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The July 2021 floods in Europe stand out as one of the most devastating flood-related disasters to impact the continent in recent years, affecting multiple countries at once. As climate change intensifies, such cross-border disasters are expected to become more frequent. Here we use unique cross-country survey data from flooded homeowners to understand the patterns and limits of how households in different nations respond to shared flood crises. We find evidence of financial, institutional, and psychological limits to household adaptation. Insurance compensation is associated with private adaptation actions shortly after flooding. Households that suffered flood damage are more likely to mitigate future risks to their homes. Yet, this intention encounters limits for extreme flood damage. Once experienced flood damages exceed a threshold of around 60% of the home reconstruction value, homeowners begin to view private adaptation efforts as less effective, prompting a shift toward relocating to safer areas. Homeowners are more likely to take flood adaptation measures after experiencing damage, mainly when supported by insurance, and this effect weakens with extreme damage, according to an analysis that uses survey data from 719 flooded homeowners in the Netherlands, Belgium, and Germany.

The spatial transfer of flood damage models among regions and countries is a challenging but unavoidable approach for performing flood risk assessments in data- and model-scarce regions. In these cases, similarities and differences between the contexts of application should be considered to obtain reliable damage estimations, and, in some cases, the adaptation of the original model to the new conditions is required. This study exemplifies a replicable procedure for the adaptation to the Belgian context of a multi-variable, synthetic flood damage model for the residential sector originally developed for Italy (INSYDE). The study illustrates necessary amendments in model assumptions, especially regarding default input values for the hazard and building parameters and damage functions describing the modeled damage mechanisms.

This study compares operational Flood Forecasting and Early Warning Systems (FFEWSs) in transboundary river basins in Northwestern Europe, covering parts of Luxembourg, Germany, The Netherlands and Belgium. This region was hit by an extreme flood event in 2021 with more than 200 fatalities. Due to the high death toll and the large number of people who did not receive warnings, the FFEWSs were heavily criticized afterward. This study shows strong improvements in FFEWSs after the flood event in all countries. Interviews with experts across the region reveal that warning thresholds are optimized, some regions include new warning thresholds for extreme events (e.g. dark purple), and flood crisis management plans are improved. In addition, all countries now use mobile phone-based alerts using cell broadcasting technology. The assessment of the warning systems shows strong differences between and within countries, with different flood warning levels and warning colour codes in use. The interviews also reveal that the adoption of operational impact-based forecasts remains a challenge, while these are crucial for translating hydrological forecasts into effective actions. For example, the interviewees stress the need for operational flood inundation forecasts, which are currently only provided in Flanders. Our study has four concrete recommendations: (1) investigate the benefit of streamlined warning levels and colour codes between and within different countries; (2) assess the added value of more extreme warning levels for catastrophic events, such as the purple levels in Luxembourg and some German regions; (3) accelerate the development of operational impact-based forecasting systems, and (4) implement a structural evaluation of warning communication chains. These challenges must be addressed to reduce the gap between early warning and early action during impactful flood events.

Flash floods cause high numbers of casualties and enormous economic damage. Good knowledge of the damage processes is crucial for the implementation of effective flash flood risk management. However, little is known about the damage processes that occur during flash floods, despite their severity. To gain more knowledge, independent data collection initiatives were carried out in the affected areas of Belgium and Germany after the 2021 floods. The resulting datasets include 420 damaged residential buildings in the Vesdre valley in Belgium, 277 in the Ahr valley in Rhineland‐Palatinate (Germany) and 332 in North Rhine‐Westphalia (Germany). A total of 30 potential damage‐influencing variables were harmonized across the regions, providing valuable insights into hazard characteristics, the vulnerability of exposed assets, the coping capacity of inhabitants, and socio‐economic factors. Machine learning‐based analysis reveals the significant importance of hazard variables, such as water depth and sediment transport, particularly for building damage. In addition to these, exposure (living area) and physical vulnerability factors (building type and wall type) also play a role in determining building damage across the affected regions. For content damage, besides water depth and living area, socio‐economic vulnerability (ownership status of the building) and emergency measures were found to be important predictors. These key drivers of building and content damage from flash floods can be utilized to develop more accurate damage models, thereby improving flash flood risk assessments, enhancing risk communication, and supporting better preparedness strategies.

This study proposes a novel approach to improve the classification of severe building losses caused by river floods (i.e., identification of buildings with high flood damages). In addition to traditional variables reflecting flood hazard and building vulnerability, we investigate the impact of coping capacity variables (i.e., variables accounting for the preparedness and disaster response of the population and management authorities). These coping capacity variables are evaluated at three different scales: the building level (micro-scale), the census tract level (meso-scale), and the municipality level (macro-scale). Specifically, at the macro- and meso-scale these include: (i) the surprise effect (the ratio of the number of flooded buildings to the number of flooded buildings located in an official flood hazard area), (ii) the overwhelming effect (the fraction of flooded buildings compared to the total number of buildings within each census tract or municipalities), and (iii) flood rarity (the ratio of the peak discharge of the considered event to the 100-year flood peak). A binomial logistic regression model is used to classify flood losses based on field survey data from the extreme 2021 flood in eastern Belgium. Each variable is assessed for statistical significance, physical relevance, and multicollinearity. The results show that macro- and meso-scale coping capacity variables are insignificant in classifying building losses using the current dataset, suggesting that data on the building level are needed to reliably estimate building losses. Instead, the variables that contribute most to the classification are water depth, building footprint area, building finishing level and the heating system location. The performance of the classifier, measured by the AUC value, achieves an accuracy of 83%.

This study compares operational Flood Forecasting and Early Warning Systems (FFEWSs) in transboundary river basins in Northwestern Europe, covering parts of Luxembourg, Germany, the Netherlands and Belgium. This region was hit by an extreme flood event in 2021 with over 200 fatalities. Due to the high death toll, FFEWSs were heavily criticized in the aftermath. Expert interviews from the region revealed strong improvements of the FFEWSs after this flood event in all countries. All regions have invested in probabilistic flood forecasting systems, and all countries now use mobile phone-based alerts. Strong differences in flood warning levels and color codes exist across and within the countries. In response to the 2021 flood, some regions have introduced an additional purple warning level. The interviews also revealed that the uptake of operational impact-based forecasts remains challenging, while these are crucial for translating hydrological forecasts to effective actions. For example, interviewees highlighted the need for operational flood inundation forecasts. However, Flanders is the only region where such forecasts are provided. It is recommended to enhance forecasts with impact-based information, including inundation maps delineating the people and objects at risk. This can improve the early actions taken by first responders and the affected people.

Non-invasive transcranial alternating current stimulation (tACS) of the cochlea might be a promising new therapeutic option for patients with chronic tinnitus. However, electric stimulation of small, sensitive target regions, such as the inner ear, can cause adverse side effects (SEs). To identify stimulation parameters with low side-effect profiles while reliably stimulating the cochlea, thereby improving patient comfort and safety and paving the way for the development of a medical device for treating patients with chronic tinnitus. Hearing-healthy participants were stimulated with electrodes in the ear canal. Stimulation of the cochlea elicits a soft hearing impression (HI) in participants, indicating successful stimulation of the early auditory pathway. We systematically compare HS and SEs across distinct electrode configurations and stimulation parameters, including stimulation frequency and the presence of a Direct Current (DC)-offset. We record SE occurrence via visual analog scales after stimulation. We find that tACS stimulation between 250 Hz and 2000 Hz reliably elicits HIs in participants. SEs are generally low. No occurrence of SEs resulted in participant withdrawal or severe adverse events, with only phosphenes, skin tingling, and a sense of vibration being reported as impactful. The addition of a slight DC-offset increases the occurrence and magnitude of SEs considerably. Our results demonstrate the feasibility of tACS in non-invasively stimulating the auditory pathway with minimal adverse SE. Stimulation parameters with a low SE profile can be applied in further studies with tinnitus patients.

Cancer is the leading cause of death in Puerto Rico (PR). Hurricane Maria (HM) and its aftermath lead to widespread devastation on the island, including the collapse of the healthcare system. Medically fragile populations, such as cancer survivors, were significantly affected. The goal of this study was to assess the impact of HM on barriers to care, emotional distress, and inflammatory biomarkers among cancer survivors in PR. This exploratory longitudinal study was conducted in health care facilities and community support groups from PR. Cancer survivors (n = 50) and non-cancer participants (n = 50) completed psychosocial questionnaires and provided blood samples that were used to assess inflammatory cytokines levels. Among this cohort, we identified 41 matched cancer survivors/non-cancer participants pairs. Data were analyzed through descriptive, frequencies, correlational, and regression analyses. Cancer survivors that were affected by HM reported increased barriers in accessing medical care, which were directly associated with anxiety, perceived stress, and post-traumatic symptomatology. Moreover, being a cancer survivor, predicted more barriers to receiving health care, especially in the first six weeks after the event, after which the effect was attenuated. Several inflammatory cytokines, such as CD31, BDNF, TFF3, Serpin E-1, VCAM-1, Vitamin D BP, and PDGF-AA, were significantly upregulated in cancer survivors while MMP9 and Osteopontin both had significant positive correlations with barriers to care. HM significantly impacted Puerto Ricans psychosocial well-being. Cancer survivors had significant barriers to care and showed increased serum inflammatory cytokines but did not show differences in anxiety, stress, and post-traumatic symptoms compared to non-cancer participants.

The increasing demand for non-invasive biocompatible materials in biomedical applications, driven by accidents and diseases like cancer, has led to the development of sustainable biomaterials. Here, we report the synthesis of four block formulations using polycaprolactone (PCL), polylactic acid (PLA), and zinc oxide nanoparticles (ZnO-NPs) for subdermal tissue regeneration. Characterization by Fourier transform infrared spectroscopy (FT-IR) and X-ray diffraction (XRD) confirmed the composition of the composites. Additionally, the interaction of ZnO-NPs mainly occurred with the C=O groups of PCL occurring at 1724 cm−1, which disappears for F4, as evidenced in the FT-IR analysis. Likewise, this interaction evidenced the decrease in the crystallinity of the composites as they act as crosslinking points between the polymer backbones, inducing gaps between them and weakening the strength of the intermolecular bonds. Thermogravimetric (TGA) and differential scanning calorimetry (DSC) analyses confirmed that the ZnO-NPs bind to the carbonyl groups of the polymer, acting as weak points in the polymer backbone from where the different fragmentations occur. Scanning electron microscopy (SEM) showed that the increase in ZnO-NPs facilitated a more compact surface due to the excellent dispersion and homogeneous accumulation between the polymeric chains, facilitating this morphology. The in vivo studies using the nanocomposites demonstrated the degradation/resorption of the blocks in a ZnO-NP-dependant mode. After degradation, collagen fibers (Type I), blood vessels, and inflammatory cells continue the resorption of the implanted material. The results reported here demonstrate the relevance and potential impact of the ZnO-NP-based scaffolds in soft tissue regeneration.

Landscapes can lead to different emotions towards nature that in turn shape people’s environmental behavior and decision processes. This study explores the role of emotions that Mediterranean landscapes foster in people and to what extent these emotions are associated with human–nature connectedness (HNC). We conducted 176 face-to-face surveys to explore HNC and the diversity of emotions associated with a suite of landscapes in Southeast Spain. Results revealed that Marine and Coastal Protected Areas received the highest number of positive emotions, whereas Greenhouses and Non-Protected Littoral were linked to negative emotions. We propose a framework for classifying emotional landscapes according to four groups: emotionally positive, negative, polarized or neutral. Results showed that emotions might play a key role in shaping HNC in Spanish Mediterranean landscapes and may be used as a common ground for understanding roots underpinning human decisions and actions that lead to sustainable management or landscape degradation.