Drought Atlas of India, 1901-2020.

India has been considerably affected by droughts in the recent past. Despite the considerable impacts of droughts on agriculture and water resources, long-term datasets to examine droughts and their consequences at appropriate spatial and temporal scales have been lacking in India. Datasets that provide drought information are mostly available for a short period and at coarser resolutions, therefore, these do not comprehend the information regarding the major droughts that occurred in the distant past at administrative scales of decision-making. To fill this critical gap, we developed the high-resolution (0.05°) and long-term monthly precipitation and temperature datasets for the 1901-2021 period. We used long-term high-resolution precipitation and temperature to estimate droughts using standardized precipitation and evapotranspiration index (SPEI). As SPEI considers the role of air temperature in drought estimation, it can be used to examine meteorological, agricultural, and hydrological droughts. Using high-resolution SPEI, we developed drought atlas for India (1901-2020) that can provide comprehensive information on drought occurrence, impacts, and risks in India.

Hydrological model-based streamflow reconstruction for Indian sub-continental river basins, 1951-2021.

Streamflow is a vital component of the global water cycle. Long-term streamflow observations are required for water resources planning and management, hydroclimatic extremes analysis, and ecological assessment. However, long-term streamflow observations for the Indian-Subcontinental (ISC) river basins are lacking. Using meteorological observations, state-of-the-art hydrological model, and river routing model, we developed hydrological model-simulated monthly streamflow from 1951-2021 for the ISC river basins. We used high-resolution vector-based routing model (mizuRoute) to generate streamflow at 9579 stream reaches in the sub-continental river basins. The model-simulated streamflow showed good performance against the observed flow with coefficient of determination (R2) and Nash-Sutcliffe efficiency (NSE) above 0.70 for more than 60% of the gauge stations. The dataset was used to examine the variability in low, average, and high flow across the streams. Long-term changes in streamflow showed a significant decline in flow in the Ganga basin while an increase in the semi-arid western India and Indus basin. Long-term streamflow can be used for planning water management and climate change adaptation in the Indian sub-continent.

Rigorous and rapid evidence assessment in digital health with the evidence DEFINED framework.

Dozens of frameworks have been proposed to assess evidence for digital health interventions (DHIs), but existing frameworks may not facilitate DHI evidence reviews that meet the needs of stakeholder organizations including payers, health systems, trade organizations, and others. These organizations may benefit from a DHI assessment framework that is both rigorous and rapid. Here we propose a framework to assess Evidence in Digital health for EFfectiveness of INterventions with Evaluative Depth (Evidence DEFINED). Designed for real-world use, the Evidence DEFINED Quick Start Guide may help streamline DHI assessment. A checklist is provided summarizing high-priority evidence considerations in digital health. Evidence-to-recommendation guidelines are proposed, specifying degrees of adoption that may be appropriate for a range of evidence quality levels. Evidence DEFINED differs from prior frameworks in its inclusion of unique elements designed for rigor and speed. Rigor is increased by addressing three gaps in prior frameworks. First, prior frameworks are not adapted adequately to address evidence considerations that are unique to digital health. Second, prior frameworks do not specify evidence quality criteria requiring increased vigilance for DHIs in the current regulatory context. Third, extant frameworks rarely leverage established, robust methodologies that were developed for non-digital interventions. Speed is achieved in the Evidence DEFINED Framework through screening optimization and deprioritization of steps that may have limited value. The primary goals of Evidence DEFINED are to a) facilitate standardized, rapid, rigorous DHI evidence assessment in organizations and b) guide digital health solutions providers who wish to generate evidence that drives DHI adoption.

Increased hydropower but with an elevated risk of reservoir operations in India under the warming climate.

Hydropower is a significant contributor to clean global electricity generation; therefore, it plays a crucial role in climate change mitigation. Notwithstanding major hydropower dams in India are in diverse climatic regions and exposed to risks because of the warming climate, potential changes in hydroclimate remain largely unexplored. Using observations and climate projections, we demonstrate the hydroclimatic changes in the upstream catchments and their implications for the hydropower generation of 46 major hydropower dams in India. A warmer (up to 5.0°C) and wetter projected climate with a substantial increase (5.0-33%) in precipitation will lead to an increased (7-70%) inflow to reservoirs of major dams. Increased inflow will enhance (9-36%) the hydropower production for most dams in the future, with a more prominent rise in central India dams. A simultaneous rise in extreme inflow and high reservoir storage conditions is projected under future climate for most dams. However, future climate changes project a favorable hydroclimate for hydropower production, with the associated risks related to extremes.

Climate warming and summer monsoon breaks drive compound dry and hot extremes in India.

Considering the severe impacts of compound dry and hot extremes, we examine the primary drivers of CDHEs during the summer monsoon in India. Using ERA5 reanalysis, we show that most of the CDHEs in India occur during the droughts caused by the summer monsoon rainfall deficit. Despite a decline in the frequency of summer monsoon droughts in recent decades, increased CDHEs are mainly driven by warming and dry spells during the summer monsoon particularly in the Northeast, central northeast, and west central regions. A strong land-atmospheric coupling during droughts in the summer monsoon season leads to frequent CDHEs in the Northwest and southern peninsular regions. Furthermore, regional variations in land-atmospheric coupling cause substantial differences in the CDHE occurrence in different parts of the country. Summer monsoon rainfall variability and increased warming can pose a greater risk of compound dry and hot extremes with severe impacts on various sectors in India.

Factors That Influence Clinician Experience with Electronic Health Records.

Objectives: To report quantitative and qualitative analyses of features, functionalities, organizational, training, clinical specialties, and other factors that impact electronic health record (EHR) experience based on a survey by two large healthcare systems. Materials and Methods: A total of 816 clinicians-352 (43 percent) physicians, 96 (12 percent) residents/fellows, 177 (22 percent) nurses, 96 (12 percent) advanced practice providers, and 95 (12 percent) allied health professionals-completed surveys on different EHRs. Responses were analyzed for quantitative and qualitative factors. The measured outcome was calculated as a net EHR experience. Results: Net EHR experience represents overall satisfaction that clinicians report with the EHR and its usability. EHR experience for Virginia Commonwealth University Medical Center and University of Chicago Medicine was low. There were noticeable differences in physician and nursing experiences with EHRs at both universities. EHR personalization, years of practice, impact on efficiency, quality of care, and satisfaction with EHR training contributed significantly to the net EHR experience. Satisfaction of certain specialty practitioners such as endocrinology, family medicine, infectious disease, nephrology, neurology, and pulmonology was noted to be especially low. Ability to use a split-screen function to view labs, follow-up training from other providers rather than vendors, reduced documentation time burden, fewer click boxes, more customizable order sets, improved messaging, e-prescribing, and improved integration were the most common desired EHR improvements requested on qualitative analysis. Discussion: EHR experience was low regardless of the system and may be improved by better EHR training, increased utilization of personalization tools, reduced documentation burden, and enhanced EHR design and functionality. There was a difference between provider and nursing experiences with the EHR. Conclusion: Designing better EHR training, increasing utilization of personalization tools, enhancing functionality, and decreasing documentation burden may lead to a better EHR experience.

Global distribution, trends, and drivers of flash drought occurrence.

Flash drought is characterized by a period of rapid drought intensification with impacts on agriculture, water resources, ecosystems, and the human environment. Addressing these challenges requires a fundamental understanding of flash drought occurrence. This study identifies global hotspots for flash drought from 1980-2015 via anomalies in evaporative stress and the standardized evaporative stress ratio. Flash drought hotspots exist over Brazil, the Sahel, the Great Rift Valley, and India, with notable local hotspots over the central United States, southwestern Russia, and northeastern China. Six of the fifteen study regions experienced a statistically significant increase in flash drought during 1980-2015. In contrast, three study regions witnessed a significant decline in flash drought frequency. Finally, the results illustrate that multiple pathways of research are needed to further our understanding of the regional drivers of flash drought and the complex interactions between flash drought and socioeconomic impacts.

Changes in Physician Telemedicine Use during COVID-19: Effects of Practice Setting, Demographics, Training, and Organizational Policies.

Telemedicine use increased during the COVID-19 pandemic, but uptake was uneven and future use is uncertain. This study, then, examined the ability of personal and environmental variables to predict telemedicine adoption during the COVID-19 pandemic. A total of 230 physicians practicing in the U.S. completed questions concerning personal and environmental characteristics, as well as telemedicine use at three time points: pre-pandemic, during the pandemic, and anticipated future use. Associations between use and characteristics were determined to identify factors important for telemedicine use. Physicians reported that telemedicine accounted for 3.72% of clinical work prior to the pandemic, 46.03% during the pandemic, and predicted 25.44% after the pandemic ends. Physicians within hospitals reported less increase in telemedicine use during the pandemic than within group practice (p = 0.016) and less increase in use at hospitals compared to academic medical centers (p = 0.027) and group practice (p = 0.008). Greater telemedicine use was associated with more years in practice (p = 0.009), supportive organizational policies (p = 0.001), organizational encouragement (p = 0.003), expectations of greater patient volume (p = 0.003), and perceived higher quality of patient care (p = 0.032). Characteristics such as gender, number of physicians, and level of telemedicine training were not significant predictors. Organizations interested in supporting physicians to adopt telemedicine should encourage its use and create policies supporting its use. More senior physicians had a greater degree of telemedicine uptake, while training programs did not predict use, suggesting that efforts to develop telemedicine competency in younger physicians may be ineffective and should be re-examined.

Storm types in India: linking rainfall duration, spatial extent and intensity.

We examine wet events (WEs) defined from an hourly rainfall dataset based on 64 gauged observations across India (1969-2016). More than 90% of the WEs (accounting for nearly 60% of total rainfall) are found to last less than or equal to 5 h. WEs are then clustered into six canonical local-scale storm profiles (CanWE). The most frequent canonical type (CanWE#1 and #2) are associated with very short and nominal rainfall. The remaining canonical WEs can be grouped into two broad families: (i) CanWE#3 and #5 with short (usually less than or equal to 3-4 h), but very intense rainfall strongly phase-locked onto the diurnal cycle (initiation peaks in mid-afternoon) and probably related to isolated thunderstorms or small mesoscale convective clusters (MCS), and (ii) CanWE#4 and #6 with longer and lighter rainfall in mean (but not necessarily for their maximum) and more independent of the diurnal cycle, thus probably related to larger MCSs or tropical lows. The spatial extent of the total rainfall received during each CanWE, as shown by IMERG gridded rainfall, is indeed smaller for CanWE#3 and #5 than for CanWE#4 and especially #6. Most of the annual maximum 1 hour rainfalls occur during CanWE#5. Long-term trend analysis of the June-September canonical WEs across boreal monsoonal India reveals an increase in the relative frequency of the convective storm types CanWE#3 and #5 in recent years, as expected from global warming and thermodynamic considerations. This article is part of a discussion meeting issue 'Intensification of short-duration rainfall extremes and implications for flash flood risks'.

Telerounding: A scoping review and implications for future healthcare practice.

Introduction: Telerounding is slated to become an important avenue for future healthcare practice. As utilization of telerounding is increasing, a review of the literature is necessary to distill themes and identify critical considerations for the implementation of telerounding. We provide evidence of the utility of telerounding and considerations to support its implementation in future healthcare practice based on a scoping review. Method: We collected articles from nine scientific databases from the earliest dated available articles to August 2020. We identified whether each article centered on telerounding policies, regulations, or practice. We also organized information from each article and sorted themes into four categories: sample characteristics, technology utilized, study constructs, and research outcomes. Results: We identified 21 articles related to telerounding that fit our criteria. All articles emphasized telerounding practice. Most articles reported data collected from surgical wards, had adult samples, and utilized robotic telerounding systems. Most articles reported null effects or positive effects on their measured variables. Discussion: Providers and patients can benefit from the effective implementation of telerounding. Telerounding can support patient care by reducing travel expenses and opportunities for infection. Evidence suggests that telerounding can reduce patient length of stay. Patients and providers are willing to utilize telerounding, but patient willingness is influenced by age and education. Telerounding does not appear to negatively impact satisfaction or patient care. Organizations seeking to implement telerounding systems must consider education for their providers, logistics associated with hardware and software, scheduling, and characteristics of the organizational context that can support telerounding. Considerations provided in this article can mitigate difficulties associated with the implementation of telerounding.

Runoff sensitivity of Indian sub-continental river basins.

Understanding the sensitivity of water availability in the current and future climate in the Indian sub-continent is vital for food and water security. Using the Variable Infiltration Capacity (VIC) model and Budyko's framework with two observational datasets, we estimated water budget and mean annual runoff sensitivity to precipitation and potential evapotranspiration (PET) over 18 major river basins and 222 sub-basins in the Indian sub-continent. The river basins located in the north experienced a decline in mean annual precipitation while the basins in the south witnessed an increase in mean annual precipitation. Declined precipitation and increased PET resulted in a decrease in mean annual runoff in Brahmaputra, Ganga, and Indus basins during 1980-2014. On the other hand, mean annual runoff has increased in Sabarmati, South Coast, Subernarekha, Tapi, Mahanadi, East coast, Cauvery, and Brahmani river basins. Mean annual AET estimated using the Budyko's framework was underestimated while mean annual total runoff was overestimated for the majority of the basins in comparison to the estimates from the VIC model. Moreover, the Budyko's framework with both observational datasets underestimated runoff sensitivity to the changes in precipitation and PET in comparison to the VIC model. Runoff is more sensitive to change in precipitation than PET for the majority of the river basins highlighting the importance of changes in precipitation for water availability in the Indian sub-continent. The VIC model simulated runoff and evapotranspiration are in better agreement with the observations in comparison to the estimates from the Budyko's framework. However, a large uncertainty was found in water budget and runoff sensitivity estimated using the VIC and Budyko's models, which highlights the importance of considering multiple models for estimation of the water budget and runoff sensitivity in the sub-continental river basins.

Bias-corrected climate projections for South Asia from Coupled Model Intercomparison Project-6.

Climate change is likely to pose enormous challenges for agriculture, water resources, infrastructure, and livelihood of millions of people living in South Asia. Here, we develop daily bias-corrected data of precipitation, maximum and minimum temperatures at 0.25° spatial resolution for South Asia (India, Pakistan, Bangladesh, Nepal, Bhutan, and Sri Lanka) and 18 river basins located in the Indian sub-continent. The bias-corrected dataset is developed using Empirical Quantile Mapping (EQM) for the historic (1951-2014) and projected (2015-2100) climate for the four scenarios (SSP126, SSP245, SSP370, SSP585) using output from 13 General Circulation Models (GCMs) from Coupled Model Intercomparison Project-6 (CMIP6). The bias-corrected dataset was evaluated against the observations for both mean and extremes of precipitation, maximum and minimum temperatures. Bias corrected projections from 13 CMIP6-GCMs project a warmer (3-5°C) and wetter (13-30%) climate in South Asia in the 21st century. The bias-corrected projections from CMIP6-GCMs can be used for climate change impact assessment in South Asia and hydrologic impact assessment in the sub-continental river basins.

Extremes in water availability and suicide: Evidence from a nationally representative sample of rural Indian adults.

BACKGROUND: Extremes in water availability, either exceptionally wet or dry conditions, can damage crops and may detrimentally affect the livelihood and well-being of people engaged in agriculture. We estimated the effect of water availability on suicide in rural India, a context where the majority of households are dependent upon agriculture. METHODS: We used data from a nationally representative sample of 8.5 million people who were monitored for causes of death from 2001 to 2013. Water availability was measured with high-resolution precipitation and temperature data (i.e., the Standardized Precipitation Evapotranspiration Index). We used a fixed effects approach that modeled changes in water availability within districts (n = 569) over time (n = 13 years) to estimate the impact on suicide deaths. We restricted our analysis to rural areas and to deaths occurring during the growing season (June-March) among adults aged 15 or older, and controlled for sex, age, region, and year. We used Poisson regression with standard errors clustered at the district level and total deaths as the offset. RESULTS: There were 9456 suicides and 249,786 total deaths in our study population between 2001 and 2013. Compared to normal growing seasons, the percent of deaths due to suicide increased by 18.7% during extremely wet growing seasons (95% CI: 6.2, 31.2) and by 3.6% during extremely dry growing seasons (95% CI: -17.9, 25.0). We found that effects varied by age. CONCLUSIONS: We found extremes is water availability associated with an increase in suicide. Abnormally wet growing conditions may play an important, yet overlooked, role in suicide among rural Indian adults.

COVID-19 and telehealth, education, and research adaptations.

For decades, there have been government funded services to provide healthcare telephonically to remote sites both on the earth and in the air. This capability has evolved into what we now know as telehealth. The use of telehealth dramatically accelerated as a result of concerns for patient and healthcare provider safety during the SARS-CoV2 pandemic. Similarly, concerns regarding transmission of infection have required medical schools to provide robust, easily accessible virtual education options. At short notice, faculties have had to develop new telehealth focused curriculum components. However, telehealth, online education, and internet enabled research should not be simply a new way to do traditional jobs but rather, an opportunity to take advantage of how technology can best be used to develop new and better ways to provide care, educate health care providers, and support research.

Automating Vancomycin Monitoring to Improve Patient Safety.

INTRODUCTION: Intravenous vancomycin is a frequently used antibiotic and a common cause of medication-related harm because of its narrow therapeutic range. Improving monitoring of drug levels with automation in the electronic health record (EHR) may decrease this harm. METHODS: After examining the existing state of vancomycin ordering, administration, and monitoring, an automated process was created in the EHR that, on initiation of a new vancomycin order, automatically ordered a vancomycin trough level 30 minutes before the fourth dose. In addition, a nursing alert was integrated into the bar coding medication administration process that, if no trough level had been drawn by the time of the administration of the fourth dose, prompted the nurse to draw a trough level. Data from a three-month, post-implementation period was compared to data from a preceding three-month period. RESULTS: The frequency of trough levels drawn between the third and fourth dose increased from 58.6% to 75.8% (p < 0.01). However, the percentage of trough levels drawn within one hour of the fourth dose remained unchanged, possibly because nursing staff waited for the result of the level prior to administering the next dose of vancomycin. A minority of patients in both groups had trough levels that were in range (difference between groups, p = 0.46). CONCLUSION: Automation of vancomycin monitoring was associated with improvement in the frequency of monitoring and only delayed medication dosing by six minutes. Because vancomycin is high risk, this type of process should be broadly implemented, and outcomes should be assessed to identify unexpected outcomes and necessary further refinements.

Measuring electronic communication networks in virtual care teams using electronic health records access-log data.

OBJECTIVE: To develop methods for measuring electronic communication networks in virtual care teams using electronic health records (EHR) access-log data. METHODS: For a convenient sample of 100 surgical colorectal cancer patients, we used time-stamped EHR access-log data extracted from an academic medical center's EHR system to construct communication networks among healthcare professionals (HCPs) in each patient's virtual care team. We measured communication linkages between HCPs using the inverse of the average time between access events in which the source HCPs sent information to and the destination HCPs retrieved information from the EHR system. Social network analysis was used to examine and visualize communication network structures, identify principal care teams, and detect meaningful structural differences across networks. We conducted a non-parametric multivariate analysis of variance (MANOVA) to test the association between care teams' communication network structures and patients' cancer stage and site. RESULTS: The 100 communication networks showed substantial variations in size and structures. Principal care teams, the subset of HCPs who formed the core of the communication networks, had higher proportions of nurses, physicians, and pharmacists and a lower proportion of laboratory medical technologists than the overall networks. The distributions of conditional uniform graph quantiles suggested that our network-construction technique captured meaningful underlying structures that were different from random unstructured networks. MANOVA results found that the networks' topologies were associated with patients' cancer stage and site. CONCLUSIONS: This study demonstrates that it is feasible to use EHR access-log data to measure and examine communication networks in virtual care teams. The proposed methods captured salient communication patterns in care teams that were associated with patients' clinical differences.

Qualitative and Quantitative Analysis of Patients' Perceptions of the Patient Portal Experience with OpenNotes.

BACKGROUND: Access to medical encounter notes (OpenNotes) is believed to empower patients and improve the quality and safety of care. The impact of such access is not well understood beyond select health care systems and notes from primary care providers. OBJECTIVES: This article analyzes patients' perceptions about the patient portal experience with access to primary care and specialist's notes and evaluates free-text comments as an improvement opportunity. MATERIALS AND METHODS: Patients at an academic health care system who accessed the patient portal from February 2016 to May 2016 were provided a link to complete a 15-item online survey. Those who had viewed at least one note were asked about patient characteristics, frequency of note access, note usefulness, note understanding, and if any action was taken after accessing the note. Free-text comments were associated with nine questions which were analyzed using qualitative methods. RESULTS: A total of 23% (1,487/6,439) of patients who viewed the survey in the portal, participated. Seventy-six percent (1,126/1,487) knew that the notes were available on the portal, and of those, 957 had viewed at least one note to continue the survey. Ninety percent of those were older than 30 years of age, and 90% had some college education. The majority (83%) thought OpenNotes helped them take better care of themselves, without increasing worry (94%) or contacting the physician after reading the note (91%). The qualitative analysis of free-text responses demonstrated multiple positive and negative themes, and they were analyzed for potential improvement opportunities. CONCLUSION: Our survey confirms that patients who choose to access their primary care and specialists' online medical records perceive benefits of OpenNotes. Additionally, the qualitative analysis of comments revealed positive benefits and several potential patient portal improvement opportunities which could inform implementation of OpenNotes at other health systems.

Predicting the Future: Using Simulation Modeling to Forecast Patient Flow on General Medicine Units.

BACKGROUND: Hospitals are complex adaptive systems within which multiple components such as patients, practitioners, facilities, and technology interact. A careful approach to optimization of this complex system is needed because any change can result in unexpected deleterious effects. One such approach is discrete event simulation, in which what-if scenarios allow researchers to predict the impact of a proposed change on the system. However, studies illustrating the application of simulation in optimization of general internal medicine (GIM) team inpatient operations are lacking. METHODS: Administrative data about admissions and discharges, data from a time-motion study, and expert opinion on workflow were used to construct the simulation model. Then, the impact of four changes: aligning medical teams with nursing units, adding a hospitalist team, adding a nursing unit, and adding both a nursing unit and hospitalist team with higher admission volume were modeled on key hospital operational metrics. RESULTS: Aligning medical teams with nursing units improved team metrics for aligned teams but shifted patients to unaligned teams. Adding a hospitalist team had little benefit, but adding a nursing unit improved system metrics. Both adding a hospitalist team and a nursing unit would be required to maintain operational metrics with increased patient volume. CONCLUSION: Using simulation modeling, we provided data on the implications of four possible strategic changes on GIM inpatient units, providers, and patient throughput. Such analyses may be a worthwhile investment to study strategic decisions and make better choices with fewer unintended consequences.

A sixfold rise in concurrent day and night-time heatwaves in India under 2 °C warming.

Heatwaves with severe impacts have increased and projected to become more frequent under warming climate in India. Concurrent day and nighttime heatwaves can exacerbate human discomfort causing high morbidity and mortality; however, their changes in the observed and projected climate remain unrecognized. Here using observations and model simulations from climate of 20th century plus (C20C+) detection and attribution (D&A) and coupled model intercomparison project 5 (CMIP5) projects, we show that 1 and 3-day concurrent hot day and hot night (CHDHN) events have significantly increased during the observed climate in India. Our results show that the anthropogenic emissions contribute considerably to the increase of 1 and 3-day CHDHN events in India. The frequency of 3-day CHDHN events is projected to increase 12-fold of the current level by the end of 21st century and 4-fold by the mid 21st century under the high emission pathway of RCP 8.5. The increase in 3-day CHDHN events can be limited to only 2-fold by the end of 21st century under low emission scenario of RCP 2.6. One and 3-day CHDHN events are projected to increase by 4, 6, and 8 folds of the current level in India under the 1.5, 2, and 3 °C warming worlds, respectively. Restricting global mean temperature below 1.5° from the pre-industrial level can substantially reduce the risk of 1 and 3-day CHDHN events and associated implications in India.

Projected Increase in Hydropower Production in India under Climate Change.

Hydropower is a valuable renewable energy resource in India, which can help in climate change mitigation and meet the increasing energy demands. However, the crucial role of climate change on hydropower production in India remains unexplored. Here using the observations and model simulations, we show that seven large hydropower projects experienced a significant (p-value < 0.05) warming and a decline in precipitation and streamflow during the observed period of 1951-2007. However, all the hydropower projects are projected to experience a warmer and wetter climate in the future. Multimodel ensemble mean annual average temperature (precipitation) is projected to rise up to 6.3 ± 1.6 °C (18 ± 14.6%) in the catchments upstream of the other reservoirs by the end of the 21st century under representative concentration pathway (RCP) 8.5. Due to the projected increase in precipitation, mean annual streamflow (up to +45%) and hydropower (up to +25%) production are projected to rise under the future climate. However, significant warming (6.25 ± 1.62 °C) is projected to result in a decline in streamflow and hydropower production in May- June for snow-dominated Nathpa Jhakri and Bhakra Nangal hydropower projects. Our results provide insights into the development and planning of hydropower projects in India under the current projected future climate.