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Rainfall and overland flow are fundamental processes for Earth's ecosystems but can also be land disturbing forces, particularly when triggered by extreme hydro-meteorological events. Examples of these extremes are rainstorms and related phenomena due to rainfall aggressiveness. They produce high-impact land processes such as soil erosion and nutrient losses. Economic and social consequences of these processes can be quite severe. However, hydrological extremes and their environmental implications are still poorly understood, particularly if analyzed in the context of climate change. Here, we analyze a 300 year long times series of historical rainfall patterns across the Mediterranean in the last three centuries and we investigate changes in the erosive forcing as related to climate changes. Our results show that the erosive forcing increased towards the end of the Little Ice Age (similar to 1850) over western and central Mediterranean and that has been increasing in the recent warming period at low Mediterranean latitudes, due to a higher frequency of intensive storms. Such increased concentrated precipitation may lead to an intensification of land degradation processes triggered by soil erosion and transport across a range of scales from hillslopes to small catchments.

Abstract Floods are challenging the resilience of societies all over the world. In many countries there are discussions on diversifying the strategies for flood risk management, which implies some sort of policy change. To understand the possibilities of such change, a thorough understanding of the forces of stability and change of underlying governance arrangements is required. It follows from the path dependency literature that countries which rely strongly on flood infrastructures, as part of flood defense strategies, would be more path dependent. Consequently there is a higher chance to find more incremental change in these countries than in countries that have a more diversified set of strategies. However, comparative and detailed empirical studies that may help scrutinize this assumption are lacking. To address this knowledge gap, this paper investigates how six European countries (Belgium, England, France, The Netherlands, Poland and Sweden) essentially differ with regard to their governance of flood risks. To analyze stability and change, we focus on how countries are responding to certain societal and ecological driving forces (ecological turn; climate change discourses; European policies; and the increasing prevalence of economic rationalizations) that potentially affect the institutional arrangements for flood risk governance. Taking both the variety of flood risk governance in countries and their responses to driving forces into account, we can clarify the conditions of stability or change of flood risk governance arrangements more generally. The analysis shows that the national-level impact of driving forces is strongly influenced by the flood risk governance arrangements in the six countries. Path dependencies are indeed visible in countries with high investments in flood infrastructure accompanied by strongly institutionalized governance arrangements (Poland, the Netherlands) but not only there. Also more diversified countries that are less dependent on flood infrastructure and flood defense only (England) show path dependencies and mostly incremental change. More substantial changes are visible in countries that show moderate diversification of strategies (Belgium, France) or countries that ‘have no strong path yet’ in comprehensive flood risk governance (Sweden). This suggests that policy change can be expected when there is both the internal need and will to change and a barrage of (external) driving forces pushing for change.

Background: Sodium oxybate (SMO) has been shown to be effective in the maintenance of abstinence (MoA) in alcohol-dependent patients in a series of small randomized controlled trials (RCTs). These results needed to be confirmed by a large trial investigating the treatment effect and its sustainability after medication discontinuation. Aims: To confirm the SMO effect on (sustained) MoA in detoxified alcohol-dependent patients. Methods: Large double-blind, randomized, placebo-controlled trial in detoxified adult alcohol-dependent outpatients (80% men) from 11 sites in four European countries. Patients were randomized to 6 months SMO (3.3–3.9 g/day) or placebo followed by a 6-month medication-free period. Primary outcome was the cumulative abstinence duration (CAD) during the 6-month treatment period defined as the number of days with no alcohol use. Secondary outcomes included CAD during the 12-month study period. Results: Of the 314 alcohol-dependent patients randomized, 154 received SMO and 160 received placebo. Based on the pre-specified fixed-effect two-way analysis of variance including the treatment-by-site interaction, SMO showed efficacy in CAD during the 6-month treatment period: mean difference +43.1 days, 95% confidence interval (17.6–68.5; p = 0.001). Since significant heterogeneity of effect across sites and unequal sample sizes among sites ( n = 3–66) were identified, a site-level random meta-analysis was performed with results supporting the pre-specified analysis: mean difference +32.4 days, p = 0.014. The SMO effect was sustained during the medication-free follow-up period. SMO was well-tolerated. Conclusions: Results of this large RCT in alcohol-dependent patients demonstrated a significant and clinically relevant sustained effect of SMO on CAD. Trial registration: ClinicalTrials.gov Identifier: NCT04648423