Assessing the possible influence of human activities on sediment transport in the Saskatchewan River and its delta.

Sediment transport is a complex, multi-dimensional process. With the advancement in computing power and sophistication of computer applications over recent decades, it has become possible to conduct detailed analysis and simulations of soil erosion and sediment transport. The primary objective of this study was to examine and predict the potential influence of human activities on sediment transport. This was achieved by analyzing sediment transport in the Saskatchewan River beneath the E.B. Campbell Dam and in the Saskatchewan River Delta. The Hydrologic Engineering Center's-River Analysis System (HEC-RAS) was deployed to ascertain the sediment transport capacity and estimate erosion, sedimentation, and riverbed changes. Cross-sectional data, flow data, and sediment data were used in conjunction with HEC-RAS. The simulation results reveal that sediment transport below the E.B. Campbell Dam is limited, leading to notable sediment erosion. The selected study area has witnessed significant erosion during high-flow periods, particularly in the event of floods. Between 2012 and 2019, the riverbed elevation at the selected survey site decreased by approximately 0.45 m. The study findings corroborate that the Saskatchewan River and its delta have been impacted by human activities. Potential erosion and deposition below the E.B. Campbell Dam have been simulated for the selected site. The aim is to provide decision-makers or related stakeholders with insight into how dam operations can be adjusted to decrease erosion while sustaining hydrological, ecological, and environmental outcomes from human activities.

Hydraulic modeling of the Periyar River using HEC-RAS: unraveling flow dynamics.

The Periyar River, a vital component of Kerala's ecosystem in India, serves as a lifeline supporting agriculture, hydropower generation, and ecological equilibrium. This study adopts a multifaceted approach to address critical challenges in the Periyar basin, with a primary focus on flood mitigation due to the region's susceptibility to devastating floods. Covering a length of 67.85 km, the study intricately segments the Periyar River into distinct reaches for a comprehensive steady flow analysis, considering factors such as seasonal monsoon fluctuations, diverse catchment topography, and human-induced alterations. Utilizing advanced modeling techniques, particularly HEC-RAS software, the study effectively predicts and simulates shifts in hydraulic behavior. The results, including velocity plots and cross-sectional maps, offer accurate insights into critical parameters, enabling the identification of areas with high velocity occurrence. This information proves instrumental in making informed decisions for the construction of river restoration structures, crucial for mitigating the impact of floods. The study's findings contribute valuable tools for future forecasting and sustainable management of the Periyar River, addressing the complex interplay of natural and anthropogenic factors.

Optimization of Manning's roughness coefficient using 1-dimensional hydrodynamic modelling in the perennial river system: A case of lower Narmada Basin, India.

This research bears significant implications for river management, flood forecasting, and ecosystem preservation in the Lower Narmada Basin. A more precise estimation of Manning's Roughness Coefficeint (n) will enhance the accuracy of hydraulic models and facilitate informed decision-making regarding flood risk management, water resource allocation, and environmental conservation efforts. Ultimately, this study aspires to contribute to the sustainable management of perennial river systems in India and beyond by offering a robust methodology for optimizing Manning's n tailored to the complex hydrological dynamics of the Lower Narmada Basin. Through a synthesis of empirical evidence and computational modelling, it seeks to empower stakeholders with actionable insights toward preserving and enhancing these invaluable natural resources. Using the new HEC-RAS v 6.0, a one-dimensional hydrodynamic model was developed to predict overbank discharge at different points along the basin. The study analyzes water levels, stream discharges, and river stage, optimizing Manning's n and required flood risk management. The model predicted a strong output agreement with R2, NSE, and RMSE for the 2020 event as 0.83, 0.81, and 0.36, respectively, with an optimum Manning's n of 0.03. The lower Narmada Basin part near the coastal zone (validation point) appears inundated frequently. The paper aims to provide insights into optimizing Manning's coefficient, which can ultimately lead to better water flow predictions and more efficient water management in the region.

Analysis of Uncertainty and Sensitivity in Tailings Dam Breach-Runout Numerical Modelling.

Tailings dam breaches (TDBs) and subsequent flows can pose significant risk to public safety, the environment, and the economy. Numerical runout models are used to simulate potential tailings flows and understand their downstream impacts. Due to the complex nature of the breach-runout processes, the mobility and downstream impacts of these types of failures are highly uncertain. We applied the first-order second-moment (FOSM) methodology to a database of 11 back-analyzed historical tailings flows to evaluate uncertainties in TDB runout modelling and conducted a sensitivity analysis to identify key factors contributing to the variability of the HEC-RAS model output, including at different locations along the runout path. The results indicate that prioritizing resources toward advancements in estimating the values of primary contributors to the sensitivity of the selected model outputs is necessary for more reliable model results. We found that the total released volume is among the top contributors to the sensitivity of modelled inundation area and maximum flow depth, while surface roughness is among the top contributors to the sensitivity of modelled maximum flow velocity and flow front arrival time. However, the primary contributors to the sensitivity of the model outputs varied depending on the case study; therefore, the selection of appropriate rheological models and consideration of site-specific conditions are crucial for accurate predictions. The study proposes and demonstrates the FOSM methodology as an approximate probabilistic approach to model-based tailings flow runout prediction, which can help improve the accuracy of risk assessments and emergency response plans. Supplementary Information: The online version contains supplementary material available at 10.1007/s10230-024-00970-w.

Las roturas de presas de relaves (TDBs) y los flujos subsiguientes pueden suponer un riesgo significativo para la seguridad pública, el medio ambiente y la economía. Los modelos numéricos de desbordamiento se utilizan para simular posibles flujos de relaves y comprender su impacto aguas abajo. Debido a la naturaleza compleja de los procesos de rotura-desbordamiento, la movilidad y los impactos aguas abajo de este tipo de fallos tienen mucha incertidumbre. Se aplicó la metodología del segundo-momento de primer-orden (FOSM) a una base de datos de 11 flujos históricos de relaves analizados retrospectivamente para evaluar las incertidumbres en la modelización del desbordamiento de TDB y se realizó un análisis de sensibilidad para identificar los factores clave que contribuyen a la variabilidad de los resultados del modelo HEC-RAS, incluso en diferentes ubicaciones a lo largo de la trayectoria de fuga. Los resultados indican que es necesario priorizar los recursos hacia avances en la estimación de los valores de los principales contribuyentes a la sensibilidad de los resultados del modelo seleccionado para obtener resultados más fiables del modelo. El volumen total liberado se encuentra entre los principales contribuyentes a la sensibilidad del área de inundación modelizada y la profundidad máxima del flujo, mientras que la rugosidad de la superficie se encuentra entre los principales contribuyentes a la sensibilidad de la velocidad máxima del flujo modelizado y el tiempo de llegada del frente de flujo. Sin embargo, los principales factores que contribuyen a la sensibilidad de los resultados del modelo varían dependiendo del caso de estudio; por lo tanto, la selección de modelos reológicos apropiados y la consideración de las condiciones específicas del emplazamiento son cruciales para obtener predicciones precisas. El estudio propone y muestra la metodología FOSM como un enfoque probabilístico aproximado para la predicción de la extensión de flujos de relaves basada en modelos, que puede ayudar a mejorar la precisión de las evaluaciones de riesgos y los planes de respuesta a emergencias.

Prolonged usage of fosaprepitant for prevention of delayed chemotherapy-induced nausea and vomiting(CINV) in patients receiving highly emetogenic chemotherapy.

BACKGROUND: Even though chemotherapy-induced nausea and vomiting (CINV) can be well controlled in the acute phase, the incidence of delayed CINV remains high. In this study, we intend to investigate whether prolonged use of NK-1 receptor antagonist (RA) in addition to 5-HT3 RA and dexamethasone (DEX) was more effective in preventing delayed CINV. METHODS: This randomised, open-label, controlled study was designed to compare the efficacy and safety of fosaprepitant 150 mg given on days 1,3 (prolonged group) versus on day 1 (regular group) in patients receiving highly emetogenic chemotherapy (HEC). All patients also treated with palonosetron on day 1 and DEX on days 1-3. The primary endpoint was the incidence of delayed nausea and vomiting. The second endpoint was AEs. All the above endpoints were defined according to CTCAE 5.0. RESULTS: Seventy-seven patients were randomly assigned to prolonged group and seventy-nine to regular group. Prolonged group demonstrated superiority in controlling delayed CINV to regular group, with statistically significant lower incidence of nausea (6.17% vs 12.66%, P = 0.0056), and slightly lower incidence of grade 1 vomiting (1.62% vs 3.80%, P = 0.0953) in the delayed phase. In addition, prolonged use of fosaprepitant was safe. No significant difference was found between the two groups regarding constipation, diarrhea, hiccough, fatigue, palpitation and headache in delayed phase. CONCLUSIONS: Prolonged use of fosaprepitant can effectively and safely prevent delayed CINV in patients receiving HEC.

2023 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following high-emetic-risk antineoplastic agents.

PURPOSE: This systematic review updates the MASCC/ESMO recommendations for high-emetic-risk chemotherapy (HEC) published in 2016-2017. HEC still includes cisplatin, carmustine, dacarbazine, mechlorethamine, streptozocin, and cyclophosphamide in doses of > 1500 mg/m2 and the combination of cyclophosphamide and an anthracycline (AC) in women with breast cancer. METHODS: A systematic review report following the PRISMA guidelines of the literature from January 1, 2015, until February 1, 2023, was performed. PubMed (Ovid), Scopus (Google), and the Cochrane Database of Systematic Reviews were searched. The literature search was limited to randomized controlled trials, systematic reviews, and meta-analyses. RESULTS: Forty-six new references were determined to be relevant. The main topics identified were (1) steroid-sparing regimens, (2) olanzapine-containing regimens, and (3) other issues such as comparisons of antiemetics of the same drug class, intravenous NK1 receptor antagonists, and potentially new antiemetics. Five updated recommendations are presented. CONCLUSION: There is no need to prescribe steroids (dexamethasone) beyond day 1 after AC HEC, whereas a 4-day regimen is recommended in non-AC HEC. Olanzapine is now recommended as a fixed part of a four-drug prophylactic antiemetic regimen in both non-AC and AC HEC. No major differences between 5-HT3 receptor antagonists or between NK1 receptor antagonists were identified. No new antiemetic agents qualified for inclusion in the updated recommendations.

Integrated assessment of climate change and reservoir operation on flow-regime and fisheries of the Sekong river basin in Lao PDR and Cambodia.

This study assesses the cumulative impact of climate change and reservoir operation on flow regime and fisheries in the Sekong River Basin. Ensemble of five selected Regional Climate Models (RCMs) were used to project the future climate under RCP4.5 and RCP8.5 scenarios. The projected future climate was used to simulate the future hydrology using the SWAT model while HEC-ResSim was utilized for reservoir simulation. Finally fish-flow relationship was developed to estimate the fish catch and productivity in future. Upon investigation we found that, Sekong River Basin is likely grow warmer and drier in future under climate change. The basin is expected to face 1.3-3.6 °C rise in mean annual temperature and receive 0-6% less annual rainfall in future. The wet season in the basin is anticipated to be drier (0% to -6%) while the dry season rainfall shows no particular trend (-3%-10%). Such a change in climate is likely to alter the mean annual flow in future between -3 and 5% at Attapeu, -6 to 2% at Ban Veunkhane, Lao PDR, and -7 to 1% at Siempang, Cambodia (basin outlet). Under climate change, we expect decrement in minimum flow but increment in the maximum flow while opposite is anticipated under reservoir operation. Operation of Xekaman 1 and Sekong 4A are likely to increase the minimum flow at river outlet by 32-59% and 13-18% respectively whereas maximum flow is expected to decrease by 28-5%. In addition, climate change is likely to have crucial impact on fisheries with up to 19% and 12% reduction in fish catches and fish productivity respectively. However, reservoirs tend to have negligible impact on fisheries.

Future projections of worst floods and dam break analysis in Mahanadi River Basin under CMIP6 climate change scenarios.

This study provides a comprehensive analysis of the hydrological effects and flood risks of the Hirakud Reservoir, considering different CMIP6 climate change scenarios. Using the HEC-HMS and HEC-RAS models, the study evaluates future flow patterns and the potential repercussions of dam breaches. The following summary of the work: firstly, the HEC-HMS model is calibrated and validated using daily stage-discharge observations from the Basantpur station. With coefficient of determination (R2) values of 0.764 and 0.858 for calibration and validation, respectively, the model demonstrates satisfactory performance. Secondly, The HEC-HMS model predicts future flow for the Hirakud Reservoir under three climate change scenarios (SSP2-4.5, SSP3-7.0 and SSP5-8.5) and for three future periods (near future, mid future and far future). Thirdly, by analyzing time-series hydrographs, the study identifies peak flooding events. In addition, the HEC-RAS model is used to assess the effects of dam breaches. Downstream of the Hirakud Dam, the analysis highlights potential inundation areas and depth variations. The study determines the following inundation areas for the worst flood scenarios: 3651.52 km2, 2931.46 km2 and 4207.6 km2 for the near-future, mid-future and far-future periods, respectively. In addition, the utmost flood depths for these scenarios are determined to be 31 m, 29 m and 39 m for the respective future periods. The study area identifies 105 vulnerable villages and several towns. This study emphasizes the importance of contemplating climate change scenarios and implementing proactive measures to mitigate the peak flooding events in the Hirakud reservoir region.

Snow parameters modeling using remote sensing techniques and HEC-HMS hydrological modeling-case study: Kan Basin.

Floods occur yearly, with great property and human life damage worldwide due to severe climate changes. Snow cover dominates the mountainous areas in winter. Therefore, the river discharge increases significantly in spring, when the snow melts gradually and is accompanied by rain this season. This study aims to evaluate the snow parameters such as snow cover, monthly average snow cover, and snowmelt from early winter to late summer 2020 by using the Terra satellite, MODIS sensor, and the FLDAS model to estimate the amount of water equivalent to snowmelt in the Google Earth Engine system for Kan basin in Tehran province. The hydrological model HEC-HMS was used for assessing the effect of snow parameters on the amount of Kan River discharge in this study. The land use map was extracted by using the image of the Sentinel-2 satellite to acquire more accuracy in this study. Finally, Sentinel-1 radar images were used to evaluate the effect of flood on the area and monitor the changes.

Effect of climate change on reservoir water balance and irrigation water demand: a case of Gidabo irrigation project, Rift Valley Basin, Ethiopia.

The consequences of climate change on agriculture water demand are among the current and prospective challenges. The amount of water needed by crops is significantly affected by the regional climate. The influence of climate change on irrigation water demand and reservoir water balance components were examined. The results of seven regional climate models were compared, and the top-performing model was chosen for the study area. After model calibration and validation, the HEC-HMS model was used to forecast future water availability in the reservoir. The results show that under the RCP 4.5 and RCP 8.5 emission scenarios, the reservoir's water availability in the 2050s will decline by approximately 7% and 9%, respectively. The CROPWAT results showed that the required irrigation water might rise by 26 to 39% in the future. However, the water supply for irrigation may be drastically reduced due to the drop in reservoir water storage. As a result, the irrigation command area could drop up to 21% (2878.4 ha) to 33% (4502 ha) in future climatic conditions. Therefore, we recommend alternative watershed management techniques and climate change adaptation measures to endure upcoming water shortages in the area.

Flood risk assessment in the Karamana river basin, Kerala, using HEC-RAS.

The State of Kerala has frequently been facing a series of flooding phenomena that have adversely affected its multiple sectoral growths. The floods of 2018 have happened to be one of the most devastating floods that have occurred in the State of Kerala. It was seen that nearly thirteen out of fourteen districts in Kerala were tremendously affected during the 2018 August floods. The worst affected districts during the 2018 floods were Trivandrum, Pathanamthitta, Idukki, Thrissur, Ernakulam, and Kottayam. A sub-region near the Karamana basin located in the Trivandrum district is considered for the present study. The Karamana sub-region is a highly urbanized area that is also more or less prone to intense riverine flooding. The major rivers-Karamana and Killi-along with their respective tributaries, are the water bodies in the study region. Extensive urbanization, along with the overflowing of rivers during monsoon seasons, has paved the way for intense flooding in the region. This, in turn, necessitates developing a flood model for the sub-region. The development of an efficient flood model will aid in understanding the future challenges related to a flooding event in a region. In this study, the flood return probability water levels for the 5-year, 10-year, 25-year, 50-year, 100-year, 250-year, and 500-year were estimated for the Karamana sub-region. Besides, the flood risk zoning for the study area was conducted and elaborated as very high risk, high risk, moderate risk, and low risk for the different areas of the sub-region. Overall, the study can be helpful in identifying the most vulnerable areas to flooding in the Karamana region. By the proper identification of vulnerable areas in the region, proper planning and early warning measures can be devised and carried out by policymakers.

Vitexin suppresses the proliferation, angiogenesis and stemness of endometrial cancer through the PI3K/AKT pathway.

CONTEXT: Endometrial cancer is a common gynecologic malignancy. Vitexin is an active flavonoid compound with an antitumor function. OBJECTIVE: This study elucidated the role of vitexin in endometrial cancer development and clarified the potential mechanism. MATERIALS AND METHODS: The toxicity of vitexin (0-80 µM) treatment for 24 h on HEC-1B and Ishikawa cells was tested utilizing the CCK-8 assay. Endometrial cancer cells were divided into vitexin 0, 5, 10, and 20 µM groups. Cell proliferation, angiogenesis and stemness in vitro after treatment with vitexin (0, 5, 10, 20 µM) for 24 h were evaluated using the EdU staining assay, tube formation assay and sphere formation assay, respectively. Twelve BALB/c mice were grouped into control and vitexin (80 mg/kg) groups to monitor tumour growth for 30 days. RESULTS: Vitexin suppressed cell viability of HEC-1B (IC50 = 9.89 µM) and Ishikawa (IC50 = 12.35 µM) cells. The proliferation (55.3% and 80% for HEC-1B; 44.7% and 75% for Ishikawa), angiogenesis (54.3% and 78.4% for HEC-1B; 47.1% and 68.2% for Ishikawa) and stemness capacity (57.2% and 87.3% for HEC-1B; 53.4% and 78.4% for Ishikawa) of endometrial cancer cells were inhibited by 10 and 20 µM vitexin. Furthermore, the inhibitory effects of vitexin on endometrial cancer were reversed by PI3K/AKT agonist 740Y-P (20 µM). Moreover, the xenograft tumour experiment lasting for 30 days proved that vitexin (80 mg/kg) blocked tumour growth of endometrial cancer in vivo. DISCUSSION AND CONCLUSIONS: Vitexin has therapeutic potential on endometrial cancer, which supports further clinical trials.

Credentialing Character: A Virtue Ethics Approach to Professionalizing Healthcare Ethics Consultation Services.

In the process of professionalization, the American Society for Bioethics and Humanities (ASBH) has emphasized process and knowledge as core competencies for clinical ethics consultants; however, the credentialing program launched in 2018 fails to address both pillars. The inadequacy of this program recalls earlier critiques of the professionalization effort made by Giles R. Scofield and H. Tristram Engelhardt, Jr.. Both argue that ethics consultation is not a profession and the effort to professionalize is motivated by self-interest. One argument they offer against professionalization is that ethics consultants lack normative expertise. Although the question of expertise cannot be resolved completely, the accusation of self-interest can be addressed. Underlying these critiques is a concern for hubris, which can be addressed in certification and the vetting of candidates.Drawing on the virtue ethics literature of Alasdair MacIntyre and Edmund D. Pellegrino, I argue that medicine is a moral community in which ethics consultants are moral agents with a duty to foster the virtue of humility (or what Pellegrino and Thomasma call self-effacement). The implications of this argument include a requirement for self-reflection in one's role as a moral agent and reflection on one's progress toward developing or deepening virtuous engagement with the moral community of medicine. I recommend that professionalization of clinical ethics consultants include a self-reflective narrative component in the initial certification and ongoing renewal of certification where clinical ethics consultants address the emotional dimensions of their work as well as their own moral development. Adopting a teleological view of ethics consultation and incorporating narratives that work toward that purpose will mitigate the self-interest and hubris of the professionalization project.

Fucoxanthin prevents cell growth and induces apoptosis in endometrial cancer HEC-1A cells by the inhibition of the PI3K/Akt/mTOR pathway.

Endometrial cancer is the major type of gynecological cancer and ranks as the sixth most common cancer in women. Endometrial cancer usually is diagnosed in an advanced stage, complicating the treatments in many cases. The present research was focused on unveiling the in vitro anticancer role of fucoxanthin against the endometrial cancer HEC-1A cells by inhibiting the phosphatidylinositol-3-kinase/Akt/mammalian target of rapamycin (PI3K/Akt/mTOR) signaling axis. The cytotoxicity of fucoxanthin against the endometrial cancer HEC-1A cells was studied using the MTT test. The level of reactive oxygen species (ROS) production, mitochondrial membrane potential (MMP) status, and apoptotic cell death in the 7.5 and 10 µM administered HEC-1A cells were assayed using fluorescent staining techniques. The messenger RNA expression was analyzed using RT-PCR for PI3K/Akt/mTOR signaling molecules, proapoptotic (Bax and caspase-3) antiapoptotic (cyclin D1 and Bcl-2) genes, and inflammatory markers like tumour necrosis factor α (TNFα), nuclear factor kappa B (NF-κB), Cox-2, and interleukin (IL)-6. The cell viability assay proved that fucoxanthin effectively prevented HEC-1A cell viability, where the IC50 was 7.5 µM. Fucoxanthin at 7.5 and 10 µM remarkably improved ROS production and apoptosis and decreased the MMP in HEC-1A cells. The fucoxanthin effectively inhibited the PI3K/Akt/mTOR cascade along with the expression of TNF-α, NF-κB, Cox-2, and IL-6 and antiapoptotic genes cyclin D1 and Bcl-2 in the HEC-1A cells. Fucoxanthin treatment also enhanced the Bax and caspase-3 expressions in the HEC-1A cells. Our results from this work unveiled that fucoxanthin triggered growth inhibition and apoptosis in endometrial cancer HEC-1A cells. Besides, fucoxanthin inhibited the PI3K/Akt/mTOR cascade and improved apoptotic marker expressions in the HEC-1A cells.

Promyelocytic Leukemia Protein Potently Restricts Human Cytomegalovirus Infection in Endothelial Cells.

PML nuclear bodies (PML-NBs) are dynamic macromolecular complexes that mediate intrinsic immunity against viruses of different families, including human cytomegalovirus (HCMV). Upon HCMV infection, PML-NBs target viral genomes entering the nucleus and restrict viral immediate-early gene expression by epigenetic silencing. Studies from several groups performed in human fibroblast cells have shown that the major PML-NB components PML, Daxx, Sp100 and ATRX contribute to this repression in a cooperative manner. Their role for HCMV restriction in endothelial cells, however, has not yet been characterized although infected endothelium is thought to play a crucial role for HCMV dissemination and development of vascular disease in vivo. Here, we use conditionally immortalized umbilical vein endothelial cells (HEC-LTT) as a cell culture model to elucidate the impact of PML-NB proteins on lytic HCMV infection. Depletion of individual PML-NB proteins by lentiviral transduction showed a particularly strong antiviral effect of PML in HEC-LTT, compared to human fibroblasts. A closer characterization of this antiviral function revealed that PML may not only effectively inhibit HCMV immediate-early gene expression but also act at later steps of the viral replication cycle. At contrast, we surprisingly noted an antiviral behavior of Daxx in complementary approaches: Depletion of Daxx resulted in decreased viral gene expression, while overexpression of Daxx promoted HCMV infection. In summary, our data demonstrate a cell type-specific effect of PML-NB components on lytic HCMV infection and suggest an important role of PML in the inhibition of HCMV dissemination through infected endothelial cells.

Application of Unmanned Aerial Vehicle DEM in flood modeling and comparison with global DEMs: Case study of Atrak River Basin, Iran.

Digital Elevation Models (DEMs) play a significant role in hydraulic modeling and flood risk management. This study initially investigated the effect of Unmanned Aerial Vehicle (UAV) DEM resolutions, ranging from 1 m to 30 m, on flood characteristics, including the inundation area, mean flow depth, and mean flow velocity. Then, the errors of flood characteristics for global DEMs, comprising ALOS (30 m), ASTER (30 m), SRTM (30 m), and TDX (12 m) were quantified using UAV DEM measurements. For these purposes, the HEC-RAS 2D model in steady-state conditions was used to simulate the flood with return periods of 5- to 200 years along 20 km reach of Atrak River located in northeastern Iran. Results indicated when UAV DEM resolution decreased from 1 m to 30 m, inundation area and mean flow depth increased 17.0% (R2 = 0.94) and 10.2% (R2 = 0.96) respectively, while mean flow velocity decreased 16.8% (R2 = -0.94). Validation of the hydraulic modeling using the modified normalized difference water index demonstrated that the HEC-RAS 2D model in conjunction with UAV DEM simulates the flood with ⁓92% accuracy. Comparing the global DEMs with UAV DEM showed that the root mean square error (RMSE) values of the flow depth for ASTER, SRTM, ALOS, and TDX DEMs were 1.77, 1.12, 1.02, and 0.93 m, and the RMSE values of the flow velocity for the same DEMs were 0.81, 0.66, 0.55, and 0.47 m/s, respectively. Furthermore, TDX DEM with a 6.15% error in the inundation area was the nearest to UAV measurements. Overall, TDX DEM revealed a better performance in hydraulic modeling of the fluvial flood characteristics. Hence, it is recommended for environments where high-resolution topography data is scarce. The results of this study could potentially serve as a guideline for selecting global DEMs for hydraulic simulations.

An improved MOPSO algorithm for multi-objective optimization of reservoir operation under climate change.

Gradually, the previously proposed water resource management schemes and reservoir operating policies adjusted to the historically experienced climatic conditions are losing their validity and efficacy, urging building up the models compatible with the likely climatic change conditions at the future. This paper aims at optimizing the reservoir operation under climate change conditions targeting the objectives including (1) minimizing the shortages in meeting the reservoir downstream water demands and (2) maximizing the sustainability of the reservoir storage. For evaluating the effects of the climate change, six general circulation models (GCMs) built up under the representative concentration pathway (RCP4.5) emission scenario are adopted and utilized to predict the climate variables over a 30-year planning period. To solve this problem, an improved version of our recently proposed fuzzy multi-objective particle swarm optimization (f-MOPSO) algorithm, named f-MOPSO-II, is proposed. The f-MOPSO takes a novel approach to handle multi-objective nature of the optimization problems. In this approach, the common concept of "diversity" is replaced with "extremity," to choose the better guides of the search agents in the algorithm. The f-MOPSO-II is based on the f-MOPSO. However, it is aimed at simultaneously mitigating the f-MOPSO computational complexity and enhancing the quality of the final results presented by this algorithm. The results obtained by the f-MOPSO-II were then compared with those yielded by the popular non-dominated sorting genetic algorithm-II (NSGA-II). As the results suggest, the f-MOPSO-II is capable of simultaneously meeting the water demands and holding the reservoir storage sustainable, much better than the NSGA-II.

The "Ladder of Inference" as a Conflict Management Tool: Working with the "Difficult" Patient or Family in Healthcare Ethics Consultations.

Conflict resolution is a core component of healthcare ethics consultation (HEC) and proficiency in this skill set is recognized by the national bioethics organization and its HEC certification process. Difficult interpersonal interactions between the clinical team and patients or their families are often inexorably connected to the normative disputes that are the catalyst for the consult. Ethics consultants are often required to navigate challenging dynamics that have become entrenched and work with patient-provider or family-provider relationships that have already broken down. The first step in conflict resolution is diagnosing the source of the conflict. Because so many interpersonal and normative conflicts rest on misunderstanding and mischaracterization, the diagnosis of the problem requires untangling the actual positions and perspectives of the conflicting parties from the fallacious assumptions made about the parties' respective positions and views. Developed in management science, the Ladder of Inference (LOI) is a diagnostic tool for assisting stakeholders in re-examining the process they used to form beliefs about others involved in the conflict. The LOI is a device that detects errors in reasoning, including implicit racial bias, that lead to false judgments and counterproductive responses to those judgments. The LOI is an instrument that can be used by ethics consultants to help resolve contentious bedside conflicts, but the LOI can also be employed as a teaching tool used by healthcare ethics consultants in training the clinical staff in how to avoid such conflicts in the first place.

Avoidable Acute Care Use Associated with Nausea and Vomiting Among Patients Receiving Highly Emetogenic Chemotherapy or Oxaliplatin.

PURPOSE: Chemotherapy-induced nausea and vomiting (CINV) contributes to avoidable acute care, a metric now tracked in Medicare's oncology outcome measure. CINV is preventable, yet guidelines are often not followed. We sought to quantify acute care involving CINV and other avoidable toxicities after highly emetogenic chemotherapy (HEC) to identify excess risk and assess clinician adherence to antiemesis guidelines for HEC. MATERIALS AND METHODS: We retrospectively evaluated U.S. electronic health records (2012-2018) using Medicare's OP-35 outcome measure to identify avoidable acute care involving any of 10 toxicities, including CINV, after HEC regimens relative to non-HEC. Antiemetic guideline adherence was defined as use ofneurokinin-1 (NKl) receptor antagonists Q5 (RAs) plus 5-hydroxytryptamine type 3 RA+ dexamethasone at HEC initiation. RESULTS: Among 17,609 patients receiving HEC, acute care rates associated with HEC chemotherapy included 32% cisplatin, 31% carboplatin, and 21% anthracycline/cyclosphospharnide (AC), with 76% meeting the criteria as avoidable events. Oxaliplatin rates were 29%. Avoidable acute care occurred 1.83 times (95% confidence interval, 1.76-1.91, p < .0001) as often after HEC versus non-HEC excluding oxaliplatin; CINV-related acute care occurred 2.29 times as often. Nonadherence to antiemesis guidelines occurred in 34% and 24% of cisplatin and AC courses, respectively, because of omission of a NKl RA. CONCLUSIONS: Patients treated with HEC regimens experienced high avoidable acute care use, 1.8 times the risk seen for other chemotherapy. Nonadherence to guideline-directed antiemetic prophylaxis highlights the need to ensure adherence to antiemetic guidelines, including the use of NKl RA in HEC. IMPLICATIONS FOR PRACTICE: After survival, perhaps the most important goal in oncology is limiting avoidable acute care, a goal now used by Medicare to impact cancer reimbursement. This study found that patients treated with highly emetogenic chemotherapy (HEC) regimens had high rates of avoidable acute care use, 1.8 times the risk seen for other chemotherapy. A substantial proportion of the avoidable acute care involved chemotherapy-induced nausea and vomiting. Results showed that incomplete adherence to national antiemetic guidelines for HEC regimens primarily driven by omission of upfront neurokinin-1 receptor antagonist use, suggesting that improved adherence can meaningfully resolve this gap in quality and cost of care.

The effectiveness of NEPA in the prevention of chemotherapy-induced nausea vomiting among chemo naive patients in an Indian setting.

BACKGROUND: Chemotherapy induced nausea- vomiting (CINV) is considered as the most common, feared and most troublesome side effect of chemotherapy. NEPA (NEtupitant 300 mg + PAlonosetron 0.50 mg) is the first commercially available oral fixed-dose combination (FDC) of two active antiemetic agents in India. The present study was planned to evaluate the effectiveness of NEPA in the real world setting of India. METHODS: This was a multicentric retrospective study conducted in two centers in India. The data of all chemonaive patients, who were prescribed NEPA was analyzed. Effectiveness i.e. complete response and complete protection in controlling overall, acute and delayed phase was analyzed. RESULTS: A total of 329 patients were enrolled in the study. 260 received highly emetogenic chemotherapy (HEC) regimen and 69 received moderately emetogenic chemotherapy (MEC) regimen. Among all the enrolled patients, complete response in acute, delayed and overall phase was 93, 85.71 and 85.41% respectively; and completed protection was 88.44, 81.76 and 80.54% respectively. Those who received HEC regimen, the completed response and complete protection in overall phase was 84.61 and 79.61% respectively and those who received MEC regimen the completed response and complete control in overall phase was 84.05 and 84.05% respectively. CONCLUSION: A single oral dose of NEPA targeting dual pathways showed effective control of nausea-vomiting in patients on the HEC and MEC regimens and had good control over nausea-vomiting in acute, delayed and overall phase of nausea-vomiting.