Bring the noise: Piecing together a discharge record from an automated salt dilution gauging setup and various other information sources

<p>Streamflow measurement and prediction are important for proper water resources management. In this case, the water resources problem is drought in the Coastal Mountains of British Columbia, Canada, where a village is drawing drinking water from a mountain stream. Because of challenges with other flow measurement methods in streep turbulent streams, salt dilution gauging is the best way to measure streamflow, but it is labour intensive.</p><p>To advance progress towards the singularity, an intelligent automated salt dilution gauging system was deployed, and provides good results, but some disturbances occur due to the presence of a tributary and a drinking water intake. We show how this noise can be turned into signals and discuss a range of other signals that together provide input for the discharge record.</p>

Remote sensed water discharge to analyze flood frequency

<p>Historical and current information regarding river discharge is essential, not only from a water management, energy, or global change perspective but also to better analyze, control and forecast flooding. However, globally the number of ground-based gauging stations declines, and data that is measured by ground-based gauging stations is often not, or shared with a considerable delay.</p><p>It has been demonstrated that existing satellite sensors can be utilized for useful discharge measurements without requiring ground-based information. The DFO – Flood Observatory uses the Advanced Microwave Scanning Radiometer band at 36.5 GHz (e.g. TRMM, AMSR‐E, AMSR2, GMP), pre-processed by the Joint Research Center (JRC) to estimate discharges. With a nearly-daily repeat interval, this microwave signal has been successfully applied to measure water discharge at a global scale, where the calibration of the microwave discharge signal to discharge units is accomplished by comparison to results from a global hydrological numerical model, the Water Balance Model (WBM), for a calibration period. Once calibrated, daily discharge can be back-calculated to January 1998, providing a daily discharge record for more than 20 years.</p><p>Here we present the methods used to utilize remote sensing to measure discharge. We indicate the challenges and how to overcome these when using a multiple sensor approach to capture daily discharges for over a 20-year period. And we show an example for the Amazon river, comparing the remote sensed discharge data with ground observations for multiple locations. Additionally, applications are shown on how this discharge can be combined with flood extent maps to analyze flood frequency.</p>

Characterizing Clostridioides difficile infections and hospital exposures in California using surveillance and administrative data, 2014–2015

Objective: To evaluate a method to identify hospitals contributing to Clostridioides difficile infections (CDI) at subsequent hospitalizations. Design: Retrospective cohort study. Methods: We merged 2014–2015 National Healthcare Safety Network (NHSN) inpatient CDI laboratory-identified events with hospital patient discharge data. For patients with incident community-onset CDI (CO CDI), we identified immediately preceding admissions (within 12 weeks) unrelated to CDI at different (exposure) hospitals. We calculated an exposure rate, and we selected hospitals with the highest (90th–100th percentile) rates by hospital type and compared these rates with reported standardized infection ratios (SIR) for CDI. Results: We successfully matched 44,691 of 58,842 NHSN CDI records (76.0%) with a hospital discharge record. Among 36,215 unique matched records, 5,234 (14.5%) had an admission not related to CDI within 12 weeks prior to an incident CO CDI event, and 1,574 of these admissions (30.1%) occurred in a different hospital. For 33 hospitals with an exposure ranking within the 90th–100th percentile, CDI SIRs for 22 (66.7%) were not significantly different; 3 (9.1%) were lower; and 8 (24.2%) were higher than the national baseline. Also, 12 (36.4%) had an SIR ≤1.0. Conclusions: The identification of high-ranked exposure hospitals presents an alternative to SIR for measuring the contribution of hospitals to the CDI burden across the continuum of care. Further exploration of the potential factors leading to high exposure rank, such as antibiotic use and infection control practices, is indicated and may inform CDI prevention outreach to healthcare facilities and provider networks in California and elsewhere.

Difficulties in diagnosis of heart failure with preserved ejection fraction in clinical practice: dissonance between echocardiography, NTproBNP and H2HFPEF score

This pilot study was aimed to assess the percentage of patients admitted to a Russian hospital and diagnosed with heart failure with preserved ejection fraction (HFpEF) maintaining this diagnosis when evaluated against the ESC 2016 and Russian 2017 heart failure guidelines. In addition, we reviewed the probability of an HFpEF diagnosis when patients were assessed against the H2FPEF score. Forty-two patients (mean age 68 ±7,5) diagnosed with HFpEF on their discharge record, admitted between March 2018 and May 2018, were included. Twenty percent of patients did not meet Russian guideline criteria for HFpEF due to either the absence of symptoms and/or echocardiographic evidence of structural/functional abnormalities. Using the ESC 2016 guidelines (which required an elevation in NT Pro BNP) the diagnosis was confirmed in only 37% of patients, mostly due to the normal level of NTproBNP in 54.8% of those investigated. The probability of HFpEF by H2FPEF score in patients with dyspnea and HFpEF by ESC 2016 criteria was 93% and without HFpEF by ESC 2016 criteria 68% (p = 0.054). In contrast, the probability of HFpEF by H2FPEF score in patients with dyspnea and HFpEF by Russian criteria was 84.4%.

143. Opioid Use and Hospitalizations for Endocarditis, Osteomyelitis, and Central Nervous System Abscess among Adults — New York City, 2001–2014

Background Along with a growing opioid epidemic nationwide, opioid users often have an increased risk of severe infectious diseases including endocarditis, osteomyelitis, and central nervous system (CNS) abscess. As the largest city in the United States, New York City (NYC) may serve as a study model for opioid use and infectious diseases. We investigated the association between opioid use and hospitalizations for endocarditis, osteomyelitis, and CNS abscess in NYC. Methods Data for NYC residents aged ≥18 years discharged from New York State hospitals during 2001–2014 were analyzed using a hospital discharge dataset. We defined a hospitalization for endocarditis, osteomyelitis, and CNS abscess as one with a principal or secondary diagnosis for these conditions within the discharge record. We identified opioid users by examining principal or secondary diagnoses for opioid use within the discharge record at the time of hospitalization for endocarditis, osteomyelitis, and CNS abscess. Log-binomial model was applied among all hospitalized patients using endocarditis, osteomyelitis, and CNS abscess as the outcome, adjusting for age, sex, race, and borough. Results During 2001–2014, there were 139,392 hospitalizations in total for endocarditis, osteomyelitis, or CNS abscess, of which 8,823 (6.3%) were among opioid users. There was an increased risk of hospitalization for endocarditis [RR: 2.6 (95% CI: 2.5–2.7)], osteomyelitis [RR: 1.1 (95% CI: 1.1–1.1)], and CNS abscesses [RR: 1.9 (95% CI: 1.8–2.1)] among hospitalized opioid users compared with hospitalized nonopioid users, adjusted by age, sex, race, and borough. Hospitalized opioid users had four times the risk for endocarditis hospitalization compared with hospitalized nonopioid users in the 18–44 year age group (RR: 4.2 [95% CI: 3.9–4.5]) (Table 1). Conclusion These results provide further evidence that opioid use is associated with an increased risk of endocarditis, osteomyelitis, and CNS abscess. Efforts to combat the opioid epidemic might lower the overall incidence of endocarditis, osteomyelitis, and CNS abscess. Disclosures All authors: No reported disclosures.

Flood risk management in Allala River (Algeria) using Flood frequency analysis and hydraulic modeling

The objective of flood frequency analysis (FFA) is to associate flood intensity with a probability of exceedance and for making probabilistic estimates of a future flood event in Allala basin based on the historical discharge record at Sidi Akkacha gauging station, the peak floods discharge of Allala river for 5, 10, 50, 100 years return period are estimated using exponential distribution and the stage at different position of river are calculated using HEC RAS model . Based on the modeling study carried out considering 62 cross sections for 8 km length of river, The Output HEC-RAS model show that the existing embankments system on the banks of Allala River is not sufficient to resist the peak flood discharge of 100 years return period, water level profile shows that a maximum of 1.25m in left bank((at 1.2 km downstream) is needed to protect the inundation of the low laying areas of Old tenes.

Solar modulation of flood frequency in Central Europe during spring and summer on inter-annual to millennial time-scales

Solar influences on climate variability are one of the most controversially discussed topics in climate research. We analyze solar forcing of flood frequency in Central Europe on inter-annual to millennial time-scales using daily discharge data of River Ammer (southern Germany) back to AD 1926 and revisiting the 5500 year flood layer time-series from varved sediments of the downstream Lake Ammersee. Flood frequency in the discharge record is significantly correlated to changes in solar activity during solar cycles 16–23 (r = −0.47, p < 0.0001, n = 73). Flood layer frequency (n = 1501) in the sediment record depicts distinct multi-decadal variability and significant correlations to 10Be fluxes from a Greenland ice core (r = 0.45, p < 0.0001) and 14C production rates (r =0.36, p < 0.0001), proxy records of solar activity. Flood frequency is higher when solar activity is reduced. These correlations between flood frequency and solar activity might provide empirical support for the solar top-down mechanism expected to modify the mid-latitude storm tracks over Europe by model studies. A lag of flood frequency responses in the Ammer discharge record to changes in solar activity of about one to three years could be explained by a modelled ocean–atmosphere feedback delaying the atmospheric reaction to solar activity variations up to a few years.