Caste Inequality in Occupational Exposure to Heat Waves in India.

India is a leading global hot spot for extreme heat waves induced by climate change. The social demography of India is centered on its caste hierarchy rooted in endogamous occupational groups. We investigate the association between caste and climate inequality by studying occupational exposure during the 2019 and 2022 heat waves.

Impacts of irrigation expansion on moist-heat stress based on IRRMIP results.

Irrigation rapidly expanded during the 20 century, affecting climate via water, energy, and biogeochemical changes. Previous assessments of these effects predominantly relied on a single Earth System Model, and therefore suffered from structural model uncertainties. Here we quantify the impacts of historical irrigation expansion on climate by analysing simulation results from six Earth system models participating in the Irrigation Model Intercomparison Project (IRRMIP).

Groundwater sustainability in India through nonrice-dominated cropping pattern.

Over-exploitation of groundwater for irrigation caused rapid groundwater depletion in north India, leading to food and water security challenges. However, the crucial role of changing cropping patterns on groundwater savings under the observed and projected warming climate remains unexplored. Here, we show that altering the existing rice-dominated cropping systems in India can be a potential solution for groundwater sustainability under the current and future climate.

Patient care in complex Sociotechnological ecosystems and learning health systems.

The learning health system (LHS) model was proposed to provide real-time, bi-directional flow of learning using data captured in health information technology systems to deliver rapid learning in healthcare delivery. As highlighted by the landmark National Academy of Medicine report "Crossing the Quality Chasm," the U.S.

Drought Atlas of India, 1901-2020.

India has been considerably affected by droughts in the recent past. Despite the considerable impacts of droughts on agriculture and water resources, long-term datasets to examine droughts and their consequences at appropriate spatial and temporal scales have been lacking in India. Datasets that provide drought information are mostly available for a short period and at coarser resolutions, therefore, these do not comprehend the information regarding the major droughts that occurred in the distant past at administrative scales of decision-making.

Hydrological model-based streamflow reconstruction for Indian sub-continental river basins, 1951-2021.

Streamflow is a vital component of the global water cycle. Long-term streamflow observations are required for water resources planning and management, hydroclimatic extremes analysis, and ecological assessment. However, long-term streamflow observations for the Indian-Subcontinental (ISC) river basins are lacking.

Rigorous and rapid evidence assessment in digital health with the evidence DEFINED framework.

Dozens of frameworks have been proposed to assess evidence for digital health interventions (DHIs), but existing frameworks may not facilitate DHI evidence reviews that meet the needs of stakeholder organizations including payers, health systems, trade organizations, and others. These organizations may benefit from a DHI assessment framework that is both rigorous and rapid. Here we propose a framework to assess Evidence in Digital health for EFfectiveness of INterventions with Evaluative Depth (Evidence DEFINED).

Increased hydropower but with an elevated risk of reservoir operations in India under the warming climate.

Hydropower is a significant contributor to clean global electricity generation; therefore, it plays a crucial role in climate change mitigation. Notwithstanding major hydropower dams in India are in diverse climatic regions and exposed to risks because of the warming climate, potential changes in hydroclimate remain largely unexplored. Using observations and climate projections, we demonstrate the hydroclimatic changes in the upstream catchments and their implications for the hydropower generation of 46 major hydropower dams in India.

Climate warming and summer monsoon breaks drive compound dry and hot extremes in India.

Considering the severe impacts of compound dry and hot extremes, we examine the primary drivers of CDHEs during the summer monsoon in India. Using ERA5 reanalysis, we show that most of the CDHEs in India occur during the droughts caused by the summer monsoon rainfall deficit. Despite a decline in the frequency of summer monsoon droughts in recent decades, increased CDHEs are mainly driven by warming and dry spells during the summer monsoon particularly in the Northeast, central northeast, and west central regions.

Telerounding: A scoping review and implications for future healthcare practice.

Introduction: Telerounding is slated to become an important avenue for future healthcare practice. As utilization of telerounding is increasing, a review of the literature is necessary to distill themes and identify critical considerations for the implementation of telerounding. We provide evidence of the utility of telerounding and considerations to support its implementation in future healthcare practice based on a scoping review.

Factors That Influence Clinician Experience with Electronic Health Records.

Objectives: To report quantitative and qualitative analyses of features, functionalities, organizational, training, clinical specialties, and other factors that impact electronic health record (EHR) experience based on a survey by two large healthcare systems.

Materials And Methods: A total of 816 clinicians-352 (43 percent) physicians, 96 (12 percent) residents/fellows, 177 (22 percent) nurses, 96 (12 percent) advanced practice providers, and 95 (12 percent) allied health professionals-completed surveys on different EHRs. Responses were analyzed for quantitative and qualitative factors.

Global distribution, trends, and drivers of flash drought occurrence.

Flash drought is characterized by a period of rapid drought intensification with impacts on agriculture, water resources, ecosystems, and the human environment. Addressing these challenges requires a fundamental understanding of flash drought occurrence. This study identifies global hotspots for flash drought from 1980-2015 via anomalies in evaporative stress and the standardized evaporative stress ratio.

Changes in Physician Telemedicine Use during COVID-19: Effects of Practice Setting, Demographics, Training, and Organizational Policies.

Telemedicine use increased during the COVID-19 pandemic, but uptake was uneven and future use is uncertain. This study, then, examined the ability of personal and environmental variables to predict telemedicine adoption during the COVID-19 pandemic. A total of 230 physicians practicing in the U.

Storm types in India: linking rainfall duration, spatial extent and intensity.

We examine wet events (WEs) defined from an hourly rainfall dataset based on 64 gauged observations across India (1969-2016). More than 90% of the WEs (accounting for nearly 60% of total rainfall) are found to last less than or equal to 5 h. WEs are then clustered into six canonical local-scale storm profiles (CanWE).

Runoff sensitivity of Indian sub-continental river basins.

Understanding the sensitivity of water availability in the current and future climate in the Indian sub-continent is vital for food and water security. Using the Variable Infiltration Capacity (VIC) model and Budyko's framework with two observational datasets, we estimated water budget and mean annual runoff sensitivity to precipitation and potential evapotranspiration (PET) over 18 major river basins and 222 sub-basins in the Indian sub-continent. The river basins located in the north experienced a decline in mean annual precipitation while the basins in the south witnessed an increase in mean annual precipitation.

Bias-corrected climate projections for South Asia from Coupled Model Intercomparison Project-6.

Climate change is likely to pose enormous challenges for agriculture, water resources, infrastructure, and livelihood of millions of people living in South Asia. Here, we develop daily bias-corrected data of precipitation, maximum and minimum temperatures at 0.25° spatial resolution for South Asia (India, Pakistan, Bangladesh, Nepal, Bhutan, and Sri Lanka) and 18 river basins located in the Indian sub-continent.

COVID-19 and telehealth, education, and research adaptations.

For decades, there have been government funded services to provide healthcare telephonically to remote sites both on the earth and in the air. This capability has evolved into what we now know as telehealth. The use of telehealth dramatically accelerated as a result of concerns for patient and healthcare provider safety during the SARS-CoV2 pandemic.

Automating Vancomycin Monitoring to Improve Patient Safety.

Introduction: Intravenous vancomycin is a frequently used antibiotic and a common cause of medication-related harm because of its narrow therapeutic range. Improving monitoring of drug levels with automation in the electronic health record (EHR) may decrease this harm.

Methods: After examining the existing state of vancomycin ordering, administration, and monitoring, an automated process was created in the EHR that, on initiation of a new vancomycin order, automatically ordered a vancomycin trough level 30 minutes before the fourth dose.

Measuring electronic communication networks in virtual care teams using electronic health records access-log data.

Objective: To develop methods for measuring electronic communication networks in virtual care teams using electronic health records (EHR) access-log data.

Methods: For a convenient sample of 100 surgical colorectal cancer patients, we used time-stamped EHR access-log data extracted from an academic medical center's EHR system to construct communication networks among healthcare professionals (HCPs) in each patient's virtual care team. We measured communication linkages between HCPs using the inverse of the average time between access events in which the source HCPs sent information to and the destination HCPs retrieved information from the EHR system.

Qualitative and Quantitative Analysis of Patients' Perceptions of the Patient Portal Experience with OpenNotes.

Background: Access to medical encounter notes (OpenNotes) is believed to empower patients and improve the quality and safety of care. The impact of such access is not well understood beyond select health care systems and notes from primary care providers.

Objectives: This article analyzes patients' perceptions about the patient portal experience with access to primary care and specialist's notes and evaluates free-text comments as an improvement opportunity.

Predicting the Future: Using Simulation Modeling to Forecast Patient Flow on General Medicine Units.

Background: Hospitals are complex adaptive systems within which multiple components such as patients, practitioners, facilities, and technology interact. A careful approach to optimization of this complex system is needed because any change can result in unexpected deleterious effects. One such approach is discrete event simulation, in which what-if scenarios allow researchers to predict the impact of a proposed change on the system.

A sixfold rise in concurrent day and night-time heatwaves in India under 2 °C warming.

Heatwaves with severe impacts have increased and projected to become more frequent under warming climate in India. Concurrent day and nighttime heatwaves can exacerbate human discomfort causing high morbidity and mortality; however, their changes in the observed and projected climate remain unrecognized. Here using observations and model simulations from climate of 20 century plus (C20C+) detection and attribution (D&A) and coupled model intercomparison project 5 (CMIP5) projects, we show that 1 and 3-day concurrent hot day and hot night (CHDHN) events have significantly increased during the observed climate in India.

Projected Increase in Hydropower Production in India under Climate Change.

Hydropower is a valuable renewable energy resource in India, which can help in climate change mitigation and meet the increasing energy demands. However, the crucial role of climate change on hydropower production in India remains unexplored. Here using the observations and model simulations, we show that seven large hydropower projects experienced a significant (p-value < 0.

An exploratory study of networks constructed using access data from an electronic health record.

Network analysis may be a powerful tool for studying interprofessional practice. Using electronic health record data and social network analysis, the network of healthcare professionals involved in colorectal cancer care at a large, urban academic medical center were mapped and studied. A total of 100 surgical colorectal cancer patients receiving treatment in 2013 and 2014 were selected at random.