Demonstrating the utility of a drought termination framework: prospects for groundwater level recovery in England and Wales in 2018 or beyond

During prolonged droughts, information is needed about when and how the extreme event is likely to terminate. A drought termination framework based on historical data comprising current rate and historical ensemble approaches is presented here for assessing the prospects of groundwater level recovery. The current rate approach is evaluated across all initialisation months in the historical record and provides reasonable estimates for the duration of recovery from relatively severe groundwater level deficiencies in some slowly responding boreholes. The utility of the framework is demonstrated through a near-real-time application to 30 groundwater boreholes in England and Wales from October 2017 onwards. Recovery during winter 2017/18 was considered unlikely, as some aquifers required increases in groundwater levels that have occurred seldom, if ever before, in long historical records. Data to February 2018 confirmed the success of these pre-winter outlooks. Recovery by mid- to late-2018 or beyond was more likely; slow rates of recovery by October 2017 and increasing return periods of effective rainfall required for recovery over timeframes in the summer half-year underlined the importance of winter rainfall and suggested that the historical ensemble may underestimate the duration of recovery. There was moderate confidence for a delay in recovery beyond the end of 2018 in some slowly responding Chalk boreholes in south-central and eastern England. There is considerable potential for the transferability of the drought termination framework beyond the UK wherever there are sufficient historical data. The two approaches provide limited information in distinctly different circumstances and their relevance and value may differ in space and time, suggesting their complimentary use as the most robust way to incorporate information on the prospects for groundwater level recovery into existing seasonal forecasting services, supporting decision-making by water managers during prolonged droughts

Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience

Background: Intravenous medication administrations have a high incidence of error but there is limited evidence of associated factors or error severity. Objective: To measure the frequency, type and severity of intravenous administration errors in hospitals and the associations between errors, procedural failures and nurse experience. Methods: Prospective observational study of 107 nurses preparing and administering 568 intravenous medications on six wards across two teaching hospitals. Procedural failures (eg, checking patient identification) and clinical intravenous errors (eg, wrong intravenous administration rate) were identified and categorised by severity. Results: Of 568 intravenous administrations, 69.7% (n=396; 95% CI 65.9 to 73.5) had at least one clinical error and 25.5% (95% CI 21.2 to 29.8) of these were serious. Four error types (wrong intravenous rate, mixture, volume, and drug incompatibility) accounted for 91.7% of errors. Wrong rate was the most frequent and accounted for 95 of 101 serious errors. Error rates and severity decreased with clinical experience. Each year of experience, up to 6 years, reduced the risk of error by 10.9% and serious error by 18.5%. Administration by bolus was associated with a 312% increased risk of error. Patient identification was only checked in 47.9% of administrations but was associated with a 56% reduction in intravenous error risk. Conclusions: Intravenous administrations have a higher risk and severity of error than other medication administrations. A significant proportion of errors suggest skill and knowledge deficiencies, with errors and severity reducing as clinical experience increases. A proportion of errors are also associated with routine violations which are likely to be learnt workplace behaviours. Both areas suggest specific targets for intervention.8 page(s

Unfitness to Plead. Volume 1: Report.

This has been produced along with Volume 2: Draft Legislation as a combined document Presented to Parliament pursuant to section 3(2) of the Law Commissions Act 1965 Ordered by the House of Commons to be printed on 12 January 201

Developing observational methods to drive future hydrological science: can we make a start as a community?

Hydrology is still, and for good reasons, an inexact science, even if evolving hydrological understanding has provided a basis for improved water management for at least the last three millennia. The limitations of that understanding have, however, become much more apparent and important in the last century as the pressures of increasing populations, and the anthropogenic impacts on catchment forcing and responses, have intensified. At the same time, the sophistication of hydrological analyses and models has been developing rapidly, often driven more by the availability of computational power and geographical data sets than any real increases in understanding of hydrological processes. This sophistication has created an illusion of real progress but a case can be made that we are still rather muddling along, limited by the significant uncertainties in hydrological observations, knowledge of catchment characteristics and related gaps in conceptual understanding, particularly of the sub-surface. These knowledge gaps are illustrated by the fact that for many catchments we cannot close the water balance without significant uncertainty, uncertainty that is often neglected in evaluating models for practical applications

Insights into the Mechanism for Orogen-Related Carbonate Remagnetization from Growth of Authigenic Fe-Oxide: A Scanning Electron Microscopy and Rock Magnetic Study of Devonian Carbonates from Northern Spain

A rock magnetic and SEM study of Devonian carbonates from the Cantabria-Asturias Region, northern Spain, was undertaken to further our understanding of the pervasive remagnetization of carbonate rocks during the Late Paleozoic, and the mechanism by which these remagnetizations occur. These rocks contain three ancient Late Paleozoic magnetizations. The rock magnetic properties of mineral extracts were compared with those of whole rock chips and nonmagnetic\u27\u27 residue to deduce magnetic carrier(s) and grain sizes. Hysteresis measurements for rock chips show typical\u27\u27 wasp-waisted loops, whereas extract shows typical pseudosingle-domain-like (PSD) unrestricted loops. Within all sites, there is a noticeable contribution of superparamagnetic (SP) grains seen in hysteresis properties and low-temperature magnetization measurements of whole rock chips, whereas a trend away from a strong SP contribution is seen when hysteresis properties of whole rock are compared with those of residue and extract. Consequently, our extraction process (predictably) removes SP grains, while preserving the characteristic fraction of remanence-carrying material, which behaves like a typical mixture of single-domain (SD) and PSD magnetite. Paradoxically, the typical fingerprint\u27\u27 of remagnetized carbonates, as seen in the whole rock data, seems to be a response to abundant SP grains associated with the acquisition of chemical remanent magnetizations (CRM), and not the actual remanence carrying population itself. Scanning electron microscopy (SEM) observations of magnetic extract reveal abundant authigenic Fe-oxides, characterized as either 10-100 mum Ni-free spherules or individual 0.1-10 mum euhedral grains. SEM observations of thin sections reveal abundant evidence of fluid flow driven chemical reactions that resulted in formation of new Fe oxide. Such reactions occurred along cracks and grain boundaries and within void space, and are associated with Fe-rich clay and calcite-dolomite reactions or as oxidation of Fe-sulfide framboids. Together, the SEM observations and rock magnetic experiments reveal that the three Late Paleozoic remagnetizations experienced by Cantabria-Asturias Paleozoic carbonates are CRMs facilitated by the presence of fluids activated during Late Paleozoic Variscan deformation

Detecting referral and selection bias by the anonymous linkage of practice, hospital and clinic data using Secure and Private Record Linkage (SAPREL): case study from the evaluation of the Improved Access to Psychological Therapy (IAPT) service

Background: The evaluation of demonstration sites set up to provide improved access to psychological therapies (IAPT) comprised the study of all people identified as having common mental health problems (CMHP), those referred to the IAPT service, and a sample of attenders studied in-depth. Information technology makes it feasible to link practice, hospital and IAPT clinic data to evaluate the representativeness of these samples. However, researchers do not have permission to browse and link these data without the patients’ consent. Objective: To demonstrate the use of a mixed deterministic-probabilistic method of secure and private record linkage (SAPREL) - to describe selection bias in subjects chosen for in-depth evaluation. Method: We extracted, pseudonymised and used fuzzy logic to link multiple health records without the researcher knowing the patient’s identity. The method can be characterised as a three party protocol mainly using deterministic algorithms with dynamic linking strategies; though incorporating some elements of probabilistic linkage. Within the data providers’ safe haven we extracted: Demographic data, hospital utilisation and IAPT clinic data; converted post code to index of multiple deprivation (IMD); and identified people with CMHP. We contrasted the age, gender, ethnicity and IMD for the in-depth evaluation sample with people referred to IAPT, use hospital services, and the population as a whole. Results: The in IAPT-in-depth group had a mean age of 43.1 years; CI: 41.0 - 45.2 (n = 166); the IAPT-referred 40.2 years; CI: 39.4 - 40.9 (n = 1118); and those with CMHP 43.6 years SEM 0.15. (n = 12210). Whilst around 67% of those with a CMHP were women, compared to 70% of those referred to IAPT, and 75% of those subject to indepth evaluation (Chi square p< 0.001). The mean IMD score for the in-depth evaluation group was 36.6; CI: 34.2 - 38.9; (n = 166); of those referred to IAPT 38.7; CI: 37.9 - 39.6; (n = 1117); and of people with CMHP 37.6; CI 37.3- 37.9; (n = 12143). Conclusions: The sample studied in-depth were older, more likely female, and less deprived than people with CMHP, and fewer had recorded ethnic minority status. Anonymous linkage using SAPREL provides insight into the representativeness of a study population and possible adjustment for selection bias

Knowledge gaps in our perceptual model of Great Britain’s hydrology

There is a no lack of significant open questions in the field of hydrology. How will hydrological connectivity between freshwater bodies be altered by future human alterations to the hydrological cycle? Where does water go when it rains? Or what is the future space-time variability of flood and drought events? However, the answers to these questions will vary with location due to the specific and often poorly understood local boundary conditions and system properties that control the functional behaviour of a catchment or any other hydrologic control volume. We suggest that an open, shared and evolving perceptual model of a region’s hydrology is critical to tailor our science questions, as it would be for any other study domain from the plot to the continental scale. In this opinion piece, we begin to discuss the elements of and point out some knowledge gaps in the perceptual model of the terrestrial water cycle of Great Britain. We discuss six major knowledge gaps and propose four key ways to reduce them. While the specific knowledge gaps in our perceptual model do not necessarily transfer to other places, we believe that the development of such perceptual models should be at the core of the debate for all hydrologic communities, and we encourage others to have a similar debate for their hydrologic domain

Multifactorial day hospital intervention to reduce falls in high risk older people in primary care: a multi-centre randomised controlled trial [ISRCTN46584556]

Falls in older people are a major public health concern in terms of morbidity, mortality and cost. Previous studies suggest that multifactorial interventions can reduce falls, and many geriatric day hospitals are now offering falls intervention programmes. However, no studies have investigated whether these programmes, based in the day hospital are effective, nor whether they can be successfully applied to high-risk older people screened in primary care. The hypothesis is that a multidisciplinary falls assessment and intervention at Day hospitals can reduce the incidence of falls in older people identified within primary care as being at high risk of falling. This will be tested by a pragmatic parallel-group randomised controlled trial in which the participants, identified as at high risk of falling, will be randomised into either the intervention Day hospital arm or to a control (current practice) arm. Those participants preferring not to enter the full randomised study will be offered the opportunity to complete brief diaries only at monthly intervals. This data will be used to validate the screening questionnaire. Three day hospitals (2 Nottingham, 1 Derby) will provide the interventions, and the University of Nottingham's Departments of Primary Care, the Division of Rehabilitation and Ageing Unit, and the Trent Institute for Health Service Research will provide the methodological and statistical expertise. Four hundred subjects will be randomised into the two arms. The primary outcome measure will be the rate of falls over one year. Secondary outcome measures will include the proportion of people experiencing at least one fall, the proportion of people experiencing recurrent falls (>1), injuries, fear of falling, quality of life, institutionalisation rates, and use of health services. Cost-effectiveness analyses will be performed to inform health commissioners about resource allocation issues. The importance of this trial is that the results may be applicable to any UK day hospital setting. SITES: General practices across Nottinghamshire and Derbyshire. Day hospitals: Derbyshire Royal Infirmary (Southern Derbyshire Acute Hospitals NHS Trust) Sherwood Day Service (Nottingham City Hospital Trust) Leengate Day Hospital (Queen's Medical Centre Nottingham University Hospital NHS Trust

Hydrological Outlook UK: an operational streamflow and groundwater level forecasting system at monthly to seasonal time scales

This paper describes the development of the first operational seasonal hydrological forecasting service for the UK, the Hydrological Outlook UK (HOUK). Since June 2013, this service has delivered monthly forecasts of streamflow and groundwater levels, with an emphasis on forecasting hydrological conditions over the next three months, accompanied by outlooks over longer time horizons. This system is based on three complementary approaches combined to produce the outlooks: (i) national-scale modelling of streamflow and groundwater levels based on dynamic seasonal rainfall forecasts, (ii) catchment-scale modelling where streamflow and groundwater level models are driven by historical meteorological forcings (i.e. the Ensemble Streamflow Prediction, ESP, approach), and (iii) a catchment-scale statistical method based on persistence and historical analogues. This paper provides the background to the Hydrological Outlook, describes the various component methods in detail and then considers the impact and usefulness of the product. As an example of a multi-method, operational seasonal hydrological forecasting system, it is hoped that this overview provides useful information and context for other forecasting initiatives around the world