Modeling the impact of future rainfall changes on the effectiveness of urban stormwater control measures.

The convergence of urban expansion, deteriorating infrastructure, and a changing climate will escalate the risks of stormwater pollution and urban flooding in the coming decades. Using outputs from an ensemble of global climate models to drive a high spatial resolution stormwater model, we analyzed climate change impacts on urban stormwater runoff and control measures for 23 cities across the United States. Runoff model outputs for two future emissions scenarios ending in 2055 were compared against a historical scenario to assess changes. All cities showed increases in average annual stormwater runoff, with changes up to 30% over the next 30 years due to a greater frequency of high intensity storm events. Runoff model outputs showed substantial variation across cities with untreated stormwater runoff increasing by as much as 48%. Patterns of future runoff impacts within cities will affect the performance of distributed treatment strategies such as Green Stormwater Infrastructure (GSI) to meet municipal water quality improvement and runoff reduction goals. Results indicate that adoption of adaptable design standards and decision support tools that readily accommodate projected precipitation changes are critical for supporting more resilient designs of stormwater control measures.

Assessing the influence of urban greenness and green stormwater infrastructure on hydrology from satellite remote sensing.

Green stormwater infrastructure (GSI), which includes features like rain gardens, constructed wetlands, or urban tree canopy, is now widely recognized as a means to reduce urban runoff impacts and meet municipal water quality permit requirements. Many co-benefits of GSI are related to increased vegetative cover, which can be measured with satellite imagery via spectral indices such as the Normalized Difference Vegetation Index (NDVI). In urban landscapes, there remain critical gaps in understanding how urban greenness and GSI influence hydrology. Here, we quantify these relationships to assess the feasibility of tracking the effectiveness of urban greening for improving downstream hydrologic conditions. We combined hydrologic data from the United States Geological Survey (USGS) gauges with an NDVI time series (1985-2019) derived from Landsat satellite imagery, and synthesis of GSI implementation data from a set of 372 urbanized watersheds across the United States. We used a multivariate panel modeling approach to account for spatial and time varying factors (rainfall, temperature, urban cover expansion) in an effort to isolate the relationships of interest. After accounting for expansion of urban boundaries, only 32 watersheds (9%) showed significant greenness trends, a majority of which were reductions. Urban greenness had significant influences on downstream flow responses, so that on average, a 10% greenness increase showed a corresponding reduction of total flow (-3.8%), flow variance (-7.7%), peak flows (-4.7%), high flows (-7.6%), flashiness (-2.2%), and high flow frequency (-1.5%); and a corresponding increase in baseflow (4.3%). For a subset of these watersheds for which GSI data were available (n = 48), the level of GSI implementation showed a significant, but weak influence on urban greenness with a 20% increase in BMP density corresponding to a greenness increase of 0.9%. The study results may support valuation and verification of GSI co-benefits in urbanized landscapes at the watershed scale.

A Novel, Minimally Invasive Approach to Replacing Missing Teeth: Two Case Reports.

For the replacement of missing teeth, resin-bonded fixed partial dentures (RBFPDs) are a routine, minimally invasive option clinicians can use on patients who either cannot or will not move forward with surgical interventions. Advances in materials and design have greatly improved the longevity and prognoses for these prostheses. In some patients, however, debonding remains a clinical problem. In this clinical report, novel RBFPD designs are presented with the aim of improving retention and esthetics while offering short treatment time and minimal preparation without the need for local anesthesia.

Alcohol withdrawal requiring massive prolonged benzodiazepine infusion.

The objective of this case report is to describe a patient with prolonged alcohol withdrawal requiring massive standing doses of benzodiazepines. The setting is the medical intensive care unit of the Tripler Army Medical Center, Honolulu, Hawaii. The patient is a 58-year-old alcohol-dependent male presenting with mental status changes and agitation following an uncomplicated cystoprostatectomy, who ultimately required massive doses of benzodiazepines to treat his symptoms effectively. We conclude that symptom-triggered therapy proved ineffective in this case due to inability to achieve adequate frequency of assessments. Ultimately, a lengthy, high-dose, fixed interval benzodiazepine regimen was required. The 5-week period of intensive care illustrated that scheduled doses of benzodiazepines may be required and massive and prolonged doses are sometimes necessary. Adherence to a slow-weaning protocol understood by an interdisciplinary team was critical to this patient's recovery. Additionally, toxicity from the high-dose medication was not observed.