Gully and Stream Bank Toolbox. A technical guide for gully and stream bank erosion control programs in Great Barrier Reef catchments

This Toolbox is a guide to targeting, designing and implementing gully and stream bank erosion control activities in Great Barrier Reef (GBR) catchments. This third edition builds on 7 years of implementing these activities in multiple programs and it aims to inform the ongoing efforts to reduce the amount of fine sediment and associated nutrients delivered to the GBR lagoon. Sub‑soil erosion, predominantly from gullies and stream banks, contributes the vast bulk of the fine sediment load delivered to the GBR. The large area and extensive erosion in GBR catchments, and the limited resources available, make it important for erosion control to be targeted to cost‑effective sites and implemented using best practice based on best available information. Landholder support and site maintenance increase the likelihood that sediment reductions will persist over the long term

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial

Background: Intensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) with that of guideline-based antiplatelet therapy.Methods: We did an international, prospective, randomised, open-label, blinded-endpoint trial in adult participants with ischaemic stroke or transient ischaemic attack (TIA) within 48 h of onset. Participants were assigned in a 1:1 ratio using computer randomisation to receive loading doses and then 30 days of intensive antiplatelet therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily) or guideline-based therapy (comprising either clopidogrel alone or combined aspirin and dipyridamole). Randomisation was stratified by country and index event, and minimised with prognostic baseline factors, medication use, time to randomisation, stroke-related factors, and thrombolysis. The ordinal primary outcome was the combined incidence and severity of any recurrent stroke (ischaemic or haemorrhagic; assessed using the modified Rankin Scale) or TIA within 90 days, as assessed by central telephone follow-up with masking to treatment assignment, and analysed by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN47823388.Findings: 3096 participants (1556 in the intensive antiplatelet therapy group, 1540 in the guideline antiplatelet therapy group) were recruited from 106 hospitals in four countries between April 7, 2009, and March 18, 2016. The trial was stopped early on the recommendation of the data monitoring committee. The incidence and severity of recurrent stroke or TIA did not differ between intensive and guideline therapy (93 [6%] participants vs 105 [7%]; adjusted common odds ratio [cOR] 0·90, 95% CI 0·67–1·20, p=0·47). By contrast, intensive antiplatelet therapy was associated with more, and more severe, bleeding (adjusted cOR 2·54, 95% CI 2·05–3·16,

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Capture of overland flow by a tree belt on a pastured hillslope in south-eastern Australia

We describe a rainfall simulator experiment designed to measure the capture, by a fenced tree belt, of excess water generated as Hortonian flow from a pasture slope. Three rainfall events (48, 49, and 75 mm/h for 13, 30, and 30 min, respectively) were applied, of which 15%, 29%, and 44%, respectively, ran off and drained onto the tree belt. The tree belt captured 100%, 32–68%, and 0–28% of the runoff from the 3 events, respectively. These captured runoff volumes represented 31–39%, 22–45%, and 0–29% increases in water supply to the trees, in addition to incident rainfall. Infiltration rates within the tree belt were up to 46% higher than in the pasture zone. This higher infiltration was mainly attributed to better soil surface conditions in the absence of stock and a 50-mm layer of tree litter. Overland flows within the tree belt formed tree litter into microterraces, which spread and slowed flows and allowed greater time for infiltration

Quantifying diffuse pathways for overland flow between the roads and streams of the mountain ash forests of central Victoria Australia

Limiting connectivity between road runoff sources and stream networks is crucial for preservation of water quality in forested environments. Where flow is non-eroding, the length of hillslope available to accommodate volumes of discharged water is the key to restricting connectivity. Hairsine et al. (2002, Hydrological Processes 16: 2311–2327) proposed a probabilistic model of diffuse overland flow that predicted the hillslope lengths required to infiltrate road discharge, based on the concept of volume to breakthrough (Vbt). This paper extends this analysis to a different forest environment with the aim of testing the portability of the Hairsine et al. (2002) model. The volume of flow required to travel overland to a distance of 5 and 10 m (Vbt5 and Vbt10) from drainage outlets was measured in deep, highly conductive mountain soils in the Upper Tyers catchment, Victoria, Australia. Rainfall, hydraulic conductivity and soil depths contrasted markedly with those in the Hairsine et al. (2002) study, and represent an extreme in Australian forests. Statistical analyses revealed the population of Vbt5 to be indistinguishable from that observed by Hairsine et al. (2002), indicating the model is valid for a range of forest soils. There was no significant correlation of sediment plume length with site characteristics such as slope, width of flow, or existence of incised pathways. It is suggested there are universal properties of pathways draining tracks and roads, with bioturbation acting to restore available pore spaces filled by antecedent plumes. Drain discharge design criteria may be developed for local conditions using the Hairsine et al. (2002) model, providing a robust tool for protection of water quality in the siting of new forest roads, and maintenance of exiting roads and tracks

Quantifying diffuse pathways for overland flow between the roads and streams of the Mountain Ash forests of central Victoria Australia

Limiting connectivity between road runoff sources and stream networks is crucial for preservation of water quality in forested environments. Where flow is non-eroding, the length of hillslope available to accommodate volumes of discharged water is the key to restricting connectivity. Hairsine et al. (2002, Hydrological Processes 16: 2311–2327) proposed a probabilistic model of diffuse overland flow that predicted the hillslope lengths required to infiltrate road discharge, based on the concept of volume to breakthrough (Vbt). This paper extends this analysis to a different forest environment with the aim of testing the portability of the Hairsine et al. (2002) model. The volume of flow required to travel overland to a distance of 5 and 10 m (Vbt5 and Vbt10) from drainage outlets was measured in deep, highly conductive mountain soils in the Upper Tyers catchment, Victoria, Australia. Rainfall, hydraulic conductivity and soil depths contrasted markedly with those in the Hairsine et al. (2002) study, and represent an extreme in Australian forests. Statistical analyses revealed the population of Vbt5 to be indistinguishable from that observed by Hairsine et al. (2002), indicating the model is valid for a range of forest soils. There was no significant correlation of sediment plume length with site characteristics such as slope, width of flow, or existence of incised pathways. It is suggested there are universal properties of pathways draining tracks and roads, with bioturbation acting to restore available pore spaces filled by antecedent plumes. Drain discharge design criteria may be developed for local conditions using the Hairsine et al. (2002) model, providing a robust tool for protection of water quality in the siting of new forest roads, and maintenance of exiting roads and tracks

Gully and Stream Bank Toolbox. A technical guide for gully and stream bank erosion control programs in Great Barrier Reef catchments

This Toolbox is a guide to targeting, designing and implementing gully and stream bank erosion control activities in Great Barrier Reef (GBR) catchments. This third edition builds on 7 years of implementing these activities in multiple programs and it aims to inform the ongoing efforts to reduce the amount of fine sediment and associated nutrients delivered to the GBR lagoon. Sub‑soil erosion, predominantly from gullies and stream banks, contributes the vast bulk of the fine sediment load delivered to the GBR. The large area and extensive erosion in GBR catchments, and the limited resources available, make it important for erosion control to be targeted to cost‑effective sites and implemented using best practice based on best available information. Landholder support and site maintenance increase the likelihood that sediment reductions will persist over the long term