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A data-driven modelling approach was applied to quantify the potential groundwater yield from weathered crystalline basement aquifers in West Africa, which are a strategic resource for achieving water and food security. To account for possible geological control on aquifer productivity, seven major geological domains were identified based on lithological, stratigraphic, and structural characteristics of the crystalline basement. Extensive data mining was conducted for the hydrogeological parameterisation that led to the identification of representative distributions of input parameters for numerical simulations of groundwater abstractions. These were calibrated to match distributions of measured yields for each domain. Calibrated models were then applied to investigate aquifer and borehole scenarios to assess groundwater productivity. Considering the entire region, modelling results indicate that approximately 50% of well-sited standard 60-m-deep boreholes could sustain yields exceeding 0.5 L/s, and 25% could sustain the yield required for small irrigation systems (> 1.0 L/s). Results also highlighted some regional differences in the ranges of productivities for the different domains, and the significance of the depth of the static water table and the lateral extent of aquifers across all geological domains. This approach can be applied to derive groundwater maps for the region and provide the quantitative information required to evaluate the potential of different designs of groundwater supply networks.

Background Observational studies have shown an association between higher bilirubin levels and improved respiratory health outcomes. Targeting higher bilirubin levels has been proposed as a novel therapeutic strategy in COPD. However, bilirubin levels are influenced by multiple intrinsic and extrinsic factors, and these observational studies are prone to confounding. Genetic analyses are one approach to overcoming residual confounding in observational studies. Objectives To test associations between a genetic determinant of bilirubin levels and respiratory health outcomes. Methods COPDGene participants underwent genotyping at the baseline visit. We confirmed established associations between homozygosity for rs6742078 and higher bilirubin, and between higher bilirubin and decreased risk of acute respiratory events within this cohort. For our primary analysis, we used negative binomial regression to test associations between homozygosity for rs6742078 and rate of acute respiratory events. Results 8,727 participants (n = 6,228 non-Hispanic white and 2,499 African American) were included. Higher bilirubin was associated with decreased rate of acute respiratory events [incidence rate ratio (IRR) 0.85, 95% CI 0.75 to 0.96 per SD increase in bilirubin intensity]. We did not find significant associations between homozygosity for rs6742078 and acute respiratory events (IRR 0.94, 95% CI 0.70 to 1.25 for non-Hispanic white and 1.09, 95% CI 0.91 to 1.31 for African American participants). Conclusions A genetic determinant of higher bilirubin levels was not associated with better respiratory health outcomes. These results do not support targeting higher bilirubin levels as a therapeutic strategy in COPD.

Background Bilirubin is a potent antioxidant and higher serum bilirubin levels have been associated with improved COPD outcomes. We performed a systematic review to evaluate the association between serum bilirubin levels and lung function (FEV 1 ), prevalence/incidence of COPD, acute exacerbations of COPD, respiratory health status, and mortality. Methods MEDLINE® and Embase were searched using Ovid® (search updated October 1st, 2019). We included studies that measured serum bilirubin levels and outcomes of interest in adults with or without underlying lung disease. We excluded studies of those with liver disease or drug-induced elevations in bilirubin. We used the Newcastle–Ottawa scale to assess individual study risk of bias (ROB) and the US Agency for Healthcare Research and Quality—Evidence Based Practice tool to assess overall strength of evidence (SOE). Two authors independently determined eligibility, performed data abstraction, assessed ROB, and determined SOE. Results Thirteen studies (5 low risk of bias, 3 moderate and 5 high risk) were included. We found low strength of evidence for the association between higher bilirubin levels and lower risk of acute exacerbations of COPD (2 studies), mortality (3 studies), COPD diagnosis (4 studies), and lung function (FEV 1 ) (8 studies). We found insufficient evidence on the relationship between serum bilirubin and respiratory health status/exercise capacity (1 study) and airflow obstruction (FEV 1 /FVC ratio) (4 studies). Conclusion Higher bilirubin levels may be associated with lower mortality and improved COPD outcomes. Randomized trials are needed to evaluate the effect of medications that raise serum bilirubin on COPD outcomes. PROSPERO registration : CRD42019145747.

Weathered basement aquifers are vital sources of drinking water in Africa. In order to better understand their role in the urban water balance, in a weathered basement aquifer in Kampala, Uganda, this study installed a transect of monitoring piezometers, carried out spring flow and high-frequency groundwater level monitoring, slug tests and hydrochemical analyses, including stable isotopes and groundwater residence time indicators. Findings showed a typical weathered basement aquifer with a 20–50-m thickness. Groundwater recharge was 3–50 mm/year, occurring during sustained rainfall. Recharge to a deep groundwater system within the saprock was slow and prolonged, while recharge to the springs on the valley slopes was quick and episodic, responding rapidly to precipitation. Springs discharged shallow groundwater, mixed with wastewater infiltrating from onsite sanitation practices and contributions from the deeper aquifer and were characterised by low flow rates (< 0.001 m3/s), low pH (<5), high nitrate values (61–190 mg/L as NO3), and residence times of <30 years. The deeper groundwater system occurred in the saprolite/saprock, had low transmissivity (< 1 × 10−5 m2/s), lower nitrate values (<20 mg/L as NO3), pH 6–6.5 and longer residence times (40–60 years). Confined groundwater conditions in the valleys were created by the presence of clay-rich alluvium and gave rise to artesian conditions where groundwater had lower nitrate concentrations. The findings provide new insights into weathered basement aquifers in the urban tropics and show that small-scale abstractions are more sustainable in the deeper groundwater system in the valleys, where confined conditions are present.

Rationale Pulmonary hypertension (PH) in COPD confers increased risk of exacerbations (ECOPD). Electrocardiogram (ECG) indicators of PH are prognostic both in PH and COPD. In the Beta-Blockers for the Prevention of Acute Exacerbations of COPD (BLOCK-COPD) trial, metoprolol increased risk of severe ECOPD through unclear mechanisms. Objective We evaluated whether an ECG indicator of PH, P-pulmonale, would be associated with ECOPD and whether participants with P-pulmonale randomized to metoprolol were at higher risk of ECOPD and worsened respiratory symptoms given the potential detrimental effects of beta-blockers in PH. Methods ECGs of 501 participants were analyzed for P-pulmonale (P wave enlargement in lead II). Cox proportional hazards models evaluated for associations between P-pulmonale and time to ECOPD (all and severe) for all participants and by treatment assignment (metoprolol vs. placebo). Linear mixed-effects models evaluated the association between treatment assignment and P-pulmonale on change in symptom scores (measured by CAT and SOBQ). Results We identified no association between P-pulmonale and risk of any ECOPD or severe ECOPD. However, in individuals with P-pulmonale, metoprolol was associated with increased risk for ECOPD (aHR 2.92, 95% CI: 1.45–5.85). There was no association between metoprolol and ECOPD in individuals without P-pulmonale (aHR 1.01, 95% CI: 0.77–1.31). Individuals with P-pulmonale assigned to metoprolol experienced worsening symptoms (mean increase of 3.95, 95% CI: 1.32–6.58) whereas those assigned to placebo experienced a mean improvement in CAT score of -2.45 (95% CI: -0.30- -4.61). Conclusions In individuals with P-pulmonale, metoprolol was associated with increased exacerbation risk and worsened symptoms. These findings may explain the findings observed in BLOCK-COPD.

Slow heart rate recovery (HRR) after exercise is associated with autonomic dysfunction and increased mortality. What HRR criterion at 1-minute after a 6-minute walk test (6MWT) best defines pulmonary impairment?. A total of 5008 phase 2 COPDGene (NCT00608764) participants with smoking history were included. A total of 2127 had COPD and, of these, 385 were followed-up 5-years later. Lung surgery, transplant, bronchiectasis, atrial fibrillation, heart failure and pacemakers were exclusionary. HR was measured from pulse oximetry at end-walk and after 1-min seated recovery. A receiver operator characteristic (ROC) identified optimal HRR cut-off. Generalized linear regression determined HRR association with spirometry, chest CT, symptoms and exacerbations. HRR after 6MWT (bt/min) was categorized in quintiles: ≤5 (23.0% of participants), 6-10 (20.7%), 11-15 (18.9%), 16-22 (18.5%) and ≥23 (18.9%). Compared to HRR≤5, HRR≥11 was associated with (p<0.001): lower pre-walk HR and 1-min post HR; greater end-walk HR; greater 6MWD; greater FEV %pred; lower airway wall area and wall thickness. HRR was positively associated with FEV %pred and negatively associated with airway wall thickness. An optimal HRR ≤10 bt/min yielded an area under the ROC curve of 0.62 (95% CI 0.58-0.66) for identifying FEV <30%pred. HRR≥11 bt/min was the lowest HRR associated with consistently less impairment in 6MWT, spirometry and CT variables. In COPD, HRR≤10 bt/min was associated with (p<0.001): ≥2 exacerbations in the previous year (OR=1.76[1.33-2.34]); CAT≥10 (OR=1.42[1.18-1.71]); mMRC≥2 (OR=1.42[1.19-1.69]); GOLD 4 (OR=1.98[1.44-2.73]) and GOLD D (OR=1.51[1.18-1.95]). HRR≤10 bt/min was predicted COPD exacerbations at 5-year follow-up (RR=1.83[1.07-3.12], P=0.027). HRR≤10 bt/min after 6MWT in COPD is associated with more severe expiratory flow limitation, airway wall thickening, worse dyspnoea and quality of life, and future exacerbations, suggesting that an abnormal HRR≤10 bt/min after a 6MWT may be used in a comprehensive assessment in COPD for risk of severity, symptoms and future exacerbations.

Groundwater in sub-Saharan Africa supports livelihoods and poverty alleviation 1 , 2 , maintains vital ecosystems, and strongly influences terrestrial water and energy budgets 3 . Yet the hydrological processes that govern groundwater recharge and sustainability—and their sensitivity to climatic variability—are poorly constrained 4 , 5 . Given the absence of firm observational constraints, it remains to be seen whether model-based projections of decreased water resources in dry parts of the region 4 are justified. Here we show, through analysis of multidecadal groundwater hydrographs across sub-Saharan Africa, that levels of aridity dictate the predominant recharge processes, whereas local hydrogeology influences the type and sensitivity of precipitation–recharge relationships. Recharge in some humid locations varies by as little as five per cent (by coefficient of variation) across a wide range of annual precipitation values. Other regions, by contrast, show roughly linear precipitation–recharge relationships, with precipitation thresholds (of roughly ten millimetres or less per day) governing the initiation of recharge. These thresholds tend to rise as aridity increases, and recharge in drylands is more episodic and increasingly dominated by focused recharge through losses from ephemeral overland flows. Extreme annual recharge is commonly associated with intense rainfall and flooding events, themselves often driven by large-scale climate controls. Intense precipitation, even during years of lower overall precipitation, produces some of the largest years of recharge in some dry subtropical locations. Our results therefore challenge the ‘high certainty’ consensus regarding decreasing water resources 4 in such regions of sub-Saharan Africa. The potential resilience of groundwater to climate variability in many areas that is revealed by these precipitation–recharge relationships is essential for informing reliable predictions of climate-change impacts and adaptation strategies. Analysis of multidecadal hydrograph and precipitation data for sub-Saharan Africa shows a complex relationship between groundwater recharge and precipitation, and that a drier climate does not necessarily mean less recharge.

We assessed the potential for using optical functional types as effective markers to monitor changes in vegetation in floodplain meadows associated with changes in their local environment. Floodplain meadows are challenging ecosystems for monitoring and conservation because of their highly biodiverse nature. Our aim was to understand and explain spectral differences among key members of floodplain meadows and also characterize differences with respect to functional traits. The study was conducted on a typical floodplain meadow in UK (MG4-type, mesotrophic grassland type 4, according to British National Vegetation Classification). We compared two approaches to characterize floodplain communities using field spectroscopy. The first approach was sub-community based, in which we collected spectral signatures for species groupings indicating two distinct eco-hydrological conditions (dry and wet soil indicator species). The other approach was “species-specific”, in which we focused on the spectral reflectance of three key species found on the meadow. One herb species is a typical member of the MG4 floodplain meadow community, while the other two species, sedge and rush, represent wetland vegetation. We also monitored vegetation biophysical and functional properties as well as soil nutrients and ground water levels. We found that the vegetation classes representing meadow sub-communities could not be spectrally distinguished from each other, whereas the individual herb species was found to have a distinctly different spectral signature from the sedge and rush species. The spectral differences between these three species could be explained by their observed differences in plant biophysical parameters, as corroborated through radiative transfer model simulations. These parameters, such as leaf area index, leaf dry matter content, leaf water content, and specific leaf area, along with other functional parameters, such as maximum carboxylation capacity and leaf nitrogen content, also helped explain the species’ differences in functional dynamics. Groundwater level and soil nitrogen availability, which are important factors governing plant nutrient status, were also found to be significantly different for the herb/wetland species’ locations. The study concludes that spectrally distinguishable species, typical for a highly biodiverse site such as a floodplain meadow, could potentially be used as target species to monitor vegetation dynamics under changing environmental conditions.

The need for the development of adaptation strategies for climate change in Africa is becoming critical. For example, infrastructure with a long lifespan now needs to be designed or adapted to account for a future climate that will be different from the past or present. There is a growing necessity for the climate information used in decision making to change from traditional science-driven metrics to decision-driven metrics. This is particularly relevant in East Africa, where limited adaptation and socio-economic capacity make this region acutely vulnerable to climate change. Here, we employ an interdisciplinary consultation process to define and analyse a number of such decision-oriented metrics. These metrics take a holistic approach, addressing the key East African sectors of agriculture, water supply, fisheries, flood management, urban infrastructure and urban health. A multifaceted analysis of multimodel climate projections then provides a repository of user-focused information on climate change and its uncertainties, for all metrics and seasons and two future time horizons. The spatial character and large intermodel uncertainty of changes in temperature and rainfall metrics are described, as well as those of other relevant metrics such as evaporation and solar radiation. Intermodel relationships amongst metrics are also explored, with two clear clusters forming around rainfall and temperature metrics. This latter analysis determines the extent to which model weights could, or could not, be applied across multiple climate metrics. Further work must now focus on maximising the utility of model projections, and developing tailored risk-based communication strategies.

We present results from the first high-resolution seismic reflection survey of the inner Western Indus Shelf, and Indus Delta, Arabian Sea. The results show major regional differences in sedimentation across the shelf from east to west, as well as north to south, both since the Last Glacial Maximum (~20 ka) and over longer time scales. We identify 10 major regional reflectors, interpreted as representing sea level lowstands. Strong compressive folding is observed underlying a reflector we have called Horizon 6 in the north-western shelf, probably compression associated with the transpressional deformation of the Murray Ridge plate boundary. Downslope profiles show a series of well developed clinoforms, principally at the shelf edge, indicating significant preservation of large packages of sediment during lowstands. These clinoforms have developed close to zones of deformation, suggesting that subsidence is a factor in controlling sedimentation and consequently erosion of the Indus Shelf. These clinoforms fan out from dome features (tectonic anticlines) mostly located close to the modern shoreline.