Impacts of Climate Change on Stream Inflows into the Volta Lake

The study examined the impact of climate change on future water availability in the Volta Lake from climate downscaled data using ensemble projections of two Global Climate Models (MPEH5 and HADCM3) and two emission scenarios (A1B and A2) used in the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. The SWAT hydrological model was calibrated and validated and then used with the downscaled climate change data to assess the impacts of climate change on the inflows to the Lake. Results from the impact assessment showed that future mean annual streamflow into the Volta Lake could increase by about 17 and 16 percent under the A1B and A2 scenarios, respectively. However, streamflow from Geoere, Boromo and Dapola in the Black Volta basin and Nawuni in the White Volta basin could decrease. The projected increase in total annual streamflow in the basin is consistent with the increase in annual rainfall in the basin under both the A1B and A2 scenarios of between 2.0 and 8.0 percent obtained in a separate climate downscaling study. Since streamflow in some of the sub-basins were found to decrease under the climate change scenarios investigated, integrated and prudent management of the basin's water resources would be necessary to ensure sustainability in water use

Designing a combined Liothyronine (LT3), L-thyroxine (LT4) trial in symptomatic hypothyroid subjects on LT4 – the importance of patient selection, choice of LT3 and trial design

Approximately 10%–15% of subjects with hypothyroidism on L-thyroxine (LT4) alone have persistent symptoms affecting their quality of life (QoL). Although the cause is unclear, there is evidence that “tissue T3 lack” may be responsible. If so, combining liothyronine (LT3) with LT4 would be helpful. However, randomized controlled trials (RCT), have not established greater efficacy for the LT3 + LT4 combination in these subjects than for LT4 alone. While the trial design may have been responsible, the use of unphysiological, short-acting LT3 preparations and non-thyroid-specific patient-reported outcome measures (PROMs) may have contributed. We recommend attention to the following aspects of trial design for future RCTs of LT3 + LT4 compared to LT4 alone: (a) Subject selection—(i) measurable symptoms (disadvantages should be recognized); (ii) using a validated thyroid specific PROM such as ThyPRO39 or the Composite scale derived from it; (iii) those taking over 1.2 μg/day or 100 μg/day (for pragmatic reasons) of LT4 defining a population likely without intrinsic thyroid activity who depend on exogenous LT4; (iv) recruiting a preponderance of subjects with autoimmune thyroiditis increasing generalisability; and (v) those with a high symptom load with a greater response to combination therapy e.g. those with the deiodinase 2 polymorphism. (b) The use of physiological LT3 preparations producing pharmacokinetic similarities to T3 profiles in unaffected subjects: two long-acting LT3 preparations are currently available and must be tested in phase 2b/3 RCTs. (c) The superiority of a crossover design in limiting numbers and costs while maintaining statistical power and ensuring that all subjects experienced the investigative medication

A nationwide study of adults admitted to hospital with diabetic ketoacidosis or hyperosmolar hyperglycaemic state and COVID‐19

AimsTo investigate characteristics of people hospitalized with coronavirus-disease-2019 (COVID-19) and diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic state (HHS), and to identify risk factors for mortality and intensive care admission.Materials and methodsRetrospective cohort study with anonymized data from the Association of British Clinical Diabetologists nationwide audit of hospital admissions with COVID-19 and diabetes, from start of pandemic to November 2021. The primary outcome was inpatient mortality. DKA and HHS were adjudicated against national criteria. Age-adjusted odds ratios were calculated using logistic regression.ResultsIn total, 85 confirmed DKA cases, and 20 HHS, occurred among 4073 people (211 type 1 diabetes, 3748 type 2 diabetes, 114 unknown type) hospitalized with COVID-19. Mean (SD) age was 60 (18.2) years in DKA and 74 (11.8) years in HHS (p < .001). A higher proportion of patients with HHS than with DKA were of non-White ethnicity (71.4% vs 39.0% p = .038). Mortality in DKA was 36.8% (n = 57) and 3.8% (n = 26) in type 2 and type 1 diabetes respectively. Among people with type 2 diabetes and DKA, mortality was lower in insulin users compared with non-users [21.4% vs. 52.2%; age-adjusted odds ratio 0.13 (95% CI 0.03-0.60)]. Crude mortality was lower in DKA than HHS (25.9% vs. 65.0%, p = .001) and in statin users versus non-users (36.4% vs. 100%; p = .035) but these were not statistically significant after age adjustment.ConclusionsHospitalization with COVID-19 and adjudicated DKA is four times more common than HHS but both associate with substantial mortality. There is a strong association of previous insulin therapy with survival in type 2 diabetes-associated DKA

Agro-Climatic and hydrological characterization of selected watersheds of northern Ghana. IWMI Working Paper 173. Colombo, Sri Lanka: IWMI.

This paper provides the climatic and biophysical context of three watersheds in northern Ghana. The objective of the study is to describe the agro-climatic and hydrological features of the watersheds from a landscape perspective. The analyses show that water surplus occurs about 3 months in a year, with only one month providing a significant surplus. Small-scale irrigation is, therefore, carried out in the dry months between November and June. The quality of water used for irrigation from wells, reservoirs and rivers is good for irrigation and domestic purposes. The soil chemical parameters across the study sites show that the soils are suitable for irrigation and crop system intensification, although it requires substantial fertilizer inputs. The paper concludes that there are opportunities from both a soil quality and water availability perspective to enhance sustainable intensification through small- and medium-scale irrigation in the selected watersheds

Quantifying Cooperation Benefits for New Dams in Transboundary Water Systems Without Formal Operating Rules

New dams impact downstream ecosystems and water infrastructure; without cooperative and adaptive management, negative impacts can manifest. In large complex transboundary river basins without well codified operating rules and extensive historical data, it can be difficult to assess the benefits of cooperating, in particular in relation to new dams. This constitutes a barrier to harmonious development of river basins and could contribute to water conflict. This study proposes a generalised framework to assess the benefits of cooperation on the management of new dams in water resource systems that do not have formal sharing arrangements. Benefits are estimated via multi-criteria comparison of historical reservoir operations (usually relatively uncooperative) vs. adopting new cooperative rules which would achieve the best results for riparian countries as evaluated by a water resources simulator and its performance metrics. The approach is applied to the Pwalugu Multipurpose Dam (PMD), which is being built in Ghana in the Volta river basin. The PMD could impact downstream ecosystems and infrastructure in Ghana and could itself be impacted by how the existing upstream Bagre Dam is managed in Burkina Faso. Results show that with cooperation Ghana and Burkina Faso could both increase energy production although some ecosystem services loss would need to be mitigated. The study confirms that cooperative rules achieve higher overall benefits compared to seeking benefits only for individual dams or countries