The challenge of unprecedented floods and droughts in risk management.

Risk management has reduced vulnerability to floods and droughts globally1,2, yet their impacts are still increasing3. An improved understanding of the causes of changing impacts is therefore needed, but has been hampered by a lack of empirical data4,5. On the basis of a global dataset of 45 pairs of events that occurred within the same area, we show that risk management generally reduces the impacts of floods and droughts but faces difficulties in reducing the impacts of unprecedented events of a magnitude not previously experienced. If the second event was much more hazardous than the first, its impact was almost always higher. This is because management was not designed to deal with such extreme events: for example, they exceeded the design levels of levees and reservoirs. In two success stories, the impact of the second, more hazardous, event was lower, as a result of improved risk management governance and high investment in integrated management. The observed difficulty of managing unprecedented events is alarming, given that more extreme hydrological events are projected owing to climate change3.

Changing climate both increases and decreases European river floods.

Climate change has led to concerns about increasing river floods resulting from the greater water-holding capacity of a warmer atmosphere1. These concerns are reinforced by evidence of increasing economic losses associated with flooding in many parts of the world, including Europe2. Any changes in river floods would have lasting implications for the design of flood protection measures and flood risk zoning. However, existing studies have been unable to identify a consistent continental-scale climatic-change signal in flood discharge observations in Europe3, because of the limited spatial coverage and number of hydrometric stations. Here we demonstrate clear regional patterns of both increases and decreases in observed river flood discharges in the past five decades in Europe, which are manifestations of a changing climate. Our results-arising from the most complete database of European flooding so far-suggest that: increasing autumn and winter rainfall has resulted in increasing floods in northwestern Europe; decreasing precipitation and increasing evaporation have led to decreasing floods in medium and large catchments in southern Europe; and decreasing snow cover and snowmelt, resulting from warmer temperatures, have led to decreasing floods in eastern Europe. Regional flood discharge trends in Europe range from an increase of about 11 per cent per decade to a decrease of 23 per cent. Notwithstanding the spatial and temporal heterogeneity of the observational record, the flood changes identified here are broadly consistent with climate model projections for the next century4,5, suggesting that climate-driven changes are already happening and supporting calls for the consideration of climate change in flood risk management.

Isolation of clade 2.3.4.4b A(H5N8), a highly pathogenic avian influenza virus, from a worker during an outbreak on a poultry farm, Russia, December 2020.

This study presents the isolation of influenza A(H5N8) virus clade 2.3.4.4b from a poultry worker during an outbreak of highly pathogenic avian influenza A(H5N8) among chickens at a poultry farm in Astrakhan, Russia in December 2020. Nasopharyngeal swabs collected from seven poultry workers were positive for influenza A(H5N8), as confirmed by RT-PCR and sequencing. The influenza A(H5N8) virus was isolated from one of the human specimens and characterised. Sporadic human influenza A(H5)2.3.4.4. infections represent a possible concern for public health.

Mercury in the Barents region - River fluxes, sources, and environmental concentrations.

Arctic rivers are receiving increased attention for their contributing of mercury (Hg) to the Arctic Ocean. Despite this, the knowledge on both the terrestrial release sources and the levels of Hg in the rivers are limited. Within the Arctic, the Barents region has a high industrial development, including multiple potential Hg release sources. This study presents the first overview of potential Hg release sources on Norwegian and Russian mainland draining to the Barents Sea. Source categories cover mining and metallurgy industry; historical pulp and paper production; municipal and industrial solid waste handling; fossil fuel combustion; and past military activities. Available data on Hg in freshwater bodies near the identified potential release sources are reviewed. Levels of Hg were occasionally exceeding the national pollution control limits, thereby posing concern to the local human population and wildlife. However, the studies were sparse and often unsystematic. Finally, we present new data of Hg measured in five Barents rivers. These data reveal strong seasonality in the Hg levels, with a total annual flux constituting 2% of the panarctic total. With this new insight we aspire to contribute to the international efforts of reducing Hg pollution, such as through the effective implementation of the Minamata Convention. Future studies documenting Hg in exposed Barents freshwater bodies are warranted.

Assessment of seasonal variability of input of microplastics from the Northern Dvina River to the Arctic Ocean.

Northern Dvina River is one of the largest rivers in the European Arctic flowing into the White Sea through the populated regions with developed industry. Floating plastics include microplastics (0.5-5 mm) and mesoplastics (5-25 mm) were observed on seasonal variations in the Northern Dvina River mouth. The samples were collected every month from September to November 2019 and from May to October 2020 with a Neuston net that was togged 3 nautical miles in the Korbel'nyy Branch of the River delta. Chemical composition of the plastic particles was determined using a Fourier transmission infrared spectrometer. The majority of the microplastics were identified as polyethylene 52.6%, followed by polypropylene 36.8%. After estimating the export fluxes of microplastics from the Northern Dvina River to the Arctic, there is no significant seasonal variation of the river export of microplastics. The microplastics export rate during the spring flood period in May turned out to be maximum, 58 items/s, while the minimum discharge was in September with a value of 9 items/s. The average weight concentration of microplastics was 18.5 µg/m3, which is higher than it was found in the Barents Sea - 12.5 µg/m3 and several times higher than in the Eurasian Arctic on average - 3.7 µg/m3. These results indicate that the Northern Dvina River is being one of the main sources of microplastic pollution of the White and the Barents Seas.

A database of water chemistry in eastern Siberian rivers.

Permafrost degradation leads to considerable changes in river ecosystems. The Eastern Siberian River Chemistry (ESRC) database was constructed to create a spatially extensive river chemistry database to assess climate warming-induced changes in freshwater systems in permafrost-dominated eastern Siberia. The database includes 9487 major ion (Na+, K+, Ca2+, Mg2+, Cl-, SO42- and HCO3-) data of chemical results from 1434 water samples collected mainly in six large river basins in eastern Siberia spanning 1940-2019. Data were obtained from public databases, scientific literature in English and Russian, and researchers and were formatted with a consistent table structure. The database is transparent and reproducible. Climate variable (air temperature and precipitation) data, discharge data, trace element concentration data, and isotope data at the basin and subbasin scales are also provided. This database enhances knowledge about the water chemistry of the permafrost region, especially in eastern Siberia, where data are scarce. The database will be useful to those assessing spatiotemporal changes in river water chemistry associated with permafrost degradation or other environmental stressors in a warmer climate.

Global trends in water and sediment fluxes of the world's large rivers.

Water and sediment transport from rivers to oceans is of primary importance in global geochemical cycle. Against the background of global change, this study examines the changes in water and sediment fluxes and their drivers for 4307 large rivers worldwide (basin area ≥1000 km2) based on the longest available records. Here we find that 24% of the world's large rivers experienced significant changes in water flux and 40% in sediment flux, most notably declining trends in water and sediment fluxes in Asia's large rivers and an increasing trend in suspended sediment concentrations in the Amazon River. In particular, nine binary patterns of changes in water-sediment fluxes are interpreted in terms of climate change and human impacts. The change of precipitation is found significantly correlated to the change of water flux in 71% of the world's large rivers, while dam operation and irrigation rather control the change of sediment flux in intensively managed catchments. Globally, the annual water flux from rivers to sea of the recent years remained stable compared with the long-time average annual value, while the sediment flux has decreased by 20.8%.

Changing climate shifts timing of European floods.

A warming climate is expected to have an impact on the magnitude and timing of river floods; however, no consistent large-scale climate change signal in observed flood magnitudes has been identified so far. We analyzed the timing of river floods in Europe over the past five decades, using a pan-European database from 4262 observational hydrometric stations, and found clear patterns of change in flood timing. Warmer temperatures have led to earlier spring snowmelt floods throughout northeastern Europe; delayed winter storms associated with polar warming have led to later winter floods around the North Sea and some sectors of the Mediterranean coast; and earlier soil moisture maxima have led to earlier winter floods in western Europe. Our results highlight the existence of a clear climate signal in flood observations at the continental scale.

Sleep Quality and Factors Influencing Self-Reported Sleep Duration and Quality in the General Internal Medicine Inpatient Population.

BACKGROUND: Sleep quality in hospitalized Canadian General Internal Medicine patients is not well characterized. Our goals were to characterize hospital sleep quality in this population and identify potentially modifiable barriers to good sleep. METHODS: GIM inpatients at a quaternary centre in Edmonton, Canada completed a survey, including the Verran-Snyder Halpern (VSH) questionnaire, to characterize the previous night's sleep within 48 hours prior to discharge. A chart review was also completed to assess comorbidities, discharge diagnoses, and pharmaceutical sleep aid use. RESULTS: Patients reported significantly worse nighttime sleep duration in hospital compared with home (mean 5.5 versus 7.0 hours per night, p < 0.0001). Sleep quality was poor, as measured by the VSH disturbance (mean 371), effectiveness (190), and supplementation (115) subscales. Variables independently associated with poorer sleep duration in multivariable regression include prior diagnosis of sleep disorder and multi-patient occupancy rooms. Age, sex, admitting diagnosis, length of stay, frequency of vital checks, and use of sleep pharmaceuticals during the index hospitalization were not associated with sleep duration. The most frequently reported reasons for poor sleep included noise (59%), nursing interruptions (30%), uncomfortable beds (18%), bright lights (16%), unfamiliar surroundings (14%), and pain (9%). CONCLUSIONS: Sleep quality for GIM inpatients is significantly worse in hospital than at home. There is a need to test non-pharmacologic interventions to address the most frequently identified factors causing poor sleep hygiene for GIM inpatients.

Improving residents' handovers through just-in-time training for structured communication.

In a recent quality assurance project we learned that nearly half of the handovers we examined were characterized as unsatisfactory by our residents, who provided examples in which their anxiety had been piqued and patient care had been affected. These reports substantiated a growing body of literature on the relationship between the quality of handover and the quality of patient care, so we sought to improve the quality and consistency of the in-hosptial handovers undertaken by our internal medicine residents. Senior residents attended morning report for three consecutive month long blocks and evaluated the quality of the handovers using an observational protocol comprised of 16 aspects of effective handover. During the first block, the resident observed a median of eight of the 16 practices occurring across the 46 handovers, and a large amount of variability. At the beginning of the subsequent block we presented a concise introduction to a structured handover procedure (SBARR). The median quality of the subsequent 33 handovers rose to 11, and the variability decreased considerably. In the next block we refined the SBARR orientation to focus on the errors observed in the previous blocks, and the improvement in the quality and variability was sustained. The minor change, which requires few resources to sustain, had a favourable impact on the quality of our residents' in-hospital handovers.

Assessing the use of international classification of diseases-10th revision codes from the emergency department for the identification of acute heart failure.

OBJECTIVES: The objective of this study was to compare administrative codes with chart review for patients with acute heart failure (AHF). BACKGROUND: Administrative databases are used in population health research; however, the validity of codes in the emergency department (ED) for AHF compared with chart review is uncertain. METHODS: A cohort of 952 patients with suspected AHF were prospectively recruited from 4 EDs in Edmonton, Alberta, Canada, from 2009 to 2012. Patients had their diagnoses adjudicated by expert physicians using a standardized scoring system and detailed chart review. ED and hospital discharge International Classification of Diseases-10th Revision (ICD-10) codes were captured in the main diagnosis or in any diagnostic field. RESULTS: The 897 patients had a median age of 77 years (interquartile range: 67 to 85 years), and 806 (90%) were admitted to the hospital. Overall, 809 patients (90.2%) had AHF by adjudication and 660 (73.6%) had ICD-10 code I50.x as a main diagnosis in the ED administrative data, respectively. The positive predictive value of an AHF main diagnosis in the ED administrative data was 93.3% (95% confidence interval [CI]: 92.0% to 94.7%), with sensitivity of 76.1% (95% CI: 75.0% to 77.2%) and specificity of 50.0% (95% CI: 39.8% to 60.1%). The positive predictive value for AHF in any diagnostic field of the ED administrative data was 92.0% (95% CI: 91.1% to 93.0%), with a sensitivity of 89.4% (95% CI: 88.5% to 90.4%) and specificity of 28.4% (95% CI: 20.1% to 37.9%). CONCLUSIONS: An ICD-10 I50.x diagnosis in the ED is highly predictive of AHF compared with chart-level adjudication using a validated score. Thus, the use of these codes in ED administrative databases could identify AHF for clinical and epidemiological studies.