Water and nitrate exchange between a managed river and a peri-urban floodplain aquifer: quantification and management implications

The management of rivers for navigation, hydropower and flood risk reduction involves the installation of in‐channel structures. These influence river levels and can affect groundwater flow within hydraulically‐connected riparian floodplain aquifers. A comprehensively monitored, peri‐urban, lowland river floodplain in the southern United Kingdom was used to explore these dependencies and to examine the implications for the flux exchange of water and nitrate between the river and the floodplain alluvial aquifer. The study demonstrated that rivers maintained at high levels by management structures, result in raised groundwater levels in the adjacent aquifer and complex groundwater flow patterns. Engineered river management structures were shown to promote flow from river to aquifer through the river bed but the majority of the associated nitrate was removed in the hyporheic zone. High‐ nitrate groundwater recharge to the alluvial aquifer also occurred through overbank flood flows. Across the floodplain, substantial denitrification occurred due to anaerobic conditions resulting from carbon‐rich sediments and the shallow water table, the latter linked to the river management structures. An upper limit on the total annual mass of nitrate removed from river water entering the floodplain aquifer was estimated for the study site (2.9 x 104 kg), which was three orders of magnitude lower than the estimate of annual in‐channel nitrate flux (1.8 x 107 kg). However, this capacity of lowland floodplains to reduce groundwater nitrate concentrations has local benefits, for example for private and public water supplies sourced from alluvial aquifers. The insights from the study also have relevance for those considering schemes that include the installation, removal or redesign of river management structures, as the resultant change in groundwater levels may have consequences for floodplain meadows and the nutrient status of the aquatic system

Prevention of Psychosis: Advances in Detection, Prognosis, and Intervention.

Detection, prognosis, and indicated interventions in individuals at clinical high risk for psychosis (CHR-P) are key components of preventive psychiatry. To provide a comprehensive, evidence-based systematic appraisal of the advancements and limitations of detection, prognosis, and interventions for CHR-P individuals and to formulate updated recommendations. Web of Science, Cochrane Central Register of Reviews, and Ovid/PsychINFO were searched for articles published from January 1, 2013, to June 30, 2019, to identify meta-analyses conducted in CHR-P individuals. MEDLINE was used to search the reference lists of retrieved articles. Data obtained from each article included first author, year of publication, topic investigated, type of publication, study design and number, sample size of CHR-P population and comparison group, type of comparison group, age and sex of CHR-P individuals, type of prognostic assessment, interventions, quality assessment (using AMSTAR [Assessing the Methodological Quality of Systematic Reviews]), and key findings with their effect sizes. In total, 42 meta-analyses published in the past 6 years and encompassing 81 outcomes were included. For the detection component, CHR-P individuals were young (mean [SD] age, 20.6 [3.2] years), were more frequently male (58%), and predominantly presented with attenuated psychotic symptoms lasting for more than 1 year before their presentation at specialized services. CHR-P individuals accumulated several sociodemographic risk factors compared with control participants. Substance use (33% tobacco use and 27% cannabis use), comorbid mental disorders (41% with depressive disorders and 15% with anxiety disorders), suicidal ideation (66%), and self-harm (49%) were also frequently seen in CHR-P individuals. CHR-P individuals showed impairments in work (Cohen d = 0.57) or educational functioning (Cohen d = 0.21), social functioning (Cohen d = 1.25), and quality of life (Cohen d = 1.75). Several neurobiological and neurocognitive alterations were confirmed in this study. For the prognosis component, the prognostic accuracy of CHR-P instruments was good, provided they were used in clinical samples. Overall, risk of psychosis was 22% at 3 years, and the risk was the highest in the brief and limited intermittent psychotic symptoms subgroup (38%). Baseline severity of attenuated psychotic (Cohen d = 0.35) and negative symptoms (Cohen d = 0.39) as well as low functioning (Cohen d = 0.29) were associated with an increased risk of psychosis. Controlling risk enrichment and implementing sequential risk assessments can optimize prognostic accuracy. For the intervention component, no robust evidence yet exists to favor any indicated intervention over another (including needs-based interventions and control conditions) for preventing psychosis or ameliorating any other outcome in CHR-P individuals. However, because the uncertainty of this evidence is high, needs-based and psychological interventions should still be offered. This review confirmed recent substantial advancements in the detection and prognosis of CHR-P individuals while suggesting that effective indicated interventions need to be identified. This evidence suggests a need for specialized services to detect CHR-P individuals in primary and secondary care settings, to formulate a prognosis with validated psychometric instruments, and to offer needs-based and psychological interventions