Background: The COVID-19 pandemic continues to escalate. There is urgent need to stratify patients. Understanding risk of deterioration will assist in admission and discharge decisions, and help selection for clinical studies to indicate where risk of therapy-related complications is justified. Methods: An observational cohort of patients acutely admitted to two London hospitals with COVID-19 and positive SARS-CoV-2 swab results was assessed. Demographic details, clinical data, comorbidities, blood parameters and chest radiograph severity scores were collected from electronic health records. Endpoints assessed were critical care admission and death. A risk score was developed to predict outcomes. Findings: Analyses included 1,157 patients. Older age, male sex, comorbidities, respiratory rate, oxygenation, radiographic severity, higher neutrophils, higher CRP and lower albumin at presentation predicted critical care admission and mortality. Non-white ethnicity predicted critical care admission but not death. Social deprivation was not predictive of outcome. A risk score was developed incorporating twelve characteristics: age > 40, male, non-white ethnicity, oxygen saturations < 93%, radiological severity score > 3, neutrophil count > 8.0 x10 9 /L, CRP > 40 mg/L, albumin < 34 g/L, creatinine > 100 μmol/L, diabetes mellitus, hypertension and chronic lung disease. Risk scores of 4 or higher corresponded to a 28-day cumulative incidence of critical care admission or death of 40.7% (95% CI: 37.1 to 44.4), versus 12.4% (95% CI: 8.2 to 16.7) for scores less than 4. Interpretation: Our study identified predictors of critical care admission and death in people admitted to hospital with COVID-19. These predictors were incorporated into a risk score that will inform clinical care and stratify patients for clinical trials.

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The Danish Watercourse Law of 1982 states that major river works and maintenance procedures must be planned and undertaken with regard to water quality and the physical form of the river channel. Fluvial geomorphology is an essential component of alternative procedures of river management which work with nature rather than against it. A survey of Danish stream channels has been produced by collating data obtained from maps, field surveys and engineering documents. This indicates that 97.8 per cent of Danish watercourses have been artificially straightened and that only 2.2 per cent (880 km) have natural morphological characteristics. The density of channel works is 300 times greater than in the U.S.A. and 15 times greater than in England and Wales. It is suggested that since there are only a few naturally sinuous channels in Denmark these should be given special consideration with regard to stream management practices. Measurements undertaken at approximately 300 sites in Denmark indicate five major processes of adjustment within straightened reaches. These adjustments include degradation of the channel bed with associated bank slumping, armouring of the bed, the development of a sinuous thalweg by the deposition of sediment at low gradients, and restoration of meanders. Channel stability is related to specific stream power and the results may be useful in predicting potential adjustments following channel straightening. Deposition in natural reaches below straightened channels often obliterates pool and riffle sequences but several channel adjustments may provide a greater variability of physical habitats than the initial uniform straightened channel; their significance for the biology of the watercourse is best considered before traditional management practices are carried out to control the adjustment.

This paper addresses the role that fluvial geomorphology might play in the management of sediment-related river maintenance in the U.K. Sediment-related river maintenance refers to the operational requirement of river management authorities to remove deposits of sediment or protect river boundaries from erosion, where these compromise the flood defence levels of service. Using data collected as part of a National Rivers Authority (NRA) Research and Development Project it is possible to identify the geomorphic causes of problems, and engineering responses to sediment-related river maintenance (SRRM) in England and Wales. The Project identified the management problem as widespread and often treated in isolation from the causative processes. Geomorphological guidance is shown to be both relevant and complementary to conventional engineering practice through its ability to identify the cause of a SRRM problem. A methodology for conducting a geomorphological survey, or 'fluvial audit', is presented, which synthesizes historical data on the catchment land-use and channel network, with contemporary morphological maps to present a statement of the location and type of sediment supply, transport and storage within the river basin under scrutiny. The application of geomorphology to two contrasting SRRM problems is explored using case studies from two catchments: the River Sence, a fine sediment system, and the Shelf Brook, a coarse sediment system.

Relatively little attention has been given to river channel adjustments that occur downstream from channelization works. This study is concerned with the nature of channel adjustments downstream from a total of 46 channelization works located in low and high energy environments in England and Wales. Channel changes are identified principally by the method of field survey and by reconstructing the original positions of eroded beds and banks. Use is also made of maps, aerial photographs, and engineering drawings of different dates and the technique of space-for-time substitution is applied.Enlargement of channel cross-sections through erosion had occurred downstream from a variety of types, sizes, and dates of channelization works. The maximum increase of channel size was 153 per cent. Out of a total of 14 sites with enlarged channel cross-sections, seven had undergone a change of width only, at a further three width increased rather than depth, and at the remaining four sites depth increases were dominant. These sites all have relatively high stream powers.Factors causing spatial variation of erosion included tree roots locally binding bank sediments and the Occurrence of bends. Planform change had taken place at only one site. A further three high stream power sites had downstream reaches incised into bedrock and therefore did not exhibit adjustment.Channel enlargement is explained in terms of increased flood flows downstream from channelization works causing higher stream velocities, which in turn cause erosion, thereby increasing channel width and/or depth. Examination of flow records for 35 stations revealed flood events which would formerly have spread overbank but are now confined by the Channelization works and are therefore likely to alter downstream flows. At sites with downstream change it is proposed that the energy of increased flows was sufficient to exceed a threshold required for erosion of perimeter sediments. By contrast the absence of change at a majority of sites in low energy lowland areas could be a reflection of both the incompetence of increased flows to erode and resistance provided by perimeter sediments. Sites with erosion features appear not to have yet attained new equilibrium conditions.