Influence of catchment quality and altitude on the water and sediment composition of 68 small lakes in Central Europe

68 lakes (63 Swiss, 2 French and 3 Italian) located in an altitudinal range between 334 and 2339m spanning a wide range of land-use have been investigated. The aim of the study was to discuss influences of geographic location, vegetation and land-use in the catchment area on the water and sediment chemistry of small lakes. Detailed quantitative description of land-use, vegetation, and climate in the watershed of all lakes was established. Surface and bottom water samples collected from each lake were analyzed for major ions and nutrients. Correlations were interpreted using linear regression analysis. Chemical parameters of water and sediment reflect the characteristics of the catchment areas. All lakes were alkaline since they were situated on calcareous bedrock. Concentrations of nitrogen and phosphorus strongly increase with increasing agricultural land-use. Na and K, however, are positively correlated with the amount of urbanization within the catchment area. These elements as well as dissolved organic carbon (DOC), Mg, Ca, and alkalinity, increase when the catchment is urbanized or used for agriculture. Total nitrogen and organic carbon in the sediments decrease distinctly if large parts of the catchment consist of bare land. No correlations between sediment composition and maximum water depth or altitude of the lakes were found.¶Striking differences in the water compositions of lakes above and below approximately 700 m of altitude were observed. Concentrations of total nitrogen and nitrate, total phosphorus, DOC, Na, K, Mg, Ca, and alkalinity are distinctly higher in most lakes below 700 m than above, and the pH of the bottom waters of these lakes is generally lower. Estimates of total nitrogen concentrations, even in remote areas, indicate that precipitation is responsible for increased background concentrations. At lower altitudes nitrogen concentrations in lakes is explained by the nitrogen loaded rain from urban areas deposited on the catchment, and with high percentages of agricultural land-use in the watershed.

Assertive community treatment as part of integrated care versus standard care: a 12-month trial in patients with first- and multiple-episode schizophrenia spectrum disorders treated with quetiapine immediate release (ACCESS trial)

The ACCESS trial examined the 12-month effectiveness of continuous therapeutic assertive community treatment (ACT) as part of integrated care compared to standard care in a catchment area comparison design in patients with schizophrenia spectrum disorders treated with quetiapine immediate release.

Incidence, clinical presentation and imaging findings of cavernous malformations of the CNS. A twenty-year experience

Up to 88% of cavernous malformations (CMs) of the central nervous system can become symptomatic and cause long-term disability. The aim of this study was to document the characteristics of CMs in the catchment area of our institution.

Seasonal variability in spontaneous cervical artery dissection

We examined the seasonal variability of spontaneous cervical artery dissection (sCAD) by analysing prospectively collected data from 352 patients with 380 sCAD (361 symptomatic sCAD; 305 carotid and 75 vertebral artery dissections) admitted to two university hospitals with a catchment area of 2,200,000 inhabitants between 1985 and 2004. Presenting symptoms and signs of the 380 sCAD were ischaemic stroke in 241 (63%), transient ischaemic attack in 40 (11%), retinal ischemia in seven (2%), and non-ischaemic in 73 (19%) cases; 19 (5%) were asymptomatic sCAD. A seasonal pattern, with higher frequency of sCAD in winter (31.3%; 95% confidence interval (CI): 26.5 to 36.4; p=0.021) compared to spring (25.5%; 95% CI: 21.1 to 30.3), summer (23.5%; 95% CI: 19.3 to 28.3), and autumn (19.7%; 95% CI: 15.7 to 24.1) was observed. Although the cause of seasonality in sCAD is unclear, the winter peaks of infection, hypertension, and aortic dissection suggest common underlying mechanisms.

The importance of glacier and forest change in hydrological climate-impact studies

Changes in land cover alter the water balance components of a catchment, due to strong interactions between soils, vegetation and the atmosphere. Therefore, hydrological climate impact studies should also integrate scenarios of associated land cover change. To reflect two severe climate-induced changes in land cover, we applied scenarios of glacier retreat and forest cover increase that were derived from the temperature signals of the climate scenarios used in this study. The climate scenarios were derived from ten regional climate models from the ENSEMBLES project. Their respective temperature and precipitation changes between the scenario period (2074–2095) and the control period (1984–2005) were used to run a hydrological model. The relative importance of each of the three types of scenarios (climate, glacier, forest) was assessed through an analysis of variance (ANOVA). Altogether, 15 mountainous catchments in Switzerland were analysed, exhibiting different degrees of glaciation during the control period (0–51%) and different degrees of forest cover increase under scenarios of change (12–55% of the catchment area). The results show that even an extreme change in forest cover is negligible with respect to changes in runoff, but it is crucial as soon as changes in evaporation or soil moisture are concerned. For the latter two variables, the relative impact of forest change is proportional to the magnitude of its change. For changes that concern 35% of the catchment area or more, the effect of forest change on summer evapotranspiration is equally or even more important than the climate signal. For catchments with a glaciation of 10% or more in the control period, the glacier retreat significantly determines summer and annual runoff. The most important source of uncertainty in this study, though, is the climate scenario and it is highly recommended to apply an ensemble of climate scenarios in the impact studies. The results presented here are valid for the climatic region they were tested for, i.e., a humid, mid-latitude mountainous environment. They might be different for regions where the evaporation is a major component of the water balance, for example. Nevertheless, a hydrological climate-impact study that assesses the additional impacts of forest and glacier change is new so far and provides insight into the question whether or not it is necessary to account for land cover changes as part of climate change impacts on hydrological systems.

Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared

Introduction: Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. Methods: The two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender. Results: Of 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001). These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73-1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20-1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51-0.93). Conclusions: In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.

Mass-movement and flood-induced deposits in Lake Ledro, southern Alps, Italy: implications for Holocene palaeohydrology and natural hazards

High-resolution seismic profiles and sediment cores from Lake Ledro combined with soil and riverbed samples from the lake's catchment area are used to assess the recurrence of natural hazards (earthquakes and flood events) in the southern Italian Alps during the Holocene. Two well-developed deltas and a flat central basin are identified on seismic profiles in Lake Ledro. Lake sediments have been finely laminated in the basin since 9000 cal. yr BP and frequently interrupted by two types of sedimentary events (SEs): light-coloured massive layers and dark-coloured graded beds. Optical analysis (quantitative organic petrography) of the organic matter present in soil, riverbed and lacustrine samples together with lake sediment bulk density and grain-size analysis illustrate that light-coloured layers consist of a mixture of lacustrine sediments and mainly contain algal particles similar to the ones observed in background sediments. Light-coloured layers thicker than 1.5 cm in the main basin of Lake Ledro are synchronous to numerous coeval mass-wasting deposits remoulding the slopes of the basin. They are interpreted as subaquatic mass-movements triggered by historical and pre-historical regional earthquakes dated to AD2005, AD1891, AD1045 and 1260, 2545, 2595, 3350, 3815, 4740, 7190, 9185 and 11 495 cal. yr BP. Darkcoloured SEs develop high-amplitude reflections in front of the deltas and in the deep central basin. These beds are mainly made of terrestrial organic matter (soils and lignocellulosic debris) and are interpreted as resulting from intense hyperpycnal flood event. Mapping and quantifying the amount of soil material accumulated in the Holocene hyperpycnal flood deposits of the sequence allow estimating that the equivalent soil thickness eroded over the catchment area reached up to 5mm during the largest Holocene flood events. Such significant soil erosion is interpreted as resulting from the combination of heavy rainfall and snowmelt. The recurrence of flash flood events during the Holocene was, however, not high enough to affect pedogenesis processes and highlight several wet regional periods during the Holocene. The Holocene period is divided into four phases of environmental evolution. Over the first half of the Holocene, a progressive stabilization of the soils present through the catchment of Lake Ledro was associated with a progressive reforestation of the area and only interrupted during the wet 8.2 event when the soil destabilization was particularly important. Lower soil erosion was recorded during the mid-Holocene climatic optimum (8000-4200 cal. yr BP) and associated with higher algal production. Between 4200 and 3100 cal. yr BP, both wetter climate and human activities within the drainage basin drastically increased soil erosion rates. Finally, from 3100 cal. yr BP to the present-day, data suggest increasing and changing human land use.

Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia spectrum and bipolar I disorders: the 24-month follow-up ACCESS II study

OBJECTIVE The ACCESS treatment model offers assertive community treatment embedded in an integrated care program to patients with psychoses. Compared to standard care and within a controlled study, it proved to be more effective in terms of service disengagement and illness outcomes in patients with schizophrenia spectrum disorders over 12 months. ACCESS was implemented into clinical routine and its effectiveness assessed over 24 months in severe schizophrenia spectrum disorders and bipolar I disorder with psychotic features (DSM-IV) in a cohort study. METHOD All 115 patients treated in ACCESS (from May 2007 to October 2009) were included in the ACCESS II study. The primary outcome was rate of service disengagement. Secondary outcomes were change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication nonadherence, length of hospital stay, and rates of involuntary hospitalization. RESULTS Only 4 patients (3.4%) disengaged with the service. Another 11 (9.6%) left because they moved outside the catchment area. Patients received a mean of 1.6 outpatient contacts per week. Involuntary admissions decreased from 34.8% in the 2 previous years to 7.8% during ACCESS (P < .001). Mixed models repeated-measures analyses revealed significant improvements among all patients in psychopathology (effect size d = 0.64, P < .001), illness severity (d = 0.84, P = .03), functioning level (d = 0.65, P < .001), quality of life (d = 0.50, P < .001), and client satisfaction (d = 0.11, P < .001). At 24 months, 78.3% were fully adherent to medication, compared to 25.2% at baseline (P = .002). CONCLUSIONS ACCESS was successfully implemented in clinical routine and maintained excellent rates of service engagement and other outcomes in patients with schizophrenia spectrum disorders or bipolar I disorder with psychotic features over 24 months. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01888627.

Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians.

BACKGROUND Transient ischemic attacks (TIA) are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs) and hospital physicians (HPs) knew about stroke risk after TIA, and to measure their referral rates. METHODS We used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient's risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients. RESULTS Of the 1545 physicians, 40% (614) returned the survey. Of these, 75% (457) overestimated stroke risk within 24 hours, and 40% (245) overestimated risk within 3 months after TIA. Only 9% (53) underestimated stroke risk within 24 hours and 26% (158) underestimated risk within 3 months; 78% (473) of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543) would rigorously investigate the cause of a TIA, but only 38% (229) would refer TIA patients for urgent investigations "very often". Physicians most commonly gave these reasons for not making emergency referrals: patient's advanced age; patient's preference; patient was multimorbid; and, patient needed long-term care. CONCLUSIONS Although physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.

Reconstruction of Holocene vegetation dynamics at Lac de Bretaye, a high-mountain lake in the Swiss Alps

A deeper understanding of past vegetation dynamics is required to better assess future vegetation responses to global warming in the Alps. Lake sediments from Lac de Bretaye, a small subalpine lake in the Northern Swiss Alps (1780 m a.s.l.), were analysed to reconstruct past vegetation dynamics for the entire Holocene, using pollen, macrofossil and charcoal analyses as main proxies. The results show that timberline reached the lake’s catchment area at around 10,300 cal. BP, supporting the hypothesis of a delayed postglacial afforestation in the Northern Alps. At the same time, thermophilous trees such as Ulmus, Tilia and Acer established in the lowlands and expanded to the altitude of the lake, forming distinctive boreo-nemoral forests with Betula, Pinus cembra and Larix decidua. From about 5000 to 3500 cal. BP, thermophilous trees declined because of increasing human land use, mainly driven by the mass expansion of Picea abies and severe anthropogenic fire activity. From the Bronze Age onwards (c. 4200–2800 cal. BP), grazing indicators and high values for charcoal concentration and influx attest an intensifying human impact, fostering the expansion of Alnus viridis and Picea abies. Hence, biodiversity in alpine meadows increased, whereas forest diversity declined, as can be seen in other regional records. We argue that the anticipated climate change and decreasing human impact in the Alps today will not only lead to an upward movement of timberline with consequent loss of area for grasslands, but also to a disruption of Picea abies forests, which may allow the re-expansion of thermophilous tree species.

An Appraisal of the Current Status and the Potential of Surface Water in Upper Anseba Catchment, Eritrea

The study deals with the status and potential of surface water resources in Upper Anseba, Central Highlands of Eritrea, one of the most densely populated regions in Eritrea, including small scale farming and the country's capital city. water demand is increasing rapidly for all uses. The area has no perennial water course and depends very largely on reservoirs for its water supply. The report finds that there are 74 reservoirs in the area, of which 49 are in Upper Anseba. Total reservoir capacity already corresponds to 70% of runoff. the capacity of some of the reservoirs already exceeds annual runoff of their catchment. Recommendations thus include the use of water saving technologies for irrigation; and above all, preparation of a regional master plan for development, including water allocation planning with a mid term perspective.

Holocene vegetation development in the catchment of Sagistalsee (1935 m asl), a small lake in the Swiss Alps

Pollen and plant macrofossils were analysed at Sägistalsee (1935 m asl), a small lake near timber-line in the Swiss Northern Alps. Open forests with Pinus cembra and Abies alba covered the catchment during the early Holocene (9000–6300 cal. BP), suggesting subcontinental climate conditions. After the expansion of Picea abies between 6300 and 6000 cal. BP the subalpine forest became denser and the tree-line reached its maximum elevation at around 2260 m asl. Charcoal fragments in the macrofossil record indicate the beginning of Late-Neolithic human impact at ca. 4400 cal. BP, followed by a extensive deforestation and lowering of the forest-limit in the catchment of Sägistalsee at 3700 cal. BP (Bronze Age). Continuous human activity, combined with a more oceanic climate during the later Holocene, led to the local extinction of Pinus cembra and Abies alba and favoured the mass expansion of Picea and Alnus viridis in the subalpine area of the Northern Alps. The periods before 6300 and after 3700 cal. BP are characterised by high erosion activity in the lake's catchment, whereas during the phase of dense Picea-Pinus cembra-Abies forests (6300–3700 cal. BP) soils were stable and sediment-accumulation rates in the lake were low. Due to decreasing land-use at higher altitudes during the Roman occupation and the Migration period, forests spread beween ca. 2000 and 1500 cal. BP, before human impact increased again in the early Middle Ages. Recent reforestation due to land-use changes in the 20th century is recorded in the top sediments. Pollen-inferred July temperature and annual precipitation suggest a trend to cooler and more oceanic climate starting at about 5500 cal. BP.

Decision-Support tools for assessing land degradation and realising sustainable land management, Study Case of El Mkhachbiya Catchment, Northwest of Tunisia

Land degradation is intrinsically complex and involves decisions by many agencies and individuals, land degradation map- ping should be used as a learning tool through which managers, experts and stakeholders can re-examine their views within a wider semantic context. In this paper, we introduce an analytical framework for mapping land degradation, developed by World Overview for Conservation Approaches and technologies (WOCAT) programs, which aims to develop some thematic maps that serve as an useful tool and including effective information on land degradation and conservation status. Consequently, this methodology would provide an important background for decision-making in order to launch rehabilitation/remediation actions in high-priority intervention areas. As land degradation mapping is a problem-solving task that aims to provide clear information, this study entails the implementation of WOCAT mapping tool, which integrate a set of indicators to appraise the severity of land degradation across a representative watershed. So this work focuses on the use of the most relevant indicators for measuring impacts of different degradation processes in El Mkhachbiya catchment, situated in Northwest of Tunisia and those actions taken to deal with them based on the analysis of operating modes and issues of degradation in different land use systems. This study aims to provide a database for surveillance and monitoring of land degradation, in order to support stakeholders in making appropriate choices and judge guidelines and possible suitable recommendations to remedy the situation in order to promote sustainable development. The approach is illustrated through a case study of an urban watershed in Northwest of Tunisia. Results showed that the main land degradation drivers in the study area were related to natural processes, which were exacerbated by human activities. So the output of this analytical framework enabled a better communication of land degradation issues and concerns in a way relevant for policymakers.