Spain, Water and Climate Change in COP 15 and Beyond: Aligning Mitigation and Adaptation through Innovation

The water/energy nexus opens a range of opportunities to align mitigation and adaptation framed by human security, which prioritises human development. In this context, Spain has an opportunity to play a leading role in realising this potential by pursuing a coherent multilevel strategy specifically designed for water and climate variability and change

Uncertainty in Climate Change

This Working Paper reviews the main reasons why definite and conclusive evidence in the field of climate change is almost an impossibility. It analyses the main elements that explain natural climatic change and reflects on the high level of uncertainty in the system, which in many ways is inherent to the system itself, and presents the latest evidence. The following section presents in a stylised fashion the key features of uncertainty and how it relates to climate change. Then, an analysis of how GHG have been measured is followed by a discussion of the different GHG, natural and human-induced events that have a significant bearing on climate change. The Working Paper concludes with an overview of past, present and future climate change and with a summary of the main ideas discussed throughout the text

Conjunctive Management Through Collective Action

This chapter focuses on the interaction between conjunctive management and collective action. Collective action has several characteristics that provide a natural ‘fit’ with conjunctive management. These include building trust and ownership to enhance water user’s acceptance of the need for better and more integrated management and resolving conflict and facilitating trade-offs between and across water users. But what are the opportunities and challenges for conjunctive management through collective action? And what types of settings encourage broadbased collective action by water users and governments? These questions are addressed through a comparative analysis of specific instances of groundwater governance in Australia, Spain, and the western United States of America. For each case, the diverse policy and institutional settings are explained, and consideration given to the motivators for, and successes of, conjunctive management and collective action. The chapter draws comparisons across the cases to suggest lessons on incentives for conjunctive management, as well as exploring its challenges, before identifying future directions for more effective integrated water management.This research was partially funded by an ARC Discovery Early Career Researcher Award (DE140101216) and an ARC Linkage Grant (LP130100967)

State of the art and latest advances in exploring business models for nature-based solutions

Nature-based solutions (NBS) offer multiple solutions to urban challenges simultaneously, but realising funding for NBS remains a challenge. When the concept of NBS for societal challenges was first defined by the EC in 2017, financing was recognised as one of the major challenges to its mainstreaming. The complexity of NBS finance has its origin in the multiple benefits/stakeholders involved, which obscures the argument for both public and private sector investment. Since 2017, subsequent waves of EU research-and innovation-funded projects have substantially contributed to the knowledge base of funding and business models for NBS, particularly in the urban context. Collaborating and sharing knowledge through an EU Task Force, this first set of EU projects laid important knowledge foundations, reviewing existing literature, and compiling empirical evidence of different financing approaches and the business models that underpinned them. The second set of EU innovation actions advanced this knowledge base, developing and testing new implementation models, business model tools, and approaches. This paper presents the findings of these projects from a business model perspective to improve our understanding of the value propositions of NBS to support their mainstreaming

A scale-based framework to understand the promises, pitfalls and paradoxes of irrigation efficiency to meet major water challenges

An effective placement of irrigation efficiency in water management will contribute towards meeting the pre-eminent global water challenges of our time such as addressing water scarcity, boosting crop water productivity and reconciling competing water needs between sectors. However, although irrigation efficiency may appear to be a simple measure of performance and imply dramatic positive benefits, it is not straightforward to understand, measure or apply. For example, hydrological understanding that irrigation losses recycle back to surface and groundwater in river basins attempts to account for scale, but this generalisation cannot be readily translated from one location to another or be considered neutral for farmers sharing local irrigation networks. Because irrigation efficiency (IE) motives, measures, effects and technologies play out at different scales for different people, organisations and purposes, and losses differ from place to place and over time, IE is a contested term, highly changeable and subjective. This makes generalisations for science, management and policy difficult. Accordingly, we propose new definitions for IE and irrigation hydrology and introduce a framework, termed an ‘irrigation efficiency matrix’, comprising five spatial scales and ten dimensions to understand and critique the promises, pitfalls and paradoxes of IE and to unlock its utility for addressing contemporary water challenges

Climate Change Impacts on Groundwater and Dependent Ecosystems - in press

[EN] Aquifers and groundwater-dependent ecosystems (GDEs) are facing increasing pressure from water consumption, irrigation and climate change. These pressures modify groundwater levels and their temporal patterns and threaten vital ecosystem services such as arable land irrigation and ecosystem water requirements, especially during droughts. This review examines climate change effects on groundwater and dependent ecosystems. The mechanisms affecting natural variability in the global climate and the consequences of climate and land use changes due to anthropogenic influences are summarised based on studies from different hydrogeological strata and climate zones. The impacts on ecosystems are discussed based on current findings on factors influencing the biodiversity and functioning of aquatic and terrestrial ecosystems. The influence of changes to groundwater on GDE biodiversity and future threats posed by climate change is reviewed, using information mainly from surface water studies and knowledge of aquifer and groundwater ecosystems. Several gaps in research are identified. Due to lack of understanding of several key processes, the uncertainty associated with management techniques such as numerical modelling is high. The possibilities and roles of new methodologies such as indicators and modelling methods are discussed in the context of integrated groundwater resources management. Examples are provided of management impacts on groundwater, with recommendations on sustainable management of groundwaterThe preparation of this review was partly funded by EC 7th framework Project GENESIS (Contract Number 226536).Klove, B.; Ala-Aho, P.; Bertrand, G.; Gurdak, JJ.; Kupfersberger, H.; Kværner, J.; Muotka, T.... (2014). Climate Change Impacts on Groundwater and Dependent Ecosystems - in press. Journal of Hydrology. 518(Part B):250-266. https://doi.org/10.1016/j.jhydrol.2013.06.037S250266518Part

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defi ned criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specifi c DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI).Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defi ned criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specifi c DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI)

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely