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Water temperature is critical for the ecology of lakes. However, the ability to predict its spatial and seasonal variation is constrained by the lack of a thermal classification system. Here we define lake thermal regions using objective analysis of seasonal surface temperature dynamics from satellite observations. Nine lake thermal regions are identified that mapped robustly and largely contiguously globally, even for small lakes. The regions differed from other global patterns, and so provide unique information. Using a lake model forced by 21 st century climate projections, we found that 12%, 27% and 66% of lakes will change to a lower latitude thermal region by 2080–2099 for low, medium and high greenhouse gas concentration trajectories (Representative Concentration Pathways 2.6, 6.0 and 8.5) respectively. Under the worst-case scenario, a 79% reduction in the number of lakes in the northernmost thermal region is projected. This thermal region framework can facilitate the global scaling of lake-research. Water temperature is a critical variable for lakes, but its spatial and temporal patterns are not well characterised globally. Here, the authors use surface temperature dynamics to define lake thermal regions that group lakes with similar patterns, and show how these regions shift under climate change.

To quantify the effects of recent and potential future decreases in surface wind speeds on lake thermal stratification, we apply the one-dimensional process-based model MyLake to a large, shallow, polymictic lake, Võrtsjärv. The model is validated for a 3-year period and run separately for 28 years using long-term daily atmospheric forcing data from a nearby meteorological station. Model simulations show exceptionally good agreement with observed surface and bottom water temperatures during the 3-year period. Similarly, simulated surface water temperatures for 28 years show remarkably good agreement with long-term in situ water temperatures. Sensitivity analysis demonstrates that decreasing wind speeds has resulted in substantial changes in stratification dynamics since 1982, while increasing air temperatures during the same period had a negligible effect. Atmospheric stilling is a phenomenon observed globally, and in addition to recent increases in surface air temperature, needs to be considered when evaluating the influence of climate change on lake ecosystems.

In an era of looming land scarcity and environmental degradation, the development of low carbon energy systems without adverse impacts on land and land-based resources is a global challenge. 'Floatovoltaic' energy systems-comprising floating photovoltaic (PV) panels over water-are an appealing source of low carbon energy as they spare land for other uses and attain greater electricity outputs compared to land-based systems. However, to date little is understood of the impacts of floatovoltaics on the hosting water body. Anticipating changes to water body processes, properties and services owing to floatovoltaic deployment represents a critical knowledge gap that may result in poor societal choices and water body governance. Here, we developed a theoretically-derived hierarchical effects framework for the assessment of floatovoltaic impacts on freshwater water bodies, emphasising ecological interactions. We describe how the presence of floatovoltaic systems may dramatically alter the air-water interface, with subsequent implications for surface meteorology, air-water fluxes and physical, chemical and biological properties of the recipient water body. We apply knowledge from this framework to delineate three response typologies-'magnitude', those for which the direction and magnitude of effect can be predicted; 'direction', those for which only the direction of effect can be predicted; and 'uncertain', those for which the response cannot be predicted-characterised by the relative importance of levels in the effects hierarchy. Illustrative decision trees are developed for an example water body response within each typology, specifically, evaporative water loss, cyanobacterial biomass, and phosphorus release from bed sediments, and implications for ecosystem services, including climate regulation, are discussed. Finally, the potential to use the new understanding of likely ecosystem perturbations to direct floatovoltaic design innovations and identify future research priorities is outlined, showcasing how inter-sectoral collaboration and environmental science can inform and optimise this low carbon, land-sparing renewable energy for ecosystem gains.

The Omicron variant of SARS‐CoV‐2 achieved worldwide dominance in late 2021. Early work suggests that infections caused by the Omicron variant may be less severe than those caused by the Delta variant. We sought to compare clinical outcomes of infections caused by these two strains, confirmed by whole genome sequencing, over a short period of time, from respiratory samples collected from SARS‐CoV‐2 positive patients at a large medical center. We found that infections caused by the Omicron variant caused significantly less morbidity, including admission to the hospital and requirement for oxygen supplementation, and significantly less mortality than those caused by the Delta variant.

Heat fluxes at the lake surface play an integral part in determining the energy budget and thermal structure in lakes, including regulating how lakes respond to climate change. We explore patterns in turbulent heat fluxes, which vary across temporal and spatial scales, using in situ high-frequency monitoring data from 45 globally distributed lakes. Our analysis demonstrates that some of the lakes studied follow a marked seasonal cycle in their turbulent surface fluxes and that turbulent heat loss is highest in larger lakes and those situated at low latitude. The Bowen ratio, which is the ratio of mean sensible to mean latent heat fluxes, is smaller at low latitudes and, in turn, the relative contribution of evaporative to total turbulent heat loss increases toward the tropics. Latent heat transfer ranged from ~ 60% to > 90% of total turbulent heat loss in the examined lakes. The Bowen ratio ranged from 0.04 to 0.69 and correlated significantly with latitude. The relative contributions to total turbulent heat loss therefore differ among lakes, and these contributions are influenced greatly by lake location. Our findings have implications for understanding the role of lakes in the climate system, effects on the lake water balance, and temperature-dependent processes in lakes.

We estimated the burden of RSV‐associated hospitalizations in US adults 1 year prior to RSV vaccine introduction. The overall annual incidence rate of RSV‐associated hospitalization was 31.47 (95% CI: 21.89–43.97) per 100,000 adults. Rates were 10‐fold and 17‐fold higher among adults 60 to 74 years and ≥ 75 years compared with adults 18 to 49 years old. This prospective assessment demonstrated the burden of RSV‐associated hospitalizations among adults, with the highest hospitalization rates among adults ≥ 60 years old, in the year prior to RSV vaccine introduction.

Near‐term ecological forecasting can be used to improve operational resource management in freshwater ecosystems. Here, we developed a framework that uses water temperature forecasting as a tool to predict the migrations of Atlantic salmon (Salmo salar) and European eel (Anguilla anguilla) between freshwater and the sea. We used historical observations of lake water temperature and fish migrations from an internationally important long‐term monitoring site (the Burrishoole catchment, Ireland) to generate daily probabilistic predictions (0%–100%) of when relatively large numbers of fish migrate. For this, we produced daily lake water temperature forecasts that extended up to 34 days into the future using Forecasting Lake and Reservoir Ecosystems (FLARE), an open‐source ensemble‐based forecasting system. We used this system to forecast lake water temperature conditions associated with percentile‐based fish migrations. Two metrics, P66 and P95, were used to indicate days with migrations in excess of 66% and 95%, respectively, of the historical daily fish counts. The results were first validated against water temperature observations, with an overall root mean squared error (RMSE) of 0.97°C. Our forecasts outperformed two other possible water temperature forecasting approaches, using site climatology (1.36°C) and site persistence (1.19°C). The predictions for fish migrations performed better for the P66 metric than for the more extreme P95 metric based on the continuous ranked probability score (CRPS), and the best results were obtained for the salmon downstream migration. This forecasting approach with quantified uncertainty levels has the potential to assist decision making, especially in the face of increased risks for these species. We conclude by discussing the scalability of the framework to other settings as a tool aimed at supporting management practices in real time.

AbstractObjectivesThe surgical airway is a high acuity, low occurrence procedure. Data on the complications and outcomes of surgical airways are limited. Our primary objective was to describe immediate complications, late complications, and clinical outcomes of patients who underwent a surgical airway procedure in the prehospital or emergency department (ED) setting. MethodsWe conducted a retrospective chart review of patients ≥14 years at an academic medical center who underwent a surgical airway procedure in the ED, the prehospital setting, or at a referring ED prior to interfacility transfer. We identified cases from keyword searches of prehospital text pages and hospital electronic medical records from June 1, 2008 to July 1, 2022. Manual chart review was used to confirm inclusion and determine patient and procedure characteristics. Outcomes included immediate complications, delayed in‐hospital complications, and neurologic disability as defined by Modified Rankin Score (mRS) at discharge. ResultsWe identified 63 patients (34 prehospital, 11 ED, and 18 referring ED). Immediate complications included mainstem intubation (46.0%) and bleeding that required direct pressure (23.4%). Overall, 29 patients (46%) died after arrival to the hospital. Of the patients surviving to hospital admission, 25 (48%) had an airway‐related complication. Nine complications were deemed directly related to technical components of the procedure. Of the patients who survived to discharge, 18 (52.9%) had poor neurologic function (mRS 4–5). ConclusionProcedural complications, mortality, and poor neurologic function were common following a surgical airway procedure in the prehospital or ED setting. Most patients surviving to discharge had a moderate to severe neurologic disability.

Background Prior studies in critically ill patients suggest the supra-physiologic chloride concentration of 0.9% (“normal”) saline may be associated with higher risk of renal failure and death compared to physiologically balanced crystalloids. However, the comparative effects of 0.9% saline and balanced fluids are largely unexamined among patients outside the intensive care unit, who represent the vast majority of patients treated with intravenous fluids. Methods/design This study, entitled Saline Against Lactated Ringer’s or Plasma-Lyte in the Emergency Department (SALT-ED), is a pragmatic, cluster, multiple-crossover trial at a single institution evaluating clinical outcomes of adults treated with 0.9% saline versus balanced crystalloids for intravenous fluid resuscitation in the emergency department. All adults treated in the study emergency department receiving at least 500 mL of isotonic crystalloid solution during usual clinical care and subsequently hospitalized outside the intensive care unit are included. Treatment allocation of 0.9% saline versus balanced crystalloids is assigned by calendar month, with study patients treated during the same month assigned to the same fluid type. The first month (January 2016) was randomly assigned to balanced crystalloids, with each subsequent month alternating between 0.9% saline and balanced crystalloids. For balanced crystalloid treatment, clinicians can choose either Lactated Ringer’s or Plasma-Lyte A©. The study period is set at 16 months, which will result in an anticipated estimated sample size of 15,000 patients. The primary outcome is hospital-free days to day 28, defined as the number of days alive and out of the hospital from the index emergency department visit until 28 days later. Major secondary outcomes include proportion of patients who develop acute kidney injury by creatinine measurements; major adverse kidney events by hospital discharge or day 30 (MAKE30), which is a composite outcome of death, new renal replacement therapy, and persistent creatinine elevation >200% of baseline; and in-hospital mortality. Discussion This ongoing pragmatic trial will provide the most comprehensive evaluation to date of clinical outcomes associated with 0.9% saline compared to physiologically balanced fluids in patients outside the intensive care unit. Trial registration ClinicalTrials.gov, NCT02614040 . Registered on 18 November 2015.

AbstractObjectivesThe objective of this study was to evaluate the performance of non‐targeted hepatitis C virus (HCV) screening in emergency departments (EDs) and other healthcare settings in terms of patients identified with HCV infection and linked to HCV care. MethodsIn the Southern Appalachian region of the United States, we developed non‐targeted HCV screening and linkage‐to‐care programs in 10 institutions at different healthcare settings, including EDs, outpatient clinics, and inpatient units. Serum samples were tested for HCV antibodies, and if positive, reflexed to HCV ribonucleic acid (RNA) testing as a confirmatory test for active infection. Patients with positive RNA tests were contacted to link them to HCV care. ResultsBetween 2017 and 2019, among 195,152 patients screened for HCV infection, 16,529 (8.5%) were positive by antibody testing, 10,139 (5.2% of screened patients and 61.3% of patients positive by antibody test) were positive by RNA testing, and 5778 (3.0% of screened patients and 57.0% of patients positive by RNA test) were successfully linked to HCV care. Among 83,645 patients screened in EDs, 9060 (10.8%) were positive by HCV antibody, and 5243 (6.3%) were positive by RNA test. Among patients positive by RNA testing, linkage to care was lower for patients screened in the ED (44.1%) compared with outpatient clinics (67.6%) ( P < 0.01) and inpatient units (50.9%) ( P < 0.01). ConclusionsNon‐targeted HCV screening in acute care settings can identify large numbers of people with HCV infection. To optimize the utility of these screening programs, future work is needed to develop best practices that consistently link these patients to HCV care.