el punto de vista de las líneas de investigación del solicitante, el articulo supone una contribución más a esta tradicional línea, fundamental en su carrera investigadora., Background & aims: The relationship between acute-on-chronic liver failure (ACLF) and acute variceal bleeding (AVB) is poorly understood. Specifically, the prevalence and prognosis of ACLF in the context of AVB is unclear, while the role of transjugular intrahepatic portosystemic shunt (TIPS) in the management in patients with ACLF has not been described to date. Methods: A multicenter, international, observational study was conducted in 2,138 patients from 34 centers between 2011 and 2015. ACLF was defined and graded according to the EASL-CLIF consortium definition. Placement of pre-emptive TIPS (pTIPS) was based on individual center policy. Patients were followed-up for 1 year, until death or liver transplantation. Cox regression and competing risk models (Gray's test) were used to identify independent predictors of rebleeding or mortality. Results: At admission, 380/2,138 (17.8%) patients had ACLF according to EASL-CLIF criteria (grade 1: 38.7%; grade 2: 39.2%; grade 3: 22.1%). The 42-day rebleeding (19% vs. 10%; p <0.001) and mortality (47% vs. 10%; p <0.001) rates were higher in patients with ACLF and increased with ACLF grades. Of note, the presence of ACLF was independently associated with rebleeding and mortality. pTIPS placement improved survival in patients with ACLF at 42 days and 1 year. This effect was also observed in propensity score matching analysis of 66 patients with ACLF, of whom 44 received pTIPs and 22 did not. Conclusions: This large multicenter international real-life study identified ACLF at admission as an independent predictor of rebleeding and mortality in patients with AVB. Moreover, pTIPS was associated with improved survival in patients with ACLF and AVB. Lay summary: Acute variceal bleeding is a deadly complication of liver cirrhosis that results from severe portal hypertension. This study demonstrates that the presence of acute-on-chronic liver failure (ACLF) is the strongest predictor of mortality in patients with acute variceal ble, Depto. de Medicina, Fac. de Medicina, TRUE, pub