Assessment of Flood Risk Under Future Climate Conditions

Global climate change is predicted to have impacts on the frequency and severity of flood events. In this study, output from Global Circulation Models (GCMs) for a range of possible future climate scenarios was used to force hydrologic models for four case study watersheds built using the Soil and Water Assessment Tool (SWAT). GCM output was applied with either the delta change method or a bias correction. Potential changes in flood risk are assessed based on modeling results and possible relationships to watershed characteristics. Differences in model outputs when using the two different methods of adjusting GCM output are also compared. Preliminary results indicate that watersheds exhibiting higher proportions of runoff in streamflow are more vulnerable to changes in flood risk. The delta change method appears to be more useful when simulating extreme events as it better preserves daily climate variability as opposed to using bias corrected GCM output

Forcing Hydrologic Models with GCM Output: Bias Correction vs. the Delta Change Method

Global climate change is predicted to have impacts on the frequency and severity of flood events. Hydrologic modeling can be used to gain a deeper understanding of the flood risk projected under future climatic conditions. In this study, output from several global circulation models (GCMs) for a range of possible future climate scenarios was used to force a hydrologic model for a case study watershed built using the soil and water assessment tool (SWAT). GCM output was obtained from the World Climate Research Programme\u27s (WCRP\u27s) Coupled Model Intercomparison Project phase 3 (CMIP3) multimodel dataset. At the watershed scale, the output was applied with either the delta change method or a bias correction. This research compares the differences in SWAT model outputs and associated flood risk projections when using the two different methods of adjusting GCM output. Preliminary results indicate that the delta change method is more useful when simulating extreme events as it better preserves daily climate variability as opposed to using bias-corrected GCM output. The delta change method appears to produce estimates of flood risk that are more realistic than those obtained using GCM output with a bias correction

Integration of Pediatric Palliative Care Into Cardiac Intensive Care: A Champion-Based Model

Integration of pediatric palliative care (PPC) into management of children with serious illness and their families is endorsed as the standard of care. Despite this, timely referral to and integration of PPC into the traditionally cure-oriented cardiac ICU (CICU) remains variable. Despite dramatic declines in mortality in pediatric cardiac disease, key challenges confront the CICU community. Given increasing comorbidities, technological dependence, lengthy recurrent hospitalizations, and interventions risking significant morbidity, many patients in the CICU would benefit from PPC involvement across the illness trajectory. Current PPC delivery models have inherent disadvantages, insufficiently address the unique aspects of the CICU setting, place significant burden on subspecialty PPC teams, and fail to use CICU clinician skill sets. We therefore propose a novel conceptual framework for PPC-CICU integration based on literature review and expert interdisciplinary, multi-institutional consensus-building. This model uses interdisciplinary CICU-based champions who receive additional PPC training through courses and subspecialty rotations. PPC champions strengthen CICU PPC provision by (1) leading PPC-specific educational training of CICU staff; (2) liaising between CICU and PPC, improving use of support staff and encouraging earlier subspecialty PPC involvement in complex patients\u27 management; and (3) developing and implementing quality improvement initiatives and CICU-specific PPC protocols. Our PPC-CICU integration model is designed for adaptability within institutional, cultural, financial, and logistic constraints, with potential applications in other pediatric settings, including ICUs. Although the PPC champion framework offers several unique advantages, barriers to implementation are anticipated and additional research is needed to investigate the model\u27s feasibility, acceptability, and efficacy