The impact of uncertainties in ice sheet dynamics on sea-level allowances at tide gauge locations

Sea level is projected to rise in the coming centuries as a result of a changing climate. One of the major uncertainties is the projected contribution of the ice sheets in Greenland and Antarctica to sea-level rise (SLR). Here, we study the impact of different shapes of uncertainty distributions of the ice sheets on so-called sea-level allowances. An allowance indicates the height a coastal structure needs to be elevated to keep the same frequency and likelihood of sea-level extremes under a projected amount of mean SLR. Allowances are always larger than the projected SLR. Their magnitude depends on several factors, such as projection uncertainty and the typical variability of the extreme events at a location. Our results show that allowances increase significantly for ice sheet dynamics uncertainty distributions that are more skewed (more than twice, compared to Gaussian uncertainty distributions), due to the increased probability of a much larger ice sheet contribution to SLR. The allowances are largest in regions where a relatively small observed variability in the extremes is paired with relatively large magnitude and/or large uncertainty in the projected SLR, typically around the equator. Under the RCP8.5 (Representative Concentration Pathway) projections of SLR, the likelihood of extremes increases more than a factor 104 at more than 50-87% of the tide gauges

International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea

Background The association between spontaneous cerebrospinal fluid (CSF) leak/rhinorrhea and idiopathic intracranial hypertension (IIH) has been increasingly recognized over the last years. However, considerable variability of opinion regarding the assessment, investigations, and management of patients with spontaneous CSF rhinorrhea remains.Methods A consensus group was formed from experts from Europe, Asia, Australia, South and North America. Following literature review and open discussions with members of the panel, a set of 61 statements was produced. A modified Delphi method was used to refine expert opinion with 3 rounds of questionnaires and a consensus group meeting in Santo-Rhino meeting in September 2019.Results Fifty statements (82% of total) on spontaneous CSF leak and IIH reached consensus. In 38 of 50 statements, the median response was 7 (strongly agree) and in the 12 remaining statements the median response was 6 (agree). Eleven statements were excluded because they did not reach consensus and one new statement was added during SantoRhino meeting. The final statements refer to patient history and clinical examination ("History taking should include presence of headache, tinnitus and visual defects"), investigations (role of Thin Slice Computed Tomography and CISS/FLAIR sequences in Magnetic Resonance Imaging), principles of management (watchful waiting or measures to reduce ICP are supplementary but cannot subsitute surgical closure), surgical technique, intraoperative, early postoperative and long term management.Conclusion We present fifty consensus statements on the diagnosis, investigation, and management of spontaneous CSF rhinorrhea based on the currently available evidence and expert opinion. Although by no means comprehensive and final, we believe they can contribute to the standardization of clinical practice. Early diagnosis, prompt surgical closure of the defect, assesment for and treatment of potentially co-existing idiopathic intracranial hypertension in a comprehensive multidisciplinary approach are essential in order to successfully manage spontaneous CSF rhinorrhea, reduce associated morbidity and prevent recurrence.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie