The EVERT (effective verruca treatments) trial protocol: a randomised controlled trial to evaluate cryotherapy versus salicylic acid for the treatment of verrucae

<p>Abstract</p> <p>Background</p> <p>Verrucae are a common, infectious and sometimes painful problem. The optimal treatment for verrucae is unclear due to a lack of high quality randomised controlled trials. The primary objective of this study is to compare the clinical effectiveness of two common treatments for verrucae: cryotherapy using liquid nitrogen versus salicylic acid. Secondary objectives include a comparison of the cost-effectiveness of the treatments, and an investigation of time to clearance of verrucae, recurrence/clearance of verrucae at six months, patient satisfaction with treatment, pain associated with treatment, and use of painkillers for the treatments.</p> <p>Methods/Design</p> <p>This is an open, pragmatic, multicentre, randomised controlled trial with two parallel groups: cryotherapy using liquid nitrogen delivered by a healthcare professional for a maximum of 4 treatments (treatments 2-3 weeks apart) or daily self-treatment with 50% salicylic acid for a maximum of 8 weeks. Two hundred and sixty-six patients aged 12 years and over with a verruca are being enrolled into the study. The primary outcome is complete clearance of all verrucae as observed on digital photographs taken at 12 weeks compared with baseline and assessed by an independent healthcare professional. Secondary outcomes include self-reported time to clearance of verrucae, self-reported clearance of verrucae at 6 months, cost-effectiveness of the treatments compared to one another, and patient acceptability of both treatments including possible side effects such as pain. The primary analysis will be intention to treat. It is planned that recruitment will be completed by December 2009 and results will be available by June 2010.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN18994246.</p

Water Banking Can Help Great Salt Lake

Utah’s Great Salt Lake is a treasured resource, yet dedicated flows have not been established to preserve the economic, ecological, and cultural values that the lake provides. Utah’s prior appropriation law allocates water rights based on time of first use, meaning agricultural water uses typically have senior rights. Utah’s Water Banking Act, which was adopted in 2020, presents an opportunity to reallocate some water to the environment within existing appropriative rights water law.Under the act, water users can create local water banks to temporarily lease water. Leased water can be used for various purposes, including environmental or agricultural uses. Water banking under the act allows right holders to lease some or all of their water and, crucially, protects banked water rights from forfeiture. Additionally, the water and money from leases remain in the local watershed. Water banking presents an opportunity to flexibly manage water and help preserve the dwindling Great Salt Lake. This analysis estimates the volume of water that could be delivered to Great Salt Lake and the lake’s water level based on wet-year water banking in Utah’s Cache Valley

Assessing Downstream Aquatic Habitat Availability Relative to Headwater Reservoir Management in the Henrys Fork Snake River

Reservoirs are sometimes managed to meet agricultural and other water demands, while also maintaining streamflow for aquatic species and ecosystems. In the Henrys Fork Snake River, Idaho (USA), irrigation-season management of a headwater reservoir is informed by a flow target in a management reach ~95 km downstream. The target is in place to meet irrigation demand and maintain aquatic habitat within the 11.4 km management reach and has undergone four flow target assignments from 1978 to 2021. Recent changes to irrigation-season management to maximize reservoir carryover warranted investigation into the flow target assignment. Thus, we created a streamflow-habitat model using hydraulic measurements, habitat unit mapping, and published habitat suitability criteria for Brown Trout (Salmo trutta), Rainbow Trout (Oncorhynchus mykiss), and Mountain Whitefish (Prosopium williamsoni). We used model output to compare habitat availability across two management regimes (1978–2017 and 2018–2021). We found that efforts to minimize reservoir releases in 2018–2021 did not reduce mean irrigation-season fish habitat relative to natural flow, but did reduce overall fish habitat variability during the irrigation season compared to streamflow management in 1978–2017. Field observations for this research led to an adjusted flow target in 2020 that moved the target location downstream of intervening irrigation diversions. Using our model output, we demonstrated that moving the location of the target to account for local irrigation diversions will contribute to more consistently suitable fish habitat in the reach. Our study demonstrates the importance of site selection for establishing environmental flow targets

Climatization-Negligent Attribution of Great Salt Lake Desiccation: A Comment on Meng (2019)

A recent article reviewed data on Great Salt Lake (Utah) and concluded falsely that climate changes, especially local warming and extreme precipitation events, are primarily responsible for lake elevation changes. Indeed climatically influenced variation of net inflows contribute to huge swings in the elevation of Great Salt Lake (GSL) and other endorheic lakes. Although droughts and wet cycles have caused lake elevation changes of over 4.5 m, they have not caused a significant long-term change in the GSL stage. This recent article also suggests that a 1.4 °C rise in air temperature and concomitant increase in the lake\u27s evaporative loss is an important reason for the lake\u27s decline. However, we calculate that a 1.4 °C rise may have caused only a 0.1mdecrease in lake level. However, since 1847, the lake has declined 3.6 m and the lake area has decreased by ≈50%, despite no significant change in precipitation (p = 0.52) and a slight increase, albeit insignificant, in river flows above irrigation diversions (p = 0.085). In contrast, persistent water extraction for agriculture and other uses beginning in 1847 now decrease water flows below diversions by 39%. Estimates of consumptive water use primarily for irrigated agriculture in the GSL watershed suggest that approximately 85% (2500 km2) of the reduced lake area can be attributed to human water consumption. The recent article\u27s failure to calculate a water budget for the lake that included extensive water withdrawals misled the author to focus instead on climate change as a causal factor for the decline. Stable stream flows in GSL\u27s headwaters, inadequate temperature increase to explain the extent of its observed desiccation, stable long-term precipitation, and the magnitude of increased water consumption from GSL together demonstrate conclusively that climatic factors are secondary to human alterations to GSL and its watershed. Climatization, in which primarily non-climatic processes are falsely attributed to climatic factors, is a threat to the credibility of hydrological science. Despite a recent suggestion to the contrary, pressure to support Earth\u27s rising human population-in the form of increasing consumption of water in water-limited regions, primarily to support irrigated agriculture-remains the leading driver of desiccation of inland waters within Earth\u27s water-limited regions

Managing Lake Urmia, Iran for Diverse Restoration Objectives: Moving Beyond a Uniform Target Lake Level

There is widespread interest in restoring drying saline lakes. At Iran’s hypersaline Lake Urmia, managers have sought a uniform target lake level of 1274.1 m above sea level to lower salinity below 263 g L−1 and recover Artemia to sufficient densities to support flamingos. We suggest that addressing a broader range of objectives will allow more flexibility for managing the lake. We define eight restoration objectives to lower salinity, sustain Artemia and flamingo populations, separate islands from each other and the mainland, reduce lakebed dust, maintain commercially valuable ions, and improve recreational access from resort beaches. We use 40 years of experimental, field, satellite, and model data to relate each objective to lake level. We describe variations through time and associated uncertainties for meeting each objective

NCER Assistance Agreement Annual Progress Report for Grant #83582401 - Assessment of Stormwater Harvesting via Manage Aquifer Recharge (MAR) to Develop New Water Supplies in the Arid West: The Salt Lake Valley Example

The aims of the original proposed project remain the same, that is, to test the hypothesis that Managed Aquifer Recharge (MAR) for stormwater harvesting is a technically feasible, socially and environmentally acceptable, economically viable, and permittable option for developing new water supplies for arid Western urban ecosystems experiencing increasing population, and climate change pressures on existing water resources. The project is being carried out via three distinct but integrated components that include: 1) Monitoring of existing distributed Managed Aquifer Recharge (MAR) harvesting schemes involving a growing number of demonstration Green Infrastructure (GI) test sites; 2) Integrated stormwater/vadose zone/groundwater/ ecosystem services modeling; and 3) Social Science research assessing Stakeholder attitudes, and solicitation of their collaboration on feasible distributed MAR scenario development and subsequent analysis of scenario outcomes. Each of these components are discussed separately in the material presented below

Can the Desiccation of Great Salt Lake be Stopped?

Great Salt Lake is a terminal lake, with its watershed in the Wasatch and Uinta Mountains of Utah, Wyoming and Idaho. Like all terminal lakes, the water inflows are balanced only by evaporative loss from its surface—when inflows decrease the lake shrinks until evaporation matches that inflow

Hydrologic Response and Watershed Sensitivity to Climate Warming in California's Sierra Nevada

This study focuses on the differential hydrologic response of individual watersheds to climate warming within the Sierra Nevada mountain region of California. We describe climate warming models for 15 west-slope Sierra Nevada watersheds in California under unimpaired conditions using WEAP21, a weekly one-dimensional rainfall-runoff model. Incremental climate warming alternatives increase air temperature uniformly by 2°, 4°, and 6°C, but leave other climatic variables unchanged from observed values. Results are analyzed for changes in mean annual flow, peak runoff timing, and duration of low flow conditions to highlight which watersheds are most resilient to climate warming within a region, and how individual watersheds may be affected by changes to runoff quantity and timing. Results are compared with current water resources development and ecosystem services in each watershed to gain insight into how regional climate warming may affect water supply, hydropower generation, and montane ecosystems. Overall, watersheds in the northern Sierra Nevada are most vulnerable to decreased mean annual flow, southern-central watersheds are most susceptible to runoff timing changes, and the central portion of the range is most affected by longer periods with low flow conditions. Modeling results suggest the American and Mokelumne Rivers are most vulnerable to all three metrics, and the Kern River is the most resilient, in part from the high elevations of the watershed. Our research seeks to bridge information gaps between climate change modeling and regional management planning, helping to incorporate climate change into the development of regional adaptation strategies for Sierra Nevada watersheds

Improving Lake Mixing Process Simulations in the Community Land Model by Using K Profile Parameterization

We improved lake mixing process simulations by applying a vertical mixing scheme, K profile parameterization (KPP), in the Community Land Model (CLM) version 4.5, developed by the National Center for Atmospheric Research. Vertical mixing of the lake water column can significantly affect heat transfer and vertical temperature profiles. However, the current vertical mixing scheme in CLM requires an arbitrarily enlarged eddy diffusivity to enhance water mixing. The coupled CLM-KPP considers a boundary layer for eddy development, and in the lake interior water mixing is associated with internal wave activity and shear instability. We chose a lake in Arctic Alaska and a lake on the Tibetan Plateau to evaluate this improved lake model. Results demonstrated that CLM-KPP reproduced the observed lake mixing and significantly improved lake temperature simulations when compared to the original CLM. Our newly improved model better represents the transition between stratification and turnover. This improved lake model has great potential for reliable physical lake process predictions and better ecosystem services