Trends In Discharge Research Articles

Trends in outpatient radical prostatectomy and same day discharge for prostate cancer: Analysis of the National Inpatient Sample and Nationwide Ambulatory Surgery Sample.

Interest has grown in optimizing radical prostatectomy (RP) pathways for prostate cancer (PCa) and RP has been removed from Centers for Medicare & Medicaid Services inpatient only list. We aim to determine national trends in outpatient RP. The National Inpatient Survey (NIS) and Nationwide Ambulatory Surgery Survey (NASS) were queried to categorize RPs between 2016-2020 as inpatient RP and outpatient RPs, comprising same day discharge (SDD) and ambulatory encounters. Trends in outpatient RP over time were analyzed. Multivariable logistic regression analysis identified factors associated with SDD. Multivariable generalized linear models were used to compare total hospital charges between SDD and inpatient RPs. In a cohort of 362,123 RPs from 2016-2020, outpatient RPs increased from 4.8% to 53.7% (p<0.01) and SDD increased from 0.03% to 2.0% (p<0.01). Minimally invasive surgery (OR 1.59, p<0.01), highest quartile annual hospital caseload (OR 1.98, p=0.01), and low hospital bed count (OR 1.96, p=0.03) were associated with SDD. <20% of centers utilized SDD, although a select few hospitals discharged over 50% of RPs the same day. Ambulatory ($63,060) and SDD ($63,332) RPs had lower total charges compared to inpatient RPs ($69,951). Multivariable analysis demonstrated that SDD was associated with a reduction in total charges (OR 0.88, p<0.01). Over 50% of RPs are now performed as ambulatory or SDD encounters. SDD RP is more common in high volume facilities with lower bed counts. Though our data suggest lower hospital charges, further study is warranted to evaluate the impact of SDD on readmission rates and direct patient costs.

Oral health-related conditions in Ecuador: A temporal trend analysis of hospital discharges from 2000-2023.

Monitoring hospitalization rates associated with oral health conditions is an important part of epidemiological surveillance, especially when these conditions have increased significantly in low-and middle-income countries. This study aimed to evaluate the temporal trends in hospital discharges associated with oral health-related conditions in Ecuador from 2000 to 2023 and identify the leading diagnoses groups. An ecological time-series study was conducted based on annual data from the National Institute of Statistics and Censuses of Ecuador. We identified oral conditions using hospital discharge records, which were classified according to the International Classification of Diseases. We estimated crude and age-standardized rates per 100,000 inhabitants for the entire population and crude rates by sex, age, region, and the diagnosis. Joinpoint analysis was used to identify national trends in hospital discharges. A total of 93652 hospitalizations were identified. Malignant tumors of the head, face, and neck were the most common diagnosis attributed to hospital discharges (16.5%), followed by cleft palate (14.5%) and cleft lip (7.8%) and other diseases of the jaws (5.4%). The crude rate of OHRC increased from 17.94 to 28.81 hospitalizations per 100,000 population between 2000 and 2023. Based on joinpoint analysis, hospital discharges increased by 2.2% annually during the study period. However, three temporal trends were identified: from 2000 to 2017, hospital discharges increased annually by 4.3% (p<0.05); from 2017 to 2020 decreased by 17.2%; and from 2020 to 2023 increased annually by 12.9%. Average hospitalization rates were higher among those aged 0-9 and > 64 years. Hospitalization rates associated with oral health-related conditions in Ecuador have increased significantly over the past twenty-four years, except during the COVID-19 pandemic, where cases dropped considerably. Many of the oral conditions identified in the study were malignancies, which are caused by a complex relationship between genetic, environmental, and behavioral factors. Conducting early detection analysis is essential to reduce their occurrence.

Dissolved phosphorous through dry-wet-dry transitions in a small-dammed river basin: integrated understanding on transport patterns, export controls, and fate.

An integrated understanding of dissolved phosphorous (DP) export mechanism and controls on export over dry and wet periods is crucial for riverine ecological restorations in dammed river basins considering its high bioavailability and retention rates at dams. Riverine DP transport patterns (composition, sources, and transport pathways), export controls, and fate were investigated over the 2020 wet season (5 events) and dry seasons before and after it (2 events: dry(before) and dry(after)) in a semi-arid, small-dammed watershed to comprehend the links between terrestrial DP sources and aquatic DP sinks. Close spatiotemporal monitoring of the full range of phosphorous and total suspended solids (TSSs) and subsequent analyses (hysteresis, hierarchical partitioning, and coefficient of variation) provided the basis for the study. Total-DP (TDP) shared 13-39% (25%) of total-P (TP) through storms, dissolved organic-P (DOP) shared 6-21% (12%), and phosphate-P shared (PO4-P) 7-22% (13%). DP forms displayed strong connections with discharge trends across the wet season, and marked changes in the shares were reported over dry-wet and wet-dry transitions. The DOP fraction of TDP increased from 4% in dry(before) baseflow to 64% at the end of the wet season. The DOP flux increment in stormflow was 20 folds compared to dry(before) baseflow, while that of PO4-P was 2 folds. DOP displayed the least spatial source heterogeneity with minimum anthropogenic pressure on inherent fluxes. DOP originated from overland and near-stream soil sources and was transported via surface runoff and soil water runoff, respectively. Across the wet season, the attrition of overland DOP sources and activation of near-stream soil DOP sources through strengthened hydrological connectivity governed the seasonal DOP trends. Surface and groundwater runoff pathways were important for PO4-P delivery during stormflow; nonetheless, wastewater treatment plant (WWTP) effluent was the main PO4-P source under both baseflow and stormflow regimes, followed by near-stream traditional agriculture lands. The interaction patterns of small dam systems with DP inputs through dry-wet periods were explained. The riverine PO4-P fluxes were profoundly impacted by in-stream biogeochemical and physical processes and small dam systems, while riverine DOP fluxes were relatively less influenced.

Climatic impacts on spring disappearance in the Indian Himalayas

Due to climate change the drop in spring-water discharge poses a serious issue in the Himalayan region, especially in the higher section of Himachal Pradesh. This study used different climatic factors along with long-term rainfall data to understand the decreasing trend in spring-water discharge. It was determined which climate parameter was most closely correlated with spring discharge volumes using a general as well as partial correlation plot. Based on 40 years (1981–2021) of daily average rainfall data, a rainfall-runoff model was utilised to predict and assess trends in spring-water discharge using the MIKE 11 NAM hydrological model. The model’s effectiveness was effectively proved by the validation results (NSE = 0.79, R2 = 0.944, RMSE = 0.23, PBIAS = 32%). Model calibration and simulation revealed that both observed and simulated spring-water runoff decreased by almost 29%, within the past 40 years. Consequently, reduced spring-water discharge is made sensitive to the hydrological (groundwater stress, base flow, and stream water flow) and environmental entities (drinking water, evaporation, soil moisture, and evapotranspiration). This study will help researchers and policymakers to think and work on the spring disappearance and water security issues in the Himalayan region.

Comparing surface currents near the mouth of three bays along the U.S. East Coast: Chesapeake Bay, Delaware Bay, and New York Bay

Monthly surface currents at 2 km resolution near the mouths of three U.S. east coast bays were obtained from high-frequency radars (Coastal Ocean Dynamics Application Radar, CODAR) during 2012–2024. The currents near these bays, the Chesapeake Bay (CB), the Delaware Bay (DB) and the New York Bay (NB) were analyzed to infer similarity and differences, as well as potential common forcing from regional and basin-scale factors. The contribution to flow variability from local and remote forcing is evaluated by comparing surface currents with (a) river discharges into each bay, (b) with local and regional winds, and (c) with the North Atlantic Oscillation (NAO). The results show that surface flow variability near the mouth of the bays is linked with all three driving factors. The three bays often show similar flow patterns not only of the seasonal cycle, but also during extreme weather events. For example, increased surface flow into the bays from the Atlantic Ocean is seen when hurricanes are observed offshore in the fall, and increased surface flow from the bays is seen during winter storms. During positive NAO phases, eastward flow from all three bays increased due to intensified westerly winds, while during negative NAO phases flow decreased with weakening winds in the region. River discharges into the bays increased during 2012–2019 but decreased during 2019–2024. This change in river discharge trend was especially large in the CB, resulting in a change in trends of the surface currents. Monthly currents of each bay are only weakly correlated with the monthly river flow (R ~ 0.2–0.3; P < 0.05), while the seasonal cycles of rivers and currents have higher correlations (R ~ 0.6–0.7). Local winds show high correlations with the monthly currents (R ~ 0.75) with the current direction ~ 45° to the right of the wind, as expected from Ekman theory. However, contributions to current variability from regional and remote factors cannot be ignored. The results demonstrate the complex nature of the currents near the mouth of bays since multiple drivers, including estuarine, coastal and open ocean dynamics contribute to the observed variability.

Salt-wedge estuary's response to rising sea level, reduced discharge, and Nature-Based Solution

Vulnerable estuaries face resilience challenges against climate-induced salinization. This study examines the Po di Goro estuary in the Northern Adriatic Sea using an innovative modeling approach. It assesses the effectiveness of a Nature-Based Solution in reducing the threat of salt-wedge intrusion. An intermediate-complexity numerical model is considered, leveraging its low computational cost, which is suitable for climate projections, along with robust physics encompassing the main estuarine processes. Two centennial climate experiments covering 1991–2100 are proposed following a mechanistic modeling approach to understand the compound effects of sea level rise and river discharge changes. The first experiment is a full forcing experiment. The second experiment uses the same model but removes the sea level rise as an input forcing. A third experiment, referred to as the Digital Twin Experiment, assesses the effectiveness of a location-specific Nature-Based Solution. This experiment specifically examines the impact of reducing salt levels in the water by using a halophyte plant along the estuary. The results show that, in a future climate change scenario, the salt-wedge intrusion increases. This response is due to the non-linear combination of reduced river discharge and the local sea level rise. The discharge decrease acts as the main driver in the mid-term future (i.e., 2050–2080). In the long-term future (i.e., 2080–2100), the local sea level rise becomes more relevant as the discharge trend is expected to be null. The salt-wedge intrusion in the Po di Goro is projected to increase up to 63% annually (120% in summertime). Additionally, the river mouth salinity could rise by 27% annually (69% in summertime) in the long-term future (2081–2100). The halophyte plant, Atriplex portulaciodes, proposed as Nature-Based Solution, could reduce salt-wedge intrusion in the Po di Goro by up to 16% annually (22% in summer) in the long-term future. In the short-term future, this Nature-Based Solution may be effective enough to counteract the salt increase.

Climatic and Anthropogenic Influences on Long-Term Discharge and Sediment Load Changes in the Second-Largest Peninsular Indian Catchment

In recent decades, understanding how climate variability and human activities drive long-term changes in river discharge and sediment load has become a crucial field of research in fluvial geomorphology, particularly for South Asia’s densely populated and environmentally sensitive regions. This study analyses spatio-temporal trends in water discharge (Qd) and sediment load (Qs) in the Krishna basin, Peninsular India’s second-largest catchment. Using nearly 50 years of daily discharge, sediment concentration, and rainfall data from the Central Water Commission (CWC) and India Meteorological Department (IMD), we applied Mann–Kendall, Pettitt tests, and double mass equations to detect long-term trends, abrupt changes, and the relative influence of climate and anthropogenic effects. Results showed a notable decline in the annual discharge, with 15 of 20 stations showing decreasing trends, especially along the Bhima, Ghataprabha, and lower Krishna rivers. The annual stream flow data showed a 53% decline in the mean Qd from 26.01 × 109 m3 year−1 before 2000 to 12.32 × 109 m3 year−1 after 2000 at the terminal station. Eight of ten gauging stations showed a significant decrease (p-value &lt; 0.05) in their annual sediment load, with a 76% reduction across the Krishna basin after its changepoint in 1983. The Pettitt test identified a statistically significant downward shift in discharge at seven stations. Double mass plots indicate that anthropogenic factors, such as large-scale reservoirs and water diversion, are the main contributors, accounting for 82.7% of sediment decline, with climatic factors contributing 17.1%. The combined trend analysis and double mass plots confirm these findings, underscoring the need for further study of human impacts on the basin’s hydro-geomorphology. This study offers a clear and robust approach to quantifying the relative effects of climate and human activities, providing a versatile framework that can enhance understanding in similar studies worldwide.

Wavelet analysis of discharge and sediment load for the Subarnarekha, Brahmani, and Mahanadi rivers of India

ABSTRACT This study aims to identify distinct small-scale temporary patterns between the river discharge and suspended sediment load for the main tropical rivers using continuous wavelet transform. Strong annual and irregular semi-annual variabilities, with few quarterly and interdecadal variabilities, are observed in river discharge and sediment load. The wavelet coherence reveals that the strongest in-phase coherence relationships exist between total suspended sediment and streamflow. The methodology for identifying the primary climate factors that integrate the partial wavelet coherence (PWC), multiple wavelet coherence (MWC), and quadruple wavelet coherence (QMWC) techniques is presented. The results show that the El-Nino/Southern Oscillation (ENSO) is the major regulator of streamflow followed by Indian Ocean Dipole (IOD) and Pacific Decadal Oscillation (PDO). The chosen rivers show a statistically significant ( p ≤ 0.05 ) descending trend in sediment load but no significant positive or negative trend in river discharge. This could be due to regional sediment storage and large-scale stream events affecting the sediment transport dynamics.

Medium term hydrochemical and CO2 responses to anthropogenic and environmental changes in karst headwater streams.

This study investigates the intricate effects of lithology, temperature, discharge, and land use changes on headwater stream chemistry by analysing two decades of hydrochemical data from twenty karst headwater catchments in the Garonne River basin, France. Focused on the Pyrenees and the lowland (LM) and upland (UM) regions of the Massif Central, this study identified significant regional variations and commonalities in water chemistry. The headwater streams were clustered based on their hydrological and hydrochemical profiles, revealing strong similarities between upland sites, i.e. UM and Pyrenees, despite their geographical distance. The findings revealed a predominance of water driven by calcite dissolution, with specific influences from minor lithologies. Seasonal variations in water chemistry were primarily driven by hydrological conditions. Trend analyses highlighted increased pCO2 concentration in both the Pyrenees and UM, linked to higher forest density and agricultural activities, respectively. In contrast, LM exhibited increasing Ca2+ and HCO3- concentrations alongside decreasing trends in pCO2 and discharge, and increased nitrate concentration. While overall water temperatures increase, only a few sites exhibited significant warming trends, consistent with similar studies in the region and worldwide. These findings underscore the complex interplay between land use changes and hydrochemical dynamics in karst headwaters. They reveal that rising pCO2 concentration trends in upland regions are driven by reforestation and agricultural practices, which have significant implications in CO2 emissions, and consequently for regional and global carbon budgets and carbon-related policies. In lowland areas, declining water resources and increasing ion concentrations highlight potential challenges for water management, particularly in sensitive karst catchments. This study provides a baseline for understanding how karst headwaters respond to environmental changes. Expanding this research to other karst systems worldwide, under different climates, would help validate and model these findings, and improve our understanding of the global carbon cycle.

Assessing the long-term trend of spring discharge in a climate change hotspot area

Global warming affects atmospheric and oceanic energy budgets, modifying the Earth’s water cycle. The Mediterranean region is a critical zone for climate change due to a decrease in recharge and an increase in the frequency and severity of droughts over recent decades. While the impacts of possible emissions scenarios on surface water have been extensively studied, the effects on groundwater discharge remain uncertain at both global and local scales. The primary objective of this study is to predict the long-term effects of climate change on the discharge of two springs with extensive discharge records, located in distinctly different hydrogeological settings within the Mediterranean climate zone. Through multivariate statistical analyses on secular time-series, correlation factors were identified between the springs' historical discharge and recharge-related parameters representative of their catchment. Future climate projections from a Regional Circulation Model were used to estimate long-term discharge trends of the springs for the 2040–2070 period. The results indicate that the discharge of both springs, on a multi-decadal trend scale, could decrease by 9 % to 11 % by 2040-2070 compared to that of the past few decades. The consistent negative trends observed across the two different hydrogeological settings suggest that the multi-decadal decline in spring discharge is more influenced by climatic factors than by specific hydrogeological features. This leads to the speculation that similar trends could be expected in other springs within Mediterranean-type climates worldwide. Future water shortages will significantly impact the hydrogeological contexts within these climates. Therefore, the long-term outcomes of this study are crucial for assisting water utility agencies in the sustainable management of groundwater resources, providing them with adequate time to plan and implement large-scale infrastructure projects over the coming decades.

Impact of Forest Dieback on Hydrology and Nitrogen Export Using a New Dynamic Water Quality Model

AbstractForest status is crucial for catchment hydrology and water quality but is increasingly disturbed by human activities and climatic factors. Therefore, it is urgently necessary to develop water quality models that can adapt to these changes. This study used a new dynamic Hydrological Predictions for the Environment (HYPE) model to assess the effect of rapid and continuous forest changes on catchment hydrology and nitrogen export. The modified HYPE model was implemented for the 25 years period in the Große Ohe catchment in Germany, which has experienced severe forest dieback and recovery. Due to the stochastic nature of infestation events, data covering the entire process of forest change are rare. The modified HYPE model performed well at different scales for discharge and dissolved inorganic nitrogen (DIN) export. It was able to (a) capture the timing of peak flows and the seasonal DIN concentration dynamics and (b) reflect the initial increase and subsequent decrease trend in discharge and DIN export in accordance with forest dieback and regeneration. The increase in nitrogen export after forest dieback primarily resulted from reduced forest uptake and increased soil nitrogen availability from tree residues. The difference in runoff and nitrogen export increment with or without regeneration highlights the importance of forest regeneration in restoring catchment hydrology and water quality. Additionally, a decrease in DIN export after residue removal implies the impact of sound post‐disturbance management strategies. The dynamic modeling under changing catchment forests can enhance the analysis of catchment water quality and effectively support forest management.

Trends in home treatment and early discharge of patients with low-risk pulmonary embolism

Abstract Background A strategy of ambulatory treatment or early discharge (≤ 48 hours) of patients with acute low-risk pulmonary embolism (PE) has been adopted by the most recent guideline recommendations. However, the adoption of such a change of paradigm in PE care in the ‘real-world’ clinical setting, outside the concept of prospective cohort (management) studies, remains unknown. Aims To determine the proportion of patients with PE who fulfill eligibility criteria for home treatment or early discharge, to investigate in how many of them such a management strategy is actually followed, and to discover differences in early complications between early or later discharge among low-risk patients. Methods We used two nationwide databases, the US Nationwide Emergency Department Sample (NEDS) and Nationwide Readmission Database (NRD), to identify patients with low-risk PE (absence of the following at presentation: haemodynamic instability, cor pulmonale, tachycardia, dyspnea, hypothermia, altered mental status, and fulfilment of the Hestia critieria). We investigated the proportion of patients that were discharged entirely at home, or discharged early (hospital stay £ 2 days) and their association with predictor variables. We also studied the 90-day occurrence of venous thromboembolism recurrence and major bleeding. Results From 2016 to 2020, there were 2,099,390 emergency department visits for PE (NEDS Database), with 641,621 (30.6%) classified as low-risk. Home treatment was documented in 20.3% of all cases, with 31.5% of low-risk PE cases being treated at home and an increasing trend over time (Figure 1A). Factors associated with home treatment for low-risk PE included younger age, female sex, and absence of comorbidities; home treatment was more frequent at university hospitals, non-metropolitan hospitals, and those with higher emergency department volumes (Figure 2A). In the NRD Database, there were 1,950,708 PE hospitalizations during the same period with 481,321 classified as low-risk (24.7%). An early discharge strategy was followed in 22.6% of all cases, increasing to 45.9% for low-risk PE admissions, with a rising trend observed from 2016 (Figure 1B). Factors associated with early discharge for low-risk PE included younger age, male sex, and absence of comorbidities; here, university hospitals and metropolitan hospitals were less likely to implement early discharge (Figure 2B). The 90-day incidence of VTE recurrence among low-risk patients was lower with early discharge (1.3% vs. 1.8%, p&amp;lt;0.001), as was major bleeding (1.5% vs. 2.8%, p&amp;lt;0.001). Conclusion Our results reveal an increasing implementation of early discharge and home treatment for low-risk PE across recent years. Factors influencing these strategies are related to demographics and hospital type. Early discharge was associated with favourable outcomes in the real-world setting, thus supporting the results of previously performed prospective cohort studies and randomized trials.Figure 1Figure 2

Differential Spatiotemporal Patterns of Major Ions and Dissolved Organic Carbon Variations from Non-Permafrost to Permafrost Arctic Basins: Insights from the Severnaya Dvina, Pechora and Taz Rivers

The Arctic river basins, among the most sensitive regions to climate warming, are experiencing rapid temperature rise and permafrost thawing that profoundly affect their hydrological and hydrochemical systems. However, our understanding of chemical export from Arctic basins to oceans remains limited due to scarce data, particularly in permafrost-dominated regions. This study examines the spatiotemporal variations and seasonal dynamics of major ions (Na+, K+, Mg2+, Ca2+, Cl−, SO42−) and dissolved organic carbon (DOC) concentrations across three river basins with varying permafrost extents: the Severnaya Dvina (2006–2008, 2012–2014), the Pechora (2016–2019) and the Taz Rivers (2016–2020). All the data were sourced from published Chemical Geological researches and were taken from Mendeley and PANGAEA datasets. Our results showed that DOC concentrations ranged from 1.75 to 26.40 mg/L, with the Severnaya Dvina River exhibiting the highest levels of DOC concentrations, alongside significantly elevated ion concentrations compared to the other two basins. A positive correlation was observed between DOC concentrations and river discharge, with peaks during the spring flood and summer baseflow due to leaching processes. The Severnaya Dvina and Pechora Rivers exhibited the highest DOC values during the spring flood, reaching 26.40 mg/L and 8.07 mg/L, respectively. In contrast, the Taz River had the highest runoff during the spring flood season, but the DOC concentration reached its highest value of 11.69 mg/L in the summer. Specifically, a 1% increase in river discharge corresponded to a 1.25% rise in DOC concentrations in the Severnaya Dvina River and a 1.04% increase in the Pechora River, while there was no significant correlation between runoff and DOC concentrations in the Taz River. Major ion concentrations demonstrated a negative correlation with river discharge, remaining relatively high during winter low-flow period. A robust power-law relationship between river discharge and concentration of DOC and major ions was observed, with distinct variations across the three river basins depending on permafrost extent. The Pechora and Taz Rivers, characterized by extensive permafrost, exhibited increasing trends in river discharge and DOC concentrations, accompanied by decreasing major ion concentrations, whereas the non-permafrost-dominated Severnaya Dvina River basin showed the opposite pattern. The Taz River, with the most extensive permafrost, also displayed a delayed DOC peak and more complex seasonal ion concentration patterns. These findings highlight the importance of varying permafrost extents and their implications for water quality and environmental protection in these vulnerable regions.

Multi-objective calibration and evaluation of the ORCHIDEE land surface model over France at high resolution

Abstract. Here we present a strategy to obtain a reliable hydrological simulation over France with the ORCHIDEE land surface model. The model is forced by the SAFRAN atmospheric reanalysis at 8 km resolution and hourly time steps from 1959 to 2020 and by a high-resolution DEM (around 1.3 km in France). Each SAFRAN grid cell is decomposed into a graph of hydrological transfer units (HTUs) based on the higher-resolution DEM to better describe lateral water movements. In particular, it is possible to accurately locate 3507 stations among the 4081 stations collected from the national hydrometric network HydroPortail (filtered to drain an upstream area larger than 64 km2). A simple trial-and-error calibration is conducted by modifying selected parameters of ORCHIDEE to reduce the biases of the simulated water budget compared to the evapotranspiration products (the GLEAM and FLUXCOM datasets) and the HydroPortail observations of river discharge. The simulation that is eventually preferred is extensively assessed with classic goodness-of-fit indicators complemented by trend analysis at 1785 stations (filtered to have records for at least 8 entire years) across France. For example, the median bias of evapotranspiration is −0.5 % against GLEAM (−4.3 % against FLUXCOM), the median bias of river discharge is 6.3 %, and the median Kling–Gupta efficiency (KGE) of square-rooted river discharge is 0.59. These indicators, however, exhibit a large spatial variability, with poor performance in the Alps and the Seine sedimentary basin. The spatial contrasts and temporal trends of river discharge across France are well represented with an accuracy of 76.4 % for the trend sign and an accuracy of 62.7 % for the trend significance. Although it does not yet integrate human impacts on river basins, the selected parameterization of ORCHIDEE offers a reliable historical overview of water resources and a robust configuration for climate change impact analysis at the nationwide scale of France.

The analysis of the long-term trend of extreme precipitation and discharge in Burundi

The analysis of the long-term trend of extreme precipitation and discharge in Burundi

Spatial Variation of Changes in Extreme Discharge Seasonality Across the Northeastern United States

ABSTRACTThe Northeast United States exhibits significant spatial heterogeneity in flood seasonality, with spring snowmelt‐driven floods historically dominating northern areas, while other regions show more varied flood seasonality. While it is well documented that since 1996 there has been a marked increase in extreme precipitation across this region, the response of flood seasonality to these changes in extreme precipitation and the spatial distribution of these effects remain uncertain. Here we show that, historically, snowmelt‐dominated northern regions were relatively insensitive to changes in extreme precipitation. However, with climate warming, the dominance of snowmelt floods is decreasing and thus the extreme flood regimes in northern regions are increasingly susceptible to changes in extreme precipitation. While extreme precipitation increased everywhere in the Northeastern United States in 1996, it has since returned to near pre‐1996 levels in the coastal north while remaining elevated in the inland north. Thus, the inland north region has and continues to experience the greatest changes in extreme flooding seasonality, including a substantial rise in floods outside the historical spring flood season, particularly in smaller watersheds. Further analysis reveals that while early winter floods are increasingly common, the magnitude of cold season floods (Nov‐May) have remained unchanged over time. In contrast, warm season floods (June‐Oct), historically less significant, are now increasing in both frequency and magnitude in the inland north. Our results highlight that treating the entire Northeast as a uniform hydroclimatic region conceals significant regional variations in extreme discharge trends and, more generally, climate warming will likely increase the sensitivity of historically snowmelt dominated watersheds to extreme precipitation. Understanding this spatial variability in increased extreme precipitation and increased sensitivity to extreme precipitation is crucial for enhancing disaster preparedness and refining water management strategies in affected regions.

LANDSCAPE CHANGES BASED ON HYDROLOGICAL CHARACTERISTICS IN THE WAE RIUAPA WATERSHED WEST SERAM REGENCY, MALUKU, INDONESIA

Changes in the Wae Riuapa River Basin landscape in West Seram Regency, Maluku, reflect complex ecological and social dynamics. The Wae Riuapa watershed is an integral part of the hydrological cycle in the region, influencing water availability, water quality, and geomorphological processes. This research aims to model changes in the landscape of the Wae Riuappa watershed regarding hydrological characteristics. The research method uses ArcGIS 10.3 for spatial analysis of 2010 and 2020 Landsat images and hydrooffice 12.0 software, BFLOW 3.0 module, a hydrological model for graphical separation of daily discharge. The results of modeling landscape changes in the Wae Riuappa watershed on hydrological characteristics obtained a regression model that depicts landscape changes as having a significant simultaneous and partial influence on discharge conditions in the Wae Riuappa watershed during the research period. The spatial pattern of area distribution for the nine land cover types in the study period was relatively similar. Widespread forest land cover still dominates the landscape of the Wae Riuapa watershed. However, the pattern of widespread distribution of changes is starting to decrease in primary and secondary forest land cover. Meanwhile, the distribution pattern of changes in agricultural land and mixed gardens and settlements has increased slowly and significantly. The results of a multi-temporal analysis of the hydrological characteristics of the Wae Riuapa watershed show that the daily discharge trend experiences multi-temporal fluctuations.

Readmission Rates After Expedited Postpartum Discharge.

To characterize national trends in expedited postpartum discharge and, secondarily, to identify predictors of expedited postpartum discharge and assess whether expedited postpartum discharge was associated with postpartum readmissions within 60 days of delivery hospitalization discharge. Birth hospitalizations and subsequent 60-day postpartum readmissions were extracted from the 2016-2020 Nationwide Readmissions Database for this retrospective cohort study. Postpartum discharge was categorized as expedited (less than 2 days after vaginal birth or less than 3 days after cesarean birth), routine (2 days after vaginal birth or 3 days after cesarean birth), or prolonged (more than 2 days after vaginal birth or more than 3 days after cesarean birth). Trends in expedited discharge were assessed over the study period with joinpoint regression. Unadjusted and adjusted logistic regression models were performed to assess clinical, hospital, and demographic predictors of expedited postpartum discharge. Sixty-day postpartum readmission risk was calculated, and adjusted regression models were performed to evaluate the association between expedited postpartum discharge and readmission. Of 17.9 million birth hospitalizations, 32.9% had expedited postpartum discharge. The overall 60-day postpartum readmission rate after delivery hospitalization discharge was 1.7% for all patients, 1.4% for expedited postpartum discharge, 1.6% for routine discharge, and 3.3% for prolonged discharge. Rates of expedited postpartum increased from 29.1% in 2016 to 31.4% in 2019 and to 43.8% in 2020. This trend was not significant (average annual percent change: 9.9%, 95% CI, -1.6% to 23.7%), although rates of expedited discharge were significantly higher in 2020 than in 2016-2019 ( P <.01). Younger and older age, chronic comorbid conditions, mental health conditions, and obstetric complications (eg, transfusion, chorioamnionitis or endometritis) were associated with lower likelihood of expedited postpartum discharge. Expedited postpartum discharge was associated with 14% lower adjusted odds of 60-day postpartum readmission compared with routine discharge (adjusted odds ratio 0.86, 95% CI, 0.85-0.88). Rates of expedited postpartum discharge increased significantly in 2020 compared with 2016-2019 and were not associated with 60-day postpartum readmission. These findings suggest that broader use of expedited postpartum discharge has not resulted in increased risk of postpartum readmissions.

Factors Influencing Discharges to Hospice for Patients With Late-Stage Huntington's Disease.

Background: Hospice services for patients with Huntington's disease (HD) are likely beneficial in relieving significant burdens and minimizing costly hospitalizations at the end of life, though there has been little study or clinical guidance on hospice enrollment for patients with HD. Objectives: The primary objective of this study was to identify clinical, sociodemographic, and system-level factors associated with discharges to hospice compared to other dispositions for hospitalized patients with late-stage HD. Methods: These analyses used data from the Nationwide Inpatient Sample between the years 2007 and 2011. Weighted logistic regression with a forward selection approach was performed to identify factors associated with discharge to hospice compared to discharge to home, facility, other locations, and death in hospital. Results: These analyses included 6544 hospitalizations of patients with late-stage HD. There was a significant increasing trend in discharges to hospice over the study period (P < 0.001). After adjustment, multiple clinical, sociodemographic, and system-level variables were identified as being associated with discharges to hospice. Patients with aspiration pneumonia and non-aspiration pneumonias had lower odds of being discharged to hospice compared to dying in the hospital. When comparing to discharges to facilities and home, weight loss and palliative care consultation were associated with greater odds of discharge to hospice. Conclusions: Our findings serve as a foundation for future studies on these factors, and thus help clinician decision-making on when to start advance care planning or end-of-life care for patients with HD. These results also support studies developing hospice referral criteria specific to patients with HD.

Same-Day Discharge for Elective Pediatric Laparoscopic Gastrostomy Tube Insertion is Safe and Increasing in Frequency; A NSQIP Pediatric Retrospective Review 2017 to 2021

BackgroundThere is limited literature reviewing same-day discharge for elective pediatric gastrostomy tube placement. Our aim was to assess the outcomes and national trends of same-day discharge following elective pediatric laparoscopic gastrostomy. MethodsACS NSQIP-P registry data from 2017 to 2021 was used to evaluate elective pediatric laparoscopic gastrostomy patients who presented from home and discharged home with a diagnosis of failure to thrive, feeding difficulty or dysphagia. Patients discharged same-day postoperatively (SDD) were compared to those discharged 1–2 days postoperatively (non-SDD) for the primary outcome of unplanned 30-day readmission. Secondary outcomes included bleeding events, wound infection, and 30-day reoperation. ResultsThere were 5,947 patients identified; 4.7% were discharged same-day. The annual rate of SDD over 5 years went from 2.7% to 4.6%–4.8% to 4.5%–6.3%. There were no significant differences between SDD and non-SDD patients for early readmission or reoperation (0.7% vs 0.3%, p = 0.279), 30-day unplanned readmission (8.5% vs 8.0%, p = 0.407), reoperation (0.1% vs 1.4%, p = 1.000), or any other complications (p > 0.05). Binary logistic regression found pre-operative steroid use within 30 days increased risk of serious complication (OR 2.02, 95% CI 1.29–3.15, p = 0.002) and 30-day readmission or reoperation (OR 2.10, 95% CI 1.34–3.27, p = 0.001). All 6 patients (0.1%) who required reoperation within 3 days were identified prior to discharge, and none of the 16 patients readmitted within 3 days of surgery required reoperation. ConclusionThough rates of same-day discharge following pediatric gastrostomy tube placement are low, they continue to increase annually. There were no significant differences in outcomes between same-day and non-same-day day discharge for elective cases presenting from and discharging home. In non-steroid using patients, same-day discharge following laparoscopic gastrostomy can be a safe option. Level of Evidence (I-V)Level III.