The spatial configuration of local climate zones reveals effects on wayfinding in human walking.

The importance of easy wayfinding in complex urban settings has been recognized in spatial planning. Empirical measurement and explicit representation of wayfinding, however, have been limited in deciding spatial configurations. Our study proposed and tested an approach to improving wayfinding by incorporating spatial analysis of urban forms in the Guangdong-Hong Kong-Macau Great Bay Area in China. Wayfinding was measured by an indicator of intelligibility using spatial design network analysis. Urban spatial configurations were quantified using landscape metrics to describe the spatial layouts of local climate zones (LCZs) as standardized urban forms. The statistical analysis demonstrated the significant associations between urban spatial configurations and wayfinding. These findings suggested, to improve wayfinding, 1) dispersing LCZ 1 (compact high-rise) and LCZ 2 (compact mid-rise) and 2) agglomerating LCZ 3 (compact low-rise), LCZ 5 (open mid-rise), LCZ 6 (open low-rise), and LCZ 9 (sparsely built). To our knowledge, this study is the first to incorporate the LCZ classification system into the wayfinding field, clearly providing empirically-supported solutions for dispersing and agglomerating spatial configurations. Our findings also provide insights for human-centered spatial planning by spatial co-development at local, urban, and regional levels.

Water quality management at a critical checkpoint by coordinated multi-catchment urban-rural load allocation.

Improving river water quality at critical checkpoints, defined as locations with significant impacts on water use, to satisfy regulation standards is an important goal of sustainable catchment management. Challenges remain in investigating pollution hotspots, designing efficient target reduction, and evaluating management performance. To address these challenges, we develop a systems approach for water quality management that integrates natural physical processes with human activities and their environmental impacts. In this approach, we firstly expand the concepts of headroom (amount under a permitted value) and excess (amount exceeding a permit) onto the source, spatial, and temporal domains for water quality management. We evaluate system-wide pollution contributions by simulating physical processes in a semi-distributed integrated representation using the CatchWat-SD model. We apply the model to the Upper Thames River basin and validate it using available monitoring data. We then incorporate the evaluated headroom-excess into a coordinated load allocation to enhance the efficiency and feasibility of interventions. Load allocation scenarios where headroom-excess is coordinated at different domains are generated and simulated. Finally, we evaluate the performance of these scenarios using multi-criteria metrics to demonstrate the advantages of headroom-excess coordination. Results show that urban sources, downstream sub-catchments, and dry season flows are associated with excess, thus, enabling managers to identify which cases (pollution sources, locations, and times) to focus load reductions towards. The more a load allocation strategy coordinates headroom-excess across domains, the more target reduction is allocated to the cases with excess, and the better performance it obtains in all the criteria. The study emphasises the need to incorporate headroom-excess in load allocation, which helps to improve systems-level water quality performance more efficiently. The approach can be further expanded to water quality management at multiple checkpoints for sustainable management of regional water systems.

Optimisation of urban-rural nature-based solutions for integrated catchment water management.

Nature-based solutions (NBS) have co-benefits for water availability, water quality, and flood management. However, searching for optimal integrated urban-rural NBS planning to maximise co-benefits at a catchment scale is still limited by fragmented evaluation. This study develops an integrated urban-rural NBS planning optimisation framework based on the CatchWat-SD model, which is developed to simulate a multi-catchment integrated water cycle in the Norfolk region, UK. Three rural (runoff attenuation features, regenerative farming, floodplain) and two urban (urban green space, constructed wastewater wetlands) NBS interventions are integrated into the model at a range of implementation scales. A many-objective optimisation problem with seven water management objectives to account for flow, quality and cost indicators is formulated, and the NSGAII algorithm is adopted to search for optimal NBS portfolios. Results show that rural NBS have more significant impacts across the catchment, which increase with the scale of implementation. Integrated urban-rural NBS planning can improve water availability, water quality, and flood management simultaneously, though trade-offs exist between different objectives. Runoff attenuation features and floodplains provide the greatest benefits for water availability. Regenerative farming is most effective for water quality and flood management, though it decreases water availability by up to 15% because it retains more water in the soil. Phosphorus levels are best reduced by expansion of urban green space to decrease loading on combined sewer systems, though this trades off against water availability, flood, nitrogen and suspended solids. The proposed framework enables spatial prioritisation of NBS, which may ultimately guide multi-stakeholder decision-making, bridging the urban-rural divide in catchment water management.

Liver transplantation in hepatocellular carcinoma - should we perform downstaging?

AIM: To compare the long-term outcomes between liver transplant (LT) recipients with hepatocellular carcinoma (HCC) who were downstaged with transarterial-chemoembolization (TACE) to the Milan criteria (MC) and those initially meeting the MC. METHODS: This retrospective study enrolled 198 patients with HCC: 38 were downstaged and 160 patients initially met the MC. Post-LT survival and HCC recurrence-free survival were evaluated. We assessed the association of death and HCC recurrence with TACE, baseline (age, sex, disease etiology, Model of End-stage Liver Disease, tumor number and the sum of maximum tumor diameters, waiting time, alpha-fetoprotein level) and explant characteristics (tumor number and the sum of maximum tumor diameters, micro- and macrovascular invasion). RESULTS: The recipient survival rates one, three, and five years after LT were 88.2%, 80.1%, and 75.9%, respectively. HCC recurrence-free probabilities were 92.3%, 87.9%, and 85%, respectively. The outcomes were comparable between the groups. In multivariate analysis, the number of tumors on the explant, age, and tumor recurrence were independent risk factors for death. Only the sum of maximum tumor diameters on the explant was an independent risk factor for HCC recurrence. CONCLUSIONS: Patients successfully downstaged with TACE to the MC can achieve post-LT recipient and HCC recurrence-free survival comparable with patients initially within the MC. Good response to TACE as a criterion for LT may be a method of selecting patients with favorable biological characteristics.

Water neutrality framework for systemic design of new urban developments.

The climate emergency and population growth threaten urban water security in cities worldwide. Growth, urbanisation, and changes to way of life have increased housing demand, requiring cities such as London to increase their housing stock by more than 15% over the next 10 years. These new urban developments will increase water demand, urban flood risk, and river water pollution levels; therefore, an integrated systems-based approach to development and water management is needed. Water Neutrality (WN) has emerged as a concept to frame the concerns about escalating water stresses in cities. We frame WN as a planning process for new urban developments that aims to minimise impacts on urban water security and offset any remaining stresses by retrofitting existing housing stock. In this work, we present a novel systemic design framework for future urban planning called CityPlan-Water, which guides how WN might be achieved to tackle current and future water pressures at a city scale. CityPlan-Water integrates spatial data with an integrated urban water management model, enabling urban design at a systems level and systematic assessment of future scenarios. We define a Water Neutrality Index that captures how successful a given urban planning scenario is in achieving WN and how multiple interventions could be combined at a city scale to improve WN. Results from CityPlan-Water suggest that it will be necessary to retrofit almost the same number of existing homes with WN design options to completely offset the impact imposed by proposed new developments. Combining options such as water efficient appliances, water reuse systems, and social awareness campaigns can offset the impact of new development on water demand by 70%, while to neutralise potential flood risk and water pollution at a city scale, interventions such as rainwater harvesting and Blue Green Infrastructure need to be added both in new urban developments and 432,000 existing London households. We see CityPlan-Water as a tool that can support the transition of urban planning towards using data-driven analysis to effectively design water neutral housing and drive sustainable development.

Predicting catchment suitability for biodiversity at national scales.

Biomonitoring of water quality and catchment management are often disconnected, due to mismatching scales. Considerable effort and money are spent each year on routine reach-scale surveying across many sites, particularly in countries like the UK, where nationwide sampling has been conducted using standardised techniques for many decades. Most of these traditional freshwater biomonitoring schemes focus on pre-defined indicators of organic pollution to compare observed vs expected subsets of common macroinvertebrate indicator species. Other taxa, including many threatened species, are often ignored due to their rarity, as are many invasive species, which are seen as undesirable despite becoming increasingly common and widespread in freshwaters, especially in urban ecosystems. Both these types of taxa are often monitored separately for reasons related to biodiversity concerns rather than for gauging water quality. Repurposing such data could therefore provide important new biomonitoring tools that can help catchment managers to directly link the water quality they aim to control with the biodiversity they are trying to protect. Here we used extensive data held in the England Non-Native and Rare/Protected species records that track these two groups of species as a proof-of-concept for linking catchment scale management of freshwater ecosystems and biodiversity to a range of potential drivers across England. We used national land use (Centre for Ecology and Hydrology land cover map) and water quality indicator (Environment Agency water quality data archive) datasets to predict, at the catchment scale, the presence or absence of 48 focal threatened or invasive species of concern routinely sampled by the English Environment Agency, with a median accuracy of 0.81 area under the receiver operating characteristic curve. A variety of water quality indicators and land-use types were useful in predictions, highlighting that future biomonitoring schemes could use such complementary measures to capture a wider spectrum of drivers and responses. In particular, the percentage of a catchment covered by freshwater was the single most important metric, reinforcing the need for space/habitat to support biodiversity, but we were also able to resolve a range of key environmental drivers for particular focal species. We show how our method could inform new catchment management approaches, by highlighting how key relationships can be identified and how to understand, visualise and prioritise catchments that are most suitable for restoration or water quality interventions. The scale of this work, in terms of number of species, drivers and locations, represents a significant step towards forging a new approach to catchment management that enables managers to link drivers they can control (water quality and land use) to the biota they are trying to protect (biodiversity).

Integrating the Budyko framework with the emerging hot spot analysis in local land use planning for regulating surface evapotranspiration ratio.

Land use planning regulates surface hydrological processes by adjusting land properties with varied evapotranspiration ratios. However, a dearth of empirical spatial information hampers the regulation of place-specific hydrological processes. Therefore, this study proposed a Local Land Use Planning framework for EvapoTranspiration Ratio regulations (ETR-LLUP), which was tested for the developments of spatially-varied land use strategies in the Dongjiang River Basin (DRB) in Southern China. With the first attempt at integrating the Emerging Hot Spots Analysis (EHSA) with the Budyko framework, the spatiotemporal trends of evapotranspiration ratios based on evaporative index and dryness index, from 1992 to 2018, were illustrated. Then, representative land-cover types in each sub-basin were defined using Geographically Weighted Principal Component Analysis, in two wet years (1998 and 2016) and three dry years (2004, 2009, and 2018), which in turn were identified using the Standard Precipitation Index. Finally, Geographically Weighted Regressions (GWRs) were used to detect spatially-varied relationships between land-cover proportions and evaporative index in both dry and wet climates. Results showed that the DRB was consistently a water-limited region from 1992 to 2018, and the situation was getting worse. We also identified the upper DRB as hotspots for hydrological management. Forests and croplands experienced increasingly water stress compared to other vegetation types. More importantly, the spatial results of GWR models enabled us to adjust basin land use by 1) expanding and contracting a combination of 'mosaic natural vegetation' and 'broadleaved deciduous trees' in the western and eastern parts of the basin, respectively; and 2) increasing 'broadleaved evergreen trees' in the upstream parts of the basin. These spatially-varied land use strategies based on the ETR-LLUP framework allow for place-specific hydrological management during both dry and wet climates.

Evaluating natural capital performance of urban development through system dynamics: A case study from London.

Natural capital plays a central role in urban functioning, reducing flooding, mitigating urban heat island effects, reducing air pollution, and improving urban biodiversity through provision of habitat space. There is also evidence on the role played by blue and green space in improving physical and mental health, reducing the burden on the health care service. Yet from an urban planning and development view, natural capital may be considered a nice to have, but not essential element of urban design; taking up valuable space which could otherwise be used for traditional built environment uses. While urban natural capital is largely recognised as a positive element, its benefits are difficult to measure both in space and time, making its inclusion in urban (re)development difficult to justify. Here, using a London case study and information provided by key stakeholders, we present a system dynamics (SD) modelling framework to assess the natural capital performance of development and aid design evaluation. A headline indicator: Natural Space Performance, is used to evaluate the capacity of natural space to provide ecosystem services, providing a semi-quantitative measure of system wide impacts of change within a combined natural, built and social system. We demonstrate the capacity of the model to explore how combined or individual changes in development design can affect natural capital and the provision of ecosystem services, for example, biodiversity or flood risk. By evaluating natural capital and ecosystem services over time, greater justification for their inclusion in planning and development can be derived, providing support for increased blue and green space within cities, improving urban sustainability and enhancing quality of life. Furthermore, the application of a SD approach captures key interactions between variables over time, showing system evolution while highlighting intervention opportunities.

Hierarchical systems integration for coordinated urban-rural water quality management at a catchment scale.

Managing river quality is important for sustainable catchment development. In this study, we present how catchment management strategies benefit from a coordinated implementation of measures that are based on understanding key drivers of pollution. We develop a modelling approach that integrates environmental impacts, human activities, and management measures as three hierarchical levels. We present a catchment water management model (CatchWat) that achieves all three hierarchical levels and is applied to the Cherwell Catchment, UK. CatchWat simulations are evaluated against observed river flow and pollutant data including suspended solids, total nitrogen, and total phosphorus. We compare three competing hypotheses, or framings, of the catchment representation (integrated, urban-only, and rural-only framings) to test the impacts of model boundaries on river water quality modelling. Scenarios are formulated to simulate separate, combined and coordinated implementation of fertiliser application reduction and enhanced wastewater treatment. Results show that models must represent both urban and rural pollution emissions to accurately estimate river quality. Agricultural activities are found to drive river quality in wet periods because runoff is the main pathway for rural pollutants. Meanwhile, urban activities are the key source of pollution in dry periods because effluent constitutes a larger percentage of river flow during this time. Based on this understanding, we identify a coordinated management strategy that implements fertiliser reduction measures to improve river quality during wet periods and enhanced wastewater treatment to improve river quality during dry periods. The coordinated strategy performs comparably to the combined strategy but with higher overall efficiency. This study emphasises the importance of systems boundaries in integrated water quality modelling and simulating the mechanisms of seasonal water quality behaviour. Our key recommendation is that incorporating these mechanisms is required to develop coordinated strategies for river water quality management, that can ultimately lead to more efficient and sustainable catchment management.

Small intestinal bacterial overgrowth and non-alcoholic fatty liver disease diagnosed by transient elastography and liver biopsy.

BACKGROUND: We aimed to determine if there was a higher incidence of small intestinal bacterial overgrowth (SIBO) in non-alcoholic fatty liver disease (NAFLD) than in patients without NAFLD. Moreover, we assessed whether patients with significant fibrosis (SF) had a higher incidence of SIBO compared with patients with non-significant or no liver fibrosis. METHODS: NAFLD was diagnosed in 117 patients by using Fibroscan with a controlled attenuation parameter (CAP) as well as liver biopsy (LB). SIBO was defined by esophagogastroduodenoscopy with an aspiration of the descending duodenum. RESULTS: Patients with non-alcoholic steatohepatitis (NASH) and those with SF on LB had a significantly higher incidence of SIBO than patients without NASH and those without SF, respectively (P < .05). According to histological characteristics, there was a higher proportion of patients in the SIBO group with higher steatosis and fibrosis grade, lobular and portal inflammation, and ballooning grade (P < .001). In multivariate analysis, significant predictors associated with SF and NASH were type 2 diabetes mellitus (T2DM) and SIBO. Moreover, in multivariate analysis, significant predictors that were independently associated with SIBO were T2DM, fibrosis stage and ballooning grade (OR 8.80 (2.07-37.37), 2.50 (1.16-5.37) and 27.6 (6.41-119), respectively). The most commonly isolated were gram-negative bacteria, predominantly Escherichia coli and Klebsiella pneumoniae. CONCLUSION: In this relatively large population of patients, we used a gold standard for both SIBO (quantitative culture of duodenum's descending part aspirate) and NAFLD (LB), and we demonstrated that NASH patients and those with SF had a higher incidence of SIBO. Moreover, significant predictors independently associated with SIBO were T2DM, fibrosis stage and ballooning grade. Although TE is a well-investigated method for steatosis and fibrosis detection, in our study, independent predictors of SIBO were histological characteristics of NAFLD, while elastographic parameters did not reach statistical significance.

Relationship between coffee consumption, sleep duration and smoking status with elastographic parameters of liver steatosis and fibrosis; controlled attenuation parameter and liver stiffness measurements.

AIM: our aim was to explore the association between life habits and the controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) as the surrogate markers of liver steatosis and fibrosis in a large cohort of non-alcoholic fatty liver disease (NAFLD) patients. METHODS: In this prospective, cross-sectional study we had analysed 1998 patients with diagnosed NAFLD. Sleeping duration was categorised in three groups: short (S) (<6 hours), moderate (M) (6-8 hours) and long (L) (>8 hours) sleep duration. Coffee drinking was categorized into no (0), moderate (1-2) and frequent (≥3) consumption (in cups/day). Smoking was categorised as yes versus no. RESULTS: Frequent coffee consumers had the lowest prevalence of obesity, hypertension, dyslipidaemia and diabetes. Furthermore, coffee non-consumers had highest values of hepatic enzymes, CAP and LSM. Moderate sleep duration was associated with lower values of CAP and LSM. Coffee consumption was associated with lower CAP in all the multivariate models (CAP unadjusted and model 1, 2 and 3), with largest effect in most frequent coffee consumers (≥3, model 3). Also, most frequent coffee consumers were associated with lower LSM in unadjusted model, model 1 and 2, while this was not the case for model 3 and those who consumed 1-2 cups of coffee per day. Reduced sleeping was confirmed as risk factor for elevated CAP in most of the models (unadjusted and model 1 and 2). Also, negative association of LSM was also confirmed in unadjusted model and model 2. Patients which slept 6-8 hours per day were mostly associated with lower CAP and LSM. Smoking status was not associated with CAP or LSM values. CONCLUSION: Coffee consumption has beneficial effect on CAP and LSM and this effect is dose dependent since and independent of a variety of relevant confounders. We have shown that moderate sleep duration has also beneficial effect on CAP and LSM.

Gravimetry-based water storage shifting over the China-India border area controlled by regional climate variability.

The regional water storage shifting causes nonstationary spatial distribution of droughts and flooding, leading to water management challenges, environmental degradation and economic losses. The regional water storage shifting is becoming evident due to the increasing climate variability. However, the previous studies for climate drivers behind the water storage shifting are not rigorously quantified. In this study, the terrestrial water storage (TWS) spatial shifting pattern during 2002-2017 over the China-India border area (CIBA) is developed using the Gravity Recovery and Climate Experiment (GRACE), suggesting that the Indus-Ganges-Brahmaputra basin (IGBB) was wetting while the central Qinghai-Tibet Plateau (QTP) was drying. Similar drying and wetting patterns were also found in the precipitation, snow depth, Palmer Drought Severity Index (PDSI) and potential evaporation data. Based on our newly proposed Indian monsoon (IM) and western North Pacific monsoon (WNPM) variation indices, the water shifting pattern over the CIBA was found to be affected by the weakening of the variation of IM and WNPM through modulating the regional atmospheric circulation. The weakening of IM and WNPM variations has shown to be attributed to the decreasing temperature gradient between the CIBA and the Indian Ocean, and possibly related to increasing regional temperatures associated with the increasing global temperature. As the global warming intensifies, it is expected that the regional TWS shifting pattern over the CIBA will be further exaggerated, stressing the need of advancing water resources management for local communities in the region.

A spatio-temporal land use and land cover reconstruction for India from 1960-2010.

In recent decades India has undergone substantial land use/land cover change as a result of population growth and economic development. Historical land use/land cover maps are necessary to quantify the impact of change at global and regional scales, improve predictions about the quantity and location of future change and support planning decisions. Here, a regional land use change model driven by district-level inventory data is used to generate an annual time series of high-resolution gridded land use/land cover maps for the Indian subcontinent between 1960-2010. The allocation procedure is based on statistical analysis of the relationship between contemporary land use/land cover and various spatially explicit covariates. A comparison of the simulated map for 1985 against remotely-sensed land use/land cover maps for 1985 and 2005 reveals considerable discrepancy between the simulated and remote sensing maps, much of which arises due to differences in the amount of land use/land cover change between the inventory data and the remote sensing maps.

Multiple well systems with non-Darcy flow.

Optimization of groundwater and other subsurface resources requires analysis of multiple-well systems. The usual modeling approach is to apply a linear flow equation (e.g., Darcy's law in confined aquifers). In such conditions, the composite response of a system of wells can be determined by summating responses of the individual wells (the principle of superposition). However, if the flow velocity increases, the nonlinear losses become important in the near-well region and the principle of superposition is no longer valid. This article presents an alternative method for applying analytical solutions of non-Darcy flow for a single- to multiple-well systems. The method focuses on the response of the central injection well located in an array of equally spaced wells, as it is the well that exhibits the highest pressure change within the system. This critical well can be represented as a single well situated in the center of a closed square domain, the width of which is equal to the well spacing. It is hypothesized that a single well situated in a circular region of the equivalent plan area adequately represents such a system. A test case is presented and compared with a finite-difference solution for the original problem, assuming that the flow is governed by the nonlinear Forchheimer equation.