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Introduction Pedicled nasoseptal flap (NSF) placement is a critical component of skull base reconstruction after endoscopic endonasal approaches (EEAs). The effectiveness of NSF reuse has not been thoroughly studied. Prior reports using flaps harvested at one center and reused at another may have technical variability bias. Methods We identified patients who underwent both their initial and NSF-reused surgeries at Weill Cornell Medical College from 2004 to 2022 using a prospective database of all EEAs. Surgical pathology, intraoperative leak grade, use of cerebrospinal fluid (CSF) diversion and skull base coverage were examined. The primary outcome measure was occurrence of CSF leak. Results Fourteen patients (six women, eight men) underwent 14 first time and 14 revision operations with median age of 36.6 years (interquartile range [IQR]: 23.9–61.3) at the time of the NSF reuse. The median interval between the first NSF use and reuse was 70.6 months (IQR: 16.6–87). Eight patients were operated on for pituitary adenoma. Nonadenomas included three craniopharyngiomas and one case each of epidermoid, ependymoma, and chordoma. There were 16 high-flow, 8 low-flow intraoperative leaks, and 4 with no leak. CSF diversion was used in 24 operations. There were three postoperative leaks, one after a first operation and two after NSF reuse. All postoperative CSF leaks, whether first or second operations, occurred in cases with both high-flow intraoperative CSF leak and incomplete NSF coverage (p = 0.006). Conclusion NSF reuse is effective at preventing postoperative CSF leak. The primary predictors of leak are high-flow intraoperative leak and inadequate defect coverage with NSF, regardless of the operation number. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To review the literature on the different indications and recommendations for high-flow therapy in the hospital and at home. MATERIALS AND METHODS: Retrospective study based on a review of articles published in English or Spanish and indexed in the published in English or Spanish and indexed in PubMed, SciELO and Medline databases, with MeSH: oxygen; high flow; respiratory failure; nasal cannula; hypoxaemia and ROX index. RESULTS: Seventy-eight articles were identified. The main indication for high flow therapy was found in patients with hypoxemic respiratory failure, mainly with PaO2/FiO2 less than 200 mmHg, where it was shown to reduce the risk of intubation, days on mechanical ventilation and the risk of associated infectious complications. It currently has other indications of clinical importance. CONCLUSIONS: High flow therapy has been shown to be effective in the treatment of inpatients and outpatients with hypoxemic and hypercapnic respiratory failure. Since it is a strategy that avoids escalation of oxygen treatments, the earlier it is indicated, the greater the benefits it will bring to the clinical evolution of the patient. [ABSTRACT FROM AUTHOR]

Long-term oxygen therapy (LTOT) is a treatment that involves the provision of supplemental oxygen to individuals with respiratory disease to correct hypoxemia in the post-acute care environment. Over 1.5 million adults in the United States use supplemental oxygen for various respiratory disorders. This paper explores literature published on LTOT from September 2022-September 2023. Upon the conclusion of this literature review, 4 distinct categories emerged. This paper highlights the significant findings associated with the 4 categories: supplemental oxygen and COVID-19, telemonitoring, LTOT equipment, and in-home high-flow nasal cannula. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to assess the predictors of need for paediatric intensive care unit (PICU) admission for inter‐hospital transfer patients to a tertiary paediatric hospital ED on high flow (HF) or continuous positive airway pressure (CPAP) ventilation. Methods: Single‐centre retrospective study of patients transferred to the state's tertiary paediatric hospital. Demographic information and disease management information was obtained. Results: Between October 2021 and September 2022, 53 patients were transferred to the tertiary hospital on HF or CPAP. Of these, 23 required admission to PICU. Those admitted to PICU had a higher median fraction of inspired oxygen than those not admitted (0.4 vs 0.3, respectively, P = 0.013). Patients transported by road (vs flight) were more likely (20/23 patients, RR = 3.15, P = 0.016) to be admitted to PICU (56% vs 18%). Those who had received CPAP prior to or during transfer were more likely to require PICU admission (P = 0.012). Conclusion: We have demonstrated that children who require CPAP to manage their respiratory disease are more likely to require PICU care on transfer to the tertiary paediatric hospital. In addition, those patients being transferred from secondary metropolitan hospitals after a trial of HF are also likely to require PICU care. This suggests that these patients should be directly admitted to PICU, allowing for improved patient experience and flow as well as reducing unnecessary ED resource utilisation. [ABSTRACT FROM AUTHOR]

Abstract Purpose Tracheostomized patients often present with muscle weakness, altered consciousness, or swallowing difficulties. Hence, the literature is scarce regarding the challenging management of tracheostomy weaning. There is a need to strengthen the understanding of respiratory mechanisms with the different tracheostomy tube modalities that compose this weaning pathway. We aimed to evaluate the impact of these modalities on the work of breathing (WOB), total positive end-expiratory pressure (PEEPtot), and tidal volume (V T). Methods With a three-dimensional (3D) printed head mimicking human upper airways, we added a tracheal extension, and pierced to allow insertion of a size 7.0 tracheostomy cannula. The whole was connected to an artificial lung. Three lung mechanics were simulated (normal, obstructive and restrictive). We compared five different tracheostomy tube modalities to a control scenario in which the tube was capped and the cuff was deflated. Results A marginal difference was observed on the WOB within conditions with a slight increase + 0.004 [95% CI (0.003–0.004); p

Upper and lower percentiles of Flow Duration Curves (FDCs) of daily streamflow data were investigated to develop frequency curves. Upper percentiles with exceedance probability of 1, 5 and 10% (Q1, Q5, Q10) were used for high flows, and lower percentiles with non-exceedance probability of 10, 5 and 1% (Q90, Q95, Q99) for low flows. Median value (Q50) was covered to represent the average conditions of streamflow. A mixed frequency analysis based on the total probability theorem taking zero values into account was applied for the lower percentiles of FDC. Case studies were performed for three intermittent Streamflow Gauging Stations (SGSs) from Kucuk Menderes River Basin in western Turkey. An overall assessment of results shows that the best-fit probability distribution function does not change from one SGS to another considerably for low flows while each SGS has its own probability distribution function for high flows. Upper and lower percentiles, and median value were calculated at various return periods by using the identified probability distribution functions. The calculated values were plotted in the form of frequency curves of high flow percentiles and low flow percentiles. The frequency curves have a practically significant potential use in hydrological analysis, water resources management and hydraulic design under high and low flow conditions. They are yet open to further development for regionalization and their applicability can be extended to ungauged sites in river basins. [ABSTRACT FROM AUTHOR]

Rivers are vital and complex natural systems that provide a wide range of ecosystem services. This study presents a methodology for assessing the riverine provisioning and supporting ecosystem services, whose applicability has been demonstrated over the Budhabalanga River Basin of India. The Soil and Water Assessment Tool (SWAT) is used to generate streamflow time series at various ungauged sites, and then the streamflow is characterized for the evaluation of provisioning services. Further, the diversity and abundance of macroinvertebrates, along with the Lotic-invertebrate Index for Flow Evaluation (LIFE), is used to study the riverine supporting ecosystem services. The streams show intermittent behavior and strong seasonality for low flows, which limits the water availability, particularly during pre-monsoon season. The Baseflow Index (BFI) is greater than 0.6, indicating that groundwater contributes more than 60% of the total streamflow. Interestingly, despite the high BFI, the streams did not conform to the prevailing opinion that a greater baseflow contribution results in a later commencement of the low-flow period in the hydrological year. Furthermore, the study depicts significant variations in the diversity and abundance of the macroinvertebrates across the various sampling sites. However, the LIFE score across the sites remained consistent within a narrow range, i.e., 8 to 9, suggesting a steady supply of supporting ecosystem services. The results of the study can help the policymakers towards an informed decision making and the simplistic methodology proposed in this study can be replicated in other river basins for identifying vulnerable watersheds and prioritizing management actions. [ABSTRACT FROM AUTHOR]

Purpose: Tracheostomized patients often present with muscle weakness, altered consciousness, or swallowing difficulties. Hence, the literature is scarce regarding the challenging management of tracheostomy weaning. There is a need to strengthen the understanding of respiratory mechanisms with the different tracheostomy tube modalities that compose this weaning pathway. We aimed to evaluate the impact of these modalities on the work of breathing (WOB), total positive end-expiratory pressure (PEEPtot), and tidal volume (VT). Methods: With a three-dimensional (3D) printed head mimicking human upper airways, we added a tracheal extension, and pierced to allow insertion of a size 7.0 tracheostomy cannula. The whole was connected to an artificial lung. Three lung mechanics were simulated (normal, obstructive and restrictive). We compared five different tracheostomy tube modalities to a control scenario in which the tube was capped and the cuff was deflated. Results: A marginal difference was observed on the WOB within conditions with a slight increase + 0.004 [95% CI (0.003–0.004); p < 0.001] when the cuff was inflated in the normal and restrictive models and a slight decrease in the obstructive model. The highest PEEPtot that was reached was + 1 cmH2O [95% CI (1–1.1); p < 0.001] with high-flow therapy (HFT) with the cuff inflated in the obstructive model. We observed a statistically significant reduction in VT [up to − 57 mL 95% CI (− 60 to − 54); p < 0.001] when the cuff was inflated, in both the normal and obstructive models. Conclusions: Our results support the use of conditions that involve cuff deflation. Intermediate modalities with the cuff deflated produced similar results than cannula capping. [ABSTRACT FROM AUTHOR]

Satellite-based precipitation estimates are a critical source of information for understanding and predicting hydrological processes at regional or global scales. Given the potential variability in the accuracy and reliability of these estimates, comprehensive performance assessments are essential before their application in specific hydrological contexts. In this study, six satellite-based precipitation products (SPPs), namely, CHIRPS, CMORPH, GSMaP, IMERG, MSWEP, and PERSIANN, were evaluated for their utility in hydrological modeling, specifically in simulating streamflow using the Variable Infiltration Capacity (VIC) model. The performance of the VIC model under varying flow conditions and timescales was assessed using statistical indicators, viz., R2, KGE, PBias, RMSE, and RSR. The findings of the study demonstrate the effectiveness of VIC model in simulating hydrological components and its applicability in evaluating the accuracy and reliability of SPPs. The SPPs were shown to be valuable for streamflow simulation at monthly and daily timescales, as confirmed by various performance measures. Moreover, the performance of SPPs for simulating extreme flow events (streamflow above 75%, 90%, and 95%) using the VIC model was assessed and a significant decrease in the performance was observed for high-flow events. Comparative analysis revealed the superiority of IMERG and CMORPH for streamflow simulation at daily timescale and high-flow conditions. In contrast, the performances of CHIRPS and PERSIANN were found to be poor. This study highlights the importance of thoroughly assessing the SPPs in modeling diverse flow conditions. [ABSTRACT FROM AUTHOR]

This study evaluates hydrology and hydrological extremes under future climate change scenarios. The climate change scenarios were developed from multiple Global Circulation Models (GCMs), Representative Concentration Pathway (RCP) scenarios, and statistical downscaling techniques. To ensure hydrological model robustness, the Soil Water Assessment Tool (SWAT) was calibrated and validated using the Differential Split Sample Test (DSST) approach. The model was also calibrated and validated at the multi-gauges of the watershed. Future climate change scenarios revealed a reduction in precipitation (in the order of −9.1% to 4.9%) and a consistent increase in maximum temperature (0.34°C to 4.10°C) and minimum temperature (−0.15 °C to 3.7°C) in different climate model simulations. The climate change scenarios triggered a reduction of surface runoff and streamflow and a moderate increase in evapotranspiration. Future climate change scenarios projected a decrease in high flow (Q5) and low flow (Q95). A higher reduction of Q5 and annual minimum flow is also simulated in future climate scenarios, whereas an increase in annual maximum flow is simulated in climate change scenarios developed from the RCP8.5 emission scenario. The study suggests optimal water management structures which can reduce the effect of change in high and low flows. [ABSTRACT FROM AUTHOR]

The hydrological cycle is anticipated to become increasingly variable due to intensified global climate extremes and frequent floods. Understanding the evolution and driving mechanisms of floods in the context of climatic extremes is essential, particularly on the Loess Plateau (LP) where anthropogenic activities are significant. Here, we examined the spatiotemporal variability of climate extremes and their impacts on flood processes on the LP during 1956–2015. We employed a paired year approach to quantitatively assess the driving role of anthropogenic activities on flood changes in 11 major basins. Our findings indicated a general decline in extreme precipitation indices, while temperature has increased across most of the LP. Both annual runoff (Q) and high flow (Q5) magnitude significantly decreased in all basins. We identified that the major climatic indices driving Q5 included erosive precipitation amount, flood season precipitation, heavy precipitation amount, and maximum 7-day precipitation amount. Importantly, anthropogenic activities have mitigated the impact of climate extremes on Q5 regimes. Compared the post-2000 with reference period (1956–1979), under similar climatic conditions, we observed a reduction in the average Q5 magnitude by 30.19–78.14% and a decrease in the average Q5 duration by 46.48–100.00% across the basins. The contributions of climate variability and anthropogenic activities to Q5 magnitude changes among 11 basins ranged from –37.58% to 22.02% and –56.84% to –15.08%, respectively, highlighting the crucial role of ecological restoration in reducing Q5 magnitude. These results underscore the importance of ecological restoration in flood regulation and offer valuable insights for basin management in the Yellow River Basin.

The current study focused on investigating the effectiveness of a flexible structural approach for mitigating local scour along longitudinal walls in rivers with well-levelled granular beds. To carry out this study, a hydraulic channel was used as the experimental setup. The experiment aimed to evaluate the influence of several key parameters, including slope (ranging from 1 % to 2.5 %), flow rate (set at 0.017 m3/s and 0.030 m3/s) and width of the flexible structure (which was varied at 0.08, 0.12, and 0.15 m). The results of this study are remarkable and have important implications for river engineering and erosion control. The 0.15 m flexible system exhibited a remarkable ability to decrease scouring, especially under conditions of high flows and steeper slopes. In such scenarios, the flexible structure demonstrated efficiencies exceeding 80 %, signifying a substantial reduction in local scour. These findings are important because they suggest that the flexible structural approach can be an effective solution for mitigating scour in rivers with well-levelled granular beds.

Abstract Aims Patients with high‐flow arteriovenous (AV) access are at risk of developing high‐output cardiac failure (HOCF) and subsequent hospitalization. However, diagnosing HOCF is challenging and often requires invasive procedures. The role of systemic vascular resistance (SVR) in diagnosing HOCF is underestimated, and its predictive value is limited. Our study aims to identify non‐invasive risk factors for HOCF to facilitate early diagnosis and timely surgical interventions. Methods and results We included 109 patients with high‐flow AV access who underwent serial echocardiography. The retrospective cohort was divided into two groups based on their hospitalization due to HOCF. The two groups were matched for age and gender. After a mean follow‐up of 25.1 months, 19 patients (17.4%) were hospitalized due to HOCF. The two groups had similar baseline characteristics. However, the HOCF group had a higher value of vascular access blood flow (Qa) (2168 ± 856 vs. 1828 ± 617 mL/min; P = 0.045). Echocardiographic analysis revealed that the HOCF group had more pronounced left ventricular diastolic dysfunction (E/e′: 21.1 ± 7.3 vs. 16.2 ± 5.9; P = 0.002), more severe pulmonary hypertension (right ventricular systolic pressure: 41.4 ± 16.7 vs. 32.2 ± 12.8; P = 0.009), a higher Doppler‐derived cardiac index (CI) (4.3 ± 0.8 vs. 3.7 ± 1.1; P = 0.031), and a lower Doppler‐derived estimated SVR (eSVR) value (5.5 ± 0.3 vs. 6.9 ± 0.2; P = 0.002) than the non‐HOCF group. Using multivariable Cox regression analysis, a low eSVR value (

Aims: Patients with high‐flow arteriovenous (AV) access are at risk of developing high‐output cardiac failure (HOCF) and subsequent hospitalization. However, diagnosing HOCF is challenging and often requires invasive procedures. The role of systemic vascular resistance (SVR) in diagnosing HOCF is underestimated, and its predictive value is limited. Our study aims to identify non‐invasive risk factors for HOCF to facilitate early diagnosis and timely surgical interventions. Methods and results: We included 109 patients with high‐flow AV access who underwent serial echocardiography. The retrospective cohort was divided into two groups based on their hospitalization due to HOCF. The two groups were matched for age and gender. After a mean follow‐up of 25.1 months, 19 patients (17.4%) were hospitalized due to HOCF. The two groups had similar baseline characteristics. However, the HOCF group had a higher value of vascular access blood flow (Qa) (2168 ± 856 vs. 1828 ± 617 mL/min; P = 0.045). Echocardiographic analysis revealed that the HOCF group had more pronounced left ventricular diastolic dysfunction (E/e′: 21.1 ± 7.3 vs. 16.2 ± 5.9; P = 0.002), more severe pulmonary hypertension (right ventricular systolic pressure: 41.4 ± 16.7 vs. 32.2 ± 12.8; P = 0.009), a higher Doppler‐derived cardiac index (CI) (4.3 ± 0.8 vs. 3.7 ± 1.1; P = 0.031), and a lower Doppler‐derived estimated SVR (eSVR) value (5.5 ± 0.3 vs. 6.9 ± 0.2; P = 0.002) than the non‐HOCF group. Using multivariable Cox regression analysis, a low eSVR value (<6) emerged as an independent predictor of HOCF hospitalization with a hazard ratio of 9.084 (95% confidence interval, 2.33–35.39; P = 0.001). Receiver operating characteristic curve analysis indicated that CI/eSVR values more accurately predicted HOCF hospitalization [sensitivity: 94.7%, specificity: 51.0%, area under the curve (AUC): 0.75, P < 0.001] than the Qa/cardiac output ratio (AUC: 0.50, P = 0.955), Qa values ≥ 2000 mL/min (AUC: 0.60, P = 0.181), and Qa values indexed for height in metres (AUC: 0.65, P = 0.040). Conclusions: In patients with high‐flow AV access, low eSVR values obtained through non‐invasive Doppler echocardiography were associated with a high rate of HOCF hospitalizations. Therefore, routine eSVR screening in these patients might expedite the diagnosis of HOCF. [ABSTRACT FROM AUTHOR]

Introduction: Patients with coronavirus disease 2019 (COVID-19) can develop rapidly progressive respiratory failure. Ventilation strategies during the COVID-19 pandemic seek to minimize patient mortality. In this study we examine associations between the availability of emergency department (ED)-initiated high-flow nasal cannula (HFNC) for patients presenting with COVID-19 respiratory distress and outcomes, including rates of endotracheal intubation (ETT), mortality, and hospital length of stay.  Methods: We performed a retrospective, non-concurrent cohort study of patients with COVID-19 respiratory distress presenting to the ED who required HFNC or ETT in the ED or within 24 hours following ED departure. Comparisons were made between patients presenting before and after the introduction of an ED-HFNC protocol. Results: Use of HFNC was associated with a reduced rate of ETT in the ED (46.4% vs 26.3%, P

Introduction: Nasal high flow (nHF) improves the likelihood of successful neonatal intubation on the first attempt without physiological instability. The effect of nHF on cerebral oxygenation is unknown. The aim of this study was to compare cerebral oxygenation during endotracheal intubation in neonates receiving nHF and those receiving standard care. Methods: A sub-study of a multicentre randomized trial of nHF during neonatal endotracheal intubation. A subset of infants had near-infrared spectroscopy (NIRS) monitoring. Eligible infants were randomly assigned to nHF or standard care during the first intubation attempt. NIRS sensors provided continuous regional cerebral oxygen saturation (rScO2) monitoring. The procedure was video recorded, and peripheral oxygen saturation and rScO2 data were extracted at 2-second intervals. The primary outcome was the average difference in rScO2 from baseline during the first intubation attempt. Secondary outcomes included average rScO2 and rate of change of rScO2. Results: Nineteen intubations were analyzed (11 nHF; 8 standard care). Median (interquartile range [IQR]) postmenstrual age was 27 (26.5–29) weeks, and weight was 828 (716–1,135) g. Median change in rScO2 from baseline was −1.5% (−5.3 to 0.0) in the nHF group and −9.4% (−19.6 to −4.5) in the standard care group. rScO2 fell more slowly in infants managed with nHF compared with standard care: median (IQR) rScO2 change −0.08 (−0.13 to 0.00) % per second and −0.36 (−0.66 to −0.22) % per second, respectively. Conclusions: In this small sub-study, regional cerebral oxygen saturation was more stable in neonates who received nHF during intubation compared with standard care. [ABSTRACT FROM AUTHOR]

Arteriovenous fistula is the preferred vascular access for hemodialysis patients. High-flow arteriovenous fistula may cause high-output heart failure. Various procedures are used to reduce high-flow arteriovenous fistula. This study aimed to assess the efficacy of proximal artery restriction combined with distal artery ligation on flow reduction for high-flow arteriovenous fistula and on cardiac function and echocardiographic changes in patients undergoing hemodialysis. A retrospective analysis was performed on data collected from the medical records of patients undergoing hemodialysis with heart failure and high-flow arteriovenous fistula between May 2018 and May 2021. Thirty-one patients were treated with proximal artery restriction (banding juxta-anastomosis of the proximal artery) combined with distal artery ligation (anastomosis distal artery ligation). Changes in the Acute Dialysis Quality Initiative Workgroup cardiac function class, blood pressure, and echocardiography before and 6 months after flow restriction were compared, and post-intervention primary patency was followed-up. The technical success rate of the surgery was 100%, and no surgery-related adverse events occurred. Blood flow and blood flow/cardiac output decreased significantly after flow restriction. Blood flow decreased from 2047.21 ± 398.08 mL/min to 1001.36 ± 240.42 mL/min, and blood flow/cardiac output decreased from 40.18% ± 6.76% to 22.34% ± 7.21% (P <.001). Post-intervention primary patency of arteriovenous fistula at 6, 12, and 24 months was 96.8%, 93.5%, and 75.2%, respectively. The Acute Dialysis Quality Initiative Workgroup cardiac function class improved significantly after 6 months of flow restriction (P <.001). The systolic and diastolic left heart function improved, as evidenced by a significant decrease in left atrial volume index, left ventricular end-diastolic/end-systolic diameters, left ventricular end-diastolic volume, left ventricular mass index, cardiac output, and cardiac index and an increase in lateral peak velocity of longitudinal contraction, average septal-lateral s', and lateral early diastolic peak velocity after flow restriction (P <.05). Systolic pulmonary artery pressure decreased from 32.36 ± 8.56 mmHg to 27.57 ± 8.98 mmHg (P <.05), indicating an improvement in right heart function. Proximal artery restriction combined with distal artery ligation effectively reduced the blood flow of high-flow arteriovenous fistula and improved cardiac function. [ABSTRACT FROM AUTHOR]

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Understanding the impact of climate change on runoff and its extremes is of great significance for water resource assessment and adaptation strategies, especially in water-scarce regions. This study aims to analyze the impact of future climate change on runoff and its extremes in the upper reaches of the Heihe River basin in northwest China. The projected runoff was derived using the Soil Water Assessment Tool with climate data from the CSIRO-MK-3-6-0 model under the scenario of RCP4.5, and a frequency analysis of runoff was performed by generalized extreme value distribution. The results indicate that, compared with the baseline period of 1961 to 2000, the minimum and maximum temperatures in the period 2031 to 2070 were predicted to increase by 2.5 °C on average. The precipitation in most months was also predicted to increase, with an average rise of 16.5%. The multi-year average runoff was projected to increase by 8%. The annual mean and extreme flows were also expected to rise under future climate change at different return periods, and the low flow was expected to increase the most. [ABSTRACT FROM AUTHOR]

We performed a single-center retrospective study of prospectively collected data for all patients who had flow reduction surgery with FRAME FR between November 2020 and January 2021. Ten patients had arteriovenous fistula flow reduction surgery with this technique. One patient had a distal fistula, whereas nine were within the cubital fossa. In nine patients the device was applied over the postanastomotic arteriovenous fistula outflow vein and in one in the preanastomotic radial artery. Technical success was achieved in all patients with a median flow reduction from 2150 to 825 mL/min. There were no wound or device-specific complications.

Climate change and its impact on surface runoff in the upper Blue Nile basin and sub-basins have been widely studied in future climate projections. However, the impact on extreme flow events of rivers is barely investigated discretely. In this paper, the change in temperature and rainfall under the Representative Concentration Pathway (RCP) highest emission scenario (RCP 8.5) and its impact on the high flow and low flow simulated by the Soil and Water Assessment Tool (SWAT 2012) in major watersheds of the Lake Tana Basin has been evaluated by comparing the baseline period (1971–2000) with the 2020s (2011–2040), 2050s (2041–2070), and 2080s (2071–2100). The high flows of watersheds were selected by the Annual Maximum Series (AMS) model, whereas the low-flow watersheds were selected by the 7-day sustained mean annual minimum flow method. The result showed that the highest change in maximum temperature ranged from 2.93 °C to 5.17 °C in monthly time scales in the 2080s. The increment in minimum temperature is also more prominent in the 2080s and it is expected to rise by 4.75 °C. Inter-annual variability of the change in rainfall has shown increasing and decreasing patterns. The highest increments are expected by 22.37%, 25.58%, and 29.75% in the 2020s, 2050s, and 2080s, respectively, whereas the projected highest decrease in rainfall dictates the decrease of 6.42%, 7.11%, and 9.26% in 2020s, 2050s, and 2080s, respectively. Due to changes in temperature and rainfall, the low flow is likely to decrease by 8.39%, 8.33%, 6.21%, and 5.02% in Ribb, Gumara, Megech, and Gilgel Abay watersheds, respectively, whereas the high flow of Gilgel Abay, Megech, Gumara, and Ribb watersheds are expected to increase by 13.94%, 12.16%, 10.90%, and 10.24%, respectively, every 30 years. [ABSTRACT FROM AUTHOR]

Aim: To determine the prevalence of high flow nasal cannula (HFNC) therapy in infants presenting to hospital in Australia and New Zealand with bronchiolitis over four bronchiolitis seasons. Secondary aims were to determine temporal trends in HFNC use, and associations between HFNC, hospital length of stay (LOS) and intensive care unit (ICU) admission. Methods: A planned sub‐study of a multi‐centre international cluster randomised controlled trial investigating knowledge translation strategies for a bi‐national bronchiolitis guideline. Demographics, management and outcomes data were collected retrospectively for infants presenting with bronchiolitis to 26 hospitals between 1 May 2014 and 30 November 2017. Prevalence data are presented as absolute frequencies (95% confidence interval (CI)) with differences between groups for continuous and categorical variables analysed using linear and logistic regression, respectively. Results: 11 715 infants were included with 3392 (29.0%, 95% CI (28.1–29.8%)) receiving oxygen therapy; of whom 1817 (53.6%, 95% CI (51.9–55.3%)) received HFNC. Use of oxygen therapy did not change over the four bronchiolitis seasons (P = 0.12), while the proportion receiving HFNC increased (2014, 336/2587 (43.2%); 2017, 609/3720 (57.8%); P ≤ 0.001). Infants who received HFNC therapy were not substantially different to infants who received oxygen therapy without HFNC. HFNC use was associated with increases in both hospital LOS (P < 0.001) and ICU admissions (P < 0.001). Conclusion: Use of HFNC therapy for infants with bronchiolitis increased over 4 years. Of those who received oxygen therapy, the majority received HFNC therapy without improvement in hospital LOS or ICU admissions. Strategies to guide appropriate HFNC use in infants with bronchiolitis are required. [ABSTRACT FROM AUTHOR]

Resumen: Introducción: El uso de la terapia con cánulas de alto flujo (CNAF) en las unidades neonatales ha experimentado un incremento en los últimos años, pero no existen guías de consenso sobre sus indicaciones y estrategias de aplicación. Nuestro objetivo fue conocer la tasa de empleo de CNAF, sus indicaciones y la variabilidad de uso entre las unidades neonatales españolas. Material y métodos: Encuesta de 25 preguntas dirigida a personal médico y de enfermería. Se contactó telefónicamente con unidades de nivel II y III y se envió en formato Google Forms entre septiembre 2016 y diciembre 2018. Resultados: Se recibieron 97 respuestas (63,9% medicina, 36,1% enfermería), de 69 unidades neonatales que representan a 15 comunidades autónomas (87% nivel asistencial III; 13% nivel II). Todas las unidades, salvo una, disponen de CNAF con sistema humidificado y caliente. Sus indicaciones más frecuentes son: destete de ventilación no invasiva (VNI) (79,4%), bronquiolitis (69,1%), distrés respiratorio del recién nacido a término (RNT) (58,8%), tras extubación (50,5%). El flujo mínimo varía entre 1-5 lpm y el flujo máximo entre 5-15 lpm. El 22,7% ha experimentado algún efecto indeseado por su uso (9 fuga aérea, 12 traumatismo nasal).Menos de la mitad tiene protocolo de empleo, pero todas las respuestas coinciden en la utilidad de unas recomendaciones nacionales. Conclusiones: La terapia con CNAF está ampliamente extendida en las unidades españolas, pero existe gran variabilidad en sus indicaciones y estrategias de utilización. Unas recomendaciones a nivel nacional serían aplicables en la mayoría de las unidades y permitirían unificar su empleo. Abstract: Introduction: The use of high-flow cannula therapy (HFNC) in neonatal units has increased in recent years, but there are no consensus guidelines on its indications and application strategies. Our aim was to know the rate of use of HFNC, their indications and the management variability among Spanish neonatal units. Material and methods: Twenty-five-question survey for medical and nursing staff. Level II and III units were contacted by phone and sent in Google forms between September 2016 and December 2018. Results: Ninety-seven responses (63.9% medical, 36.1% nursing), from 69 neonatal units representing 15 autonomous communities (87% level of care III; 13% level II). All units except one have HFNC with a humidified and heated system. Their most frequent indications are: non-invasive ventilation weaning (79.4%), bronchiolitis (69.1%), respiratory distress of the term newborn (58.8%), after extubation (50.5%). Minimum flow (1–5 L/min) and maximum flow (5–15 L/min) are variable between units. 22.7% have experienced some adverse effect from its use (9 air leak, 12 nasal trauma).Less than half have an employment protocol, but all the answers agree on the usefulness of national recommendations. Conclusions: HFNC therapy is widely used in Spanish units, but there is great variability in its indications and strategies of use. National recommendations would be applicable in most units and would allow unifying its use.

• Precipitation and temperatures are more extreme in the southern of the LP. • R12, FSPTOT, R25, and R7X were the main extreme climate indices that promoted Q 5 magnitude generation. • The impact of climate extremes on Q 5 can be weakened by anthropogenic activities. • Anthropogenic activities have effectively reduced Q 5 magnitude and duration in 11 basins. The hydrological cycle is anticipated to become increasingly variable due to intensified global climate extremes and frequent floods. Understanding the evolution and driving mechanisms of floods in the context of climatic extremes is essential, particularly on the Loess Plateau (LP) where anthropogenic activities are significant. Here, we examined the spatiotemporal variability of climate extremes and their impacts on flood processes on the LP during 1956–2015. We employed a paired year approach to quantitatively assess the driving role of anthropogenic activities on flood changes in 11 major basins. Our findings indicated a general decline in extreme precipitation indices, while temperature has increased across most of the LP. Both annual runoff (Q) and high flow (Q 5) magnitude significantly decreased in all basins. We identified that the major climatic indices driving Q 5 included erosive precipitation amount, flood season precipitation, heavy precipitation amount, and maximum 7-day precipitation amount. Importantly, anthropogenic activities have mitigated the impact of climate extremes on Q 5 regimes. Compared the post-2000 with reference period (1956–1979), under similar climatic conditions, we observed a reduction in the average Q 5 magnitude by 30.19–78.14% and a decrease in the average Q 5 duration by 46.48–100.00% across the basins. The contributions of climate variability and anthropogenic activities to Q 5 magnitude changes among 11 basins ranged from –37.58% to 22.02% and –56.84% to –15.08%, respectively, highlighting the crucial role of ecological restoration in reducing Q 5 magnitude. These results underscore the importance of ecological restoration in flood regulation and offer valuable insights for basin management in the Yellow River Basin. [ABSTRACT FROM AUTHOR]

Abstract We conducted a systematic review on the impacts of natural causes of variation or changes in flow magnitude (resulting from climatic variability and broad‐scale drivers such as climate‐induced change) on fish abundance and biomass in temperate regions. Following our systematic review protocol (Birnie‐Gauvin et al., 2021), we examined commercially published and grey literature originally identified during a recent systematic map process (Rytwinski et al., 2020) and a systematic search update. Articles were screened using an a priori eligibility criteria, with consistency checks performed at the title and abstract, and full text screening stages. All eligible articles were assessed for study validity. A narrative synthesis included all available evidence (300 studies from 219 articles), and meta‐analyses (1863 datasets from 193 studies) were conducted where appropriate. Most studies were conducted in the United States (65%) on genera in the Salmonidae and Leuciscidae families (29% and 28%, respectively), and mainly investigated variation in flow magnitude, followed by droughts and floods. We found that fish abundance and biomass responses to changes in natural flow magnitude were mainly negative, but analyses do not support clear generalizable signals across all contexts (e.g. types of changes in flow magnitude, taxa, locations). When exploring reasons for heterogeneity in effect sizes, we found a detectable effect of intervention type on average fish abundance within the first year of the natural change in flow magnitude, with floods and droughts associated with overall negative responses. However, these patterns were more variable when considering between‐year variation or specific taxonomic responses. Our results suggest that while immediate responses were more apparent and relatively consistent within specific types of natural events, fish populations may recover after such events (i.e. ≥2 years post‐natural event); however, most studies were short in duration (

Oxygen therapy should be carefully considered and monitored because, as any other medications, it can cause harm to patients, if used inappropriately. This paper focus on the distinction between low-flow and high-flow oxygen therapy. A discussion about Venturi system for oxygen administration is carried on, given that some authors include it in the low-flow devices group despite its characteristics to deliver high flow therapy.

Glaciated Andean mountains have experienced several decades of shrinkage in their transition to non-glaciated regimes. This study analyses the period of hydrologic transition from 1956 to 2020 in a watershed of the Sierra Nevada del Cocuy (SNC), which is the most extensive remaining tropical glacier in Colombia. Using ground hydrometeorological data, remote sensing products, a metric of extreme flow regulation, and decadal flow duration curves, the study shows how the combined effect of continuous glacier shrinkage, highly variable precipitation regimes and increasing human extractions have altered the hydrological capacity of the watershed to regulate high, low, and mean flows. The alteration is noticeable since the 2000s, when communities have effectively benefited from the surplus of baseflow provided by the shrinking glacier to the limit, creating an unsustainable dependency with potential restrictions of use in the short run and major implications for water security of humans and the environment in the forthcoming decades. [ABSTRACT FROM AUTHOR]

Abstract Background The dead space washout and provision of some level of positive airway pressure by nasal high-flow (NHF) cannula could improve the efficiency of ventilation, oxygenation and maintenance of the upper airway in patients undergoing deep sedation. This study aimed to compare the incidences of events represented oxygenation and ventilation, i.e. desaturation and upper airway obstruction, and arterial blood gas (ABG) levels between using NHF cannula and conventional nasal cannula (NC2) during deep sedation of adult surgical patients. Methods In this prospective randomized single-blinded study, the patients who were 20–80 years old, ASA physical status of 1 to 3, scheduled for surgery under intravenous sedation (IVS) were included. The patients were randomly divided into two groups, i.e., NC2 or NHF groups. Propofol infusion was given to maintain deep sedation. The desaturation (SpO2

With major alterations in the regimes of snow-fed mid-latitude rivers projected for the end of this century, the output from hydroelectric river run-off schemes will potentially be affected to a similar extent. While resulting changes in the annual and seasonal power output have been investigated for a number of catchments, more transparency is needed in terms of dominant mechanisms driving these changes and model component-specific uncertainty. In this study an ensemble of 32 hydrological simulations is used to investigate the hydroelectric power potential of the Clutha River (Southern Alps, New Zealand) under 21st century climate change. The ensemble encompasses two emission scenarios, four General Circulation Models, two bias correction methods and two snow models. The fully distributed hydrological model WaSiM is used to model both the main natural processes and major forms of water management in the catchment. The catchment’s largest hydroelectric scheme is modelled by an external component. In the 2090s the results show substantial increases in the output for winter (18%) and spring (7%), followed by reductions in summer (-19%) and autumn (-4%). A net increase in annual streamflow does not lead to a corresponding increase in annual output, which is attributed to excess water being spilled during high flow events. The driving controls behind this are identified as more winter precipitation, a reduction in the solid fraction of precipitation and an increase in extreme precipitation events. The relatively large variation in the projected seasonal output is found to be primarily caused by the General Circulation Model and the emission scenario, while bias correction and the snow model made a smaller contribution to the overall uncertainty. [ABSTRACT FROM AUTHOR]

Purpose: Obstructive sleep apnea hypopnea syndrome (OSAHS) is characterized by the aggravation of upper airway constriction or obstruction, and it is associated with high incidence of various metabolic diseases and high mortality. Continuous positive airway pressure (CPAP) is now recommended as the first-line therapy for OSAHS, but its application is limited by its unsatisfactory patient tolerance. Previous studies have showed that high flow nasal cannula (HFNC) may improve symptoms in some patients with OSAHS. Therefore, the aim of the present study was to evaluate the effect of HFNC on OSAHS in a larger cohort than in previous research and to study the details of its therapeutic characteristics. Methods: Polysomnography recording with and without HFNC was performed in 56 OSAHS patients with a wide spectrum of disease severity. Subgroups were divided by different treatment response criteria to identify the effect of this device. Results: Of 56 patients enrolled, 9 were of mild severity (AHI, 5 to <15 events/h), 30 were of moderate severity (AHI, 15 to <30 events/h), and 17 patients were severe (AHI ≥ 30 events/h); 34 patients were younger than 50 years old and 22 patients were older than 50 years old. AHI decreased significantly (from 26.9 ± 14.7 to 21.5 ± 17.0 events/h, p < 0.001) after HFNC treatment in general. The subjects of responder group accounted for 21%. There was a negative correlation between the difference of AI and the difference of HI in nonresponder group before and after HFNC treatment, and the negative correlation was strong (Pearson's test, r = − 0.804, p = 0.000). Of the patients with mild to moderate severity, 76% achieved any AHI reduction and 24% of patients achieved at least 50% reduction in AHI. Older patients (the age of responder group 52.6 ± 11.7 vs. nonresponder group 43.7 ± 12.1 years old, p < 0.05), especially patients older than 50 years, had a better response rate (≤ 50 years 9% vs. > 50 years 41%, p = 0.007). Conclusion: HFNC may be useful in treating patients with OSAHS, especially older patients and those with mild to moderate severity. HFNC may be an alternative treatment when patients are intolerant of CPAP. [ABSTRACT FROM AUTHOR]

Understanding the impact of climate change on runoff and its extremes is of great significance for water resource assessment and adaptation strategies, especially in water-scarce regions. This study aims to analyze the impact of future climate change on runoff and its extremes in the upper reaches of the Heihe River basin in northwest China. The projected runoff was derived using the Soil Water Assessment Tool with climate data from the CSIRO-MK-3-6-0 model under the scenario of RCP4.5, and a frequency analysis of runoff was performed by generalized extreme value distribution. The results indicate that, compared with the baseline period of 1961 to 2000, the minimum and maximum temperatures in the period 2031 to 2070 were predicted to increase by 2.5 °C on average. The precipitation in most months was also predicted to increase, with an average rise of 16.5%. The multi-year average runoff was projected to increase by 8%. The annual mean and extreme flows were also expected to rise under future climate change at different return periods, and the low flow was expected to increase the most.

Providing supplemental oxygen to hospitalized adults is a frequent practice and can be administered via a variety of devices. Oxygen therapy has evolved over the years, and clinicians should follow evidence-based practices to provide maximum benefit and avoid harm. This systematic review and subsequent clinical practice guidelines were developed to answer questions about oxygenation targets, monitoring, early initiation of high-flow oxygen (HFO), benefits of HFO compared to conventional oxygen therapy, and humidification of supplemental oxygen. Using a modification of the RAND/UCLA Appropriateness Method, 7 recommendations were developed to guide the delivery of supplemental oxygen to hospitalized adults: (1) aim for ... range of 94-98% for most hospitalized patients (88-92% for those with COPD), (2) the same ... range of 94-98% for critically ill patients, (3) promote early initiation of HFO, (4) consider HFO to avoid escalation to noninvasive ventilation, (5) consider HFO immediately postextubation to avoid re-intubation, (6) either HFO or conventional oxygen therapy may be used with patients who are immunocompromised, and (7) consider humidification for supplemental oxygen when flows > 4 L/min are used. [ABSTRACT FROM AUTHOR]

Background: The dead space washout and provision of some level of positive airway pressure by nasal high-flow (NHF) cannula could improve the efficiency of ventilation, oxygenation and maintenance of the upper airway in patients undergoing deep sedation. This study aimed to compare the incidences of events represented oxygenation and ventilation, i.e. desaturation and upper airway obstruction, and arterial blood gas (ABG) levels between using NHF cannula and conventional nasal cannula (NC2) during deep sedation of adult surgical patients. Methods: In this prospective randomized single-blinded study, the patients who were 20–80 years old, ASA physical status of 1 to 3, scheduled for surgery under intravenous sedation (IVS) were included. The patients were randomly divided into two groups, i.e., NC2 or NHF groups. Propofol infusion was given to maintain deep sedation. The desaturation (SpO2 < 92%) and upper airway obstruction events (presence of snoring with paradoxical breathing) after application of NC2 or NHF were observed and collected. Other outcomes included interventions during IVS, such as jaw lifting or airway instrument insertion, mouth dryness, and post- ABG analyses were also collected and compared. Results: Thirty-six patients undergoing endovascular surgery were randomized into NC2 or NHF groups (18 in each group). No patients dropped out of the study. There were no significant differences in age, sex, ASA physical status, pre-sedation and pre-application of NC2 and NHF ABG analyses (PaO2, SaO2, pH, PaCO2, and PaO2/FiO2). NHF group had significantly lower in the incidence of desaturation [5 (27.78%) vs 13 (72.22%), p = 0.008], upper airway obstruction [4 (22.22%) vs 13 (72.22%), p = 0.003], and airway maneuver [6 (33.33%) vs 13 (72.22%), p = 0.019] than NC2 group. There were no differences in the ABG analyses after oxygen supplementation and no significant differences in mouth dryness between groups. Conclusion: The use of NHF cannula in patients undergoing endovascular surgery under deep sedation reduced desaturation events and required fewer airway interventions than NC2 with no difference in arterial blood gas analyses and mouth dryness. [ABSTRACT FROM AUTHOR]

Despite many studies on the hydrological responses to forest cover changes in micro and mesoscale watersheds, the hydrological responses to forest cover alterations and associated mechanisms through the large spatial scale of the river watershed have not been comprehensively perceived. This paper thus reviews a wide range of available scientific evidence concerning the impacts exerted by the forest removal on precipitation, water yield, stream flow, and flow regimes. It is concluded that there is no statistical correlation between forest cover and precipitation and water yield at the micro and mesoscale. In contrast, there is a relative correlation coefficient (r = 0.77, p < 0.05) between forest cover and water yield at large scales (>1000 km2 ). These findings help our understanding of the hydrological response to forest disturbance at large and regional scale and provide a scientific perception to future watershed management in the context of human activities and natural hazards. [ABSTRACT FROM AUTHOR]

Priapism is a rare andrological emergency characterized by a prolonged penile erection that is not provoked by sexual excitation or stimulation and lasts longer than 4 hours. There are three different types of this emergency that can be encountered in clinical practice based on the episode history and pathophysiology, including veno-occlusive (ischemic or low-flow priapism), arterial (non-ischemic or high-flow priapism), and stuttering priapism. High-flow priapism is the less common type, which accounts for approximately 5%–10% of cases. This type is caused mainly by trauma to the penis, perineum, or a pelvis fracture that may lead to an arterio-cavernous fistula or pseudoaneurysm with a subsequent uncontrolled arterial inflow to the penis. This type of emergency is under-reported, and a low number of cases have been documented. Therefore, the effectiveness, encountered risks, as well as management outcomes are still limited. Hereby, we report a case of a 29-year-old male who presented to the emergency department complaining of a persistent painless penile erection for 2 weeks following perineal trauma (falling astride). A multidisciplinary clinical evaluation and management by a selective embolization technique are discussed in this case report.

Background: High‐flow nasal cannula (HFNC) therapy is widely used for respiratory support within paediatrics, most commonly used as a supportive measure in acute respiratory failure, aiming to avoid invasive mechanical ventilation (IMV). It is increasingly being used following extubation of critically ill children potentially at a higher risk of requiring re‐intubation. Less data indicate the use for post‐extubation HFNC therapy or possible clinical outcomes of this therapy. Aims and objectives: To identify reasons for, and variables to predict, the use of HFNC therapy post‐extubation. Design This was a retrospective case‐control study. Methods: All children admitted to a nine‐bedded regional paediatric intensive care unit requiring IMV between 18 December 2017 and 28 November 2018 were identified. The demographic data and bedside clinical and laboratory variables of the patients requiring HFNC therapy were compared with those who did not require HFNC. Results: There was no statistical difference in the median age and weight of children receiving HFNC therapy post‐extubation compared with children not receiving it. In a logistic regression model, the highest ventilation (peak inspiratory pressure) and oxygen requirements in the first 24 hours of admission, along with the presence of comorbidity and use of HFNC therapy prior to intubation, predicted the use of HFNC following extubation, (r2 0.42, area under the receiver operating curve 0.843, P <.0001). Conclusions: The direct correlation between high initial ventilatory requirements and pre‐existing comorbidity was significant for the use of post‐extubation HFNC therapy. This may be useful to stratify children in the use of HFNC therapy post‐extubation in the critically ill population. Relevance to clinical practice: This study provides evidence that it may be possible to predict the use of HFNC therapy post‐extubation. Avoiding unnecessary use of this therapy improves patient care while providing a positive economic impact. [ABSTRACT FROM AUTHOR]

Understanding the projected changes in the mean and high flows remains a significant challenge due to uncertainty arising from global climate models (GCMs) and hydrological models. Moreover, the calibration approaches used for hydrological models can influence the climate change impact assessment. We use the combination of three hydrological models, four global climate models, and two RCPs (2.6 and 8.5) to analyze the projected changes in mean flow, high flow, and the frequency of high flow under the projected future climate in the Godavari River basin (GRB) until the gauge Tekra. The two evaluation approaches: a simple approach (TASK A) based on the calibration and validation at a single streamflow gauge station and a comprehensive approach (TASK B) based on multi-variable and multisite calibration and validation and trend analysis were employed to evaluate the hydrological models. The differences between the projected changes in mean and high flows calculated using models after TASK A and TASK B were estimated. Our results show that the differences can be up to 10–13% in mean annual flow and high flow, and up to 40% in high flow frequency. The comprehensively evaluated hydrological models were chosen for impact assessment, and they project increases in mean and high flows, and the frequency of high flow at all four gauge stations in the GRB. The projected increases are higher under RCP 8.5 and in the End century (2071–2100). Our results demonstrate the importance of the comprehensive evaluation of hydrological models in advance of climate change impact assessment. [ABSTRACT FROM AUTHOR]

High flow nasal cannula (HFNC) provides warmed and humidified air with flow rates up to 60 liters/min with relatively fixed oxygen content (FiO2). It has been extensively evaluated for hypoxemic respiratory failure and has been used in mild acute respiratory distress syndrome, pre-intubation, bronchoscopy and pediatric obstructive sleep apnea. Recent data has suggested a role in stable hypercapnic chronic obstructive pulmonary disease (COPD) and even in acute exacerbations, though, the use has not been advocated by any guidelines yet. We present a case of acute hypercapnic exacerbation of COPD, intolerant to non-invasive ventilation, showing response and improvement on use of HFNC. This case highlights this potential mechanisms and prospects for the same.

Introduction Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has presented health-care systems worldwide with novel challenges and experiences and evidence is emerging during the pandemic. Patients requiring hospitalization frequently suffer from respiratory failure of different severities. Aim The aim of this guideline is the treatment of patients with SARS CoV-2 (COVID-19) in hospital; in particular, it addresses the treatment of respiratory failure treated in general Internal Medical- and Pulmonary Medical wards. Results Elderly patients and patients with chronic disease are particularly vulnerable to COVID-19. Target oxygen saturation should be between 92% and 96% in patients without chronic lung diseases. Treatment with >5 L oxygen/min should be in close collaboration with intensive care colleagues and >15 l/min preferably in intensive care units. High-flow nasal canula (HFNC) and long-term Continuous Positive Airway Pressure (CPAP) are recommended for patients not responding to conventional oxygen therapy. Non-invasive ventilation (NIV) is only recommended for selected patients, such as those with a ceiling of treatment or patients presenting with hypercapnic failure. With the use of humidification protective equipment as FFP2-3 masks should be used. Nebulized medication should be avoided, and spacers should be used instead. Conclusion Respiratory failure is frequently the cause of hospitalization in patients with COVID-19 and should be monitored closely.

Widespread floods that affect several catchments are associated with large damages and costs. To improve flood protection, a better understanding of the driving processes of such events is needed. Here, we assess how spatial flood connectedness varies with the flood generation process using a flood event classification scheme that distinguishes between rainfall-driven and snowmelt-influenced flood types. Our results show that the dominant flood generation processes in Europe vary by region, season, and event severity. Specifically, we show that severe floods are more often associated with snow-related processes than moderate events. In addition, we find that snow-influenced events show stronger spatial connections than rainfall-driven events. The spatial connectedness of rainfall-driven events depends on the rainfall duration, and the connectedness decreases with increasing duration. These findings have potential implications for flood risk in a warming climate, both locally and regionally. The projected decrease in the frequency of occurrence of snowmelt-influenced floods may translate into a decrease in the frequency of severe and widespread floods in catchments where snowmelt processes are important for flood generation.

Background Aims Methods Results Conclusion Oxygen therapy is required to prevent hypoxaemia during the endobronchial ultrasonography (EBUS) procedure.To compare the effectiveness of oxygen therapy delivered through high‐flow nasal cannula (HFNC) and conventional nasal cannula (CNC) in patients undergoing EBUS. The primary outcome was the proportion of patients who desaturated. Patient compliance and satisfaction were also evaluated.This single‐centre prospective interventional study was conducted in a tertiary hospital among patients who presented to the EBUS unit in 2018 and 2019. Patients were randomly assigned to the HFNC group or the CNC group.The study included 170 patients (111 men and 59 women) with a mean age of 58 ± 14 years. The number of patients experiencing desaturation while receiving oxygen was statistically significantly lower (P < 0.001) in the HFNC group (n = 5) compared with the CNC group (n = 26). Oxygen therapy was adjusted in two patients in the CNC group due to desaturation. Saturation was significantly higher in the HFNC group (P < 0.0001) at the end of the EBUS procedure. Heart rate at the end of EBUS was lower in the HFNC group, but this difference was not statistically significant (96 ± 16 vs 101 ± 19, P = 0.13). Five patients in the HFNC group and 18 patients in the CNC group reported discomfort during the procedure (P = 0.006).Oxygen therapy delivered by HFNC seems to be safer and more effective than by CNC in patients undergoing EBUS. Oxygen therapy with HFNC may be considered as an alternative to CNC because it may increase patient comfort and thereby improve compliance. [ABSTRACT FROM AUTHOR]