Contrasting signatures of distinct human water uses in regulated flow regimes

In the last century, about 50,000 dams have been constructed all around the world, and regulated rivers are now pervasive throughout the Earth\u2019s landscapes. Damming has produced global-scale alterations of the hydrologic cycle, inducing severe consequences on the ecological and morphological equilibrium of streams. However, a recognizable link between specific uses of reservoirs and their impact on flow regimes has not been disclosed yet. Here, extensive hydrological data are integrated with a physically-based model to investigate hydrological alterations downstream of 47 isolated dams in the Central Eastern U.S. Our results reveal a strong connection between the anthropogenic use and the hydrological impact of dams. Flood control reduces the temporal variability and spatial heterogeneity of river flows proportionally to the specific capacity allocated to mitigate floods (i.e., capacity scaled to the average inflow). Conversely, water supply increases the relative variability and regional heterogeneity of streamflows proportionally to the relative amount of withdrawn inflow. Accordingly, downstream of our multipurpose reservoirs the impact of regulation on streamflow variability is smoothed due to the compensating effect of flood control and water supply. Nevertheless, reservoirs with high storage capacity and overlapping uses produce regulated hydrographs that increase their unpredictability for larger aggregation periods and, thus, resemble an autocorrelated red noise. These findings suggest that the increase of freshwater demand could redefine the cumulative effects of dams at regional scale, reshaping the trajectories of eco-morphological alteration of dammed rivers

In Beers We Trust: Using Deprescribing Tools to Reduce Inappropriate Polypharmacy in Adults Age ≥ 65

Background: Adverse drug events (ADEs) are a significant cause of morbidity and mortality in older adults (age ≥ 65). Polypharmacy and potentially inappropriate medications (PIMs) are especially prevalent in this population and are a notable contributing risk factor for ADEs. Research demonstrates that comprehensive medication reconciliation that includes evaluation of both the risks and benefits of medications, in conjunction with deprescribing practices, can reduce PIMs; therefore, reducing ADEs. Purpose: The aim of this quality improvement project was to empower clinicians to deprescribe current medications that are inappropriate, as well as reduce the rate of newly prescribed PIMs among patients age ≥ 65 in the primary care setting by establishing a multi-modal educational intervention. Methods: A detailed educational program that incorporated evidence-based resources composed of the American Geriatrics Society (AGS) 2019 Beers Criteria®, PIMs, and deprescribing was introduced to 88 clinicians in a large academic, urban-based general internal medicine primary care clinic. Data was collected through pre-post intervention surveys to assess provider knowledge, prescribing practices, and self-efficacy in deprescribing. A retrospective medication chart review then assessed actual trends of prescribed PIMs in the clinic. Results: The 34 clinicians who completed each survey demonstrated an increased knowledge of AGS Beers Criteria® medications and reported a greater frequency in medication reconciliation performance. Notably, a paired t-test was performed to measure 13 providers’ reported self-efficacy deprescribing; and each participant’s response improved post-intervention. Conclusion: Proper medication safety standards in older adults is a complex issue that requires significant education in order for clinicians to adopt informed prescribing practices, thus ongoing provider education and evaluation are recommended. This multi-modal educational intervention is feasible for implementation in various healthcare settings to expand provider knowledge

Metabolomics application in maternal-fetal medicine

Metabolomics in maternal-fetal medicine is still an "embryonic" science. However, there is already an increasing interest in metabolome of normal and complicated pregnancies, and neonatal outcomes. Tissues used for metabolomics interrogations of pregnant women, fetuses and newborns are amniotic fluid, blood, plasma, cord blood, placenta, urine, and vaginal secretions. All published papers highlight the strong correlation between biomarkers found in these tissues and fetal malformations, preterm delivery, premature rupture of membranes, gestational diabetes mellitus, preeclampsia, neonatal asphyxia, and hypoxic-ischemic encephalopathy. The aim of this review is to summarize and comment on original data available in relevant published works in order to emphasize the clinical potential of metabolomics in obstetrics in the immediate future

CUSTOMER BASE SEGMENTATION AND A BASELINE APPROACH TO MIXED EFFECTS SURVIVAL FOREST

ope

Emerging Practices in Intergovernmental Functional Assignment

Attaining the benefits of (especially fiscal) decentralization in government remains an enduring challenge, in part because the re-arrangement of public functions across levels of government has often been carried out poorly. This book aims to provide a firmer conceptual basis for the re-arrangement of public functions across levels of government. In doing so, it offers practical advice for policy makers from developing and emerging countries and development cooperation practitioners engaged in such activity. Combining a theoretical approach for inter-governmental functional assignment with an in-depth analysis of real-life country cases where functional assignment (FA) has been supported in the context of international development cooperation, it underscores the common technical and political challenges of FA, and also demonstrates the need to expect and support country made and context-specific solutions to FA processes and results. Examples are drawn from a number of developing/transition countries from the Asia-Pacific region, Africa and the OECD, which outline and suggest advisory approaches, tools, principles and good practices and approaches. This text will be of key interest to scholars, students, policy-makers and practitioners in public policy, decentralization, local governance studies, public administration and development administration/studies. The Open Access version of this book, available at www.taylorfrancis.com, has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0 license

Un Modelo Dinámico que Analiza su Problemática y Permite Explorar Estrategias para Combatirla

El presente trabajo fue motivado por el deseo de profundizar la problemática de la educación universitaria en Argentina, donde sobresalen como relevantes, entre otras dificultades, los elevados índices de deserción y desgranamiento del alumnado universitario, sobre todo al inicio de su carrera. Para estudiar sus posibles causas y las estrategias a seguir para reducir sus efectos negativos ([1] a [5]) se buscó la construcción de un modelo mediante un sistema dinámico ([6] a [15], que reflejase el rendimiento de los alumnos en el primer año de su carrera universitaria y el comportamiento asumido en respuesta a dicho rendimiento; antes del inicio de segundo año. Los pasos principales seguidos en el desarrollo del proceso fueron la aplicación de análisis estadísticos al conjunto de variables, ([16] a [18]) la construcción del modelo que simula la reacción de los alumnos ante hipotéticas variaciones en los parámetros relevantes el planteo y la elaboración de conclusiones y recomendaciones de estrategias procedimentales y actitudinales orientadas a la reducción de los niveles de deserción mediante la retención de indecisos y disconformes, segmento de alumnado con muy elevado índice de abandono