Search

This paper presents a modelling study on the spatial and temporal variability of climate-induced hydrologic changes in the Fraser River basin, British Columbia, Canada. This large basin presents a unique modelling case due to its physiographic heterogeneity and the potentially large implications of changes to its hydrologic regime. The macro-scale Variable Infiltration Capacity (VIC) hydrologic model was employed to simulate 30-year baseline (1970s) and future (2050s) hydrologic regimes based on climate forcings derived from eight global climate models (GCMs) runs under three emissions scenarios (B1, A1B and A2). Bias Corrected Spatial Disaggregation was used to statistically downscale GCM outputs to the resolution of the VIC model (1/16°). The modelled future scenarios for the 11 sub-basins and three regions (eastern mountains, central plateau and coastal mountains) of the FRB exhibit spatially varied responses, such as, shifts from snow-dominant to hybrid regime in the eastern and coastal mountains and hybrid to rain-dominant regime in the central plateau region. The analysis of temporal changes illustrated considerable uncertainties in the projections obtained from an ensemble of GCMs and emission scenarios. However, direction of changes obtained from the GCM ensembles and emissions scenarios are consistent amongst one another. The most significant temporal changes could include earlier onsets of snowmelt-driven peak discharge, increased winter and spring runoff and decreased summer runoff. The projected winter runoff increases and summer decreases are more pronounced in the central plateau region. The results also revealed increases in the total annual discharge and decreases in the 30-year mean of the peak annual discharge. Such climate-induced changes could have implications for water resources management in the region. The spatially and temporally varied hydro-climatic projections and their range of projections can be used for local-scale adaptation in this important water resource system for British Columbia. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The discharge and stage measurements in a river system are characterized by a number of sources of uncertainty, which affects the accuracy of a rating curve established from measurements. This paper presents a fuzzy set theory based methodology for consideration of different sources of uncertainty in the stage and discharge measurements and their aggregation into a combined uncertainty. The uncertainty in individual measurements of stage and discharge is represented using triangular fuzzy numbers, and their spread is determined according to the International Organization for Standardization (ISO) standard 748 guidelines. The extension principle based fuzzy arithmetic is used for the aggregation of various uncertainties into overall stage-discharge measurement uncertainty. In addition, a fuzzified form of ISO 748 formulation is used for the calculation of combined uncertainty and comparison with the fuzzy aggregation method. The methodology developed in this paper is illustrated with a case study of the Thompson River near Spences Bridge in British Columbia, Canada. The results of the case study show that the selection of number of velocity measurement points on a vertical is the largest source of uncertainty in discharge measurement. An increase in the number of velocity measurement points provides the most effective reduction in the overall uncertainty. The next most important source of uncertainty for the case study location is the number of verticals used for velocity measurements. The study also shows that fuzzy set theory provides a suitable methodology for the uncertainty analysis of stage-discharge measurements. [ABSTRACT FROM AUTHOR]

River discharge is typically derived from a single valued stage-discharge relationship. However, the relationship is affected by different sources of uncertainty, especially, in the measurement of discharge and stage values. The measurement uncertainty propagates into stage-discharge relationship curve and affects the discharge values derived from the relation. A fuzzy set theory based methodology is investigated in this paper for the analysis of uncertainty in the stage-discharge relationship. Individual components of stage and discharge measurement are considered as a fuzzy numbers and the overall stage and discharge uncertainty is obtained through the aggregation of all uncertainties using fuzzy arithmetic. Building on the previous work—fuzzy discharge and stage measurements, we use fuzzy nonlinear regression—in this case study for the analysis of uncertainty in the stage-discharge relationship. The methodology is based on fuzzy extension principle and considers input and output variables as well as the coefficients of the stage-discharge relationship as fuzzy numbers. Two different criteria are used for the evaluation of output fuzziness: (1) minimum spread and (2) least absolute deviation criteria. The results of the fuzzy regression analysis lead to a definition of lower and upper uncertainty bounds of the stage-discharge relationship and representation of discharge value as a fuzzy number. The methodology developed in this work is illustrated with a case study of Thompson River near Spences Bridge in British Columbia, Canada. [ABSTRACT FROM AUTHOR]

Background: Patients and their families often have an inadequate understanding of the risks and benefits of their advance care planning (ACP) options. Improving patients' knowledge of therapeutic interventions allows them to better select treatments they believe are most appropriate for their condition., Objectives: To determine if a video aimed at educating and engaging hospitalised patients on a standardised ACP order set can improve (1) inpatient understanding of key ACP concepts, (2) ACP documentation within 48 hours of hospital admission, (3) concordance between a patient's expressed and chart-documented care preferences, (4) patient satisfaction with decision-making, and (5) patient's decisional confidence., Methods: A prospective, non-randomised, pre-post intervention study of 252 inpatients in a 215-bed community-based hospital in Comox, British Columbia, Canada., Results: Our video decision support tool was associated with significant improvements in (1) patient understanding of key ACP concepts (70%-100%; p<0.0001), (2) ACP documentation within 48 hours of hospital admission (81%-92%; p=0.01), (3) concordance between patients' expressed wishes and chart documentation (69%-89%; p<0.0001), (4) patient satisfaction with decision-making (Canadian Health Care Evaluation Project Lite score: 4.3-4.5, p=0.001), and (5) patient's decisional confidence (patients with no decisional conflict, increased from 72% to 93%; p<0.0001)., Conclusion: A 13 min video aimed at educating and engaging inpatients on ACP concepts improved patient understanding of key ACP concepts, rates of ACP documentation and patient satisfaction with decision-making., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The Vancouver Island Health Authority (VIHA) implemented a standard advance care planning (ACP) document called the medical order for scope of treatment (MOST) in February 2016 to improve end of life communication and documentation. This study aims to see if the MOST implementation improves inpatient ACP documentation when compared with the 'do not resuscitate' (DNR) order. Improvement is measured by: (1) proportion of inpatients with documented orders for life-sustaining treatment, (2) discordance between patient's expressed wishes and chart documentation, (3) patient satisfaction and (4) days admitted to an acute care hospital within 90 days of study inclusion., Methods: We performed a single-centre quality improvement study tracking the effects of MOST implementation. 329 consecutive patients were enrolled at a 215-bed community hospital located in Comox, British Columbia, Canada., Results: The MOST integrated well into the process of care, significantly improving ACP documentation from 33% preimplementation to 100% over 8 months of implementation. MOST completion was associated with a significant decrease in discordance between patients' wishes and documented goals of care. Patients with a MOST were significantly older and had a higher charlson comorbidity score than those without a MOST. Despite this, there was no difference in the number of days study patients were admitted to hospital within 90 days of study inclusion., Conclusions: MOST implementation improves the frequency and quality of inpatient ACP documentation with no effect on acute care utilisation., Competing Interests: Competing interests: None declared.