Background: Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children. Methods: A task force supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results: The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework. Conclusion: Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.

Snow in the High Atlas Mountains is a major source for freshwater renewal and for water availability in the semi-arid lowlands of south-eastern Morocco. Snowfall- and snow-ablation monitoring and modelling is important for estimating potential water delivery from the mountain water towers to the forelands. This study is part of GLOWA-IMPETUS, an integrated management project dealing with scarce water resources in West Africa. The Ameskar study area is located to the south of the High Atlas Mountains, in their rain shadow. As a part of the M’Goun river basin within the upper Drâa valley, the study area is characterised by high radiation inputs, low atmospheric humidity and long periods with sub-zero temperatures. Its altitude ranges between 2000 m and 4000 m, with dominant north- and south-facing slopes. Snowfall occurs mainly from November to April but even summit regions can become repeatedly devoid of snow cover. Snow cover maps for the M’Goun basin (1240 km²) are derived from calculations of NDSI (Normalized Difference Snow Index) from MODIS satellite images and snow depth is monitored at four automatic weather stations between 2000–4000 m. Snowfall events are infrequent at lower altitudes. The presence of snow penitentes at altitudes above 3000 m indicates that snow sublimation is an important component of snow ablation. Snow ablation was modelled with the UEB Utah Energy Balance Model (Tarboton and Luce, 1996). This single layer, physically-based, point energy and mass balance model is driven by meteorological variables recorded at the automatic weather stations at Tounza (2960 m) and Tichki (3260 m). Data from snow pillows at Tounza and Tichki are used to validate the model’s physical performance in terms of energy and water balances for a sequence of two snowfall events in the winter of 2003/4. First UEB modelling results show good overall performance and timing of snowmelt and sublimation compared to field investigations. Up to 44% of snow ablation is attributed to snow sublimation in typical winters with subzero temperatures and low atmospheric humidity at an altitude of 3000 m. At altitudes below 3000 m snowmelt generally dominates over sublimation. Unfortunately, the highest altitude zones suffer long periods with direct water loss into the atmosphere by sublimation in the course of which they cannot contribute to direct runoff or groundwater formation in the southern High Atlas Mountains. Keywords: sublimation, snow ablation modelling, energy balance model, High Atlas Mountains

Mountain hydrology, in particular in the European Alps, has undergone significant changes within the last decades due to climate and land use change as well as altered water consumption patterns. Climate change influences both the characteristics of droughts and floods as well as evapotranspiration, snow-rainfall ratios, snow seasonality and water reserves locked in glaciers. Land use change and altered water use may strongly outweigh these impacts, in particular through industrialization, urbanization and tourism. Extreme hydrological situations such as new floods types have evolved from combined land-use and climate change and new types of water scarcity in association with accelerated and seasonally shifted water abstraction. Related water quality and pollution issues are of growing concern especially in seasonally highly populated areas. Main methodological challenges include keeping pace with recent hydrological change such as altered water inputs, water abstraction and water quality. Emphasis should be put on the significance of small proportional changes within the total water cycle as these may have major impacts on floods, water scarcity and general livelihood. Political challenges are strongest concerning problem reporting, initiation of monitoring programs and data transparency. The general lack of higher altitude hydrological data and experience with new hydrological phenomena will require an analytical approach directed more strongly towards interactions between scientists, stakeholders and decision makers encompassing local stakeholder knowledge and historical evidence. Data and innovative practices need to be exchanged more strongly between alpine regions and between the local and European level. It should be recognized that an alternative water management in mountains is fundamental for the future.

Primary ciliary dyskinesia (PCD) is a genetic, heterogeneous disease caused by dysfunction of cilia. Evidence is sparse and reports of lung function in PCD patients range from normal to severe impairment. This systematic review and meta-analysis of studies of lung function in PCD patients examines the spirometric indices of PCD patients and differences by age group and sex.We searched PubMed, Embase and Scopus for studies that described lung function in 10 or more patients with PCD. We performed meta-analyses and meta-regression to explain heterogeneity. We included 24 studies, ranging from 13 to 158 patients per study.The most commonly reported spirometric indices were forced expiratory volume in 1 s (FEV₁) and forced vital capacity presented as mean and standard deviation of percent predicted values. We found considerable heterogeneity for both parameters (I²=94–96%). The heterogeneity remained when we stratified the analysis by age; however, FEV₁in adult patients was lower. Even after taking into account explanatory factors, the largest part of the between-studies variance remained unexplained.Heterogeneity could be explained by genetic differences between study populations, methodological factors related to the variability of study inclusion criteria or details on the performance and evaluation of lung function measurements that we could not account for. Prospective studies therefore need to use standardised protocols and international reference values. These results underline the possibility of distinct PCD phenotypes as in other chronic respiratory diseases. Detailed characterisation of these phenotypes and related genotypes is needed in order to better understand the natural history of PCD.